Intro to Perinatal Nursing L1 Flashcards
Pitocin
synthetic form of oxytocin: uterotonic med used to produce contractions for induction or augmentation of labor
Tachysystole
Too many uterine contractions over a given period of time
what are typical values for Tachysystole?
greater than or equal to 6 uterine contractions in 10 minutes without sufficient (1 minute) uterine relaxation between contractions
how are contractions measured?
measured from the beginning of one contraction to the beginning of the next
Apgar score
what is it?
when is it done?
a quick way to assess a newborn
done at 1 minute of life and again at 5 minutes of life
an Apgar score above _ means what?
an Apgar score above 8 means newborn is transitioning well to extrauterine life.
Cerebral Palsy
A neurological disorder that can be caused by prolonged hypoxia and ischemia at the time of birth
perinatal nurses care for:
1) patients throughout their reproductive years
2) pregnant patients
3) neonates
4) postpartum patients
5) families
nurses are legally responsible for practicing within their scope of practice, which is dictated by…
the states Nursing Practice Act
TJC
The Joint Commission - sets standards for facility accreditation and licensing standards and releases yearly national patient safety goals
how do community standards/facility policies interact with a nurses scope of practice?
sometimes things that fall under a nurse’s scope according to NPAs are overwritten by facility policy
Example: IFM/IUPC insertion - within nursing scope of practice for perinatal nurse, not allowed under P&P @ UCSF
HHS
Health and human services- focus on reducing health disparities
Association of Women’s Health, Neonatal, and Obstetric Nurses (AWHONN)
A professional organization for perinatal nurses that creates the standards of practice for nurses in perinatal nursing, provides continuing education for nurses, education for patients, advocacy, etc.
what are the perinatal nursing specialties?
1) labor and delivery
2) Nursery/Level 2 Nsy/NICU
3) postpartum/mother-baby
4) antepartum
what do NPs do?
1) provide comprehensive health assessment
2) determine diagnoses
3) plan/prescribe treatments/medications
4) manage health care regimens for individuals, families, and the community
how were NPs created?
shortage of pediatric MDs led to creation of NPs
what organization defines advanced practice nursing roles?
The American Nurses Association
what are the educational requirements for NPs?
certifications, Master’s, or doctorate. many institutions are trending toward doctoral degrees for NPs and other advanced practice nurses
where do NPs practice?
they provide family or specialized care most often in primary care or specialty clinics
what are the education requirements for Clinical Nurse Specialists?
MSN or Doctorate
Clinical Nurse Specialist is an expert in…
planning, supervising, and delivering nursing care
what sort of roles can a clinical nurse specialist fill?
1) case manager or consultant
2) staff and family educator
3) care coordinators for families requiring intensive nursing support
4) research activities/articles
traditionally what setting do clinical nurse specialists operate in?
traditionally in hospitals
what is a CNMs scope of practice?
1) independent management of women’s health/pregnancy
2) family planning, low risk ob/gyn, & peri/postmenopausal care
3) primary care
CNM educational requirements
certificate or MSN
Mary Breckenridge
- the first nurse-midwife to practice in the USA
- established frontier nursing services
in facilities that employ CNMs, there are lower rates of…
cesarean sections
CNMs provide care to…
people with low incomes, uninsured, and minorities who don’t seek out regular health care
what kinds of anesthesia do CRNAs administer?
general, regional, local, and sedative anesthesia
what are the responsibilities of a CRNA?
1) pre-anesthesia assessment
2) anesthesia and immediate post-anesthesia care
3) management of ABCs
4) rapid response and code leader
what are the educational requirements for CRNAs?
MSN or doctorate
what is involved with a CRNAs duty as a rapid response and code leader?
1) ACLS
2) procedures such as intubation
what % of CRNAs practice in an anesthesia care team and what % practice independently?
80% practice in an anesthesia care team
20% practice independently
what advanced practice nursing role is the oldest?
CRNA
what is a nurse consultant?
they are experts in a specific area of nursing. usually charge a fee
what are nurse consultants used for?
1) expert witness in malpractice cases
2) used by corporations for the development of products or equipment
3) consult for texts, electronic media, and periodicals
describe the rate of malpractice cases associated with the perinatal specialty
high number of malpractice cases
what specialty has the highest number of malpractice cases?
surgery
theory of liability - negligence
- proof that a duty exists
- a breach of that duty occurred
- an injury resulted as a result of the breach of duty
standard of care
minimum standard of care that a reasonable, prudent nurse would provide in the same or similar circumstances
what is malpractice associated with the perinatal specialty?
alleged injury to fetus, neonate, or birthing parent
what are malpractice suits based on?
based on the assumption that the healthcare provider failed to meet the professional standard of care and it resulted in injury
what is the statute of limitations for malpractice suits in CA?
1 year from the date that the plaintiff knows or should have known about the injury or
3 years from the date of the injury. whichever is the earlier date
or up until 8 years of child’s life
what sort of evidence is used in malpractice suits?
1) hospital procedures
2) nursing policies
3) guidelines established by professional organizations
4) CA NPA
5) TJC standards
6) textbooks
what is the providers role in informed consent?
discussing procedure/surgery/medications
- the who, what, why, and how
- risks
- benefits
- alternatives
what is the nurses role in informed consent?
- ensure discussion was thorough and patient understands
- obtaining signature on the form
- patient education
- consent for RN procedures
without proper consent, the provider could be subject of a lawsuit alleging…
- assault
- battery
- negligence
- or a combination of actions
what are the different types of consent?
1) expressed
2) implied
3) emergency
what is expressed consent?
written or oral
e.g. surgery
pt needs to have the capacity/ competency to give expressed consent
what is implied consent?
non-verbal consent
e.g. pt extends arm when phlebotomist says they are there to draw blood
what is emergency consent?
consent is bypassed (exception) due to emergency
e.g. crash cesarean section or pt unconscious
who is the only one who can give consent?
the pt
when can a patient refuse treatment?
- any time. before tx or once tx has begun.
- pt can refuse treatment even if consent was previously given
- pt must know they are refusing and understand consequences
what is AMA?
against medical advise - if a refusal of treatment could be detrimental to the pt/baby, pt must sign AMA form and be told of the potential consequences
informed refusal/declination must be…
- voluntary
- uncoerced
- not made under fraudulent circumstances
where should an AMA be documented?
refusal/declination should be documented in pt chart
fi pt leaves hospital AMA, what should the pt chart include?
- signed refusal form by pt
- nurse notes should include time left, left with whom, risks and consequences of no further treatment, and who will be notified
“informed consent of vitamin K for baby declined” is an example of what?
documented informed refusal in pt chart
what are the pitfalls in OB?
1) failure to observe or take appropriate action
2) failure to communicate changes in a pt’s condition in a timely manner
3) incomplete or inadequate documentation
4) inappropriate pitocin (oxytocin) monitoring or usage
5) improper sponge/instrument count
what is this an example of?
“failure to use or interpret fetal monitoring appropriately”
failure to observe or take appropriate action
what is this an example of?
“did not document that RN informed MD or that RN turned pt and increased fluids”
incomplete or inadequate documentation
what is this an example of?
“did not tell the MD about recurrent late decelerations?”
failure to communicate changes
what percentage of OBs have been sued?
how many cases are settled out of court?
- 2/3 OBs have been sued
- most settled out of court
what percentage of OBs have more than 2 cases against them?
40%
what are some cost containment methods in the perinatal specialty?
1) shorter length of stays
2) use of UAPs/NAPs
3) reduced number of staff members
what is the difference between fetus and neonate?
fetus is still inside the womb, neonate is the first 28 days after birth
better communication = what?
less litigation
what is the chain of command on a floor?
RN–>Charge RN/resident–>CNM/attending MD–>Unit director
look at P26-29 on PP1
why is erythromycin used on the eyes of newborns?
to prevent chlamydia or gonorrhea infections
what can a gonorrhea or chlamydia infection in a newborn’s eyes cause?
blindness
gestational carrier
carries a baby but does not share genetic information with child; both egg and sperm are from intended parents (or donors)
Surrogate
carries a baby created with their own egg and sperm from intended parent (or donor)
when was electronic fetal monitoring introduced and where?
yale 1958
things to note about electronic fetal monitoring:
- has not reduced rates of cerebral palsy
- partially responsible for increased rates of cesarean sections
- under constant threat of legal action
what part of perinatal nursing is EFM common?
normal in antepartum and intrapartum
