I am stuck. Please can i get nursing care plan for the following…

Question Answered step-by-step I am stuck. Please can i get nursing care plan for the following… I am stuck. Please can i get nursing care plan for the following clinical scenario using the diagnosis: Nursing Diagnoses·      Risk for Injury (to the fetus) related to trauma during the birth process·      Risk for Injury (to the mother) related to trauma associated with maneuvers employed during the shoulder dystocia or perineal trauma·      Anxiety related to the emergent situation and possible neonatal and maternal morbidityThe care plan for each diagnosis is expected to entailASSESSMENT subjective and objectiveNURSING DIAGNOSIS PLANNING/ OUTCOME (Client Centered) 1 Short Term, 1 Long TermINTERVENTIONS (Nurse Centered) 1 Monitoring, 1 Action & 1 Teaching per GoalRATIONALE FOR INTERVENTIONS 1 per InterventionEVALUATION (Evaluate each Goal)Scenario OverviewPatient: Amelia SungDiagnosis: Labor Induction due to gestational diabetesBrief Summary: This case presents a 36-year-old Filipino woman, G2P1 (L1) at 39 weeks gestation, who presented to the labor and delivery unit for labor induction due to gestational diabetes. Her diabetes has been well controlled during the pregnancy. The estimated fetal weight by ultrasound is 4000 g (8 lbs 13 oz), and at delivery an unexpected shoulder dystocia occurred. You are expected to recognize the factors in the patient’s prenatal and intrapartum history that put her at risk for shoulder dystocia. You should prepare the labor room with the necessary equipment in anticipation of an obstetric emergency. When the emergency is called, the You are expected to initiate appropriate actions, including assisting the patient into McRoberts position, and applying suprapubic pressure as dictated by the provider. In addition, you should display effective communication with the obstetric team, the patient, and the support person.Patient Case Introduction Location: Labor and Birthing roomTime: 0700hAmelia Sung is a 36-year-old Filipino female, G2P1 (L1) at 39 weeks of gestation, who was admitted 24 hours ago for induction of labor.First-born male delivered vaginally 3 years and 3 months ago. Weight: 3,345 g (7 lb 6 oz). Length 55 cm (22 in).She was started on oxytocin at 1 mL/1 mU, and the infusion was increased throughout the day per protocol. A mainline IV of lactated Ringer’s is running at 125 mL/hr, and oxytocin (30 units in 500 mL normal saline) is running at 20 mU/min (20 mL/hr).Her cervical exam at admission was 2 cm dilation, 80% effaced, at -1 station, with fetus in vertex position. At 0100 hours, dilation was 4 cm, 100% effaced, still at -1 station and fetus in vertex position. She received an epidural shortly after that, and 1 hour later, her membranes ruptured; the fluid was clear.Three hours ago, she was fully dilated and started pushing. The fetal heart rate has been stable with a baseline of 120/min, moderate variability, and early decelerations since she started pushing. She is getting tired from pushing, and the descent of the fetal head has been slow.During the past few contractions, the baby has started to crown. The provider has been called and has arrived, so Amelia may continue pushing.Patient DetailsPatient Data: Female – Age 36 years. Weight 83 kg (184 lbs). Height 157 cm (62 in). Gravida: 2 Para 1 (L1)Gestation week: 39DOB: 7/11/XXAllergies: ShellfishPast Medical History: No surgical history.Provider’s Orders Assessment:o  BP Q 1 hour x 2 then Q 4 hourso  Temp, HR, RR Q 1 houro  Temp Q 2 hours after rupture of membranes intrapartum or if temp greater than 38° C (100.4° F) orally.o  Breath sounds Q 4 hourso  Head-to-toe assessment Q 4 hourso  Deep tendon reflexes Q 4 hourso  Vaginal examo  Assess IVo  Continuous pulse oxo  Continuous external monitoring (fetal HR and uterine activity)  Meds:o  Oxytocin 30 units in 500 mL normal saline IV. Begin at 1 mU/min (1 mL/hr). Increase 1 to 2 mU/min every 30 to 60 min until adequate labor achieved. Maximum 20 mU/mino  Lactated Ringer’s 1000 mL IV 125 mL/hro  Epidural anesthesia via catheter infusion at 10 ml/hro  Lactated Ringer’s 500 mL IV bolus (For nonreassuring fetal heart pattern)·      Respiratory:o  Oxygen 10 L/min per non-rebreather mask for nonreassuring (Category II or III) fetal heart rateo  May discontinue oxygen when fetal heart returns to reassuring (Category I)Routine Tests:o  Complete blood count, STATCall orders:o  Temp > 38° Co  HR < 50, > 100o  RR < 12, > 24o  BP sys < 90, > 140; dia > 90o  SpO2 < 94%o  Meconium-stained fluido  Non reassuring fetal HRo  Rupture of membranes greater than 12 hours This patient's history included excessive weight gain and prolonged second stage. Requesting additional assistance using clear, direct language while assisting the patient into McRoberts position is expected. McRoberts maneuver, in which the mother's legs are flexed back against her abdomen, allowing the pelvis to open to its maximum dimension, is the least invasive technique. The next maneuver would be adding application of suprapubic pressure with the palm or fist. Suprapubic pressure is applied at the direct request of the provider and is facilitated by the extra height of the step stool; the pressure may allow for the anterior shoulder to be pushed in a downward and lateral direction so that it passes under the pubic bone. If those two maneuvers fail, the provider should try other measures in a timely manner until the baby is delivered. Health Science Science Nursing NURSING 103 Share QuestionEmailCopy link Comments (0)