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NRSG 422

NRSG 422. High Risk Labor & Delivery Simulation Clinical Dawn Tassemeyer Spring 2014. Plan for today. Review Short Break Split into 2 groups Switch, quick BR break Lunch Simulations NCLEX review, wrap up Have fun!. Outcomes/Expectations. Comfort in Clinical Setting

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NRSG 422

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  1. NRSG 422 High Risk Labor & Delivery Simulation Clinical Dawn Tassemeyer Spring 2014

  2. Plan for today • Review • Short Break • Split into 2 groups • Switch, quick BR break • Lunch • Simulations • NCLEX review, wrap up • Have fun!

  3. Outcomes/Expectations • Comfort in Clinical Setting • Prioritization/critical thinking • Learn from own mistakes, and mistakes & experiences of peers • Trust yourself, but don’t be afraid to ask questions • Be the kind of nurse you want caring for you or a loved one

  4. #1 Goal of Labor/Delivery Nursing… Healthy Mom & Healthy Baby • Safe nursing care • Prepare for possible complications before they happen

  5. Example of hospital wide safety initiative TeamSTEPPS • Team structure • Leadership • Situation Monitoring • Mutual Support • Communication • https://www.youtube.com/watch?v=EXpVKz4NDj8

  6. Concept: Perfusion • As it relates to the OB Setting • Complications: Placental problems, Postpartum bleeding, high risk pregnancy, high risk neonate

  7. Lets review…

  8. High-risk pregnancy • Maternal age • Maternal parity • Maternal obstetric and gynecologic history • Maternal medical history • Maternal lifestyle • Cultural background • Family history

  9. Bleeding disorders • Spontaneous abortion • Ectopic pregnancy • Gestational Trophoblastic Disease • Placenta previa • Abruptio placenta • Postpartum hemorrhage • Hematomas • Retained placenta • Uterine involution

  10. High risk obstetrics • Amniotic fluid embolism • Umbilical cord prolapse • Oligohydramnios • Polyhydramnios • Inductions • Shoulder dystocia • Forceps/vacuum • Version • Cesarean births

  11. Preterm Labor • Incompetent cervix • PPROM • Multiple gestation

  12. High Risk Neonate • Resuscitation • Stabilization

  13. Hypertension • BP • Systolic 140 mmHg or greater • Diastolic 90 mmHg or greater Hypertensive disorders classified into four categories: -Preeclampsia/eclampsia syndrome -Preeclampsia superimposed on chronic hypertension -Gestational hypertension -Chronic hypertension

  14. Gestational hypertension • Vasospasm • Increased blood pressure • Decreased circulating volume • Increased extravascular fluid • Decreased organ perfusion • Vascular damage • How does this affect organs?

  15. Preeclampsia • hypertensive, multisystem disorder of pregnancy • Etiology unknown • Pregnancy specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation

  16. Preeclampsia and liver function • In preeclampsia there is an increase in micro vascular fat deposits in liver- can cause epigastric pain. • Liver damage may be mild or it can progress to HELLP syndrome • (Hemolysis, Elevated Liver enzymes, and Low Platelets)

  17. Preeclampsia and Kidney function • Glomerular endothelial damage, fibrin deposits resulting in ischemia reduce renal blood flow and decrease glomerular filtration rate • Protein excreted in urine • Oliguria sign of severe preeclampsia and kidney damage

  18. Preeclampsia and coagulation system • Thrombocytopenia • Platelet count < 100,000 cells/mm3 indicates severe preeclampsia

  19. Preeclampsia and the brain • Edema • Cerebral hemorrhage • Can lead to hyperreflexia • Severe headaches • Can progress to eclamsia • Retinal arterial spasms can cause blurring or double vision, spots before the eyes

  20. Treatment • Depends on severity • Magnesium sulfate- a CNS depressant • Helps reduce seizure activity without long term adverse effects to woman and fetus • Do need to monitor for magnesium toxicity

  21. Intrauterine resuscitation • Left lateral side (see which position fetus tolerates best) • IV Fluids • Oxygen 8-10L per mask • Stop Pitocin if infusing • Palpate uterus for tachysystole

  22. References • Durham, R.F., Chapman, L. (2014). Maternal-Newborn Nursing: The critical components of Nursing Care. F.A. Davis Co: Philadelphia. • Luxner, K.L. (2004). Delmar’s Maternal-Infant Nursing Care Plans, 2nd Ed. Delmar Cengage Learning: Clifton Park: NY.

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