Trend: Braxton Hicks – NCLEX-RN®

00:01 Let's meet Liv. Liv is a gravita 1 para 0, G1P0, who's a client at 31 weeks gestation.

00:12 She presents to labor and delivery triage and she reports to the nurse that she's been having contractions on and off all day long.

00:20 Liv fears that she might be in labor. Let's listen to her story.

00:25 At 15:45 when she arrives on the unit, the nurse puts Liv on the monitor and finds that the fetal heartrate is regular at 150 beats per minute and there are no signs of fetal distress.

00:37 Next, the nurse performs a vaginal exam and notes no cervical changes, so, the cervix is closed.

00:44 The membranes are not ruptured and there is no bleeding noted on the exam.

00:48 On the monitor, the contractions are irregular and per Liv, they do not seem to be increasing in intensity.

00:56 The client reports, that's Liv, that the pain is 4 out of 10 but she does say that lying down helps.

01:05 Now, let's move forward.

01:07 An hour and a half later, that's 17:15, the nurse rechecks Liv's cervix and finds it unchanged.

01:14 On the monitor, the contractions continue to be irregular.

01:19 So, the decision is made to discharge the patient home.

01:24 So, now, let's look at the scenario from the perspective of a next generation question.

01:29 So, we can see the nurse's notes of everything that happened and now, we want to determine which of the following statements by the nurse would be something the nurse would say that would be correct during the discharge.

01:42 We'll look at these as a select all that apply type question. It's a lot of questions.

01:47 So, let's take each one, one by one.

01:51 Take the ibuprofen as ordered and do not go above the recommended daily amount.

01:56 Ibuprofen is a non-steroidal anti-inflammatory and it can cause serious kidney problems for the fetus and it can also cause premature closure of the patent ductus. Rest on your left side.

02:08 If you can remember from maternity, resting on the left side increases circulation.

02:13 It increases cardiac output and blood flow.

02:17 Increase the amount of water you drink to avoid dehydration.

02:21 Dehydration and exertion can bring on those Braxton hicks contractions.

02:26 Remember that. Come back in 24 hours for a second vaginal exam.

02:33 We've had two vaginal exams already without any cervical change.

02:37 So, having another vaginal exam might actually only increase the risk of infection.

02:44 A cerclage will be placed on your next follow-up visit. This client is 31 weeks.

02:50 It's pretty late to place a cerclage. Come back when your contractions are two minutes apart.

02:56 Well, contractions that are two minutes apart are usually what happens when the patient is around eight centimeters. Would we wanna wait that long? What do you know about the signs of true labor? Hmm, that might be important for determining when someone is in labor.

03:14 You will receive steroids to speed up the long development of your baby in case of an early birth.

03:20 Is she in labor? If she's not in labor, does she need steroids? You may feel these kinds of contractions when your bladder is very full or after exertion.

03:32 So, if we have a full bladder that's pressing on our uterus, would that cause more or less contractions? Let's think about it. So, now, that we have looked at each one of these individual statements, let's go back and choose the right answers.

03:48 Well, rest on your left side, definitely something we would do to help increase our cardiac output and make sure we have more blood flow and slow down contractions.

03:58 Absolutely. Increase water to avoid dehydration because we know that being dehydrated causes contractions.

04:06 That makes sense. What do we know about the differences between true and false labor? Would it be important to teach the client that so they know when to come back? Yes. And you may feel these types of contractions when your bladder is very full or after exertion.

04:21 We want them to know that so that they can differentiate between when it's time to come back or when they should stay home because they may choose to empty their bladder and see if they're still contracting.

04:32 So, these are the correct answers.