Jenny Theriot Scenario 4
Four days later Mrs. Theriot remains on bedrest and continues to leak small amounts of amniotic fluid. Assessment: BP 110/70 mmHg, P. 78 beats/minute, R 20 breaths/minute, T. 99.4o F. Due to the potential for developing chorioamnionitis, her healthcare provider is increasingly concerned about possible pre-term delivery and writes new orders for her continuing care. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED:
1Perform Non-Stress Test (NST) now and bi-weekly BPP and every shift; teach woman to do Daily Fetal Movement Counts (DFMCs).Reactive NST indicative of fetal well-being; slowing of fetal movement is a sign of fetal compromise. Biophysical Profile (BPP) builds on the NST with fetal ultrasound to evaluate a babys heart rate, breathing, movements, muscle tone and amniotic fluid level. The NST is performed now and each shift to identify signs of fetal compromise 2Administer Betamethasone 12 mg IM for two doses 24 hours apart.Stimulates fetal lung maturity by promoting release of enzymes that induce production or release of lung surfactant.
3Administer a broad-spectrum antibiotic (e.g., ampicillin, erythromycin) and continue for 7 days.Treat infection, decrease incidence of chorioamnionitis while allowing an additional 24 hours to elapse after administration of Betamethasone.
4Request neonatologist to visit patient.Affords opportunity to discuss care of infant if born preterm; allays fear and anxiety.
5Assess results of daily CBC.Increasing WBC indicative of infection.