Question

A 22-year-old woman presents to the hospital at 34 weeks gestation. She is G1P1. It was an uncomplicated pregnancy until 12 hours prior to admission, she experienced escape of fluid from the vagina, non-foul smelling.

She developed fever (38.2 degrees centigrade) around 6 hours prior to admission and she currently experiencing mild to moderate uterine contractions. She was started on antimicrobial treatment per IV. FHR is 118 bpm, RR=28   PR=90 BP= 110/70

Write an NCP about:

A. Dystocia refers to difficulty in labour which is because of the uterine dysfunction, fatal malpresentation, or pelvic abnormality

B. Preterm labour also called premature labour. It is the rhythmic uterine contraction leading to cervical changes after fatal viability but before fatal maturity, this usually occurs in the 20 tie and 37 the weeks of gestation

Please differentiate which one of these are actual and potential problems :( thank you so much!

2. Prepare an NCP following the format:

3.1. Subjective/objective data

3.2. Nursing Diagnosis

3.3 Rationale (should indicate book sources or references)

3.4 Goals/ objectives

3.5 Nursing interventions

3.6. Scientific rationale for the interventions

3.7. Evaluation criteria

Answer 1

ASSESSMENT	NURSING DIAGNOSIS	GOALS	INTERVENTIONS	SCIENTIFIC RATIONALE	IMPLEMENTATION	EVALUATION
A) Objective data - uterine dysfunction - premature uterine contractions	Risk for injury, fetal related to abnormalities of the maternal pelvis, premature uterine contractions, fetal malposition and pelvic abnormality	Patient participates in interventions to improve labor patternand to reduce the identified risk factors.	Assess the FHR manually / electronically Note frequency of uterine contractions Identify maternal factors such as dehydration, acidosis, anxiety. Monitor fetal decent in birth canal in relation to ischial spine note color and amount of amniotic fluid administer antibiotics as prescribed prepare the patient for normal or cesarean section as per the condition	Assessment gives a baseline data. Detects abnormal responses such as bradycardia, tachycardia, stress, acidosis, sepsis contractions 2 or less than indicates fetal compromise Sometimes simple procedures such as turning patient to recumbent procedure can increase circulating blood and oxygen to uterus and placenta and prevent or correct fetal hypoxia. Decent that is less than 1cm/hr in primi para indicates malposition and CPD. noting helps to identify the potential needs of newborn and also to rule out meconium aspiration prevent from infection caused by the rupture of membrane early interventions prevent complications	Assessment shows FHR- 118bpm, RR- 28breaths, PR- 90 bpm BP- 110/70 mm of Hg Contractions are rhythemic mild to moderate no signs of such maternal factors identified Fetal decent is monitored color of amniotic fluid is clear. antibiotic started as prescribed prepared the patient.	Patient participated in the interventions actively and the risk are identified and managed.
B) Subjective data Woman says, " I feel tightening on the abdomen at frequent intervals. Some fluid leaked Objective data - escape of fluid - non foul smelling secretion - rhythmic uterine contraction leading to cervical changes	Risk for respiratory distress related to immaturity of the lungs, with decreased production surfactant that cause hypoxemia and acidosis.	The fetus remains free from the risk of respiratory distress	Assess the color of the amniotic fluid. Assess the strength of contractions Check the working conditions of all the emergency equipments keep all the emrgency medications with in easy reach keep informed the pediatrician about the woman condition check the fetal heart rate at regular intervals and also the mother condition for bp, pulse and respiration prepare the pateint for emergency cesarean	provides a baseline data and assess the risk pattern contractions less than 1cm/hr indicates CPD / fetal malposition helps to prevent delay in emergency helps to prevent delay i providing emergency care helps to prevent delay if emergency arrives helps to prevent complication and provide care on an emergency basis helps if needed	Assessment shows that the color of amniotic fluid is clear the contractions are rhythemic and mild and moderate Checked the working conditions of all the equipments such as suction, oxygen hood / apparatus emergency drugs both for mother and the fetus are kept within easy reach informed the pediatrician fetal heart rate checked 118bpm preparation done	the fetus is protected from the risk of respiratory distress to some extent