Case on Gallbladder. General data 89 year old, woman Chief Complaint Severe abdominal pain.
Nursing Care : for for Pregnant’s Woman with Preterm Labor Pain.
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Transcript of Nursing Care : for for Pregnant’s Woman with Preterm Labor Pain.
Nursing Care :Nursing Care :
for for
Pregnant’s Woman Pregnant’s Woman
with Preterm Labor Pain .with Preterm Labor Pain .
DefinitionDefinition
Preterm Labor refers to onset of Labor ocPreterm Labor refers to onset of Labor occurs after 20 week’ gestation and prior to curs after 20 week’ gestation and prior to 37 completed week’ gestation or 259 days 37 completed week’ gestation or 259 days of LMP of LMP event notevent not Low Birth weight of Ne Low Birth weight of New Bornw Born . .
Preterm Labor PainPreterm Labor Pain
Mortality or Morbidity Mortality or Morbidity 75 - 85 %75 - 85 %Low Birth WeightLow Birth WeightRespiratory Distress Syndrome !Respiratory Distress Syndrome !
EtiologyEtiology
Decrease of Progesterone during ChDecrease of Progesterone during Chorion & Decidua to activated arachidoorion & Decidua to activated arachidonic acid goes to Prostaglandins platelenic acid goes to Prostaglandins platelet - activating factors & monokines stimt - activating factors & monokines stimulated to Labor !ulated to Labor !
Risk Factors !Risk Factors !
Obstetrics HisroryObstetrics HisroryMedical HistoryMedical HistorySociodemographicSociodemographicNon cause : Non cause : 50 %50 %
Obstetric HistoryObstetric History
Multifetal gestationMultifetal gestationAbnormal or incompetent cervixAbnormal or incompetent cervixUterine anormaliesUterine anormaliesExcessive uterine activityExcessive uterine activityIncompetent cervixIncompetent cervix
Medical HistoryMedical History
AnemiaAnemiaHypertensionHypertensionPyelonephritis and UTIPyelonephritis and UTISexually transmitted diseaseSexually transmitted diseaseSmoking & other substance abuSmoking & other substance abu
se se
SociodemographicSociodemographic
Age : less than 20 or more 35 yrs.Age : less than 20 or more 35 yrs.Non - WhiteNon - WhiteLow socioeconomic statusLow socioeconomic statusPoor weight gainPoor weight gainPoor Prenatal CarePoor Prenatal Care
Psychological StressPsychological Stress
Initial EvaluationInitial Evaluation
Is Preterm labor Present ?Is Preterm labor Present ?Symptoms Symptoms SignsSigns
SymptomsSymptoms
Persistant contractions,Persistant contractions,
both painful & painless both painful & painless SpottingSpotting Menstrual - like cramps or pressMenstrual - like cramps or press
ureureAn increase in vaginal dischargeAn increase in vaginal discharge
SignsSigns
Contractions at a frequency Contractions at a frequency
of 6 to 8 / hr of 6 to 8 / hr Cevical dilatation of 2 cm or greater Cevical dilatation of 2 cm or greater
or effacement of greater than 80 %or effacement of greater than 80 %Change in dilatation or effacement Change in dilatation or effacement
on serial examinationon serial examination
ManagementManagement
Bed Rest 80 %Confirm the Diagnosis of Preterm LaborEvaluate CervixStart IV Fluid & hydrate with 1 lt. of NS
SDocument Fetal Well - BeingUltrasoundTocolysis consider Corticosteroids
IndicationIndication
Fetal well - beingFetal well - beingGestational age 20 - 37 wks.Gestational age 20 - 37 wks.Regular Uterine Contraction 1 time Regular Uterine Contraction 1 time
within 10 min. more than 30 sec.within 10 min. more than 30 sec.Cervical change of 2 cm or greater Cervical change of 2 cm or greater
& effacement greater than 80 %& effacement greater than 80 %Membrane IntactMembrane Intact
ContraindicationContraindication
Active phase : Cx > 4 cm.Active phase : Cx > 4 cm.Premature Rupture of MembranePremature Rupture of MembraneSevere ComplicationSevere ComplicationMaternal Heart DiseaseMaternal Heart DiseaseContraindacation of SympathomiContraindacation of Sympathomi
metic drugsmetic drugs
Tocolytic AgentsTocolytic Agents
Beta - adrenergic receptor agonists Beta - adrenergic receptor agonists *Terbutaline ( Bricanyl *Terbutaline ( Bricanyl RR ) )
Calcium channel blocking drugs Calcium channel blocking drugs * Verapamil * Verapamil
Magnesium SulfateMagnesium SulfateAntiprostaglandins or prostaglandin sAntiprostaglandins or prostaglandin s
ynthetase inhibitor * Salicylateynthetase inhibitor * Salicylateother other :*Ritrodrine:*Ritrodrine ,* Progesterone ,* ,* Progesterone ,*
Ethanol , * DiazoxideEthanol , * Diazoxide
Complication:Complication:
Fetal Heart Rate : < 120 / min oFetal Heart Rate : < 120 / min or > 140 / min r > 140 / min Fetal distress !Fetal distress !
Ps > 20 mmHg , Pd > 10 mmHgPs > 20 mmHg , Pd > 10 mmHgProlonged ( > 24 hr ) infusion of Prolonged ( > 24 hr ) infusion of
parenteral tocolytics.parenteral tocolytics.
Nursing Guide !Nursing Guide !
Before Nursing Care Before Nursing Care During Nursing Care During Nursing Care After Nursing CareAfter Nursing Care
* * Before Nursing CareBefore Nursing Care
Initial assessment to determine whether genuine Preterm Labor consider specific management strategies .
Search for a cause / precipitating factors .
* During Nursing Care* During Nursing Care
Honesty about value of preventitative
factors .General Health CareLeft Lateral Recumbent PositionInitiate Tocolysis consider Corticor
steroids if gestation is at 26 - 32 wks .Psycho - support & Closed Observati
on !
* After Nursing Care* After Nursing Care
Closed Observation Side Effects Discharge PlanningHome Care Management Involvement of Husband or
significant other
Discharge PlanningDischarge Planning
Fetal Growth & statusPersonal HygienePhysical & Emotional ChangeSexual needs / change ; intercourseAlleviation of Backache, Braxton hic
ks contaction, Dyspnea, Round ligament pain, Leg ache or edema
Preparation for babyDanger signs
Questions or Suggestion : Questions or Suggestion : feel free !feel free !
* * http://start.at/noina http://start.at/noina
* E- mail : [email protected]* E- mail : [email protected]
* ICQ # 5403640* ICQ # 5403640
Thank you !Thank you !