Case Study: A 25-year-old presented to the labor and delivery unit with complaints of uterine cramping and lower back pain. The client denied any vaginal bleeding and had a history of preterm birth at 32 weeks (about 7 and a half months) gestation with her last pregnancy. The baby from that pregnancy is three years old has no developmental issues. The client's gestational age is 30 weeks (about 7 months). She is O+, and all other lab values are normal. No evidence of sexually transmitted infections (STI's).
(Group Beta Strep is missing from the labs and most often is obtained at 35 - 37 weeks (about 8 and a half months) gestation. Without this information, it is often determined to treat the patient anyway, to protect a premature baby from the risk.)
What additional information should the nurse obtain from the client?
What nursing intervention is most appropriate in this situation?
What screening tests should be obtained to determine the risk for preterm labor?
If the client is in preterm labor, what medications would the nurse expect to be ordered, and what are the priorities for the nurse to assess post-administration? (Include dose, side effects and expected outcomes of the medication).
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Additional information that the nurse should obtain from the client includes:
- Detailed description of the uterine cramping and lower back pain, including the duration, intensity, and frequency of the symptoms
- Any recent changes in fetal movement or any other concerning symptoms
- Past medical history, including any chronic illnesses or conditions that could contribute to preterm labor
- Any recent infections or illnesses that the client may have had
- Any recent trauma or accidents that the client may have experienced
The most appropriate nursing intervention in this situation is to assess the client's vital signs, including blood pressure, heart rate, and temperature. The nurse should also perform a thorough assessment of the client's abdomen, checking for any signs of uterine contractions or tenderness. The fetal heart rate should be monitored to assess fetal well-being. Additionally, the nurse should obtain a urine sample from the client to check for signs of infection.
Screening tests that should be obtained to determine the risk for preterm labor include:
- Cervical length measurement: This can be done using transvaginal ultrasound to assess the risk of premature cervical dilation.
- Fetal fibronectin test: This test helps in assessing the risk of preterm labor by detecting a substance called fetal fibronectin in vaginal secretions.
- Maternal blood test: This may include a complete blood count (CBC) to check for signs of infection or inflammation, as well as a test for fetal blood type and Rh factor compatibility.
If the client is in preterm labor, the nurse would expect the following medications to be ordered:
- Tocolytics: These medications are used to suppress uterine contractions and delay preterm labor. Examples include terbutaline (dose: 0.25 mg subcutaneously every 20 minutes, up to three doses), magnesium sulfate (dose: loading dose of 4-6 g given over 20 minutes, followed by a maintenance dose of 2-4 g per hour), and nifedipine (dose: 10-20 mg orally every 4-6 hours).
- Corticosteroids: These medications are typically given to enhance fetal lung maturity. Betamethasone is commonly used (dose: 12 mg intramuscularly, two doses 24 hours apart).
- Antibiotics: If group B Streptococcus (GBS) status is unknown, antibiotics such as penicillin or ampicillin may be administered to prevent neonatal GBS infection.
The priorities for the nurse to assess post-administration of these medications include monitoring the client's vital signs and assessing for any adverse reactions or side effects such as tachycardia, hypotension, or respiratory distress. The nurse should also monitor fetal heart rate and activity to assess fetal well-being. In the case of tocolytics, the nurse should assess for any decrease in uterine contractions and monitor for signs of maternal or fetal distress. Additionally, the nurse should provide education and support to the client regarding the purpose of the medications and any potential risks or benefits.
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