Nursing Care Plan (NCP) for Chorioamnionitis

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Outline

Pathophysiology

Chorioamnionitis is a bacterial infection of the membranes (amnion and chorion) and amniotic fluid surrounding a fetus within the uterus. This condition is common in births in which membranes rupture prematurely. It is much more uncommon in full-term births, and typically occurs in the later stages of pregnancy. The infection starts in the vagina, anus or rectum of the mother and moves up into the uterus.

Etiology

When the membranes rupture and a long labor ensues, this leaves the vaginal canal open to the uterus and allows opportunity for bacteria (commonly Group B Streptococcus, GBS) to travel from the vagina into the uterus. It can lead to further complications such as blood clots in the pelvis and lungs of the mother and infections such as pneumonia of the fetus.  Risk factors include compromised maternal immune system, obesity, use of internal monitoring devices and multiple (more than 4) vaginal exams during labor.

Desired Outcome

Patient (mother and fetus) will be free from infection, prevention of complications or fetal infection

Chorioamnionitis Nursing Care Plan

Subjective Data:

  • Abdominal (uterine) tenderness

Objective Data:

  • Fever
  • Vaginal discharge 
  • Diaphoresis
  • Tachycardia 
  • Bad smell from amniotic fluid

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Monitor maternal vital signs for fever or tachycardia that may indicate infection Symptoms are similar to other diseases and must be monitored closely to prevent development of complications
Monitor fetal heart rate Elevated fetal heart rate indicates a sign of distress. If the fetal heart rate increases, assess the mother for signs of infection.
Monitor diagnostic test results including white blood cell count and urinalysis Patients may be asymptomatic, but have bacteria in the urine.

An elevated white count may indicate infection, but is also a common occurrence during labor and delivery.

Assess and culture vaginal discharge, if present Some STDs and GBS may be the bacterial cause of chorioamnionitis.

Note color, odor and consistency of any discharge and culture to determine the appropriate course of treatment.

Verify allergies and administer medications as necessary

Antibiotics, antipyretics)

Depending on cause of infection, antibiotics may include penicillin or erythromycin;

Antipyretics may be given for fever, such as acetaminophen;

If a patient is in labor, administer medications via IV route if appropriate.

Assess for allergies prior to administering medications.

Prepare patient for vaginal or c-section delivery if indicated Advanced infection may require early termination of pregnancy. Depending on gestational age, patients may have induced labor or c-section delivery to prevent complications and fetal infection.
Promote rest Encourage patient to rest as much as possible to promote healing and reduce fetal distress
Provide patient education for prevention of further infection If membranes have ruptured, avoid tub or sitz bath to reduce bacterial exposure to the vagina and uterus.

Writing a Nursing Care Plan (NCP) for Chorioamnionitis

A Nursing Care Plan (NCP) for Chorioamnionitis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

https://my.clevelandclinic.org/health/diseases/12309-chorioamnionitis

https://www.stanfordchildrens.org/en/topic/default?id=chorioamnionitis-90-P02441

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Transcript

Hey everyone today, we’re going to be putting together a nursing care plan for Chorioamnionitis. So let’s get started. First, we’re going to go over the pathophysiology. Chorioamnionitis is a bacterial infection of the membranes, amnion and chorion, and the amniotic fluid surrounding a fetus within the uterus. Nursing considerations. We’re going to monitor maternal vital signs, fetal heart rate, diagnostic tests, administer medications, promote rest, and prepare the patient for delivery. Desired outcome. The patient, the mother, and the fetus will be free from infection prevention of complications or fetal infection. 

So we’re going to go ahead and get started on writing out our care plan. We’re going to have some subjective data and some objective data. So what are we going to see with the patient that has Chorioamnionitis? Some subjective data would be some abdominal tenderness, fever, maybe some vaginal discharge. Some other things that we may see are tachycardia and maybe a bad smell from that amniotic fluid. 

Nursing interventions. We want to monitor the maternal vital signs. We’re going to be looking for fever. So they could be tachycardic; it may indicate infection for them. Symptoms are similar to other diseases and must be monitored closely to prevent any sort of development of complications. Another intervention we’re going to be doing is monitoring the fetal heart rate. Elevated fetal heart rate indicates a sign of distress. If the fetal heart rate increases in the mother, we’re going to assess the mother for signs of infection. So another invention we’re going to be doing is we’re going to be monitoring diagnostic test results, including white blood cell count and a urinalysis. So some patients may be asymptomatic, but they may have bacteria in the urine with an elevated white blood count. It may indicate infection, but it’s also a common occurrence during labor and delivery. We’re going to assess and culture vaginal discharge. So if they’re having vaginal discharge, we’re going to do a culture. Some STDs and GBS may be the bacterial cause of Chorioamnionitis. You want to make sure you’re noting the color, the odor, the consistency of any discharge and culture to determine the appropriate course of treatment. We want to verify any allergies and administer any medications as necessary. So we’re going to be giving medication, such as antibiotics and antipyretics, depending on the cause of the infection. Antibiotics may include penicillin and erythromycin; antipyretics are going to be given for the fever, such as acetaminophen. If a patient is in labor, we want to administer medications via IV route, if appropriate. Make sure you assess for allergies prior to administering any sort of medication. We want to make sure that we’re promoting rest. We want to encourage the patient to rest as much as possible to promote healing and reduce fetal distress. Sofor fetal distress, we’re going to prepare the patient for vaginal or C-section delivery. Advanced infection may require an early termination of the pregnancy. So depending on the gestational age, patients may have an induced labor or a C-section to prevent complications and fetal infection. 

So we’re going to go over the key points here. So a bacterial infection of the membranes, amnion and chorion, and the amniotic fluid surrounding the fetus within the uterus. It is caused by group B strep and GBS. Some subjective objective data that you’re going to see with these patients: abdominal, uterine tenderness, fever, vaginal discharge, diaphoresis tachycardia, bad smell from the amniotic fluid. We’re going to monitor the maternal vital signs, fetal heart rate, do diagnostic testing, assess, and culture vaginal discharge. Administer medications, make sure we’re promoting rest, and that we’re preparing for delivery if an advanced infection is present. And there we have that completed care for you guys. 

We love ya. Go out, be your best self today, and as always happy nursing.

 

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