Women's and Family Class 3302-3 PDF

**VOCABULARY** - - - - - - - - - - - - - Module 1 & 2 Objectives +-----------------------------------------------------------------------+ | **Describe legal and ethical issues that influence nursing care** | |...

**VOCABULARY** - - - - - - - - - - - - - Module 1 & 2 Objectives +-----------------------------------------------------------------------+ | **Describe legal and ethical issues that influence nursing care** | | | | **of childbearing families** | +=======================================================================+ | **Informed Consent:** person's agreement to allow something to happen | | such as surgery or an invasive diagnostic procedure, based on full | | disclosure of risk , benefits , alternatives and consequences of | | refusal. Failure to obtain consent could possibly result in a claim | | of battery. | | | | **Ethical Principles** are standards of what is right or wrong with | | regard to important social values and norms. Pertaining the the | | patient are: | | | | - - - - - - - | | | | Ex: Ethical dilemmas occur in maternal and child health nursing as | | they do in other areas of nursing. Such situations are common in | | perinatal and neonatal care because the well-being of both the mother | | and her neonate must be considered. Most believe pregnancy is not an | | exception to the principle that a patient capable of making decisions | | has the right to refuse treatment, even treatment needed to maintain | | life. Therefore, a capable pregnant woman's decision to refuse | | recommended medical or surgical interventions should be respected | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | **Discuss the impact of culture when caring for the childbearing | | family** | +=======================================================================+ | **Pregnancy and Childbirth Beliefs:** | | | | - - | | | | **Pain Perception and Management:** | | | | - | | | | **Postpartum Practices:** | | | | - | | | | **Role of Family:** | | | | - - | | | | **Terms** | | | | - - - - - | +-----------------------------------------------------------------------+ **Describe evidence-based practice in nursing, including rationale for its use** EBP is widely recognized as the key to improving health-care quality and patient outcomes. - - - Example: Evidence has shown "skin to skin" with baby and mother has the best outcomes and that you shouldn't separate - +-----------------------------------------------------------------------+ | **Current trends in maternal and infant health outcomes** | +=======================================================================+ | - - - - - - - - - - | +-----------------------------------------------------------------------+ The AWHONN is the professional nursing association representing nurses in neonatal nursing. AWHONN supports the protection of an individual nurse's right to choose to participate in any reproductive health-care service or research activity. Nurses have the right under federal law to refuse to assist in the performance of any health-care procedure in keeping with personal moral, ethical, or religious beliefs (AWHONN, 2016b). **AWHONN's Perinatal Quality Measures emphasize collaborative, interdisciplinary approaches, such as:** - - - **By integrating these measures into clinical practice, AWHONN aims to ensure safe, equitable, and high-quality care for childbearing families.** Healthy people 2023, is a program of nation wide promotion and disease prevention goal set up by the USA department of health services : Provides: - - **Goals:** - - - - - - +-----------------------------------------------------------------------+ | **Physiologic Changes that occur DURING the Postpartum Period** | +=======================================================================+ | **Uterine Involution: (takes about 6wks)** | | | | - - - - - - - - | | | | **Lochia Discharge:** | | | | - - - - | | | | **Breast Changes:** | | | | - - - | | | | **Hormonal Shifts:** | | | | - - - | | | | **Cardiovascular Adjustments:** | | | | - - - - - | | | | **Perineal and Abdominal Healing:** | | | | - - - - - - - | | | | **Return of Ovulation and Menstruation:** | | | | - - | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | **Emotional changes that occur Postpartum** | +=======================================================================+ | Baby Blues: | | | | - - | | | | Bonding with the Baby: | | | | - | | | | Sense of Role Transition: (Rubin's Restorative Phase) | | | | - | +-----------------------------------------------------------------------+ +-----------------------+-----------------------+-----------------------+ | **Maternal Phases | | | | (Rubin's Restorative | | | | Phase)** | | | +=======================+=======================+=======================+ | **Taking In Phase** | **Taking Hold Phase** | **Letting Go Phase** | +-----------------------+-----------------------+-----------------------+ | **The taking-in | **The taking-hold | **In the letting-go | | phase, a period of | phase, the movement | phase, the movement | | ­dependent behaviors, | between ­dependent | from independence to | | occurs during the | and independent | the new role of | | first 24 to 48 hours | behaviors, follows | mother is fluid and | | after birth and | the ­taking-in phase. | ­interchangeable with | | includes the | It can last weeks and | the taking-hold | | following maternal | includes the | phase. Maternal | | behaviors:** | ­following maternal | ­characteristics | | | behaviors:** | during this phase | | - - - | | are:** | | | ** The focus moves | | | **The woman is | from self to the | ** Grieving and | | dependent on ­others | infant.** | letting go of old | | for her and her | | ­relationship | | infant's ­immediate | ** The woman begins | behaviors in favor of | | needs.** | to be independent.** | new ones.** | | | | | | ** The woman has a | ** The woman has an | ** Incorporating the | | decreased ­ability to | increased ability to | infant into her life | | make decisions.** | make decisions.** | whereby the baby | | | | becomes a separate | | | ** The woman is | entity from her.** | | | interested in the | | | | infant's cues and | ** Accepting the | | | needs.** | infant as the child | | | | really is.** | | | ** The woman gives | | | | up the pregnancy role | ** Giving up the | | | and initiates taking | fantasy of what it | | | on the maternal | would or could have | | | role.** | been.** | | | | | | | ** The woman is | ** Independence | | | eager to learn** | returns; may go back | | | | to work or school.** | | | ** The woman begins | | | | to like the role of | ** May have feelings | | | "mother."** | of grief, guilt, or | | | | anxiety.** | | | | | | | | ** Reconnection and | | | | growth in | | | | ­relationship with | | | | partner** | +-----------------------+-----------------------+-----------------------+ ### **Psychological Changes postpartum** - - - - Rho immune globulin is given to Rh-negative women at 28 weeks' gestation. Rh-negative women who gave birth to an Rh-positive neonate are screened for anti-Rh antibodies (Coombs' test). A second injection of Rho immune globulin is given to the woman in the postpartum period if her baby is Rh positive and she is Coombs' negative. ​​Rh (D) immune globulin (RhoGAM, Rhophylac) - - - - - **"**BUBBLELE" Overview of the Postpartum Assessment Vital signs, pain, breath and heart sounds Laboratory findings, such as CBC, rubella status, and Rh status Vaccination status, including tetanus, diphtheria, and acellular pertussis (Tdap); influenza; pneumococcal; and COVID-19 vaccine Breasts Uterus Bladder Bowel Lochia Episiotomy, lacerations, perineum, hemorrhoids Lower extremities Emotions, bonding with infant, fatigue, psychosocial factors Pain in the postpartum period may result from uterine contractions or afterpains, perineal trauma, lacerations, episiotomy, surgical incision after cesarean delivery, nipple pain caused by improper infant latch, breast engorgement, hemorrhoids, and general soreness related to the work of labor and birth. - Examples of nonpharmacological interventions include: Ice packs Warm compresses Aromatherapy Sitz baths Repositioning Walking Showering Topical treatments, such as witch hazel pads and anesthetic sprays applied to localized perineal discomfort Pharmacological interventions may include: NSAIDs such as ibuprofen (for mild to moderate pain): Ibuprofen (Motrin) may be administered with food or milk to decrease GI upset. Give with a full glass of water. Patients with asthma, nasal polyps, or who are allergic to aspirin are at risk for hypersensitivity to ibuprofen. Route and dose for ibuprofen: PO; 400 to 600 mg every 4 to 6 hours PRN, maximum 24-hour dose 3,200 mg/day. Assess pain before and 30 minutes after administration. Acetaminophen 650 mg every 4 hours PRN Opioid analgesics are reserved for moderate to severe pain that persists after the previously listed interventions have been conducted with the patient. The medications should be used in combination with a nonopioid medication for added analgesic effect. **Monitoring Vital Signs:** - **Assessing Surgical Site:** - **Uterine Assessment:** - **Pain Management:** - **Mobility and Circulation:** - - **Urinary Catheter Care:** - AWHONN Postpartum Discharge Teaching Project: Warning Signs Call 911 for: - - - - Call your provider for: - - - - - **Educating Patients when they are discharged** Heavy lochia (saturating a pad in 1 hour) indicates possible secondary postpartum hemorrhage. The return of bright red, heavy bleeding after lochia has diminished or that becomes serosa or alba, or the passage of clots the size of an egg or larger indicates possible secondary postpartum. Foul-smelling lochia indicates possible infection. Increased temperature (100.4°F \[38°C\] or higher) indicates possible infection. Pelvic or abdominal tenderness or pain indicates possible infection. Frequency, urgency, or burning on urination indicates possible cystitis. Unilateral breast tenderness, warm reddened area, and chills and fever indicate possible mastitis, which often occurs 3 to 4 weeks after delivery. Blurry vision, severe headaches, epigastric abdominal pain, and fluid retention may be associated with preeclampsia. Leg pain, swelling, and redness may indicate venous thrombosis. Chest pain and difficulty breathing may be associated with pulmonary embolism. Thoughts of harming the infant or self, difficulty caring for self or the infant, difficulty sleeping or sleeping too much, and persistent feelings of depression and sadness are associated with postpartum depression. Expected physical changes Uterine involution, afterpains, progression of lochia Breast changes, engorgement Diaphoresis and diuresis - - - - 1. 2. 3. **Book NOTES (Teacher Highlighted)** - **Uterine Atony (Boggy Uterus)** - - - - - **Oxytocin (Pitocin) Administration** **Oxytocin stimulates the upper segment of the myometrium to contract rhythmically, which constricts spiral arteries and decreases blood flow through the uterus. Oxytocin is an effective first-line treatment for postpartum hemorrhage. As a high-alert medication, IV oxytocin premixed bags should be administered on an infusion pump in a standardized concentration as per facility protocol. The bag should also be prominently and clearly labeled and stored separately and use a barcode scanning technology** **Lochia is a bloody discharge from the uterus that contains red blood cells (RBCs), sloughed-off decidual tissue, epithelial cells, and bacteria ­(Cunningham et al., 2018). The placental site heals by exfoliation, which involves sloughing of necrotic endometrial tissue and regeneration of the endometrium at the placental site ­(Cunningham et al., 2018; Smith, 2018). This prevents scarring of the endometrial tissue (James & Suplee, 2020). Changes in lochia reflect the healing stages of the uterine placental site (Table 12-2).** - - - - - - **Breast:** **Colostrum, a yellowish fluid, precedes milk production and is secreted after delivery. It is higher in protein and lower in carbohydrates than breast milk and contains immunoglobulins G and A, which provide protection for the newborn during the early weeks of life. Colostrum continues for 5 days to 2 weeks post delivery, during which time transition to mature milk occurs ­(Cunningham et al., 2018). Mature milk contains proteins, carbohydrates, fat, minerals, vitamins, hormones, and immunological substances such as secretory IgA, lymphocytes, and growth factor ­(Cunningham et al., 2018). The composition of breast milk changes during the feeding and throughout the course of feedings during the day.** **A primary complication associated with breastfeeding is mastitis, an infection of the breast.** **Cardiovascular issues postpartum** **Assess for orthostatic hypotension. Women are at risk for orthostatic hypotension during the first postpartum week when standing from a seated or prone position.** ** Explain the cause and incidence of orthostatic hypotension.** ** Instruct the woman to rise slowly to a standing position.** ** Assist the woman when ambulating during the first 24 hours postbirth.** ** Assist the woman to a sitting or supine position if she becomes dizzy or faint.** ** Use an ammonia ampule if the woman faints.** ** Check laboratory values such as a complete blood count (CBC), if ordered.** ** Rationale: Components of the CBC, such as the hematocrit and hemoglobin, are assessed in cases where excessive blood loss has occurred. The hematocrit measures the concentration of RBCs in the blood (Kee, 2018). Hemoglobin decreases by 1 to 1.5 g/dL and hematocrit decreases 3% to 4% per 500 mL of blood loss** ** Assess the calves and the groin area for tenderness, edema, and sensation of warmth each shift. Compare pulses in both extremities. Measure the calf width if thromboembolism is suspected (James & Suplee, 2020).** ** Rationale: Symptoms of deep vein thrombosis include muscle pain; tenderness; redness or increased warmth to touch; palpation of a hard, cord-like vessel; swelling of veins; edema; and decreased blood circulation to the affected area.** +-----------------------------------------------------------------------+ | **Excessive bleeding and Early Warning Signs** | +=======================================================================+ | **Assess the position, tone, and location of the fundus.** | | | | ** ** If the uterus is boggy, massage it. | | | | If the uterus is boggy and displaced to the side, instruct the | | patient to void and reevaluate. | | | | Ambulate the patient to the bathroom and measure the void. Use a | | bladder scanner when available. | | | | Quantify blood loss (QBL) by weighing all blood-soaked peripads and | | materials. | | | | 1 g equals 1 mL of fluid. | | | | Realtime completion of QBL reduces delay in interventions and may | | reduce the need for additional interventions such as administration | | of uterotonic medication, unnecessary procedures, and blood | | transfusions. | | | | QBL promotes team awareness improving response time for additional | | resources and improves patient outcomes. | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | **Shorter Gestational Period RISK** | +=======================================================================+ | **A shorter gestational period increases the risk of complications | | related to immature body organs and systems that have lifelong | | negative effects, including but not limited to:** | | | | ** Respiratory disorders** | | | | ** Cerebral palsy** | | | | ** Vision and hearing disorders** | | | | ** Developmental delays** | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | **Neonatal Birth Weight Rates** | +=======================================================================+ | **Neonatal birth weight rates are reported by the CDC in three major | | categories: low, normal, and high.** | | | | - - | | | | | | | | - | +-----------------------------------------------------------------------+ +-----------+-----------+-----------+-----------+-----------+-----------+ | **MATERNA | | | | | | | L | | | | | | | DEATH & | | | | | | | MORTALITY | | | | | | | RATES** | | | | | | +===========+===========+===========+===========+===========+===========+ | **Materna | **Direct | **Indirec | **Late | **Pregnan | **Materna | | l | Obstetric | t | Maternal | cy | l | | Death** | Death** | Obstetric | Death** | Related | Mortality | | | | Death** | | Death** | Ratio** | +-----------+-----------+-----------+-----------+-----------+-----------+ | is | Results | Caused by | Occurs | A woman | **(MMR) | | defined | from | a pre | more than | **during* | is | | by the | complicat | existing | **42 days | * | defined | | WHO as | ions | disease | after | pregnancy | as the | | the death | during | or a | terminati | **or | number of | | of a | pregnancy | disease | on | within 1 | maternal | | woman | , | that | of | year** of | deaths | | during | labor, | develops | pregnancy | the end | per | | pregnancy | birth, or | during | ** | of | 100,000 | | or within | the | pregnancy | from a | pregnancy | live | | 42 days | postpartu | without | direct or | from a | births.** | | of | m | direct | indirect | pregnancy | In the | | pregnancy | period, | obstetric | obstetric | complicat | United | | terminati | including | al | al | ion, | States, | | on | deaths | cause but | cause. | a chain | MMR had | | caused by | caused by | is | | of events | significa | | condition | intervent | aggravate | | initiated | ntly | | s | ions, | d | | by | decreased | | aggravate | omission | by the | | pregnancy | from | | d | of | pregnancy | | , | 607.9 in | | by the | intervent |. | | or the | 1915 to | | pregnancy | ions, | | | aggravati | 12 in | | or | or | **Ex: is | | on | 1990 | | associate | incorrect | death | | of an | (Hoyert, | | d | treatment | related | | unrelated | 2007); 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