What are the next steps in evaluation of this patient?

A healthy, 28-year-old patient presents to labor and delivery at 39 weeks of gestation complaining of “campiness” overnight. Her vital signs are all stable. The fetal heart tracing is reassuring, and there do not appear to be any regular contractions. What are the next steps in evaluation of this patient? If it appears, she is in labor, discuss your management plan for this patient, including pharmacologic and follow ups.Student reply to answer to:After reviewing this patient’s vital signs, fetal heart tracing, and irregular contraction pattern, I would check her prenatal records and see if she is a nulliparous or multiparous patient. If the patient is multiparous, I would look to see what type of delivery she previously had with her first baby. This would give me insight on how to proceed with management for this patient. It would also allow me to review her group beta streptococcus (GBS) results in order to determine if IV antibiotics will be needed. Next, I would perform a pelvic examination in order to assess her cervix. Upon examination, the patient’s cervix appears to be dilated. Her examination is 3/80/-2. The next step would be to discuss the plan of care with the patient and her spouse and discuss the option for augmentation since she is already 3 centimeters dilated. “Augmentation refers to the stimulation of uterine contractions when spontaneous contractions have failed to result in progressive cervical dilation or descent of the fetus” (Beckmann, Ling, Herbert, Laube, Smith, Casanova, Chuang, Goepfert, Hueppchen, & Weiss, 2014, p. 108).Prior to beginning the augmentation, an assessment of the maternal pelvis and fetal position should be done. This will ensure that the infant is in the cephalic position, her pelvis is of adequate proportion for delivery, and that the weight of the infant is suitable for a vaginal delivery. After assessing the position, maternal pelvis, and fetal weight, we can begin the augmentation. First, I would start an IV in order to hydrate the patient and also have access to administer the oxytocin. We would continuously monitor the infant’s heart rate, vital signs, as well as the contraction pattern during the augmentation. The patient would be given the option to receive an epidural during her labor to reduce the pain from the contractions. If the patient wishes to use other medications instead of an epidural, she will be given the option to receive IV Stadol and Phenergan. It is essential to discuss how the patient will feel on these medications so she and her partner know what to expect. Another thing to consider would be an amniotomy (AROM) if the membranes have not ruptured and adequate cervical change has not been made. This will be done once the head of the infant if properly engaged. This will allow the infant to be well-engaged in the pelvis through gravity and allow for adequate contact with the cervix upon contractions in order to help the patient dilate. According to Hidalgo-Lopezosa, Hidalgo-Maestre, & Rodriguez-Borrego (2016), “oxytocin is the most frequent medication used for labor induction in obstetrics. Among the known benefits of its use is the improvement of contraction. Oxytocin is commonly used in modern obstetric practice to increase uterine activity, in cases in which the labor process has failed, with the aim to enable it to progress to vaginal delivery. In the case of a multiparous mother, I would assess her cervix hourly because she should be progressing at about 1.5 centimeters per hour.As a labor and delivery nurse, I find that the most important thing is communication. Constantly updating the patient and her support person on what is happening gives them comfort and assurance in the care they are receiving. It will allow them to be open to suggestions because you are developing a trusting relationship with them. Labor can be scary and overwhelming and keeping your patient well informed and involved in their care will make the process easier and more enjoyable for everyone.ReferencesBeckmann R.B., C., Ling, F.W., Herbert, W.N., Laube, D.W., Smith, R.P., Casanova, R., Chuang, A., Goepfert, A.R., Hueppchen, N.A., & Weiss, P.M. (2014). The Obstetrician-Gynecologist’s Role in Screening and Preventive Care. Obstetrics and Gynecology (7th ed.). Philadelphia: Lippincott Williams & Wilkins.Hidalgo-Lopezosa, P., Hidalgo-Maestre, M., & Rodriguez-Borrego, M.A. (2016). Labor stimulation with oxytocin: effects on obstetrical and neonatal outcomes. Revista Latino-Americana de Enfermagem, (24). doi:10.1590/1518-8345.0765.2744.