Lee Arthur VSIM NSG 270 Brenda Patton
CONCEPT MAP WORKSHEET
DESCRIBE DISEASE PROCESS AFFECTING PATIENT
(INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)
Group B Strep is a gram positive bacteria that can be found in adults and infants. It is often found within the lower GI tract or the intestines;
however can colonize in the rectum, vagina, cervix and the urethra. Normally, Strep B doesn’t cause any problems unless there are
underlying medical conditions such as diabetes, and liver disease. It can also cause problems when a woman is pregnant. Testing and
rd
screening are usually done around the 3 trimester. An infant can be exposed to the Strep B upon vaginal birth due to the fluids that may
contain the Strep B bacteria. Early onset can be as early as 48 hours to 1 week after birth. Late onset can occur after the first week of birth
up to three months. Menningitis is the usual manifestation. Signs and symptoms may include a fever, difficulty feeding or breathing, feeling
of lethargy, irritable and jaundice. To diagnose Strep B a screening can be done if a woman is pregnant and between 35-37 weeks gestation.
If the test is positive there will be implications put in place to protect the infant from contracting the bacteria upon delivery. If the infant
seems to become ill a physician may order a urine culture, chest x-ray or even a lumbar puncture. Treatment for the bacteria is usually a
group of antibiotics given orally or IV. During pregnancy these anitibiotics are consider safe: penicillin, cephalexin. As a nurse we should
perform some interventions to help our patients. These may include determine status of maternal membranes, monitoring fetal heart rates.
Administer medications as ordered: analgesics, antipyretics, and antibiotics. Continued on Page 7.
DIAGNOSTIC TESTS PATIENT INFORMATION ANTICIPATED PHYSICAL
(REASON FOR TEST AND RESULTS) FINDINGS
Group B strep culture: Positive result can lead 18 year old female fever
To preterm labor or PROM; can be passed to G1P0 abdominal tenderness
Fetus with delivery 38 2/7 weeks gestation Burning upon urination
WBC: 11 elevated; can indicate infection Admitted to L&D for assessment of labor malodorous discharge
Fetal Heart Rate Monitoring Ruptured membranes edema in extremities
Amnisure testing 50% effacement reports “gush of fluid from vagina”
4cm dilation clear fluids present
Fetus is at -2 station
NKDA
Height: 165cm
Weight: 68kg
Smokes ½ pack per week
ANTICIPATED NURSING INTERVENTIONS
Administer antibiotics as ordered
Fetal heart monitoring
I&O assessment
Monitor vitals: pulse, respiratory rate, temperature q2hour; notify provider if temper greater than 100*F
Ambulation of patient
Preparation for birth
Obtain vaginal/rectal cultures for streptococcus beta-hemolytic if not done
Obtain vaginal culture for chlamydia and Neisseria gonorrhoeae
Vaginal examination limitation
Monitor uterine contractions
Encourage hydration
Obtain labs: CBC
Anticipate prescription for 7-day antibiotic broad spectrum
Education of breathing exercises
, vSim ISBAR ACTIVITY STUDENT WORKSHEET
INTRODUCTION Rebekah Taylor, SN from labor and delivery reporting on Brenda
Patton
Your name, position (RN), unit you are
working on
SITUATION Brenda Patton, 18-year-old female admitted this morning to labor and
delivery for further assessment due to rupture of membranes. She is 38
Patient’s name, age, specific reason for visit 2/7 weeks gestation; G1P0. Stated that her water broke this morning;
consisted of a clear liquid. Full Code. NKDA, height 165cm, weight
68kg. Smokes ½ pack cigarettes per week. Group B strep was
performed at 36 weeks gestation results were positive. Boyfriend at
bedside is next of kin; mother has been notified via Ms. Patton about
admission.
BACKGROUND Ms. Patton was admitted for diagnosis of rupture of membranes on
January 12, 2021. Her amnisure test was positive and upon vaginal
Patient’s primary diagnosis, date of examination she is 50% effaced, 4 cm dilated and the fetus is at a -2
admission, current orders for patient station. Current orders are: Clear liquid diet, Activity: up Ad Lib, BP
Q1H X2 then Q4H, Temperature, Heart rate, respiratory rate Q1H;
Temperature Q2H after ROM intrapartum or temperature >100.4
orally; head to toe assessment Q4H; deep tendon reflexes Q4H;
continuous pulse oximetry; continuous external monitoring (fetal heart
rate and uterine acceleration); vaginal examination if indicated;
continuous infusion: peripheral locked; CBC stat; Vagino-rectal Group
B strep obtained if not already in lab; Medications: Initiate intrapartum
prophylaxis for Group B strep disease with Penicillin 5million units
IVPB now and 2.5million units IVPB Q4H until delivery if any one of
the following criteria is met: Previous infant with early-onset GBS
disese, GBS bacteruria during current pregnancy, Positive vagino-
rectal GBS screening culture; Promethazine 12.5mg IVPB Q4H PRN
for nausea/vomiting; Lactated Ringers 500ml IV bolus for
nonreassuring fetal heart rate; Respiratory: Oxygen 10L/min per non
rebreather mask for nonreassuring (cat II or III) FHR, may D/C when
FHR returns to reassuring (cat I); Call physician if: Temperature
>38*C, HR <50 >100, RR <12 >24, BP sys <90 >140; dia <90, SpO2
<94%, meconium stained fluid, non-reassuring FHR.
NSG 270 Brenda Patton
Rebekah Taylor VSIM
CONCEPT MAP WORKSHEET
DESCRIBE DISEASE PROCESS AFFECTING PATIENT
(INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)
Group B Strep is a gram positive bacteria that can be found in adults and infants. It is often found within the lower GI tract or the intestines;
however can colonize in the rectum, vagina, cervix and the urethra. Normally, Strep B doesn’t cause any problems unless there are
underlying medical conditions such as diabetes, and liver disease. It can also cause problems when a woman is pregnant. Testing and
rd
screening are usually done around the 3 trimester. An infant can be exposed to the Strep B upon vaginal birth due to the fluids that may
contain the Strep B bacteria. Early onset can be as early as 48 hours to 1 week after birth. Late onset can occur after the first week of birth
up to three months. Menningitis is the usual manifestation. Signs and symptoms may include a fever, difficulty feeding or breathing, feeling
of lethargy, irritable and jaundice. To diagnose Strep B a screening can be done if a woman is pregnant and between 35-37 weeks gestation.
If the test is positive there will be implications put in place to protect the infant from contracting the bacteria upon delivery. If the infant
seems to become ill a physician may order a urine culture, chest x-ray or even a lumbar puncture. Treatment for the bacteria is usually a
group of antibiotics given orally or IV. During pregnancy these anitibiotics are consider safe: penicillin, cephalexin. As a nurse we should
perform some interventions to help our patients. These may include determine status of maternal membranes, monitoring fetal heart rates.
Administer medications as ordered: analgesics, antipyretics, and antibiotics. Continued on Page 7.
DIAGNOSTIC TESTS PATIENT INFORMATION ANTICIPATED PHYSICAL
(REASON FOR TEST AND RESULTS) FINDINGS
Group B strep culture: Positive result can lead 18 year old female fever
To preterm labor or PROM; can be passed to G1P0 abdominal tenderness
Fetus with delivery 38 2/7 weeks gestation Burning upon urination
WBC: 11 elevated; can indicate infection Admitted to L&D for assessment of labor malodorous discharge
Fetal Heart Rate Monitoring Ruptured membranes edema in extremities
Amnisure testing 50% effacement reports “gush of fluid from vagina”
4cm dilation clear fluids present
Fetus is at -2 station
NKDA
Height: 165cm
Weight: 68kg
Smokes ½ pack per week
ANTICIPATED NURSING INTERVENTIONS
Administer antibiotics as ordered
Fetal heart monitoring
I&O assessment
Monitor vitals: pulse, respiratory rate, temperature q2hour; notify provider if temper greater than 100*F
Ambulation of patient
Preparation for birth
Obtain vaginal/rectal cultures for streptococcus beta-hemolytic if not done
Obtain vaginal culture for chlamydia and Neisseria gonorrhoeae
Vaginal examination limitation
Monitor uterine contractions
Encourage hydration
Obtain labs: CBC
Anticipate prescription for 7-day antibiotic broad spectrum
Education of breathing exercises
, vSim ISBAR ACTIVITY STUDENT WORKSHEET
INTRODUCTION Rebekah Taylor, SN from labor and delivery reporting on Brenda
Patton
Your name, position (RN), unit you are
working on
SITUATION Brenda Patton, 18-year-old female admitted this morning to labor and
delivery for further assessment due to rupture of membranes. She is 38
Patient’s name, age, specific reason for visit 2/7 weeks gestation; G1P0. Stated that her water broke this morning;
consisted of a clear liquid. Full Code. NKDA, height 165cm, weight
68kg. Smokes ½ pack cigarettes per week. Group B strep was
performed at 36 weeks gestation results were positive. Boyfriend at
bedside is next of kin; mother has been notified via Ms. Patton about
admission.
BACKGROUND Ms. Patton was admitted for diagnosis of rupture of membranes on
January 12, 2021. Her amnisure test was positive and upon vaginal
Patient’s primary diagnosis, date of examination she is 50% effaced, 4 cm dilated and the fetus is at a -2
admission, current orders for patient station. Current orders are: Clear liquid diet, Activity: up Ad Lib, BP
Q1H X2 then Q4H, Temperature, Heart rate, respiratory rate Q1H;
Temperature Q2H after ROM intrapartum or temperature >100.4
orally; head to toe assessment Q4H; deep tendon reflexes Q4H;
continuous pulse oximetry; continuous external monitoring (fetal heart
rate and uterine acceleration); vaginal examination if indicated;
continuous infusion: peripheral locked; CBC stat; Vagino-rectal Group
B strep obtained if not already in lab; Medications: Initiate intrapartum
prophylaxis for Group B strep disease with Penicillin 5million units
IVPB now and 2.5million units IVPB Q4H until delivery if any one of
the following criteria is met: Previous infant with early-onset GBS
disese, GBS bacteruria during current pregnancy, Positive vagino-
rectal GBS screening culture; Promethazine 12.5mg IVPB Q4H PRN
for nausea/vomiting; Lactated Ringers 500ml IV bolus for
nonreassuring fetal heart rate; Respiratory: Oxygen 10L/min per non
rebreather mask for nonreassuring (cat II or III) FHR, may D/C when
FHR returns to reassuring (cat I); Call physician if: Temperature
>38*C, HR <50 >100, RR <12 >24, BP sys <90 >140; dia <90, SpO2
<94%, meconium stained fluid, non-reassuring FHR.
NSG 270 Brenda Patton
Rebekah Taylor VSIM
