| Course | NR 327 Maternal-Child Nursing |
|---|---|
| Week | 4 |
| Paper type | Labor case response |
| Length | About 1,140 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 327 Week 4
Labor Case Response: A First Labor in Four Releases, From a Fall in Heart Rate After the Epidural to Variable Decelerations While Pushing
Student Name
College of Nursing, Chamberlain University
NR 327: Maternal-Child Nursing
Instructor Name
Month Day, Year
Labor Case Response: A First Labor in Four Releases, From a Fall in Heart Rate After the Epidural to Variable Decelerations While Pushing
Release 1, 1400: Active First Stage
Ms. K. is 24, in her first pregnancy, at 39 weeks and 4 days, admitted in spontaneous labor. At 1400 her cervix is 5 centimeters dilated, fully effaced, with the head at 0 station. Contractions come every 3 minutes and last 60 seconds. Her vital signs are normal. The fetal heart rate baseline is 135 beats a minute with moderate variability and accelerations, and no decelerations.
Stage. At 5 centimeters with regular contractions, she is in the active phase of the first stage. The baby. A normal baseline, moderate variability and accelerations make this a Category I tracing under the three-tier system described at the 2008 national workshop on fetal monitoring (Macones et al., 2008), which predicts a well-oxygenated fetus at this moment. Actions. Routine intermittent assessment, encourage position changes and fluids, and support her plan for an epidural. Nothing here is urgent, and the most useful thing the nurse does is establish her baseline and the baby's so later changes can be read against them.
Release 2, 1518: Seventeen Minutes After the Epidural
Progress slowed after 1400, and oxytocin was started at 1430 at 2 milliunits a minute. An epidural was placed at 1500. At 1515 her blood pressure is 84/46, down from 118/70, and she says she feels sick. At 1516 the fetal heart rate falls to 90 and stays there. At 1518 it is still 90.
Stage. Still active first stage, at about 6 centimeters. The baby. A fall of 45 beats below baseline lasting more than 2 minutes is a prolonged deceleration by the workshop definitions (Macones et al., 2008), and in the minutes after an epidural with a falling maternal pressure, the likeliest cause is reduced blood flow to the uterus. The baby is not tolerating what is happening to the mother's circulation.
Actions, ranked. First, turn her fully onto her left side, because the uterus compressing the large vessels is the quickest cause to remove and costs nothing. Second, stop the oxytocin, because contractions squeeze the blood supply to the placenta and the baby needs longer rests between them now. Third, open the intravenous fluids to a bolus under the standing order and call anesthesia to the room for the blood pressure, since treating the hypotension with medication is their decision. Fourth, call the provider, and check the cervix if the rate does not recover, to exclude a rapid descent or a cord. Intrauterine resuscitation measures of this kind are set out in the national guidance on managing intrapartum tracings (American College of Obstetricians and Gynecologists [ACOG], 2010).
If it does not recover. A deceleration that has not begun to come back up by about the sixth minute despite these steps changes the call. The provider is asked to come to the bedside now rather than advised by phone, the charge nurse is told, and the room is quietly prepared for an expedited birth in case one is needed. Choosing that route is not the nurse's decision, but having the room ready before it is chosen is, and it is also the moment to tell Ms. K. in one sentence what is happening and why so many people are arriving.
What an action costs the other patient. Stopping the oxytocin helps the baby and costs Ms. K. time: her contractions will space out and her labor, which had already slowed, will slow further. That is the right trade at 1518, and it should be said to her plainly, because she will notice the change.
Release 3, 1740: Pushing
By 1524 her pressure was 108/62 after fluids and a dose of medication from anesthesia, and the fetal heart rate had returned to 135 with moderate variability. Oxytocin was restarted at 1600 at the provider's order. At 1720 she was fully dilated and began pushing at 1730. At 1740, the tracing shows decelerations with most contractions, falling abruptly to about 105 and returning within 40 seconds, with a baseline of 140 and moderate variability between them.
Stage. Second stage, active pushing. The baby. Abrupt drops with quick recovery are variable decelerations, most often from cord compression, and with each push they are common. Taken alone in the first stage, recurrent variables would be worth close attention. Here, what matters is what the baby shows between contractions: a normal baseline, moderate variability and full recovery each time. That describes a fetus coping with pushing. The finding to watch for is change: the baseline rising, variability flattening, or decelerations lasting longer or recovering more slowly.
Actions, ranked. Continue pushing and continue continuous monitoring. Tell the provider at the next check that variables are present with good recovery. If recovery begins to lengthen, change her position and ask her to push with every other contraction. The cost. Pushing with every other contraction gives the baby more recovery time and costs Ms. K. a longer second stage, at the point where she is tired and wants the labor over.
Release 4, 1841: After the Birth
A boy is born at 1841, cries at once, and is placed skin to skin. His Apgar scores are 8 and 9. The placenta delivers at 1849. At 1855 her uterus is firm at the umbilicus, and the blood collected under her measures 350 milliliters by weight.
Stage. Third stage complete; early fourth stage. Both patients. The baby is transitioning well. For Ms. K., the first hour after birth is when bleeding is most likely, and one risk factor is present: a labor augmented with oxytocin, after which the uterus can be slower to stay contracted. Actions. Check her fundus and bleeding every 15 minutes, keep oxytocin running as ordered after delivery, and keep the baby skin to skin, which supports both his temperature and her uterus through early breastfeeding.
Handed On
At 1918, at the change to the recovery nurse, the report opens with the two things most likely to matter in the next hour: "Ms. K., first baby, born at 1841, blood loss 350 by weight so far, fundus firm at the umbilicus, oxytocin running after delivery. She had a prolonged deceleration after her epidural at 1516 from hypotension, resolved with position, fluids and anesthesia, and a 71-minute second stage with variables that recovered well. The baby is skin to skin, Apgars 8 and 9." The provider was informed at each release as it happened, and anesthesia has been told the epidural remains in place until the repair is finished.
References
American College of Obstetricians and Gynecologists. (2010). Practice bulletin no. 116: Management of intrapartum fetal heart rate tracings. Obstetrics & Gynecology, 116(5), 1232-1240. https://doi.org/10.1097/AOG.0b013e3182004fa9
Macones, G. A., Hankins, G. D. V., Spong, C. Y., Hauth, J., & Moore, T. (2008). The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: Update on definitions, interpretation, and research guidelines. Obstetrics & Gynecology, 112(3), 661-666. https://doi.org/10.1097/AOG.0b013e3181841395
What the NR 327 Week 4 assignment asks for
The Week 4 case presents a labor in stages and asks you to respond to each new piece of information. The brief normally asks for the stage of labor, interpretation of the fetal heart rate tracing using standard terms, prioritized nursing actions with rationale, communication with the provider and evidence in APA. Name the stage before you judge any finding, because the same tracing can be routine in one stage and urgent in another. Interpret the tracing with the national definitions. Rank your actions and explain the order. Say what would change your plan if the first steps failed. Keep both patients in view after the birth, and finish with what you would hand on.
Inside the NR 327 Week 4 example
Release 1 at 1400 places Ms. K. in active first stage at 5 centimeters and reads a Category I tracing. Release 2 at 1518 links her blood pressure of 84/46 after the epidural to a prolonged deceleration, then ranks the actions: left side, stop the oxytocin, a fluid bolus with anesthesia called for the pressure, then the provider. A paragraph sets the sixth-minute point at which the call changes, and another states that stopping oxytocin costs her labor time. Release 3 reads variables during second-stage pushing as common with good recovery and lists what would change that. Release 4 covers the birth at 1841, Apgars of 8 and 9 and the hemorrhage risk after augmentation. The handoff opens with blood loss and fundal tone.
Reading the NR 327 Week 4 grading rubric
Unfolding case rubrics in this course tend to reward correct identification of the stage, accurate interpretation of fetal monitoring, prioritized and justified interventions, communication, attention to both patients and use of evidence with APA. Interpretation earns points when each tracing is described by baseline, variability and decelerations using Macones and colleagues' definitions. Prioritization is credited when the order of actions is argued, as with the left side coming first because it costs nothing. The paper wins credit for clinical judgment by saying when the plan changes if recovery fails. Communication scores through the provider call and the handoff wording. Writing down the cost of stopping oxytocin shows the attention to both patients that graders look for. ACOG's practice bulletin supports the actions.
Common NR 327 Week 4 mistakes, and how to avoid them
Points are lost most often when a finding is called good or bad without saying where in labor it occurred. A second common error is following the woman and forgetting the baby, or the reverse, so one patient disappears from a release. Actions listed without an order, or ordered without reasons, earn less than students expect. Many responses also stop at the birth and never mention the fourth stage, where hemorrhage risk peaks. Using informal words such as "a dip" instead of the defined terms costs accuracy points. Keep doses and orders within what the case gives you. A case with different releases can be worked the same way, and our writers will rank the actions in each one for your NR 327 response.
Get a NR 327 Week 4 example written to your instructions
Send the Week 4 case your classroom posted, plus whatever answer template came with it, and a custom response is written to that case and returned inside 24 to 48 hours. The first one is free. Cases that arrive in several parts are fine; send all the parts and the response tracks them in the order they were released.
More NR 327 papers and pre-licensure samples
- NR 327 Week 1: Normal Pregnancy Adaptation Post
- NR 327 Week 2: Antenatal Assessment Write-Up
- NR 327 Week 3: Fetal Movement Teaching Plan
- NR 327 Week 5: Postpartum Assessment Write-up
- NR 327 Week 6: Newborn Transition Write-up
- NR 327 Week 7: Concept Map
- NR 327 Week 8: Family Care Plan
- NR 328 Week 4: Weight-based Dosage Set
- NR 326 Week 4: Mental Status Exam Write-Up
- NR 341 Week 4: Shock Case Response
- NR 325 Week 4: Heart Failure Case Response
NR 327 Week 4 questions, answered
Do I have to name a specific stage of labor?
Name it every single time. A response calling a finding reassuring without saying when it was taken cannot be marked, because reassurance depends entirely on where labor has reached. Where the case leaves it vague, say which stage you are reading it at and hold to that throughout. An assumption you write down can be marked. One you leave in your head cannot be.
How much detail about pain relief is expected?
Enough to show what it changed for both of them. An epidural is not only a comfort decision; it alters what the woman can feel, what she can do in second stage, and what the monitoring then has to do more of. Sections differ on whether pharmacology falls inside this week, so take that from yours, but the paired effect earns marks wherever it appears.
What if I would do something the case does not offer?
Say so, say why, then work with what is on the page. Markers reward a response that names a missing option and explains what having it would have added, provided the rest of the answer still uses the resources the case actually supplied. What loses ground is an answer built entirely on equipment, staffing or a setting the case never said was there.
Where can I find a free NR 327 Week 4 sample paper?
This page shows the whole Week 4 labor case response for Ms. K., all four releases with ranked actions, the plan if the deceleration does not recover, the handoff and the references.
What is the first action in the NR 327 Week 4 response to the deceleration after the epidural?
Turning Ms. K. fully onto her left side, because relieving pressure on the large vessels is the quickest cause to remove and costs nothing, before stopping the oxytocin and giving fluids.