Describe other nursing interventions

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Question

"I Think I'm in Labor" Erica is a 15-year-old G 1 P 0 at 39 weeks gestation. She presents by ambulance to the triage area in your labor and birth unit and announces, "I'm here to have my baby. I think I'm in labor." Erica reports that she saw a thick brownish red vaginal discharge several days ago and noticed bright red vaginal spotting when wiping after urinating earlier today. She states that she has lower abdominal cramping ("It feels like the cramps I have with my periods") but denies leakage of vaginal fluid. Erica also reports active fetal movement. When asked to rate her pain, she replies that her current pain level is 8 on a scale of 1 to 10, while alternating between texting on her phone and chatting with her mother, who accompanied her to the hospital.

1. What is the priority concern or client need in this situation? Support your answer with data as stated in the case.

2. List other client needs/problems in this case.

3. Identify any additional information or assessment data that is needed by the nurse in planning care for this client.

4. What nursing actions are appropriate in this situation?

a. What is the priority nursing action? (What should the nurse do first?)

b. Describe other nursing interventions that are important to providing optimal client care.

5. Describe the roles/responsibilities of the interprofessional health care team members (other than nurses) who may be involved in providing care for this client.

Reference no: EM133845142

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