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Addressing the case study of a 25-year-old client presenting with uterine cramping and lower back pain
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).
In addressing the case study of a 25-year-old client presenting with uterine cramping and lower back pain at 30 weeks of gestation, it is essential to gather comprehensive information and implement appropriate interventions and assessments. Below are the answers to the questions posed based on the clinical scenario.
1. Additional Information to Obtain from the Client
To better assess the risk of preterm labor and the client’s condition, the nurse should obtain the following additional information:
- History of Current Symptoms: Duration and severity of cramping and lower back pain, any associated symptoms (e.g., pressure in the pelvis, changes in vaginal discharge).
- Frequency of Cramping: Whether the cramping is intermittent or constant.
- Hydration Status: Intake of fluids and any signs of dehydration.
- Contractions: If the client has experienced any contractions (frequency, duration, intensity).
- Previous Pregnancies: Any other complications in her previous pregnancies aside from the preterm birth.
- Lifestyle Factors: Stress levels, work activity, physical activity, and any recent changes that could affect her health.
- Fetal Movement: Assessment of fetal movement patterns, which can provide insight into fetal well-being.
2. Most Appropriate Nursing Intervention
The most appropriate nursing intervention in this situation would be:
- Monitoring and Assessment: Continuously monitor the client’s vital signs, uterine activity, fetal heart rate, and any changes in symptoms. This includes performing a physical examination to assess for cervical changes.
3. Screening Tests to Determine Risk for Preterm Labor
To determine the risk for preterm labor, the following screening tests should be obtained:
- Cervical Assessment: Transvaginal ultrasound to measure cervical length. A shortened cervix can indicate an increased risk for preterm labor.
- Fetal Fibronectin Test (fFN): A test done on vaginal secretions to determine if there is a risk for preterm labor. fFN is typically positive if there is a risk of preterm delivery within the next two weeks.
- Urinalysis: To check for urinary tract infections (UTIs) that may cause or exacerbate contractions.
4. Expected Medications and Nursing Priorities Post-Administration
If the client is confirmed to be in preterm labor, the nurse would expect the following medications to be ordered:
- Tocolytics: Medications such as Terbutaline or Nifedipine may be ordered to suppress uterine contractions.
- Terbutaline
- Dose: Typically given subcutaneously at a dose of 0.25 mg every 20 minutes up to three doses.
- Side Effects: Tachycardia, palpitations, tremors, anxiety, and potential pulmonary edema.
- Expected Outcomes: Reduction in frequency and intensity of uterine contractions.
- Nifedipine
- Dose: Usually an initial dose of 30 mg orally, followed by 10 mg every 8 hours.
- Side Effects: Hypotension, headache, flushing, dizziness, and peripheral edema.
- Expected Outcomes: Decreased uterine activity and improved uterine relaxation.
- Corticosteroids: Such as Betamethasone may also be administered to accelerate fetal lung maturity if preterm birth is imminent.
- Dose: Typically given as two doses of 12 mg intramuscularly 24 hours apart.
- Side Effects: Increased blood sugar levels, fluid retention, mood changes.
- Expected Outcomes: Improved lung development in the fetus.
Nursing Priorities Post-Administration:
1. Monitor Maternal Vital Signs: Assess for signs of tachycardia or hypotension post-administration of tocolytics.
2. Monitor Fetal Heart Rate: Continuous fetal monitoring to assess fetal response to medications.
3. Assess for Side Effects: Regularly check for adverse effects related to medications (e.g., tachycardia from Terbutaline).
4. Educate the Client: Explain the medication regimen and possible side effects to the client and family.
5. Fluid Intake and Output Monitoring: Ensure adequate hydration and monitor for signs of overhydration or pulmonary edema.
Conclusion
In conclusion, managing a client at risk for preterm labor involves thorough assessment, appropriate nursing interventions, relevant screening tests, and prompt administration of medications as necessary. Continuous monitoring is critical to ensure both maternal and fetal safety while addressing the underlying causes of preterm labor.