A pregnant patient at 34 weeks of gestation presents with signs of premature rupture of membranes (PROM) and suspected chorioamnionitis. Which nursing intervention is the priority to prevent fetal complications associated with this condition?

C) Initiate broad-spectrum antibiotics as prescribed

A) Administer intravenous fluids to maintain hydration

B) Monitor maternal vital signs every 15 minutes

C) Initiate broad-spectrum antibiotics as prescribed

D) Prepare for immediate cesarean delivery

A pregnant patient with a confirmed case of chorioamnionitis and penicillin allergy is being treated with clindamycin and gentamicin. Her condition is deteriorating with signs of fetal distress and oligohydramnios. Considering these findings, what is the most appropriate nursing action to prioritize at this time?

B) Prepare for possible expedited delivery due to fetal distress

A) Increase maternal hydration to address oligohydramnios

B) Prepare for possible expedited delivery due to fetal distress

C) Monitor blood glucose levels and adjust insulin as needed

D) Administer corticosteroids to enhance fetal lung maturity

A pregnant patient with chorioamnionitis, a penicillin allergy, and gestational diabetes is showing signs of systemic inflammatory response and fetal distress. The healthcare team is considering administering corticosteroids for fetal lung maturity. Which nursing intervention should be prioritized to address the patient's current condition?

A) Initiate continuous fetal heart rate monitoring to assess for ongoing fetal distress.

B) Administer a bolus of intravenous fluids to address potential dehydration and improve maternal circulation.

C) Educate the patient on the importance of monitoring blood glucose levels closely and adjusting insulin doses.

D) Prepare the patient for immediate cesarean delivery due to signs of fetal distress.

A pregnant patient with suspected chorioamnionitis is receiving corticosteroids to promote fetal lung maturity and antibiotics for infection. Despite treatment, her temperature remains elevated, and fetal monitoring indicates tachycardia with late decelerations. Which is the most appropriate nursing action based on the current assessment findings?

B) Prepare the patient for possible cesarean delivery due to signs of fetal distress.

A) Increase the frequency of maternal temperature monitoring to every hour.

B) Prepare the patient for possible cesarean delivery due to signs of fetal distress.

C) Administer an additional dose of corticosteroids to enhance fetal lung maturity.

D) Continue current monitoring and document findings until the next scheduled assessment.

A pregnant patient at risk for preterm delivery is receiving corticosteroids to promote fetal lung maturity. Despite antibiotic therapy, she exhibits signs of infection with an elevated temperature and heart rate. Fetal monitoring shows tachycardia with occasional late decelerations. What should be the nurse's priority action in this scenario?

B) Prepare the patient for possible expedited delivery.

A) Continue to monitor the patient's vital signs every 4 hours.

B) Prepare the patient for possible expedited delivery.

C) Increase the frequency of insulin administration to stabilize blood glucose levels.

D) Administer an antipyretic to manage the patient's fever.

A pregnant patient at 32 weeks of gestation is diagnosed with a Group B Streptococcus infection and shows signs of both maternal and fetal distress, including elevated maternal heart rate, fever, and fetal tachycardia with late decelerations. What is the priority nursing intervention?

C) Prepare the patient for an expedited delivery to address fetal distress.

A) Increase the rate of intravenous fluids to improve maternal perfusion.

B) Administer acetaminophen to reduce maternal fever and discomfort.

C) Prepare the patient for an expedited delivery to address fetal distress.

D) Reassess the patient's oxygen saturation and adjust supplemental oxygen as needed.

A pregnant patient with confirmed Group B Streptococcus infection is experiencing elevated maternal temperature, tachycardia, fetal tachycardia with late decelerations, and decreased oxygen saturation. What is the priority nursing intervention?

C) Prepare for immediate cesarean delivery to address fetal and maternal distress.

A) Initiate continuous fetal monitoring to assess for further fetal distress.

B) Administer antipyretics to manage the patient's elevated temperature.

C) Prepare for immediate cesarean delivery to address fetal and maternal distress.

D) Increase the rate of intravenous fluids to improve maternal circulation.

A patient with confirmed Group B Streptococcus bacteremia and worsening respiratory status is being evaluated for potential acute respiratory distress syndrome (ARDS). Which intervention should the nurse prioritize to address the patient's compromised respiratory function while awaiting further treatment guidance?

A) Initiate high-flow nasal cannula oxygen therapy

B) Perform chest physiotherapy to mobilize secretions

C) Position the patient in a semi-Fowler's position to improve ventilation

D) Administer a bronchodilator to alleviate wheezing

A patient with worsening infection due to Group B Streptococcus bacteremia is showing signs of respiratory distress with oxygen saturation at 91% and bilateral infiltrates on chest X-ray. What is the most appropriate initial nursing intervention to address the patient's respiratory status?

C) Initiate high-flow nasal cannula therapy

A) Increase the patient's supplemental oxygen to 100%

B) Prepare for endotracheal intubation and mechanical ventilation

C) Initiate high-flow nasal cannula therapy

D) Administer bronchodilators to improve airway clearance

PROM - Nursing Case Study

Pathophysiology

• Primary mechanism: Premature rupture of membranes (PROM) primarily occurs due to weakening or inflammation of the amniotic sac, often caused by infection or structural abnormalities, leading to early membrane rupture before labor onset.

• Secondary mechanism: An imbalance in collagen synthesis and degradation within the amniotic sac can compromise membrane integrity, exacerbated by factors such as stress, smoking, or nutritional deficiencies, further increasing PROM risk.

• Key complication: PROM can lead to complications like intrauterine infection (chorioamnionitis) due to ascending bacteria from the vagina, posing risks to both maternal and fetal health and necessitating prompt medical intervention.

Patient Profile

Demographics:

34-year-old female, office administrator

History:

• Key past medical history: Previous preterm delivery at 32 weeks, gestational diabetes

• Current medications: Prenatal vitamins, Metformin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Leakage of amniotic fluid for the past 24 hours

• Key symptoms: Mild abdominal pain, intermittent contractions, low-grade fever

• Vital signs: Temperature 100.4°F, Heart rate 105 bpm, Blood pressure 140/90 mmHg, Respiratory rate 22 breaths per minute

Section 1

Initial Assessment Findings:

Upon further assessment, the patient exhibited signs that warranted immediate attention. Her abdominal examination revealed tenderness, particularly in the lower quadrants, suggesting potential irritation or infection. The fundal height was appropriate for gestational age, but fetal heart rate monitoring indicated a baseline of 170 bpm, which is higher than the normal range, suggesting fetal tachycardia. Her urine output was noted to be decreased, with a darker color, indicating potential dehydration or an evolving infection. A sterile speculum examination confirmed the continued leakage of clear amniotic fluid, and a nitrazine test turned blue, confirming the diagnosis of PROM. Additionally, a sample was sent for analysis to rule out any signs of infection.

The healthcare team also noted an elevated white blood cell count of 16,000/mm³ and an increased C-reactive protein level, both markers suggestive of an inflammatory or infectious process such as chorioamnionitis. Her blood glucose levels were slightly elevated at 145 mg/dL, which could be attributed to her history of gestational diabetes. The combination of these findings, along with her fever and tachycardia, raised concerns for an intrauterine infection, necessitating prompt initiation of broad-spectrum antibiotics, given her penicillin allergy, to target potential pathogens while awaiting specific culture results.

These assessment findings emphasize the importance of continuous monitoring and timely intervention to prevent further complications for both the mother and fetus. The clinical team must remain vigilant for any changes in maternal or fetal status, considering her previous history of preterm delivery, and prepare for potential preterm labor management strategies should the situation escalate.

Section 2

As the clinical team continued to monitor the patient closely, new diagnostic results began to clarify the evolving situation. The culture and sensitivity tests confirmed the presence of Escherichia coli, a common pathogen associated with chorioamnionitis, which aligned with her elevated white blood cell count and C-reactive protein levels. Given her penicillin allergy, the medical team had initiated treatment with clindamycin and gentamicin, which are effective broad-spectrum antibiotics suitable for such infections. Meanwhile, her blood glucose levels remained elevated, with a new reading of 155 mg/dL, necessitating adjustments to her insulin regimen to better manage her gestational diabetes and reduce the risk of hyperglycemia-related complications.

Despite these interventions, the patient's condition showed signs of further deterioration. Her temperature spiked to 101.5°F, and her heart rate remained elevated at 112 bpm, indicating persistent systemic inflammatory response. The fetal heart rate also continued to show tachycardia, now fluctuating between 170 and 180 bpm, raising concerns about fetal distress. A repeat ultrasound revealed oligohydramnios, a condition characterized by low amniotic fluid volume, which could compromise fetal well-being and increase the risk of cord compression. These findings prompted the team to consider accelerating the delivery plan, balancing the risks of prematurity against the potential for worsening maternal and fetal conditions.

The healthcare team now faced critical decisions, weighing the benefits of continuing conservative management with antibiotics and hydration against the potential need for expedited delivery. The obstetricians, neonatologists, and the nursing team discussed the possibility of administering corticosteroids to enhance fetal lung maturity, given the high likelihood of preterm birth. This stage of the patient's journey required careful clinical reasoning, as the team aimed to stabilize both mother and baby while preparing for the imminent challenges of preterm labor and potential neonatal care.

Section 3

The clinical team decided to proceed with administering corticosteroids to promote fetal lung maturity, given the likelihood of preterm delivery. As the corticosteroid treatment began, the nursing team continued to monitor the patient closely, observing for any immediate changes in her condition. Despite the antibiotic regimen, her temperature remained elevated at 101.3°F, and her heart rate persisted at 115 bpm. The patient reported feeling increasingly fatigued and experienced episodes of chills, further indicating that the infection was not yet under control.

New diagnostic results revealed an increase in her CRP levels to 12 mg/L, suggesting an escalating inflammatory response. The fetal heart monitoring showed continued tachycardia, now consistently above 175 bpm with occasional late decelerations, heightening the concern for fetal distress. In addition, her blood glucose levels remained challenging to stabilize despite adjustments to her insulin regimen, with readings fluctuating between 150 and 165 mg/dL, complicating her management plan.

Faced with these evolving challenges, the healthcare team recognized the critical need to reassess their approach. The persistent signs of infection, alongside the unstable maternal and fetal conditions, prompted discussions on the feasibility of expedited delivery. The team considered the risks associated with surgical intervention versus the potential for worsening outcomes if the current management strategy failed to yield improvements. The decision-making process required careful clinical reasoning, weighing the potential for maternal and neonatal complications against the benefits of mitigating further deterioration. This pivotal moment in the patient's journey underscored the importance of dynamic and collaborative care planning to optimize outcomes for both mother and baby.

Section 4

As the team continued to monitor the patient, a new set of diagnostic results indicated a further rise in her white blood cell count to 18,000/mm³, confirming the progression of her infection. The blood cultures returned positive for Group B Streptococcus, necessitating a more targeted antibiotic regimen. Despite these adjustments, the patient's condition showed little improvement; her temperature remained elevated at 101.8°F, and her heart rate increased to 120 bpm. Additionally, the fetal heart rate persisted with tachycardia, now averaging 180 bpm with more frequent late decelerations, raising alarms for potential fetal hypoxia.

The patient's respiratory status also began to decline, with her oxygen saturation dropping to 94% on room air, prompting supplemental oxygen administration via nasal cannula. Her breath sounds revealed diminished air entry at the lung bases, suggesting potential early signs of pulmonary involvement. The nursing team reported her increased restlessness and anxiety, likely exacerbated by her deteriorating condition and the stress of impending decisions regarding delivery.

The healthcare team faced a critical juncture, necessitating a multidisciplinary discussion to reassess and refine the care plan. The escalating maternal and fetal distress highlighted the urgent need to consider expedited delivery to prevent further complications. The team deliberated the timing and method of delivery, weighing the risks of a cesarean section against the potential for rapid maternal and neonatal recovery. This decision required integrating the patient's clinical data, balancing the immediate risks with the long-term health outcomes for both mother and baby, ultimately underscoring the complexity of managing preterm labor complicated by infection.

Section 5

As the healthcare team continued to monitor the patient, new diagnostic results revealed further complications. A repeat complete blood count showed a rising white blood cell count of 20,500/mm³, indicating a worsening infection despite the targeted antibiotic therapy. Additionally, the patient's C-reactive protein (CRP) levels were significantly elevated, reflecting systemic inflammation. The blood cultures confirmed persistent Group B Streptococcus bacteremia, prompting a review of the current antibiotic regimen and consideration for broadening antimicrobial coverage.

The patient's respiratory status continued to decline, with oxygen saturation falling to 91% despite supplemental oxygen. Arterial blood gas analysis showed mild respiratory alkalosis, likely secondary to hyperventilation due to anxiety and the stress of infection. A chest X-ray was ordered, revealing bilateral infiltrates, suggestive of possible pneumonia or an emerging acute respiratory distress syndrome (ARDS). Her breath sounds were further diminished at the bases, and she developed a productive cough with purulent sputum, indicating a significant pulmonary involvement.

Given these developments, the healthcare team recognized the urgent need to address both the infectious process and the compromised respiratory function. They decided to escalate respiratory support, considering options such as high-flow nasal cannula or non-invasive ventilation, while awaiting further guidance from the infectious disease consultant on the antibiotic therapy. The patient's declining condition and the sustained fetal tachycardia with recurrent late decelerations intensified the discussion around the timing of delivery, with the consensus shifting towards an expedited cesarean section to mitigate the risks of maternal sepsis and fetal hypoxia. This decision emphasized the critical importance of timely intervention in the context of evolving maternal and fetal complications.