Preterm premature rupture of the membranes (PPROM) is diagnosed when rupture of the amniotic membranes occurs prior to the completion of the 36th week of gestation. Client will be free of infection as evidenced by: Maternal temperature remains WNL during labor and fetal heart rate remains between 120 and 160. Risk for Infection is related to the increased susceptibility to infection. Advise all patients with rupture of membranes that they are at increased risk of infection and need hospital care promptly. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. <>/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>> Assist client to learn stress-reducing techniques. 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. If its yellow or has an odor, its likely urine. Ideally, these treatments allow your pregnancy to progress to at least 34 weeks. Wound healing alterations caused by infection. In addition to the above causes, other risk factors include: Bacterial vaginosis can produce a similar result. Basic and effective defense against the fetus contracting an infection is lost and the risk of ascending intrauterine infection, known as chorioamnionitis, is increased. History of previous genital herpes with unknown culture result and infant delivered vaginally or by C-section after rupture of membranes. View full document. ACOG practice bulletin no. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Previable rupture of membranes also can lead to Potters syndrome, which results in pressure deformities of the limbs and face and pulmonary hypoplasia. Chorioamnionitis is an infection of the placenta and the amniotic fluid. PROM is marked by amniotic fluid gushing from the vagina. Investigate the use of medications or treatment modalities that may cause immunosuppression.Antineoplastic agents, corticosteroids, and so on can suppress immune function. Goal. 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. The patient is to be kept overnight for monitoring and complete bed rest. Handwashing is the best way to break the chain of infection. Encourage hand hygiene and explain the importance of proper handwashing. St. Louis, MO: Elsevier. 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. Berman, A., Snyder, S. J., Kozier, B., Erb, G. L., Levett-Jones, T., Dwyer, T., & Parker, B. When there is PROM the risk of serious infection is increased (1% versus 0.5% for women with intact membranes). Consultation with a neonatologist and physician experienced in the management of preterm PROM may be beneficial. Research is ongoing to make vaccines to prevent GBS infection. In addition, the physician should observe closely for fetal or maternal tachycardia, oral temperature exceeding 100.4F (38C), regular contractions, uterine tenderness, or leukocytosis, which are possible indicators of amnionitis. The neonate is most likely to be hypothermic. Ferning refers to the fern-like pattern of dry amniotic fluid. If your water breaks before 37 weeks, your provider will help you make the safest choice. endobj Regularly assess the patients stoma and surrounding skin for color, exudates, erythema, and crusting lesions. Guppy, M. P., Mickan, S. M., Del Mar, C. B., Thorning, S., & Rack, A. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. American College of Obstetricians and Gynecologists. If loading fails, click here to try again. Monitor fetal heart rate continuously. % A common means for infectious diseases to spread is by directly transferring bacteria, viruses, or other germs from one person to another. 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. Encourage spitting onto a tissue and discarding the tissues immediately. Change dressing and bandages that are soiled or wet. It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. (2020). Approximately 90% of people will go into spontaneous labor within 24 hours if theyre between 37 and 40 weeks pregnant when their water breaks. A good understanding of the chain of infection helps in the early diagnosis and prevention of infection. Tonsillitis may cause blockage of airways, which may lead to respiratory distress. Knowledge of ways to reduce or eliminate germs reduces the likelihood of transmission. 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. 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. Uterine rupture. Advise the patient and carer to prevent scratching the affected areas. The best thing you can do is avoid smoking cigarettes, maintain a healthy pregnancy and attend all of your prenatal exams. An upright position and regular position changes prevent the pooling of mucus, therefore preventing infection. Secure the tracheostomy tube. 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. 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/). Definition: this is a premature breakage of the membranes such as the amniotic sac that holds the baby in place. If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. The regimen studied by the National Institute of Child Health and Human Development trial25 uses an intravenous combination of 2 grams of ampicillin and 250 mg of erythromycin every six hours for 48 hours, followed by 250 mg of amoxicillin and 333 mg of erythromycin every eight hours for five days. 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. Infections prolong healing and can result in death if left untreated. Recommend the use of soft-bristled toothbrushes and stool softeners to protect mucous membranes. However, infection can also be an etiologic factor that causes prelabor rupture of. Ensure that any articles used are properly disinfected or sterilized before use. Assess vital signs and observe for any signs of infection as well as for any signs of respiratory distress. See permissionsforcopyrightquestions and/or permission requests. However, if your baby is born before 37 weeks, theyre at higher risk for complications of being born early. PROM occurs in approximately 10% of pregnancies. This can be a problem because without amniotic fluid, your chances of infection, premature birth and other complications increase. Such patients, if they are stable, may benefit from transport to a tertiary facility. The leading cause of death associated with PROM is infection. lovely update, I like the write up,it has really helped me in my project writing. The infection occurs in the lining of the uterus (the endometrium) or the upper genital tract. The leading cause of death associated with PROM is infection. Educate the patient on the need for staff to use personal protective equipment when looking after them. 8. Premature rupture of membranes (PROM) is the rupture of the fetal membranes before the onset of labor. Multiple courses of corticosteroids and the use of corticosteroids after 34 weeks gestation are not recommended. Management: Manage Settings Perform measures to break the chain of infection and prevent infection. These nursing interventions help reduce the risk for infection, including implementing strategies to prevent infection. Giving antibiotics to patients with preterm PROM can reduce neonatal infections and prolong the latent period. It happens more often when the amniotic sac is broken for a long time before birth. Signs and symptoms include localized swelling, localized redness, pain or tenderness, loss of function in the affected area, palpable heat. endobj A study33 of patients with preterm PROM randomized to home versus hospital management revealed that only 18 percent of patients met criteria for safe home management. In older patients, the infection may be present without an increased WBC count. What causes PPROM? If membranes rupture at term, but she has no sign of imminent delivery, infection or fetal distress, have patient go to hospital in anticipation of delivery. Some people feel a slow leak or trickle of fluid. A separate swab should be used to obtain fluid from the posterior fornix or vaginal sidewalls. -The patient will verbalized the importance of refraining from sexual intercourse of any typeorusage of tampons until after pregnancy. This refers to how the pathogen leaves the reservoir. Mother states / shows are free of any signs of infection. No studies are available comparing delivery with expectant management when patients receive evidence-based therapies such as corticosteroids and antibiotics. Copyright 2006 by the American Academy of Family Physicians. Patient information: See related handout on preterm premature rupture of membranes, written by the authors of this article. Saunders comprehensive review for the NCLEX-RN examination. Mode of transmission. Observe and report if an older client has a low-grade fever or new onset of confusion. Preterm PROM complicates approximately 3 percent of pregnancies and leads to one third of preterm births.1It increases the risk of prematurity and leads to a number of other perinatal and neonatal complications, including a 1 to 2 percent risk of fetal death.2 Physicians caring for pregnant patients should be versed in the management of preterm PROM because rapid diagnosis and appropriate management can result in improved outcomes. ]7W|+;JqWfPAU2M0a Some of the most common causes include: The most obvious symptom of your membranes rupturing is feeling a gush of fluid from your vagina. Some hospitals may have the information displayed in digital format, or use pre-made templates. 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. You also have a higher chance of having your baby born early. 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. Low-grade temperature elevation that appears in older clients must be reported as it could potentially be an infection. PROM is associated with malpresentation, possible weak areas in the amnion and chorion, subclinical infection, and, possibly, incompetent cervix. Treatment depends on the gestational age of the pregnancy (a term to describe how far along your pregnancy is), the health of the fetus and how severe your condition is. Hypoxia and asphyxia of the woman in labour is a common complication of prolonged PROM. Encourage coughing and deep breathing exercises; frequent position changes.Helps reduce the stasis of secretions in the lungs and bronchial tree. Repeated vaginal examinations play a role in the incidence of ascending tract infections. xZ[o~7/po$788i.46xCRq,IHM@S;[fw"LG%Br{//X ,n(" She denies having any labor contractions. 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. 6. | 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. Infectious agent (pathogen). 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. Prolonged rupture of amniotic membranes before delivery puts the mother and neonate at increased risk for infection. Physicians should not perform digital cervical examinations on patients with preterm PROM because they decrease the latent period. 10. Vital signs are important markers of infection. Also, having inadequate resources, lack of knowledge, and being malnourished place an individual at high risk of developing an infection. A meta-analysis2 showed that patients receiving antibiotics after preterm PROM, compared with those not receiving antibiotics experienced reduced postpartum endometritis, chorioamnionitis, neonatal sepsis, neonatal pneumonia, and intraventricular hemorrhage. Methylin blue dye should not be used because it has been associated with hyperbilirubinemia and hemolytic anemia in infants.20 Even when ultrasonography is not necessary to confirm PROM, it may help determine the position of the fetus, placental location, estimated fetal weight, and presence of any anomalies. Speculum examination to determine cervical dilation is preferred because digital examination is associated with a decreased latent period and with the potential for adverse sequelae. 20. Risk for infection is a NANDA nursing diagnosis that involves the alteration or disturbance in the bodys inflammatory response, which allows microorganisms to invade the body and cause infection. (2015). Due to the limited knowledge of the disease, self-isolation is encouraged to prevent the transfer of infection to other people. Another common medical intervention is called immunization. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. -The nurse will educate the patient on 6 signs and symptoms of infection the patient should watch out for. Preterm PROM complicates approximately 3 percent of pregnancies and leads to one third of preterm births. Diseases, medical conditions, and related nursing care plans for Risk for Infection nursing diagnosis: Assessment is paramount in identifying factors that may precipitate infection. Educate the patient with easy-to-understand words on the pathology of tuberculosis. Nursing Diagnosis: Risk for infection related to loss of protective barrier as evidence by positive ferns test. She denies having any labor contractions. The physician should instill 1 mL of indigo carmine dye mixed in 9 mL of sterile saline. Handwashing versus alcoholic rub can we afford 100% compliance?. Treatment can be started as soon as an infection is identified. Keep a suction machine by the patients bedside. Nursing Care Plans for Risk for Infection, Nursing Assessment for Risk for Infection, Nursing Interventions for Risk for Infection, All-in-One Nursing Care Planning Resource E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health, Nursing Care Plans (NCP): Ultimate Guide and Database, Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing, Role of hand hygiene in healthcare-associated infection prevention, Removal of nail polish and finger rings to prevent surgical infection, Advising patients to increase fluid intake for treating acute respiratory infections, Hand washing: a modest measurewith big effects, The bidirectional relationship between sleep and immunity against infections, Oxidative stress in infection and consequent disease. 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). Patients with PROM present with leakage of fluid, vaginal discharge, vaginal bleeding, and pelvic pressure, but they are not having contractions. VS HR 85, BP 130/82, Temp. Improving compliance with hand hygiene in hospitals. Patients often report a sudden gush of fluid with continued leakage. Determine maternal and fetal status, including estimated gestational age. It can lead to significant perinatal morbidity, including respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death. Encourage increased fluid intake unless contraindicated (e.g., heart failure, kidney failure). 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. Its important to note that just because you cant feel contractions, your body is still preparing for labor. Proper hygiene promotes wellness and prevents further infection. When the latent period (time between rupture of membranes and onset of labor) is less than 24 hours, the risk of infection is low. A more recent article on preterm labor is available. Using separate eating utensils from the rest of the household will prevent cross-contamination. 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. Nursing Diagnosis: Risk for Infection related to contagious skin infection. 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. Initiate specific precautions for suspected agents as determined by CDC protocol. When stasis occurs, microbial infection of the respiratory tract occurs and may lead to pneumonia. Buy on Amazon, Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Preventing infection is a vital role of all healthcare professionals. Before touching a patient.2. In most cases, this occurs near term, but when membrane rupture occurs before 37 weeks gestation, it is known as preterm PROM.

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