Preterm labor, also called premature labor, is the onset of rhythmic uterine contractions that produce cervical change after fetal viability but before fetal maturity. It usually occurs between the 20th and 37th weeks of gestation.
Nursing Care Plans
Management involves suppression of preterm labor when tests show immature fetal pulmonary development, cervical dilation is less than 4 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 patients with preterm labor.
- Activity Intolerance
- Risk for Poisoning
- Risk for [Fetal] Injury
- Acute Pain
- Deficient Knowledge
Risk for Poisoning
- Risk for Poisoning
- Dose-related and toxic or side effects of tocolytics
Possibly evidenced by
- Not applicable.
- Patient will display no evidence of untoward effects of tocolytic therapy.
- Patient will prevent or minimize maternal injury.
- Patient will demonstrate cessation of uterine contractions, dependent of fetal well-being.
|Place client in lateral recumbent position. Elevate head during infusion of IV drug.||Decreases uterine irritability, increases placental perfusion and reduces supine hypotension.|
|Monitor vital signs. Auscultate lung sounds, investigate cardiac irregularities, and investigate reports of dyspnea and/or chest tightness.||Complications, such as pulmonary edema, cardiac arrhythmia, agitation, dyspnea, and chest pain may occur with administration of beta-receptor agonist such as terbutaline sulfate (Brethine) or ritodrine (Yutopar).|
|Measure intake and output. Encourage fluid intake between 2,000 and 3,000 ml/day, unless contraindicated (e.g., during administration of magnesium sulfate).||Promotes adequate hydration and prevents fluid excess, especially when magnesium sulfate is administered which is excreted through the kidneys, therefore urine output must be maintained.|
|Weight client daily.||Detects potential alteration in urinary functioning and/or retention of fluid.|
|Monitor for drowsiness, hot flashes, visual disturbances, respiratory depression, and depressed tendon reflexes.||Indicates neuromuscular depression, indicating increasing serum levels of magnesium sulfate.|
|Have antidotes readily available:
||Administration of antidote may be necessary to reverse or counteract effects of tocolytic agents.|
|Assist as needed with sterile vaginal examination. Vaginal examinations should be kept to a minimum.||To assess cervical status. Vaginal examinations are kept to a minimum because they may contribute to uterine irritability and infection.|
|Administer IV solution or fluid bolus as indicated.||Hydration may decrease uterine activity. Before beginning drug therapy, hydration promotes renal clearance and minimizes hypotension.|
|Administer IV solutions containing tocolytic agents (e.g., magnesium sulfate, terbutaline sulfate) by infusion pumps or microdrip equipment, or by subcutaneous route.||Magnesium sulfate acts directly on myometrial tissue to promote relaxation; therefore, there are fewer side effects than other drug choices.
Terbutaline sulfate relaxes uterine muscle as well as bronchioles and blood vessel walls.
|Obtain serum potassium level prior to initiation of IV terbutaline and periodically per protocol. Monitor serum glucose and potassium levels.||Terbutaline sulfate cause movement of potassium ions into cells, decreasing plasma levels; elevated blood glucose and plasma insulin levels, and release of glycogen from muscle and liver may result in hyperglycemia.|
|Administer nifedipine (Procardia) to be chewed and swallowed with food or drink. Nifedipine may occasionally be alternated with terbutaline sulfate.||Nifedipine, a calcium channel blocker, has been used experimentally when other drugs fail to suppress uterine activity.|
|Monitor nifedipine levels. Note development of tachycardia, hypotension, peripheral edema, or proteinuria.||The therapeutic dosage of nifedipine for preterm labor has not been established. Periodic monitoring may avert or prevent development of adverse effects (e.g., heart failure).|
|Apply antiembolic hose as indicated, and provide passive range of motion exercises to legs every 1-2 hours.||Prevents pooling of blood in lower extremities, which can occur because of smooth muscle relaxation.|
|Monitor serum magnesium levels per protocol during administration of magnesium sulfate.||Therapeutic level is 4-7 mEq/L, or 6-8 mg/dL. Toxic signs and symptoms develop above 10 mg/dL.|
|Insert indwelling catheter, as indicated.||Urine output must be monitored and maintained when administering magnesium sulfate. Output should be at least 30 ml/hr, or 100 ml in a 4-hour period.|
|Assess uterine contractions and FHR electronically while IV tocolytics are administered, or at least twice a day when oral route is used.||Tactile electronic monitoring of uterine contractions and FHS provides a continuous fetal/uterine assessment and basis for altering or maintaining rate of drug administration.|
|Decrease IV dose of tocolytics and gradually wean client to subcutaneous or oral dose, as indicated.||IV therapy should continue at least 12 hour after contraction cease. Oral or subcutaneous therapy should begin 30 mins before stopping IV infusion.|
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Maternal and Newborn Care Plans
Nursing care plans related to the care of the pregnant mother and her infant. See care plans for maternity and obstetric nursing:
- Abruptio Placenta| 3 Care Plan
- Cesarean Birth | 10 Care Plans
- Cleft Palate and Cleft Lip | 6 Care Plans
- Dysfunctional Labor (Dystocia) | 4 Care Plans
- Elective Termination | 6 Care Plans
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperbilirubinemia | 4 Care Plans
- Labor Stages, Induced and Augmented Labor | 36 Care Plans
- Neonatal Sepsis | 5 Care Plans
- Perinatal Loss | 5 Care Plans
- Placenta Previa | 3 Care Plans
- Postpartum Hemorrhage | 8 Care Plans
- Postpartum Thrombophlebitis | 4 Care Plans
- Prenatal Hemorrhage | 7 Care Plans
- Prenatal Substance Dependence/Abuse | 6 Care Plans
- Precipitous Labor | 3 Care Plans
- Pregnancy Induced Hypertension | 6 Care Plans
- Premature Dilation of the Cervix | 3 Care Plans
- Prenatal Infection | 3 Care Plans
- Preterm Labor | 6 Care Plans
- Puerperal Infection | 4 Care Plans