Preterm Labor - Nursing Care Plan

by - June 24, 2020

DESCRIPTION:
Preterm labor is labor that occurs before the end of week 37 of gestation. It is potentially serious because the result will be an immature infant that is usually responsible for almost two thirds of infant deaths in neonatal period.
FOCUS ASSESSMENT (SIGNS AND SYMPTOMS):
The signs and symptoms that mother will feel if she is experiencing preterm labor are persistent, dull, and low backache, vaginal spotting, pelvic pressure or abdominal tightening, menstrual – like cramping, increased vaginal discharge,  uterine contractions, and intestinal cramping.

DIAGNOSTIC AND LABORATORY TEST:
Ultrasound exam is being used because it can predict which pregnancies will end early by analyzing the cervix. Fetal fibronectin test will be done also in order to analyze the vaginal mucus for any presence of fetal fibronectin, which is a substance that acts as a glue between the fetal sac and uterine lining and is discharge during labor. If this vaginal mucous is present, then it predicts that a preterm contractions are ready to occur and if there is no protein it tells that labor will not occur for at least 14 days. Vaginal and cervical cultures and a clean – catch uterine sample are needed in order to rule for an infection.

RISK FACTORS:
The risk factors that are associated with preterm labor are dehydration, urinary tract infection, periodontal disease, chorioamnionitis, large fetal size, those who receive inadequate prenatal care, working a strenuous jobs that leads to fatigue, intimate partner violence, and trauma.

PATHOPHYSIOLOGY:
NURSING DIAGNOSES BY PRIORITY:
Acute pain related to labor contractions
Activity Intolerance related to cellular hypersensitivity secondary to uterine contractions
Deficient knowledge regarding preterm labor treatment needs and prognosis may be related to lack of information and misinterpretation
Anxiety related to perceived threats to the fetus
Risk for fetal injury as evidenced by immature infant

NURSING CARE PLAN:
Acute pain related to labor contractions
Activity Intolerance related to cellular hypersensitivity secondary to uterine contractions
Deficient knowledge regarding preterm labor treatment needs and prognosis may be related to lack of information and misinterpretation
NURSING MANAGEMENT / INTERVENTION:
A woman who is in preterm labor are usually placed on a bed rest to relive the pressure on the cervix. An external fetal and uterine contraction monitors are needed in order to monitor the fetal heart rate and the intensity of each contractions. Intravenous fluid therapy will be administered, as prescribed, in order to keep the mother well hydrated and it may help to stop the contractions.

MEDICAL / SURGICAL MANAGEMENT:
Medications are needed to administer to women who are having preterm labor just like terbutaline in order to prevent and treat bronchospasm, magnesium sulfate for treating pre – eclampsia and prevent preterm labor, and betamethasone for the formation of lung surfactant to reduce respiratory distress syndrome or bronchopulmonary dysplasia. If the woman is positive for urinary tract infection, then she will be prescribed for an antibiotic that is effective for group B streptococcus since this infection can be fatal to the newborn.

REFERENCES:

  • Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2016). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. Philadelphia, Pennsylvania: F.A. DAVIS COMPANY
  • Potter et. Al (2017). Fundamentals of Nursing (9th ed.). Singapore: Elsevier Inc.

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