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Pre Term Labor
| Question | Answer |
|---|---|
| What Nursing Diagnosis would apply to Preterm Labor? | Fear r/t the unknown. Fear r/t fear of the outcome. Knowledge Deficient r/t Ineffective Individual/Family Coping. Risk for Maternal and Fetal Injury |
| We would consider a women having preterm labor if she has | A PATTERN of labor. More than 1 hour with contractions of 30 seconds and 10 minutes apart. |
| Some women might delay seeking help when they are experiencing preterm labor because | They think they are experiencing Braxton Hicks contractions. |
| What are Braxton Hicks contractions? | Painless uterine contractions. |
| Preterm labor occurs more frequently in | Young adolescents and African American women. |
| Frequently we will see preterm labor associated with | Dehydration, UTI(infection), Chorioamniotis (infection). Women who work strenuous jobs and shift work. |
| What is chorioamniotis? | It is an infection of the chorion and the amnion layers. |
| What are the signs and symptoms of preterm labor? | Persistent, dull low backache, vaginal spotting, feeling of pelvic pressure or abdominal tightening. Menstrual-like cramping. Increased vaginal discharge. Uterine contractions. Intestinal cramping. |
| Why might a pregnant woman not recognize pelvic pressure or abdominal tightening as a symptom of preterm labor? | As pregnancy progresses, you get a lot of that tightening as ligaments stretch and they might not necessarily assume that this is preterm labor. |
| Why might a pregnant woman not recognize increased vaginal discharge as a symptom of preterm labor? | Some women just experience an increase in vaginal discharge and not necessarily with preterm labor. |
| Why might a pregnant woman not recognize uterine contractions as a symptom of preterm labor? | Because as pregnancy progresses the uterus does have a lot of false labor contractions. Remember preterm labor has a PATTERN! |
| Why might a pregnant woman not recognize perisitent, dull low backache as a symptom of preterm labor? | Some women might not make this connection because sometimes during pregnancy, this is experienced. |
| What is the substance in vaginal secretions that can determine whethere a woman is in preterm labor called. | FFN Fetal Fibrinectin |
| When should FFN be present and when should it not be present? | Up to 20 weeks it is normal to see FFN, after 20 weeks it is not normal to see FFN and this would be an indicator of preterm labor. |
| What are the 5 things we do therapeutically for the management of preterm labor? | Admit the patient to the hospital.Bedrest, rehydrate with IV fluids. Vaginal and cervical cultures. |
| What are the criteria for trying to stop labor if a woman is in preterm labor? | Fetal No signs of bleeding. Cervix is not dilated more than 4-5 cm. Effacement not greater than 50%. |
| Of the criteria for determining whether or not to stop preterm labor which three are the most important, and cannot be "cheated" on. | MEMBRANES INTACT NO FETAL DISTRESS NO SIGNS OF BLEEDING |
| Why would we perform vaginal and cervical cultures along with a clean catch when someone goes into preterm labor? | To rule out infection. Infection is a major predictor. A lot of times when someone goes into preterm labor, if they don't have some other complication, infection is a really big issue. |
| What kind of a drug is Betamethasone? | A corticosteroid. |
| How long does it take for Betamethasone to become effective and how long will it last? | It takes 24 hours to be effective and get into the baby's system and then it will last for 7 days. |
| When is Betamethasone given for the first time? | When the mother is admitted to the hospital to be treated for preterm labor IF it is before 34 weeks. |
| What are the three benefits of Betamethasone? | Accelerates lung development. Decreases the risk of necrotizing enterocolitis. Decreases intraventricular hemorrhage. |
| Why are there some concerns with using corticosteroids with a diabetic mom? | Because the steroids raise blood sugar. |
| Any drug that halts labor is a: | Tocolytic Agent |
| What two tocolytic drugs are not used very often? | Calcium Channel Blockers - Procardia Prostaglandin Antagonists - Endocine |
| What are the effects of Calcium Channel Blockers (Procardia) when used for preterm labor? | They relax the smooth muscles including the uterus. |
| What are the effects of Prostaglandin Antagonists (Endocine) when used for preterm labor? | It can be used to halt labor because it can relax smooth muscle. However, it has a lot of side effects, especially fetal side effects. |
| Why would Prostaglandin Antagonists (Endocine) be the last resort in choices of medications to try to halt preterm labor? | It can decrease the fetal urine output, amniotic fluid and it can cause premature closure of the ductus arteriosis. |
| What is the first choice of tocolytic drugs in dealing with preterm labor? | Magnesium Sulfate |
| Besides preterm labor, what other purpose would Magnesium Sulfate be used for during prgnancy? | Pregnancy Induced Hypertension (PIH) |
| What are the effects of Magnesium Sulfate? | It is a CNS depressant that relaxes all the smooth muscles. It relaxes everything. This effect also helps to reduce BP which could become elevated in preterm labor. |
| Because Magnesium Sulfate is a CNS depressant and it relaxes smooth muscle, it is important that we as nurses watch and assess what? | Check their deep tendon reflexes.Check their respiratory rate. < 12 is a warning sign. Check urine output. <30 mL/hr would be a concern. Monitor magnesium levels. >10 would be a concern. Monitor for severe hypotension. |
| Why would severe hypotension occur if a patient is being treated with magnesium sulfate? | Because the muscles in the blood vessels will relax, and patient will end up with dilation of the blood vessels and the BP will go down. |
| If a mother receives magnesium sulfate, and she happens to go into labor, what would the baby look like or what would their behavior be like? | It would be very flaccid, very weak and kind of lethargic. |
| What effect do Beta-Sympathomimetics have when they are used in treating preterm labor? | They compete for the Beta 2 receptor sites in the smooth muscle to relax the muscles. |
| What are the two Beta-Sympathomimetic drugs are used to treat preterm labor? | Ritodrine HCL (Yutopar)Terbutaline (Brethine) |
| What are the side effects of Ritodrine (Yutopar) and Terbutaline (Brethine)? | Hypotension, Hypokalemia, Increased blood glucose levels, Headaches, Nausea and vomiting. |
| Why would hypotension be a potential side effect of Ritodrine (Yutopar) and Terbutaline (Brethine)? | Because the smooth muscles in the blood vessels will relax. |
| Why would hypokalemia be a potential side effect of Ritodrine (Yutopar) and Terbutaline (Brethine)? | Because these drugs will cause the patient to have shifts. You will have potassium coming into and out of the cells causing potassium shifts. |
| Why shoud Ritodrine (Yutopar) and Terbutaline (Brethine)be used cautiously in pregnant diabetics? | Because they can increase blood glucose levels. |
| Why would patients taking Ritodrine (Yutopar) and Terbutaline (Brethine)experience headaches? | Because of the dilation of the cerebral vessels. |
| What baseline labs will we take a look at BEFORE administration of tocolytic drugs? | Hematocrit, Glucose, Electrolytes, CO2 level, EKG, External and fetal monitor. |
| Why would we get a baseline hematocrit before administering a tocolytic drug? | We look at this because of the potential for dehydration. |
| Why would we get a baseline glucose before administering a tocolytic drug? | Because tocolytic drugs can increase the glucose levels. |
| Why would we get baseline electorlyte levels before administering a tocolytic drug? | Because of the potential for shifts that the tocolytic agents can cause. |
| Why will we get a baseline EKG before administering a tocolytic drug? | Because the patient can end up with some arrhythmias when tocolytic drugs are used. |
| Why would we hook an external uterine and fetal monitor before administering a tocolytic drug? | So that we can determine how th patient and the fetus respond. |
| What is Ritrodrine (Yutopar) the beta-sympathomimetic drug mixed mixed with when administerd with IV fluids, and why? | It has to be mixed with Ringers Lactate and not dextrose because of the blood glucose issues. |
| Why would we want to piggback Ritodrine (Yutopar)? | In case we need to DC it right away, we would still havae another line running. |
| What rate dow we administer Ritodrine (Yutopar)? | Initially the rate is calculated and started and then we titrate it Q10 minutes until uterine activity halts. |
| What is the maximum dose of Ritodrine (Yutopar)? | 0.35 mg/min |
| When we administer Ritodrine (Yutopar) how often do we assess the pulse and BP? | Q15 minutes while the flow rate is increased, and Q30 minutes until the contractions halt. |
| When administering Ritodrine (Yutopar) what parameters will we look at? | Heart Rate >120 bpm BP<90/60 Arrhythmias Complaints of chest pain and dyspnea. Auscultating chest/lungs Hourly I & O Observe fetal heart tones for tachycardia, late decelerations, or variable decelerations. Monitor daily weights. |
| When a patient is receiving tocolytic drugs, why would we monitor the heart rate? | We know it is going to go up a little bit, because with these drugs, we want to make sure that it doesn't go up too high. |
| Why woud we auscutate the chest and lungs when a patient is receiving Ritodrine? | Because the patient can go into fluid overload very easily with this drug, so we have to monitor for fluids in the chest. |
| When monitoring I & O of a patient receiving Ritodrine (Yutopar) what amount do we need to ensure it does not exceed? | 100 mL/hour |
| What would we do for a patient who is responding well to Ritodrine, her heart rate is fine and her pulse is normal, but her BP is low. | We can give her a Beta Blocker like Inderol. It becomes a competitive antagonist and helps to inhibit the effects the tocolytic agent has on the BP. |
| What does a competitive antagonist do? | It cancels out the other drug. They compete for the same site. |
| Why would we want to monitor daily weights when a patient is receiving Ritodrine (Yutopar)? | Because the best way to determine fluid retention is taking daily weights and then comparing it with the I & O. |
| What is the equation we use when determining fluid retention with weight gain. | 2 lbs in one day is equal to about a liter of fluid. (2-1-1) |
| If you have a pregnant mom who was being treated for preterm labor and she gained 5 pounds in a day, how much fluid is she holding? | 2.5 liters |
| How long would we continue our infusions after the halt of the contractions? | Continue for another 12-24 hours to keep up a good blow flow. |
| After the first 24 hours we switch the patient over to oral Ritodrine or Terbutaline, when will we give he first dose? | 30 minutes BEFORE DC of the IV in order to build up a blood level. |
| How long does the pregnant mother need to continue taking Ritodrine or Terbutaline once she goes home? | It is important that she continues to take the medication at home until she is 37 weeks or until fetal lung maturity is established at 34 weeks. |
| Regarding the patient who is takin Ritodrine or Terbutaline at home, what is it important to teach her about her pulse? | How to take her pulse and monitor it. The patient should call the healthcare provider if it is over 120. |
| If a patient is taking Ritodrine or Terbutaline at home, if they feel like they can't sit still or they experience extreme nervousness, what should they do? | They should contact their healthcare provider. However it is normal for a patient to experience a little bit of shaking. |
| What should we teach a patient taking Ritodrine or Terbutaline to do if she forgets to take her medication? | Do not double up. Take it as soon as they remember and reset their schedule. |
| What are the benefits of patients receiving Terbutaline SQ through a pump similar to an insulin pump are: | This can actually delay labor 8-9 weeks whereas orally it only delays labor about 2 weeks. This might be used with twins or multiples. |
| What is the first thing we want a patient who goes into preterm labor at home to do? | Empty her bladder. She is going to be on restricted bedrest now. |
| What position do we want the patient to assume when she has gone into preterm labor at home? | Side lying, preferrably on the left side. |
| Why is the left side preferred when having the pregnant patient lie in side lying position? | The weight is off of the inferior vena cava and we don't have the inferior vena cava syndrome then. |
| Why is it important to rehydrate the patient who has gone into preterm labor at home? | Dehydration is one of the factors that can be a risk for preterm labor. We want the patient to drink 3-4 cups of water. |
| What should the patient do if preterm labor has started at home and after 30 minutes, symptoms don't subside? | She needs to contact her healthcare provider. |
| How long does the patient need to rest for before resuming activity if preterm labor occurs at home? | She should rest for 30 minutes and then slowly resume activity if the symptoms subside. |
| What is important for the nurse to find out when a patient is going home on restricted bedrest? | Find out the kind of a situation they are going home to, do they have other children, do they have a support system. |
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