Question

Client Profile Fayola is a 23-year-old GIP0 recent Nigerian immigrant. Her husband is an ex- change student at the university doing graduate work in medicine. He works very long hours, leaving her alone most of the time. Her English is not good and she is very shy. She misses her family, especially now that she is pregnant. She started her prenatal care at 8 weeks gestation and looks to her midwife as a replacement mother. This has accounted for at least one phone call a week Nurse Midwife (CNM) for one reason or another. Often these calls are just to re- ceive reassurance. the Certified Case Study Fayola is now 24 wga. She calls the clinic to talk to her midwife with complaints of a low backache. Questions 1. What are the most common reasons for back- ing every 10 minutes. What further evaluation will aches at 24 wga? be done to confirm if these are labor or Braxton Hicks contractions? 2. List at least five questions the nurse needs to ask Fayola about her backache to begin to assess the ne- cessity of her coming to the clinic at this time. 3. What are 9. Fayola has not been drinking much for the past few days. How does dehydration relate to uterine contractions? xton Hick contr 10. At the hospital triage Fayola's cervix was found to have no signs of preterm labor. She is given 500 ml of lactated Ringers IV solution, the contractions stop, and after two hours of observation, they dis- charge her with advice to drink more water on a regular basis. How much should she be drinking and how often? 4. Is it common for women expecting their first babies to have uncomfortable Braxton Hicks con- tractions at this time in their pregnancies? 5. What are the typical characteristics of Braxton Hicks contractions? 6. What advice can the nurse give Fayola if she be- lieves that the contractions are Braxton Hicks? 7. If the nurse suspects preterm labor, what should she advise Fayola to do? 11. Identify two nursing diagnoses that apply to Fayola at this time. 8. Fayola goes to the hospital, where her contrac- tions are timed at being 30 to 40 seconds and com-

Answer 1

Qn:

1. What are the most common reasons for back- ing every 10 minutes. What further evaluation will aches at 24 wga? be done to confirm if these are labor or Braxton Hicks contractions?

Answer

Backaches are common during pregnancy in the second trimester. Because of changing shape and new center of balance and additional pressure on growing uterus. The growing abdomen is placing strain on the back muscles and causing changes in posture

Braxton Hicks contractions are irregular, infrequent, spasmodic, painless contractions. Ask the patient regarding the location, duration, intensity, interval and progress of pain to differentiate braxton hicks from true contraction. Because true contractions are painful and regular frequent progress of pain will be there.

Qn:

2. List at least five questions the nurse needs to ask Fayola about her backache to begin to assess the ne- cessity of her coming to the clinic at this time.

Answer

Is there radiation of pain towards thigh and abdomen?

Is the fetal movements are normal?

Duration and time interval of pain?

Is there any vaginal discharge?

Is the bachache relieves while on rest?

Qn:

3. What are Braxton Hick contraction

Answer

Braxton hicks contractions are not a true labour contraction. These are false labor pains. It starts around 6 weeks gestation but usually are not felt until the second or third trimester of the pregnancy.

Qn:

4. Is it common for women expecting their first babies to have uncomfortable Braxton Hicks con- tractions at this time in their pregnancies?

Answer

Braxton hicks contractions are common. It is present throughout pregnancy. But it became only evident on second or third trimester. At the end of third trimester due to the prersence of estrogen, oxytocin and prostaglandin the gap junction formation increases and the contractions became severe. But during early pregnacy the progesterone inhibits the gap junction formation. So the contraction are not evident.

Qn:

5. What are the typical characteristics of Braxton Hicks contractions?

Answer

Braxton Hicks contractions are irregular, infrequent, spasmodic, painless contractions

Qn:

6. What advice can the nurse give Fayola if she be- lieves that the contractions are Braxton Hicks?

Answer

• Drink plenty of water.
• Take a walk. False labor contractions often stop when changing position or get up and move.
• Adequate rest
• Relax by taking a warm bath or listening to music.
• Back massage.

Qn:

7. If the nurse suspects preterm labor, what should she advise Fayola to do?

Answer

Preterm labor can result in premature birth. The earlier premature birth happens, the greater the health risks for your baby.

• Advice the patient to take adequate rest
• Count the fetal movement
• Report to the hospital if there is progress of pain and the pain is rediates towards lower abdomen and thigh

Qn:

8. Fayola goes to the hospital, where her contrac- tions are timed at being 30 to 40 seconds and com-

Answer

The mild to koderate contractions may last for 30 – 40 seconds. More frequent and intense Braxton Hicks contractions can signal pre-labor, which is when cervix starts to thin and widen.

Qn:

9. Fayola has not been drinking much for the past few days. How does dehydration relate to uterine contractions?

Answer

Dehydration causes lack of fluid. It will eventually reduces the amniotic fluid index.

Braxton Hicks contractions tend to occur more frequently in case of dehydration. so drink plenty of water. Relaxing can also stop Braxton Hicks contractions

Qn:

10. At the hospital triage Fayola's cervix was found to have no signs of preterm labor. She is given 500 ml of lactated Ringers IV solution, the contractions stop, and after two hours of observation, they dis- charge her with advice to drink more water on a regular basis. How much should she be drinking and how often?

Answer

Drink at least 8 to 12 glasses of water per day.

Qn:

11. Identify two nursing diagnoses that apply to Fayola at this time.

Answer

1) Acute pain on the lower back related to change in posture and shape and pressure on growing uterus as evidenced by verbalization and pain scale reading

2) Anxiety related to outcome of pregnancy as evidenced by dull facial expression.