An 18-year-old  Primigravida presents to Labor and delivery with what appears to be active labor.  Upon questioning you discover that she has received no prenatal care.  In obtaining some history while placing her on the fetal monitor you learn she is a smoker, approximately 1 pack per day, occasional marijuana for  stress,, and denies any support system.  The Father of the baby (FOB) has no knowledge of the pregnancy.  She does not take prenatal vitamins.  She states “They were too hard to swallow”.  She has no idea when her LMP was and she relates always being irregular.  * remember LMP is to ask the first day of her Last Menstrual not when the bleeding stopped.

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What other questions are essential for her safe care?

What lab values do you need to obtain?

What exam findings should you obtain at this time?

What education will you provide for her?

She asks you how long this will take to have the baby- what is your best response?

Part 2 

Objective information:
fetal heart tones are 130 with minimal variability.

Vaginal exam reveals 4 cm dilated, 90% effaced , -1 station

She is complaining of pain 8/10 on a numeric scale.

An IV has been started with an 18 gauge catheter with 1 liter of Lactated Ringers at 150 cc/hour in the left forearm.

How can you provide non-pharmacological comfort to this patient?

What are the pharmacological methods to use?

Without prenatal records or history GBS is unknown, What must you provide?

Contractions are 5 minutes apart and you receive an order to augment labor- what non-pharmacological methods can you provide or  ask the provider to provide?

Pitocin is ordered please include at what rate you will start Pitocin and how  often you titrate. What equipment is necessary to run and hang Pitocin?

Minimum 500 words including intext citations, 500 words does not include citations and cover page and use APA style