OB Complication Pre-Sim Assignment
- What assessments are vital for the nurse to perform on the postpartum patient?
- What factors increase a woman’s risk for postpartum hemorrhage
- What are the differences between early and late postpartum hemorrhage?
- What is uterine atony, (what would you feel and see on assessment) and how does it cause postpartum hemorrhage? List other causes of excessive postpartum bleeding and nursing interventions?
- What are the indications and contraindications of common medications used to treat
postpartum hemorrhage?
i). FIRST LINE MEDS:
ii).OTHERS:
7.Describe care of the healthy newborn during the first 24-72 hours of life. Normal assessments, procedures, and testing.
8.What should you be on alert for in the newborn during the first 24-72 hours of life? What potential things can go wrong?
9.How do we ensure we are delivering care to incorporate diversity, equity, and inclusion? What are some strategies that can be utilized to support and promote the inclusion of families of sexual and/or gender minorities?
10.Name some health care risks factors and health inequities associated with members of sexual and/or gender minorities?
11.List 3 Social Determinants of Health Questions to ask during Simulation.
12. Collaborate as a team to create an SBAR for handoff to the next nursing shift and/or provider report. You all will give the SBAR prior to the start of the Simulation.
Title: Addressing Obstetric Complications: Pre-Simulation Assignment
1. Vital Assessments for Postpartum Patients
In caring for postpartum patients, crucial assessments include monitoring vital signs, uterine involution, lochia flow, perineal healing, bladder function, and emotional well-being. It’s essential to assess for signs of postpartum hemorrhage (PPH), such as excessive bleeding, tachycardia, hypotension, and changes in mental status.
2. Factors Increasing Risk for PPH
Various factors increase a woman’s risk for PPH, including prolonged labor, precipitous delivery, multiple gestations, macrosomia, uterine atony, retained placental fragments, and coagulation disorders.
3. Early vs. Late PPH
Early PPH occurs within 24 hours postpartum, usually due to uterine atony or genital tract trauma. Late PPH happens between 24 hours and 6 weeks postpartum, often due to retained placental tissue or infection.
4. Uterine Atony and Excessive Bleeding
Uterine atony is the most common cause of PPH, characterized by inadequate uterine contraction. On assessment, the uterus may feel boggy and enlarged. Other causes of excessive postpartum bleeding include genital tract trauma, retained placental tissue, and coagulation disorders. Nursing interventions include fundal massage, administering uterotonic medications, and notifying the healthcare provider.
5. Medications for PPH
i. First-Line Meds: Oxytocin, Methylergonovine, Carboprost ii. Others: Misoprostol, Tranexamic acid
Indications for use include persistent bleeding despite initial interventions. Contraindications vary depending on the medication but may include hypertension, cardiovascular disease, or allergy.
6. Care of Healthy Newborn in First 24-72 Hours
Normal assessments for newborns include monitoring vital signs, feeding patterns, elimination, jaundice, and conducting a physical exam. Common procedures include vitamin K administration, eye prophylaxis, and monitoring for congenital abnormalities. Testing may include newborn metabolic screening.
7. Alert Signs in Newborns
Alert signs in newborns include respiratory distress, cyanosis, poor feeding, lethargy, and temperature instability. Potential complications include hypoglycemia, jaundice, infection, and congenital anomalies.
8. Incorporating Diversity, Equity, and Inclusion
To ensure inclusive care, healthcare providers should respect and validate patients’ diverse identities and experiences. Strategies include using inclusive language, providing LGBTQ+-friendly resources, and promoting cultural humility. Supporting families of sexual and/or gender minorities involves creating safe spaces, offering tailored education, and facilitating access to supportive services.
9. Health Inequities for Sexual and/or Gender Minorities
Healthcare risks for sexual and/or gender minorities include discrimination, limited access to care, higher rates of mental health issues, and increased risk of certain health conditions such as HIV/AIDS and substance abuse disorders.
10. Social Determinants of Health Questions
a. What social support networks do you have in place? b. Are there any housing or financial concerns impacting your health? c. Do you have access to transportation for medical appointments?
11. SBAR Handoff for Nursing Shift
Situation: Postpartum patient experiencing excessive bleeding due to uterine atony. Background: Patient had a vaginal delivery, no significant antenatal history, but prolonged labor. Currently receiving uterotonics and undergoing fundal massage. Assessment: Uterus remains boggy despite interventions, ongoing blood loss. Recommendation: Requesting provider assessment for possible further interventions, considering escalation if bleeding persists.
In addressing obstetric complications, thorough assessments, prompt interventions, and effective communication are essential for optimal patient outcomes.
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