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