Labor Management Essay

For this week’s assignment I want all students to respond to the topics below. Review the questions and respond to at least half of the questions posted. Include how we treat Group B Strep + patients to protect their newborns from infection. A 25 y/o presents to Labor and Delivery with complaints of uterine cramping and lower back pain. Denies any vaginal bleeding at this time. Has related history of a preterm birth at 32 weeks gestation with her last pregnancy. The baby is 3 years old now and has no developmental issues. Her current gestational age is 30 weeks. She is O+ and all other lab values are normal. No noted STI\’s. 1. Group Beta Strep is missing from the labs – most often is obtained at 35 – 37 weeks gestation. 2. Without this information it is often determined to treat the patient anyway – presumptively to protect a premature baby from the risk. 3. What other information would you like to ask her? 4. What nursing intervention will you provide? 5. What screening tests are often obtained to help determine her risk for preterm labor. 6. And if it is determined she is in preterm labor what medications may you want to use with a doctors order? 7. Please also give dose, side effects and possible result of the medication. You must have a reference and I require one in text citation.Labor Management Essay

Group B Strep test

With the patient having a history of preterm labor and delivery, obtaining the Group B Strep test would be beneficial for mother and baby. GBS can be a cause for preterm labor (GBS, 2017). The protocol is to test at 35-37 weeks of gestation; however, protocols are meant to be broken sometimes. Testing the mother is a simple vaginal and rectal swab that takes a few seconds (GBS, 2017) and the results are available in 24-48 hours. Because of the risk of infection to the baby, prophylactically treating this patient with IV antibiotics until the results come back will reduce the risk of the baby contracting this illness upon birth (GBS, 2017). The type of antibiotic to treat this illness would be IV penicillin since an oral medication would be a band aid for the illness and only temporarily treat the illness whereas, the IV medication fights harder against this illness and eliminates GBS (GBS, 2017). Keeping the mother and baby safe is the number one priority for nurses.Labor Management Essay

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Additional information

There are many questions that come to mind for this patient. Finding out as much as possible will help us build a better background for information and determine the best plan of care for this patient. The additional information I would like to know is:

• Do you have allergies?
• What medications are you currently taking?
• Do you drink alcohol, use tobacco, or use recreational drugs? Have you used any of these during this pregnancy?
• What is your pain level? How would you describe it?
• Do you have any other symptoms?
• Have you received prenatal care?
• When was the last time you ate?
• Do you feel safe in your home?
• Have you had any previous miscarriages or losses?
• When was the last time you drank fluids?
• What is your previous medical history? – Surgeries, complications, diabetes, cardiac history, etc.
• Are you up to date on your vaccines?Labor Management Essay

Nursing interventions

The nursing interventions for this patient include:

• Left side lying
• Bed rest
• Fetal heart monitoring
• Monitor contractions
• Fluids- lactated ringers
• Medications (Jeung-Im, 2018)

Magnesium sulfate is given to patients who are at risk for delivery within the next 24 hours and given to those who are at less than 32 weeks of gestation to reduce the risk of cerebral palsy. Corticosteroids like betamethasone and dexamethasone pass the placental barrier and allow for the lungs, brain, and other organs to mature more and increase the chance of survival for the fetus. These medications are beneficial between weeks 24-34 for the patients who are in preterm labor. Tocolytics can delay labor progression for roughly 48 hours and allow the steroids and magnesium to do what they need to for a better outcome during delivery

Screening tests

There are 2 tests that are used to determine the risk for preterm labor – these are:

Fetal fibronectin test- This test uses the cervicovaginal fluid found until roughly 16-20 weeks to determine if the “glue” is still present (Ward &Hisley, n.d.). The glue is actually the fetal fibronectin that attaches to the uterus until contractions or a disturbance to the surface occurs (Ward, Hisley, n.d.).

Assessment of the cervical length- The cervix shouldn’t be less than 15-25mm (Ward &Hisley, n.d.). Once it begins to shorten, the risk of preterm labor becomes greater. The test is performed with a transvaginal ultrasound (Ward &Hisley, n.d.).Labor Management Essay

Medications

If the patient is in fact in preterm labor, then the doctor will order for certain medications to be administered. My suggestion would be to administer a corticosteroid, specifically betamethasone. My reasoning for this is because the surfactant on a baby’s lungs does not fully develop until around 36 weeks (Ward &Hisley, n.d.) and the steroid will cross the placental barrier and reach the baby to help boost the maturity of the organs and their ability to function (Jeung-Im, 2018).  The dose I would administer IM is 12mg daily for 2-3 days (Davis, 2016). The major possible side effects are a thromboembolism, peptic ulcer, nausea, hypertension, depression, euphoria, adrenal suppression, decreased wound healing, moon face, and increased risk of infection (Davis, 2016). The possible result of this medication is the reduction of respiratory distress in the newborn (Davis, 2016) and this is important for the newborn’s survival outcome to be a positive one. 

References

Davis, F. A. (2016). Taberscyclopedic medical dictionary, index valler and drug guide, 15th ed.   Place of publication not identified: F A Davis.

Group B Strep Infection: GBS. (2017, March 02). Retrieved from   Jeung-Im Kim. (2018). Preterm Labor and Birth: Definition, Assessment, and   Management. Korean Journal of Women Health Nursing, 24(3), 231–232.

Reproductive Health. (2018).

Ward, S., &Hisley, S. (2016).The process of labor and birth.In Maternal-child nursing care optimizing outcomes for mothers, children, & families (2nd ed., p. 437,438,488,491).

Ward, S., Hisley, S. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children,   & Families (with The Women’s Health Companion). [Bookshelf Ambassadored]. Labor Management Essay