NRSG 422

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NRSG 422
High Risk Labor & Delivery
Simulation Clinical
Dawn Tassemeyer
Spring 2014
Plan for today
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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
TeamSTEPPS
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Team structure
Leadership
Situation Monitoring
Mutual Support
Communication
https://www.youtube.com/watch?v=EXpVKz4
NDj8
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
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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
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Increased blood pressure
Decreased circulating volume
Increased extravascular fluid
Decreased organ perfusion
Vascular damage
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How does this affect organs?
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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
 (Hemolysis, Elevated Liver enzymes, and
Low Platelets)
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
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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
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Treatment
 Depends
on severity
 Magnesium sulfate- a CNS depressant
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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
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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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