by · February 24, 2010
- Severe reduction of amniotic fluid volume (typically less than 500 ml at term); highly concentrated urine.
- Possibility of prolonged, dysfunctional labor (usually beginning before term).
- Fetal risk: renal anomalies, pulmonary hyperplasia, hypoxia, increased skeletal deformities, and wrinkled, leathery skin.
- Exact cause is unknown.
- Any condition that prevents the fetus from making urine or that blocks urine from going into the amniotic sac.
- Contributing factors: uteroplacental insufficiency, premature rupture of membranes prior to labor onset, maternal hypertension, maternal diabetes, intrauterine growth restriction, postterm pregnancy, fetal renal genesis, polycystic kidneys, and urinary tract obstructions.
- Lagging fundal height growth.
- Ultrasonography reveals no pockets of amniotic fluid larger than 1 cm.
- Close medical supervision of the mother and fetus.
- Fetal monitoring
- Amnioinfusion (infusion of warmed sterile normal saline or lactated Ringer’s solution) to treat or prevent variable decelerations during labor.
- Monitor maternal and fetal status closely, including vital signs and fetal heart rate patterns.
- Monitor maternal weight gain pattern, notifying the health care provider if weight loss occurs.
- Provide emotional support before, during, and after ultrasonography.
- Inform the patient about coping measures if fetal anomalies are suspected.
- Instruct her about signs and symptoms of labor, including those she’ll need to report immediately.
- Reinforce the need for close supervision and follow up.
- Assist with amnioinfusion as indicated.
- Encourage the patient to lie on her left side.
- Ensure that amnioinfusion solution is warmed to body temperature.
- Continuously monitor maternal vital signs and fetal heart rate during the amnioinfusion procedure.
- Note the development of any uterine contractions, notify the health care provider, and continue to monitor closely.
- Maintain strict sterile technique during amnioinfusion.
What Do You Think?
The client chosen for this case is R.T.C NORD, female, 26 years of age,. Her religion is Roman Catholic She wasborn on July 24, 1981 in Tuguegarao City. And married to PO1 T.C PNPSAF B96L28 from Paliparan Dasma, Cavite.Admitted to OBward by admitting officer/ admitting physician PSUPT Guiatani on 21 2330H July 2008, roomnumber 3 with hospital no. 04-01-35. Is Dependent, ambulatory, First type of admission with Direct source of Admission. Has admitting Diagnosis of G2P1 PU 23 4/7 weeks AOG, Pre Term Labor. R.T.C is accompanied by husbandwith cc of vaginal spotting or verbalized. LmP is February 22, 2008, EDC is November 29, 2008, RR of 21 cycles/min,BP 130/80mmhg with temp of 36.7 and cardiac rate of 78bpm.Conscious and coherent, with negative uterinecontraction and positive on vaginal spotting.We chose this case because this case is more challenging among other cases that we’ve handled and there’sa lot to learn from this case. In addition to that, the diagnosis of the patient might be a threat to the fetus that needsto be focused on, assessed for nursing intervention to help prevent further complications.
II Nursing HistoryA.Past health History
R.T.C 26 y/o G2P1 doesn’t have history on Hypertension, Diabetes mellitus, and asthma. She is diagnosed of hyperthyroidism during her first pregnancy on the year 2006 on PTV but stop after several weeks.B
. History of Present Illness