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OB > OB emergencies/loss and greif > Flashcards

OB emergencies/loss and greif Flashcards

1
Q

What is a uterine rupture? What is the first sign?

A

Tear in the uterus

1st sign: FHR changes, loss variability

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2
Q

Symptoms of a uterine rupture are often ______ and it takes 17 minutes to significant _______

A

Symptoms are typically nonspecific, 17 min tosignificantfetal morbidity

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3
Q

What are possible symptoms that a patient with uterine rupture could experience?

A

May have sudden onset constant severe abdominal pain
Elevated resting tone measured by IUPC,
Fetus can end up in the abdominal cavity in rare cases
Internal bleeding common, may have minimal to extensive external bleeding -> hypovolemic shock

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4
Q

What are risk factors of a uterine rupture? (8)

A

Previous uterine scare (c/s or other)
Fetal malpresentation
Grand multiparty
Operative vaginal birth
Induction with oxytocin
Short inter-pregnancy/inter-delivery interval
Older mothers
Fetal Macrosomia

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5
Q

What could a uterine rupture cause?

A

neonataland maternal M&M

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6
Q

How do you prevent the risk of a uterine rupture?

A

Appropriate TOLAC candidate
Avoid unnecessary IOL
Continuous EFM during TOLAC

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7
Q

What is the treatment for a uterine rupture? How is it diagnosed?

A

Suspected uterine rupture (as diagnosis can only be made with visualization of the uterus)

Emergency C/S
Possible hysterectomy (up to 70%)
Additional line placed, blood type and match for potential tranfusion.

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8
Q

What is the leading cause of non-obstetrical deaths in pregnant women?

A

MVA

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9
Q

What makes trauma so much more deadly for a pregnant women?

A

Pregnant women have extra 45% in blood volume, 40% in cardiac output —> Greater volume of blood loss before shock symptoms seen

Increase clotting factors —>increase rick of post trauma clot and delayed recognition of DIC

Blood is shunted away from uterus & fetusto maintain her hemodynamic status

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10
Q

During a trauma do you usually save the fetus or the mother first? Why?

A

Save the mother first

Babies are resuscitated better intrauterinely

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11
Q

What can trauma lead to?

A

Maternal death
Fetal death
Non-OB complications: broken arms and legs
OB complications

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12
Q

What OB complications can trauma lead to?

A

Abruption
Feto-maternal bleeding
Uterine rupture
DIC
Direct fetal injury

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13
Q

MVA cause maternal death by?

A

associated with ejection from the vehicle or exsanguination from rupture of a major blood vessel

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14
Q

What are the risks associated with a MVA? Do they die from these?

A

Hemorrhage
Abruption
Maternal-fetal hemorrhage

Pregnant women 10x more likely to die as a result of these injuries

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15
Q

Should pregnant women wear seatbelts?

A

YES

SEATBELTS NEED TO BE WORN CORRECTLY! – low and across hips and in 3rd trimester under belly

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16
Q

What increases the risk of domestic violence in pregnancy?

A

Teen relationships
Unintended pregnancies

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17
Q

Why should you always ask about domestic violence throughout their whole pregnancy and PP period?

A

Violence often begins or escalates during pregnancy (repeatedly ask throughout their pregnancy and PP)

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18
Q

What does domestic violence increase the risk of?

A

Increased risk of miscarriage, preterm & low birth weight

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19
Q

When are victims of domestic violence typically killed?

A

Most likely time to be killed is after attempts to leave – help them get resources so they are successful at leaving the first time

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20
Q

Is there a typical abuser profile?

A

No “typical” abuser profile – not coming to any appts or coming to all appts, both could be an abuser

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21
Q

What should be looked for regarding domestic violence? When is a really important time to ask about DV?

A

Look for bruises & burns in hidden areas

ASK –especially postpartum before discharge home because they may change their mind when baby is being taken home

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22
Q

How does a catastrophic trauma victim change the order of ABCs?

A

Changes to CABD (circulation, airway, breathing, delivery)

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23
Q

What should you do for a catastrophic trauma victim r/t CABD?

A

Move uterus off Vena Cava
Large bore IV X 2, replace fluids
Estimate age of fetus, rough fundal height (if baby is above umbilicus assume baby is viable, below assume baby is not viable – especially if unconcoius)

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24
Q

If how long should CPR is occur on a catastrophic trauma victim? What are the 3 situations?

A

CPR for 4-5 min

If CPR not effective, to save mom. Need to do a perimortem C/S to get baby off vena cava so CPR will work
Imminent maternal death, save viable baby
Stable mother, non-reassuring FHT’s, save viable baby

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25
Q

What is the management of a catastrophic trauma patient?

A

Stabilize injury and promote well being for mom and baby
Evaluate for abruption, preterm labor, blood mixing

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26
Q

How do you evaluate for abruption, preterm labor, blood mixing?

A

Continuous EFM from viable fetus, US, CBC, kleihauer-Batke for RH neg moms (to determine need for additional Rhogam)

Infant death may occur from delayed recognition of non-reassuring fetal heart rate patterns so always assess, even after minor trauma. (babies can still die from small trauma)

27
Q

How do you manage the fetus in a catastrophic trauma patient?

A

EFM within 30 min
Continue EFM for at least 4 hr after trauma
Watch for signs of abruption (irritability pattern on contraction strip)
Any early s/sx of abruption, continue EFM X 24hr

28
Q

What is the patho of amniotic fluid embolism?

A

Amniotic fluid containing fetal cells, hair, or other debris enters the mother’s blood stream via the placental bed of the uterus and triggers an anaphylactic allergic reaction. This reaction then results in cardiorespiratory (heart and lung) collapse and coagulopathy.

29
Q

Can amniotic fluid embolism be prevented?

A

Many associations however none are considered causative, therefore should be considered unpredictable and unpreventable

30
Q

How does a patient with amniotic fluid embolism present?

A

acute shortness of breath and hypotension which quickly progresses to cardiac arrest, coagulopathy and coma within 30 min of labor and birth, C/S or D&E (miscarriage or abortion).

May exhibit dyspnea, cough, seizure, confusion, agitation, fetal distress, nausea, vomiting, fever or feeling of impending doom.

31
Q

How fast does a patient with amniotic fluid embolism get DIC?

A

80%-> DIC in 10 min

Nearly 100% within 30 min

32
Q

What is the management of a patient with amniotic fluid embolism?

A

Supportive of all organ systems -> ICU
Immediate CPR
Intubation
Blood products (d/t DIC)
2 large bore IV;s caution with fluids
Norepinephrine, dopamine

33
Q

What is perinatal loss? (4)

A
  1. Infertility during the preconception period
    2.Fetal death during pregnancy
  2. Infant death in the first year of life

*Can also include the non-death loss associated with adoption.

34
Q

What are the types of perinatal loss? (10)

A

Infertility
Ectopic pregnancy
Elective abortion
Fetal death
Miscarriage (spontaneous abortion)
Therapeutic abortion (lethal anomaly and terminates)
Stillbirth
Neonatal death
Sudden infant death syndrome (SIDS)
Adoption*

35
Q

What is the definition of infertility?

A

inability to conceive after at least 1 year of trying

36
Q

What are the most common causes of infant mortality?

A

Serious birth defects
Preterm birth
SIDs
Affected by maternal complications of pregnancy (severe HTN)
Injuries (example: suffocation, atrmgulation in bed)

37
Q

What is grief?

A

normal internal emotional response to loss

38
Q

What is mourning?

A

external expression of this grief

39
Q

Does everyone experience grief/mourning the same way?

A

No two peoplegrieve or mourn the same event or loss exactly the same way

Responses to perinatal loss can range from disappointment to life-altering anguish

40
Q

What are the 5 stages of grief according to Kübler-Ross?

A

Denial
Anger
Bargaining
Depression
Acceptance

41
Q

According to peppers and knapp, when does attachment begin?

A

Attachment begins when planning a pregnancy

42
Q

What are some common grief responses that can occur?

A

Heavy or aching arms
Avoiding pregnant women and babies (and places babies would be)
Sense of loss of the future and shattered dreams (feel like their future is hopeless so less likely to move forward such as get a degree)
Sense of vulnerability in the world (not as safe as always assumed)
Hyper-vigilance with other children

43
Q

Perinatal grief is recognized as _______ type of grief

A

Parental grief has been recognized as the most intense and overwhelming type of grief

44
Q

How does perinatal loss effect the parents?

A

long term effects on women’s psyche, relationships with others and on her parenting with subsequent children.
Because men and women often grieve differently, parents’ reactions may be disparate even though both have experienced the same loss. This cancause significant relationship stress. (stronger or relationship dissolves)

45
Q

How can nurses support parents with grief?

A

Provide parents with anticipatory guidance. Reminding them that partners often grieve differently and on differente schedules.
Provide parents with detailed information about support services and options.
Present options to parents as labor, birth and discharge unfold, rather thanas a vast, all-inclusive menu.
Listen to families and be a physical presence.
Avoid cliche’s: “you are young, you can have others,Jesusmust have needed another angel, it wasn’t meant to bed, at leastyou weren’t too far alone,to least you have other children. “

46
Q

How is miscarriage, ectopic pregnancy, adoption and absorption commonly seen? What can nurses do?

A

Miscarriage, ectopic pregnancy, adoption and abortion may not be acknowledged by a woman’s friends and family as a true form of loss. Therefore its critical that nurses support these women and their partners medically and emotionally.

Nurses can assist these families by listening to their stories, acknowledging their loss, offering support options and helping them create their own memories.

47
Q

How do children grieve differently?

A

Children grieve in ways quite different than adults.

Depending of their developmental stage, often in an uneven pattern.

Told not to blame for the loss. (can feel responsible b/c they didn’t want a sibling at some point)

48
Q

How do grandparents grieve?

A

A grandparents response to the loss of a grandchild may differ from the parents’ response

Often their initial response is to care for their own child

49
Q

What are the birthing option for up to 10 weeks gestation?

A

Expectant management (waiting for the body to naturally miscarriage)

Medical (induced abortion) misoprostol causes emptying of uterus

Surgical (dilation and curettage) done under anesthesia as outpatient procedure

50
Q

What are the birthing options for 11-14 weeks gestation? What is not recommended

A

D&C or medical management

Expectant management is not recommended due to excessive blood loss.

51
Q

What is the birthing recommendation after 20 weeks? Why? What is not recommend and why?

A

Induction of labor and a vaginal birth is the safest option and helps to decrease risks in subsequent deliveries.

Avoiding the process of labor and optioning for a cesareansection may seem like a “kinder option, but because a vaginal birth has so fewer risks for the mothers, this is almost alwaysthe recommended route of delivery.

52
Q

How can families plan for birth? What cases is this done in?

A

For instances where death is inevitable and there is time to plan, nurses can help women write a birth experience plan

Reviewing the expected steps at time or birth and knowing their options can help them to mentally and emotionally prepare for the birth.
It may help families address palliative care issues and rituals they would like to incorporate to provide a more positive experience with their child

53
Q

What is the nursing care at the time of birth?

A

Refer to the baby by their name if they have been given one, if not use pronouns
Grief-related information should be offered based on the mother’s readiness.
Limit the number of staff interacting
Unrestricted family contact with the deceased fetus
Holding the baby should be offered but never forced.
Mementos should be collected and saved even if not ready to accept them now
Physical care of the mother should be as thorough as is done with a healthy labor and birth

54
Q

What mementos and photos can be gathered to help the family?

A

Gather mementos and photos.
Photography may be unacceptable to some.
Photos of hands or feet.
Footprints can be collected.
Black and white photography.
Snip of hair
Baby blanket

55
Q

What does giving the baby a name do for the parents?

A

increases the baby’s social status and personhood

56
Q

What should be asked regarding momentos and photos?

A

Ask about cultural beliefs because some of this may not be allowed in their culture

57
Q

What should be asked about rituals and services for the baby? How should this be done?

A

Rituals, baptism, songs, reading and ceremonies
Give families time to make arrangements for funeral and memorial services
Memorial services can be done at any time even long after the actual death

Ask open ended questions about beliefs and wishes and traditions

58
Q

What should be done for the care of the deceased?

A

It may be appropriate to gently warm a baby under radiant warmers if a baby is coming back up to the family after being in the morgue.

Burial and cremation are the primary means of dealing with a deceased baby’s body.

Gestational age, state law, religion and culture all must be considered in care of a deceased baby

Nurses must know their institution’s protocols and explain all options and procedures to parents.

Organ and tissue donation (particularly heart valve donation) may be an option in postmortem babies that survived to term.

59
Q

What does an autopsy provide? What should be explained to parents? How long does it take?

A

Autopsy often provides valuable medical information about the cause of death; it also can provide guidance for future pregnancies.

Parents should receive information about the purpose of an autopsy and be asked for consent to have the procedure done.

It can take up to several months to get all results back.

60
Q

What physical care should discharge planning include?

A

Basic activities of daily living.

Contraceptive counseling. Recommend 1 year to decrease physical risk and allow for grief

Breast care after 20 week – milk may come in by 72 hours so comfort strategies and how to promote cessation of laction

Warning signs to seek care

61
Q

What social and emotional care should be included in discharge planning?

A

Common responsesto grief and loss
Community resources
Return home to pregnancy and baby-related furniture, room, objects and people asking about baby
Informing friends, family, employment
Return to intimacy
Making a to-do list for friends and family
Perform postpartum depression screening
Follow up calls 1 week

62
Q

What is pregnancy after perinatal loss often accompanied by?

A

high levels of anxiety and fear

63
Q

How does nursing care change for patients with pregnancies after loss?

A

Acknowledge the woman’s loss.
Acknowledge her fear and anxiety, particularly around milestone anniversaries.
Provide reassurance without promising guarantees.
Encourage her to come in and call as often as she needs to.

64
Q

Does caring for grieving families affect the caregiver? What should you do for that?

A

Caring for grieving families can take a toll on the caregiver.

Acknowledge your connection to each baby and family.
Allow yourself to grieve. Showing emotion is okay.
Talk with others; gain support.
Take care of yourself physically, emotionally, socially and spiritually.
Self-reflection is critical for self care.

OB (16 decks)

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