Maternity Case 4: Brenda Patton (Complex)
Documentation Assignments
1. Document your initial assessment data of Ms. Patton, including uterine activity
(frequency and duration), fetal heart rate (FHR) activity (baseline FHR, longterm variability, accelerations, and decelerations), vaginal discharge, and
maternal vital signs.
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Palpation indicated the uterus was soft between contractions. Regular
contractions with moderate intensity had started. Contractions were 4-5
minutes apart and lasted 50 seconds.
FHR 181 at baseline with occasional acceleration and no episodes of
deceleration.
Maternal vital signs: HR: 97, BP: 129/78, RR: 24, SPO2: 98%, Temp: 39.1
2. Document the medication(s) that you administered.
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IV bolus of 500 mL of lactated Ringer was given over 60 minutes
Piggyback infusion of 12.5 mg of promethazine IV
1000-mg dose of acetaminophen orally
Piggyback infusion of 2g of cefazolin IV
3. Document Ms. Patton’s pain during labor (severity during contractions,
location, quality, interventions taken, and response to interventions) and the
measures that were taken to promote her desire for a natural birth.
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Ms. Patton’s pain was about a two between contractions.
The pain was everywhere
Promethazine was given for nausea
Acetaminophen was given PRN for fever
She still felt nauseas at the by the end of the sim.
4. Document in situation-background-assessment-recommendation (SBAR)
format your communication to the provider regarding Ms. Patton’s status and
note her future care needs.
• Situation: Brenda Patton is an 18-year-old Caucasian female, G1P0 at 36 2/7 weeks
of gestation admitted to the labor and delivery unit for labor assessment. Patient
states that her water may have broken earlier this morning and she thinks she is in
labor.
From vSim for Nursing | Maternity. © Wolters Kluwer Health.
• Background: The patient wishes to have a natural birth without medication.
Admission intrapartum orders have been initiated, initial labs have been drawn, and a
saline lock has been placed in her forearm.
• Assessment: AmniSure was positive. HR: 97, BP: 130/77, RR: 24, SPO2: 98%,
Temp: 39.1. Vaginal exam reveals 90% effacement of cervix, cervical dilation 4 cm,
and fetus at -1 station.
• Recommendation: Continuous monitoring of vital signs, FHR monitoring, Vagorectal Group B strep test. Oxygen 10 L/min for no reassuring FHR.
5. Document the informal patient education that you provided Ms. Patton during
this scenario regarding group B streptococcus and the patient’s response to
this teaching session.
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The nurse would educate Ms. Patton that between 35- and 37-weeks’ gestation,
GBS screening is done to detect this bacterium caused by group B
streptococcus.
The patient gives consent to take the Vago-rectal group B strep Test.
Guided Reflection Questions:
Opening Questions
How did the simulated experience of Brenda Patton’s case make you feel?
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This simulation made me feel a little less anxious compared to last weeks.
Brenda was in early active labor with a dilation of 4cm and appeared to be
uncomfortable with a pain rate of 2/10, but tolerable per patient. Patient’s VS
were NOT stable, T 39.1C; R 24 BP 130/77 O2 <98% RA cont’ and fetus HR was
auscultated at 140 bpm.
Describe the actions you felt went well in this scenario.
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Gathering essential data prior to IV administration.
From vSim for Nursing | Maternity. © Wolters Kluwer Health.
Scenario Analysis Questions1
EBP Based on the initial assessment of Brenda Patton, what findings did you
find concerning?
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Patient’s group B strep vagino rectal culture taken at 36 weeks was positive and
the patient is a G1P0 at 38 2/7 weeks of gestation.
Patient delayed coming in right away when membranes were ruptured, increases
risk for infection.
PCC Brenda Patton stated that she would like to labor free of medication. What
are some techniques that could be used to help her with her pain?
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Guided imagery, rhythmic breathing, music, dimming the lights to enhance a
sense of relaxation, warm/cool compresses, and gentle touch or massage.
T&C What key elements would you include in the handoff report for this patient?
Consider the situation-background-assessment-recommendation (SBAR)
format.
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18-year-old G1P0, 38 2/7 weeks of gestation, admit for rupture of membranes;
100% effacement of cervix, cervical dilation 4cm and fetus at -1 station. Pain c/o
general pain 2/10 between contractions and wishes to have a labor free of
medication. FHR 140 bpm. VSS, bilateral lung sounds CTA, bilateral deep
tendon reflexes normal, +2, IV site CDI. Promethazine 12.5mg Q4hours PRN
IVPB administered at 1519.
S/QI Based on your experience with Brenda Patton’s case, reflect on possible
nursing actions for enhanced safety and quality improvement.
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Home safety
Emergency response plan.
o Newborn 1st week of life shows s/s fever, dyspnea, lethargic (hard to
awaken), difficult feeding or cyanotic r/t early-onset GBS disease.
Safe use of equipment.
o Correct way to assess newborn for fever.
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The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN)
competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP),
Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: http://qsen.org/
From vSim for Nursing | Maternity. © Wolters Kluwer Health.
Concluding Questions
Reflecting on Brenda Patton’s case, were there any actions you would do
differently? Explain.
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I would remember to assess the patient’s skin; head, chest, arms, abdomen,
pelvis, and legs. I also should have palpated the patient’s uterus for contractions.
I think a routine of palpating the patient’s uterus for contractions and then placing
the fetal HRM on would be best practice to ensure safety and efficient care.
Describe how you would apply the knowledge and skills that you obtained in
Brenda Patton’s case to an actual patient care situation.
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I would have started the patient on Promethazine prior or at the same time as the
cefazolin 2g IVPB to help decrease the chance of nausea from occurring. I would
also remember to educate my patient on any questions that she had during this
process or in the overall labor delivery process since this is her first.
From vSim for Nursing | Maternity. © Wolters Kluwer Health.