solved

Question
Answered step-by-step
Asked by ChefAntelope1324

A 22 year old woman is admitted to the labor room with a diagnosis of preterm labor. She states that she has not seen a physician because this is her third baby and she “knows what to do while she is pregnant.” She says her last menstrual period was October 13, 2018. She tests positive for Chlamydia and Group B Strep. Her vital signs are: T 1000 F; P 98; R 18; B/P 140/88; and the fetal heart rate is 140-150. Contractions are every 10 minutes lasting 30 to 40 seconds. Her cervical exam is 40% effaced, 2 cm dilated and the fetus is at -1 station. The physician’s orders include the following:

NPO
Bedrest
IV fluids: D5LR- 1,000 mL q8h
Electronic fetal monitoring
Vital signs q4h
Dexamethasone 12 mg IM q 12h for 2 doses
Brethine(terbutaline sulfate) 0.25 mg subcutaneous q 30 minutes for 2 h
Rocephin (ceftriaxone sodium) 250 mg IM stat
Penicillin G 5 million units IVPB (IV piggy back) stat; then 2.5 million units q4h
Zithromax (azithromycin) 500mg IVPB stat and then daily for 2 days

 

 

Calculate her due date.  July 20, 2019

          

 

What is her EGA(estimated gestational age) today (05/11/19) based on her last menstrual period?
30 weeks

          

            

What are some symptoms of preterm labor? List/describe 4. (4) 
 Regular or frequent sensations of abdominal tightening (contractions)
Constant low, dull backache.
A sensation of pelvic or lower abdominal pressure.
Mild abdominal cramps.

 

 

 

List 4 possible predisposing factors of preterm labor with rational for each.(4) 

 

 

Why are IV fluids ordered for this patient? 

 

 

 

Calculate the rate of flow for the D5LR in mL/hr.(1) Calc

          

 

 The label on the dexamethasone reads 8 mg/mL. How many milliliters will you administer per dose? (1) Calc

          

 

In this situation, why is betamethasone ordered? (1) Ref

 

 

 

 

 

The label on the terbutaline reads 1 mg/mL. How many milliliters will you administer for each dose? (1) Calc

     ▪       Brethine(terbutaline sulfate) 0.25 mg subcutaneous q 30 minutes for 2 h

 

In this situation, why is terbutaline ordered? (1) ref

             

 

 

List three possible side effects of terbutaline will you discuss with your patient. (3) ref

          

            

List two lab values that should be monitored when a patient is receiving terbutaline. (2) ref

          

 

  The label on the ceftriaxone states to reconstitute the 1 g vial with 2.1 mL of sterile water for injection, which results in a strength of 350 mg/mL. How many milliliters will you administer?

 

 

In this situation, why is ceftriaxone ordered? (1) ref

                     

 

 What are four possible complications if this infection is present and goes untreated in your patient?  (4)

 

What is a possible complication if this infection is present and goes untreated in the baby? 

      

 

   The instructions state to reconstitute the penicillin G (use the minimum amount of dilutent), add to 100 mL D5W, and infuse over one hour. The drop factor is 15. What is the rate of flow of the stat dose in gtts/min? (1) calc

        

 

In this situation, why is penicillin G ordered? (1) ref

          

            

What can happen if your patient does not receive the penicillin G prior to delivery of her baby?

 

 

 

 

 The instructions for the azithromycin state to reconstitute the 500 mg vial with 4.8 mL until dissolved to yield a strength of 100 mg/mL and add to 250 mL of D5W and administer over at least 60 minutes. At what rate will you set the infusion pump if you choose to administer the medication over 90 minutes? 

 

In this situation, why is azithromycin ordered? (1) ref

          

 

What are four possible complications if this infection is present and goes untreated in your patient?

 

 

 

What are two possible complications if this infection is present and goes untreated in the baby? (2)ref

 

1000 The patient continues to have uterine contractions. A new order has been written:magnesium sulfate 4 g IV bolus over 20 minutes, then 1g/hr.

The label on the IV bag states magnesium sulfate 40g in 1,000 mL.

 

 

 

 

 

What is the rate of flow in mL/hr for the bolus dose? (1) calc

 

 

 

What is the rate of flow in mL/hr for the maintenance dose?(1) calc

 

 

 

In this situation, why is magnesium sulfate ordered? (1) ref

          

 

What is the mechanism of action of magnesium sulfate in this patient? (1) ref

 

 

 

List 4 possible side effects will you discuss with your patient. (4) ref

 

 

2200 -The patient continues to have contractions and her membranes rupture. Her cervix is 90% effaced and dilated 5 cm. The fetus is at 0 station. The following orders are written:

Discontinue the magnesium sulfate.
Pitocin (oxytocin) 10 units/1,000 mLLR,

o Start at 0.5 mU/min increase by 1 mU/min q20 minutes.

Stadol (butorphanol tartrate0 1 mg IVPstat.

 

 

In this situation, why is Pitocin ordered? (1)ref

 

 

What is the rate of flow in mL/hr for the initial dose of Pitocin? (1) calc

 

 

The Pitocin is infusing at 9 mL/hr. How many mU/hr is the patient receiving? (1) calc

          

SCIENCE
HEALTH SCIENCE
NURSING
NUR 202