Analysis of Bare Bone Case - Essay Example

? Bare Bone Case Analysis Bare Bone Analysis Learning Objectives Enhance patient awareness and offer continuous risk assessment and progression of individualized patient management plan. Recognizing epidemiologic, social, financial and medical outcome of the patient. Understanding nursing role and procedure of abnormal labor plus delivery. Pathophysiology The major pathophysiology situation for Patience preterm labor is the shattering of membranes and weakened cervix, due to considerable build up of pressure on cervix. This is augmented by the partial dilatation which results in a sufficient opening to permit the fetus to descend into the pelvic canal. Furthermore, the patient undergoes premature progression and formation of myometrial gash junctions, in addition to inflammatory mediator enthused contractions. The other pathophysiology effect is atypical placental implantation and augmented ligamental laxity that results in back pain (Chao, et al, 2011). Physiology A normal physiologic scenario is one that is affected by innate human capability of the mother and fetus. Unlike in this scenario, Braxton-Hick or pre-labor contractions normally subside with rest or fluids and do not thus transform the cervix during actual labor contractions do. The mucus plug which keeps the cervix closed is lost, since the body facilitates the uterus contraction. Aches and provisional quick groin pains occur due to gentle straining of the ligaments attached to the pelvic bones, plus lower back. In addition, oxygen supply during labor is normally reduced due to interferences of supply of oxygenated maternal blood to placenta by the contractions (Kaimal, et al, & Cheng, 2011). There is also an increase in maternal blood supply, couple with lowering of systemic vascular resistance from blood vessels due to mounting intensity of hormones. Thus, cardiac output increases considerably leading to a decrease in blood pressure. Renal clearance is usually elevated resulting in lower-than-normal serum levels from renal markers referred to as blood-urea-nitrogen and creatinine (Kaimal, et al , & Cheng, 2011). Predisposing Factors There are numerous predisposing factors that could have led to Patience condition. First, the fact that she lost two previous pregnancies to first trimester miscarriages exposed her to preceding second-trimester dilation and evacuation, in addition to uterine anomalies like outsized fibroids and mullerian abnormalities. Second, Patience could have gone through short inter-pregnancy timeline of less than six months, considering that she may possibly have had a cervical injury, cervical insufficiency, diethylstilbestrol, or previous cervical surgery. Therefore, the premature effacement or shortening of vaginal section of Patience cervix and dilation could be due to structural weakness in her cervix) exposure, and anatomic abnormalities of the cervix (Maloni, 2012). Thirdly, fetal abnormalities or even untimely placental separation could be a causative factor, and are thus making the abruption. Other features could be demographic factors given that previous studies reveal that nonwhite races have a high probability of preterm birth, especially in Black race (Maloni & Damato, 2004). The concerns about anemia could possibly imply existence of uteroplacental insufficiency, such as hypertension, and this brought about trichomonas condition. Furthermore, she could be having low pre-pregnancy weight and body mass index, and her prenatal care was not as continuous or none at all. Others include, grave maternal infections like, urinary tract infection, placenta previa, bacterial vaginosis or intrauterine growth constraint. Moreover, hormonal changes especially mediated by maternal and fetal stress could also be a factor (Chao, et al, & Leven, 2011). Treatment Modalities Treatment modalities can begin with offering Patience prophylactic pharmacologic therapy, so as to extend her gestation and decrease her chances of getting respiratory distress syndrome or even intra-amniotic infectivity. Medicines are used to slow or even halt the contractions in order to stop the cervix from dilating wider or effacing. One recently approved drug is the hydroxyprogesterone caproate, which is a synthetic progestin and is used to minimize the risk of preterm delivery, especially for those who have had more than one unprompted premature birth (Aschenbrenner, 2011). Also, short-term management with tocolytic medicine could be effective, as tocolytics can delay birth for additional 48 hours (ACOG practice bulletin, 2003). However, tocolytic therapy will have to be set off when indicated prior to the formation of a plan concerning maternal plus fetal surveillance with her. This will help to improve Patience neonatal outcome. Notably, visual inspection of her cervix will be significant in evaluating the extent of any injury or risk. Thus, trans-vaginal ultrasonic measurements need to be done accurately in order to conclude the risk of her cervical incompetence. Cervical length can be conducted trans-vaginally through serial screening when timing corticosteroids. Therefore, either two doses of the betamethasone, or even four doses comprising dexamethasone IM and necrotizing enterocolitis can considerably reduce severity of preterm birth (Kaimal, et al, & Cheng, 2011). Prior to digital examination, fetal fibronectin or biological “glue” could be placed to clasp amnion to her uterine deciduas, and ensure her membranes are intact (Chao, et al, & Leven, 2011). In order to decrease extreme prematurity, timely referral to sub-specialized obstetrical treatment will aid in identifying risk for her delivery. Steroid injection is applied to ensure maturity of the fetus lungs earlier. Vaginal injection of progesterone weekly will assist in preventing recurrent preterm birth scenario. Lifestyle issues include high levels of alcohol use, drug abuse, smoking and psychosocial stress. Also, poor nutrition, low body mass and poor weight increases, are also contributory factors. Therefore, this calls for regular prenatal care, resting and taking plenty of fluids to discontinue premature contractions and to delay labor. Eating foods having folic acid, iron, protein and prenatal vitamin is also helpful. Dental care and management of chronic conditions will help to lessen risk factors for the premature birth (Chao, et al, & Leven, 2011). Nursing assessment Vital signs, such as contractions and fetal status, pelvic examination and cervical incompetence (Maloni J. A., 2012). Modification of risk factors, including preparing Patience for possible delivery. Psychosocial reactions to treatment, her perception of stressors and lifestyle modification factors. Nursing Care Physical nursing care entails evaluating signs of labor via systematic obstetric history, physical exams, and sterile speculum exams (Maloni & Damato, 2004). Bimanual cervical assessment is done to determine the frequency, interval, and intensity of Patience uterine contractions. Digital plus ultrasound examination of Patience cervix is done, so as to weigh up cervical dilation, effacement, and her bloody show. Fetus should be looked for distress, mass, and maturity through sonography or lecithin-sphingomyelin proportion (Kaimal, et al, & Cheng, 2011). Measures to administer or alter preterm labor should be conducted by placing Patience on bed rest, but in a side-lying posture. This then paves way to possible ultrasonography, followed by amniocentesis, tocolytic contraction and inhibition medications or drug therapy, then steroid therapy. Side effects such as reduced maternal blood pressure, chest pain, or FHR< 180 beats per min should be administered (Maloni J. A., 2012). Provision of physical plus emotional support through individualized counseling focused on answering her questions concerning the status of her fetus, and preparing for care when averting delivery or essential groundwork for preterm delivery. Patience family education will include, teaching her preventive measures to steer clear of early delivery, stressors and domestic violence screening. This entail helping Patience and her husband to comprehend the rationale for sexual activity curb. Blending of physical findings plus diagnostic tests interpreted within the framework of extent of risk to Patience through telephone support. Home uterine monitors are used to monitor her uterine activity but only with the assistance of her nurse. Nutritional counseling is done to control her weight-for-height condition and to monitor her activity restriction (Kaimal, et al, & Cheng, 2011). Desired Clients Outcome Extension of pregnancy for longer period, usually 24-48 hours or longer duration. To have interim labor inhibition with early hospital discharge of Patience and her baby. Patience overcomes the sense of indecisive motherhood, and acquires a sense of being a genuine mother for her preterm infant and to gain as much control as possible. References ACOG practice bulletin. (2003). Management of preterm labor. Int J Gynaecol Obstet , 82 (1), 127-135. Aschenbrenner, D. S. (2011). New Drug to Reduce the Risk of Preterm Birth. American Journal of Nursing , 111 (6), 24-25. Chao, T. T., Bloom, S. L., Mitchell, J. S., McIntire, D. D., & Leven, k. J. (2011). The diagnosis and natural history of false preterm labor. Obstet Gynecol , 118 (6), 1301-1308. Kaimal, A., Bruckner, T., Hallaron, D., Caughey, A., & Cheng, Y. (2011). Perinatal morbidity associated with late preterm deliveries compared with deliveries between 37 and 40 weeks of gestation. BJOG , 118 (12), 1446-1454. Maloni, J. A. (2012). Prevention of preterm birth, preterm labor, and low birth weight. Encyclopedia of Nursing Research. (J. Fitzpatrick, & M. W. Kazer, Eds.) New York: Springer. Maloni, J., & Damato, E. (2004). Reducing risk for pre-term birth. Family Teaching Toolbox Advances in Neonatal Care , 4 (3), 175-176. Read More