Case Scenario

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 of 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.
You are the nurse on duty, based on the information provided, identify two most likely nursing
diagnoses appropriate for P.T
1. Acute Pain r/t uterine cramping

2. Stress Urinary Incontinence r/t increase intraabdominal pressure due to pregnancy
You need additional information from P.T. to determine what to do next. What important
questions do you need to ask to properly assess the condition of P.T.?
1. When was your last previous preterm labor or premature birth?

2. Do you smoke?
3. Do you by any chance have some chronic conditions, such as high blood pressure, diabetes,
autoimmune disease or depression?
4. Whenever you experience uterine cramps, how would you rate your pain on a scale of 0 to 10
with 0 being no pain and 10 being the worst pain you can imagine?
5. Duration of pain?
6. Do you feel any regular or frequent sensations of abdominal tightening (contractions)?
7. Is your backache constant? Duration and rate the pain?
8. Any unusual vaginal discharge? Like spotting or bleeding? watery, mucus-like or bloody?
9. Do you feel pain whenever you urinate?
10. Do you perform any exercise that helps strengthen your pelvic floor muscles? (Ex. Kegels
exercise)
What actions would you take to help identify her underlying problem before calling the
physician on duty?
- Tell p.t that it is normal to experience frequency in urination in her term and that the uterine
cramps and your growing baby probably caused the lower back pain.
Early recognition of preterm labor is essential to successfully implement interventions. The

diagnosis of preterm labor is based on what three major diagnostic criteria?
1. gestational age between 20-37 weeks

2. uterine activity (contractions)
3. progressive cervical changes (effacement of 80% cervical dilation 2cm)
What is the consequence of misdiagnosing preterm labor?
- Diagnosis is arguably the most important task a clinician performs because it determines the
subsequent course of evaluation and treatment, with the direct and indirect costs of diagnostic
error, placing large financial burdens on the mother and the baby. Delivering a preterm baby
can pose a number of health concerns, such as low birth weight, breathing difficulties,
underdeveloped organs and vision problems. Children who are born prematurely also have a
higher risk of cerebral palsy, learning disabilities and behavioral problems.
What other possible nursing problem of patient P.T. should you should consider?
1. Anxiety
2. Discomfort
CASE STUDY PROGRESS. P.T.'s history reveals that she had one preterm delivery 4 years ago at 31
weeks' gestation. The infant, a girl, was in the neonatal intensive care unit (NICU) for 3 weeks and
discharged without sequelae. The second preterm infant, a boy, was delivered 2 years ago at 35 weeks'
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 non
tender, with fundal height at 29 cm, fetus in a vertex presentation.
While waiting for laboratory results, what therapeutic measures may be performed by the
nurse?
When caring for a woman with symptoms of preterm labor, it is important to ask whether she
experienced the symptoms when she engaged in certain activities that required lifestyle modifications.
What activities should you assess for?
CASE STUDY PROGRESS. While waiting for laboratory results, you consider that if P.T. is experiencing
preterm labor, she would receive antenatal glucocorticoids.
What is the rationale for the administration of antenatal glucocorticoids for preterm labor?
a. To accelerate fetal lung maturity
b. To stop uterine contractions

c. To soften the cervix
d. To prevent maternal infection
How long does it take for these drugs to take effect?
Which of the following are considered contraindications to antenatal glucocorticoids when a

woman is in preterm labor? (Select all that apply.)
a. Cord prolapse
b. Chorioamnionitis
c. Presence of twin fetuses
d. Cervical dilation of 2.5 cm
e. Abruptio placenta
CASE STUDY OUTCOME. Two hours later, the laboratory results indicate a urinary tract infection. The
contraction monitor indicates infrequent, mild contractions. She was discharged by her physician and
was given antibiotic as take-home meds for the UTI.
What are the discharge instructions to be provided to the client?

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Scenario. P.T. is a married 30-year-old gravida 4, para 1203 at 28 weeks' gestation.

She arrives in the

1. Acute Pain r/t uterine cramping

1. When was your last previous preterm labor or premature birth?

Early recognition of preterm labor is essential to successfully implement interventions. The

1. gestational age between 20-37 weeks

a. To accelerate fetal lung maturity

b. To stop uterine contractions

d. To prevent maternal infection

How long does it take for these drugs to take effect?

Which of the following are considered contraindications to antenatal glucocorticoids when a

c. Presence of twin fetuses

d. Cervical dilation of 2.5 cm

What are the discharge instructions to be provided to the client?

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