Nursing Considerations

00:01 <b>So when we think about what may need to happen in terms of </b> <b>managing a PPROM or a PROM,</b> <b>we want to talk to the client about what's going on.</b> <b>Let them know what the risk factors are.</b> <b>Let them know that their water has broken and what our </b> <b>management plan is going to be.</b> <b>We also want to minimize the risk of infection.</b> <b>If you know the client has membranes that had been released,</b> <b>you know that protective barrier between the baby and the </b> <b>outside world has been broken,</b> <b>so anything that goes in the vagina can potentially increase</b> <b> the risk of infection</b> <b>which will necessitate the baby being delivered ASAP.</b> <b>We want to offer support, because if someone's membranes had</b> <b> broken</b> <b>and they're not yet in labor, or goodness, if it's before 37</b> <b> weeks and they're not in labor,</b> <b>they may need to stay in the hospital for a really long time</b> <b>and so we need to be prepared to offer them support for </b> <b>that.</b> <b>Often, if we have premature rupture of the membrane </b> <b>especially prolonged,</b> <b>then we may need to administer antibiotics to decrease that </b> <b>risk of infection.</b> <b>And then, always, always, we want to make sure the baby is </b> <b>doing okay.</b> <b>So if it's really early and the baby's really high and the </b> <b>membranes have ruptured,</b> <b>we might worry about complication like prolapsed cord</b> <b>in addition to infection, so we want to make sure Cletus is </b> <b>doing okay.</b> <b>Let's look at some of the potential complications for a baby</b> <b> that's born premature.</b> <b>They may experience increased risks of respiratory distress </b> <b>syndrome, bronchopulmonary dysplasia,</b> <b>apnea, intraventricular hemorrhage, necrotizing </b> <b>enterocolitis, or patent ductus arteriosus.</b> <b>So these are all pretty severe consequences,</b> <b>so having a preterm baby actually increases their risk of </b> <b>death,</b> <b>so we want to avoid this in any way possible.</b> <b>Hypothermia is going to be an issue because the baby doesn't</b> <b> have enough brown fat to stay warm.</b> <b>They may experience hyperbilirubinemia as the body really </b> <b>tries</b> <b>to make more oxygen to support this baby or deal with any </b> <b>other sickness or trauma that's going on.</b> <b>They may experience hypoglycemia because their body is </b> <b>immature</b> <b>and not really able to manage all of these systems just yet.</b> <b>They may experience long-term physiologic and developmental </b> <b>disability,</b> <b>just because they're early.</b> <b>They may experience retinopathy from the increased exposure </b> <b>to oxygen.</b> <b>They may have feeding problems because their reflexes are </b> <b>not quite developed yet.</b>