Discharge And Home Healthcare Guidelines

Refer patients at increased risk for skin breakdown to a home healthcare agency to assist with monitoring skin and providing pressure-relieving devices in the home environment. Teach the patient or caregiver about frequent turning and positioning, how to keep the skin clean and dry, signs and symptoms of early breakdown and complications of existing ulcers, strategies to manage redness or skin breakdown, appropriate wound care and dressing techniques. Use a return demonstration before discharge to assess the understanding and ability to perform wound care.

Preterm labor (PTL) refers to labor that occurs after the completion of the 20th week and before the beginning of the 37th week of gestation. In order to be considered PTL, the uterine contractions must occur at a frequency of four in 20 minutes or eight in 60 minutes. Spontaneous rupture of the membranes often occurs in PTL. If the membranes are intact, documented cervical change (80% effacement or >1 cm dilation) must be noted during a vaginal examination for the situation to be classified as PTL.

PTL has a poorly understood etiology, unclear mechanisms, and an absence of medical consensus related to diagnosis and treatment. This is unfortunate because preterm birth is the second highest cause of the high infant morbidity and mortality rate in the United States (birth defects is the first). From 8% to 10% of all births in the United States are preterm, and the risk of having a recurrent preterm birth after one, two, or three occurrences is 15%, 30%, and 45%, respectively. The major fetal risk of preterm delivery is related to immaturity of the lungs and respiratory system. Preterm infants can have many other problems as well, such as neurological complications, thermoregulation problems, and immaturity of major organ systems. Maternal risks of PTL are related to the pharmacologic treatment involved in stopping the labor.

In many cases, the cause cannot be identified. Preterm premature rupture of membranes occurs in about one-third of the cases, but its causes are also unknown. Intrauterine, genital tract, and/or periodontal infection can precede or follow premature rupture of membranes. Infectious processes that occur prior to and early in pregnancy are thought to be linked to PTL/rupture of membranes owing to the inflammatory response that weakens the fetal membranes. There is also evidence that an idiopathic, undiagnosed PTL leads to microbial invasion owing to a breakdown in the cervical barrier function, and this eventually manifests itself as chorioamnionits and true clinical PTL. Several risk factors have been identified (Box 3).

• BOX 3 Risk Factors for Preterm Labor

Historical Diethystilbesterol exposure

Preterm Labor

0 0

Post a comment