Definition: this is a premature breakage of the membranes such as the amniotic sac that holds the baby in place. Wear personal protective equipment (PPE) properly. Its sometimes hard to tell if youre leaking amniotic fluid, vaginal discharge (which increases in pregnancy) or pee. Proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection. Tonsillitis may cause blockage of airways, which may lead to respiratory distress. (2015). The major symptom is fever. 2. Risk for Infectionrelated to invasive procedures, recurrent vaginal examination, andamnioticmembrane rupture. Patients should be informed and well-educated by nurses on recognizing the signs of infection and how to reduce their risk. Long fingernails tend to contain more bacteria. One of the most common complications of preterm PROM is early delivery. PROM is associated with malpresentation, possible weak areas in the amnion and chorion, subclinical infection, and, possibly, incompetent cervix. These include: The biggest concern with PROM is premature birth. The nurse is reviewing orders on a patient admitted for preterm premature rupture of membranes. Rates are as follows: 5. To determine the severity of varicella infection and any affected areas that require special attention or skin care. There isnt a way to prevent PROM. In this condition, the sac (amniotic membrane) surrounding your baby breaks (ruptures) before week 37 of pregnancy. Microorganisms such as bacteria, viruses, fungus, and other parasites invade susceptible hosts through inevitable injuries and exposures. | 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. In mothers diagnosed with PPROM without evidence . Handwashing is the single best way to prevent infection. 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. Monitor temperature, pulse, respiration, and white. Another meta-analysis24 found a decrease in neonatal intraventricular hemorrhage and sepsis. Physicians should administer a course of corticosteroids and antibiotics to patients without documented fetal lung maturity and consider delivery 48 hours later or perform a careful assessment of fetal well-being, observe for intra-amniotic infection, and deliver at 34 weeks, as described above. Anna Curran. Signs and symptoms include localized swelling, localized redness, pain or tenderness, loss of function in the affected area, palpable heat. The best thing you can do is avoid smoking cigarettes, maintain a healthy pregnancy and attend all of your prenatal exams. Its important to note that if you already have an infection at the time of rupture or develop one afterward, delivery is necessary. Figure 1 is an algorithm for management of preterm PROM. Surgery can be the treatment of choice if the tonsillitis is causing difficult to manage complications such as apnea, swallowing difficulty, and abscess formation. Preterm PROM complicates approximately 3 percent of pregnancies and leads to one third of preterm births. If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. 2. Use of corticosteroids between 32 and 34 weeks is controversial. Low-grade temperature elevation that appears in older clients must be reported as it could potentially be an infection. Expectant management is a treatment that delays labor. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. It happens more often when the amniotic sac is broken for a long time before birth. Friction and running water effectively remove microorganisms from hands. You have not finished your quiz. Scratching the infected skin areas will allow the bacteria to transfer into the fingernails and onto the fingerpads. If the patients immune system cannot battle the invading microorganism sufficiently, an infection occurs. Your healthcare provider may call it prelabor rupture of membranes. Prelabor is the newer, preferable term because it describes membrane rupture before labor starts prelabor rupture without implying prematurity. 19. This refers to how the pathogen gets into the host. 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. Background More than 2 million third-trimester stillbirths occur yearly, most of them in low- and middle-income countries. No edema is present and UA comes back as negative. She has worked in Medical-Surgical, Telemetry, ICU and the ER. Preterm Premature Rupture of Membrane - NursingAnswers.net However, if your baby is born before 37 weeks, theyre at higher risk for complications of being born early. Perform a focused assessment on the oropharyngeal region, particularly checking for any collection of abscess. Before clean or aseptic procedure (wound dressing, starting an IV, etc.).3. stream This was so helpful thanks for sharing i have understood the interventions well. Your pregnancy care provider diagnoses PROM with a sterile speculum exam. It surrounds the fetus during pregnancy. Your water breaking early may be a shock to you. Bacterial vaginosis can produce a similar result. Putting the patient in isolation reduces the risk of others contracting it. Copyright 2023 American Academy of Family Physicians. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Corticosteroid administration may lead to an elevated leukocyte count if given within five to seven days of PROM. Not completing the prescribed antibiotic regimen can lead to drug resistance in the pathogen and reactivation of symptoms. Proper hygiene promotes wellness and prevents further infection. PROM is rupture of the chorion and amnion 1 hour or more before the onset of labor. Premature Rupture of Membranes Nursing Care Plans | Maternity Diagnosis Encourage spitting onto a tissue and discarding the tissues immediately. Your water breaking isnt something you can control. What causes PPROM? Which of the following would the nurse Sandra most likely expect to find when assessing a pregnant client with abruption placenta? Desired Outcome: The patient will demonstrate lifestyle changes to promote a safe environment. 4. LeMoine F, Moore RC, Chapple A, Moore FA, Sutton E. Do not treat a patient based on this care plan. Speculum examination is preferred. Which assessment data indicates a potential infection? Blunt trauma to the abdomen is a common cause of PROM. Encourage the use of separate utensils for eating. 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. In some cases, the risk of infection and complications is too high, and delivery is necessary. We do not endorse non-Cleveland Clinic products or services. 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) To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. PROM occurs in approximately 10% of pregnancies. If your pregnancy reaches 37 weeks, complications from premature birth are lower. It is a common problem in people with low immune system. Without the protection of amniotic fluid, the pregnancy is at risk for other complications, including: Your pregnancy care provider weighs the risks of premature birth against the risks of infection and other complications before deciding when its best to deliver. Manage Settings 7. The, Sax, H., Allegranzi, B., Uckay, I., Larson, E., Boyce, J., & Pittet, D. (2007). Assessment Findings 1. Another method providers may use is a fern test or ferning. 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. Common symptoms of early preterm labor are persistent, dull, and low backache; vaginal spotting; a feeling of pelvic pressure or abdominal tightening; menstrual-like cramping; increased vaginal discharge; uterine contractions; and intestinal cramping. A retrospective analysis31 of 134 women with preterm PROM at 24 to 32 weeks gestation who received steroids and antibiotics found a nonsignificant trend toward intrauterine inflammation in patients with a latency period longer than one week. Multiple courses are not recommended because studies have shown that two or more courses can result in decreased infant birth weight, head circumference, and body length.23. The following are the common causes of infection: Nursing Diagnosis: Risk for infection related to Viral illness and immunocompromised status (e.g. During pregnancy, a fluid-filled sac called the amniotic sac surrounds and protects the fetus. Your membranes are a fluid-filled sac (also called the amniotic sac) containing amniotic fluid. All reflexes are checked and are intact. A number of antibiotic regimens are advocated for use after preterm PROM. Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client CareIdentify interventions to plan, individualize, and document care for more than 800 diseases and disorders. The majority of patients will deliver within one week when preterm PROM occurs before 24 weeks gestation, with an average latency period of six days.15 Many infants who are delivered after previable rupture of the fetal membranes suffer from numerous long-term problems including chronic lung disease, developmental and neurologic abnormalities, hydrocephalus, and cerebral palsy. Sometimes, your provider can visually confirm the rupture of membranes if they see pooling of amniotic fluid at the top of your vagina during this exam. Patients often report a sudden gush of fluid with continued leakage. Which of the following increases the risk of placental abruption? This care plan is listed to give an example of how a Nurse (LPN or RN) may plan to treat a patient with those conditions. Home management of patients with preterm PROM is controversial. ^0ZMDK,F{)HYX[7:eUv. cKMIce3NWE_V8T3|*+n*G:PHZ8gdhZ}^WV K}XUccQt8P;'7 s6BFfDB^5CYI$+FybIEpJhmC 3mk cE)Ok63 ]7W|+;JqWfPAU2M0a Buy on Amazon, Silvestri, L. A. However, sometimes it breaks before labor begins or several weeks before labor begins. Recommended nursing diagnosis and nursing care plan books and resources. Color of respiratory secretions.Yellow or yellow-green sputum is indicative of respiratory infection. 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? . Intervention #2. Prematurity, congenital defects, and maternal complications such as premature rupture of membranes (PROM) or . Client will be free of infection as evidenced by: Maternal temperature remains WNL during labor and fetal heart rate remains between 120 and 160. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders. Here are the common causes of infection and factors that place a patient at risk for infection: Inadequate primary defenses (e.g., break in skin integrity, tissue damage). A temperature of up to 38 C (100.4 F) 48 hours post-op is usually related to surgical stress after 48 hours. Using tobacco is a risk factor for developing PROM (as well as other pregnancy complications). Chorioamnionitis | Cedars-Sinai No studies are available comparing delivery with expectant management when patients receive evidence-based therapies such as corticosteroids and antibiotics. When the patient touches other people or objects with infected hands, the infection will likely spread. The consent submitted will only be used for data processing originating from this website. It also involves swabbing your vaginal fluid and testing the pH. When ultrasonography is inconclusive or the clinical situation depends on a precise diagnosis (e.g., when contemplating transport to a tertiary care facility), amniocentesis may help determine whether the membranes are ruptured. An example of data being processed may be a unique identifier stored in a cookie. Physicians should be reassured that careful visual inspection via a speculum examination is the safest method for determining whether dilation has occurred after preterm PROM. All Rights Reserved. 11. Ideally, these treatments allow your pregnancy to progress to at least 34 weeks. A 24 year old pregnant female presents to the L&D triage area complaining of gush of water and constantly feeling wet. Some cases of PROM occur without a sudden gush of clear watery fluid from the vagina, so you should always take account of other diagnostic signs such as reduction in size of the abdomen and clearly palpable fetal parts. Keep the stoma clean and dry. Learn how your comment data is processed. Repeated vaginal examinations play a role in the incidence of ascending tract infections. 1 0 obj 5. Excessive stress predisposes clients to infection. Complications from premature birth include breathing difficulties, low body temperature and poor growth. Once the sac breaks, you have an increased risk for infection. Client will remain free of infection, as evidenced by normal vital signs and absence of signs and symptoms of infection. It's commonly called your "water breaking.". Knowledge of ways to reduce or eliminate germs reduces the likelihood of transmission. Preterm PROM (or PPROM) is when the amniotic sac breaks before 37 weeks of pregnancy. Nitrazine test tape turns a blue-green color. She states the she is 37 weeks along. Chorioamnionitis is an infection of the placenta and the amniotic fluid. If loading fails, click here to try again. 3 0 obj To assess for the evidence of ongoing infection. Good luck! Goal. Preterm Premature Rupture of Membranes: Diagnosis and Management 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. This postpartum . Intrapartum Management of Intraamniotic Infection | ACOG Its commonly called your water breaking. If it happens after 37 weeks of pregnancy, your provider delivers your baby. It is also harmful for pregnant women as it can affect the unborn baby. A fern test is ordered and comes back as positive. Continuously monitor maternal and fetal vitals. Promote nail care by keeping the client and the nurses fingernails short and clean. (2011). Saunders comprehensive review for the NCLEX-RN examination. 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. Your pregnancy care provider will watch for signs of fetal distress and infection to determine when they should deliver your baby. Evidence suggests that prolonged latency may increase the risk of intra-amniotic infection. This is the final step in the chain of infection. The first stage of dilatation begins with the initiation of true labor contractions and ends when the cervix is fully dilated. PPROM and PROM can have different causes. For pregnant clients, assess the intactness of amniotic membranes. Multiple courses of corticosteroids and the use of corticosteroids after 34 weeks gestation are not recommended. The most common assessment finding in a client with abruption placenta is a rigid or boardlike abdomen. You may ask patients during history taking when they were last immunized. Ibarra-Coronado, E. G., Pantalen-Martnez, A. M., Velazquz-Moctezuma, J., Prospro-Garca, O., Mndez-Daz, M., Prez-Tapia, M., & Morales-Montor, J. 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. Methods A prospective cohort study was completed . Prevent infection and other potential complications. This study investigated the stillbirth rate and risk factors associated with stillbirth in four district hospitals in Pemba Island, Tanzania. Please follow your facilities guidelines and policies and procedures. Premature rupture of membranes (PROM) is when you leak amniotic fluid before labor begins. Premature rupture of membranes, or PROM, is when your water breaks before labor starts. Ferning refers to the fern-like pattern of dry amniotic fluid. Tocolytic therapy may prolong the latent period for a short time but do not appear to improve neonatal outcomes.26 In the absence of data, it is not unreasonable to administer a short course of tocolysis after preterm PROM to allow initiation of antibiotics, corticosteroid administration, and maternal transport,27 although this is controversial. It may be helpful to put a white paper towel on the fluid. 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. Limited data are available to help determine whether tocolytic therapy is indicated after preterm PROM. endobj In the absence of intra-amniotic infection, the physician should attempt to prolong the pregnancy until 34 weeks gestation. Appropriate evaluation and management are important for improving neonatal outcomes. She denies having any labor contractions. Chapter 16: Intrapartum Complications Flashcards | Quizlet However, its not always a gush. This is the way the pathogen transfers from the reservoir to the host. Inadequate primary defenses such as broken skin. The serious impairment of this system can predispose to severe, even life-threatening, infections. PPROM accounts for 25% of all cases of premature rupture of the membranes and is responsible for 30%-40% of all preterm deliveries. Isolate the patient in his/her room ideally during the first 48 hours since the appearance of blisters. Guppy, M. P., Mickan, S. M., Del Mar, C. B., Thorning, S., & Rack, A. Studies show PPROM is more likely to affect twin pregnancies. When stasis occurs, microbial infection of the respiratory tract occurs and may lead to pneumonia. endobj Risk for Infection Care Plan. It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. This is also universally used for those who are at high risk for infection. Your doctor will be able to help you make the best decisions for you and your baby. Approximately 90% of people will go into spontaneous labor within 24 hours if theyre between 37 and 40 weeks pregnant when their water breaks. If hands were not in contact with anyone or anything in the room, use an alcohol-based hand rub and rub until dry. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 11 0 R 40 0 R 41 0 R] /MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S>> Important Disclosure: Please keep in mind that these care plans are listed for, Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on Pinterest (Opens in new window), Click to share on Reddit (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on WhatsApp (Opens in new window), Click to share on Pocket (Opens in new window), Click to share on Telegram (Opens in new window), Click to share on Skype (Opens in new window), Most DIFFICULT Patients EVER!! For patients with preterm PROM at 32 or 33 weeks gestation with documented pulmonary maturity, induction of labor and transportation to a facility that can perform amniocentesis and care for premature neonates should be considered.30 Prolonging pregnancy after documentation of pulmonary maturity unnecessarily increases the likelihood of maternal amnionitis, umbilical cord compression, prolonged hospitalization, and neonatal infection.6. Risk for infection related to prolonged rupture of membranes. While many people are at risk for infection in the community, about 1.7 million patients acquire healthcare-associated or nosocomial infections, with a death record of 98,000 annually. Preventing infection is a vital role of all healthcare professionals. American College of Obstetricians and Gynecologists. Some hospitals may have the information displayed in digital format, or use pre-made templates. The patient can make an informed choice about getting vaccinated when information is available. Ivanov, A. V., Bartosch, B., & Isaguliants, M. G. (2017). Administer antiviral medication as prescribed. Diseases, medical conditions, and related nursing care plans for Risk for Infection nursing diagnosis: Assessment is paramount in identifying factors that may precipitate infection. 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. Additionally, without the protection of amniotic fluid and the amniotic sac, the fetus and your uterus are at risk for infection. Educate the patient and carer about proper wound hygiene through washing the rash with soap and water. When the pathogen reaches the host, the body fights off the microorganism. Investigate the use of medications or treatment modalities that may cause immunosuppression.Antineoplastic agents, corticosteroids, and so on can suppress immune function. Nursing Care Plans Nursing Diagnosis & Intervention (10th Edition)Includes over two hundred care plans that reflect the most recent evidence-based guidelines. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Insufficient knowledge to avoid exposure to pathogens. Elevated temperature.Fever is often the first sign of an infection. Copyright 2006 by the American Academy of Family Physicians. Also, having inadequate resources, lack of knowledge, and being malnourished place an individual at high risk of developing an infection. According to the patients last menstrual period she is indeed 37 weeks along. A common means for infectious diseases to spread is by directly transferring bacteria, viruses, or other germs from one person to another. -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. This risk is compared with the risks of prematurity. People have dedicated cells or tissues that deal with the threat of infection. Nursing diagnoses handbook: An evidence-based guide to planning care. Premature rupture of membranes (water breaking) before you reach full term. An upright position and regular position changes prevent the pooling of mucus, therefore preventing infection. Vaginal fluid has a lower pH than amniotic fluid. Other symptoms include a fast heart rate, sore or painful uterus, and amniotic fluid that smells bad. Newborn Nursing Diagnosis & Care Plan | NurseTogether This information will aid the clinician in targeting at-risk women for intensified obstetric care and entry into prevention programs.Methods: 28,725 deliveries were analyzed over a 16-month time frame (January 1, 1995-April 30, 1996). 16. Some physicians are concerned that not performing a digital examination may lead to the misdiagnosis of advanced preterm labor with imminent delivery, which has important implications for patients who require transfer to a tertiary care center; however, a prospective comparison17 found that the difference between digital and speculum examinations was not clinically significant. Physicians must balance the risk of respiratory distress syndrome and other sequelae of premature delivery with the risks of pregnancy prolongation, such as neonatal sepsis and cord accidents. 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. The incidence of this syndrome is related to the gestational age at which rupture occurs and to the level of oligohydramnios. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented. A blue result means the fluid on the paper has a pH of greater than 6.0 and is likely amniotic fluid. Risk for infection related to loss of protective barrier as evidence by positive ferns test. Wash hands or perform hand hygiene before having contact with the patient. Patient information: See related handout on preterm premature rupture of membranes, written by the authors of this article. Early recognition of infection to allow for prompt treatment. Risk factors in premature rupture of membranes - PubMed People with incomplete immunizations may not have sufficient acquired active immunity. Educate patient on the signs of infection such as the following: Changes in cough or having a new cough. Tonsillitis can lead to peritonsillar abscess. 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. PPROM occurs in about 3% of pregnancies. Teach the importance of physical distancing. Tips to help you get the most from a visit to your healthcare provider: Monitor the patients vital signs and signs of infection. All reflexes are checked and are intact. Fetal Heart Rate is present with a rate 130 bpm. Occasionally, patients present with conflicting history and physical examination findings (e.g., a history highly suspicious for ruptured membranes with a normal fern test but positive nitrazine test). View full document. Group B Streptococcus Infection in Babies - Health Encyclopedia 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). As it has helped me alot in my educational field. Assess for the presence of local infectious processes in the skin or mucous membranes. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. Handwashing versus alcoholic rub can we afford 100% compliance?. The most widely used and recommended regimens include intramuscular betamethasone (Celestone) 12 mg every 24 hours for two days, or intramuscular dexamethasone (Decadron) 6 mg every 12 hours for two days.22 The National Institutes of Health recommends administration of corticosteroids before 30 to 32 weeks gestation, assuming fetal viability and no evidence of intra-amniotic infection.