CH 10

Question 1

Chorioamnionitis

Answer 1

Infection of the amniotic sac

Question 2

What are subjective assessment findings of a woman In preterm labor

Answer 2

Persistent low backache
Pressure in the pelvis and cramping
GI cramping, sometimes with diarrhea
Urinary frequency
Vaginal discharge

Question 3

What are objective physical assessment findings of a woman In preterm labor

Answer 3

Increase change or blood in vaginal discharge
Change in cervical dilation
Regular uterine contractions with a frequency of q10 min or greater lasting 1 hour or longer
PROM

Question 4

What are lab tests to determine if a woman is in preterm labor

Answer 4

Fetal fibronectin
Cervical cultures
CBC
urinalysis

Question 5

When should a swab of vaginal secretions for fetal fibronectin be done

Answer 5

Between 24-34 weeks gestation. This protein can be found in the vaginal secretions when fetal membrane integrity is lost

Question 6

What is preterm labor defined as

Answer 6

It is defined as uterine contractions and cervical changes that occur between 20 and 37 weeks gestation

Question 7

What tests provide information about a fetus’ well being

Answer 7

BPP and no stress test

Question 8

What are nursing interventions for a client in preterm labor

Answer 8

FOCUSING ON STOPPING UTERINE CONTRACTIONS!!!!!!!!!
Activity restriction/ resting in the left lateral position increases blood flow to the uterus and decrease uterine activity/ avoid sex
Ensuring hydration/ preventing dehydration prevents the release of oxytocin, which stimulates uterine contractions.
Identify and treat infection
Monitor FHR and contraction pattern
Administer meds/ nifedipine ( procardia) , magnesium sulfate, indomethacin, or betamethasone.

Question 9

When should chorioamniotitis suspected

Answer 9

With the occurrence of elevated temp, and tachycardia

Question 10

What are nursing considerations for administering calcium channel blockers to a woman in preterm labor

Answer 10

Monitor for headache, flushing, dizziness, and nausea. They are usually r/t orthostatic hypotension that occurs with administration.
Do not administer concurrently with magnesium sulfate.

It is used to suppress contractions by inhibiting calcium from entering smooth muscles.

Question 11

What is magnesium sulfate used for

Answer 11

It,is a commonly used tocolytic that relaxes the smooth muscle of the uterus and thus inhibits uterine activity by suppressing contractions

Question 12

When should tocolytic therapy be discontinued

Answer 12

Magnesium sulfate therapy should be discontinued if the c,isn’t exhibits manifestations of PE, which includes chest pain, SOB, RESPIRATORY DISTRESS, audible wheezes and crackles, and or a productive cough containing blood tinged sputum.

Question 13

What is indomethacin used for

Answer 13

It is a NSAID that suppresses preterm labor by blocking the production of prostaglandins. This inhibition of prostaglandins suppresses uterine contractions

Question 14

How long should indomethacin treatment be prescribed

Answer 14

It should not exceed 48 hr. It should only be used if gestational age is less than 32 weeks

Question 15

When should betamethasone be administered

Answer 15

It should be administered into the gluteal muscle 24-48 hr prior to birth

Question 16

What is betamethasone

Answer 16

It is a glucocorticoid, administered IM, in 2 injections, 24 hour apart, and requires a 24 hour period to be effective. The action is to enhance fetal lung maturity and surfactant production.

Question 17

What are nursing considerations for the med betamethasone

Answer 17

Administer deep into the gluteal muscle 24 and 48 hours prior to birth of a preterm neonate.
Monitor the client and neonate for pulmonary edema by assessing lung sounds
Monitor for maternal and neonate hyperglycemia
Monitor neonate for heart rate chAnges

Question 18

Wha pt are signs of pulmonary edema that a client should be educated about

Answer 18

Chest pain
SOB
crackles

Question 19

What is PROM

Answer 19

Premature rupture of membranes is the spontaneous rupture of the amniotic membranes 1 hour or more prior to the onset of true labor. For most woman PROM signals the onset of true labor is gestational age is at term

Question 20

What is PPROM

Answer 20

Preterm premature rupture of the membranes is the premature spontaneous rupture of membranes after 20 weeks of gestation and prior to 37 weeks gestation.

Question 21

What are risk factors for PROM and PPROM

Answer 21

Infection
Chorioamniotitis
There is an increased risk of infection if there is a lag period over the 24 hour period from when the membranes rupture to delivery

Question 22

What are objective physical assessment findings of a woman with PROM or PPROM

Answer 22

Temp elevated
Increased maternal HR or FHR
foul smelling fluid or vaginal discharge
Abdominal tenderness

Assess for prolapsed umbilical cord/ abrupt FHR variable or prolonged deceleration and a visible or palpable cord at the introitus

Question 23

What are lab tests to verify PROM or PPROM

Answer 23

A positive nitrazine paper test ( blue, pH 6.5- 7.5) or positive ferning test

Question 24

What is the med ampicillin used for

Answer 24

It is an antibiotic used to treat infection as in the case of PROM or PPROM

Obtain vaginal, urine, and blood cultures prior to administration of antibiotics

Question 25

For a client with rupture of membranes, with dilation of 3 cm what can the nurse expect

Answer 25

The client will be discharged home if no evidence of infection, contractions, and no malpresentation occurs
The client should take temp q4 hr while awake and report a temp greater than 38 ( 100f)

Question 26

What are contraindications for the administration of magnesium sulfate

Answer 26

Acute fetal distress
Vaginal bleeding
Cervical dilation greater than 6 cm

Question 27

What are indications for the use of magnesium sulfate

Answer 27

Preterm labor

Gestational hypertension