logging in or signing up Pre-Mature Rupture of the Membranes Epistaxis Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1783 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: February 02, 2009 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: samihrabah (8 month(s) ago) can i download this ppt Saving..... Post Reply Close Saving..... Edit Comment Close By: samihrabah (8 month(s) ago) can i download this ppt Saving..... Post Reply Close Saving..... Edit Comment Close By: samihrabah (8 month(s) ago) i want 2 download this one Saving..... Post Reply Close Saving..... Edit Comment Close By: ettenan (10 month(s) ago) can i download this ppt Saving..... Post Reply Close Saving..... Edit Comment Close By: ettenan (10 month(s) ago) can i download this ppt Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript PREMATURE RUPTURE OF MEMBRANES : PREMATURE RUPTURE OF MEMBRANES Risk factorsThe membranes may resist to a pressure higher than the intrauterine one.They rupture if damaged by any risk factor, as those listed below: : Risk factorsThe membranes may resist to a pressure higher than the intrauterine one.They rupture if damaged by any risk factor, as those listed below: Predisposing infection (cervico-vaginitis); cervical incompetence; invasive procedures in the cervix; low placental insertion; Precipitating Smoking Low socio-economic condition Signs and Symptoms: : Signs and Symptoms: Fever CARDIO: heart rate of mother and infants ? HEMAT: WBC ? REPROD: Uterine tenderness on palpation Free flowing amniotic fluid Fluid passing through the vagina suddenly, and then small amounts of fluid flow through the vagina intermitently, particularly when the increased of abdorminal pressure (cough,sneeze,et al) Diagnostics : Diagnostics cervical examination - an examination by a physician's gloved fingers of the cervix can help determine if the cervix has softened, shortened, thinned, or dilated (opened) - all signs of preterm labor. ultrasound (with a vaginal transducer to measure the length of the cervix, or with an abdominal transducer to check the fetus and amniotic fluid levels) testing for premature rupture of membranes (the amniotic sac) testing for fetal fibronectin (FFN) - a protein that helps glue together the tissues of the placenta. FFN may be released when there is a disruption in these tissues or with infection. The protein is then found in cervical secretions where it can be sampled and tested. “fern” test Slide 7: Fifty percent of all preterm births are due to premature labor, defined as regular uterine contractions with progressive cervical dilatation [1]. Preterm birth can occur secondary to a number of diverse pathologies. Chronic inflammation as well as acute infection, occurring locally within the uterus, can cause the production of autocrine/paracrine hormones, as well as the classical cytokines, that then activate the myometrium causing preterm labor. the principal factors likely to affect the autocrine/paracrine balance of hormones and cytokines to initiate preterm labor are shown. The same substances can also act via an alternative pathway, increasing the available active matrix metalloproteinases (MMPs) via alteration of the MMP/tissue inhibitor of metalloproteinase (TIMP) balance. The consequences of this would be increased matrix degradation in the fetal membranes and cervix. This can lead to decidual activation and increased production of cytokines and prostaglandins, leading to myometrial activation. Alternatively, after membrane rupture, ascending infection is a rapid process that also terminates in uterine contraction. Medical and Surgical management : Medical and Surgical management Perform sterile speculum examination Document maternal and fetal vital signs Administer antibiotics Antenatal corticosteroid treatment Tocolytics Cervical cerclage Nursing management : Nursing management Fetus surveillance: count fetal movement at least BID, 10 fetal movements in a 12-hours period. Understand the volume of amniotic fluid remained in the amniotic sack Signs of stress on Fetal monitor Stick prevention of infection due to amniotic sac is ruptured and bacterial may enter the uterus to infect fetus. Relieve psychological stress due to prolonged bed rest and possibility of premature birth Dx:Risk for infection r/t premature rupture of membranes w/out accompanying labor : Dx:Risk for infection r/t premature rupture of membranes w/out accompanying labor Promote bed rest either at home or at the hospital Monitor for sx of infection such as fever, pain, inc FHR, and laboratory test. Avoid vaginal examinations to prevent introduction of microorganisms. Administer antibiotics Administer tocolytics Dx:Risk for Fetal Injury r/t Preterm Birth : Dx:Risk for Fetal Injury r/t Preterm Birth Monitor fetal status and labor problems. Assess WBC count frequently. A count of 18,000-20,000/mm3 suggests infection. Reassure misconceptions about difficulty of labor after preterm rupture of the membranes (dry labor) since amniotic fluid is always being formed so there is no such thing as dry labor Encourage the woman to assume positions that will enhance placental perfusion. Assist with delivery of infant as needed. Slide 12: Dx:Fear r/t uncertain outcome of pregnancy Provide support persons because she is apt to be more concerned than the average person about labor. Encourage expression of feelings and anxieties to facilitate coping with actual situation. Provide frequent assurance during labor that she is breathing well with contractions and continue until postpartum period because she may not be mentally prepared for the labor because it has come unexpectedly. Comment on strengths of the family unit. Convey confidence in client’s ability to cope with current situation. Dx:Anxiety r/t outcome of labor : Dx:Anxiety r/t outcome of labor Encourage use of guided imagery,visualization nad relaxation techniques to promote sense of self Involve exrtended family/SOs in treatment plan.Increases likelihood they will provide appropriate support to client Provide accurate information on the status of the fetus and labor (contraction pattern). Allow the woman and her support person to verbalize their feelings If a private room is not used, do not place the woman in a room with a woman who is in labor or who has lost an infant. Dx:Knowledge deficit : Dx:Knowledge deficit Assess the client’s level of capability and the possibilities of the situation Identify information that needs to be remembered. Verbalize understanding of condition Reassure misconceptions about difficulty of labor after preterm rupture of the membranes (dry labor) since amniotic fluid is always being formed so there is no such thing as dry labor Provide accurate information on the status of the fetus and labor (contraction pattern). That ends our report on PROM.;] : That ends our report on PROM.;] You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Pre-Mature Rupture of the Membranes Epistaxis Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1783 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: February 02, 2009 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: samihrabah (8 month(s) ago) can i download this ppt Saving..... Post Reply Close Saving..... Edit Comment Close By: samihrabah (8 month(s) ago) can i download this ppt Saving..... Post Reply Close Saving..... Edit Comment Close By: samihrabah (8 month(s) ago) i want 2 download this one Saving..... Post Reply Close Saving..... Edit Comment Close By: ettenan (10 month(s) ago) can i download this ppt Saving..... Post Reply Close Saving..... Edit Comment Close By: ettenan (10 month(s) ago) can i download this ppt Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript PREMATURE RUPTURE OF MEMBRANES : PREMATURE RUPTURE OF MEMBRANES Risk factorsThe membranes may resist to a pressure higher than the intrauterine one.They rupture if damaged by any risk factor, as those listed below: : Risk factorsThe membranes may resist to a pressure higher than the intrauterine one.They rupture if damaged by any risk factor, as those listed below: Predisposing infection (cervico-vaginitis); cervical incompetence; invasive procedures in the cervix; low placental insertion; Precipitating Smoking Low socio-economic condition Signs and Symptoms: : Signs and Symptoms: Fever CARDIO: heart rate of mother and infants ? HEMAT: WBC ? REPROD: Uterine tenderness on palpation Free flowing amniotic fluid Fluid passing through the vagina suddenly, and then small amounts of fluid flow through the vagina intermitently, particularly when the increased of abdorminal pressure (cough,sneeze,et al) Diagnostics : Diagnostics cervical examination - an examination by a physician's gloved fingers of the cervix can help determine if the cervix has softened, shortened, thinned, or dilated (opened) - all signs of preterm labor. ultrasound (with a vaginal transducer to measure the length of the cervix, or with an abdominal transducer to check the fetus and amniotic fluid levels) testing for premature rupture of membranes (the amniotic sac) testing for fetal fibronectin (FFN) - a protein that helps glue together the tissues of the placenta. FFN may be released when there is a disruption in these tissues or with infection. The protein is then found in cervical secretions where it can be sampled and tested. “fern” test Slide 7: Fifty percent of all preterm births are due to premature labor, defined as regular uterine contractions with progressive cervical dilatation [1]. Preterm birth can occur secondary to a number of diverse pathologies. Chronic inflammation as well as acute infection, occurring locally within the uterus, can cause the production of autocrine/paracrine hormones, as well as the classical cytokines, that then activate the myometrium causing preterm labor. the principal factors likely to affect the autocrine/paracrine balance of hormones and cytokines to initiate preterm labor are shown. The same substances can also act via an alternative pathway, increasing the available active matrix metalloproteinases (MMPs) via alteration of the MMP/tissue inhibitor of metalloproteinase (TIMP) balance. The consequences of this would be increased matrix degradation in the fetal membranes and cervix. This can lead to decidual activation and increased production of cytokines and prostaglandins, leading to myometrial activation. Alternatively, after membrane rupture, ascending infection is a rapid process that also terminates in uterine contraction. Medical and Surgical management : Medical and Surgical management Perform sterile speculum examination Document maternal and fetal vital signs Administer antibiotics Antenatal corticosteroid treatment Tocolytics Cervical cerclage Nursing management : Nursing management Fetus surveillance: count fetal movement at least BID, 10 fetal movements in a 12-hours period. Understand the volume of amniotic fluid remained in the amniotic sack Signs of stress on Fetal monitor Stick prevention of infection due to amniotic sac is ruptured and bacterial may enter the uterus to infect fetus. Relieve psychological stress due to prolonged bed rest and possibility of premature birth Dx:Risk for infection r/t premature rupture of membranes w/out accompanying labor : Dx:Risk for infection r/t premature rupture of membranes w/out accompanying labor Promote bed rest either at home or at the hospital Monitor for sx of infection such as fever, pain, inc FHR, and laboratory test. Avoid vaginal examinations to prevent introduction of microorganisms. Administer antibiotics Administer tocolytics Dx:Risk for Fetal Injury r/t Preterm Birth : Dx:Risk for Fetal Injury r/t Preterm Birth Monitor fetal status and labor problems. Assess WBC count frequently. A count of 18,000-20,000/mm3 suggests infection. Reassure misconceptions about difficulty of labor after preterm rupture of the membranes (dry labor) since amniotic fluid is always being formed so there is no such thing as dry labor Encourage the woman to assume positions that will enhance placental perfusion. Assist with delivery of infant as needed. Slide 12: Dx:Fear r/t uncertain outcome of pregnancy Provide support persons because she is apt to be more concerned than the average person about labor. Encourage expression of feelings and anxieties to facilitate coping with actual situation. Provide frequent assurance during labor that she is breathing well with contractions and continue until postpartum period because she may not be mentally prepared for the labor because it has come unexpectedly. Comment on strengths of the family unit. Convey confidence in client’s ability to cope with current situation. Dx:Anxiety r/t outcome of labor : Dx:Anxiety r/t outcome of labor Encourage use of guided imagery,visualization nad relaxation techniques to promote sense of self Involve exrtended family/SOs in treatment plan.Increases likelihood they will provide appropriate support to client Provide accurate information on the status of the fetus and labor (contraction pattern). Allow the woman and her support person to verbalize their feelings If a private room is not used, do not place the woman in a room with a woman who is in labor or who has lost an infant. Dx:Knowledge deficit : Dx:Knowledge deficit Assess the client’s level of capability and the possibilities of the situation Identify information that needs to be remembered. Verbalize understanding of condition Reassure misconceptions about difficulty of labor after preterm rupture of the membranes (dry labor) since amniotic fluid is always being formed so there is no such thing as dry labor Provide accurate information on the status of the fetus and labor (contraction pattern). That ends our report on PROM.;] : That ends our report on PROM.;]