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  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

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

Example of hospital wide safety initiative  Team structure  Leadership  Situation Monitoring  Mutual Support  Communication  NDj8 NDj8 TeamSTEPPS

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

Lets review…

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

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

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

Preterm Labor  Incompetent cervix  PPROM  Multiple gestation

High Risk Neonate  Resuscitation  Stabilization

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

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

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

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  ( H emolysis, E levated L iver enzymes, and L ow P latelets)

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

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

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

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

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

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, 2 nd Ed. Delmar Cengage Learning: Clifton Park: NY.