Evidence of fluid pooling in the vagina, or leaking from the cervical os when the patient coughs or when fundal pressure is applied, will help determine PROM. Integrating travel history in assessment can help stem possible outbreaks and help put infectious symptoms in context for the healthcare team. (2002). Plain soap is good at reducing bacterial counts, but antimicrobial soap is better, and alcohol-based hand rubs are the best. The leading cause of death associated with PROM is infection. Tips to help you get the most from a visit to your healthcare provider: Expectant management is a treatment that delays labor. Your water breaking isnt something you can control. This study investigated the stillbirth rate and risk factors associated with stillbirth in four district hospitals in Pemba Island, Tanzania. It may be helpful to put a white paper towel on the fluid. She states the she is 37 weeks along. Isolate the patient in his/her room ideally during the first 48 hours since the appearance of blisters. Patients with amnionitis require broad-spectrum antibiotic therapy, and all patients should receive appropriate intrapartum group B streptococcus prophylaxis, if indicated. If the membranes are ruptured, the blue dye should pass onto a vaginal tampon within 30 minutes of instillation. | 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. A fern test is ordered and comes back as positive. A fern test is ordered and comes back as positive. We strive for 100% accuracy, but nursing procedures and state laws are constantly changing. Nursing Diagnosis: Risk for Infection related to contagious skin infection. Yes, the fetus can survive if your water breaks too soon. 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. An increasing WBC count indicates the bodys efforts to combat pathogens. Early recognition of infection to allow for prompt treatment. Another common medical intervention is called immunization. Prom may occur if the uterus is over-stretched by malpresentation of the fetus, multiple pregnancy or excess amniotic fluid. endobj However, most cases of intraamniotic infection detected and managed by obstetrician-gynecologists or other . The physician should instill 1 mL of indigo carmine dye mixed in 9 mL of sterile saline. The fetal membranes are so strong that blunt trauma to the abdomen is unlikely to cause PROM. {`!lC[OW|W9XgVibMaAp\Qx- Labor or waters breaking (rupture of membranes) before 37 weeks (preterm) Rupture of membranes 18 hours or longer before delivery of a full-term pregnancy . If its clear and odorless, you should contact your pregnancy care provider. -The nurse will assess the patient from any signs and symptoms of infection every 4 hours while hospitalized.-The nurse will follow sterile procedure during any vaginal exams. 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. A 24 year old pregnant female presents to the L&D triage area complaining of gush of water and constantly feeling wet. 2. According to the patients last menstrual period she is indeed 37 weeks along. This involves your provider inserting a speculum into your vagina. If your provider wants to deliver your baby, they may arrange for specialized care (like care from a NICU) to treat your baby when theyre born. The best thing you can do is avoid smoking cigarettes, maintain a healthy pregnancy and attend all of your prenatal exams. 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 number of antibiotic regimens are advocated for use after preterm PROM. Preterm premature rupture of membranes is the rupture of membranes during pregnancy before 37 weeks gestation. Risk for infection related to prolonged rupture of membranes. Your provider will monitor you closely for signs of infection. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. Any suspicious drainage should be cultured; antibiotic therapy is determined by pathogens identified. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. If hands were not in contact with anyone or anything in the room, use an alcohol-based hand rub and rub until dry. The major symptom is fever. Preterm Premature Rupture of Membranes (PPROM) Long-term tocolytic therapy in patients with PROM is not recommended; consideration of this should await further research. -Pt will be free from any signs and symptoms of infection such as foul smelling/lookingvaginal drainage, elevated temperature, uterus tenderness or rigidness, diminished fetal movement, tachycardia, and hypo-tension throughout rest of pregnancy.-The patient will verbalized 6 signs and symptoms of infection to the nurse. However, a premature birth also comes with risks. For instance, shorter sleep durations are associated with a rise in suffering from the common cold. Basic and effective defense against the fetus contracting an infection is lost and the risk of ascending intrauterine infection, known as chorioamnionitis, is increased. The patient is to be kept overnight for monitoring and complete bed rest. Nitrazine test tape turns a blue-green color. During the speculum examination, a DNA probe or cervical culture for chlamydia and gonorrhea should be performed, because women with these infections are seven times more likely to have PROM.19 After the speculum is removed, a vaginal and perianal (or anal) swab for group B streptococcus culture should be obtained. If it occurs before 37 weeks of pregnancy (preterm PROM), your provider must weigh the risks of premature birth with the risk of complications such as infection and umbilical cord compression. Preterm PROM complicates approximately 3 percent of pregnancies and leads to one third of preterm births. A pregnant patient with premature rupture of membranes is at higher risk for postpartum infection. Cloudy amniotic fluid, with strong odor A patient with polyhydramnios is admitted to a labor-birth-recovery-postpartum (LDRP) suite. Assess the patients skin on his/her whole body. It is important to note that vaginal blood may obscure the presence of ferns, and that cervical mucus can result in a false-positive result if the external cervical os has been swabbed. Use barrier creams as needed. If taking antibiotics, instruct the patient to take the full course of antibiotics even if symptoms improve or disappear.Antibiotics work best when a constant blood level is maintained when medications are taken as prescribed. most successful method in teaching nursing students infection controlE-learning or lecture? To treat the underlying infection with broad spectrum antibiotics, then switch with the type of antibiotics to which the causative bacteria are sensitive. St. Louis, MO: Elsevier. It surrounds the fetus during pregnancy. Desired Outcome: The patient will remain free from infection as evidenced by the absence of fever and clear stoma. Change dressing and bandages that are soiled or wet. 3.2. Obtain a travel history from clients. If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. Educate the patient with easy-to-understand words on the pathology of tuberculosis. Monitor temperature, pulse, respiration, and white. This can transpire via contact, airborne, sexual contact, or sharing of IV drug paraphernalia. 45 Labor Stages, Induced and Augmented, Dystocia - Nurseslabs This is the final step in the chain of infection. However, certain conditions or factors may increase the chances of a prolapse occurring. These nursing interventions help reduce the risk for infection, including implementing strategies to prevent infection. It also involves swabbing your vaginal fluid and testing the pH. Black patients are at increased risk of preterm PROM compared with white patients.11 Other patients at higher risk include those who have lower socioeconomic status, are smokers, have a history of sexually transmitted infections, have had a previous preterm delivery, have vaginal bleeding, or have uterine distension (e.g., polyhydramnios, multifetal pregnancy).5 Procedures that may result in preterm PROM include cerclage and amniocentesis. Multiple courses of corticosteroids and the use of corticosteroids after 34 weeks gestation are not recommended. Risk for Infection is related to the increased susceptibility to infection. Monitor fetal heart rate continuously. Limit visitors.Restricting visitation reduces the transmission of pathogens. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.midwife.org/acnm/files/ACNMLibraryData/UPLOADFILENAME/000000000233/PS-Prelabor-rupture-of-membranes-FINAL-22-MAR-18.pdf), (https://www.ncbi.nlm.nih.gov/books/NBK532888/). Premature Rupture of Membranes - Medscape This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023The definitive guide to nursing diagnoses is reviewed and approved by NANDA International. Evidence suggests that prolonged latency may increase the risk of intra-amniotic infection. Before touching a patient.2. Other signs of infection can help raise suspicion so tests can be conducted to confirm the presence of infection. Risk for Infection Nursing Diagnosis Care Plan - NurseStudy.Net Ideally, the sac breaks during labor. When preterm PROM is suspected, it is important to avoid performing a digital cervical examination; such examinations have been shown to increase morbidity and mortality.14,15 Digital cervical examinations also cause an average nine-day decrease in the latent period.16 Shortening of the latent period may lead to increased infectious morbidity and sequelae from preterm labor. Buy on Amazon, Gulanick, M., & Myers, J. L. (2017). Assess for the presence, existence, and history of the common causes of infection (listed above). These include: The biggest concern with PROM is premature birth. Assess for the following signs and symptoms: 3.1. Within 4 hours after membrane rupture, chorioamnionitis incidence increased progressively in accordance with the time indicated by vital signs. Initiate specific precautions for suspected agents as determined by CDC protocol. Compromised host defenses (e.g., radiation therapy, organ transplant, medication therapy). Assess for the presence of local infectious processes in the skin or mucous membranes. The following methods help break the chain of infection and prevent conditions that may be suitable for microbial growth: 7. Encourage spitting onto a tissue and discarding the tissues immediately. 98.7, O2 Sat 98% on RA, RR 18. Limited data are available to help determine whether tocolytic therapy is indicated after preterm PROM. Recommend the use of soft-bristled toothbrushes and stool softeners to protect mucous membranes. All reflexes are checked and are intact. We offer women's health services, obstetrics and gynecology throughout Northeast Ohio and beyond. Place the patient under airborne precaution isolation. Scratching the infected skin areas will allow the bacteria to transfer into the fingernails and onto the fingerpads. When considering assessment history of a G3 P2 admitted for preterm labor, which risk factor in the womans history places her at greatest risk for preterm labor? Educating visitors on the importance of preventing droplet transmission from themselves to others reduces the risk of infection. Recommended nursing diagnosis and nursing care plan books and resources. A temperature of greater than 37.7 (99.8 F) may indicate infection; a very high temperature accompanied by sweating and chills may indicate septicemia. Using tobacco is a risk factor for developing PROM (as well as other pregnancy complications). PROM may occur if the uterus is over-stretched by malpresentation of the fetus, multiple pregnancy or excess amniotic fluid. Whether patients are referred to us or already have a Cleveland Clinic ob/gyn, we work closely with them to offer treatment recommendations and follow-up care to help you receive the best outcome. This refers to how the pathogen gets into the host. 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. Exercise good hand washing. 3. After body fluid exposure risk4. Price, V. A., Smith, R. A., Douthwaite, S., Thomas, S., Almond, D. S., Miller, A. R., & Beadsworth, M. B. When the membranes break (rupture), the amniotic fluid surrounding the fetus starts to leak or gush out your vagina. This means your uterus may be contracting, and your cervix may be thinning (effacing) and dilating (opening) without you feeling anything. <> Care Plans are often developed in different formats. If it happens after 37 weeks of pregnancy, your provider delivers your baby. History of previous genital herpes with unknown culture result and infant delivered vaginally or by C-section after rupture of membranes. PROM is marked by amniotic fluid gushing from the vagina. Other symptoms include a fast heart rate, sore or painful uterus, and amniotic fluid that smells bad. Nursing care of the patient with preterm premature rupture of membranes Desired Outcome: The patient will prevent spread of infection to the rest of the body, as well as cross-contamination to other people by following treatment regimen for varicella infection. Various health problems and conditions can create a favorable environment that would encourage the development of infections. A 24 year old pregnant female presents to the L&D triage area complaining of gush of water and constantly feeling wet. Preterm Premature Rupture of Membranes: Diagnosis and Management 22. Friction and running water effectively remove microorganisms from hands. Encourage the patient to effectively cough out mucus. An example of data being processed may be a unique identifier stored in a cookie. Magnesium sulfate to help the fetuss brain. Before clean or aseptic procedure (wound dressing, starting an IV, etc.).3. If your membranes rupture too soon, the fetus is at risk for premature birth or infection. Pain, usually reported as a sharp stabbing sensation high in the uterine fundus with the initial separation, also is common. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020).
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