# A nurse is caring for a laboring client at 36 weeks gestation who has been diagnosed with chorioamnionitis. The client's temperature is 101.2°F (38.4°C), pulse is 110 bpm, and fetal heart rate shows moderate tachycardia at 170 bpm. Which nursing intervention should be the priority?

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> subject: Maternal Newborn Health

## 문제

A nurse is caring for a laboring client at 36 weeks gestation who has been diagnosed with chorioamnionitis. The client's temperature is 101.2°F (38.4°C), pulse is 110 bpm, and fetal heart rate shows moderate tachycardia at 170 bpm. Which nursing intervention should be the priority?

## 보기

1. Encourage frequent position changes to promote comfort
2. Administer prescribed intravenous antibiotics immediately **✔ 정답**
3. Apply cool compresses to reduce maternal fever
4. Increase oral fluid intake to prevent dehydration

**정답: 2**

## 해설

Immediate IV antibiotics are the priority to prevent maternal and fetal sepsis in chorioamnionitis. Other interventions are supportive but secondary to infection control.

## 심화 해설

Understanding Chorioamnionitis and Clinical Priority

The client’s presentation—maternal fever of 101.2°F (38.4°C), maternal tachycardia at 110 bpm, and fetal tachycardia at 170 bpm—is a classic triad for chorioamnionitis, an intra-amniotic infection. This condition represents an obstetric emergency because it carries serious maternal-newborn risks, including neonatal sepsis, pneumonia, and meningitis [1]. The pathophysiologic cascade begins with bacteria ascending from the lower genital tract, triggering a maternal and fetal inflammatory response. The fetal tachycardia is a direct compensatory mechanism driven by increased metabolic demand and the pyrogenic effect of inflammatory cytokines crossing the placenta, not merely a response to maternal fever.

When prioritizing nursing interventions for a client with chorioamnionitis, the NCLEX-RN framework requires you to apply the ABCs (Airway, Breathing, Circulation) and the principle of treating the underlying cause before addressing secondary symptoms. While the fetus is not yet delivered, the source of both maternal and fetal instability is the infectious process. Delaying antimicrobial therapy allows bacterial proliferation and intensifies the inflammatory cascade, directly worsening fetal and maternal outcomes. An evidence-based infection prevention bundle approach underscores that timely recognition and treatment are critical to reducing the incidence of newborns affected by chorioamnionitis [1].

Analysis of the Priority Intervention

Administering prescribed intravenous antibiotics immediately (Option 2) is the priority because it directly halts the underlying pathophysiology. Broad-spectrum antibiotics are the cornerstone of treatment, aiming to eradicate the causative organisms and stop the progression of the infection. Stewardship principles highlight that appropriate antibiotic prescribing is essential in managing chorioamnionitis [2]. While the specific regimen may vary—options include ampicillin with gentamicin, or single agents like cefoxitin or piperacillin/tazobactam—the critical nursing action is the prompt initiation of the prescribed therapy [2]. Every hour of delay increases the risk of neonatal morbidity.

The other options, while not incorrect in a comprehensive care plan, are supportive measures that do not address the primary, life-threatening problem. Encouraging frequent position changes (Option 1) is a comfort and labor progress measure but has no direct impact on the infectious source. Applying cool compresses (Option 3) may provide temporary relief for maternal fever but does not treat the infection or stop the fetal inflammatory response. Increasing oral fluid intake (Option 4) is often contraindicated in active labor due to the risk of aspiration, and even if allowed, it is a supportive measure for hydration that is secondary to definitive antimicrobial therapy. The nursing priority is always the intervention that will most directly prevent the most serious complications, which in chorioamnionitis is achieved by immediate antibiotic administration.References (research sources)

- [1]A Three-Intervention Evidence-Based Bundle to Reduce Chorioamnionitis Among Patients with Prelabor Rupture of Membranes.Research articleLander S, Cardaci R, Mehri S, Deeb J. (2026) · DOI: 10.1097/nmc.0000000000001161

- [2]Stewarding waste and antimicrobials: an assessment of chorioamnionitis regimens.Research articleBailey P, Foy-Crowder A, Kohn J, Ereshefsky B, Beville AS, Stuart S, Crockett A. (2025) · DOI: 10.1017/ash.2025.10156

## 임상 시나리오

Clinical Practice Guide: Chorioamnionitis

Immediate Actions

- Administer broad-spectrum intravenous antibiotics (e.g., Ampicillin and Gentamicin) as prescribed without delay; this is the definitive treatment to halt the infectious process.

- Notify the obstetric provider immediately upon recognition of the classic triad: maternal fever, maternal tachycardia, and fetal tachycardia.

- Initiate continuous maternal and fetal monitoring to assess for worsening tachycardia, uterine tachysystole, or signs of fetal distress.

Ongoing Management

- Plan for expedited delivery; chorioamnionitis is not an indication for immediate cesarean unless other obstetric factors exist, but labor should be actively managed.

- Administer antipyretics (e.g., Acetaminophen) as ordered to reduce maternal fever, which may improve fetal heart rate tracing after antibiotics are initiated.

- Monitor for signs of maternal sepsis (hypotension, altered mental status) and neonatal infection risk postpartum.

Documentation

- Record time of antibiotic administration, maternal vital signs, fetal heart rate pattern, and uterine activity every 15 minutes during active labor.

- Document communication with the provider and the plan for delivery timing.

## 핵심 개념

- **Chorioamnionitis** — An intra-amniotic infection, typically ascending from the lower genital tract, causing maternal and fetal inflammatory responses and presenting with maternal fever, maternal and fetal tachycardia.
- **Fetal Tachycardia** — A fetal heart rate above 160 bpm, often a compensatory response to maternal fever, infection, or hypoxia, driven by increased metabolic demand and inflammatory cytokines.
- **ABC Framework** — A prioritization model (Airway, Breathing, Circulation) used in nursing to address life-threatening conditions first, extended to treating the underlying cause of instability.

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