Nursing Care Plan (NCP) for Preterm Labor / Premature Labor

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Outline

Pathophysiology

Preterm labor is when the body begins preparing for delivery earlier than expected. A normal pregnancy lasts 40 weeks, but in preterm labor, contractions cause the cervix to begin to change and open before 37 weeks’ gestation. This may happen between 20-36 weeks and can be dangerous if not managed properly.

Etiology

Preterm labor may be the result of one or more risk factors that include previous preterm labor, incompetent cervix, hypertension (chronic and gestational), being pregnant with multiples (twins or more), abdominal trauma or stress, poor prenatal care and use of alcohol or street drugs during pregnancy. Other causes can include being pregnant with a fetus that has known birth defects or is the result of in vitro fertilization. These factors may cause changes in the cervix causing it to thin out and open.

Desired Outcome

Labor will be suppressed, and pregnancy maintained until fetal maturity

Preterm Labor / Premature Labor Nursing Care Plan

Subjective Data:

  • Regular/frequent contractions 
  • Dull backache
  • Pelvic pressure
  • Change in type of vaginal discharge

Objective Data:

  • Vaginal spotting or light bleeding 
  • Premature rupture of membranes 
  • Cervical dilation greater than 4cm

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Obtain gynecological and obstetrical history from the patient Previous preterm labor or pregnancies too close together can increase the risk of preterm labor. Determine what symptoms began and when. 
Assess the patient’s vital signs Get a baseline set of vitals before any interventions
Place external fetal monitoring device to monitor fetal activity/ heart rate and contractions This allows you to observe and monitor the frequency and quality of contractions as well as notice any signs of fetal distress 
Place the patient in a position of comfort on the left side Positioning patient in the left side-lying position may help with comfort, reduce contractions and maintain maternal-fetal blood flow 
Initiate IV access and administer medications:

Magnesium sulfate

Antiemetics

Tocolytics

Corticosteroids

Antibiotics

Analgesics

IV fluids should be given to prevent or treat dehydration, which can cause premature labor. Medications are given to try to stop labor from progressing, or to prepare for delivery.

Magnesium sulfate- to relax the uterus and stop contractions

Antiemetics – to control nausea

Tocolytics – to stop labor from progressing

Corticosteroids – to speed up fetal lung maturity

Antibiotics – prophylactic if membranes have ruptured

Analgesics – to manage pain

Perform vaginal exam to assess for dilation and effacement Avoid multiple digital exams if membranes have ruptured. Determine progression, if any, of labor. If the cervix is dilated >4 cm, it may not be possible to stop labor from progressing. 
Provide patient education:

Symptoms of early labor

When to notify the doctor

How to time contractions

Avoid smoking

Avoid alcohol and substance abuse

Nutrition

Chronic condition management

Educate patients and caregivers regarding warning signs and symptoms, a healthy diet, and lifestyle choices to help prevent repeat preterm labor.

Encourage patients to properly manage chronic medical conditions to prevent further labor symptoms.

If labor cannot be stopped, prepare the patient for delivery In cases where labor cannot be stopped, prepare patients for delivery by providing education and information, resources for family members, and emotional support. 

Writing a Nursing Care Plan (NCP) for Preterm Labor / Premature Labor

A Nursing Care Plan (NCP) for Preterm Labor / Premature Labor starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey guys, today, we are going to be creating a nursing care plan for preterm labor and premature labor. So, let’s get started. First, we want to talk about the pathophysiology. So, when the body begins preparing for earlier than expected; normal pregnancy usually lasts around 40 weeks, but in preterm labor contractions cause the cervix to begin to change and open before 37 weeks’ gestation nursing considerations, you want to be sure you’re going to get a full gynecological obstetric history, assess vital signs, place the fetus on a monitor, position the patient on their left side. Make sure you have IV access for fluids, medications, complete a vaginal exam, and provide patient education. Some desired outcomes: labor will be suppressed, and pregnancy maintained until fetal maturity. 

So, we’re going to go ahead and get started on the care plan. We’re going to make sure that we’re going to put in here some subjective data of what the patient may tell you or some objective data that we’re going to see in a patient. So, one of the big things is going to be some frequent contractions. Mom will have frequent contractions and also any sort of vaginal spotting or bleeding. And also, you’re going to notice for any sort of preterm labor that the cervix is going to be dilated greater than four centimeters. So, if you think for a full centimeter, like the 10 centimeters across here, it’s just going to be dilated just a little bit, to like, probably about here. So, some nursing interventions that we’re going to do for this patient, we want to make sure we’re getting a full history from the mom. So, you want to know if they’ve had any preterm labor or pregnancies that have been too close together in the past, because that can increase the risk of preterm labor and also determine what symptoms began and when they began. You also want to make sure we’re getting vital signs on the mom. So, you want to get a baseline set of vitals before any sort of intervention. Other things we want to do we want to place an external fetal monitor on the mom. This is going to allow you to observe and monitor the frequency and quality of the contractions that the mom is having as well as notice any sort of signs of fetal distress – very, very important. We want to make sure we’re placing the patient in a comfortable position on the left side, which is important. This will provide comfort as well as making sure we’re reducing contractions and maintaining the maternal fetal blood flow. We want to make sure we have IV access for fluids and medications. Certain medications that we might give are some magnesium sulfate, antiemetics, tocolytics, corticosteroids, antibiotics, or analgesics. So, fluids, we want to make sure that we’re treating for dehydration as dehydration can be a major cause of preterm labor also if medications are given and able to stop the preterm labor and also progress from having delivery. We want to perform a vaginal exam, so we want to make sure we’re assessing for that dilation, and again, dilation preterm is greater than four centimeters. We want to make sure we’re providing patient education. So, any symptoms of early labor, we want to make sure we’re educating the patient on when to notify the physician and how time she has been contracting for or how much time that has been between the contractions for the mom, making sure she’s avoiding smoking, she’s avoiding any sort of alcoholic intake and making sure that she’s having proper nutrition throughout her pregnancy. And so, if preterm labor cannot be stopped, we want to make sure we’re preparing the patient for delivery. So, we’re going to give them education resources and above all give them emotional support, because this can be pretty stressful for the mom, especially since she’s not at that 40-week mark and is a lot earlier. So, we want to make sure that we’re there for her in addressing any sort of questions or concerns that she or any family member may have. 

So key points we want to go back over. So, the body begins preparing for delivery earlier than expected. Normal pregnancy lasts about 40 weeks, but in preterm, contractions cause the cervix to begin and open before 37 weeks. Causes that may cause the preterm labor: hypertension, pregnancy with multiple babies, previous babies, abdominal trauma, poor prenatal care, and the use of alcohol or street drugs, which is very common. Some subjective and objective data that you will see with these moms: they’ll have regular frequent contractions, a dull back ache, pelvic pressure, change in the type of discharge, vaginal spotting, lightly pre rupture of the membrane. So, PROM and cervical dilation greater than four centimeters. We want to assess vital signs and we want to make sure that we’re monitoring the fetus. Make sure that there’s no fetal distress. We want to give them some medications and of course education. So, we want to give fluids, make sure that the mom is hydrated, because dehydration is a major cause of preterm labor and any medications to stop preterm labor. We want to educate the patient on decreasing preterm labor and surgery if they end up having surgery. 

So, you guys are doing great. It was a great care plan for today. We love you guys. Go out, be your best self today and as always happy nursing.

 

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