NU143 Unit 10 Final Case Study Example

From Induction to a Shared Discharge: A Final Case Study Following a Composite 28-Year-Old Through Induction at 41 Weeks, a Fever in Labor, a Vaginal Birth After Twenty Hours and a Newborn Evaluated for Infection

[Student Name]

Purdue University Global

NU143: Maternal Infant Nursing

Unit 10 Final Case Study

[Instructor Name]

[Date]

The mother and newborn are composite; values are bracketed where illustrative, and treatment decisions belong to the obstetric and pediatric teams.

Induction

[Ms. H.], composite, 28, gravida 1, para 0, at 41 weeks and 1 day, was admitted for induction because pregnancy beyond 41 weeks carries rising risks. Her cervix was unfavorable, so a ripening agent was used overnight, then oxytocin. Her membranes were ruptured artificially at [4] cm, fourteen hours into the process. Group B strep screen negative. Priorities in this phase: fetal well-being on continuous monitoring, oxytocin titration to avoid excessive contractions, and comfort; she chose an epidural at [5] cm.

Fever in Labor

At eighteen hours, four hours after membranes ruptured, her temperature rose to [38.6] C, her heart rate to [112], and the fetal baseline to [170]. The provider diagnosed suspected intra-amniotic infection, an infection of the fluid and membranes around the baby. National guidance recommends prompt intrapartum antibiotics when this is suspected, along with an antipyretic, and notes that infection is not by itself a reason for cesarean birth (American College of Obstetricians and Gynecologists, 2017). IV antibiotics were started, acetaminophen given, and the pediatric team informed before birth.

Ranked problems at this point: risk for maternal sepsis; risk for fetal compromise, given tachycardia on the tracing; and risk for newborn infection.

Telling the pediatric team before the birth meant the baby's evaluation began at the bedside, not hours later.

Birth

She gave birth vaginally at twenty hours to a boy, [3,620] g, Apgar scores [7] and [9]. The pediatric team attended. Placenta delivered intact; estimated blood loss [450] mL; fundus firm after oxytocin. Her temperature returned to [37.4] C within six hours on antibiotics.

The Newborn Evaluation

Babies born to mothers with intra-amniotic infection have a higher risk of early-onset sepsis. Guidance for infants born at 35 weeks or later describes approaches that include close clinical observation, risk calculators and, for some, a blood culture and antibiotics while results are awaited (Puopolo et al., 2018). Using the unit's protocol, he had a blood culture drawn and received IV antibiotics. His vital signs were checked every [four] hours: temperature [37.0] C, heart rate [138], respirations [48], no grunting. He breastfed well.

Postpartum

Mother: fundal checks and bleeding; temperature trend; pain control; perineal care; mood. Her antibiotics stopped after delivery as ordered once she was afebrile. Newborn: culture negative at [36] hours, antibiotics stopped at [48] hours, feeding and weight normal, bilirubin below the treatment threshold.

Priorities Across Phases

Fetal well-being and contraction control during induction; infection management for mother and baby during and after the fever; hemorrhage prevention in the first hour; then feeding, recovery and teaching (Perry et al., 2022).

Supporting the Family Through the Evaluation

The newborn's IV and antibiotics were frightening for his parents, who had expected to hold a healthy baby and go home on day two. The nurse explained that the evaluation was a precaution based on the fever in labor, not a sign that he was ill, and that most babies evaluated this way have negative cultures. He stayed in the room with his mother rather than in a separate nursery, and she breastfed him with the IV in place, with the nurse showing how to position him around the line. Her own recovery from a long labor, a fever and an epidural was supported by planned rest periods and help with feeds at night. The parents were updated each time a result came back, so they did not wait without information.

Communication Between Teams

Three handoffs shaped the outcome: the call to pediatrics when her fever began, the report at birth about the antibiotics she had received and when, and the coordination of a single discharge. Each was brief and specific. The timing of her antibiotic doses mattered to the newborn team, because it influences the baby's risk and the evaluation chosen.

The Shared Discharge

Because mother and baby were cared for by two teams, the nurse coordinated a single discharge conversation. The parents learned warning signs for the mother, including fever, foul discharge, heavy bleeding, headache and low mood, and for the baby, including fever or low temperature, poor feeding, unusual sleepiness, breathing difficulty and fewer wet diapers. A postpartum visit within three weeks and a newborn visit within [48] hours were booked before they left, consistent with guidance that postpartum care should begin early rather than at a single six-week visit (American College of Obstetricians and Gynecologists, 2018). Both parents repeated the warning signs back, and his father saved the unit's phone number in both their phones.

Conclusion

The case shows how a long induction can lead to infection that affects two patients at once, and how communication across teams, from the call before birth to a shared discharge, keeps both safe.

References

American College of Obstetricians and Gynecologists. (2017). Intrapartum management of intraamniotic infection (Committee Opinion No. 712). Obstetrics & Gynecology, 130(2), e95-e101. https://doi.org/10.1097/AOG.0000000000002236

American College of Obstetricians and Gynecologists. (2018). Optimizing postpartum care (Committee Opinion No. 736). Obstetrics & Gynecology, 131(5), e140-e150. https://doi.org/10.1097/AOG.0000000000002633

Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal child nursing care (7th ed.). Elsevier.

Puopolo, K. M., Benitz, W. E., & Zaoutis, T. E. (2018). Management of neonates born at 35 0/7 weeks' gestation or more with suspected or proven early-onset bacterial sepsis. Pediatrics, 142(6), Article e20182894. https://doi.org/10.1542/peds.2018-2894