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. Redness, swelling, increased pain, purulent discharge from incisions, injury, and exit sites of tubes (IV tubings), drains, or catheters. Preterm PROM (or PPROM) is when the amniotic sac breaks before 37 weeks of pregnancy. Treatment varies depending on gestational age and includes consideration of delivery when rupture of membranes occurs at or after 34 weeks gestation. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. To determine the severity of varicella infection and any affected areas that require special attention or skin care. Within 4 hours after membrane rupture, chorioamnionitis incidence increased progressively in accordance with the time indicated by vital signs. stream
This nursing care plan diagnosis, and interventions for the following conditions: Premature Rupture of Membranes, PROM, or ROM (Rupture of Membranes). The human immune system is crucial for survival in a world full of potentially deadly and harmful microbes. PPROM and PROM can have different causes. It may be helpful to put a white paper towel on the fluid. Magnesium sulfate to help the fetuss brain. Coughing is an effective method to expectorate mucus build up to prevent infection. When preterm PROM occurs at 34 to 36 weeks gestation, physicians should avoid the urge to prolong pregnancy. Use the nursing interventions below to help you create your nursing care plan for risk for infection: 1. Background More than 2 million third-trimester stillbirths occur yearly, most of them in low- and middle-income countries. No studies are available comparing delivery with expectant management when patients receive evidence-based therapies such as corticosteroids and antibiotics. Observe and report if an older client has a low-grade fever or new onset of confusion. Manage Settings Infections occur when the natural defense mechanisms of an individual are inadequate to protect them. Do not treat a patient based on this care plan. The incidence of this syndrome is related to the gestational age at which rupture occurs and to the level of oligohydramnios. Additionally, without the protection of amniotic fluid and the amniotic sac, the fetus and your uterus are at risk for infection. Learn how your comment data is processed. It is a common problem in people with low immune system. 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. She has worked in Medical-Surgical, Telemetry, ICU and the ER. Some premature infants also have developmental delays later in life. 21. Patients often report a sudden gush of fluid with continued leakage. Maternal infection may occur during labor (chorioamnionitis) or after birth (postpartum endometritis), and prolonged rupture of membranes and multiple vaginal examinations are known risk factors for the development of maternal and neonatal infection. Premature rupture of membranes (PROM) at term is rupture of membranes prior to the onset of labor at or beyond 37 weeks' gestation. She denies having any labor contractions. endobj
Such patients, if they are stable, may benefit from transport to a tertiary facility. These nursing interventions help reduce the risk for infection, including implementing strategies to prevent infection. Educate the patient on the need for staff to use personal protective equipment when looking after them. Inadequate primary defenses such as broken skin. You may ask patients during history taking when they were last immunized. Place the patient under airborne precaution isolation. Policy. 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. Scratching the infected skin areas will allow the bacteria to transfer into the fingernails and onto the fingerpads. 3. 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. (2002). No edema is present and UA comes back as negative. Generally, there are two options: delivery or expectant management. The leading cause of death associated with PROM is infection. It can lead to significant perinatal morbidity, including respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death. | 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. Definition: this is a premature breakage of the membranes such as the amniotic sac that holds the baby in place. 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!! If your pregnancy reaches 37 weeks, complications from premature birth are lower. Also, having inadequate resources, lack of knowledge, and being malnourished place an individual at high risk of developing an infection. All reflexes are checked and are intact. Risk for Infectionrelated to invasive procedures, recurrent vaginal examination, andamnioticmembrane rupture. Various health problems and conditions can create a favorable environment that would encourage the development of infections. This is also done to prevent the risk of developing further infection in a patient with bacterial tonsillitis. Advertising on our site helps support our mission. lovely update, I like the write up,it has really helped me in my project writing. Compromised host defenses (e.g., radiation therapy, organ transplant, medication therapy). A more recent article on preterm labor is available. Encourage spitting onto a tissue and discarding the tissues immediately. Goal. Previable rupture of membranes also can lead to Potters syndrome, which results in pressure deformities of the limbs and face and pulmonary hypoplasia. Preterm PROM is not a contraindication to vaginal delivery. PROM is associated with malpresentation, possible weak areas in the amnion and chorion, subclinical infection, and, possibly, incompetent cervix. If the infection cannot be prevented, the goal is to prevent the spread of infection between individuals and treat the underlying infection. 2. 4. Patient will demonstrate a meticulous hand washing technique. This involves your provider inserting a speculum into your vagina. Risk for infection related to prolonged rupture of membranes. If your membranes rupture at term (37 weeks of pregnancy), its usually from your amniotic membranes weakening from the pressure of contractions. If it happens after 37 weeks of pregnancy, your provider delivers your baby. Other symptoms include a fast heart rate, sore or painful uterus, and amniotic fluid that smells bad. Provide surgical masks to visitors who are coughing and provide the rationale to enforce usage. 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. A good understanding of the chain of infection helps in the early diagnosis and prevention of infection. Multiple courses of corticosteroids and the use of corticosteroids after 34 weeks gestation are not recommended. Avoid talking, coughing, or sneezing over open wounds or sterile fields. When the patient touches other people or objects with infected hands, the infection will likely spread. A more recent article on preterm labor is available. ]7W|+;JqWfPAU2M0a This is the way the pathogen transfers from the reservoir to the host. If infection occurs, teach the patient to take anti-infectives as prescribed. 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. It involves placing a drop of your vaginal fluid on the strip of paper and waiting to see if the paper turns blue. Its commonly called your water breaking. If it happens after 37 weeks of pregnancy, your provider delivers your baby. St. Louis, MO: Elsevier. Antimicrobials are widely used to treat infections when susceptibility is present. TANYA M. MEDINA, M.D., AND D. ASHLEY HILL, M.D. 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. PROM is marked by amniotic fluid gushing from the vagina. PPEs protect carers and prevent the transfer of infection to other people. She denies having any labor contractions. Your provider will carefully weigh these risks before making a decision. Another method providers may use is a fern test or ferning. Nursing Diagnosis: Risk for infection related to the presence of artificial airway (tracheostomy). 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. Intraamniotic infection is a common condition noted among preterm and term parturients. Cough or expectorate onto a tissue and dispose of after use. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. Home management of patients with preterm PROM is controversial. 5. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. Fever during labor. The most common assessment finding in a client with abruption placenta is a rigid or boardlike abdomen. Instruct clients to perform hand hygiene when handling food or eating. Assess for the following signs and symptoms: 3.1. Antibiotic may protect against the development of chorioamnionitis in women at risk. To treat the underlying infection with broad spectrum antibiotics, then switch with the type of antibiotics to which the causative bacteria are sensitive. Figure 1 is an algorithm for management of preterm PROM. It's commonly called your "water breaking.". A pregnant patient with premature rupture of membranes is at higher risk for postpartum infection. If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. Preterm PROM typically occurs due to a medical condition or pregnancy complication, but it can result from unknown causes. In unusual cases in which the patients history suggests preterm PROM, but physical examination findings fail to confirm the diagnosis, ultrasonography may be helpful. The following are the common causes of infection: Nursing Diagnosis: Risk for infection related to Viral illness and immunocompromised status (e.g.
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