Black patients are at a higher risk of contracting preterm PROM when compared to the white patients (Medina & Ashley, 2006). A history of smoking, STDs, vaginal infection, preterm delivery, vaginal bleeding are all predisposing factors to preterm PROM. PROM has been noted to have no single etiology associated with it (Medina & Ashley, 2006). A good nursing care plan involves the evaluation and assessment of the patient. With a medical diagnosis of PROM and a nursing diagnosis of risk of infection associated with protective barrier loss, the patient requires a robust nursing care plan. The first step is to assess the patient. In order to determine the fetal gestational age, the nurse inquires from the patient, her last menstrual cycle date. Any prenatal record is to be reviewed to identify if there has been any pregnancy problems e.g. hypertension, bleeding, gestational diabetes, illnesses, trauma, and premature labor. It is important that the patient describes the circumstances that led to the PROM. This would enable the nurse to determine the time when the rupture occurred as well as gather other important information. For example, amount and color of the fluid and any odor of fluid if present. It is also important to inquire from the patient whether she has suffered from any pelvic, vaginal or urinary tract infections. The nurse also finds out whether the patient smokes, uses drugs and consumes alcohol Patient’s vital signs should be obtained. Incase of hyperthermia and tachycardia then
there is a possibility of an infection resulting from the PROM. Samples from the vagina and cervix are obtained and examined for Chlamydia, Streptococcus and Gonorrhea bacteria. These are commonly associated with bacterial infections of the urinary tract and appropriate antibiotics administered. Auscultation of the fetal FHR is beneficial as it reveals pertinent information with regards to infections. For example, if the fetus has an elevated FHR, this would be an indication of an infection. A lower FHR could be indicative of a prolapsed umbilical cord. When the nurse notes fetal bradycardia, a sterile examination of the vagina is conducted for umbilical cord assessment. The patient is placed in Trendelenbug’s position and the presenting part of the umbilical cord removed manually. It is important that the nurse determines whether PROM actually occurred. This is because in many cases especially the third trimester, increased leucorrhea and loss of the mucous plug are often mistaken for PROM. The nurse inspects the vaginal vault, and perineum for fluid presence noting the color odor and consistency. Amniotic fluid is clear and in some cases blood tinged. Meconium stained fluid may range in color from tan to green. The duration, frequency and intensity of contractions that may be present are determined. A sterile examination of the vagina is done in order to determine the dilatation, station, cervix effacement and fetal presentation. Palpation of the uterus is also important as it will reveal the presence of an infection if it is tender (Luxner, 2004). Patient reflexes are to be obtained and presence of edema determined. The nurse should note all the signs of an infection from her examination. After obtaining results of the bacterial cultures done, appropriate antibiotics are administered to the patient. The patient is then, evaluated periodically to check for the absence or presence of the signs of infection.