Complaints of uterine cramping and lower back pain discussion

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Part 1: 25 y/o presents to Labor and Delivery with complaints of uterine cramping and lower back pain. Denies any vaginal bleeding at this time. Has related history of a preterm birth at 32 weeks gestation with her last pregnancy. The baby is 3 years old now and has no developmental issues.
Her current gestational age is 30 weeks.
She is O+ and all other lab values are normal. No noted STI's.

1. Group Beta Strep is missing from the labs - most often is obtained at 35 - 37 weeks gestation.
2. Without this information it is often determined to treat the patient anyway - presumptively to protect a premature baby from the risk.
3. What other information would you like to ask her?
4. What nursing intervention will you provide?
5. What screening tests are often obtained to help determine her risk for preterm labor.
6. And if it is determined she is in preterm labor what medications may you want to use with a doctors order?
7. Please also give dose, side effects and possible result of the medication.

Part 2: Objective information:
Fetal heart tones are 130, with minimal variability
Vaginal exam is 4 cm/90%effaced/ -1 station
She is complaining of pain - 8/10 on a numerical scale.
An IV has been started with an 18 gauge catheter with 1 liter of Lactated Ringers at 150 ml per hr in left forearm.

How can you provide non pharmacological comfort to this patient?
What are the pharmacological methods to use?
Without prenatal records or history GBS is unknown. What must you provide?
Contractions are 5 minutes apart and you receive an order to augment labor - what non pharmacological methods can you employ (or ask the MD to provide?)
Pitocin is ordered, please include at what rate you will start Pitocin, and how often you titrate. What equipment is needed to hang and run Pitocin IV?

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Explanation & Answer

Hello, Please find the attached DQs. I have answered both of them seperately. Thanks

Discussion 1
What other information would you like to ask her?

As the nurse caring for this patient, I would take a complete health history, including past

Current medications, drug use, alcohol use, STI’s.

Has she ever been diagnosed with strep B infection?

What was she doing prior to pain and cramping?

Has she had cramping prior to this episode?

How long has she been cramping?

I would assess her nutritional status, when was the last time she ate or drank anything?
What did she eat?

I would assess vitals.

Do a physical assessment of abdomen, fundal height and positioning of fetus
(Assessment and Immediate Management of Pre-term Labour/Birth, 2011).

What nursing intervention will you provide?

I would attach the fetal heart rate monitor to monitor contractions and fetal response to

Monitor length and quality of contractions.

Initiate IV access.

PCP will check cervix for dilation and fetal positioning in the ...

Really great stuff, couldn't ask for more.


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