Core Nursing Explanation
Key Concept Analysis: This question tests the priority nursing intervention for a patient with
Chorioamnionitis (intra-amniotic infection) during labor. Chorioamnionitis is a serious bacterial infection of the fetal membranes (chorion and amnion) and amniotic fluid. The pathophysiology involves ascending bacteria from the vagina, which triggers a maternal inflammatory response, leading to fever, maternal and fetal tachycardia, and uterine tenderness. The greatest risks are progression to maternal
Sepsis and fetal infection (neonatal sepsis).
Answer Rationale:
Key Point! The cornerstone of management for chorioamnionitis is
prompt administration of broad-spectrum intravenous (IV) antibiotics. This intervention is the priority because it directly targets the cause—the infection. Antibiotics reduce maternal morbidity, prevent progression to sepsis, and decrease the risk of neonatal infection. The scenario presents classic signs: maternal fever (
101.2°F / 38.4°C), maternal tachycardia (
110 bpm), and fetal tachycardia (
170 bpm). Administering antibiotics immediately is the most critical action to stabilize both patients.
Distractor Analysis:
•
Watch out for confusion! Option ② (Prepare for cesarean): While delivery (often expedited) is part of the management plan to remove the source of infection,
antibiotics must be given first. A cesarean delivery performed in the setting of untreated infection carries a significantly higher risk of maternal wound infection and postpartum endometritis. The standard of care is to administer antibiotics and then proceed with delivery, typically vaginally if possible.
• Option ③ (Increase IV fluids): Supporting maternal circulation with IV fluids is an important supportive measure for fever and tachycardia, but it does not treat the underlying infection. It is a secondary intervention.
• Option ④ (Apply cool compresses): Managing maternal fever for comfort and to reduce fetal tachycardia is appropriate, but it is a symptomatic treatment. It does not address the root cause, which is the bacterial infection.
Related Concepts: The management of chorioamnionitis follows the principle of "treat the cause first." After antibiotic administration, other interventions include: antipyretics (e.g., acetaminophen), continuous fetal monitoring (due to increased risk of non-reassuring fetal heart rate patterns), and planning for delivery. The fetus is not considered sterile once chorioamnionitis is diagnosed.
Concept Summary
•
Chorioamnionitis: Infection of the amniotic sac and fluid.
•
Classic Triad: Maternal fever, maternal tachycardia, fetal tachycardia. (Uterine tenderness and foul-smelling amniotic fluid are also signs).
•
Pathophysiology: Ascending bacterial infection → inflammatory response → risks of maternal/fetal sepsis.
•
Priority Intervention: Immediate IV antibiotic administration (e.g., ampicillin + gentamicin).
•
Goal of Care: Treat infection, prevent sepsis, achieve safe delivery.
Side-by-Side Comparison!
| Condition | Key Feature | Priority Nursing Intervention |
|---|
| Chorioamnionitis | Infection of membranes; Fever, maternal/fetal tachycardia | Administer IV antibiotics to treat infection |
| Prolapsed Umbilical Cord | Cord presents before fetal head; Fetal bradycardia | Relieve cord pressure (e.g., knee-chest position, manual elevation) |
| Placental Abruption | Premature separation of placenta; Painful, dark vaginal bleeding; rigid uterus | Stabilize mother (ABCs), prepare for emergency delivery |
Anatomy, Physiology & Pharmacology Points
•
Anatomy/Physiology: The amniotic sac is normally a sterile environment. Rupture of membranes (ROM) or prolonged labor can allow vaginal flora (e.g., Group B Streptococcus, E. coli) to ascend and cause infection.
•
Pharmacology: First-line antibiotic regimens typically include a penicillin (e.g., ampicillin) for Gram-positive coverage and an aminoglycoside (e.g., gentamicin) for Gram-negative coverage. Clindamycin may be added for anaerobic coverage, especially if a cesarean is performed.
Memory Tips
• Mnemonic for Chorioamnionitis Signs: "
Fever,
Tachycardia (Mom & Baby),
Uterine tenderness" (FTU).
• Priority Rule: "
Antibiotics
Before
Baby" – Treat the infection before focusing on delivery mode.
High-Frequency NCLEX Topics
Chorioamnionitis is a high-yield OB complication. The NCLEX loves to test:
1. Recognizing the signs (fever + tachycardia in mom and fetus).
2. Knowing the
priority intervention is IV antibiotics.
3. Understanding that delivery is indicated but not the *first* nursing action.
Watch Out for Question Variations!
• Variation 1: "The nurse notes foul-smelling amniotic fluid. What is the
priority assessment?" (Answer: Assess maternal vital signs, especially temperature).
• Variation 2: "One hour after administering antibiotics for chorioamnionitis, the fetal heart rate shows recurrent late decelerations. What should the nurse do
next?" (Answer: Assist with expedited delivery, as antibiotics have been initiated and the fetus is now showing signs of compromise).
• Variation 3: "Which finding in a newborn would the nurse associate with maternal chorioamnionitis?" (Answer: Signs of neonatal sepsis: temperature instability, poor feeding, lethargy, respiratory distress).