PTL and PROM Flashcards
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)
