Nursing Law
Once you read the two case summaries, follow the instructions below.
Labor & Delivery, Pitocin, Fetal Monitors: Court Finds Evidence
Of Nursing Negligence.
Compare the appropriate nursing interventions by the nurse completed in Mississippi to the inappropriate nursing interventions by the nurse in the Texas case. Provide rationale supporting your comparison citing at least two scholarly sources.
The mother was admitted to the labor and delivery unit at 10:10 p.m. for induction of labor. The baby was delivered vaginally at 5:27 p.m. the next afternoon with the umbilical cord around her neck. She did not start breathing on her own for almost seven minutes and then began having seizures.
A pediatric neuroradiologist, who performed ultrasound scans on the child’s brain and who would later submit an expert report for the family in their lawsuit against the hospital, related the child’s problems to asphyxia consistent with bradycardic events prior to her delivery. The Court of Appeals of Texas accepted reports prepared by the family’s experts, an ob/gyn physician, a labor and delivery nurse and the pediatric neuroradiologist which pointed directly at the negligence of the labor and delivery nurses.
Family’s Medical Expert
When Cytotec has been used for cervi cal ripening followed by IV Pitocin for induction of labor, the labor and delivery nurses have the responsibility to maintain readable tracings of the fetal heart tones and the maternal contraction patterns. The nurses should not start or continue Pitocin when there are non-reassuring fetal heart tracings, when the contractions cannot be monitored or with uterine hyperstimulation. The physician must be notified of non-reassuring fetal heart tracings.
Family’s Nursing Expert
When Pitocin is in use the nurse must see to it that the equipment that monitors uterine contractions is recording the moth er’s contractions, the family’s nursing ex pert said. Review of the fetal heart monitor trac ings showed several lengthy intervals of non-reassuring heart rates. The records further revealed that a nurse increased the Pitocin even with late decelerations with decreased variability, until it was eventual ly decreased and then stopped a few hours before birth by a different nurse, but then restarted again until the birth with ominous tracings showing on the monitor. Abilene
Reg. Med. Ctr. v. Allen, __ S.W. 3d __, 2012
5951982 (Tex. App., November 29, 2012).
The patient’s nursing ex pert explained that the Pi tocin drip is usually con trolled by the labor and de livery nurse.It is increased to increase contractions and decreased or stopped altogether if the contractions get too strong, too long or too close to gether.The Pitocin is to be adjust ed based on whether the baby’s fetal heart tracings are reassuring or non reassuring. It is only in creased if the tracings are reassuring.The nursing expert’s re view of the chart revealed that the tocotransducer which identifies the begin ning and end of each of the mother’s contractions was not working for the first three hours after the mother was admitted to the labor and delivery unit. There were also numerous intervals evident from the fetal monitor tracings of non-reassuring tones that should have been but were not reported.If the physician had been notified of the non reassuring tones a cesare an could have been done early on to save the child from brain damage.
COURT OF APPEALS OF TEXAS
November 29, 2012
The Court of Appeals of Mississippi ruled there was no deviation from the standard of care by the patient’s labor and delivery nurses. Norris v. Southwest Miss.
Reg. Med. Ctr., __ So. 3d __, 2012 6118005
(Miss. App., December 11, 2012).
The labor and delivery nurse’s assessment was correct that the mother was not actually in labor.When the fetal heart tone was lost a nurse promptly began trying to reach the physician while another nurse kept trying to get a fetal heartbeat.
COURT OF APPEALS OF MISSISSIPPI
December 11, 2012
The patient was admitted to the hospital through the E.R. for what were at the
time believed to be labor pains.She was thirty-one years old and thirty three weeks pregnant and was considered high-risk due to obesity, insulin-dependent diabetes, four previous cesareans and hav ing given birth to very large twins.
The labor and delivery nurse immedi ately started a fetal heart monitor and a tocodynamometer and performed a vaginal exam which showed no dilation of the cer vix. The patient’s ob/gyn who had deliv ered her other children likewise found no dilation and gave orders for monitoring her blood sugars and giving insulin.Later that morning the patient’s ab dominal pain increased and so the nurse paged her physician. The nurse was get ting no heart tones on the monitor so she asked another nurse to keep checking for a fetal heartbeat while she kept paging the physician. A few minutes later the physi cian called and said he was on his way. The nurse documented all this in the chart.The physician was there within minutes and delivered the baby by cesare an, but there had been a complete uterine rupture and separation of the placenta.
Labor & Delivery:
Nurses Ruled Not
Neglig
