Case study #117

INSTRUCTION. All questions apply to this case study. Your responses should be brief and to the
point. When asked to provide several answers, list them in order of priority of significance. Do
not assume information that is not provided. Please print or write clearly. If your response is
not legible, it will be marked as? and you will need to rewrite it.

Scenario
P.T. is a married 30-year-old gravida 4, para 1203 at 28 weeks’ gestation. She arrives in the
labor and delivery unit at a level 2 hospital complaining of low back pain and frequency of
urination. She states that she feels occasional uterine cramping and believes that her
membranes have not ruptured.
1. You are the charge nurse and admit PT. based on the information you have been given,
identify the two most likely diagnoses for P.PT.
- low back pain
- uterine cramping or frequency of urination
2. You need additional information from PT to determine what you will do next. What
important questions do you need to ask to differentiate what is going on with P.T.?
- when did the pain in your low back start?
- Have you experience pain during urination?
- How painful is that?
- In level 1-10 how painful your low back now?
- Do you have UTI before?
3. What actions would you take to help identify her underlying problem before calling the
health care provider?
- check the vital signs
- perform vaginal assessment
- perform urine test
4. Early recognition of preterm labor is essential to successfully implement interventions.
The diagnosis of preterm labor is based on what three major diagnostic criteria?
- transvaginal ultrasound
- signs and symptoms
- check if there are fetal fibronectin in vaginal discharge
5. What is the significance of misdiagnosing preterm labor?
- Misdiagnosis or preterm labor can lead to unproper pharmacologic drug that can be
dangerous to the health of the mother and the fetus
6. What other problems might be going on with PT that you should consider?
- the backpain and frequent urination are part of the body changes associated with
pregnancy
- the back pain might cause the weight during pregnancy
CASE STUDY PROGRESS
P.T.’s history reveals that she had one pre term delivery 4 years ago at 32 weeks gestation. The
infant girl was in the neonatal intensive care unit (NICU) for 3 weeks and discharge without
sequelae. The second preterm infant, was delivered two years ago at 35 weeks age of gestation
and spent 4 days in the hospital before discharge. She has no other risk factors for preterm
labor. Vital signs are normal. Her vaginal examination was essentially within normal limits:
cervix long, closed and thick; membranes intact. Abdominal examination revealed that the
abdomen was nontender, with fundal height of 29cm, fetus in vertex presentation.
7. While waiting for laboratory results, what therapeutic measures do you consider?
- Because she has history of preterm deliveries, she must stay in bed to make sure she
precipitates the symptoms when she has her preterm delivery
8. When caring for a woman with history of preterm labor, it is important to question the
woman about whether she has symptoms when she engaged in certain activities that
might require lifestyle modifications. What activities should you assess for?
- Drug or alcohol abuse
- Smoking
- Life style

CASE STUDY PROGRESS

While waiting for laboratory results, you consider that P.T. is experiencing preterm labor, she
would receive antenatal glucocorticoids
9. What is the rationale for the administration of antenatal glucocorticoids for preterm
labor?
- For maturation of the lungs of the baby to reduce neonatal morbidity.
10. How long do these drugs take to become effective?
- It will show for 24 hrs. but it is mostly effective within 48 hrs. or 7 days.
11. Which of these situations are considered contraindications to antenatal glucocorticoids
when a woman is in preterm labor (select all that apply)?
a. Cord prolapse
b. Chorioamnionitis
c. Cervical dilation of 2.5 cm
d. Abriptio placenta

CASE STUDY OUTCOME

Two hours later, the laboratory results indicate a urinary tract infection. The contraction
monitor indicates infrequent, mild contraction. Her physician discharges her to home on an
antibiotic for UTI.
12. What follow-up measures should be considered in providing P.T. discharge instruction?
- Proper hygiene to prevent more infection, use mild soap
- Increase the fluid intake
- Monitor the urine output
- Follow the prescribe medication and come back if the symptoms appear again