RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Obstetrics & Gynaecology
Hard
In the emergency department you are receiving a patient who experiences preterm labor. What would be your priority nursing action for this patient?
Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Explanation
- The priority nursing action is to place the patient in a side-lying position, preferably the left lateral position.
- This position relieves the pressure of the pregnant uterus on the inferior vena cava and aorta, a condition known as aortocaval compression.
- Relieving this compression improves venous return to the mother's heart, which in turn increases cardiac output and enhances blood flow to the placenta.
- Improved uteroplacental perfusion provides the fetus with more oxygen and nutrients, which is crucial during the stress of preterm labor.
- This position can also help reduce uterine irritability and the frequency of contractions.
Why Other Options Were Wrong
- Option A: Encouraging the patient to walk can stimulate uterine contractions and may accelerate the progression of preterm labor, which is contrary to the goal of management.
- Option C: An hCG (human chorionic gonadotropin) test is used to confirm the presence of a pregnancy, typically in the early first trimester. In a patient with established preterm labor, pregnancy is already confirmed, and this test provides no useful information for immediate management.
- Option D: This is a dangerous action. Establishing intravenous (IV) access is a high priority in preterm labor. It is essential for hydration and for the administration of medications such as tocolytics (to slow contractions), corticosteroids (for fetal lung maturity), magnesium sulfate (for neuroprotection), or antibiotics.
Related Visual
Clinical Relevance
- Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Priority nursing interventions for preterm labor in acute care settings.
- Positioning is a rapid, non-invasive, and effective nursing intervention that can have immediate positive effects on fetal well-being by improving placental perfusion.
- Nurses in the emergency department and labor and delivery units must recognize the signs of preterm labor and act quickly. The initial actions, including positioning and establishing IV access, are critical components of the stabilization process.
- What if? If the fetal heart rate tracing showed late decelerations (a sign of uteroplacental insufficiency), placing the mother in the left lateral position would be the absolute first and most critical intervention, often performed simultaneously with administering oxygen and increasing IV fluids.
How to Approach the Question
- First, identify the key elements of the question: the patient is in preterm labor, the setting is the emergency department, and the question asks for the priority nursing action.
- Understand the pathophysiology of preterm labor and the immediate goals of care: to improve maternal and fetal stability and potentially inhibit or slow labor.
- Evaluate each option based on its ability to meet these goals.
- Option A (walking): Consider the effect of gravity and activity on uterine contractions. Walking is likely to increase, not decrease, labor activity. Eliminate this option.
- Option B (side-lying position): Recall the physiological changes in late pregnancy. The gravid uterus can compress major blood vessels (aortocaval compression). A side-lying position relieves this pressure, improving blood flow to the placenta and fetus. This is a direct, beneficial intervention. Keep this as a strong candidate.
- Option C (hCG test): Evaluate the purpose of this test. It confirms pregnancy. Since the patient is in preterm labor, pregnancy is already known. This is a diagnostic test for a different clinical question and not a priority action. Eliminate this option.
Concept Tested & Keywords
- Concept Tested: Priority nursing interventions for preterm labor.
- Stem keywords: preterm labor, emergency department, priority nursing action
- Lead-in keywords: priority
- Clinical cues: The setting is the emergency department, which emphasizes the need for immediate and effective interventions.
- Clinical cues: The diagnosis is preterm labor, where the primary goals are to ensure maternal and fetal stability and, if possible, delay delivery.
Question ID
Qbtd5SpaSzrK58iGVc7fKI
Reference Book
E6 Obstetrics Williams p. 23-42
Practise the full RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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