UNIVERSITY OF THE BAHAMAS

NURSING AND ALLIED HEALTH PROFESSIONS

BACHELOR OF SCIENCE NURSING PROGRAMME
NUPR 234 – Maternal and Newborn Health

Patient Profile Form

Student Name: Linea Greene Date: 3/02/2023

Patient Initials: D. D Age 31 Ward: Antenatal

Date of Admission: 01/02/2023

Admitting Diagnosis: Preterm Premature Rupture of Membrane

Parity: 𝟏+𝟏 LMP: 24/07/22 EDD: 30/04/23

Antenatal care: State whether client had ANC, where and number of visits.
Client received antenatal care at a private doctor and had a total of 6 visits with
normal booking parameters. Femina Bahamas-Dr. Nina Graham
Antenatal clients: Diagnosis, admission details
Diagnosed with preterm premature rupture of membrane. Admitted via private vehicle
with pelvic pressure and back pain denying per vaginal bleed. Patient has no known
medical illness or allergies. On arrival to ward pt. oriented x3 in nil obvious respiratory
distress. Physical assessment showed no abnormalities. Abdominal exam-small,
round abdomen, linea Negra present, fetal movement felt, fetal heart rate 145-
150bpm, fundal height 26cm, lie undetermined and pv loss clear.
Assessment:
V/S- T 96.8, P100, R 20, B/P 116/69, SPO2 97%, FHR 153-157
- Fundal height-28cm
- Lie, presentation, position of fetus- Lie-longitudinal, presentation and
position undefined.
- Fetal heart rate- 153-157bpm
- Contractions- no contractions
- Per vaginal loss (PV loss)- yellow discharge
- Urinalysis- Ascorbic acid-10, Glucose-negative, Bilirubin-negative, Ketone-
trace, specific gravity-1.01, Blood- non hemolyzed 10 trace, pH-6.5, protein-
negative, urobilinogen-02 normal 3.2, nitrite-negative, leukocyte-moderate
- Weight- 183lbs

Doctors’ orders:
Activity- Bed rest
Diet: full diet once not contracting
Vitals-q4hrly
Meds- Dexamethasone 2mg IM then 12 mg 12 hrs later
Ampicillin 2g IV stat then 1g IV q6hr
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Gravol 50mg IV stat the tid
Flagyl 2mg IV/po stat
Erythromycin 500mg IV stat then 500mg IV q8hr

IV Fluids:

Type: Erythromycin 500mg Rate: q8h _ Site: Left anterior antecubital arm

_Ampicillin 1g_____ Rate: _q6h_____

_Gravol 50mg____ Rate: _q3h_____
Rationale for use in this client:
Erythromycin 500mg IV q8h and Ampicillin 1g q6h is used for this client
because Preterm premature rupture of membranes (PPROM) is one of the
most common causes of preterm birth. Antibiotic treatment is recommended to
prolong the pregnancy course and reduce fetal morbidity in women with
PPROM. Gravol 50mg IV q3h is given to relieve or prevent nausea and
vomiting by affecting the vomiting center in the brain.

Surgery/Invasive procedures: (Points)

1. Type: N/A Date:

Wound Site/Appearance N/A

Blood investigations:

HB: 11.5 VDRL: Non-reactive

Blood group/ RH factor: A+ Chlamydia: Negative

Medications: Include Only Current Medications

Drug name and class: Include Prescribed Dosage, Route & Frequency
Dexamethasone 2mg IM then 12mg 12hrs later
Class- Corticosteroids
Reason prescribed for this client. Method of action in this client:
The use of antenatal corticosteroid Dexamethasone accelerates maturation of
administration after preterm PROM has been fetal lungs, decrease number of neonates
evaluated in several clinical trials and has been with respiratory distress syndrome and
shown to reduce neonatal mortality, respiratory
improves survival in preterm delivered
distress syndrome, intraventricular hemorrhage,
and necrotizing enterocolitis neonates. Optimal gestational age for use of
dexamethasone therapy is 31 to 34 weeks of
gestation.
Evaluation of drug effect: Related nursing care (give at least 3)
Maternal dexamethasone administration to Observe for signs of adverse reactions.
pregnant women at risk of preterm labor Monitor blood pressure 2 - 3 times daily.
improves the blood flow of the maternal uterine Test for glycosuria daily. If urine is positive for
artery, fetal MCA, descending aorta, and sugar, check each urine.
umbilical artery 24 h after its administration.

Revised 0804/SNS/revised ejw09/revised kmm22

Drug name and class: Include Prescribed Dosage, Route & Frequency
Ampicillin 1g IV q6h
Class: Penicillin
Reason prescribed for this client. Method of action in this client:
Ampicillin treatment, particularly in the first The mechanisms of action of ampicillin are
trimester of gestation, can reduce the proportion interference with cell wall synthesis by
of preterm birth in pregnant women with acute attachment to penicillin-binding proteins (PBPs),
infectious diseases of the genitourinary and inhibition of cell wall peptidoglycan synthesis
respiratory system. and inactivation of inhibitors to autolytic
enzymes.
Evaluation of drug effect: Related nursing care (give at least 3)
It is concluded that women in latent phase of Monitor for rash or hives.
preterm labor benefit from treatment with oral Watch for seizures; notify physician immediately
ampicillin, which prolongs the gestational age at if patient develops or increases seizure activity.
delivery with ensuing increase in birth weight, Monitor signs of pseudomembranous colitis,
reduction in the prevalence of histological including diarrhea, abdominal pain, fever, pus or
chorioamnionitis and in neonatal and puerperal mucus in stool, and other severe or prolonged
infectious morbidity. GI problems (nausea, vomiting, heartburn).
Drug name and class: Include Prescribed Dosage, Route & Frequency
Gravol (Dimenhydrinate) 50mg tid
Class: Antiemetics
Reason prescribed for this client. Method of action in this client:
Gravol is given to relieve or prevent nausea and Its mode of action as an antiemetic is unknown
vomiting by affecting the vomiting center in the but may be related to central anticholinergic
brain. actions or an effect on chemoreceptive triggers.
It diminishes vestibular stimulation and
depresses labyrinthine function, raising the
threshold of susceptibility.
Evaluation of drug effect: Related nursing care (give at least 3)
Most people can expect some relief of nausea Monitor any improvements in symptoms (nausea,
and vomiting within one hour of taking any form vomiting, dizziness, vertigo) to help document the
of dimenhydrinate. It works to relieve vertigo by effects of this drug.
affecting the brain and the inner ear.
Assess dizziness and drowsiness that might
affect gait, balance, and other functional
activities. Report balance problems and functional
limitations to the physician, and caution the
patient and family/caregivers to guard against
falls and trauma.

Instruct patient to report other bothersome side

effects including severe or prolonged headache
blurred vision, buzzing/ringing in the ears
(tinnitus), problems with urination, or GI problems
(constipation, diarrhea, dry mouth, loss of
appetite).

Drug name and class

Erythromycin 500mg IV q8h
Class: Macrolide Antibiotics

Reason prescribed for this client. Method of action in this client:

Erythromycin is used for this client because
Preterm premature rupture of membranes
(PPROM) can cause preterm birth. This drug
treatment is recommended to prolong the
Revised 0804/SNS/revised ejw09/revised kmm22
Erythromycin acts by inhibition of protein
synthesis by binding to the 23S ribosomal RNA
molecule in the 50S subunit of ribosomes in
susceptible bacterial organisms.
 pregnancy course and reduce fetal morbidity in
women

Evaluation of drug effect: Related nursing care (give at least 3)

Erythromycin works in PPROM by reducing risk
for infection therefore lowering white blood cell
count and reduces risk of going into early labor.
Observe for signs of adverse effects e.g.,
diarrhea, vomiting, allergic reactions.
Observe IV site closely for extravasation during
infusion of drug.
Observe for signs of renal, hepatic, and
hematological dysfunction during prolonged
therapy.

Identify nursing needs: List at least three (3)

Safety and Protection-Risk for infection r/t loss of protective barrier aeb ultrasound scan showing decreased
amniotic fluid and patient report of dampness in underwear.
Comfort-Impaired comfort r/t gestation aeb verbalize pain in specific area of the body and pain scale rated
above 3/10.
Self-Perception- Body image disturbance related to pregnancy aeb decrease in self esteem and fear of weight
gain.

Develop 1 priority need into a care plan.

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Revised 0804/SNS/revised ejw09/revised kmm22