A nurse is caring for a pregnant client at 32 weeks gestation who has been diagnosed with chorioamnionitis. Which nursing intervention should be the priority?

• Maternal Signs: Fever (often >100.4F or 38C), maternal tachycardia, foul-smelling amniotic fluid, uterine fundal tenderness.
• Fetal Signs: Fetal tachycardia (>160 bpm for 10 minutes or more) is a key indicator of fetal compromise.
• Diagnostic Criteria: Clinical diagnosis is often based on maternal fever plus at least two other signs (e.g., maternal tachycardia, fetal tachycardia, purulent discharge, uterine tenderness).

1. Notify the Provider Immediately: Report assessment findings and prepare for urgent delivery.
2. Prepare for Delivery: Regardless of gestational age, delivery is indicated. Prepare the client for labor induction or cesarean section as ordered.
3. Administer Prescribed Antibiotics: Initiate IV broad-spectrum antibiotics promptly (typically Ampicillin and Gentamicin). This is started immediately, not delayed until after delivery.
4. Continuous Fetal Monitoring: Monitor for worsening fetal tachycardia, late decelerations, or loss of variability indicating fetal distress.

• Fever Management: Administer antipyretics (e.g., acetaminophen) as ordered to reduce maternal fever and fetal tachycardia.
• Hydration: Maintain IV fluids to correct dehydration from fever and support maternal hemodynamics.
• Positioning: Position the client in a left lateral position to maximize uteroplacental blood flow while preparations for delivery are underway.

The infected fetal membranes and amniotic fluid act as a continuous reservoir for bacteria. Antibiotics alone cannot sterilize this reservoir. Delivery of the fetus and placenta is the only way to definitively remove the source of infection and halt the progression to maternal sepsis and worsening fetal compromise.