risk for infection related to rupture of membranes care plan

Premature rupture of membranes, or PROM, is when your water breaks before labor starts. Encourage hand hygiene and explain the importance of proper handwashing. Vaginal fluid has a lower pH than amniotic fluid. Adequate sleep is an essential modulator of immune responses. %PDF-1.5 Desired Outcome: The patient will demonstrate lifestyle changes to promote a safe environment. Assess the patients skin on his/her whole body. A speculum allows your provider to separate your vaginal wall and see your cervix. 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. If the rash leads to other skin breakdown which then gets infected, antibiotics is prescribed. Unlike when you pee, you wont be able to hold it in. Are Vaginal Examinations in L&D an Infection Risk? - r N Plain soap is good at reducing bacterial counts, but antimicrobial soap is better, and alcohol-based hand rubs are the best. Uterine rupture. 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. 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. Ideally, these treatments allow your pregnancy to progress to at least 34 weeks. 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. Fluids help promote diluted urine, frequent emptying of the bladder, and reducing the stasis of urine. Investigate the use of medications or treatment modalities that may cause immunosuppression.Antineoplastic agents, corticosteroids, and so on can suppress immune function. A pathogen can be a bacterium, virus, fungus, parasite, or any other microorganisms. Ivanov, A. V., Bartosch, B., & Isaguliants, M. G. (2017). A lack of sleep can weaken immunity and increased susceptibility to 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. Maternal fever, fetal tachycardia, and malodorous discharge may indicate infection. 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/). 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. 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. This information will help the patient understand the importance of lifestyle changes to avoid secondary infection and the spread of infection to others. 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. endobj Cervical incompetence in combination with PROM can be a cause of umbilical cord prolapse. Which of the following would the nurse Sandra most likely expect to find when assessing a pregnant client with abruption placenta? 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. This reduces or eliminates germs. Berman, A., Snyder, S. J., Kozier, B., Erb, G. L., Levett-Jones, T., Dwyer, T., & Parker, B. However, no antimicrobial is effective for some organisms, such as the human immunodeficiency virus (HIV). The diagnosis of PROM requires a thorough history, physical examination, and selected laboratory studies. Care plan diagnosis: Potential for infection related to rupture of Registered Nurse, Free Care Plans, Free NCLEX Review, Nurse Salary, and much more. In most cases, this occurs near term, but when membrane rupture occurs before 37 weeks gestation, it is known as preterm PROM. Compromised host defenses (e.g., radiation therapy, organ transplant, medication therapy). Knowledge of ways to reduce or eliminate germs reduces the likelihood of transmission. 2023 Nurseslabs | Ut in Omnibus Glorificetur Deus! Its sometimes hard to tell if youre leaking amniotic fluid, vaginal discharge (which increases in pregnancy) or pee. 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. If your water breaks before 37 weeks, your provider will help you make the safest choice. Evidence suggests that prolonged latency may increase the risk of intra-amniotic infection. Antibiotics should be administered to patients with preterm PROM because they prolong the latent period and improve outcomes. Keep the stoma clean and dry. Adequate nutrition enables the body to maintain and rebuild tissues and helps keep the immune system functioning well. Another meta-analysis24 found a decrease in neonatal intraventricular hemorrhage and sepsis. Join the nursing revolution. PDF Rate of Infection in Prolonged PROM at Term Some hospitals may have the information displayed in digital format, or use pre-made templates. The most important part of the care plan is the content, as that is the foundation on which you will base your care. Assist client to learn stress-reducing techniques. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. Pt denies any uterus tenderness. Nursing Care Plans Nursing Diagnosis & Intervention (10th Edition)Includes over two hundred care plans that reflect the most recent evidence-based guidelines. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. Prom may occur if the uterus is over-stretched by malpresentation of the fetus, multiple pregnancy or excess amniotic fluid. Arrowsmith, V. A., Maunder, J. However, if your baby is born before 37 weeks, theyre at higher risk for complications of being born early. Your doctor will be able to help you make the best decisions for you and your baby. This can be a problem because without amniotic fluid, your chances of infection, premature birth and other complications increase. Scratching the infected skin areas will allow the bacteria to transfer into the fingernails and onto the fingerpads. Assess vital signs and observe for any signs of infection as well as for any signs of respiratory distress. The leading cause of death associated with PROM is infection. Friction and running water effectively remove microorganisms from hands. Consider readmission to the hospital for these patients after 24 weeks gestation to allow for close fetal and maternal monitoring. Or you may need medicine to stop preterm labor. Contact your pregnancy care provider right away if you believe your membranes have ruptured. Management: Tonsillitis can lead to peritonsillar abscess. This content is owned by the AAFP. History of previous genital herpes with unknown culture result and infant delivered vaginally or by C-section after rupture of membranes. 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 includes precautions like bed rest, medications and frequent monitoring for infection or fetal distress. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. 5. Studies show PPROM is more likely to affect twin pregnancies. Ackley and Ladwigs Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning CareWe love this book because of its evidence-based approach to nursing interventions. Rarely, uterine rupture can also occur in women who have not had previous uterine surgery. Which physician order will the nurse question? It's commonly called your "water breaking.". 12. Educate the patient and carer about proper wound hygiene through washing the rash with soap and water. Within 4 hours after membrane rupture, chorioamnionitis incidence increased progressively in accordance with the time indicated by vital signs. Handwashing versus alcoholic rub can we afford 100% compliance?. Zimmerman, S., GruberBaldini, A. L., Hebel, J. R., Sloane, P. D., & Magaziner, J. Postpartum Endometritis: Everything You Need to Know - WebMD Patients with amnionitis require broad-spectrum antibiotic therapy, and all patients should receive appropriate intrapartum group B streptococcus prophylaxis, if indicated. These factors represent a break in the bodys normal first line of defense and may indicate an infection. Assist clients in carrying out appropriate skin and oral hygiene. Very low WBC count may indicate a severe risk for infection. Treatment can be started as soon as an infection is identified. In the absence of intra-amniotic infection, the physician should attempt to prolong the pregnancy until 34 weeks gestation. Patient will demonstrate a meticulous hand washing technique. We do not endorse non-Cleveland Clinic products or services. 3.4. Continuously monitor maternal and fetal vitals. After transport to a facility able to care for patients with preterm PROM before 32 weeks gestation, patients should receive daily (or continuous, if indicated) fetal monitoring for contractions and fetal well-being. 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. For more information, check out our privacy policy. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Intrapartum Management of Intraamniotic Infection | ACOG This is also done to prevent the risk of developing further infection in a patient with bacterial tonsillitis. Allowing a pregnancy to continue after the membranes rupture increases your chances of infection and other complications. 217: Prelabor Rupture of Membranes. 6. On the other hand, isolation also protects the patient from possible cross-contamination from carers, family, friends, or healthcare staff. When PROM occurs too early, surviving neonates may develop sequelae such as malpresentation, cord compression, oligohydramnios, necrotizing enterocolitis, neurologic impairment, intraventricular hemorrhage, and respiratory distress syndrome. Teach the patient how to perform proper hand hygiene. The leading cause of death associated with PROM is infection. Corticosteroids decrease perinatal morbidity and mortality after preterm PROM.21 A recent meta-analysis21 found that corticosteroid administration after preterm PROM, versus no administration, reduced the risk of respiratory distress syndrome (20 versus 35.4 percent), intraventricular hemorrhage (7.5 versus 15.9 percent), and necrotizing enterocolitis (0.8 versus 4.6 percent) without an increase in the risk of maternal or neonatal infection. Specific nursing interventions will depend on the nature and severity of the risk. Although corticosteroids are not indicated after 34 weeks gestation, physicians should prescribe appropriate antibiotics for group B streptococcus prophylaxis and should consider maternal transport to a facility skilled in caring for premature neonates, if possible. Ensure all fluid containers are covered or capped. It occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries. -The patient will verbalized the importance of refraining from sexual intercourse of any typeorusage of tampons until after pregnancy. If it happens earlier, your provider weighs the risk of premature birth against the risks of complications such as infection. 18. Fifty percent of infants with rupture at 19 weeks gestation or earlier are affected by Potters syndrome, whereas 25 percent born at 22 weeks and 10 percent after 26 weeks gestation are affected.32 Patients should be counseled about the outcomes and benefits and risks of expectant management, which may not continue long enough to deliver a baby that will survive normally. Umbilical cord prolapse can occur without any risk factors. Which of the following increases the risk of placental abruption? PROM occurs in approximately 10% of pregnancies. Nitrazine paper measures the pH (a measure of how acidic something is) of your vagina. Desired Outcome: The patient will remain free from infection as evidenced by the absence of fever and clear stoma. See our full. Other symptoms include a fast heart rate, sore or painful uterus, and amniotic fluid that smells bad. 1. 98.7, O2 Sat 98% on RA, RR 18. Up to 95% of all births occur within 28 hours of PROM when it happens at term (37 weeks). 8. 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 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. Susceptible host. 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.
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