nursing goals for an intrapartum patient.

[nickiluttrell]

so, i'm trying to write a care plan for an intrapartum gbs positive patient. as a second nursing diagnosis, i've added risk for infection r/t prolonged artificial rupture of membrane & gbs positive status. however, now i'm thinking that if the mother is gbs positive it would no longer be risk for and instead, actual infection. initially, when i thought of the risk for diagnosis i was thinking more about risk for chorioamnionitis. mom is still very much at risk for this, yes? also, i have three nursing interventions:

Nursing assessment= Assess patient for signs & symptoms of infection (such as maternal fever, uterine tenderness, general malaise, maternal tachycardia, foul smelling amniotic fluid, or an increased white blood cell count)

Education= Educate patient on importance of reporting signs & symptoms of infection (maternal fever, uterine tenderness, general malaise, maternal tachycardia)

Therapeutic= Administer 2G ampicillin @125mL/30min IV bolus, followed by 1G ampicillin @125mL/30 min q4h until delivery

so, what i really need assistance with are my nursing goals...one long term and one short term. i have such difficulty thinking of an acheivable, measurable, and realistic goal. the first thing i think is that i would like to prevent maternal infection (but, again, is she already gbs infected?) and secondly, i think even if mom is already infected, i'd like to prevent fetal infection. both of those seem like long term goals for me. could i say something like, "the mother will state signs and symptoms of maternal infection" as a short term?

soooooo confused and aggravated! please help!

[nurseprnRN, BSN, RN]

since you aren't prescribing the antibiotic and it is assumed that the nurse will follow the medical plan of care, you can't put that in your nursing interventions. is there something a nurse would do to assess what was happening with a patient getting antibiotics?

is there something else that could be actually or potentially going on with this woman? emotional? anticipatory grief? anxiety? spousal support/stress/etc? remember, intrapartum involves the whole family.

you wouldn't be in a position to prevent fetal infection, but you could hope for some other positive outcomes of your nursing care. what might those be?

[nickiluttrell]

because the antibiotics are being administered IV, i guess i could frequently assess the patient's IV site. and as for a long term goal...could i say something like, "client will receive prophylactic antibiotics during labor and prevent transmission of group b strep from mother to infant"? if risk for infection is my diagnosis, i can't imagine how any other goal (besides infection prevention) would be applicable.

[nurseprnRN, BSN, RN]

you could, but that's a real bare minimum. you could also be sure she knows what the effects are supposed to be, what side effects to report to you, watch for development of allergic sx/sx (these can develop after a few doses, you know); monitor for effectiveness (what would you see if the antibiotics are doing their job, or not?). think big; nurses have to see the big picture. i know that as a student you don't know how to do that yet, but this is how you learn:d.