Your provider may induce labor with medications or allow your labor to progress on its own. Teach the patient/ carer the proper application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection. Diagnostic methods using nitrazine paper and determination of ferning have sensitivities approaching 90 percent.18 The normal vaginal pH is between 4.5 and 6.0, whereas amniotic fluid is more alkaline, with a pH of 7.1 to 7.3. Bed rest at home before viability (i.e., approximately 24 weeks gestation) may be acceptable for patients without evidence of infection or active labor, although they must receive precise education about symptoms of infection and preterm labor, and physicians should consider consultation with experts familiar with home management of preterm PROM. Handwashing is the single best way to prevent infection. Application of non-stick bandages over the affected areas can also help prevent the spread of rash and further infection. Treatment may include medicine to help your baby's lungs develop. It is a common problem in people with low immune system. 217: Prelabor Rupture of Membranes. Your provider may also perform an ultrasound to check the fetuss position and the amount of amniotic fluid inside of your uterus. 1 It increases the risk of prematurity and leads to a number of other perinatal and. This information will help the patient understand the importance of lifestyle changes to avoid secondary infection and the spread of infection to others. Varicella infection is an infectious/ communicable skin disease to people who have not had chickenpox before. 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. 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. Varicella infection is generally treated using antiviral therapy. Also, having inadequate resources, lack of knowledge, and being malnourished place an individual at high risk of developing an infection. Important Disclosure: Please keep in mind that these care plans are listed for Example/Educational purposes only, and some of these treatments may change over time. On the other hand, isolation also protects the patient from possible cross-contamination from carers, family, friends, or healthcare staff. The gestational age of the fetus and estimates of viability affect management. The diagnosis of PROM requires a thorough history, physical examination, and selected laboratory studies. General physicians do not take adequate travel histories. Assist clients in carrying out appropriate skin and oral hygiene. 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. Consultation with a neonatologist and physician experienced in the management of preterm PROM may be beneficial. There are few data to guide the care of patients without documented pulmonary maturity. Perform measures to break the chain of infection and prevent infection. The presence of ferning indicates PROM. Monitor maternal temperature every 4 hours. These include: The biggest concern with PROM is premature birth. Which assessment data indicates a potential infection? No studies are available comparing delivery with expectant management when patients receive evidence-based therapies such as corticosteroids and antibiotics. Rates are as follows: 5. 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. A more recent article on preterm labor is available. 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. American College of Obstetricians and Gynecologists. Pt denies any uterus tenderness andthe patient states she felt the babys last movement about an hour ago. Friction and running water effectively remove microorganisms from hands. Theyll also monitor the fetuss heart rate and movement to make sure it isnt in distress. Umbilical cord prolapse can occur without any risk factors. The complications from prematurity are high when the fetus is fewer than 34 weeks gestation. This can be a problem because without amniotic fluid, your chances of infection, premature birth and other complications increase. Pt denies any uterus tenderness. 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. This can transpire via contact, airborne, sexual contact, or sharing of IV drug paraphernalia. A reservoir is a place where the pathogen normally lives. There are two purposes in isolating a person with tuberculosis: protect the patient and protect others. stream PPROM raises the risk for infection. 4. The neonate is most likely to be hypothermic. Another method providers may use is a fern test or ferning. If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. Another common medical intervention is called immunization. Inadequate primary defenses such as broken skin. Studies show PPROM is more likely to affect twin pregnancies. PROM is rupture of the chorion and amnion 1 hour or more before the onset of labor. 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. If youre at all unsure whats coming out of your vagina, contact your pregnancy care provider. 2. The latent period, which is the time from membrane rupture until delivery, generally is inversely proportional to the gestational age at which PROM occurs. . Nursing Diagnosis: Risk for Infection related to contagious skin infection. 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. Fetal Heart Rate is present with a rate 130 bpm and the patient states she felt the babys last movement about an hour ago. A 24 year old pregnant female presents to the L&D triage area complaining of gush of water and constantly feeling wet. People have dedicated cells or tissues that deal with the threat of infection. Once the fluid has dried on the slide, the physician can check for ferning (arborization) under a low-power microscope. A temperature of up to 38 C (100.4 F) 48 hours post-op is usually related to surgical stress after 48 hours. {`!lC[OW|W9XgVibMaAp\Qx- Postpartum endometritis is an infection that some women develop after giving birth. Assist client to learn stress-reducing techniques. Prematurity, congenital defects, and maternal complications such as premature rupture of membranes (PROM) or . Nursing Diagnosis: Risk for infection related to loss of protective barrier as evidence by positive ferns test. Once the sac breaks, you have an increased risk for infection. It can also cause changes to the fetuss position, which can affect delivery. endobj Signs and symptoms of infection vary according to the body area involved. Delivering within 24 hours is usually the safest option. Nursing Care Plan Name of the Patient: Mrs. FlorenceMedical Diagnosis: Post CSNursing Diagnosis: Risk for infection related to premature rupture of membranesShort-Term Goal: Within the shift, patient will be able to identify ways to reduce risk for infection. It depends on factors like the age of the pregnancy and how much amniotic fluid is left. Definition: this is a premature breakage of the membranes such as the amniotic sac that holds the baby in place. As it has helped me alot in my educational field. Investigate the use of medications or treatment modalities that may cause immunosuppression.Antineoplastic agents, corticosteroids, and so on can suppress immune function. W]1}IM%2 \Xn+#DA #`K- b:/W_+y38'0R"ls}Hy6h_[~)W^/*&V\ackh6#pn*y@lr@lx C"%Q0-z8B^b>(Q*1|7ex&HfK2me_z#A)ZIdha A more recent article on preterm labor is available. Some conditions associated with risk for infection are: Chronic illness Immunosuppression Invasive procedures Decrease in hemoglobin Leukopenia Open wounds Malnutrition Rupture of amniotic membranes Antibiotic therapy Altered pH of mucous secretions Nursing Assessment for Risk for Infection 1. 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. Unlike when you pee, you wont be able to hold it in. If its clear and odorless, you should contact your pregnancy care provider. Secure the tracheostomy tube. Compromised host defenses (e.g., radiation therapy, organ transplant, medication therapy). Previable rupture of membranes also can lead to Potters syndrome, which results in pressure deformities of the limbs and face and pulmonary hypoplasia. In most cases, this occurs near term, but when membrane rupture occurs before 37 weeks gestation, it is known as preterm PROM. Antibiotics to prevent infection and prolong the pregnancy. Involving the patient in the early identification of the presence of an infection can improve the success of treatment once started. 9. 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). The leading cause of death associated with PROM is infection. Zimmerman, S., GruberBaldini, A. L., Hebel, J. R., Sloane, P. D., & Magaziner, J. However, its not always a gush. Choose the letter of the correct answer. Care Plans are often developed in different formats. 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. There are other ways your provider can check the pH of your vaginal fluid. By accessing any content on this site or its related media channels, you agree never to hold us liable for damages, harm, loss, or misinformation. In addition to the above causes, other risk factors include: Women given this combination were more likely to stay pregnant for three weeks despite discontinuation of the antibiotics after seven days. Organs and tissues involved in the immune system include the thymus, bone marrow, lymph nodes, spleen, appendix, tonsils, and Peyers patches (in the small intestine). The consent submitted will only be used for data processing originating from this website. Some people feel a slow leak or trickle of fluid. It is advisable to administer appropriate antibiotics for intrapartum group B streptococcus prophylaxis to women who are carriers, even if these patients have previously received a course of antibiotics after preterm PROM. Situation III. Corticosteroids can reduce many neonatal complications, particularly intraventricular hemorrhage and respiratory distress syndrome, and antibiotics are effective for increasing the latency period. The following are the common causes of infection: Nursing Diagnosis: Risk for infection related to Viral illness and immunocompromised status (e.g. This is the final step in the chain of infection. Delivery before 32 weeks gestation may lead to severe neonatal morbidity and mortality. Use the nursing assessment guidelines below to identify your subjective data and objective data for your risk for infection care plan: 1. 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. Patients with PROM present with leakage of fluid, vaginal discharge, vaginal bleeding, and pelvic pressure, but they are not having contractions. Teach the importance of avoiding contact with individuals who have infections or colds. 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. Its commonly called your water breaking. If it happens after 37 weeks of pregnancy, your provider delivers your baby. In older patients, the infection may be present without an increased WBC count. Cervical incompetence in combination with PROM can be a cause of umbilical cord prolapse. 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. A good understanding of the chain of infection helps in the early diagnosis and prevention of infection. Assess for the presence of local infectious processes in the skin or mucous membranes. 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. For instance, shorter sleep durations are associated with a rise in suffering from the common cold. Research is ongoing to make vaccines to prevent GBS infection. 3.3. She states the she is 37 weeks along. This content is owned by the AAFP. Cough or expectorate onto a tissue and dispose of after use. Insufficient knowledge to avoid exposure to pathogens. Try to take comfort in that your provider is doing everything they can to make sure you and your baby are safe and healthy. Educate clients and SO (significant other) about appropriate cleaning, disinfecting, and sterilizing items. A common means for infectious diseases to spread is by directly transferring bacteria, viruses, or other germs from one person to another. Educating visitors on the importance of preventing droplet transmission from themselves to others reduces the risk of infection. Management: Promote nail care by keeping the client and the nurses fingernails short and clean. The first stage of dilatation begins with the initiation of true labor contractions and ends when the cervix is fully dilated. Congenital disorders that affect your uterus (like. The serious impairment of this system can predispose to severe, even life-threatening, infections. (2014). endobj Speculum examination is preferred. These factors represent a break in the bodys normal first line of defense and may indicate an infection. Your membranes are a fluid-filled sac (also called the amniotic sac) containing amniotic fluid. Client will be free of infection as evidenced by: Maternal temperature remains WNL during labor and fetal heart rate remains between 120 and 160. Last reviewed by a Cleveland Clinic medical professional on 12/22/2022. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. All images, articles, text, videos, and other content found on this website are protected by copyright law and are the intellectual property of RegisteredNurseRN.com or their respective owners. Microorganisms such as bacteria, viruses, fungus, and other parasites invade susceptible hosts through inevitable injuries and exposures. Regularly assess the patients stoma and surrounding skin for color, exudates, erythema, and crusting lesions. Long-term tocolytic therapy in patients with PROM is not recommended; consideration of this should await further research. Monitor white blood cell (WBC) count. 4. What nursing care plan book do you recommend helping you develop a nursing care plan? These nursing interventions help reduce the risk for infection, including implementing strategies to prevent infection. Encourage the use of separate utensils for eating. Explain to the client how infections can be transmitted from sharing personal items. Preterm PROM (or PPROM) is when the amniotic sac breaks before 37 weeks of pregnancy. Portal of exit from the reservoir. -The nurse will educate the patient on 6 signs and symptoms of infection the patient should watch out for. Color of respiratory secretions.Yellow or yellow-green sputum is indicative of respiratory infection. Prolonged rupture of amniotic membranes before delivery puts the mother and neonate at increased risk for infection. If the infection cannot be prevented, the goal is to prevent the spread of infection between individuals and treat the underlying infection. 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. A separate swab should be used to obtain fluid from the posterior fornix or vaginal sidewalls. Maintain strict asepsis for dressing changes, wound care, intravenous therapy, and catheter handling. Uterine rupture. It happens more often when the amniotic sac is broken for a long time before birth. Premature rupture of membranes (PROM) is when you leak amniotic fluid before labor begins. Its sometimes hard to tell if youre leaking amniotic fluid, vaginal discharge (which increases in pregnancy) or pee. Maintain the client on bed rest if the fetal head is not engaged. It can include people, animals, soil, or any substance. Your pregnancy care provider may also use nitrazine paper to diagnose PROM. Intraamniotic infection is a common condition noted among preterm and term parturients. Premature rupture of membranes (PROM) is when you leak amniotic fluid before labor begins. Treatment varies depending on gestational age and includes consideration of delivery when rupture of membranes occurs at or after 34 weeks gestation. Provide stoma care through the following steps: Clean the inner part of the stoma; if an inner cannula is used, replace it regularly with a new one. 6. To assess for the evidence of ongoing infection. Prom may occur if the uterus is over-stretched by malpresentation of the fetus, multiple pregnancy or excess amniotic fluid. Change dressing and bandages that are soiled or wet. Continuously monitor maternal and fetal vitals. Cloudy amniotic fluid, with strong odor A patient with polyhydramnios is admitted to a labor-birth-recovery-postpartum (LDRP) suite. Knowledge of ways to reduce or eliminate germs reduces the likelihood of transmission. Its important to note that if you already have an infection at the time of rupture or develop one afterward, delivery is necessary. 4 0 obj PATIENT EDUCATION 1. Clinical manifestations PROM is marked by amniotic fluid gushing from the vagina. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. In unusual cases in which the patients history suggests preterm PROM, but physical examination findings fail to confirm the diagnosis, ultrasonography may be helpful. According to the patients last menstrual period she is indeed 37 weeks along. The, Sax, H., Allegranzi, B., Uckay, I., Larson, E., Boyce, J., & Pittet, D. (2007). However, infection can also be an etiologic factor that causes prelabor rupture of. 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. 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. Encourage sleep and rest. People with incomplete immunizations may not have sufficient acquired active immunity. % See our full. Please follow your facilities guidelines and policies and procedures. Redness, swelling, increased pain, purulent discharge from incisions, injury, and exit sites of tubes (IV tubings), drains, or catheters. 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. 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.
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