Maternal Child Health Nursing
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).
Sample Solution
- History of preterm labor: The nurse should obtain a detailed history of the client's previous preterm labor, including the gestational age at which labor occurred, the length of labor, and any complications.
- Risk factors for preterm labor: The nurse should assess the client for risk factors for preterm labor, such as a history of preterm birth, multiple gestation, or cervical insufficiency.
Full Answer Section
- Current symptoms: The nurse should assess the client's current symptoms, including the frequency and intensity of uterine contractions, the amount of vaginal bleeding, and any other symptoms, such as nausea, vomiting, or diarrhea.
- Fetal well-being: The nurse should assess the fetal well-being by monitoring the fetal heart rate and uterine activity.
- Monitor the client's vital signs: The nurse should monitor the client's vital signs, including her temperature, pulse, respirations, and blood pressure.
- Monitor the fetal heart rate: The nurse should monitor the fetal heart rate using a fetal monitor.
- Administer medications as ordered: If the client is diagnosed with preterm labor, the nurse will administer medications as ordered by the healthcare provider. These medications may help to stop preterm labor or delay delivery.
- Provide emotional support: The nurse should provide emotional support to the client and her family. This may include listening to their concerns, providing information about preterm labor, and helping them to make decisions about their care.
- Cervical length: The nurse may measure the client's cervical length to assess her risk for preterm labor. A cervical length of less than 2.5 centimeters is considered to be a risk factor for preterm labor.
- Fetal fibronectin: The nurse may test the client for fetal fibronectin, a protein that is released from the cervix and vagina during preterm labor. A positive fetal fibronectin test is also considered to be a risk factor for preterm labor.
- Biophysical profile: The nurse may perform a biophysical profile, which is a test that evaluates the fetus's well-being. The biophysical profile includes ultrasound measurements of the fetus's breathing movements, body movements, tone, and amniotic fluid volume.