Question

LUNA RODRIGUEZ

AGE: 26 Y.O. HISPANIC

WEIGHT: 145 LBS.

GRAVIDA PARA 1

MEDICAL HISTORY: DIABETIC, HYPERTENSION, DRUG ABUSE

SCENARIO: LUNA  IS 22 WEEKS GESTATION, NO PRENATAL VISIT. SHE HAS BEEN EXPERIENCING SOME CRAMPING, SPOTTING, AND A GUSH OF LIQUID FROM HER VAGINA. LUNA’S B/P IS 200/98, TEMP 101.0, O2 SAT 98%. SHE IS ARRIVING TO THE ED HYPERVENTILATING, AND CRYING.  

• AS A NURSE IN THE ED WHAT WOULD BE YOUR FIRST STEP IN CARING FOR THIS PATIENT AND WHY?
• DESCRIBE IN DETAIL THE PHYSICAL ASSESSMENT
• WHAT TESTS FOR THE FETUS WOULD BE ORDERED AND DESCRIBE?
• WHAT LABS WOULD BE ORDERED FOR THE WOMAN AND WHY?

• WHAT INFECTION WOULD BE CONSIDERED AT THIS POINT?
• WHAT MEDICATIONS WOULD BE SAFE FOR THE MOTHER TO BE GIVEN AND WHAT ARE THE ACTIONS?
• WHAT EDUCATION WOULD YOU PROVIDE TO THE WOMAN?
• WHAT SIGNS WOULD BE OBSERVED ABOUT THE FETUS IN DISTRESS, DESCRIBE IN DETAIL?
• IS THIS A FALSE LABOR OR REAL LABOR AND DESCRIBE THE DIFFERENCES?

• WHAT ARE SIGNS AND SYMPTOMS OFA PROLAPSED UMBILICAL?

Answer 1

* As the first step in management, it is important to lower down her blood pressure as it can be life threatening for both mother and fetus.

- Administer antihypertensive as prescribed by the physician

- Administer magnesium sulphate injection to prevent seizures

- Administer corticosteroids to improve liver and platelet function. Also, it improves lung maturation of preterm baby

* Physical Assessment includes the following:

- Vaginal examination

Vaginal examination is done to identify the cervical dilatation, lie of the baby and progress of delivery

- Monitor vital signs of mother

Vitals signs like temperature, blood pressure, heart rate, respiratory rate should be monitored to prevent any complications

- Monitor Fetal Heart rate

Fetal heart rate should me monitored to identify the any fetal distress

- Abdominal palpation

To identify the position of the fetus

- Assess for complications like seizures, bleeding etc. This can be lifethreatening for mother and fetus.

*. - Non stress test to assess the Biophysical profile of the fetus

BPP is the assessment of electronic fetal heart rate monitoring (CTG) which assesses fetal movements, fetal tone, fetal breathing and estimation of amniotic fluid volume.

- Fetal ultrasound to identify the fetal well being and amniotic fluid volume

* Lab tests include the following:

- CBC profile - complete blood count to identify any abnormalities or infections

- Liver and kidney function test- hypertension can causes abnormalities in liver enzymes and can affect kidney function

- Urine analysis - to rule out proteinuria and to identify any infections as she had hyperthermia

- Heamoglobin and platelets count - To rule out aneamia and to avoid any complications of bleeding due to low platelet count

* She can be suspected to have infections like:

Urinary tract infections, bacterial vaginosis, cytomegalovirus infection, toxoplasmosis, streptococcal infections, hepatitis B etc

* Medications includes:. - Antihypertensive like injection hydralazine, labetolol and nifedipine

-Injection Febrinil which is an antipyretic agent to lower down temperature

- Magnesium sulphate injection which is an anticonvulsant to prevent seizures due to high BP

-Corticosteroids like dexamethasone to avoid fetal respiratory distress.

* The mother need to be educated about the complications of delivery, the severity of her condition, the future complications that occurs to the baby due to preterm labour

* Signs of fetal heart rate

- Abnormal fetal heart rate like tachycardia and bradycardia

- variable decelerations ( abrupt decrease in heart rate) and late decelerations ( late return to baseline heart rate after a contraction)

- decreased fetal movements

- abnormal amniotic fluid levels

* This is real labour because she had a rupture of amniotic membrane and fluid came out. This won't happen in false labour.

* Signs and symptoms of umbilical prolapse are

- feeling the cord before the delivery of the baby

- fetal distress

- fetal bradycardia