A nurse is caring for a client who is admitted in preterm labor at 32 weeks of gestation

Cerclage: A procedure in which the cervical opening is closed with stitches to prevent or delay preterm birth.

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Nursing Care Plans
Recommended Resources
Which position would the nurse suggest the client in preterm labor maintain while on bed rest?
Which drug does the nurse administer to stop or slow preterm labor?
Which nursing action is a priority when the fetus is at the +4 station quizlet?
Which phrase would the nurse use to document a fetal heart rate increase of 15 beats over?

Cerebral Palsy: A disorder of the nervous system that affects movement, posture, and coordination. This disorder is present at birth.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Corticosteroids: Drugs given for arthritis or other medical conditions. These drugs also are given to help fetal lungs mature before birth.

Dilation: Widening the opening of the cervix.

Effacement: Thinning out of the cervix.

Fetal Fibronectin: A protein that is produced by fetal cells. It helps the amniotic sac stay connected to the lining of the uterus.

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Gestational Age: How far along a woman is in her pregnancy, usually reported in weeks and days.

Hormone: A substance made in the body that controls the function of cells or organs.

Magnesium Sulfate: A drug that may help prevent cerebral palsy when it is given to women in preterm labor who may deliver before 32 weeks of pregnancy.

Neonatal Intensive Care Unit (NICU): A special part of a hospital in which sick newborns receive medical care.

Neonatologist: A doctor who specializes in the diagnosis and treatment of disorders that affect newborn infants.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Pelvic Exam: A physical examination of a woman’s pelvic organs.

Prepregnancy: Before pregnancy.

Preterm: Less than 37 weeks of pregnancy.

Progesterone: A female hormone that is made in the ovaries and prepares the lining of the uterus for pregnancy.

Tocolytics: Drugs used to slow contractions of the uterus.

Transvaginal Ultrasound Exam: A type of ultrasound in which the device is placed in your vagina.

Ultrasound Exam: A test in which sound waves are used to examine inner parts of the body. During pregnancy, ultrasound can be used to check the fetus.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus.

Preterm labor is regular uterine contractions after 20 weeks and before 37 weeks of pregnancy that cause cervical change or regular contractions with an initial presentation with cervical dilation of 2 cm or more. Preterm birth is birth after 20 weeks gestation and before 37 completed weeks gestation. Preterm birth affects over 15 million babies and their mothers and families worldwide. In 2019, in the United States, the preterm birth rate rose for the fifth year in a row to 10.23% from 10.02% in 2018, and the highest level was reported in more than a decade. Preterm babies are at risk for a multitude of complications that account for 36.3% of reported infant deaths (Griggs et al., 2020).

Nursing Care Plans

One goal of Healthy People 2030 is that 90% of all women will receive prenatal care starting in the first trimester. Early prenatal care allows clients to be educated concerning signs of preterm labor so that interventions can occur early. Management involves suppression of preterm labor when tests show immature fetal pulmonary development, cervical dilation is less than 2 cm and the absence of factors that contraindicate continuation of pregnancy.

The nurse should monitor closely for signs of fetal or maternal distress, and provide comprehensive supportive care for clients in preterm labor.

Here are 7 nursing care plans and nursing diagnoses for preterm labor:

Anxiety
Activity Intolerance
Risk for Injury (Maternal)
Risk for Injury (Fetal)
Acute Pain
Deficient Knowledge
Situational Low Self-Esteem

1. Anxiety

1. Anxiety
2. Activity Intolerance
3. Risk for Injury (Maternal)
4. Risk for Injury (Fetal)
5. Acute Pain
6. Deficient Knowledge
7. Situational Low Self-Esteem

Anxiety

Anxiety has both short-term and long-term effects on maternal, pregnancy and fetal outcomes. With increased anxiety, the cortisol hormone appears to cross the placenta and affect the fetus, disrupting ongoing processes, affecting the limbic and prefrontal cortex, and releasing chemicals such as acetylcholine and adrenaline in the mother’s body. These chemicals pass through the placenta into the fetus and have detrimental effects on proper fetal growth. Anxiety can also lead to inappropriate maternal responses to the fetus during pregnancy and decrease the ability to play a motherly role. Accordingly, it is essential to find some efficient therapeutic plans to reduce maternal anxiety during pregnancy (Bazrafshan et al., 2020).

Nursing Diagnosis

Anxiety

May be related to

Situational crisis
Perceived or actual threats to self and fetus

Possibly evidenced by

Increasing tension
Apprehension
Sympathetic stimulation

Desired Outcomes

The client will verbalize understanding of the individual situation and possible outcomes.
The client will report anxiety is reduced and/or manageable.
The client will appear relaxed; with maternal vital signs within normal limits.

Nursing Assessment and Rationales

1. Assess support systems available to the client or couple, whether the client remains hospitalized or is to return home to await delivery.
The assistance and caring of significant others, including caregivers, are extremely important during this time of uncertainty and stress. If the client is to return home, additional support will be required to meet self-care needs and homemaker activities as well as child care, as appropriate. Fostering an environment of intentional support and empathetic dialogue can build mutual trust, and assist the nurse in understanding the client’s perceptions of their experiences of preterm labor (Griggs et al., 2020).

2. Monitor maternal signs of preterm labor.
The nurse should be aware of the symptoms of preterm labor because they may occur in any pregnant woman, with or without risk factors. Common symptoms of early preterm labor are persistent, dull, and low backache; vaginal spotting; a feeling of pelvic pressure or abdominal tightening; menstrual-like cramping; increased vaginal discharge; uterine contractions; and intestinal cramping.

3. Continuously monitor maternal and fetal vitals.
Monitor the client’s vital signs and neurologic status closely. Respirations should be at least 12 breaths/min. FHR should be at 120-160 beats/min. Decreasing FHR can indicate fetal distress.

Nursing Interventions and Rationales

1. Explain the procedures, nursing interventions, and treatment regimen.
Information and knowledge of the reasons for these activities can decrease fear of the unknown. Clients desire honest and complete information, an opportunity to answer questions, and an explanation of medical terms, procedures, and expectations of care conferred in the language they understand and at the appropriate literacy level (Griggs et al., 2020).

2. Answer questions honestly, especially information regarding contraction patterns and fetal status.
The provision of clear information can help the client or couple understand what is happening and may reduce anxiety. The healthcare team should avoid using terms with negative connotations such as fetus, nonviable, incompatible with life, spontaneous abortion, and miscarriage as these terms might trivialize or dehumanize the client’s experiences (Griggs et al., 2020).

3. Encourage the use of relaxation techniques.
Application of relaxation exercises among 60 hospitalized primiparous pregnant clients at risk of preterm labor could significantly lessen the pregnancy anxiety level. The relaxation exercises were trained through the educational booklet and CD, and face-to-face and question-and-answer communications (Bazrafshan et al., 2020).

4. Encourage verbalization of fears or concerns.
The nurse should assess the client’s views of their pregnancy at the time of preterm labor. Incorporating this type of assessment will help provide individualized empathetic care (Griggs et al., 2020). Saisto et al., (2006) found that support interventions for pregnant women, which included discussions of concerns and feelings about birth, taught positive birth imagery (Kao et al., 2017).

5. Encourage the client to engage in complementary and alternative medicine (CAM).
Mind-body interventions, which constitute a major portion of the overall use of CAM, can provide support to alleviate or reduce feelings of stress. These include autogenic training, hypnotherapy, imagery, prayer, auto-suggestion, tai-chi, and yoga. These complementary therapies can have physiological as well as psychological benefits, which may consequently reduce the physio-pathological impact of stress (Kao et al., 2017).

6. Provide relaxation-focused nursing care to the client.
Relaxation-focused nursing care (RFNC) was created using Hypnobirthing and the Transactional Model. Hypnobirthing philosophy aims to reduce stress, fear, and tension in the pregnant woman by creating positive thoughts and emotions using the laws of mind. The Transactional Model defines stress as a special relationship between a person and the environment. It identifies the stressors of the person and indicates how they should be handled. RFNC is formed by using these two models and comprises positive language, a positive environment, and reducing stressors. RFNC may reduce the client’s state of anxiety, lower cortisol levels, and thus prevent preterm labor by lowering the severity of uterine contractions (Özberk et al., 2020).

7. Arrange psychotherapy sessions for the client as indicated.
The results of a study indicated that adding six sessions of individual face-to-face psychotherapy, one hour per day for six consecutive days, to inpatient medical care of clients successfully treated for preterm labor, reduced anxiety, and pregnancy stress, while enhancing their perceived control. Psychotherapy involves supportive elements focusing on responsiveness to needs for helping others through the insight obtained via empathic immersion in the therapy. This approach focuses on the client’s emotions (Mirtabar et al., 2020).

1. Anxiety

1. Anxiety
2. Activity Intolerance
3. Risk for Injury (Maternal)
4. Risk for Injury (Fetal)
5. Acute Pain
6. Deficient Knowledge
7. Situational Low Self-Esteem

Next Activity Intolerance

Recommended Resources

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References

Recommended journals, books, and other interesting materials to help you learn more about preterm labor nursing care plans and nursing diagnosis:

Which position would the nurse suggest the client in preterm labor maintain while on bed rest?

3. Perform measures to manage or stop preterm labor. Place the client on bed rest in the side-lying position. Prepare for possible ultrasonography, amniocentesis, tocolytic drug therapy, and steroid therapy.

Which drug does the nurse administer to stop or slow preterm labor?

Doctors may try to stop or delay preterm labor by administering a medication called terbutaline (Brethine). Terbutaline is in a class of drugs called betamimetics. They help prevent and slow contractions of the uterus.

Which nursing action is a priority when the fetus is at the +4 station quizlet?

At the station +4, the fetus is being born. The priority nursing action is to have a blue bulb or suction device for airway clearance and an infant warmer ready.

Which phrase would the nurse use to document a fetal heart rate increase of 15 beats over?

A NST is considered reassuring if the fetal heart rate increases at least 15 beats per minute over the baseline (between 120 and 160 beats per minute), lasting at least 15 seconds, within a 20-minute timeframe. This is called a "reactive NST."