Birthing Sim Prep
Name: Jess Mathews
Date: 09/09/2019
Patient: Noelle Rose
EDC:
08/31/2019
Prenatal Labs:
 Low hemoglobin
 Low hematocrit
 Low RBCs
 Elevated WBCs
 Positive GBS status
Goals:
 Safe delivery of baby
 Prevention of PPH
 Healthy mother and
baby
G4T3P0A0L3
Complications:
 Prolapse of umbilical
cord
 Absence of FHR and
fetal movement
 Presence of greenish
or brownish amniotic
fluid
 Painful or painless
vaginal bleeding
Assessments:
 BP, HR, and RR
every 5-15 minutes
 Uterine contractions
palpated continuously
 FHR every 15
minutes for low-risk
women and 5 minutes
for high-risk women
 Assess maternal VS
including temperature,
BP, HR, and RR
every 5-15 minutes
for the first hour after
delivery
 Assess fundus,
lochia, perineum,
laceration, bladder
distention every 15
minutes
Gestational Age:
41.2 weeks
Anticipated Needs:
 Preparation for
emergency C-section
 PPH drugs and
precautions
 Sterile table made by
scrub tech
Interventions:
 Assist woman in
pushing efforts
 Encourage woman to
assume position of
comfort
 Provide ice chips
 Maintain privacy as
woman desires
 Provide
encouragement and
praise her efforts
Test/Normal Values
Date
Pt
Values
H (high),
L (low),
WNL
Identify abnormal lab values and describe in this column (1) what
caused the abnormal value, and (2) what nursing assessments and
interventions are needed (use back of form if needed)
Prenatal Labs
White Blood Cells
(WBC)
01/20
17.6
WNL
---
9-16/µl (25 labor)

Hemoglobin
10-14g/dL
Hematocrit
32-42%
01/20
10.1
L
01/20
34%
WNL


--
Red Blood Cell Count
Low hemoglobin can be caused by an increase in fluid
retention
Make position changes slowly
Increase iron and protein in diet
Low hemoglobin can be caused by an increase in fluid
retention
Make position changes slowly
Increase iron and protein in diet
01/20
3.8
L
01/20
213
WNL
---
1 hr Glucose
Screening
06/08
139
WNL
---
Blood Type & Rh
01/20
A neg
---
---
---
Given
10/27
---
---
Rubella Status
(Immune/
Non-immune)
01/20
NonImmune
WNL
---
Group B Strep
01/20
Positive
H
Gonorrhea/Chlamydia
01/20
Negative
WNL
---
Rapid Plasma Reagin
(RPR)
01/20
Negative
WNL
---
Hepatitis B
01/20
Negative
WNL
---
Hepatitis C
01/20
Negative
WNL
---
HIV
01/20
Negative
WNL
---
HSV
01/20
Negative
WNL
---
4.0-6.0 million/µL
Platelet Count
150-350/µL
Rhogam?
☒ Yes ☐ No



Prophylactic antibiotics and antibiotic administration at time
of labor
Other Labs
Fetal Fibronectin
09/30
Negative
WNL
---
Medications: Write dose, route, time, and therapeutic use for all the medications the patient is taking. Include adverse/side effects, lab, and vital signs
to check and patient teaching for the medication you will be administering.
Adverse/Side Effects
Include life threatening
and most common
Prenatal Meds
Medication
Dose
Route
Adm
Times
Therapeutic Use
Prenatal Vitamins
1 tab
PO
Daily
Useful in preventing
birth defects in brain
and spinal cord
Lab/Vital
Signs/etc.
to check
Patient Teaching Needs (specific to
your patient)
---
---
---
Iron
325 mg
PO
Daily
Iron supplement
Anaphylactoid reaction,
hypotension, leg cramps
Withhold drug if
serum ferritin level
equals or exceeds
established
guidelines, monitor
serum H&H levels
Tetanus, diphtheria, and
pertussis vaccine (Tdap)
0.5 mL
IM
Once
Prevention of
tetanus, diphtheria,
and pertussis
Anaphylactoid reaction
---
Anti-inflammatory;
adrenal
corticosteroid; infant
lung development
Anaphylactoid reaction,
aggravation or masking
of infections, fat
embolism, acne,
impaired wound healing,
sodium and fluid
retention,
Assess
therapeutic
efficacy.
Response
following
Betamethasone
12.5 mg
IM
Twice, 24 hrs
apart

Report any of the following
promptly: itching, rash, chest pain,
headache, dizziness, nausea,
vomiting, abdominal pain, joint or
muscle pain, and numbness and
tingling.

Effective and safe way to protect
and prevent complications of
pertussis

Monitor weight at least weekly
Labor Meds
Lactated Ringers
Butorphanol Tartrate
(Stadol)
Ampicillin
125 mL/hr
1 mg
1g
IV
IVP
IVPB
Continuous
Q2H
PRN Pain
Q4H
Fluid replacement
localized or generalized
hives and itching,
swelling of the eyes,
face, or throat, coughing,
sneezing, or difficulty
breathing.
Check for fluid
overload
Narcotic analgesic
Respiratory depression,
palpitation, bradycardia,
nausea, sedation,
drowsiness, weakness
Monitor respiratory
depression, vital
signs, and observe
for neonate
respiratory
depression
Antibiotic
Anaphylactoid reaction,
thrombocytopenia,
diarrhea, nausea,
vomiting, seizures
Watch for
hypersensitivity
and anaphylactoid
reactions during
---

Lie down to control drug-induced
nausea

Report chills, wheezing, pruritus,
respiratory distress, or
palpitations, to prescriber
immediately
first 30 minutes of
administration,
monitor I&O,
baseline and
periodic renal,
hepatic, and
hematologic
function test
Oxytocin
30 units/500
mL NS
IV
Once
Oxytocic
Subarachnoid
hemorrhage, fatal
afibrinogenemia,
cardiovascular spasm
and collapse, intracranial
hemorrhage, uterine
rupture, pelvic
hematoma, fetal trauma
from too rapid propulsion
through pelvis
Monitor FHR and
maternal BP and
pulse at least
q15min during
infusion, monitor
I&O during labor,
stop infusion to
prevent fetal
anoxia

Report diarrhea to prescriber; do
not self-medicate

Be aware of purpose and
anticipated effect of oxytocin
Report sudden, severe headache
immediately to healthcare provider
