Maternal child health discussion
Reproduction
Review the case study and answer the following questions.
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 include:
The client’s current obstetric history, including any previous pregnancies, complications, and outcomes.
The client’s current symptoms, including the timing, frequency, and intensity of uterine cramping and lower back pain.
The client’s current medications and any allergies or adverse reactions.
The client’s current living situation, support system, and access to transportation.
The nursing intervention most appropriate in this situation would be to monitor the client’s vital signs and fetal heart rate, as well as to perform a pelvic exam to assess cervical dilation and effacement. The nurse should also administer tocolytics (medications that slow or stop premature labor) as ordered.
Screening tests that should be obtained to determine the risk for preterm labor include:
Fetal fibronectin (fFN) test: This test detects a protein in the cervix that is associated with an increased risk of preterm labor.
Home uterine activity monitoring (HUAM): This test monitors contractions and helps determine the risk of preterm labor.
Uterine artery Doppler: This test assesses blood flow in the uterus and placenta and can help identify women at risk of preterm labor.
If the client is in preterm labor, the nurse can expect to administer medications such as terbutaline (Brethine) and/or magnesium sulfate.
Terbutaline (dose: 0.25-0.5 mg subcutaneous every 4-6 hours as needed) is a beta-agonist that acts on the smooth muscle of the uterus to reduce contractions. Common side effects include tachycardia, tremors, and anxiety.
Magnesium sulfate (dose: 4-6 g IV loading dose, followed by 2 g/hour maintenance infusion) is an anticonvulsant that also has a tocolytic effect. Common side effects include flushing, nausea, and decreased deep tendon reflexes.
The priorities for the nurse to assess post-administration would include monitoring the client’s vital signs, fetal heart rate, and response to the medication, as well as monitoring for any adverse reactions or side effects. The nurse should also closely monitor the client’s progress and notify the healthcare provider if there are any concerns or changes in the client’s condition.
