Nurse Roles and Functions: High-Risk Mother & Child

ROLES & FUNCTIONS OF THE NURSE IN VARIED SETTINGS IN THE DELIVERY OF CARE TO AT RISK/HIGH RISK/SICK MOTHER & CHILD WEEK 14 INTRODUCTION ◼ Pregnancy can be a stressful time. Both the woman and the fetus can be at risk for complications. Either the pregnancy can complicate t...

ROLES & FUNCTIONS OF THE NURSE IN VARIED SETTINGS IN THE DELIVERY OF CARE TO AT RISK/HIGH RISK/SICK MOTHER & CHILD WEEK 14 INTRODUCTION ◼ Pregnancy can be a stressful time. Both the woman and the fetus can be at risk for complications. Either the pregnancy can complicate the disease or the disease can complicate the pregnancy. ◼ Nursing care needs to include close observation of both maternal health and fetal well-being, education for the woman and her family about special danger signs to watch for during pregnancy and actions to minimize complications whenever possible. SAMPLE FOOTER TEXT 2 ACTIONS TO MINIMIZE COMPLICATIONS ◼ Preventing disorders from affecting the health of the fetus ◼ Helping a woman regain her health as quickly as possible ◼ Helping a woman learn more about her illness NOTE: Conditions that cause severe symptoms such as marked changed in fluid & electrolyte balance, altered cardiovascular or respiratory function or severe blood loss are dangerous to fetus. SAMPLE FOOTER TEXT 3 NURSING ROLE AND NURSING CARE DURING PREGNANCY COMPLICATIONS A. CARDIOVASCULAR DISORDERS Assessment: - Thorough health history to document prepregnancy cardiac status - Document level of exercise performance - Ask if she normally has a cough or edema – pulmonary edema from heart failure may first manifest itself as a cough - For right sided heart failure, assess liver size at prenatal visits SAMPLE FOOTER TEXT 4 Nursing Interventions 1.Monitor vital signs – maternal BP is maintained above 100/60 mmHg and fetal heart rate at 110 to 160 beats/min. 2. Promote rest – two rest periods a day (full resting and full night’s sleep) 3. Promote healthy nutrition – closer supervision of nutrition (must gain enough weight but must not gain so much weight) 4. Educate regarding medication 5. Educate regarding avoidance of infection 6. Be prepared for emergency actions SAMPLE FOOTER TEXT 5 During labor and birth 7. Assess a woman’s BP, PR, RR, FHR & uterine contractions to be certain their circulatory system is not filling and the placenta is filling adequately. 8. Advice a woman to assume a side-lying position during labor to reduce the possibility of supine hypotension syndrome. 9. If the mother has pulmonary edema, elevate her head and chest (semi- fowler’s position). 10. With extreme heart disease may need oxygen administered during labor because of the need for extra oxygen due to the exertion of labor. 11. Mother should not push with contractions as pushing requires more effort than they should expend. SAMPLE FOOTER TEXT 6 Postpartum 12. Stool softener can be given (prescribed) to prevent straining with bowel movements. 13. Tell the mother that they can breastfeed without difficulty. 14. Kegel exercises are acceptable for perineal strengthening immediately. 15. Also ensure that she schedules a return appointment for a postpartum checkup for both her gynecologic health and her cardiac status. SAMPLE FOOTER TEXT 7 B. HEMATOLOGIC DISORDERS 1. Throughout pregnancy, monitor a woman’s nutritional intake to be certain she is consuming sufficient amounts of folic acid and possibly an additional folic acid supplement, which is necessary for replacing red blood cells that have been destroyed. 2. Mother should not take a routine iron supplement as sickled cells cannot incorporate iron in the same manner as non-sickled cells. 3. Ensure that the mother is drinking at least eight glasses of fluid daily. SAMPLE FOOTER TEXT 8 4. Assess mother’s lower extremities at prenatal visits for varicosities or pooling of blood in leg veins, which can lead to red cell destruction. 5. Help a mother plan her day so she has limited long periods of standing and adequate rest periods. 6. Fetal health is usually monitored by an UTZ examination at 16-24 weeks. SAMPLE FOOTER TEXT 9 C. RENAL AND URINARY DISORDERS 1. Prenatal education on voiding frequently (at least every 2 hours), emptying the bladder completely, wiping front to back after voiding and bowel movements, wearing cotton & not synthetic fiber underwear and voiding immediately after intercourse. 2. Increase fluid intake to flush out the infection from the urinary tract (up to 3-4 Liter per 24 hours) 3. Voiding immediately after sexual intercourse. SAMPLE FOOTER TEXT 10 4. Regular ante-natal check-ups. 5. Control Blood Pressure (diet: low salt, low fat) 6. Protein requirements, 71 g/day or 1.1 g/kg/day 7. Recommend women with CKD to have low-dose of aspirin (75- 150 mg) in pregnancy to reduce the risk of pre-eclampsia. 8. Antihypertensive drugs in women with CKD is continued in pregnancy unless systolic blood pressure is consistently < 110 mmHg systolic, or diastolic blood is pressure consistently < 70 mmHg diastolic BP, or there is symptomatic hypotension. SAMPLE FOOTER TEXT 11 D. RESPIRATORY DISORDERS 1. Advice pregnant patients to check with their health care providers before taking any OTC medication other than honey and lemon lozenges for colds. 2. Advice not to take aspirin during pregnancy because eit can interfere with blood clotting. 3. Use a room humidifier or apply a medical vapor rub to the chest, especially at night, to moisten nasal secretions and help mucus drain. SAMPLE FOOTER TEXT 12 4. Use cool or warm compresses to relieve sinus headache. 5. For those with asthma, advice them to consult their primary care provider about the safety of the medications routinely used to be certain that it will be safe to continue during pregnancy and breastfeeding. 6. For those with COPD, advise to have additional rest because of fatigue and may need continuous supplemental oxygen during the day. 7. Offer support at prenatal visits for smoking cessation. SAMPLE FOOTER TEXT 13 E. RHEUMATIC DISORDERS Before pregnancy 1. If a woman takes prescription or nonprescription medications for RA, these should be reviewed with a healthcare provider. 2. Women who take methotrexate should stop it at least one month before trying to conceive, although the manufacturer suggests discontinuation of this medication three full menstrual cycles before attempting pregnancy. SAMPLE FOOTER TEXT 14 4. Women who take leflunomide must stop it for at least two years before trying to conceive, unless a course of treatments to eliminate the drug from the body is used. 5. During pregnancy, care of women with RA is usually shared between a rheumatologist and an obstetrical provider. 6. During post-partum period, the determination as to the safety of breastfeeding must be individualized based on the medication each patient is taking. SAMPLE FOOTER TEXT 15 F. GI DISORDERS 1. Most GI disorders interfere with nutrition or fluid & electrolyte balance, a major intervention with all of these disorders is to ensure adequate food and fluid intake, and to assess that their disease process is resolving. 2. In hepatitis cases, bed rest must be promoted & encouraged to eat a high calorie diet preventing the mother from having hypoglycemia. 3. For cases of appendicitis, while they are waiting to be evaluated, advise the mother not to eat any food, drink any liquid or consume any laxatives because increase peristalsis could cause an inflamed appendix to rupture. SAMPLE FOOTER TEXT 16 G. DIABETES MELLITUS 1. A person with diabetes, prior to becoming pregnant, she should meet with her primary healthcare provider. 2. Advise to have a urine culture each trimester to detect asymptomatic UTIs as the increased glucose concentration in urine may lead to increased infection. 3. Advise to undergo ophthalmic examination. 4. Health teaching on diet, maintain an adequate amount of glucose intake avoiding the occurrence of hypoglycemia. 5. Advise to have at least 30 minutes of walk daily. SAMPLE FOOTER TEXT 17  INTERPROFESSIONAL CARE MAPS SAMPLE FOOTER TEXT 18 Interprofessional Map - is a collaborative and shared document and involves a joint from an interprofessional team of professionals, summarizing the patent’s current and preferred situation as well as professional goals and actions Interprofessional care in nursing - collaboration is the collaborative involvement of various professional health care providers working with patients, families, caregivers, and communites to consider and communicate each other’s unique perspective in delivering the highest quality of care SAMPLE FOOTER TEXT 19 SAMPLE FOOTER TEXT 20 ◼ In order for an interprofessional primary health care team to function effectively, the team’s purpose and goals should be clearly understood and agreed upon by all members. ◼ These goals – whether short or long-term – also need to be feasible, because the interprofessional team may function in a variety of settings and the team membership, types and intensity of services provided, and overall goals may vary. ◼ Once the team has identified programmatic goals, team members will need to identify what this may mean in reality SAMPLE FOOTER TEXT 21 BENEFITS OF INTERPROFESSIONAL PRACTICE IN HEALTH CARE: 1. helps to prevent medication errors 2. improve the patient experience 3. deliver better patient outcomes 4. can reduce healthcare costs 5. it also helps hospitals save money by shoring up workflow redundancies and operational inefficiencies. SAMPLE FOOTER TEXT 22 FOUR INTERPROFESSIONAL CORE COMPETENCIES: 1. organize the competencies within a singular domain of Interprofessional Collaboration 2. encompassing the topics of values and ethics, roles and responsibilities 3. interprofessional communication 4. teams and teamwork SAMPLE FOOTER TEXT 23 WHAT IS INCLUDED IN A NURSING CARE PLAN? A care plan includes the following components: 1. assessment 2. diagnosis 3. expected outcomes 4. interventions 5. rationale 6. evaluation SAMPLE FOOTER TEXT 24