Final answer:
A nurse can determine a pregnant client's membranes have ruptured by the leakage or gush of fluid from the vagina, a visual examination for pooled amniotic fluid, or by using indicator strips that change color in the presence of amniotic fluid. Contractions starting or intensifying after suspected rupture can also be indicative. It is vital to ensure all membranes are expelled after delivery to prevent complications.
Step-by-step explanation:
To determine if a pregnant client's membranes have ruptured, a nurse should look for specific findings that support this event. The rupture of the amniotic membranes, or when a woman's 'water breaks', can occur spontaneously at term (spontaneous rupture of membranes or SROM), or it may happen prematurely (premature rupture of membranes or PROM). In some cases, rupture can happen even before labor (preterm premature rupture of membranes or PPROM), often leading to labor within 48 hours.
A clear sign of membrane rupture is the leakage or gush of fluid from the vagina, which indicates that the forewaters, the fluid in front of the baby's head, have been released. This can sometimes be confirmed by visual inspection, or by using a speculum to look inside the vagina for pooling of amniotic fluid. The use of indicator strips that change color in the presence of amniotic fluid can also provide evidence for the rupture of membranes.
Another sign can be if contractions start or intensify after the suspected rupture of membranes, which might indicate that labor is beginning or progressing. It is also crucial for the obstetrician to later confirm that the fetal membranes have been expelled and were intact to avoid potential complications, such as postpartum hemorrhage due to retained placental fragments.