Polyhydramnios Nursing Care Plans Diagnosis and Interventions
Polyhydramnios NCLEX Review and Nursing Care Plans
Polyhydramnios is a medical condition during pregnancy in which the amniotic fluid accumulates excessively. The amniotic fluid is the substance that surrounds the baby in utero. Excessive amounts of amniotic fluid may cause pressure within the uterus and also to the surrounding organs.
Polyhydramnios usually becomes more noticeable in the middle of the second trimester due to the slow buildup of amniotic fluid.
About 1 to 2 percent of pregnant women are diagnosed with polyhydramnios, but most of these are considered mild cases. Pregnant women with mild to moderate cases of polyhydramnios are usually able to carry the baby to full-term and deliver at 39 to 40 weeks.
Severe cases of polyhydramnios may cause preterm labor and shortness of breath. Pregnant women with polyhydramnios are placed on close monitoring through the rest of their pregnancy in order to prevent complications.
Due to the excessive amniotic fluid and the possible complications, C-section delivery may be recommended to pregnant women with polyhydramnios.
Signs and Symptoms of Polyhydramnios
Mild polyhydramnios may not have any clinical manifestations at all, or few if there’s any. On the other hand, severe polyhydramnios may exhibit the following:
- Dyspnea – difficulty of breathing or shortness of breath
- Uterine discomfort
- Abdominal pain
- Fetal malposition – the fetus may have a breech presentation
- Swelling of the abdominal wall and/or lower extremities such as the ankles and feet
- Uterine contractions which may lead to preterm labor
- Enlargement of uterus – some cases exhibit an overly enlarged uterus accompanied with some difficulty in feeling the baby during prenatal checkups
Causes and Risk Factors of Polyhydramnios
The cause of polyhydramnios is still unknown. However, the following medical conditions are the known risk factors for polyhydramnios:
- Maternal diabetes
- Esophageal atresia (blockage in the gut) or other birth defects – the baby may have a birth defect which is affecting the central nervous system or gastrointestinal tract
- Fetal anemia – low red blood cell count of the baby
- Presence of infection during pregnancy
- Rhesus disease or other mother-baby blood incompatibilities
- Twin-twin transfusion – occurs in identical twin pregnancies wherein one of the babies gets too much blood, while the other twin gets too little
- Multiple gestation – pregnancy with more than one fetus
Complications of Polyhydramnios
- Premature labor
- Abruptio placentae
- Premature rupture of membranes
- Umbilical cord prolapse
- C-section delivery
- Postpartum hemorrhage due to reduced uterine muscle tone post delivery
Diagnosis of Polyhydramnios
- Fetal ultrasound – to visualize the baby in utero through high-frequency sound waves
- Measurement of the amniotic fluid volume (AFV) – to find the largest and deepest pocket of fluid around the baby and measuring the volume of amniotic fluid in it; polyhydramnios is confirmed if the AFV value is 8 centimeters or more; measuring the AFV via ultrasound is a standard procedure in all pregnancies, regardless of the risk for polyhydramnios
- Measurement of the amniotic fluid index (AFI) – the sum of measurements of the largest pockets in four areas of the uterus; polyhydramnios is confirmed if the AFI value is 25 centimeters or more
- Blood tests – to check for any presence of infection as a complication of polyhydramnios
- Amniocentesis – to collect a sample of amniotic fluid from the uterus to test for any fetal abnormalities; involves the ultrasound-guided insertion of a thin, hollow needle into the uterus through the abdominal wall.
Treatment for Polyhydramnios
- Close monitoring. Pregnant women with mild polyhydramnios may not require active management as they usually resolve on their own. Instead, they will be closely monitored for any worsening signs and symptoms. The monitoring may also include:
- Biophysical profile – an ultrasound test that can be used to check the volume of amniotic fluid in utero, as well as the breathing, movement, and tone of the baby
- Non-stress test – to check the reaction of the baby’s heart rate when he/she moves
- Amniocentesis. Severe cases of polyhydramnios may require the drainage of excess amniotic fluid through amniocentesis. This is also the treatment when preterm labor occurs due to polyhydramnios. The healthcare team will have to monitor the patient every 1 to 3 weeks following treatment.
- Medication. The physician may prescribe indomethacin therapy to facilitate the reduction of the amniotic fluid volume and fetal urine production. This medication is usually not prescribed for pregnant women above 31 weeks’ gestation.
- Treatment of underlying medical conditions. Effective management of maternal or gestational diabetes may help in resolving polyhydramnios.
Nursing Diagnosis for Polyhydramnios
Nursing Care Plan for Polyhydramnios 1
Nursing Diagnosis: Risk for Maternal and Fetal Injury related to polyhydramnios
Desired Outcome: The patient will maintain safety and participate in measures that will protect self during pregnancy.
|Nursing Interventions for Polyhydramnios||Rationale|
|Place the mother on close monitoring.||Pregnant women with mild polyhydramnios may not require active management as they usually resolve on their own. Instead, they will be closely monitored for any worsening signs and symptoms.|
|Prepare the patient for biophysical profile and non-stress test.||Biophysical profile – an ultrasound test used to check the volume of amniotic fluid in utero, as well as the breathing, movement, and tone of the baby |
Non-stress test – to check the reaction of the baby’s heart rate when he/she moves
|Prepare the patient for admission if there is any evidence of worsening maternal and/or fetal health due to polyhydramnios.||To allow the healthcare team to monitor the pregnant mother and her baby, and to provide prescribed treatments as deemed necessary.|
|Obtain consent from the patient to perform amniocentesis after explaining the procedure’s purpose, benefits, and risks.||Severe cases of polyhydramnios may require the drainage of excess amniotic fluid through amniocentesis. This is also the treatment when preterm labor occurs due to polyhydramnios. The healthcare team will have to monitor the patient every 1 to 3 weeks following treatment.|
|Administer prescribed medications for the management of AFV and fetal urine production.||The physician may prescribe medication to facilitate the reduction of the amniotic fluid volume (AFV) and fetal urine production. This medication is usually not prescribed for pregnant women above 31 weeks’ gestation.|
|Treat the underlying conditions related to polyhydramnios, such as gestational/ maternal diabetes and rhesus disease.||Effective management of maternal or gestational diabetes may help in resolving polyhydramnios. Administration of anti-D immunoglobulin injection to a pregnant woman who is Rh D negative can prevent rhesus disease which could cause polyhydramnios.|
Nursing Care Plan for Polyhydramnios 2
Nursing Diagnosis: Acute Pain related to increased uterine pressure as evidenced by pain score of 8 out of 10, verbalization of abdominal pain, swelling of the abdomen, and enlargement of uterus as seen in the ultrasound, constipation, decreased appetite and nausea
Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and gaining a better appetite.
|Nursing Interventions for Polyhydramnios||Rationale|
|Obtain consent from the patient to perform amniocentesis after explaining the procedure’s purpose, benefits, and risks.||Severe cases of polyhydramnios may require the drainage of excess amniotic fluid through amniocentesis. This procedure will help reduce the pressure in the uterine and abdominal walls, thus alleviating the pain.|
|Administer prescribed medications for the management of AFV and fetal urine production for pregnant women on 31 weeks’ gestation and below.||The physician may prescribe medication to facilitate the reduction of the amniotic fluid volume (AFV) and fetal urine production. With a decreased AFV, the pressure on the abdominal walls will be reduced.|
|Administer pain medication and/or constipation medication as prescribed.||To alleviate abdominal pain.|
|Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.||To monitor effectiveness of medical treatment for the pain relief. The time of monitoring of vital signs may depend on the peak time of the drug administered.|
Nursing Care Plan for Polyhydramnios 3
Nursing Diagnosis: Activity Intolerance related to maternal discomfort and dyspnea secondary to polyhydramnios as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, and acute abdominal pain
Desired Outcome: The patient will demonstrate alternate periods of desired activities and rest/sleep.
|Nursing Interventions for Polyhydramnios||Rationales|
|Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try. Ensure that the exercise is safe to perform during the patient’s current stage of pregnancy.||To create a baseline of activity levels and mental status related to fatigue and activity intolerance.|
|Alternate low impact activities and rest periods.||The mother with mild to moderate polyhydramnios can still ambulate and perform low impact daily activities to improve breathing and circulation. However, it is important for her to get plenty of rest to prevent fatigue.|
|When the mother experiences acute abdominal pain or shortness of breath, encourage bed rest. Encourage progressive activity through self-care and exercise as tolerated.||To reserve energy and to gradually increase the patient’s tolerance to physical activity.|
|Help the mother feel more comfortable through the following interventions:Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room. Prop up the head of the mother on two or three pillows.||To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room. To help the patient breathe deeply and alleviate shortness of breath.|
|Encourage the next of kin, relative, or carer of the mother to participate in her care, such as monitoring hydration and diet, and activities of daily living where the patient require a helping hand.||Severe polyhydramnios may cause fatigue and exhaustion of the pregnant patient, so it is best to have the partner or any carer beside her at all times and ensure her safety and assist her to perform activities of daily living.|
More Nursing Diagnosis for Polyhydramnios
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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