Maternity Shadow Health Assessments — Jennifer Wu, Daanis LaFontaine, Naomi Adebayo, Gloria Hernandez & Luna Morales

The maternity module covers five focused exams across pregnancy, labour, delivery complications, and postpartum recovery. Each patient tests a different part of obstetric nursing judgment.

• Use the Question tab to collect the full history.
• Use the Educate and Empathize tabs to show teaching and therapeutic communication.
• Document key findings in the EHR.
• Finish with either an SBAR handoff or a care plan, depending on your course setup.

Knowing that structure before you start helps you move faster and miss fewer scoring points.

Jennifer Wu is a 41-year-old Chinese American woman at 27 weeks gestation who was diagnosed with gestational diabetes after failing the glucose tolerance test at a routine prenatal visit. She denies any symptoms of gestational diabetes.

Her history is significant for one prior miscarriage, latex allergy, seasonal allergies and a fast-paced work environment as an editor. She exercises 2-3 times per week and denies alcohol, tobacco and illicit drug use. Her diet is generally balanced but her carbohydrate intake needs clinical assessment.

Key clinical points to document: Advanced maternal age (41) as a risk factor for GDM. GTT result and interpretation. Current dietary pattern and carbohydrate load assessment. Education provided on carbohydrate counting — the goal is 175g/day total with no more than 45g per meal. Blood glucose monitoring targets: fasting below 95 mg/dL, 1-hour post-meal below 140 mg/dL. Exercise safety in pregnancy. Signs requiring immediate attention — hyperglycaemic symptoms, decreased fetal movement.

Common mistakes: Not documenting the GTT result explicitly. Failing to address the advanced maternal age risk factor. Generic dietary education instead of specific carbohydrate counting guidance. Missing the endocrinology referral in the management plan.

Daanis LaFontaine is a pregnant woman in the intrapartum phase presenting for an uncomplicated vaginal delivery. This focused exam tests your ability to conduct a complete labour assessment and prepare a safe SBAR handoff to Preceptor Diana.

Subjective assessment covers: Onset and progression of contractions (frequency, duration, intensity), rupture of membranes (spontaneous or artificial, time, colour and odour of fluid), fetal movement since labour began, pain level using a validated scale, birth plan preferences and GBS status.

Objective assessment covers: Maternal vital signs, contraction pattern on external monitoring (frequency, duration, strength), fetal heart rate baseline and variability on CTG, cervical examination findings (dilation, effacement, station, presenting part), and membranes status.

SBAR to Preceptor Diana: Situation — patient in active labour, uncomplicated progression. Background — obstetric history, GBS status, current gestational age, prenatal complications if any. Assessment — current cervical dilation, FHR pattern (reassuring), maternal vital signs stable, pain managed. Recommendation — continue labour support, prepare for delivery, notify when pushing urge felt.

Common mistakes: Skipping GBS status documentation. Incomplete CTG interpretation — must document baseline rate, variability, accelerations and decelerations. Failing to document the patient's birth plan preferences in the education section.

Naomi Adebayo presents with preeclampsia — one of the most clinically serious conditions in maternity nursing and a frequent source of lost marks because students miss the severe features screening.

Preeclampsia is defined as: BP ≥140/90 mmHg on two occasions at least 4 hours apart after 20 weeks, plus either proteinuria (≥300mg in 24-hour urine or protein:creatinine ratio ≥0.3) OR severe features.

Severe features screening — ALL must be documented: BP ≥160/110, thrombocytopenia (platelets below 100,000), renal insufficiency (creatinine above 1.1), liver enzyme elevation (twice normal), pulmonary oedema, new-onset headache unresponsive to medication, visual disturbances.

Subjective assessment covers: Headache (severity, location, response to analgesia), visual disturbances (blurred vision, scotomata, photopsia), epigastric or right upper quadrant pain (liver capsule stretching), oedema progression (face, hands, sudden weight gain), fetal movement and understanding of diagnosis.

Magnesium sulfate protocol: If severe features are present, MgSO4 is initiated for seizure prophylaxis. Document the loading dose (4-6g IV over 15-20 minutes) and maintenance infusion (1-2g/hour). Monitor for toxicity — loss of deep tendon reflexes is the first sign. Calcium gluconate is the antidote and must be at bedside.

SBAR: Always state whether severe features are present or absent — this determines urgency of delivery.

Gloria Hernandez focuses on a full postpartum assessment. The easiest way to stay organized is to work through BUBBLE-HE in order.

• Breasts: check for engorgement, nipple damage, milk let-down, and feeding support.
• Uterus: document fundal height, position, and firmness. A boggy uterus suggests atony.
• Bowel: ask about bowel movement, bowel sounds, flatus, diet, and stool softener use.
• Bladder: document first void, output, distension, and catheter findings if present.
• Lochia: note color, amount, odor, and abnormal clots.
• Episiotomy or incision: use REEDA and document each finding clearly.
• Homans sign and leg check: screen for calf pain, swelling, warmth, or redness.
• Emotional wellbeing: assess bonding, support at home, infant-care plans, and postpartum mood.

Luna Morales is an early-labour case with non-reassuring fetal status. The key here is fast recognition, quick intervention, and clear SBAR communication.

Watch for these CTG patterns:

• Late decelerations: start after the contraction peak and recover after the contraction ends.
• Variable decelerations: abrupt drops linked to cord compression, especially if deep or prolonged.
• Prolonged decelerations: any drop lasting more than 2 minutes.
• Reduced variability: baseline variability under 5 bpm for more than 40 minutes.

Immediate nursing actions:

• Reposition to the left side.
• Give oxygen by non-rebreather mask.
• Start or increase an IV fluid bolus.
• Stop oxytocin if it is infusing.
• Notify the provider right away and document the exact time.

SBAR: state the FHR pattern, labour progress, key history, interventions already done, maternal response, and what urgent review is needed next.

NursingProxy has completed, A-grade verified assessments for all five maternity Shadow Health patients. Each document includes the full interview transcript, all scored subjective and objective findings, therapeutic communication documentation, SBAR handoff and Care Plan. Preview the first pages free before purchasing — download the full PDF instantly after payment.

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Naomi Adebayo → Rachel Hardy → Daanis LaFontaine → Browse all →