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Flashcards in PTL and PROM Deck (29)
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1
Q

• Regular uterine contraction and cervical dilation after 20 weeks and
before completion of 37 weeks
• 250,00-400,000 births per year in U.S.
• Accounts for almost 2/3 of infant death
• 50% of PTL has no identifiable cause
• 1/3 PTL occur after PROM

A

Preterm labor (PTL)

2
Q
  • PPROM
  • Smoking, alcohol, drug use
  • Low socioeconomic status
  • Poor nutrition esp. underweight
  • Prior episode of PTL in current pregnancy or previous
  • Interval between prior pregnancy
A

PTL assessment: Risk Factors

3
Q
  • Uterine anomalies
  • Enlarged uterine size (twins, hydramnios)
  • Prior uterine surgeries
  • Comorbidity
  • cardiovascular or endocrine disorders
  • Infection
  • Frequent UTI/pyelonephritis
  • STD
  • History of GBS
A

more risk factors for PTL

4
Q
  • S/S of uterine contractions
  • Increased vaginal discharge or bloody show
  • S/S of UTI
  • Low back pain
  • Pelvic pressure
  • GI upset –N/V, diarrhea
A

PTL assessment history

5
Q
  • Uterine contractions
  • Cervical changes
  • Engagement of presenting part
  • Elevated temperature
  • FHR tachycardia
  • Fetal fibronectin (FFN) (specific enzymes with labor)
A

PTL assessment physical signs and symptoms

6
Q
  • Stress
  • Anxiety
  • Fear of pregnancy loss
  • Fear of unknown
  • Exhibits confusion, disorganization, difficulty communicating, expresses fear
A

PTL assessment Psychosocial factors

7
Q
•CBC with WBC >18,000=Infection
•Urinalysis –WBC, RBC, bacteria
•Urine culture and sensitivity
•Amniotic fluid for fetal lung maturity testing
-Indicated for 34 week gestation or greater
•Evaluate for rupture of membranes-•Fluid seen pooling from cervical os
-Nitrazine Testing
-Ferning
•Cervical cultures
-Group B strep, Chlamydia, gonorrhea
-Fetal fibronectin (FFN)
\:Reassuring if negative
\:Poor positive predictive value
•Ultrasound exam
-Examination of presenting part
-Gestational age
-Multiple fetuses
-Amniotic fluid volume
A

PTL diagnostic procedures

8
Q
  • Palpate abdomen to assess contraction strength
  • Continuous external fetal monitoring
  • FHR pattern
  • Frequency, duration, and approx. intensity of uterine contractions
  • Hydrate with PO or IV fluids
  • Bed rest on left side –not effective
  • Alteration in comfort: pain r/t uterine contractions
  • Administer tocolytic agents
A

PTL interventions

9
Q
  • Mag Sulfate relaxes smooth muscle (muscle relaxant)
  • Dosage and administration
  • Loading dose 4-6 gm IVPB over 20-30 min
  • Maintenance dose 1-3 gr/hr IVPB
  • ALWAYS administer per pump
A

PTL tocolytic agents

MAGNESIUM SULFATE

10
Q
  • Sweating
  • Flushing
  • N/V (toxicity)
  • Depressed deep tendon reflexes (DTR)
  • Flaccid paralysis (toxicity)
  • Hypocalcemia (toxicity)
  • Depressed cardiac function (toxicity)
  • Respiratory depression (toxicity)
A

PTL MAGNESIUM SULFATE: side effects

11
Q
  • Monitor VS closely
  • Monitor DTR –patellar and biceps reflex
  • 4+ very brisk
  • 3+ brisker than average
  • 2+ average, normal response
  • 1+ diminished
A

PTL MAGNESIUM SULFATE: nursing care`

12
Q
  • Monitor serum magnesium levels
  • Therapeutic level: 4-6 mEq/L
  • Loss of DTR’s: 10 mEg/L
  • Respiratory Depression: 15 mEq/L
  • Cardiac arrest: 25 mEq/L
  • Mag Sulfate discontinued if levels too high or S/S of toxicity
  • Always have antidote at bedside
  • Calcium gluconate
A

PTL MAGNESIUM SULFATE: nursing action

13
Q

therapeutic level of magnesium sulfate

A

4-6 mEq/L

14
Q
  • May go home on PO or Subcutcutaneous
  • Dosage and administration IV
  • 5-25 mcg/min titrated to uterine activity
  • Increase by 5 mcg/min every 20 min
  • Dosage and administration Subcutaneous
  • 0.25-0.5 mg per injection or intermittent pump
  • Dosage and administration PO
  • 2.5-5 mg every 2-8 hours
A

PTL TERBUTALINE SULFATE (BRETHINE)

15
Q
  • Increase heart rate* if mom’s heartrate is over 100 you can’t give
  • Nervousness
  • Tremors
  • N/V
  • Decreased serum potassium
  • Cardiac arrhythmia
  • Pulmonary edema
  • CI same as Yutopar
A

PTL BRETHINE: side effects

16
Q
  • Nonsteroidal anti-inflammatory drug (NSAID)
  • Blocks production of prostaglandins
  • Contraction suppression (tocolytic)
  • Only used if less than 32 weeks gestation
  • PO or rectal
  • Hold if s/s of pulmonary edema
A

PTL INDOMETHACIN (INDOCIN)

17
Q
•Explain SE of tocolytics
•Monitor VS and FHR
•Monitor I & O carefully
•Comfort measures
Kidneys are good insights on how well it's working
A

PTL nursing care with Tocolytics

18
Q
  • Anxiety r/t unknown pregnancy outcome
  • Provide info regarding PTL, medications, premature delivery, premature newborn
  • Encourage verbalization of feelings
  • Knowledge deficit r/t PTL
  • Explain to client her particular risk factors
  • Teach all S/S of PTL
  • Demonstrate palpation of uterine contractions
  • Explain how to assess and record frequency and duration of contractions
A

PTL interventions

19
Q
  • Spontaneous rupture of amniotic membrane before the onset of labor
  • May occur at or before term
  • Gestational age of fetus determines plan and intervention
  • At term, deliver within 48 hours
  • May need induction or augmentation
A

Premature rupture of membranes (PROM)

20
Q
  • Premature Preterm Rupture of Membranes

* Rupture of the amniotic sac earlier than the end of the 37th week of gestation

A

PPROM

21
Q
  • Infection
  • Low socioeconomic status
  • Multiple gestation
  • Poor nutrition
  • Tobacco & substance use
  • Preterm labor history
A

Risk factors of PROM

22
Q
  • If prolonged increased risk for:
  • Maternal Infection
  • Chorioamnitis
  • Endometritis (actual infection of uterus. has localized pain, increase temp and purulent discharge)
  • Sepsis
  • Neonatal Infection
  • Meningitis
  • Pneumonia
A

Complications for PROM

23
Q
History
•Gestational age-LMP, US*
•Date and time of rupture
•Pain, cramping, pressure with PROM
•Preceding events—trauma, illness
•History of UTI
•History of vaginal infection
A

PROM assessment

24
Q
Sterile speculum exam by MD
•Pooling of fluid in vagina
•Nitrazine tape turns blue
•Ferning test positive
•Cervical changes
•Discharge
•Inflammation
•Protrusion of membranes
•Presenting part
•Umbilical cord prolapse
A

PROM assessment physical signs and symptoms

25
Q
•Amount color and consistency of fluid
-Odor
-Presence of vernix, blood, meconium
•Vital signs—increased temperature
•CBC –increased WBC
•Electronic fetal monitoring
-Uterine contractions
-Uterine irritability
-FHR tachycardia
A

PROM assessment physical signs and symptoms (2)

26
Q
-Stress factors
•Anxiety
•Fear of prenancy loss
•Feeling unprepared for delivery
•guilt
-Behavior factors
•Difficulty communicating
•Expression of fears
•Coping mechanisms
A

PROM assessment psychosocial factors

27
Q
•Nitrazine –immediate, bright blue
•Ferning –amniotic fluid crystallizes into fern pattern on microscope slide
•Amniotic fluid volume by ultrasound
•Amniocentesis
-Gram stain-+ indicates infection
-Culture and senstivity
-Fetal maturity studies by US
A

PROM diagnostic procedures

28
Q
  • High risk for infection r/t amniotic membrane rupture and proximity to vaginal and enteric flora
  • Monitor VS especially temperature
  • CBC values
  • Amniotic fluid –odor, purulence
  • Observe vaginal discharge
  • Monitor FHR –tachycardia w/maternal infection
  • Note uterine activity –contractions, irritability
  • Uterine palpation –tenderness
  • NO vaginal exams
  • Administer antibiotics
  • Alteration in tissue perfusion r/t cord compression due to decrease amniotic fluid
A

PROM interventions

29
Q
  • Bedrest with FHR monitoring
  • Continuous x 48 hours
  • Then FHR check every 4 hours with daily NST
  • Evaluate fetal presenting part by palpation or US
  • Monitor evidence of cord compression –variable decelerations
  • If pre-term with severe decels -amnioinfusion
  • Anxiety r/t possible pre-term delivery
  • Provide client and family with as much info as possible that relates to clt’s particular situation
  • Include clt in planning and decision making
  • Encourage questions, verbalization
  • Identify coping mechanisms
A

PROM interventions (2)