Case Study 117

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.
 She's in her third trimester (28 weeks), causing frequent urination and increasing weight
gain can cause back pain.
 Urinary tract infection (UTI) d/t pressure on the bladder and more exposure to
bacteria.
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.?
 First ask about previous pregnancies and if there were any complications ?
 How long has the low back pain been bothering you?
 Ask whether she is experiencing any burning sensation or pain when urinating?
 Any discharge and/or blood?
 History of STIs
3. What actions would you take to help identify her underlying problem before calling the
health care provider?
Monitor maternal and fetal vital signs.

Assist as needed with analysis of amniotic fluid from amniocentesis or vaginal
pool specimen; test for ferning.
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?
1. Transvaginal ultrasound to measure the length of the cervix

2. Signs and symptoms faced by the patient her self (diagnosed by the HCP)
3. Certain lab tests to check the presence of the protein called fetal fibronectin in
the vaginal discharge, which indicates the occurrence of a preterm labor.
5. What is the significance of misdiagnosing preterm labor?
The misdiagnosis of preterm labor can lead to the inappropriate use of pharmacologic
agents that can be dangerous to the health of the woman, the fetus, or both. Signs and
symptoms can occur normally as well or indicate any other disease or infection
6. What other problems might be going on with PT that you should consider?
 Braxton Hicks contractions

 Since she is in 3rd trimester, she has gained weight, hence low back pain and cramping
 Baby pushing on bladder, back pain, frequency of urination related to the typical body
changes associated with 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?
 Corticosteroids to help speed up the lung maturity of the baby
 Mag sulfate to help reduce risk of brain damage
 Stay in bed and find a peaceful environment
 Encourage her to drink more fluids to lower risk of infection and prevent dehydration
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 and alcohol abuse

 Smoking
 Sedentary lifestyle/ overweight
 Poorly managed diabetes
 Poorly managed HTN
CASE STUDY PROGRESS

While waiting for laboratory results, you consider that P.T. is experiencing preter labor, she
would receive antenatal glucocorticoids
9. What is the rationale for the administration of antenatal glucocorticoids for preterm
labor?
these steroids accelerate the maturation of the fetus' lungs, which reduces the likelihood of
infant respiratory distress syndrome and infant mortality.
10. How long do these drugs take to become effective?

Could start to show some benefits in approx 24 hours but most effective within 48 hours.
The effect is observed to last for around 7 days.
11. Which of these situation are considered contraindications to antenatal glucocorticoids

when a woman is in preterm labor ( select all that apply)
a. Cord collapse
b. Chorioanmnionitis
c. Presence of twin fetus
d. Cervical dilatation of 2.5cm
e. Abruption 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?
 We want to prevent reoccurrence, so proper hygiene first (hand and personal) -

 use mild liquid soap not bar soap
 Increase fluid intake
 Monitor urine output
 Make sure to completely empty bladder
 Always follow antibiotic therapy protocol thoroughly and finish supply
 prescribed. C

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CASE STUDY #117

Monitor maternal and fetal vital signs.

1. Transvaginal ultrasound to measure the length of the cervix

5. What is the significance of misdiagnosing preterm labor?

 Braxton Hicks contractions

 Drug and alcohol abuse

CASE STUDY PROGRESS

10. How long do these drugs take to become effective?

11. Which of these situation are considered contraindications to antenatal glucocorticoids

 We want to prevent reoccurrence, so proper hygiene first (hand and personal) -

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