Premature Rupture of Membranes (PROM) Nursing Care Plan & Management

Notes

Description
  • PROM is rupture of the chorion and amnion 1 hour or more before the onset of labor. The gestational age of the fetus and estimates of viability affect management.
Etiology
  • The precise cause and specific predisposing factors are unknown.
Pathophysiology
  1. PROM is associated with malpresentation, possible weak areas in the amnion and chorion, subclinical infection, and, possibly, incompetent cervix.
  2. Basic and effective defense against the fetus contracting an infection is lost and the risk of ascending intrauterine infection, known as chorioamnionitis, is increased.
  3. The leading cause of death associated with PROM is infection.
  4. When the latent period (time between rupture of membranes and onset of labor) is less than 24 hours, the risk of infection is low.

Assessment Findings

1. Clinical manifestations

  • PROM is marked by amniotic fluid gushing from the vagina. The fluid may merely trickle or leak from the vagina in the absence of contractions.
  • Pooling of amniotic fluid in the vagina will be visualized during a speculum examination.
  • Maternal fever, fetal tachycardia, and malodorous discharge may indicate infection.

2. Laboratory and diagnostic study findings. Rupture of membranes is confirmed by the following.

  • Ferning is evident.
  • Nitrazine test tape turns a blue-green color.

Nursing Management

1. Prevent infection and other potential complications.

  • Make an early and accurate evaluation of membrane status, using sterile speculum examination and determination of ferning. Thereafter, keep vaginal examinations to a minimum to prevent infection.
  • Obtain smear specimens from vagina and rectum as prescribed to test for betahemolytic streptococci, an organism that increases the risk to the fetus.
  • Determine maternal and fetal status, including estimated gestational age. Continually assess for signs of infection.
  • Maintain the client on bed rest if the fetal head is not engaged. This method may prevent cord prolapse if additional rupture and loss of fluid occur. Once the fetal head is engaged, ambulation can be encouraged.

2. Provide client and family education.

  • Inform the client, if the fetus is at term, that the chances of spontaneous labor beginning are excellent; encourage the client and partner to prepare themselves for labor and birth.
  • If labor does not begin or the fetus is judged to be preterm or at risk for infection, explain treatments that are likely to be needed.

Exam

Welcome to your Premature Rupture of Membranes (PROM) Practice Exam! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 10 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Think about the classic sign of a severe and painful complication associated with abruptio placentae.

1 / 10

1. Nurse Sandra is assessing a pregnant client suspected of having abruptio placentae. Which of the following findings would she most likely observe?

💡 Hint

Consider that PROM can present with varying symptoms, and a sudden gush is just one possible sign.

2 / 10

2. Nurse Jenna is explaining the signs of preterm premature rupture of membranes (PROM) to a patient. She mentions that a sudden gush of clear watery fluid from the vagina is not always observed in cases of PROM. Is this statement:

💡 Hint

Consider how increased uterine pressure from various conditions might contribute to the weakening of the amniotic membranes.

3 / 10

3. Nurse Clara is discussing the causes of preterm premature rupture of membranes (PROM) with a pregnant patient. She explains that PROM can occur if the uterus is overstretched due to factors such as fetal malpresentation, multiple pregnancies, or an excessive amount of amniotic fluid. Is this statement:

💡 Hint

Focus on the factor directly related to previous pregnancy outcomes that could increase the likelihood of a repeated occurrence.

4 / 10

4. Nurse Jenna is evaluating the history of a G3 P2 patient admitted for preterm labor. Which risk factor in the patient’s history significantly increases her risk for preterm labor?

💡 Hint

Think about how an open cervix and ruptured membranes can increase the risk of the umbilical cord slipping into the birth canal.

5 / 10

5. Nurse Rachel is reviewing complications associated with preterm premature rupture of membranes (PROM) with a patient. She explains that cervical incompetence, when combined with PROM, can lead to umbilical cord prolapse. Is this statement:

💡 Hint

Consider the significance of past obstetrical events when evaluating risk factors for placental abruption.

6 / 10

6. Nurse Clara is reviewing risk factors with a patient concerned about placental abruption. Which of the following would increase the patient's risk?

💡 Hint

Consider how the fetal membranes might respond to trauma and whether such an event would always, sometimes, or rarely result in PROM.

7 / 10

7. During her shift, Nurse Kelly is assessing a pregnant patient who experienced a minor car accident. She wants to reassure the patient about the integrity of the fetal membranes. Which statement reflects accurate information regarding the likelihood of blunt trauma to the abdomen causing premature rupture of membranes (PROM)?

💡 Hint

Focus on the typical maternal and fetal complications associated with prolonged PROM, particularly regarding the woman’s respiratory status.

8 / 10

8. Nurse Megan is discussing the potential complications of prolonged preterm premature rupture of membranes (PROM) with a patient in labor. She clarifies that hypoxia and asphyxia of the woman in labor is a common complication of prolonged PROM. Is this statement:

💡 Hint

Consider the risk of infection with certain procedures in a patient with ruptured membranes.

9 / 10

9. Nurse Julia is reviewing the physician's orders for a patient admitted with preterm premature rupture of membranes (PPROM). Which order should Nurse Julia question?

💡 Hint

Think about the relationship between infection and membrane integrity, as well as the risks that arise once the membranes have ruptured.

10 / 10

10. Nurse Lisa is educating a group of expectant mothers about the risks associated with preterm premature rupture of membranes (PROM). She explains that an infection in the uterus can cause PROM and may also be a complication following PROM. Is this statement:

Nursing Care Plan

Nursing Diagnosis

Risk for Infection related to invasive procedures, recurrent vaginal examination, and amniotic membrane rupture.

Goal

maternal infection does not occur

Expected outcomes

Mother states / shows are free of any signs of infection.

 

Nursing Intervention Rationale
Perform initial vaginal examination, when the contraction pattern repeat, or maternal behavior indicates progress. Repeated vaginal examinations play a role in the incidence of ascending tract infections.
Monitor temperature, pulse, respiration, and white blood cells as indicated.  Within 4 hours after membrane rupture, chorioamnionitis incidence increased progressively in accordance with the time indicated by vital signs.
Give prophylactic antibiotics when indicated. Antibiotic may protect against the development of chorioamnionitis in women at risk.