INTRODUCTION

Sometimes, labor stalls or occurs much too slowly. Prolonged labor may also be referred to as "failure to progress." Prolonged labor can be determined by labor stage and whether the cervix has thinned and opened appropriately during labor. If your baby is not born after approximately 20 hours of regular contractions, you are likely to be in prolonged labor. Some health experts may say it occurs after 18 to 24 hours. When the combined duration of the first and second stage of labour is more than the arbitrary time limit of 18 hours, it is termed prolonged labor. The prolongation encompasses delayed dilatation of the cervix (in the first stage) and/or inadequate descent of the presenting part (during the first or second stage). Inefficient uterine contraction is one of the causes of prolonged labor, others being either due to pelvis or the foetus. It must be borne in mind that prolonged labor is not synonymous with inefficient uterine contraction. The mortality for this condition is 60 to 9o%.Risk factors, Multiparous (75%), History of allergy (41%) Intrapartum period (70%),

The benefits of studyng this is to improved my knowledge about prolonged labor and be aware of it ., so that next time that I can encounter again a case like I have an idea and also I can help pregnant woman or woman who is in labor that experience like this.

PATIENT HISTORY

Name: PATEINT X Address: 48 Reyes St. Evangelista St. Santolas Pasig City B-date: Nov.12 1984 B-place: Bongabong Mindoro Age: 29 yrs. Old Civil status: Married Nationality : Filipino Religion: Roman Catholic Education attainment : College grad. Occupation: Costums rep. Husbands occupation: Costums rep. Attending physician: Dra. Eming Admission Date:

POSSIBLE REASON FOR PROLONGED LABOR

Any one or combination of the basic elements involved in labor are responsible, both in the First Stage - failure to dilate the cervix and the Second Stage - Sluggish or non-descent of the foetus in the second stage is due to

Fault in power include Inability to bear down, abnormal uterine contraction or incoordinate uterine contraction. Fault in the passage includes - contracted pelvis, pelvic tumor, eg:fibroid or even full baldder. Fault in the passenger includes - malposition and malpresentation, congenital anomalies of the foetus (hydrocephalus - common) Too often deflexed head, minor degrees of pelvic contraction and disordered uterine action have got sinister effects in causing nondilatation of the cervix. Others - Injudicious early administration of sedatives and analgesics before the actual active labor begins.

Malpresentations:
The normal position of the fetus is longitudinal with thefetal spine parallel to the mother's spine. The fetus lies in a completely flexedposition with the chin touching the chest and the arms and legs flexed infront. The fetus normally faces the mother's back for a smooth delivery.Any change in this position can cause prolongation in the duration in labor. Abreech presentation in which the fetus is in the buttocks down position, a facepresentation in which the fetus faces the mother's abdomen, or a deflexedposition of the head in which the neck of the fetus is less flexed or evenstraight or extended can all cause prolonged labor.

Cephalopelvic Disproportion (CPD)

CPDis said to occur when the size of the fetal head is bigger then the size of the maternal pelvic passage or birth canal. In most pregnant women in labor,ligaments and joints tend to become more flexible, enabling them to relaxmore at the time of labor. The baby's skull bones are

also capable of overlapping each other normally tosome extent, decreasing the size of the head('moulding'.So, it is difficult toestimate by physical examination alone if CPD is actually present.But if laboris unduly prolonged and no other cause is detected, a diagnosis of CPD is usually made.True CPD occurs only when the baby is very big, as in a diabetic motheror aphysically very small

Problems with Uterine Contraction:

The uterine muscle may fail tocontract properly when it is grossly distended as in twin pregnancy andhydramnios (excess liquor amnii). Presence of tumours like fibroids in theuterine musculature can also affect uterine-built mother, or if the mother has had a fractured pelvisat some time.

THIS IS WHAT HAPPEN BY THE PATIENT

Dystocia
characterized by slow, abnormal labor progression resulting from abnormalities of uterine contractions or maternal expulsive forces. Dystocia is the leading indication for augmentationand is the leading indication for primary cesarean delivery

Chief Complain:
Labor Pain

Rationale:
Due to labor contraction

Past history:
Patient had her first baby on and second baby was abort on 2011, and also had her prenatal checked up every month.

Present History:

Pain in due to labor pain for trial of labor, IE 3-4 cmContractions will last about 30-45 seconds, giving you 5-30 minutes of rest between contractions

G-3 P-2 T-1 P-1 A-1 L-1

ANATOMY AND PHYSIOLOGY

Amniotic fluid:
amnion

the serous fluid in which the embryo and fetus is suspended within the

Amniotic sac: The amniotic sac and its filling provide a liquid that surrounds and cushions
the fetus. It allows the fetus to move freely within the walls of the uterus. Buoyancy is also provided.

Fetus:

the unborn young from the end of the eighth week after conception to the moment of birth, as distinguished from the earlier embryo.

Umbilical cord: a cordlike structure connecting the fetus with the placenta during
pregnancy, conveying nourishment from the mother and removing wastes.

Placenta:

the vascular organ formed in the uterus during pregnancy, consisting of both maternal and embryonic tissues and providing oxygen and nutrients for the fetus and transfer of waste products from the fetal to the maternal blood circulation.

Uterus: anatomy a hollow muscular organ lying within the pelvic cavity of female mammals. It houses
the developing fetus and by contractions aids in its expulsion at parturition. Nontechnical name: womb

Cervix:

any necklike part of an organ, esp the lower part of the uterus that extends into the vagina

ROOSEVELT COLLEGE SYSTEM INSTITUTE OF NURSING & HEALTH EDUCATION SUMULONG HIGHWAY CAINTA, RIZAL

CASE STUDY PRESENTATION PROLONGED LABOR

PREPARED BY: Julius Balansag

SUBMITTED TO: Mrs. Grace Magno Rn MAn

DRUG NAME

ACTION

INDICATION

CONTRA INDICATION

ADVERSE EFFECT

NURSING CONSIDERATION

Buscopan

Hyoscine n butylbromide

Inhibits muscarinicaction Excessive of acetylcholine G in the ANS Imotility and Hypertoniain Irritable Bowel syndrome, Affecting mild neural pathway dysentery ,diverticulitis, Pylorospasm ,and cardiospasm Relieves spaticity, nausea Pre anesthetic andvomiting; sedation and reduces obstetric secretions; Amnesia blocks cardiac vagal reflexes Post operative nausea and vomiting Motion sickness

Contraindicated In patients with angleclosure Glaucoma ,obstructive uropathy, asthma, COPD, myastheniagravis, paralyticileus, intestinal atony, and unstable

CNS: dizziness ,headache, restlessness, disorientation, irritability, fever GI: constipation, dry mouth, nausea, vomiting CV: palpitations, tachycardia, flushing EENT: dilated pupils, blurred vision, photophobia, dysphagia GU: urinary hesitancy, urinary retention Skin: rash, dryness

Encourage pt to void Monitor BP for possible hypotension Monitor cervical effacement and dilatation

Promotes cervical effacement

DRUG NAME

ACTION

INDICATION

CONTRA INDICATION - Hyper sensitivity to antihistamines or Phenothiaz inesComatose patientsSevere CNS depressionBone marrow depressionVomiting of unknown causeConcomitant therapy with MAOIsLactation Precaution - Lower respiratory tract disordersGlaucomaProsthatic hypertrophyCV disease, hypertensionBreast cancer Thyro toxicosisChildren- Child with history of sleep apneaA family history of SIDS- Reyes

ADVERSE EFFECT CNS: Dizziness, drowsiness, poor coordination, confusion, restlessness, excitation, seizures, tremors, headache, blurred vision, diplopia, vertigo, tinnitus CV: Hypotension, palpitations, brad ycardia, tachycardia, extra systoles Dermatologic: Urticaria, rash, photosensitivity, chills GI: Epigastric distress, nausea, vomiting, diarrhea, constipation GU: Urinary frequency, dysuria, urinary retention, decreased libido,

NURSING CONSIDERATION

Selectively blocks the H Generic Name 1 PromethazineHC receptors, diminishing the effects of Trade Name histamine on Phenergan cells of the upper respiratory tract and eyes and decreasing the sneezing, mucus production, itching and tearing that accompany allergic reactions in sensitized people exposed to antigens; blocks cholinergic receptors in the vomiting centre that are believed to mediate the nausea and vomiting caused by gastric irritation, by input from the vestibular apparatus, and by input from the chemoreceptor trigger zone ;depresses the RAS, including the parts of the

- Prevention and treatment of nausea and vomiting associated with labyrinthitisPrevention of motion sicknessShort-term management of insomniaSymptomatic relief of perennial and seasonal allergic rhinitis, allergic conjunctivitis, and angioedemaAmelioration of allergic reactions to blood or plasmaDermatographism, adjunctive therapyin anaphylactic reactionsPreoperative, postoperative, or obstetric sedationAdjunct to analgesics to control postoperative pain- Adjunctive IV therapy with reduced amounts of meperidine or

Observe 15 rights in drug administration.Assess for hypersensitivity and other contraindications.Reduce dosage for patients with hepatic impairment.Reduce dosage of barbiturates given concurrently with promethazine by at least a half.- Arrange for dosage reduction of opioid analgesics given concomitantly by one-fourth to onehalf

brain involved with wakefulness

other opioid analgesic

syndromeElderlyPregnancy

impotence Hematologic: Hemolytic anemia, hypoplastic anemia,

ASSESSMENT

DIAGNOSIS

PLANNING

INTERVENTION RATIONALE

EVALUATION

SUBJECTIVE Sumasakit ang tiyan ko OBJECTIVE Facial Grimace Guarding Behavior PAIN SCALE 7-10 Vital Signs BP:120/70 RR: 18 PR: 84 bpm T: 36.9

Acute Pain R/T After the nursing Labor implementatio contraction n the pain scale of 7 will maintain

1.Perform pain assessment

1.to evaluate clients response to 2.Mpnitor Vital pain signs every 15 minutes 2.To observe for 3.Encourage increased/dec deep breathing rease of exercise cardinal signs 4.Encourage verbalization feelings about the pain 3.to divert the pain 4.To assist client to explore methods for alleviation of pain

After doing the nursing implementation the pain which measured by 7 will is still in 7

MANAGEMENT

DRUG NAME

ACTION

INDICATION

CONTRA INDICATION

ADVERSE EFFECT sedation. Clamminess ,sweating Headache, nervousness restlessness, depression, crying confusion, faintness, hostility, unusual dreams, hallucinations, euphoria, dysphoria, unreality, dizziness, vertigo, floating feeling, feeling of heaviness, numbness, tingling, flushing, warmth, blurred vision

NURSING CONSIDERATION 10 Rights of medications If oliguria develops, drug should be stopped .Monitor fluid Intake and output. Watch for signs of hypokalemia (muscle weakness) Advise to take drug with food to avoid GI upset

NALBUPHINE HYDRO CHLORIDE NUBAINE

Acts as an agonist at specific opioid receptors in the CNS to produce analgesia, sedation but also acts to cause hallucinations and is an antagonist at receptors

Relief of Moderate To Severe pain

Hypersensitivity To nalbuphine, sulfites; lactation. Use cautiously With Preoperative Emotionally analgesia, as Unstable clients a or those with a supplement history of to narcotic surgical abuse; pregnancy anesthesia, prior to labor, and for labor or delivery obstetrician ,bronchial asthma analgesia ,COPD, during respiratory labor and depression, delivery anoxia, increased intracranial pressure ,acute MI when nausea and vomiting are present, biliary tractsurger