A pregnant patient scheduled for a cervical cerclage presents with increased heart rate and blood pressure, mild dizziness, and anxiety. A transvaginal ultrasound shows cervical shortening and increased funneling. Which nursing intervention is the priority to address the patient’s current condition?

C) Reassess the patient's vital signs and notify the healthcare provider of the changes.

A) Administer a mild anxiolytic as prescribed to help manage anxiety.

B) Perform guided breathing exercises with the patient to reduce stress.

C) Reassess the patient's vital signs and notify the healthcare provider of the changes.

D) Prepare the patient for immediate cervical cerclage under regional anesthesia.

A patient undergoing preparation for a cervical cerclage procedure exhibits increased heart rate and blood pressure, with reports of dizziness and anxiety. A repeat ultrasound shows further cervical shortening and funnelling. Which of the following nursing interventions should be prioritized to address the patient's current condition?

A) Administer a mild anxiolytic as prescribed to manage anxiety.

B) Increase maternal hydration to address potential hypotension.

C) Encourage the patient to perform guided breathing exercises to reduce stress.

D) Position the patient in Trendelenburg to reduce intrauterine pressure.

A patient who has undergone a cervical cerclage is experiencing mild lower abdominal cramping and spotting. What is the most appropriate nursing intervention to prioritize in this situation?

B) Educate the patient about the signs of preterm labor and ensure she can identify them.

A) Administer an intravenous bolus of 500 mL normal saline.

B) Educate the patient about the signs of preterm labor and ensure she can identify them.

C) Reassess the patient's vital signs and monitor for signs of infection.

D) Increase the frequency of fetal heart monitoring to every 5 minutes.

A patient who has undergone a cervical cerclage procedure is in the recovery room and begins to experience mild lower abdominal cramping and spotting. Which of the following actions should the nurse prioritize to ensure the patient's stability and safety?

B) Continue to monitor vital signs and symptoms, and update the obstetrician if symptoms escalate

A) Administer a stronger analgesic to manage the cramping

B) Continue to monitor vital signs and symptoms, and update the obstetrician if symptoms escalate

C) Encourage the patient to ambulate around the room to relieve cramping

D) Immediately remove the cerclage to address the symptoms

A patient who recently had a cervical cerclage placed is experiencing increased abdominal discomfort and mild uterine contractions. What is the most appropriate nursing intervention to prioritize in this situation?

B) Administer a prescribed tocolytic agent to reduce contractions

A) Encourage the patient to ambulate to relieve discomfort

B) Administer a prescribed tocolytic agent to reduce contractions

C) Provide a warm compress to the abdomen to alleviate pain

D) Instruct the patient to perform deep breathing exercises to promote relaxation

A nurse is caring for a patient two hours post-cerclage procedure who is experiencing increased abdominal discomfort and mild contractions. The obstetrician has ordered tocolytic therapy. Which nursing action is the most appropriate to include in the care plan to address the patient’s current condition?

B) Administer the prescribed tocolytic agent and monitor uterine activity.

A) Encourage the patient to ambulate to promote circulation.

B) Administer the prescribed tocolytic agent and monitor uterine activity.

C) Increase the patient's oral fluid intake to manage contractions.

D) Apply a warm compress to the abdomen to relieve discomfort.

A patient who was administered a tocolytic agent exhibits decreased uterine activity and stabilized vital signs. Which nursing intervention is most appropriate to implement next?

B) Educate the patient on recognizing signs of preterm labor.

A) Increase the frequency of maternal vital sign checks to every hour.

B) Educate the patient on recognizing signs of preterm labor.

C) Discontinue electronic fetal monitoring as uterine activity has decreased.

D) Initiate ambulation to assess the patient's tolerance to activity.

A patient receiving tocolytic therapy shows a decrease in uterine activity and reports less discomfort. Which of the following actions should the nurse prioritize to ensure continued positive outcomes for this patient?

C) Educate the patient about the signs of preterm labor to report immediately.

A) Increase the frequency of vital sign monitoring to every hour.

B) Encourage the patient to ambulate to prevent thromboembolism.

C) Educate the patient about the signs of preterm labor to report immediately.

D) Request an immediate reassessment from the obstetrician.

A patient is 24 hours post-cerclage placement and presents with a mild increase in lower abdominal discomfort, a temperature of 99.5°F (37.5°C), a heart rate of 102 bpm, and increased vaginal discharge. Her lab results show leukocytosis and elevated CRP levels. Which nursing intervention is the highest priority at this time?

B) Initiate broad-spectrum antibiotics as ordered by the obstetrician.

A) Administer antipyretics to manage the elevated temperature.

B) Initiate broad-spectrum antibiotics as ordered by the obstetrician.

C) Encourage the patient to ambulate to prevent thrombosis.

D) Perform a focused respiratory assessment to rule out pneumonia.

A patient 24 hours post-cerclage placement presents with a slight increase in lower abdominal discomfort, a temperature of 99.5°F (37.5°C), a heart rate of 102 bpm, and an increase in vaginal discharge. The obstetrician has ordered a broad-spectrum antibiotic regimen. Which nursing intervention is most appropriate to prioritize at this time?

B) Monitor the patient closely for signs of allergic reactions to the antibiotics.

A) Encourage the patient to ambulate frequently to prevent thrombosis.

B) Monitor the patient closely for signs of allergic reactions to the antibiotics.

C) Educate the patient on the importance of fluid restriction to manage discomfort.

D) Instruct the patient to perform deep breathing exercises to reduce fever.

Pre-Operative Incompetent Cervix A 30-year-old female, G3P1, was admitted at 18 weeks gestation due to a history of recurrent mid-trimester pregnancy loss. She previously experienced a miscarriage at 20 weeks and had a preterm birth at 32 weeks. The patient reported increased vaginal discharge but no pain or contractions. A transvaginal ultrasound showed a short cervix measuring 18 mm with funnelling and 2 cm dilation, indicative of cervical insufficiency. Physical examination confirmed a soft cervix without active contractions or infection. Her vital signs were stable. Pre-operative diagnostic tests included a CBC, urinalysis, and cervical culture, all of which were within normal limits, ruling out infection. Given the high risk for pregnancy loss, the patient was scheduled for a cervical cerclage (McDonald or Shirodkar technique) under regional anesthesia - Nursing Case Study

Pathophysiology

• Primary mechanism: Cervical Structural Weakness

The cervix is structurally unable to maintain closure during pregnancy due to inherent tissue weakness or previous obstetric trauma, leading to premature dilation and shortening without contractions.

• Secondary mechanism: Increased Intrauterine Pressure

The growing pregnancy increases pressure on the structurally weak cervix, exacerbating cervical dilation and funnelling, particularly in the mid-trimester when fetal growth is rapid.

• Key complication: Risk of Preterm Birth or Pregnancy Loss

An incompetent cervix significantly increases the risk of preterm birth or miscarriage, as the cervix cannot sustain the growing pregnancy, necessitating interventions like cervical cerclage to prevent adverse outcomes.

Patient Profile

Demographics:

30-year-old female, occupation not specified

History:

• G3P1 with a history of recurrent mid-trimester pregnancy loss

• Previous miscarriage at 20 weeks, preterm birth at 32 weeks

• Current medications: prenatal vitamins

• Allergies: None reported

Current Presentation:

• Chief complaint: Increased vaginal discharge

• Key symptoms: Short cervix with funnelling and 2 cm dilation, no pain or contractions

• Vital signs: Stable upon admission; develop complications with some abnormal vital signs during observation

Section 1

As the patient was being prepared for the cervical cerclage procedure, the nursing team noticed a change in her status. During routine vital sign monitoring, the patient's heart rate increased to 110 beats per minute, and her blood pressure was slightly elevated at 140/90 mmHg. Although she remained afebrile, the increase in heart rate and blood pressure indicated a possible stress response or early signs of a complication. The patient mentioned feeling mildly dizzy and more anxious than usual, which could be contributing to the vital sign changes.

In response to these findings, the healthcare team decided to conduct additional assessments and closely monitor her condition. A repeat transvaginal ultrasound was performed, revealing that the cervix had further shortened to 15 mm with increased funnelling but no additional dilation beyond 2 cm. These findings suggested that the cervical insufficiency might be progressing more rapidly than initially anticipated, potentially due to increased intrauterine pressure from the growing pregnancy. Contributing factors such as maternal anxiety and stress were considered, as they could exacerbate hemodynamic changes and further compromise cervical integrity.

Given these developments, the clinical team emphasized the need for immediate intervention. The decision was made to proceed with the scheduled cervical cerclage under regional anesthesia, while also providing the patient with additional support to manage her anxiety. The team discussed the possibility of administering a mild anxiolytic, as well as non-pharmacological interventions such as guided breathing exercises. These measures aimed to stabilize her vital signs and optimize conditions for the cerclage, thereby reducing the risk of preterm birth or pregnancy loss. The plan was to continue monitoring her closely post-procedure to ensure stabilization and assess for any new complications.

Section 2

As the team proceeded with the cervical cerclage procedure, they administered a mild anxiolytic to help manage the patient's anxiety and performed guided breathing exercises, which appeared to have a positive effect. The patient's heart rate gradually decreased to 98 beats per minute, and her blood pressure stabilized at 130/85 mmHg, suggesting that the interventions were effective in alleviating her stress response. With the patient in a more relaxed state, the anesthesia was administered, and the surgical team successfully placed the cervical cerclage using the McDonald technique. The procedure was completed without immediate complications, and the patient was transferred to the recovery area for close observation.

In the recovery room, the patient's vital signs were monitored every 15 minutes. Her heart rate remained steady at 95 beats per minute, and her blood pressure was stable at 125/80 mmHg. She reported feeling more comfortable and less dizzy, which was reassuring to the healthcare team. However, approximately 30 minutes post-procedure, the patient began to experience mild lower abdominal cramping and noticed a small amount of spotting. The nursing team promptly informed the obstetrician, who performed a physical examination and reassured the patient that these symptoms could be expected post-cerclage but should be closely monitored for any escalation.

To address the cramping, the team recommended the use of a heating pad and provided the patient with acetaminophen for pain relief. The spotting was noted to be minimal and not accompanied by any signs of infection or further cervical change. The team emphasized the importance of rest and continued monitoring over the next 24 hours. They planned to conduct a follow-up ultrasound to evaluate the integrity of the cerclage and ensure that there were no new developments. These steps were crucial to ensure the patient's stability and to detect any new complications early, thereby supporting the goal of prolonging the pregnancy and reducing the risk of preterm birth.

Section 3

As the patient continued to rest in the recovery area, the nursing team remained vigilant in monitoring her condition, particularly watching for any changes in her symptoms or vital signs. About two hours post-procedure, the patient started experiencing increased abdominal discomfort and a sense of pelvic pressure. Her heart rate rose to 110 beats per minute, and her blood pressure increased slightly to 135/88 mmHg. Concerned about these changes, the healthcare team initiated a more thorough assessment to determine if these were normal post-operative symptoms or indicative of a potential complication.

The obstetrician ordered an immediate transvaginal ultrasound to assess the integrity of the cervical cerclage and to check for any signs of uterine activity or additional changes in the cervix. The ultrasound revealed that the cerclage was still intact, but there was a slight increase in uterine activity, suggesting mild contractions. The cervical length remained stable at 18 mm, but the presence of contractions raised concerns about possible preterm labor despite the recent intervention.

To address the uterine activity, the medical team decided to administer a tocolytic agent to help relax the uterus and prevent further contractions, while ensuring the patient was well-hydrated and comfortable. They also reinforced the need for continued bed rest and close monitoring over the next 24 hours. These measures were aimed at stabilizing the patient’s condition and reducing the risk of preterm labor, which was crucial for prolonging the pregnancy and improving outcomes for both the mother and the fetus. The team planned to reassess the patient’s status regularly, evaluating the effectiveness of the interventions and adjusting the care plan as needed to support her and her baby’s health.

Section 4

Response to Interventions

Following the administration of the tocolytic agent, the nursing team closely monitored the patient's response to the intervention. Over the next few hours, the patient's abdominal discomfort gradually subsided, and the sense of pelvic pressure diminished. Vital signs were reassessed, showing a heart rate that stabilized to 95 beats per minute and blood pressure that decreased slightly to 128/82 mmHg, indicating a favorable response to the treatment. The patient reported feeling more comfortable, and her anxiety about the situation seemed to ease as she engaged in conversation with the nursing staff.

Continuous electronic fetal monitoring showed a decrease in uterine activity, with contractions becoming less frequent and less intense. The nursing staff documented these changes and communicated them to the obstetrician, who expressed cautious optimism about the patient’s improved condition. The plan for strict bed rest and hydration was reinforced, and the medical team decided to continue with the current regimen of tocolytics while planning for regular reassessment every four hours.

Despite the positive response to interventions, the team remained vigilant for any new signs of complications, understanding the delicate nature of the patient's condition. The focus was on preventing further uterine activity and closely observing for any signs of infection or labor onset. As the patient approached the 24-hour mark post-procedure, the team prepared for another comprehensive evaluation to determine the next steps in managing her care, emphasizing the need for continued multidisciplinary coordination to optimize outcomes.

Section 5

New Complications

As the patient reached the 24-hour mark post-cerclage placement, the nursing team noted a subtle change in her condition. While her overall demeanor remained calm, she began to report a mild increase in lower abdominal discomfort. Upon reassessment, her vital signs showed a slight elevation in temperature to 99.5°F (37.5°C), while her heart rate had increased to 102 beats per minute. Blood pressure remained stable at 130/84 mmHg. Concerned about the potential for infection or other complications, the nursing staff promptly reported these findings to the obstetrician.

In addition to the temperature elevation, the patient also reported feeling a slight increase in vaginal discharge. The color and consistency of the discharge were noted in the patient's chart, and a sample was sent for culture to rule out chorioamnionitis or other infections. The obstetrician ordered a repeat CBC and C-reactive protein (CRP) test to further investigate the possibility of an inflammatory or infectious process. The results showed a mild leukocytosis with a white blood cell count of 11,500/mm³ and a CRP level of 12 mg/L, suggesting a possible early-stage infection.

Given these new developments, the medical team decided to implement a more aggressive monitoring strategy, including closer surveillance of vital signs and fetal heart rate patterns. They also initiated a broad-spectrum antibiotic regimen to preemptively address any potential infection. The plan included a follow-up ultrasound to reassess cervical length and fetal well-being, and to ensure the cerclage remained intact. The team emphasized the importance of continued bed rest and hydration, while maintaining an open line of communication with the patient to promptly address any further changes in her condition. This approach aimed to stabilize the patient and protect the ongoing pregnancy, with the hope of extending gestation and improving maternal and fetal outcomes.