Case Study
Client Profile
Margaret is a 22-year-old, MBF who recently moved to Georgia from Detroit. She is a G3P2002 and cur-
rently at 38 wga. Margaret started prenatal care at 8 weeks gestation. She is five feet four inches tall and her cur-
rent weight is 130 pounds. Her total weight gain thus far is 18 pounds. She works as a telemarketer 10 hours a
day, 5 days a week. She eats fast foods but loves to snack on raw vegetables. Her last baby was born five years ago,
full term, and without complications. She was not happy about the birth but endured it, and now is feeling ap-
prehensive about this coming birth. She just wants it over with so that she can get on with her life. Her husband
plans to stay with her in labor as does her mother and a sister. She has decided to get an epidural (she had one
last time) as soon as the labor becomes “too much to handle.”
Case Study
Margaret is being seen today at the prenatal clinic because of a complaint of decreased fetal movement. A bio-
physical profile reveals a healthy baby with good tone, movement, adequate amniotic fluid, breathing move-
ments, and a reactive non-stress test. The baby is estimated to be approximately 7 pounds. Her first baby was 6
pounds 9 ounces. Her cervix is soft, anterior, 30% effaced, and 1 cm dilatated. She is experiencing occasional
weak contractions throughout the visit. The physician gives her the Option of going to the hospital now and be-
ing induced, or waiting to go into labor. She decides to wait until the afternoon and then, if no regular con-_
tractions start, she will come in for an induction. Four hours later her contractions have started naturally at
home. They are coming every three minutes and lasting a full minute when she arrives at the hospital.
Although she had planned to get an epidural early, she is doing very well with the contractions andfinds that
with the support of the nurse and the Jacuzzi bath, which the nurse encourages her to use, she is getting enough
relief that she is considering not getting the epidural. Her labor progresses quickly, and within six hours Of- be-
ing admitted to the hospital she is completely effaced and 9 cm dilatated. The baby is at zero station. Her mem-
branes rupture spontaneously while she is walking back to her bed from the bathroom, and before the nurse can
even check the fetal heart tones Margaret cries out, short of breath, and holds her upper abdomen. The nurse
gets her back to bed immediately, puts on the call light, and checks her BP and the baby’s heart tones. Within a
minute her BP drops to 60/ 40‘, she becomes faint and then becomes semiconscious, and the fetal heart tone
baseline drops to 90 with a prolonged late deceleration. The physician is in the unit and immediately responds.
Margaret is rushed to the OR, where a cesarean section is performed and a 6 pound 2 ounce baby boy is deliv-
ered. Even with full resuscitative efforts, the APGAR sco’res are 1 at one minute, 1 at five minutes, and 3 at ten
minutes.
Margaret goes into cardiac arrest and is revived. Five minutes after her uterus is sutured from the cesarean
section, and her abdomen is being closed, she begins to bleed profusely from every orifice and puncture site. A
decisiOn is made to do a hysterectomy while trying to correct her bleeding problem. Margaret has four TVs in-
fusing with blood and expanders under pressure. Once again she is stabilized. An air ambulaan is called in, and
she is transported by helicopter to the regional high-risk center. Despite the immediate responses from the very
beginning of the nursing and medical team, Margaret has another cardiac arrest on board the‘hel’icopter and
dies. Her baby is also transferred to the high-risk center, and two weeks later he too dies.
The case study MUST reflect at least 6 hours of work to count as a successful clinical
day. The case study must be thorough, type written, and double-spaced, using
appropriate grammar and spelling. I need you to document your resources. You may
NOT use .com web sites to complete this assignment. You can use the online library
and ATI and any web site ending in .gov, .edu, or .org. You may not collaborate on
this assignment.
1. Identify 3 possible causes for her sudden change in condition AND provide
an in depth description for each cause
2. Could this problem have been identified prior to the crisis? Why or why not?
Describe for each condition.
3. Did the Jacuzzi tub increase her risk?
4. What factors have been associated with amniotic fluid embolism?
5. List in order the nursing actions to be taken when Margaret first called out
and within the first three minutes . V
6. On autopsy the precipitating cause was identified as a amniotic fluid
embolism, the immediate response was hypotension, followed by abruption,
leading to hemorrhage, shock, and DIC. Discuss this sequence of events
7. How frequently do AFE occur? Discuss and cite your source
8. What lab tests should the nurse anticipate that the physician will order
immediately
9. List the steps of neonatal resuscitation
10. Margaret was being transferred fro a small community hospital to a level III
care center. What is the difference between the levels of maternity care?