American College of Obstetricians and Gynecologists. Clostridium Difficile C. Diff Infection and Prevention, Hydronephrosis Nursing Diagnosis and Care Plan, Self Care Deficit Nursing Diagnosis and Care Plan, Erythema redness on the affected body part, region, or area, Warmth and/or tenderness on the affected body part, region, or area. Once you are finished, click the button below. She states the she is 37 weeks along and is nervous about the gush of water she experienced so she decided to come to the L&D triage area. Assess the patients skin on his/her whole body. Your water breaking isnt something you can control. Once the fetal head is engaged, ambulation can be encouraged. In unusual cases in which the patients history suggests preterm PROM, but physical examination findings fail to confirm the diagnosis, ultrasonography may be helpful. A more recent article on preterm labor is available. Your provider may also perform an ultrasound to check the fetuss position and the amount of amniotic fluid inside of your uterus. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers. All reflexes are checked and are intact. Good luck! 4. The risk of chorioamnionitis with term PROM has been reported to be less than 10% and to increase to up to 40% for latency periods exceeding 24 hours (Seaward, P.G et al, 1997) Pt denies any uterus tenderness. Recommended nursing diagnosis and nursing care plan books and resources. Specific nursing interventions will depend on the nature and severity of the risk. Plain soap is good at reducing bacterial counts, but antimicrobial soap is better, and alcohol-based hand rubs are the best. PROM occurs in up to 10% of all pregnancies. For more information, check out our privacy policy. This postpartum . The serious impairment of this system can predispose to severe, even life-threatening, infections. Begin taking temperature every 2 hours after rupture of membranes and more often as indicated. 3 0 obj Integrating travel history in assessment can help stem possible outbreaks and help put infectious symptoms in context for the healthcare team. Premature rupture of membranes, or PROM, is when your water breaks before labor starts. A blue result means the fluid on the paper has a pH of greater than 6.0 and is likely amniotic fluid. Delivery is necessary for patients with evidence of amnionitis. Assess for the presence, existence, and history of the common causes of infection (listed above). See permissionsforcopyrightquestions and/or permission requests. Last reviewed by a Cleveland Clinic medical professional on 12/22/2022. 13. Friction and running water effectively remove microorganisms from hands. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. Berman, A., Snyder, S. J., Kozier, B., Erb, G. L., Levett-Jones, T., Dwyer, T., & Parker, B. Magnesium sulfate to help the fetuss brain. The most important part of the care plan is the content, as that is the foundation on which you will base your care. If the diagnosis of an intrauterine infection is suspected but not established, amniocentesis can be performed to check for a decreased glucose level or a positive Gram stain and differential count can be performed.6 For patients who reach 32 to 33 weeks gestation, amniocentesis for fetal lung maturity and delivery after documentation of pulmonary maturity, evidence of intra-amniotic infection, or at 34 weeks gestation should be considered. Obtain smear specimens from vagina and rectum as prescribed to test for betahemolytic streptococci, an organism that increases the risk to the fetus. Nursing diagnoses handbook: An evidence-based guide to planning care. Compromised host defenses (e.g., radiation therapy, organ transplant, medication therapy). After touching the patients surroundings. This refers to how the pathogen gets into the host. Neonatal Survivability following Previable PPROM after Hospital Readmission for Intervention. The formatting isnt always important, and care plan formatting may vary among different nursing schools or medical jobs. Alleviate or reduce the problems related with the infection. In addition to the above causes, other risk factors include: A separate swab should be used to obtain fluid from the posterior fornix or vaginal sidewalls. Risk for infection related to prolonged rupture of membranes. Zimmerman, S., GruberBaldini, A. L., Hebel, J. R., Sloane, P. D., & Magaziner, J. Elevated temperature.Fever is often the first sign of an infection. They can then collect a sample of fluid for testing. Advise the patient and carer to prevent scratching the affected areas. 22. Its important to note that if you already have an infection at the time of rupture or develop one afterward, delivery is necessary. If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. Your provider may induce labor with medications or allow your labor to progress on its own. Place the patient in protective isolation if the patient is at high risk of infection.Protective isolation is set when the WBC indicates neutropenia. Up to 95% of all births occur within 28 hours of PROM when it happens at term (37 weeks). This is also universally used for those who are at high risk for infection. The first stage of dilatation begins with the initiation of true labor contractions and ends when the cervix is fully dilated. The leading cause of death associated with PROM is infection. Preterm premature rupture of membranes is the rupture of membranes during pregnancy before 37 weeks gestation. Consultation with a neonatologist and physician experienced in the management of preterm PROM may be beneficial. Maintain strict asepsis for dressing changes, wound care, intravenous therapy, and catheter handling. Compromised circulation (e.g., obesity, lymphedema, peripheral vascular disease). Studies have shown that labor induction clearly is beneficial at or after 34 weeks gestation. In some cases, the risk of infection and complications is too high, and delivery is necessary. You may be at higher risk for PPROM or PROM if you have or develop any conditions that weaken the chorioamniotic membrane (the outer layer of the amniotic sac). Rates are as follows: 5. On the other hand, isolation also protects the patient from possible cross-contamination from carers, family, friends, or healthcare staff. Encourage spitting onto a tissue and discarding the tissues immediately. Corticosteroids decrease perinatal morbidity and mortality after preterm PROM.21 A recent meta-analysis21 found that corticosteroid administration after preterm PROM, versus no administration, reduced the risk of respiratory distress syndrome (20 versus 35.4 percent), intraventricular hemorrhage (7.5 versus 15.9 percent), and necrotizing enterocolitis (0.8 versus 4.6 percent) without an increase in the risk of maternal or neonatal infection. A fern test is ordered and comes back as positive. Assess and monitor nutritional status, weight, history of weight loss, and serum albumin.Patients with inadequate nutrition may be anergic or unable to muster a cellular immune response to pathogens, making them susceptible to infection. Wear gloves when handling patient secretions. You have not finished your quiz. (2011). Use of corticosteroids between 32 and 34 weeks is controversial. These include: The biggest concern with PROM is premature birth. The neonate is most likely to be hypothermic. Proper hygiene promotes wellness and prevents further infection. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking. <> Bacterial vaginosis can produce a similar result. Policy. Try to take comfort in that your provider is doing everything they can to make sure you and your baby are safe and healthy. Speculum examination is preferred. It involves placing a drop of your vaginal fluid on the strip of paper and waiting to see if the paper turns blue. . Educating the patient about the disease can raise confidence and understanding of the importance of sticking to the guidelines. -The nurse will educate the patient on 6 signs and symptoms of infection the patient should watch out for. Patients with preterm premature rupture of membranes between 32-36 weeks have been studied and concluded that expedited delivery is generally the best outcome because the risk of infection outweighs letting the baby stay in utero, once the medications are administered between 1-2 days, the likelihood of survival is more favorable (Mercer, 2008). | New Nurse STORYTIME & Tips, NCLEX NGN Study Plan Strategy for Case Studies | Next Generation NCLEX, Left-Sided Heart Failure vs Right-Sided Heart Failure Pathophysiology Nursing NCLEX Review, Left-Sided vs. Right-Sided Heart Failure Nursing Review, Next Generation NCLEX Case Study Sample Questions, Wheezes (High-Pitched) Lung Sound Nursing Review. Its important to note that just because you cant feel contractions, your body is still preparing for labor. 9. Pooling of amniotic fluid in the vagina will be visualized during a speculum examination. Unlike when you pee, you wont be able to hold it in. Prevent infection and other potential complications. Your doctor will be able to help you make the best decisions for you and your baby. It can also cause changes to the fetuss position, which can affect delivery. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. LeMoine F, Moore RC, Chapple A, Moore FA, Sutton E. Nursing care plans: Diagnoses, interventions, & outcomes. (2008). Choriodecidual infection or inflammation may cause preterm PROM.12 A decrease in the collagen content of the membranes has been suggested to predispose patients to preterm PROM.13 It is likely that multiple factors predispose certain patients to preterm PROM. She received her RN license in 1997. Patients with PROM present with leakage of fluid, vaginal discharge, vaginal bleeding, and pelvic pressure, but they are not having contractions. Physicians should advise patients and family members that, despite these efforts, many patients deliver within one week of preterm PROM.4 Contraindications to conservative therapy include chorioamnionitis, abruptio placentae, and nonreassuring fetal testing. If it happens earlier, your provider weighs the risk of premature birth against the risks of complications such as infection. How do you develop a nursing care plan? Surgery can be the treatment of choice if the tonsillitis is causing difficult to manage complications such as apnea, swallowing difficulty, and abscess formation. Which of the following increases the risk of placental abruption? View full document. If youre at all unsure whats coming out of your vagina, contact your pregnancy care provider. Treatment varies depending on gestational age and includes consideration of delivery when rupture of membranes occurs at or after 34 weeks gestation. These complications include respiratory issues and trouble staying warm. Proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection. Signs and symptoms of infection vary according to the body area involved. <> We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. Intraamniotic infection is a common condition noted among preterm and term parturients. Buy on Amazon, Gulanick, M., & Myers, J. L. (2017). Inform the client, if the fetus is at term, that the chances of spontaneous labor beginning are excellent; encourage the client and partner to prepare themselves for labor and birth. Ensure all fluid containers are covered or capped. One study28 showed that conservative management between 34 and 36 weeks gestational age resulted in an increased risk of chorioamnionitis and a lower average umbilical cord pH. It occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries. 1 It increases the risk of prematurity and leads to a number of other perinatal and. What causes PPROM? Prolonged rupture of amniotic membranes before delivery puts the mother and neonate at increased risk for infection. There are few data to guide the care of patients without documented pulmonary maturity. A., & Taylor, R. (2001). Nitrazine paper will turn blue when the pH is above 6.0; however, the presence of contaminating substances (e.g., blood, semen, alkaline antiseptics) also can cause nitrazine paper to turn blue, giving a false-positive result. These factors represent a break in the bodys normal first line of defense and may indicate an infection. The patient can make an informed choice about getting vaccinated when information is available. Premature rupture of membranes (PROM) is when you leak amniotic fluid before labor begins. ABSTRACT: Intraamniotic infection, also known as chorioamnionitis, is an infection with resultant inflammation of any combination of the amniotic fluid, placenta, fetus, fetal membranes, or decidua. endobj Background More than 2 million third-trimester stillbirths occur yearly, most of them in low- and middle-income countries. Rough edges or hangnails can harbor microorganisms. St. Louis, MO: Elsevier. 3. endobj The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. A pathogen can be a bacterium, virus, fungus, parasite, or any other microorganisms. What nursing care plan book do you recommend helping you develop a nursing care plan? Educate the patient with easy-to-understand words on the pathology of tuberculosis. Price, V. A., Smith, R. A., Douthwaite, S., Thomas, S., Almond, D. S., Miller, A. R., & Beadsworth, M. B. Application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection. Using separate eating utensils from the rest of the household will prevent cross-contamination. It also increases your chance of having your baby too early. Physicians caring for patients with preterm PROM before viability may wish to obtain consultation with a perinatologist or neonatologist. Patients with amnionitis require broad-spectrum antibiotic therapy, and all patients should receive appropriate intrapartum group B streptococcus prophylaxis, if indicated. As described above, corticosteroids and antibiotics are beneficial when administered to patients with preterm PROM, but no studies of these therapies combined with tocolysis are available. Manual suctioning of the secretions may be necessary to avoid pooling of mucus in the airway if the patient is unable to independently cough it out. She states the she is 37 weeks along. If labor does not begin or the fetus is judged to be preterm or at risk for infection, explain treatments that are likely to be needed. Cervical incompetence in combination with PROM can be a cause of umbilical cord prolapse. 21. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. Vital signs monitoring including the patients temperature help in the monitoring of possible infections. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. The patient is to be kept overnight for monitoring and complete bed rest. Encourage the use of separate utensils for eating. Cough or expectorate onto a tissue and dispose of after use. Continue with Recommended Cookies. This content is owned by the AAFP. The, Sax, H., Allegranzi, B., Uckay, I., Larson, E., Boyce, J., & Pittet, D. (2007). The risk of placental abruption is increased 15- to 20-fold if an earlier pregnancy had been complicated by placental abruption.6 Other risk factors include chronic hypertension, cocaine use, preeclampsia, age over 35 years, trauma, thrombophilia, cigarette smoking, preterm premature rupture of membranes, chorioamnionitis, and multiparity. The infection occurs in the lining of the uterus (the endometrium) or the upper genital tract. After body fluid exposure risk4. Additionally, without the protection of amniotic fluid and the amniotic sac, the fetus and your uterus are at risk for infection. Another study29 of 430 women with preterm PROM revealed that there was no improvement in major or minor neonatal morbidity after 34 weeks gestation. Corticosteroids should be given to patients with preterm PROM between 24 and 32 weeks gestation to decrease the risk of intraventricular hemorrhage, respiratory distress syndrome, and necrotizing enterocolitis. Knowledge of isolation can help patients and family members cooperate with specific precautions. 5. Rarely, uterine rupture can also occur in women who have not had previous uterine surgery.
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