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Mrs. Aruna, a 26 year-old G2P0-0-1-0 last abortion 1 year. GA 32wk, . -…

- - - - Physical condition: -
      - Passenger: FHR = 138 bpm with no decelerations
      - Power: uterine contractions with duration 40-50 seconds, interval 5 minutes, moderate to strong intensity
      - Passage: cervix fully dilated, 100% effaced
      - Psychology: -
    - - Nursing Intervention
        
        Monitor uterine contraction and FHR q 30 min
        
        Monitor v/s, especially BP, HR, RR to ensure adequate blood flow and oxygen
        
        Monitor oxygen saturation to ensure the mother has adequate oxygen
        
        Observe s/s of fetal distress; abnormal heart rate, decrease in fetal movement, meconium in amniotic fluid
        
        Discontinue oxytocin if s/s of fetal distress occur
        
        Administer oxygen at 8-10 LPM as needed
        
        Administer IV as prescribed to promote blood flow and hydration status
      - Evaluation
        
        V/S within normal
        
        FHR within normal
        
        No S/S of fetal distress
    - - Nursing Intervention
        
        Keep woman informed regarding progress
        
        Coach to pant during contractions and to gently push b/w contractions when head is emerging
        
        Help to relax and conserve energy b/w contractions
        
        Assess BP, PR, RR q 15 min
        
        Encourage nondirected, spontaneous pushing efforts
        
        Assist with determination of Apgar score at 1 and 5 min after birth
        
        Assess FHR q 5 min
        
        Massage the uterus immediately after delivery of the placenta until is firm
      - Evaluation
        
        V/S within normal
        
        FHR within normal
        
        Apgar score ≥ 8
  - - - Physical condition: -
      - Passenger: FHR = 138 bpm with no decelerations
      - Power: uterine contractions with duration 40-50 seconds, interval 5 minutes, moderate to strong intensity
      - Passage: cervix was 4 cm dilated, 100% effaced, and station -2, intact membranes
      - Psychology: -
    - - Nursing Intervention
        
        Assess uterine contraction and FHR q 1 hr.
        
        Perform vaginal examination q 4 hrs
        
        Suggest upright position such as standing, sitting, squatting to promote uterine contraction and increased descent of fetus
        
        Encourage to empty bladder q 2-4 hr because full bladder inhibit efficient uterine contraction and delay progress of labor
        
        Provide soft diet to prevent dehydration and fatigue
        
        Monitor v/s q 4 hr
      - Evaluation
        
        Patient has effective progress of labor; cervix dilated at least 1 cm/hr, the fetal descent will be below station 0 , +1, +2, +3
        
        FHR = 110-160 bpm with moderate variability, early deceleration
  - - - Nursing Intervention
        
        Enhance bonding between mother and child by skin- to skin contact to prevent hypothermia of baby
        
        Encourage initial breastfeeding because this stimulate oxytocin that can help uterine contraction
        
        Measure BP, PR,RR immediately after delivery and q 15 min for the first 2 hrs
        
        Observe for signs of hemorrhage: uterine atony, vaginal or cervical lacerations, retained placental fragments, bladder distention, severe hematoma in vagina or surrounding perineum to prevent PPH
        
        Encourage bladder emptying by providing bedpan, catheterize as necessary, measure and record amount of urine output
        
        Suggest fundus massage to prevent PPH
        
        Explain plan of treatment for preterm newborn; Incubators or radiant warmers keep baby warm in the NICU. Babies GA < 37 can have problems such as low birth weight, irregular temperature, and unstable vital signs. A baby incubator helps control their temperature
      - Evaluation
        
        No S/S of PPH;uterine atony, vaginal or cervical lacerations, retained placental fragments, bladder distention, severe hematoma in vagina or surrounding perineum to prevent PPH
        
        V/S within normal
- - - - Patient not show abnormal/disorder sign leading to preterm labor
      - Patient understand about the situation and can explain what does she do to prevent the preterm labor happen
      - Patient not develop the active phase and still in the latent phase
      - Patient doesn't shown s/e such as nausea/vomiting, low blood pressure or tachycardia
    - - Laboratory assessment and physical assessment such as assess uterine contraction and fetal heart sound
      - Explain about not to push to prevent preterm labor and always empty bladder
      - Educate to reduce to do the heavy activity or heavy exercise also advice bed rest
      - Monitor and observe sign and symptom of abnormal sign that leading to preterm labor
      - Ensure intravenous hydration to get enough fluid intake
      - Medication as prescribe (Tocolytic drug) : loading dose of Nifedipine (Adalat) 10 mg per oral every 15 minutes x 4 dose and followd by 60 mg slow release nifedipine per oral OD 7 days, Dexamethasone 6 mg IM every 12 hours x 4 doses
  - - - 1) Assess V/S espescially HR, PR and BP every 15 mins after provide and then follow up every 30 mins
      - 2) Explain and educate about the side effect of the medication such as Flushing, N/V, low blood pressure and tachycardia
      - 3) Precaution for blood pressure not lower than 90/60 mmHg and PR not more than 120 bpm if have the criteria need to stop the medication immediately
      - 4) Precaution and beware of using the adalat with MgSO4 because can cause supression of respiratory and blood circulation if recieve need to closely monitor about patient breathing for respiratory muscle paralysis
      - 5) Eunsure to intake fluid adequate and encourage to intake the fluid
      - 6) Explain and educate about the criteria to giving the medication such as Adalat provide to suppress the preterm labor occur and the Dexamethasone used for the pregnancy who GA 24 - 34 weeks that has the labor pain to extend and suppress the labor and help to develop the fetus lung
    - - 1) Patient V/S is in normal range and in the criteria of giving medication
      - 2) Patient can explain about the why patient receive the medication and side effect
      - 3) Patient no develop severe side effect and can prevent or manage the side effect
- - - - D: UTIs is the one of complications of preterm labor, signs and symptoms including pain or burning while urinating, frequent urination and pressure or cramping in the groin or lower abdomen.
      - M: Amoxicillin (500 mg) tid pc and complete all medication even conditions is better and this medications side effects includes difficulty breathing, burning eyes, fever, sore throat, diarrhea that is watery or bloody
      - E: Cleaning the genital area from front to back
      - T: Take the all medication completely and drinks lots of water
      - H: Drinking lots of water, do not wear tight clothes, if any anaphylactic reactions occurs, go to the hospitals immediately
      - O: Follow up the next appointment for GA 34 week
      - D: Take the a healthy diet especially vegetables and fruits, whole grain instead of white bread