Preterm Labor and Prenatal Harm

Description of the Scenario

The patient in the case study is a 25-year-old gravida two patient on a routine prenatal visit with her midwife. MS Smith reported experiencing intermittent lower abdominal pain that radiated to her back. The initial assessment of the fetus revealed a fetal heart rate of 150, which was moderately variable. A vaginal examination that was conducted showed intact membranes and a fetal cephalic presentation. On the measurement of the vital signs, the results were as follows: blood pressure 164/102, pulse rate 86, respiratory rate 24, and a temperature of 98.6 F. the patient had a non-contributory past medical history and had undergone tonsillectomy at the age of five. The client’s social history revealed that she smoked two cigarettes packets per day for the last ten years. The family history did not indicate any significant chronic familial illness. She is currently on PNV, which she uses four times a day, and Makena injections (17OHP) and reports sulfa allergy. Her obstetric history revealed that her previous deliveries occurred at 32 weeks and had no antenatal complications. An initial obstetric exam showed that the patient had a chlamydia infection and was treated with azithromycin with her partner.

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Diagnosis and Treatment of Preterm labor

Preterm labor occurs when the cervix opens following regular contractions that occur after 20 weeks of gestation but before week 37 (Nwanodi, 2016). The medical condition can be diagnosed using various criteria, which begins by comprehensive history taking and physical assessment. The risk of preterm labor is higher among pregnant women with a positive history of the medical condition. The assessment of past medical history is thus significant in the diagnosis of preterm labor. The risk of preterm labor and premature births is higher among eh genetically susceptible. Therefore, the assessment should encompass the familial history of the client.Preterm Labor and Prenatal Harm

Pelvic examination is the most common method of diagnosing preterm labor. The healthcare service providers use the procedure to assess cervical tenderness and opening, which are definitive signs of labor. The pelvic assessment should also assess the position, presentation, and size of the baby. Another effective procedure that can confirm the diagnosis is ultrasound monitoring to assess the strength, spacing, and duration of the contractions (Wright et al., 2017).  An ultrasound can be used to determine the length of the cervix, assess the baby’s position, estimate the baby’s weight, and the volume of amniotic fluid. Laboratory tests can also be conducted to confirm the diagnosis of preterm labor. Vaginal secretion samples could be studied for the presence of fetal fibronectin.

The treatment approaches for preterm labor include bed rest, which can be prescribed at home or within the health facility. If the laboratory tests reveal that bacterial infection is the cause of preterm labor, then broad-spectrum antibiotics such as amoxicillin, erythromycin, or Augmentin can be prescribed. Tocolytic medications could be administered to slow labor progress and stop contractions (Nwanodi, 2016). Corticosteroids are also administered to help with the maturation of fetal lungs. Another effective treatment strategy for preterm labor is cervical cerclage to stitch the cervix closed in an incompetent cervix. If the treatments fail, then delivery of the baby is the remaining option, mainly achieved through the cesarean section.

Pathophysiology, Signs, and symptoms

Preterm labor’s pathophysiology is unknown, but the medical condition is believed to be precipitated by various infections, hormonal changes, polyhydramnios, a very large baby, uterine incompetence, and vaginal bleeding. Other risk factors include age between 25 and 35 years, smoking, uterine abnormalities, fetal abnormalities, twin pregnancy, underlying medical conditions, history of the condition, and stress. These factors could lead to uterine and hormonal changes that can cause contraction and preterm labor. Some of the significant clinical features of preterm labor are backache, abdominal pain, tightening of the uterus, changes in amount and type of vaginal discharge, diarrhea, and nausea.

Nursing diagnosis

Acute pain related to disease process as evidenced by patient’s verbalization.

Goal: After two hours of nursing intervention, the patient will verbalize relief from pain.

Nursing Interventions

Assess the level of pain using a pain assessment score scale

Rationale: The assessment of pain level enables the nurse to determine the best course of action to alleviate pain.

The nurse will assess the temperature, pulse, and respiratory rate of the patient.

Rationale: temperature, pulse, and respiration rates could be slightly increased in patients experiencing acute pain (Lewis et al., 2014).

The nurse will administer analgesics as prescribed; ASA 81mg PO after every six hours.

Rationale: ASA irreversibly and selectively inhibits the COX-1 pathway causing relief from pain.

Outcome

After two hours of nursing intervention, the patient verbalized relief from pain.

Nursing diagnosis

Altered tissue perfusion related to disturbed uteroplacental circulation as evidence by conjunctival pallor

Goals: After 6 hours of intervention, the patient will maintain healthy blood pressure with a systolic pressure of above 90 mm/Hg and a diastolic pressure of 60 mmHg. After 6 hours of nursing intervention, the patient will maintain a urine output level of more than 30 mL/hr.Preterm Labor and Prenatal Harm

Nursing Interventions

The nurse will administer parenteral fluids as prescribed, for instance, 500ml of normal saline after every 8 hours.

Rationale: Parenteral fluid helps to improve fluid volume quickly and is indicated for moderate to severe dehydration.

The nurse will also encourage the patient to increase fluid intake.

Rationale: Oral fluid replacement is usually indicated for mild to moderate dehydration (Lewis et al., 2014).

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The nurse will establish a fluid input and output chart to monitor for signs of fluid overload.

Rationale: A fluid chart helps the nurse to determine fluid deficit needs and fluid overload or retention.

Outcome

By the end of the nursing interventions, the patient had a 110/75 mmHg blood pressure.

References

Lewis, S. M., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. (2014). Medical-surgical nursing: Assessment and management of clinical problems.

Nwanodi, O. (2016). Preeclampsia-Eclampsia Adverse Outcomes Reduction: The Preeclampsia-Eclampsia Checklist. Healthcare, 4(2), 26. https://doi.org/10.3390/healthcare4020026

Wright, D., Dragan, I., Syngelaki, A., Akolekar, R., & Nicolaides, K. (2017). Proposed clinical management of pregnancies after combined screening for pre-eclampsia at 30-34 weeks’ gestation. Ultrasound in Obstetrics & Gynecology, 49(2), 194-200. https://doi.org/10.1002/uog.17309 Preterm Labor and Prenatal Harm