A 38-year-old female is 27 weeks pregnant and hasn’t felt the baby move as she has been. The vital signs are as follows:
HR110 bpm
RR20 bpm
BP98/55 mmHg
Temp97.6°F
Fetal HR133
The doctor has ordered a non-stress test due to the mothers age and the decrease of fetal movements. The nurse explains the procedure to the patient and prepares her to begin testing.
Anytime she feels fetal movements to push the button.
The testing is underway and the patient presses the button. The nurse notes the fetal heart rate has stayed at 130 bpm and has not changed. This happens 2 more times with the same results.
Critical Thinking Check
Bloom's Taxonomy: Analysis
What do these results this mean? What are the implications?
A non-reactive stress test indicates the baby may not be okay. Further testing is warranted!
The doctor decides to further testing by performing a contraction stress test. The nurse knows that she needs to prepare the patient for this by explaining the medication and how it will feel.
Critical Thinking Check
Bloom's Taxonomy: Analysis
What medication is given during a contraction stress test? How would you explain this procedure and medication to the patient?
This medication is given to initiate uterine contractions to see how your baby will respond to that stress. We will do the same procedure as before and see how the baby’s heart rate reacts when a contraction occurs.
Critical Thinking Check
Bloom's Taxonomy: Comprehension
Does the nurse need to get any additional equipment to perform this test?
The nurse needs to start an IV line to administer the Oxytocin, if one is not already available, but the rest of the monitoring equipment is the same.
The patient is prepared and the Pitocin is administered. The patient presses the button and the nurse notes on the fetal heart monitor that the heart rate has risen to 150 bpm. This result is confirmed 2 more times.
This nursing case study course is designed to help nursing students build critical thinking. Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process. To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs. If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding. In the end, that is what nursing case studies are all about – growing in your clinical judgement.