Disease: Premature Rupture of Membranes
A. Description: Premature rupture of membranes (PROM) at term is rupture of
membranes prior to the onset of labor at or beyond 37 weeks' gestation. PROM occurs
in approximately 10% of pregnancies.
B. Focus Assessment (Signs and Symptoms)
 An increase in the fetal heart rate
 Contractions of the uterus (womb)
 Increased heart rate and temperature in the mother
 Tenderness of the uterus
 Bad smelling vaginal discharge
 Increased white blood cell count or a change in the pattern of white blood cell
type in the mother
C. Diagnostic and Laboratory Test
LABORATORY TEST PURPOSE/INDICATION
1. Speculum examination Pooling of fluid in the
vagina or leakage of fluid
from the cervix, ferning of
the dried fluid under
microscopic examination,
and alkalinity of the fluid as
determined by Nitrazine
paper confirm the
diagnosis. Blood
contamination of the
Nitrazine paper and ferning
of cervical mucus may
produce false-positive
results.
NURSING RESPONSIBILITIES
-Ask patient to empty bladder
-Identify the specimen as to
cervical or vaginal.
-Take a patient label and attach
it to the packet. Label the
specimen with date/time/initials.
-Make sure lab order is placed
on the computer and send
Specimen to lab with computer
requisition completed.
-Handle other specimens
according to established
procedure.
-Note the color and the odor.
Deep yellow probably indicates
the release of meconium
approximately 1-2 days
previously. Greenish- brown
color indicates fresh meconium
staining of amniotic fluid. Use
this to determine bleeding and
abnormalities.
D. Risk Factors

MODIFIABLE NON-MODIFIABLE
-vaginal bleeding, -multiple births
-tobacco usage -incompetent cervix
-sexually transmitted disease -maternal age <20 years and >34 years
-prior preterm delivery -parity
-low socioeconomic status -race
-low body mass index - sexually transmitted disease

E. Pathophysiology (Diagram Form)

 F. Nursing Diagnosis (5 According to Priority)

ASSESSMENT CUES/ SIGN AND

NURSING DIAGNOSIS
SYMPTOMS USUALLY PRESENT
1. 1. Risk for Infection related to invasive
procedures and recurrent vaginal
examination
2. 2. Risk for Infection related to amniotic
membrane rupture .
3. 3. Acute Pain related to contractions of
uterus.
4. 4. Anxiety related to crisis situation
manifested by prolonged stay in the
hospital.
5. 5. Risk for infection related to loss of
protective barrier as evidence by positive
ferns test.

G. Nursing Care Plan (3 According to Priority)

1. Risk for Infection related to invasive procedures and recurrent vaginal examination.

NURSING SCIENTIFIC IMPLEMENTATIO EVALUA

ASSESSMENT PLANNING RATIONALE
DIAGNOSIS RATIONALE N T-ION
-Redness Risk for -Perform initial -Repeated -Maternal
-Swelling Infection rel vaginal vaginal infection
-Purulent ated to examination, examination does not
discharge invasive when the s play a role occurred.
procedures contraction pattern in the
and repeat, or incidence of -Client
recurrent maternal behavior ascending will
vaginal indicates tract demonstr
examination progress. infections ate
technique
-Monitor -Within 4 s to
temperature, hours after minimize
pulse, respiration, membrane risk of
and white blood rupture, infection
cells as indicated. chorioamnio
nitis
-Give prophylactic incidence
antibiotics when increased
indicated progressivel
y in
accordance
 with the time
indicated by
vital signs

-Antibiotic
may protect
against the
development
of
chorioamnio
nitis in
women at
risk

2. Risk for Infection related to amniotic membrane rupture .

NURSING SCIENTIFIC EVALUAT

ASSESSMENT PLANNING IMPLEMENTATION RATIONALE
DIAGNOSIS RATIONALE -ION
- Risk for -Patient
Infection will
related to verbalize
understan
amniotic
ding of
membrane individual
rupture. causative
/risk
factors.
-Patient
will
review
technique
s and
lifestyle
changes
to reduce
risk of
infection.
-Patient
will
initiate
behaviors
to limit
 the sprea
d of
infection,
as
appropria
te, and
reduce
the risk of
complicati
ons.

3. Acute Pain related to contractions of uterus.

NURSING SCIENTIFIC EVALUAT

ASSESSMENT PLANNING IMPLEMENTATION RATIONALE
DIAGNOSIS RATIONALE -ION
Acute Pain
related to
contractions
of uterus.

H. Nursing Management/Intervention

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.

a. Medical Intervention

Antibiotics

Intravenous antibiotics were used for 48 hours—ampicillin 2 g q6h and

erythromycin 250 mg q6h. The patients were then placed on oral amoxicillin 250 mg
q8h and enteric-coated, erythromycin-base 333 mg q8h to complete a 7-day course of
antibiotic therapy.

Antenatal corticosteroid treatment

The use of corticosteroids to accelerate lung maturity should be considered in all

patients with PPROM with a risk of infant prematurity from 24-34 weeks' gestation.

I. Drug Analysis

MECHANIS NURSING
SIDE ADVERSE CONTRAINDICATIO
DRUG M OF RESPONSIBILITI
EFFECTS EFFECT NS
ACTION ES
 Generic Bactericidal -nausea CNS: Lethargy, --Contraindicated -Take this drug
Name: action or hallucinations, with allergies to around the clock.
Ampicillin against vomiting.\ seizures penicillins, -Take the full
sensitive  -stomach GU: Nephritis cephalosporins, or course of
Brand organisms; pain or CY: heart failure other allergens. therapy; do not
Name: inhibits upset Local: Pain, -Use cautiously with stop taking the
Principen synthesis of phlebitis, renal disorders. drug if you feel
bacterial  -diarrhea thrombosis at better.
Dosage: cell wall ,  -hair loss injection site -This antibiotic is
8-14g/day causing cell - Hypersensitivit specific to your
death. tiredness y: Rash, fever, problem and
Frequency wheezing, should not be
 -
: anaphylaxis used to self-treat
dizziness
other infections.
Route: IM,  -chills
IV, Oral  -
headach
 Drug e
Classificat
ion:
Antibiotic,
Penicillin

MECHANIS NURSING
SIDE ADVERSE CONTRAINDICATIO
DRUG M OF RESPONSIBILITI
EFFECTS EFFECT NS
ACTION ES
Generic Binds 
to Burning, CNS: Vertigo, Use cautiously with -Do not take oral
Name: intracellular itching, orheadache, kidney or liver drug without
Betameth corticosteroi dryness paresthesias, disease, consulting your
asone d receptors, of the insomnia, hyperthyroidism, health care
thereby skin. seizures, ulcerative colitis with provider.
Brand initiating  Red psychosis. impending -Take single
Name: many bumps glaucoma perforation, dose or
natural around GI: Peptic or diverticulitis, active alternative day
Dosage: complex the esophageal or latent peptic dose before
12mg reactions mouth. ulcer, ulcer, inflammatory 9am.
that are pancreatitis, bowel disease, heart -Avoid exposure
Frequency responsible Extremel abdominal failure, to infections;
: 24hrs for its anti- y thick distention, hypertension, ability to fight
apart inflammator hair nausea, thromboembolic infections is
y and growth vomiting, disorder, reduced.
Route: IM immunosup on increase osteoporosis, -Wear a medical
portive unusual appetite, weight seizure disorders, alert tag so
 Drug effects. areas of gain diabetes mellitus. emergency care
Classificat the body. CV: providers know
ion:  Skin Hypotension, that you are on
Corticoste lightening shock, this medication
roid, or loss of hypertension,
Glucocort natural and heart failure
oid, skin secondary to
Hormone color. fluid retention
 Thinning
of the
skin.
 Stretch
marks.

J. References