Improving Obstetric Patient Outcomes
Order Instructions:
Maternal morbidity and mortality is a national health problem. Preventing complications of pregnancy is included in the 2020 National Health Goals. The purpose of this written assignment is to describe how evidenced based findings can improve patient outcomes related to obstetrical care.
Tanya Kim, 36, G4 P4, was in labor for 36 hours when she had a cesarean birth for a failed induction of labor. She delivered a 9 pound 8 ounce male infant. Tanya’s labor was induced with oxytocin at 41 weeks gestation and continuous epidural was placed during active labor. The epidural was discontinued after delivery. She has iron deficiency anemia but otherwise an unremarkable medical history. She has no known allergies. Her obstetrical history includes 1 spontaneous abortion 6 years ago, vaginal delivery of twins 4 years ago, one singleton vaginal delivery 2 years ago and the cesarean birth today. Tanya plans to breastfeed her infant.
Two hours post-delivery the RN assesses the following:
Vital signs: BP 90/62, pulse 88, Respirations 22, temperature 98.6°F
Skin color: pink
Fundus: boggy, firms with fundal massage, midline and at umbilicus.
Lochia: Heavy rubra with nickel-sized clots
Pain: Uterine cramping rates pain 4 out of 10 on verbal pain scale
Intravenous fluids: 3000 mL Lactated Ringers with 20 units of Pitocin in each bag.
Urinary output: 200 mL since delivery (urinary catheter in place)
Patient comments: “I’m really tired. I have been up for the last two nights.”
One hour later the patient puts her light on and makes the following comment:
“I’m really bleeding a lot!” The RN comes in the room and notes increased vaginal bleeding. The patient is pale, diaphoretic, and the uterine fundus is boggy. The fundus does not firm with massage.
Using APA format, write a 2-3 page paper (excludes cover and reference page) that addresses the following:
1.Identify at least one (1) risk factor from the patient’s obstetrical history associated with the primary problem. Describe why this piece of obstetrical history places the patient at risk for the identified problem.
2.Early identification of emergencies in the obstetric setting is essential to save lives. Four (4) approaches are identified in the literature that can be utilized to positively impact patient outcomes: simulations, drills, protocols, vital sign alerts. Select one of these approaches and address the following: ?
- Discuss two (2) benefits and two (2) limitations of the selected approach.
- Describe two (2) ways by which this approach will improve patient outcomes in the perinatal setting.
A minimum of two (2) current professional references must be provided. Only one (1) textbook that is no more than one (1) edition old may be used.
Current references include professional publications that reflect nursing care provided within the United States. Current nursing professional references must be current (five [5] years or less). Reliable internet sources such as those offered by government agencies, academic institutions or nationally recognized professional organizations may also be used. Examples of unacceptable internet sources include but are not limited to: Wikipedia, medicinenet.com, allnurses.com, and any nursing blog site.
Compose your work using a word processor (or other software as appropriate) and save it frequently to your computer. Use a 12 font size, double space your work and use APA format for citations, references, and overall format. Information on how to use the Excelsior College Library to help you research and write your paper is available through the Library Help for AD Nursing Courses page. Assistance with APA format, grammar, and avoiding plagiarism is available for free through the Excelsior College Online Writing Lab (OWL). Be sure to check your work and correct any spelling or grammatical errors before you submit your assignment
FYI: Current text books being used for this course and materials are:
Textbooks (Chapter numbers and titles may differ in subsequent editions of a given textbook. If your edition is different, use the Table of Contents in the textbook to locate the appropriate chapters to read):
Hinkle, J., & Cheever, K. (2013). Brunner and Suddarth’s textbook of medical-surgical nursing (13th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Kee, J., Hayes, E., & McCuistion, L. (2015). Pharmacology: A nursing process approach (8th ed.). Philadelphia, PA: Elsevier.
Nursing Diagnosis Guidebook – A pocket-size nursing diagnosis guidebook of your choice that is no more than one edition old, that includes NANDA International-approved nursing diagnoses, definitions, defining characteristics, and possible nursing Interventions.
Pillitteri, A. (2014). Maternal & child health nursing: Care of the childbearing and childrearing family (7th ed.). Philadelphia: Lippincott, Williams and Wilkins.
FYI Paper rubic.
NUR209 M6A3: Improving Obstetric Patient Outcomes Paper Rubric
The Case Study assignment addresses the following Student Learning Program Outcomes (SLPOs) and Course Outcomes.
Student Learning Program Outcomes (SLPO) Course Outcomes (CLO)
SLPO #2 (Nursing Judgment): Apply the nursing process to make nursing judgments, substantiated with evidence to provide safe, quality patient care across the lifespan.
2. Apply the nursing process when making nursing judgments to provide safe, quality,
nursing care for families and patients with perinatal and reproductive health care needs.
SLPO #6 (Spirit of Inquiry): Use interpreted published research and information
technology to improve the quality of care for patients.
6. Incorporate evidence-based findings and interpreted research into the provision of safe, quality nursing care for patients with perinatal and reproductive health care needs.
The following criteria are used to grade your two (2) to three (3) page (excluding the cover page and reference page) Case Study Assignment, which accounts for 10% of your final course grade.
Performance levels for each criterion include the following:
- Unacceptable indicates that the student’s attempt at the assignment is poor in quality and fails to meet minimum “adequate” criteria.
- Adequate indicates a student has met minimal requirements.
- Good indicates all expectations of the assignment were met in a comprehensive manner.
- Exceptional indicates that expectations of the assignment were exceeded, whereby a student went above and beyond the assignment as written.
- Exceptional performance is considered rare.
Expectations described under each performance level define the minimum performance that must be demonstrated to earn the minimum points at that level. - **Plagiarism is not acceptable. Evidence of plagiarism will result in a zero (0) grade for the assignment and may also result in academic discipline.**
SAMPLE ANSWER
Improving Obstetric Patient Outcomes Paper
Labour complications are the leading cause of long term disabilities, mortalities and morbidity for both the mother and the babies. One of the approaches is to assess the patient obstetrical history to identify if the pregnancy is a high risk or not. Certain maternal risks factors are associated with risk factors and are identified by assess the outcomes of previous pregnancies. In this context, the patient had suffered from spontaneous abortion during her first pregnancy. Additionally, the patient had undergone other pregnancies (multiple delieveries), and this could have had an impact with her delivery. This is the main factor that could be associated with the prolonged labour and increased bleeding post-delivery. The excessive may result due to the opened blood vessels during the caesarean delivery (Pillitteri, 2014). This is because a pregnant uterus has the most blood supplies as compared to any other body organ. Therefore, the walls of the uterus are cut wide open to access the baby. Although most of the women have the ability to tolerate the blood loss without presenting any health complications, in some few people, some complications could arise. This is severe especially in patients who have difficult in clotting; making it difficult to stop bleeding even with minor cut or even shears. Research indicates that postpartum haemorrhage is common and affects about 6% of the women undergoing caesarean delivery(Kee, Hayes, & McCuistion, 2015).
To save the lives of both the child and the mother, it is important to identify emergencies in the obstetric settings early enough. This is because emergencies can lead to the permanent disabilities or even death of the mother, the infant or both. The main approaches identified by the evidence based practice that can be utilized includes, drills, protocols, simulation and vital sign alerts. In this case study, the best approach that should be used is the protocols. The most strategic approach in this case is use of protocols. Protocols refer to set of rules and procedures that must be followed based on the conventions that have been proven to work in such incidences (Kee, Hayes, & McCuistion, 2015).
The main advantage is that it helps the healthcare provider make the most ethical decision as required by the organization and their professional standards (Kee, Hayes, & McCuistion, 2015). Secondly, because the information in the protocols are written according to the evidence based research, it provides the most effective remedy to patients irrespective of where or who delivers the care i.e. makes quality care the standard. The main challenge is the possibility of err in healthcare protocols, because the judgement value made by guideline could be the wrong choice for this particular patient. Secondly, effective use of protocols is determined by the nurse experience and clinical opinions, and thus, for an inexperienced nurse can pick the most inferior options due to misconceptions or misrepresented community norms (Hinkle & Cheever, 2013).
In this context, the protocol of postpartum assessment includes the assessment of patient’s vital signs, the assessment of breasts, bladder, fundus, perineum, lochia, legs as well as any other incision in the body. The patient pain must be assessed including the location, the type of pain, quality and degree of severity. If necessary, pain medications can be administered to reduce the irritation as well as the swelling. From the assessment records, the postpartum condition of the patient was normal. However after one hour, the patient calls for help, as she feels that she are bleeding a lot (Pillitteri, 2014).
The nurse assessment notices the vaginal bleeding, the patient if diaphoretic, pale and her fundus is boggy even with a firm massage. This is an indicator of postpartum haemorrhage, which could be due to uterine atony and trauma. Postpartum haemorrhages are grouped as emergency complications, and must be treated by a qualified physician. According to the protocols, the patient should be administered oxytocin IV or IM. If the intravenous oxytocin is unavailable, or the bleeding still continuous, then the following medication should be used, including the intravenous ergometrine, prostaglandin (sublingual misoprostol, 800 µg) or combination of oxytocin-ergometrine is strongly recommended. With effective treatment as indicated by the protocol, 90% of the patients make recovery few weeks. In some cases, blood transfusion can be administered to patients who have lost a lot of blood. Other supplements such as iron supplements, vitamins and nutritious dietary could facilitate improve the patient strength and increase patients’ blood supply. The approach will reduce the bleeding rate and improve the patients’ quality of life (Kee, Hayes, & McCuistion, 2015). The protocol also helps in the identification of the risk factors associated with postpartum haemorrhage including history of post-partum, prolonged labour, fetal macrosomia, multiple deliveries. However, it can also occur in patients not presenting the risk factors. The healthcare plan must be identified and designed before delivery. This coupled with assessment of vital signs can improve the patient’s delivery process and help in the detection of both slow and steady bleeding (Kee, Hayes, & McCuistion, 2015).
References
Hinkle, J., & Cheever, K. (2013). Brunner and Suddarth’s textbook of medical-surgical nursing (13th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Kee, J., Hayes, E., & McCuistion, L. (2015). Pharmacology: A nursing process approach (8th ed.). Philadelphia, PA: Elsevier.
Pillitteri, A. (2014). Maternal & child health nursing: Care of the childbearing and childrearing family (7th ed.). Philadelphia: Lippincott, Williams and Wilkins.
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