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PREPARED BY:
TINU VARGHESE
DEMOGRAPHIC DATA CASE NO: 052125 NAME: MS. J.J. AGE: 24 Y/O SEX: FEMALE DIAGNOSIS: PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM)
GENERAL
The patient is 24 years of age, FEMALE She is conscious, coherent, with the following Vital Signs:
BP= 110/59mmHg PR=100 bpm RR= 28 cpm Temp=37. C SPO= 98%
SKIN Fair complexion No palpable masses or lesions, moist, with good turgor
HEAD
Maxillary, frontal, and ethmoid sinuses are not tender. No palpable masses and lesions No areas of deformity
EYES Pink conjunctivae and no dryness Pupils equally round and reactive to light
EARS
No usual discharges noted
NOSE
Pink nasal mucosa No unusual nasal discharges No tenderness in sinuses
MOUTH Pink and moist oral mucosa and free of swelling and lesions
NECK AND THROAT No palpable lymph nodes No masses and lesions seen
ABDOMEN
Globular abdomen
Leopolds Maneuver done: fetus in cephalic presentation, head is round and hard, fetal back is facing right side
USG report:
o Pregnancy Uterine 33 weeks AOG by fetal Biometry live, Singleon in cephalic presentation, female fetus, Good cardiac and somatic activity, posterior placenta, Grade III, No previa, Adequate Amniotic Fluid Volume
GENITALS
EXREMITIES
Pulse full and equal No lesions noted
PATIENT HISTORY
PAST MEDICAL HISTORY
No past medical history
RESULT
10g/dl 14.04 12.1 sec 5.2 mmol/L A positive
REFERENCE RANGE
11.2-15.7g/dl 3.98-10.04 10.9-16.3sec 3.9-7.8mmol/L
NAME OF DRUG
DOSAGE 1 gm
ROUTE IV IM
1.
Ampicillin
12mg
2 Inj.Dexamethasone
Calcium channel blockers 3 Tab .Nifedipine 20mg 10mg 4 5 Tab .Nifedipine Calcium Tablet 600mg 100mg PO PO Calcium supplimentt Iron suppliment PO PO Calcium channel blockers
FeSO4 Tablet
Mix 10 U in 500 mL of IV solution, begin infusion at 1 mU/min and increase 12 mU/min q 30 min
IV
IV
INTRODUCTION
During pregnancy, the baby is surrounded in the uterus by the amniotic sac. The sac is also called the bag of waters. It protects and cushions the baby. Premature Rupture of Membranes (PROM) is defined as rupture of membranes before the onset of labor. Preterm Premature Rupture of Membranes (PPROM), which is when the membranes rupture before 37 weeks.
INTRODUCTION
The sac contains amniotic fluid and the developing baby. In PPROM, the amniotic fluid inside the sac leaks or gushes out of the vagina. Before term, PPROM is often due to an infection in the uterus.
Ultrasound Amnisure
POSITIVE
NITRAZINE TEST
POSITIVE
FERN TEST
Amniocentesis to inject indigo carmine or evans blue dye. watch for vaginal leakage of blue fluid to assess for ruptured membranes
Risk factors
Lack of prenatal care Smoking during pregnancy Low body weight Bleeding from the vagina during the 2nd or 3rd trimester Having had a sexually transmitted disease (STD) Having had certain medical procedures such as amniocentesis (a test that takes fluid from the amniotic sac) or cerclage (sewing the cervix closed during pregnancy)
Other symptoms:
Other symptoms:
If you have any of these signs & symptoms, call your healthcare provider right away
TREATMENT
Hospitalization Expectant management (in some cases of PPROM, the membranes may seal over and the fluid may stop leaking without treatment) Monitoring for signs of infection such as fever, pain, increased fetal heart rate, and/or laboratory tests Giving the mother medications called corticosteroids that may help mature the lungs of the fetus (lung immaturity is a major problem of premature babies Antibiotics (to prevent or treat infections) Tocolytics - medications used to stop preterm labor. Delivery (if PROM endangers the well-being of the mother or fetus, then an early delivery may be necessary to prevent further complication
COMPLICATIONS OF PROM
Prolapse of the umbilical cord (the baby's cord drops down interfere with the blood supply to the baby). Infection of the uterus and unborn child. Placental abruption (the placenta comes away early with bleeding and loss of blood supply to the baby). Potential increased rates cesarean delivery. Premature Birth (PPROM) Chorioamnionitis Cord compression Respiratory distress syndrome
ASSESSMENT
CUES/ EVIDENCE SUBJECTIVE: I feeing sudden gush of fluid from the vagina as verbalized by the patient. OBJECTIVE: 1.Meconium stained amniotic fluid. 2.Amnicator test result positive NURSING DIAGNOSIS Risk for infection related to loss of protective barrier by positive fern test.
PLANNING
GOALS & DESIRED OUTCOME Within 12 hours of nursing intervention , patient will have no signs of infection.
IMPLEMENTATION
NURSING ORDER/ACTION RATIONALE FOR ACTION
EVALUATION
EVALUATION
1. assess the patient from any signs and symptoms of infection v/S taken as follows: BP:130/90mmHg PR: 118 bpm RR: 28 cpm Temp: 37 C
After 12 hours of nursing intervention, the goal was fully met as evidenced by: Patient has no signs of infection
2.Provide sterile pads 3.Teach the proper hand hygiene technique to the patient.
2. prevent infections
3. To avoid infections
4.Vaginal examinations should be held to an absolute minimum, and sterile technique should be used. 5.Administer antibiotics as prescribed.
4. To prevent infections
5. To treat infection
Anxiety r/t threat to maternal or fetal wellbeing secondary to risk for infection or preterm birth
PLANNING GOALS & DESIRED OUTCOME Within 12 hours of nursing intervention , patient will
EVALUATION EVALUATION
1. To identify physical responses associated with both medical and emotional conditions. 2. To reduce anxiety by giving awareness of fetal wellbeing. 3. To relieve psychological stress due to prolonged bed rest 4. To reduce anxiety by relaxation, deep breathing. 5. To give knowledge about the risk of infection
2. Teach the patient for counting the 10 fetal movements in 12 hour periods. 3. Manage environmental factors, such as harsh lighting and high volume of CTG, which may be stressful to patient 4. instruct client in relaxation techniques and encourage participation in diversional activities 5. Explain the action and side effects of medication as prescribed. Inj. ampicillin 1gm IV
After 12 hours of nursing interventi on, the goal was fully met as evidence d by:
Temp: 37 C
CONCLUSION
This is a case of a 24 y/o Primigravida with pregnancy 33+ 1 wks by LMP, 37 wks + 1 day by USG who came in due to watery discharge, amnicator test positive. Patient was advised for expectant management. Premature Rupture of Membranes (PROM) is defined as rupture of membranes before the onset of labor. Preterm Premature Rupture of Membranes (PPROM), which is when the membranes rupture before 37 weeks. Premature Rupture of Membranes happens when the membranes that hold amniotic fluid (the water surrounding the baby) usually break at the end of the first stage of labor.
CONCLUSION
Criteria which are fulfilled by the patient, conservative management rendered such as investigations, antibiotic coverage In cases by which this patient will undergo active labor despite tocolytic medication, there will be no objection for delivery as long as all maternal & fetal consequences are explained properly to the patient.
BIBLIOGRAPHY
Maternal and Child Health Nursing by Adele Pillitteri 5th edition; volume 1 page 426- 433;page 329-332 All-in-one care planning resource page 748; by Pamela L. Swearlngen, RN Maternal Neonatal Nursing;page 30 by Lippincott Williams and Wilkins Luckman and Sorensens Medical-Surgical Nursing a Physiologic Approach 4th edition Volume 1 page 734 Lippincot Manual of Nursing Practice 9th edition http://www.ualberta.ca/~olsonlab/Am%20J%20Obstet %20Gynecol%201999%20180(1%20Pt%201).pdf
Thank you!!