Preterm Labor and Premature Rupture of Membranes - sherpath

The nurse administered magnesium sulfate to a woman experiencing preterm labor, following a health care provider prescription. Which assessment would concern the nurse?

10 respirations per minute -The nurse assesses the woman who has been administered magnesium sulfate for respirations. Ten respirations per minute is a common hospital criterion to discontinue magnesium sulfate therapy.

Preterm labor is labor that begins after week but before the end of the 37th week of pregnancy.

20 Labor begins after the 20th week, but ends before of the 37th week of pregnancy.

Match the medications to their contraindications.

33 weeks' pregnancy -Indomethacin Urine output 10 mL/hr -Magnesium Sulfate Blood pressure 96/42 mm Hg -Nifedipine Type 1 diabetes -Betamethasone

Which pregnant women are at risk for preterm premature rupture of membranes (PPROM)?

A woman who is bearing twins Bearing twins can result in overdistention of the uterus; this is a possible cause of PPROM. A woman who is depressed over losing her job A pregnant woman who is depressed over losing her job is experiencing maternal stress, which is recognized as a possible cause of PPROM. A woman with a Gardnerella vaginalis infection Gardnerella vaginalis infections predispose pregnant women to PPROM.

Which drugs would the nurse anticipate administering for tocolysis during preterm labor?

Nifedipine -Nifedipine is given in large, frequent doses to blunt or stop uterine contractions to allow for administration of corticosteroids for fetal lung maturity prior to delivery. Indomethacin -Indomethacin is utilized to blunt or stop uterine contractions during preterm labor. It is a short-term solution to allow for the administration of corticosteroids.

Which intervention by the health care team will decrease the risk of infection for a patient with preterm premature rupture of membranes during labor, delivery, and the postpartum period?

Avoiding frequent vaginal examinations to check for cervical dilation Avoiding frequent vaginal examinations, once the membranes are ruptured, helps prevent the introduction of pathogenic bacteria to the vagina and uterus, which may infect the mother or fetus.

Which medication would the nurse anticipate administering to promote fetal lung maturity?

Betamethasone Corticosteroids are administered to promote fetal lung maturity in the premature neonate. They are often prescribed and administered if birth before 34 weeks' gestation seems likely.

Which patient cue would lead the nurse to suspect preterm labor in a patient rather than Braxton Hicks contractions?

Contractions that are perceived in the back and are intermittent Preterm labor contractions are often perceived in the lower back, and the pain may be intermittent or constant.

Which assessment can the nurse initiate to determine fetal well-being in utero?

Electronic fetal monitoring Electronic fetal monitoring provides an assessment of fetal well-being.

When a preterm patient presents with a complaint of "feeling wet," which intervention would the nurse anticipate the obstetric provider performing?

Fern and pH tests -Fern and pH tests, along with other patient cues, assist the obstetric provider in determining whether a patient's membranes have ruptured. An ultrasound An ultrasound checks fetal well-being and the amniotic fluid index. A low amniotic fluid volume may support other findings to support the diagnosis of rupture of membranes. A sterile speculum examination A sterile speculum examination allows a provider to check for pooling of amniotic fluid, collect samples, and possibly visualize cervical dilation.

Which risk factor identified by the nurse places the patient at risk for preterm labor (PTL)?

Homelessness -Social and environmental factors, such as inadequate or absent prenatal or dental care, maternal domestic violence episodes, maternal smoking, homelessness, and age and ethnicity are all associated with increasing a woman's risk for PTL.

A woman who is at 36 weeks' gestation thinks she is experiencing labor. Which signs or symptoms would support the woman's suspicion?

Menstrual-like cramps -Menstrual-like cramps are a sign of preterm labor, which may be related to premature uterine contractions. Reports of pelvic pressure Pelvic pressure is a symptom of preterm labor and may also be related to premature uterine contractions. Reports that "something is wrong" A sensation that something is "wrong" or "not right" is often verbalized by women experiencing preterm labor and has been consistently shown to be a valid variable in studies.

Which symptoms and risk factors of preterm labor is this patient exhibiting?

Menstrual-like cramps Menstrual-like cramps are a sign of preterm labor, which may be related to premature uterine contractions. Previous preterm birth A previous preterm birth increases a patient's risk for subsequent preterm births. Lower back pain Lower back pain can be a subtle warning sign of preterm labor and may indicate contractions. 33-week gestation pregnancy Preterm labor is any labor that occurs before 37 weeks' gestation.

A patient is a G2/P0 at 32 weeks pregnant and experiencing regular contractions. She has a multifetal gestation pregnancy, a history of preterm birth, and has had recurrent bacterial vaginosis throughout the pregnancy. Her BMI is 22, she is 30 years' old, and she is a former smoker who quit two years ago. Of the data provided, which are risk factors for preterm labor?

Multifetal gestation -The risk for preterm labor increases when a woman experiences a multifetal pregnancy because the uterus is overdistended. Recurrent bacterial vaginosis -Recent studies have shown a link between vaginal infections in pregnancy and preterm labor.

When evaluating a patient with suspected preterm premature rupture of membranes and preterm labor, the nurse recognizes which cues as signs of preterm labor?

Pain and discomfort in the upper inner thighs -Pain in the upper inner thighs or vulva are often reported by women experiencing preterm labor. Intermittent or constant lower back pain -Preterm labor contractions are often perceived differently than term labor contractions. Women often complain of intermittent or constant lower back pain. A sensation that the fetus is frequently "balling up" -The fetus balling up is actually how the mother is perceiving the uterine contraction and is likely a uterine contraction rather than fetal movement. Diarrhea -Abdominal cramping with or without diarrhea is sometimes a cue experienced by women with preterm labor.

When preterm premature rupture of membranes is confirmed, which actions would the nurse implement?

Prepare the patient for admission to labor and delivery. Once rupture of membranes is confirmed, a patient will be required to remain in the hospital until the infant is born. The patient will need to be prepared for admission to labor and delivery. Collect a group B streptococcus swab, if not done previously. It is important to collect a group B streptococcus swab to alert the neonatal care team of the results, regardless of whether the patient will deliver before the results are received. Initiate continuous fetal monitoring. A patient who is admitted with preterm premature rupture of membranes should be placed on continuous fetal monitoring under most circumstances. Anticipate the administration of corticosteroids. Unless contraindicated, it is likely that corticosteroids will be prescribed for this patient to promote fetal lung maturity. Alert the neonatal care provider of the patient status. When the delivery of a preterm neonate or a neonate with complications is expected, the neonatal care provider should be made aware of the maternal/fetal status and updated with new information as it becomes available.

A 36-week gestation patient presents with membranes grossly ruptured and is not contracting. Which diagnosis does the nurse anticipate?

Preterm premature rupture of membranes (PPROM) -PPROM is PROM that occurs before 36 weeks of gestation. Contractions may or may not be present. PPROM is often associated with PTL, with the greatest risks from preterm birth occurring before completing 34 weeks of gestation (ACOG, 2016).

When administering nifedipine for tocolysis, it is important for the nurse to monitor for which serious side effect?

Reflex tachycardia Reflex tachycardia (maternal pulse greater than 120) can occur with large doses of nifedipine.

When administering corticosteroids to a patient in preterm labor, which information is relevant to the nurse regarding the patient's history?

The patient has type 1 diabetes. Corticosteroids can increase blood glucose levels and increase insulin resistance; therefore they should be administered cautiously or avoided altogether in patients with type 1 diabetes to avoid complications.