You are the charge nurse working in labor and delivery at a local hospital. D. H. comes to the unit having contractions and feeling somewhat uncomfortable. You take her to the intake room to provide privacy, have her change into a gown, and ask her three initial questions to determine your next course of action—that is, whether to do a vaginal examination or to continue asking her more questions.

1. What three initial questions will you ask, and why?

2. D. H. has contractions 2 to 3 minutes apart and lasting 45 seconds. It is her third pregnancy (gravida 3, para 2002). Her bag of waters is intact at this time. You determine that it is appropriate to ask for further information before a vaginal examination is done. What information do you need?

3. What assessment should you make to gain further information from D. H.?

4. On examination, D. H. is 80% effaced and 4 cm dilated. The fetal heart rate (FHR) is 150 beats/min and regular. She is admitted to a labor and delivery room on the unit. What nursing measures should be done at this time?

5. As part of your assessment, you review the fetal heart strip pictured here. What causes early decelerations and what will you do?