CH 10 Flashcards
Chorioamnionitis
Infection of the amniotic sac
What are subjective assessment findings of a woman In preterm labor
Persistent low backache Pressure in the pelvis and cramping GI cramping, sometimes with diarrhea Urinary frequency Vaginal discharge
What are objective physical assessment findings of a woman In preterm labor
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
What are lab tests to determine if a woman is in preterm labor
Fetal fibronectin
Cervical cultures
CBC
urinalysis
When should a swab of vaginal secretions for fetal fibronectin be done
Between 24-34 weeks gestation. This protein can be found in the vaginal secretions when fetal membrane integrity is lost
What is preterm labor defined as
It is defined as uterine contractions and cervical changes that occur between 20 and 37 weeks gestation
What tests provide information about a fetus’ well being
BPP and no stress test
What are nursing interventions for a client in preterm labor
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.
When should chorioamniotitis suspected
With the occurrence of elevated temp, and tachycardia
What are nursing considerations for administering calcium channel blockers to a woman in preterm labor
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.
What is magnesium sulfate used for
It,is a commonly used tocolytic that relaxes the smooth muscle of the uterus and thus inhibits uterine activity by suppressing contractions
When should tocolytic therapy be discontinued
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.
What is indomethacin used for
It is a NSAID that suppresses preterm labor by blocking the production of prostaglandins. This inhibition of prostaglandins suppresses uterine contractions
How long should indomethacin treatment be prescribed
It should not exceed 48 hr. It should only be used if gestational age is less than 32 weeks
When should betamethasone be administered
It should be administered into the gluteal muscle 24-48 hr prior to birth
What is betamethasone
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.
What are nursing considerations for the med betamethasone
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
Wha pt are signs of pulmonary edema that a client should be educated about
Chest pain
SOB
crackles
What is PROM
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
What is PPROM
Preterm premature rupture of the membranes is the premature spontaneous rupture of membranes after 20 weeks of gestation and prior to 37 weeks gestation.
What are risk factors for PROM and PPROM
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
What are objective physical assessment findings of a woman with PROM or PPROM
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
What are lab tests to verify PROM or PPROM
A positive nitrazine paper test ( blue, pH 6.5- 7.5) or positive ferning test
What is the med ampicillin used for
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
For a client with rupture of membranes, with dilation of 3 cm what can the nurse expect
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)
What are contraindications for the administration of magnesium sulfate
Acute fetal distress
Vaginal bleeding
Cervical dilation greater than 6 cm
What are indications for the use of magnesium sulfate
Preterm labor
Gestational hypertension
