All pregnant clients are screened with a vaginal-rectal culture at 36 to 37 weeks gestation.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A pregnant nurse is assigned a group of pediatric patients. Which child should she avoid caring for to protect her fetus?
Answer: A. Rubella (German measles) is teratogenic and can cause congenital rubella syndrome if a nonimmune pregnant woman is infected, especially in the first trimester. A nonimmune pregnant nurse should not care for a child with rubella.
Question 2 of 3
A nurse is teaching a community group about hepatitis A. Which statement about transmission is accurate?
Answer: B. Hepatitis A is transmitted by the fecal-oral route, often through contaminated food or water or poor hand hygiene, especially in crowded or unsanitary conditions. It is not spread primarily through blood transfusion, sexual blood exposure, or shared needles, which are routes for hepatitis B and C. Good hand washing and sanitation are key prevention measures.
Question 3 of 3
A client with schizophrenia experiencing command hallucinations to harm others is admitted to the unit. Which is the priority nursing action?
Answer: B. Command hallucinations directing harm to others pose an immediate safety risk, so the priority is to ensure the safety of the client, other clients, and staff, which may include closer observation, a low-stimulation environment, and reducing access to potential weapons. Group therapy, medication teaching, and discharge planning are appropriate later but do not take precedence over immediate safety during active, dangerous hallucinations.
Keep the streak going with more questions like these, each with a full rationale.
What is group b streptococcus?
Universal screening and intrapartum antibiotics dramatically reduce neonatal infection. Prevention centers on timely penicillin during labor.
Key points to remember
- All pregnant clients are screened with a vaginal-rectal culture at 36 to 37 weeks gestation.
- GBS-positive clients receive IV antibiotic prophylaxis during labor, ideally at least 4 hours before delivery.
- Intravenous penicillin G is the first-line agent; ampicillin is an alternative, and cefazolin or clindamycin/vancomycin are used for penicillin allergy.
- Treatment is given during labor, not during pregnancy, because colonization can recur.
- Risk factors warranting treatment without a culture include preterm labor, ruptured membranes over 18 hours, maternal fever, or a previous GBS-affected infant.
Nursing priorities
- Identify GBS status on admission and initiate IV antibiotics promptly once labor begins or membranes rupture.
- Time antibiotic administration to achieve at least 4 hours of coverage before delivery when possible.
- Monitor the newborn for signs of early-onset sepsis after birth.
- Document the number of antibiotic doses and the timing relative to delivery for the newborn team.
Labs & values
Patient teaching
- A positive GBS test does not mean you are sick; antibiotics during labor protect your baby.
- Go to the hospital promptly when your water breaks or labor starts so antibiotics can be started in time.
- GBS status can change, so screening is repeated with each pregnancy.
Red flags: report now
- Newborn temperature instability, grunting, poor feeding, or lethargy may indicate GBS sepsis and require immediate evaluation.
- Delaying or omitting intrapartum antibiotics in a GBS-positive client increases the risk of neonatal sepsis.
- Maternal fever in labor with GBS colonization signals possible chorioamnionitis and must be reported.
References
Clinical references for this topic
