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Exam 2 level 3 nursing scf Questions and Answers 100% Verified

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Preterm rupture of Membranes (PROM) - rupture of membranes after 37th wk gestation but before onset of labor Preterm Premature Rupture of Membranes (PPROM) - rupture of membranes before the 37th wk gestation (worse outcomes) possible causes of PPROM - infection (UTI) amniocentesis placental a...

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  • August 10, 2024
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Exam 2 level 3 nursing scf

Preterm rupture of Membranes (PROM) - rupture of membranes after 37th wk gestation but
before onset of labor



Preterm Premature Rupture of Membranes (PPROM) - rupture of membranes before the 37th wk
gestation (worse outcomes)



possible causes of PPROM - infection (UTI)

amniocentesis

placental abruption

hydramnios

maternal smoking

multiple gestation



assessment of rupture of membranes - time (must delivery baby w/in 24hrs)

amount

odor

color (cloudy=infection, green=fetal distress)

signs of infection

gestational age

hydration status

FHR (fetal tachy=infection)



clinical therapy for PROM - NO vaginal exam (changes environment)

sterile speculum exam (to sample fluid)

Nitrazine test

ferning test

,nitrazine test - Color will indicate whether amniotic fluid is present

Yellow = urine. Blue = Amniotic fluid

(sperm will change color too)



Ferning test - positive= indicates rupture of membranes

crystallization of amniotic fluid



indigo carmine test - green=urine

blue=amniotic fluid



hospital management of viable fetus w/ ROM - fetal lung maturity studies near 34 wks

labwork

NST qshift

biophysical profile q24hrs



Home management of viable fetus with ROM - monitor temp

record fetal movement (q4days)

pelvic rest (no sex)

twice wk NST/cbc

weekly ultrasound/cervical visual

prophylactic antibiotics



s/s of preterm labor - contractions q10min or less

mild menstrual like cramps in lower abs

with or without diarrhea

pelvic pressure

low dull back ache

,Rupture of membranes

change in vaginal discharge



risk factors for placental abruption - previous history

alcohol

domestic violence

white and black women

preterm labor - contractions and cervical dilation that occurs btw 20 and 37 wks gestation



partial placental abruption - the placenta partially detaches from the endometrium

may go undetected

baby will have decells (placental insufficiency)



marginal placental abruption - one side of the placenta detaches from endometrium



complete placental abruption - the whole placenta detaches

super painful

dark brown bleeding

low/no fetal heartbeat

rigid abdomen



maternal risks for placental abruption - hemorrhagic shock

DIC (disseminated intravascular coagulation)

renal failure



DIC (disseminated intravascular coagulation) - clotting factor bottoms out

body cant stop bleeding from every open wound/openings

, clinical therapy for placetal abruption - evaluate coag tests- fibrinogen levels, platelet count, PT &
PTT

maintain cardio status with iv fluids/blood

FHR monitoring

either induce labor or C section (if baby is alive)

(DIC treatment may only be hysterectomy)



normal platelet count - 150K-450K



Normal PT (prothrombin time) - 10-13 secs



normal aPTT - 25-35 seconds



hypovolemia with placental abruption - life threatening

treat with whole blood

lactated ringers



placental previa - improper implantation of placenta, nearing/covering the cervix



low lying placental previa - placenta attaches in lower 1/3rd of uterus, just near cervical opening



marginal placental previa - one part of placenta is over cervix



complete placental previa - placenta is completely blocking opening of cervix

only delivery option - c section



s/s of placental previa - normal FHR

painless

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