Do the reflection questions for the Vsim of Amelia Sung: Risk for…
Do the reflection questions for the Vsim of Amelia Sung: Risk for shoulder dystocia
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Amelia Sung is a 36-year-old Filipino woman, G2P1 (L1) at 39 weeks of gestation, who was admitted 6 hours ago in active labor. At admission she was 4 cm dilated, 100% effaced, -1 station, and fetus in vertex position. Epidural anesthesia was initiated at 0230 hours. At 0330 hours, her membrane ruptured; fluid was clear; dilation was 6 cm and the fetus was still at -1 station in vertex position. Two hours ago, she was fully dilated and started pushing. The fetal heart rate has been stable with a baseline of 120/min, moderate fetal heart rate variability, and variable decelerations since she started pushing. She is getting tired from pushing, and the descent of the fetal head has been slow. In the past few contractions, fetus has started to crown. She is given O2 at 10 L/min per non-rebreather mask for decelerations, and an IV with lactated Ringer’s is running at 125 mL/hr. Her last delivery ended with shoulder dystocia because the baby was large: first-born male delivered vaginally 3 years and 3 months ago, weight: 3,912 g (8 lb 10 oz), length: 55 cm (22 in). The provider has been called and has arrived, so Amelia may continue pushing.
2. Analyze cues. What could it mean? Organize and connect cues that support orcontraindicate a particular condition. What is a concern? Interpret the information andconsider what could be happening. For each of the findings consider possible disease process.
3. Prioritize Hypotheses. Where do you start? What is most/least likely? What is the highestrisk complication? Prioritize care accordingly.
4. Generate Solutions. What can you do? What are the desirable outcomes? Whatinterventions achieve those outcomes? What should be avoided? List interventions.
5. Take Action. What will you do? Identify the most appropriate action. Implement thesolution that addresses the highest priorities. List the interventions that are most appropriateand specify the most immediate priority.
6. Evaluate Outcomes. Did it help? Evaluate the actions performed based on the updatedstatus of the patient. Evaluate whether the assessment finding improved, no change ordeclined
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