LANCASTER GENERAL COLLEGE OF NURSING AND HEALTH SCIENCES DIVISION OF NURSING NURSING 112 Preterm Labor Focus Sheet

Clinical Learning Activity: The student will observe the nursing care of a woman experiencing preterm labor. Objectives: 1. Assess the nursing care needs of the client and family experiencing preterm labor (course objective A,B,C,D). 2. Discuss measures used to diagnose and stop preterm labor (course objectives A,B,C,D,E). 3. Assess the mechanisms employed by the client and family to cope with the emotional stress of preterm labor. (course objectives A,B,C,D) Be prepared to discuss:
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List client demographics: Initials, room #, age, gravida, para (written as TPAL) a. RM B 22y GTPAL - 32002 Using Nageles rule, calculate the EDC for this client. How early is this labor? a. LMP 3/10/11 b. EDD 12/17/11 c. She is 31 weeks so she is 9 weeks early What symptoms of preterm labor did this client experience? a. Back pain b. Spotting c. Cramping How was the preterm labor diagnosed? a. Preterm Labor is diagnosed when 20-37 weeks i. w/ ROM & 5-8 contractions/min or 4 contractions in 20min or 8contactions/hr ii. Membranes intact with cervical change iii. Membranes intact with dilation 2cm iv. Membranes intact with positive fetal fibronectin (The presence of cervicovaginal fetal fibronectin in the second and third trimesters of pregnancy identifies a subgroup of women who are at high risk for preterm delivery. This phenomenon may reflect the separation of the chorion from the decidual layer of the uterus, with the release of intact or degraded chorionic components of the extracellular matrix into the cervical and vaginal secretions.) b. Our patient had uterine contractions every 3-4 minutes on the tocometer. She was given a bolus of lactated ringers with no improvement at that time preventative measures were taken to ensure that the patient didnt progress into true preterm labor as described in the diagnosis criteria above. Analyze factors that may have contributed to this clients preterm labor. a. Possible infection b. Past hx (pervious pregnancy had preterm contractions, but delivered at 39 weeks) c. Depression/Anxiety Describe any self-help (non-pharmacological) measures used to help stop the labor. a. Rest b. Liquids PO Are there any activity restrictions? If on bed rest, was positioning used? If on bed rest, identify the deleterious effects that could affect this client.

The patient was placed on modified bed rest and encouraged to lay on her left side as much as possible 8. Were any measures made to hydrate this client? a. Liquids PO b. 1L of lactated rings over 1hr then 125mL/hr until discharge 9. Why is hydration important? a. Dehydration can lead to preterm labor 10. Were tocolytic agents used to halt the labor? Yes 11. What were they? a. Drug Trebutaline 0.25mg SubQ every 20min x 3 b. Class/Action Bronchodilator/adrenergic - accumulation of cAMP at adrenergic receptors, causes relaxation of smooth muscle. c. Side Effects nervousness, restlessness, tremor, headache, insomnia, angina, arrhythmias, hypertension, tachycardia, nausea, vomiting, hyperglycemia 12. How does this woman and/or her family normally cope with crisis situations? a. She relies on family specifically her mother-in-law to help with her children and support her in times of need 13. How is she coping with this one? a. Her mother-in-law is helping watch the other children and with household chores, although she is still not doing well with this pregnancy. She is very anxious and frustrated with all of the complications she has been having with this pregnancy. 14. How were her emotional, cultural, and spiritual needs met? a. The nurse comforted her and reassured her that the baby was doing well and listened to her concerns with kindness and empathy. She successfully used therapeutic communication to comfort the patient and alleviate her concerns. 15. Describe the nursing assessments involved in the care of this client. a. Obtain a thorough obstetric history b. Obtain specimens for complete blood count and urinalysis c. Determine frequency, duration, and intensity of uterine contractions d. Determine cervical dilation and effacement e. Assess status of membranes and bloody show f. Evaluate the fetus for distress, size, and maturity (sonography and lecithin-sphingomyelin ratio)
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