In cases where a patient at 30 weeks’ gestation presents with back pain and contractions, the doctor may order a fetal fibronectin (fFN) test to assess the likelihood of preterm labor

QUESTION

1. A patient who is 30 weeks’ gestation shows up in triage and complains about back pain. The nurse puts the patient on the monitor and sees contractions. She notified the doctor and receives an order for what next action?

2. The patient in labor complains about abdominal pain and asks if she can have some medication. What medication would the doctor order and what would the nurse need to assess?

3. What actions and labs is the nurse expected to perform when she has a patient in preterm labor and is going to admit for monitoring.

4. A patient in labor is positive for GBS. What medication will she be given during active labor and how many doses are needed? When will the medicine be discontinued?

5. A patient is going to receive Celestone. What is the generic name for this medication? Why will the patient receive this medication? How many doses does the patient have to receive?

6. When giving this medication the nurse warns the patient, she may have heart palpations? What is the name of the medication? Why does the patient have to receive the medication? What is the usual dose?

7. A laboring patient is starting to have abdominal pain and spikes a fever of 100.3. The nurse calls the attending to report the patient’s complaints. What does the nurse suspect is happening with the patient? What medications will the doctor use to treat this?

8: A patient is in possible preterm labor. The medication the doctor has ordered can only be given for 3 days. What is the name of this medication? Why is there a concern regarding giving the medication for more than 3 days?

9. A patient has been admitted for induction of labor. The doctor knows that he needs to soften the cervix. What is the name of the medication the nurse expects to give the patient? How is it given? What is the proper way to place this medicine? How long will the medication be in place?

10.The doctor has decided to give Cytotec for cervical riping. What will the dosage be? How often can this medicine be given? What is the generic name for this medicine? What is an acceptable route for this medicine?

11.The patient is in active labor, but the doctor would like to increase the contractions. What medication does the nurse expect to give and what is the route for this medication? How much is given?12.A patient is being admitted with signs and symptoms of Pre-eclampsia. What medication does the nurse expect to give? How long will the patient be receiving the medication? Why is this medication given to the patient?

13. What are other reasons this patient would receive this medicine? Explain two other reasons why the medicine would be given.

14.When a patient is RH- What medicine does the patient receive two times during the pregnancy? Why is it so important for the patient to receive th medicine? What is the correct route for the medication? What would happen to the unborn child if the patient does not receive this medicine?

ANSWER

The nurse receives an order for further action: In cases where a patient at 30 weeks’ gestation presents with back pain and contractions, the doctor may order a fetal fibronectin (fFN) test to assess the likelihood of preterm labor. This test helps determine if the patient is at risk for premature delivery within the next two weeks. The nurse would need to perform the fFN test by collecting a vaginal swab to check for the presence of fFN, a protein that helps bind the fetal sac to the uterine lining. The result of this test will guide further management decisions.

Medication and nursing assessment: In response to the patient’s request for abdominal pain relief during labor, the doctor may order an opioid analgesic, such as morphine or fentanyl, to provide pain relief. Before administering the medication, the nurse must assess the patient’s vital signs, pain level, and any potential contraindications, such as allergies or respiratory depression. Additionally, the nurse should assess the fetal heart rate, maternal oxygen saturation, and the patient’s overall comfort level.

Actions and labs for monitoring preterm labor: When admitting a patient for monitoring due to preterm labor, the nurse is expected to perform the following actions and labs:
Assess maternal vital signs, including blood pressure, heart rate, respiratory rate, and temperature.
Monitor fetal heart rate and uterine contractions using electronic fetal monitoring.
Obtain a complete obstetric history, including information about previous pregnancies, prenatal care, and any risk factors for preterm labor.
Conduct a physical examination to assess cervical dilation, effacement, and consistency.
Collect maternal blood and urine samples for laboratory tests, including complete blood count, urine culture, and assessment of fetal fibronectin (fFN) levels.

GBS-positive patient in active labor: A GBS-positive patient will be given intravenous antibiotics, typically penicillin or ampicillin, during active labor. The recommended protocol involves administering the first dose at least four hours before delivery and subsequent doses every four hours until delivery. Antibiotic prophylaxis is important to prevent transmission of GBS to the newborn during birth. After delivery, antibiotic treatment is discontinued unless there are other indications for continued antibiotic therapy.

Celestone medication: The generic name for Celestone is betamethasone. This medication is administered to enhance fetal lung maturity in cases of threatened preterm birth. The patient typically receives two doses, 24 hours apart, to promote the production of surfactant in the fetal lungs, which aids in respiratory function and reduces the risk of respiratory distress syndrome (RDS) in premature infants.

Medication causing heart palpitations: The medication that may cause heart palpitations is terbutaline, a beta-agonist often used to relax uterine smooth muscles and delay preterm labor. It is administered subcutaneously or intravenously. The nurse administers this medication to inhibit contractions and prolong pregnancy until further interventions or the appropriate gestational age for delivery is reached. The usual dose is titrated based on the patient’s response and maternal heart rate.

Suspected infection in laboring patient: The nurse suspects the patient may have an infection based on the symptoms of abdominal pain and a fever of 100.3°F. The doctor may use antibiotics, such as ampicillin and gentamicin, to treat a suspected intrauterine infection. Prompt treatment is necessary to prevent complications for both the mother and the baby, as intrauterine infection can lead to preterm labor, neonatal sepsis, and other adverse outcomes.

Medication with a three-day limit: The medication that can only be given for three days is magnesium sulfate. This medication is commonly used for neuroprotection in cases of preterm labor to reduce the risk of cerebral palsy in premature infants. Prolonged use of magnesium sulfate can lead to adverse effects on the mother’s renal function, so it is limited to a three-day duration.

Medication for cervical ripening: The nurse expects to administer prostaglandin E2 (PGE2), also known as dinoprostone, for cervical ripening. It is typically administered as a gel, suppository, or controlled-release vaginal insert. The proper placement of the medicine is high in the posterior fornix of the vagina, near the cervix. The medication is left in place for a specific duration, usually around 6 to 12 hours, to allow for cervical softening and effacement.

Cytotec for cervical ripening: The dosage of Cytotec (misoprostol) for cervical ripening varies based on the specific protocol used by the healthcare provider. Common dosages range from 25 to 50 micrograms. The medication can be given orally, sublingually, vaginally, or rectally. The generic name for Cytotec is misoprostol, and the acceptable routes for administration depend on the healthcare provider’s preference and established protocols.

Medication to increase contractions: The nurse expects to administer oxytocin, a synthetic form of the hormone oxytocin, to increase contractions during labor. Oxytocin is typically administered via intravenous infusion using an infusion pump. The dosage is titrated based on the patient’s response and closely monitored to achieve optimal uterine activity while ensuring maternal and fetal safety.

Medication for pre-eclampsia: The nurse expects to give magnesium sulfate to the patient with signs and symptoms of pre-eclampsia. Magnesium sulfate is administered intravenously to prevent seizures (eclampsia) in patients with severe pre-eclampsia. It is a central nervous system depressant that helps lower the risk of seizures. The duration of magnesium sulfate treatment varies depending on the severity of the condition and the patient’s response to therapy.

Other reasons for magnesium sulfate administration: Besides pre-eclampsia, magnesium sulfate may be administered for other indications such as preventing preterm labor or managing fetal neuroprotection. In cases of preterm labor, magnesium sulfate is used to delay labor and reduce the risk of neonatal complications. Fetal neuroprotection involves administering magnesium sulfate to pregnant women at risk of preterm birth to reduce the risk of cerebral palsy in the newborn.

RH-negative patient and medication: RH-negative patients receive Rh immune globulin (Rhogam) during pregnancy. Rhogam is given at two specific times: around 28 weeks of gestation and within 72 hours after delivery or any other event that could lead to mixing of fetal and maternal blood, such as miscarriage, ectopic pregnancy, or invasive prenatal procedures. It is crucial for the patient to receive Rhogam to prevent the development of Rh incompatibility and subsequent hemolytic disease of the newborn (HDN). The medication is typically administered intramuscularly, and it helps prevent the mother’s immune system from producing antibodies against Rh-positive fetal blood cells, which can harm future pregnancies if the fetus is Rh positive.