PTL and PROM Flashcards
1
Q
• Regular uterine contraction and cervical dilation after 20 weeks and
before completion of 37 weeks
• 250,00-400,000 births per year in U.S.
• Accounts for almost 2/3 of infant death
• 50% of PTL has no identifiable cause
• 1/3 PTL occur after PROM
A
Preterm labor (PTL)
2
Q
- PPROM
- Smoking, alcohol, drug use
- Low socioeconomic status
- Poor nutrition esp. underweight
- Prior episode of PTL in current pregnancy or previous
- Interval between prior pregnancy
A
PTL assessment: Risk Factors
3
Q
- Uterine anomalies
- Enlarged uterine size (twins, hydramnios)
- Prior uterine surgeries
- Comorbidity
- cardiovascular or endocrine disorders
- Infection
- Frequent UTI/pyelonephritis
- STD
- History of GBS
A
more risk factors for PTL
4
Q
- S/S of uterine contractions
- Increased vaginal discharge or bloody show
- S/S of UTI
- Low back pain
- Pelvic pressure
- GI upset –N/V, diarrhea
A
PTL assessment history
5
Q
- Uterine contractions
- Cervical changes
- Engagement of presenting part
- Elevated temperature
- FHR tachycardia
- Fetal fibronectin (FFN) (specific enzymes with labor)
A
PTL assessment physical signs and symptoms
6
Q
- Stress
- Anxiety
- Fear of pregnancy loss
- Fear of unknown
- Exhibits confusion, disorganization, difficulty communicating, expresses fear
A
PTL assessment Psychosocial factors
7
Q
•CBC with WBC >18,000=Infection •Urinalysis –WBC, RBC, bacteria •Urine culture and sensitivity •Amniotic fluid for fetal lung maturity testing -Indicated for 34 week gestation or greater •Evaluate for rupture of membranes-•Fluid seen pooling from cervical os -Nitrazine Testing -Ferning •Cervical cultures -Group B strep, Chlamydia, gonorrhea -Fetal fibronectin (FFN) \:Reassuring if negative \:Poor positive predictive value •Ultrasound exam -Examination of presenting part -Gestational age -Multiple fetuses -Amniotic fluid volume
A
PTL diagnostic procedures
8
Q
- Palpate abdomen to assess contraction strength
- Continuous external fetal monitoring
- FHR pattern
- Frequency, duration, and approx. intensity of uterine contractions
- Hydrate with PO or IV fluids
- Bed rest on left side –not effective
- Alteration in comfort: pain r/t uterine contractions
- Administer tocolytic agents
A
PTL interventions
9
Q
- Mag Sulfate relaxes smooth muscle (muscle relaxant)
- Dosage and administration
- Loading dose 4-6 gm IVPB over 20-30 min
- Maintenance dose 1-3 gr/hr IVPB
- ALWAYS administer per pump
A
PTL tocolytic agents
MAGNESIUM SULFATE
10
Q
- Sweating
- Flushing
- N/V (toxicity)
- Depressed deep tendon reflexes (DTR)
- Flaccid paralysis (toxicity)
- Hypocalcemia (toxicity)
- Depressed cardiac function (toxicity)
- Respiratory depression (toxicity)
A
PTL MAGNESIUM SULFATE: side effects
11
Q
- Monitor VS closely
- Monitor DTR –patellar and biceps reflex
- 4+ very brisk
- 3+ brisker than average
- 2+ average, normal response
- 1+ diminished
A
PTL MAGNESIUM SULFATE: nursing care`
12
Q
- Monitor serum magnesium levels
- Therapeutic level: 4-6 mEq/L
- Loss of DTR’s: 10 mEg/L
- Respiratory Depression: 15 mEq/L
- Cardiac arrest: 25 mEq/L
- Mag Sulfate discontinued if levels too high or S/S of toxicity
- Always have antidote at bedside
- Calcium gluconate
A
PTL MAGNESIUM SULFATE: nursing action
13
Q
therapeutic level of magnesium sulfate
A
4-6 mEq/L
14
Q
- May go home on PO or Subcutcutaneous
- Dosage and administration IV
- 5-25 mcg/min titrated to uterine activity
- Increase by 5 mcg/min every 20 min
- Dosage and administration Subcutaneous
- 0.25-0.5 mg per injection or intermittent pump
- Dosage and administration PO
- 2.5-5 mg every 2-8 hours
A
PTL TERBUTALINE SULFATE (BRETHINE)
15
Q
- Increase heart rate* if mom’s heartrate is over 100 you can’t give
- Nervousness
- Tremors
- N/V
- Decreased serum potassium
- Cardiac arrhythmia
- Pulmonary edema
- CI same as Yutopar
A
PTL BRETHINE: side effects
