Nursing Considerations

by Jacquelyn McMillian-Bohler

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    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>

    About the Lecture

    The lecture Nursing Considerations by Jacquelyn McMillian-Bohler is from the course Preterm Labor (Nursing).

    Included Quiz Questions

    1. The student nurse tells the client that they will perform cervical checks at increased intervals.
    2. The student nurse administers a prophylactic antibiotic as prescribed by the provider.
    3. The student nurse explains the importance of fetal surveillance to the client.
    4. The student nurse provides emotional support to the client and walks them through the following steps.
    1. Hyperbilirubinemia
    2. Intraventricular hemorrhage
    3. Hyperthermia
    4. Hyperglycemia
    5. Long-term disabilities

    Author of lecture Nursing Considerations

     Jacquelyn McMillian-Bohler

    Jacquelyn McMillian-Bohler

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