CASE STUDY 5:

P.T. is a married 30-year-old gravida 4, para 1203 at 28 weeks' gestation. She arrives in the
labor and delivery unit at a level 2 hospital complaining of low back pain and frequency of
urination. She states that she feels occasional uterine cramping and believes that her
membranes have not ruptured.

1. You are the charge nurse and admit P.T. Based on the information you have been given,
identify the two most likely diagnoses for P.T.
→ Infection R/T relaxation of ureters AEB pt experiencing low back pain and frequency
of urination
→ Risk for Braxton HIcks contractions R/T occasional uterine cramping AEB patient’s
verbalization

2. You need additional information from P.T. to determine what you will do next. What
important questions do you need to ask to differentiate what is going on with P.T.?
→ Have you had pain during urination?
→ When was the start of your low back pain?
→ What is the characteristics of your low back pain?
→ What is the level of your low back pain on a scale of 1 out of 10?
→ How frequent are the cramps?
→ How long do the cramps last?
→ Are the cramps regular?
→ Have you had excessive amount of spontaneous urination?
→ Have you had a fever since the onset of your symptoms?

3. What actions would you take to help identify her underlying problem before calling the
health care provider?
→ Tell P.T that it is normal to experience frequency in urination in her term and that
the uterine cramps and your growing baby caused the lower back pain.

4. Early recognition of preterm labor is essential to successfully implement interventions.

The diagnosis of preterm labor is based on what three major diagnostic criteria?
 → Gestational age between 20 - 37 weeks
→ Uterine activity (contractions)
→ Progressive cervical changes (Effacement of 80% cervical dilation 2 cm)

5. What is the significance of misdiagnosing preterm labor?

→ Misdiagnosis of preterm labor can cause danger the health of both the mother and the fetus
since this can lead to an unsuitable use of medication which can affect them