Clinical Presentation
A 29-year-old primigravid woman weighing 80 kg presented to the labor ward from home, at 37 weeks with one week’s history of visual disturbances and headache. In addition, she complained of epigastric pain and edema of the lower extremities. At the hospital, the patient had an episode of seizure that lasted for around 30 seconds.
Examination
The care setting comprises of a labor and delivery unit . In addition, it has a side lab for expedited laboratory measurements. The nurse present was requested to obtain the patient’s blood pressure. This was carried out by placing the cuff at the level of the heart with diastolic readings being inferred from the abolition of heart sounds. It was found out that she had a systolic blood pressure of 180mmHg and a diastolic pressure of 110mmHg. Laboratory tests revealed that she had 0.5g of proteins in her urine and there was marked thrombocytopenia together with deranged liver function. A diagnosis of preeclampsia was made. Based on these measurements the patient was classified to have severe preeclampsia and as such the severe preeclampsia protocol was initiated. Other laboratory tests carried out confirmed the diagnosis. These included an elevated aspartate aminotransferase AST level and a low platelet count.
Multidisciplinary Team Approach
The attending nurse transferred the patient to a spacious room within the labor ward. She then made a call to the attending obstetrician explaining the situation at hand. After that she made a call to the anesthetist and a registrar specializing in obstetric medicine and informed them of the same and requested their presence. An intensive care observation chart was obtained and monitoring initiated to ensure constant monitoring ...
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...on the tendon reflexes immediately after administration of the loading dose. Thereafter, monitoring is carried out on hourly basis. In addition, respiratory rate was monitored hourly in addition to checking on the level of consciousness of the patient at the rate of every hour.
and on the urine output. During the infusion process, it was observed that the urine output fell below 50ml in a period of 2 hours. The specialist obstetrician was immediately called by the attending nurse. The specialist ordered the cessation of the maintenance infusion. The anaesthetist was informed and blood drawn to determine the amount of magnesium in the blood steam. 1 g of calcium gluconate was administered intravenously over a period of 3 minutes to counter the toxic effects of magnesium sulphate on the heart. The patient was stabilized and the respiratory rate returned to normal.
In this paper I will write about my observation of the Miss Z who was a 28 year old patient in the S hospital where I had my Lifespan 1 clinical placement. Also, I will write about Mrs. M. who is a Registered Nurse at the High Risk Pregnancy Unit of the S. hospital where Miss Z. was a patient. More specifically, I will describe how Non-Stress Test was done by the nurse Z. During this test nurse repositioned Miss Z, strapped two sensors to her belly, and interacted with Miss. Z. In the second part of my writing I will discuss two types of nursing knowledge such as Case knowledge and Patient knowledge. (Joan Liashenko, Anastasia Fisher 1999) I will describe how nurse Z incorporated these types of nursing knowledge into her encounter with Miss. Z.
Neonatal nursing is a field of nursing designed especially for both newborns and infants up to 28 days old. The term neonatal comes from neo, "new", and natal, "pertaining to birth or origin”. Neonatal nurses are a vital part of the neonatal care team. These are trained professionals who concentrate on ensuring that the newborn infants under their care are able to survive whatever potential life threatening event they encounter. They treat infants that are born with a variety of life threatening issues that include instances of prematurity, congenital birth defects, surgery related problems, cardiac malformations, severe burns, or acute infection. Neonatal care in hospitals was always done by the nursing staff but it did not officially become a specialized medical field until well into 1960s. This was due to the numerous advancements in both medical care training and related technology that allowed for the improved treatment and survival rate of premature babies. According to the March of Dimes, one of every thirteen babies born in the United States annually suffers from low birth weight. This is a leading cause in 65% of infant deaths. Therefore, nurses play a very important role in providing round the clock care for these infants, those born with birth defects or other life threatening illness. In addition, these nurses also tend to healthy babies while their mothers recover from the birthing process. Prior to the advent of this specialized nursing field at risk newborn infants were mostly cared for by obstetricians and midwives who had limited resources to help them survive (Meeks 3).
Preeclampsia is a hypertensive disorder commonly experienced by women in the third trimester of pregnancy. It often presents onset elevated blood pressure, neurological impairments, and persistent headache.
Patient A.B. was a 26 year old female who had delivered her baby girl at 0502, approximately two hours before I assumed care of the patient with my preceptor. This was her third pregnancy and all were a cesarean delivery. Gestational age at time of delivery was forty weeks and one day. Mom was group B strep negative and required no antibiotics, blood loss was approximately 400ml and baby had Apgar score of eight and nine. The patient had a very detailed birth plan which included some details such as; staying with her baby, breastfeeding, and providing
There was inappropriate staffing in the Emergency Room which was a factor in the event. There was one registered nurse (RN) and one licensed practical nurse (LPN) on duty at the time of the incident. Additional staff was available and not called in. The Emergency Nurses Association holds the position there should be two registered nurses whose responsibility is to prov...
Magnesium sulfate is used as a tocoytic medicine to slow uterine contractions. It is given intravenously until contr...
My essay will include a discussion of communication, interpersonal skills used in the incident, and finally evidence-based practice. I will conclude by explaining what I have learned from the experience and how it will change my future actions. In accordance with the 2002 Nursing and Midwifery Council, the client details and placement setting has not been disclosed in order to maintain confidentiality. Critical incidents are snapshots of something that happens to a patient, their family, or nurse. It may be something positive, or it could be a situation where someone has suffered in some way (Rich & Parker 2001).
eclampsia in a pregnant woman can put her and her unborn child at risk. A risk
As an UConn graduate, I strive to practice UConn School of Nursing PRAXIS – professionalism, respect, accountability, excellence, integrity and service. Two weeks following the orientation on postpartum unit, I knew taking care of four mother-baby couplets overnight was not going to be an easy job at a level I trauma center, where we care for the sickest of the sick. After a thorough plan of care for each patient and tailoring it to their needs for the night, I felt more confident in my skills and time management. It wasn’t until I got a call from a 14 hour post-op c-section patient at 0455 complaining of dizziness, lightheaded, blurry vision and “feeling hot”, who an hour ago was walking to the bathroom, breastfeeding baby and eating with no complains of pain. I left my workstation behind to discover a pale, diaphoretic patient with low blood pressure. I froze. Screamed for resident down the hall. Rapid response team and more professionals were there in no time while I stood by my patient holding her hand, echoing the story to residents and attending MD I’ve told previously. After twenty minutes of stabilizing the patient and diagnosing at bedside with ultrasound and abdominal x-ray, the patient suffered internal hemorrhage from tubal ligation site. She was rushed to operating room. Speaking to her husband was even harder. I froze again. I sat on my knee, held his hand and cried with him. In
Postpartum hemorrhage is the leading cause of maternal mortality in the world, according to the World Health Organization. Postpartum hemorrhage (PPH) is generally defined as a blood loss of more than 500 mL after a vaginal birth, more than 1000 mL after a cesarean section, and a ten percent decrease in hematocrit levels from pre to post birth measurements (Ward & Hisley, 2011). An early hemorrhage occurs within 24 hours of birth, with the greatest risk in the first four hours. A late hemorrhage happens after 24 hours of birth but less than six weeks after birth. Uterine atony—failure for the uterine myometrium to contract—is the most common postpartum hemorrhage (Venes, Ed.).(2013). Other etiologies include lower genital tract lacerations, uterine inversion, retained products of conception and bleeding disorders (Kawamura, Kondoh, Hamanishi, Kawasaki, & Fujita, (2014).
During the therapy session, they administered VitalStim therapy. VitalStim was used for the patient because he was suffering with difficulty swallowing also known as dysphasia. Electrical stimulation is used to aid muscle strengthening and muscle recruitment to rehabilitate the swallow. The clinician applied the VitalStim while working with the patient on swallowing exercise. To make this happened she has the patient read one to two pages out a book to get the VitalStim to be effective. The patient was not only working on dysphasia, but was also working on aphasia and apraxia. All of these focuses are being worked on, but the therapy session that I saw was
In this case, the onset of sepsis was detected speedily with the Midwife acting on her instincts thus promptly informing key members of the multidisciplinary team. Sepsis may be insidious in onset however it may also rapidly progress misleading health care workers of its severity, which is evident in the latest CMACE report. Returning “back to the basics” is key in the early detection and treatment of sepsis and is an essential factor to decreasing the direct cause of maternal mortality hence midwives must remain vigilant to signs and symptoms of infection. There is clearly a need to raise both maternal and professional awareness about sepsis so that it can be prevented, where possible, and finally lead to a decrease in the direct cause of maternal death.
The pregnant trauma patient presents a unique challenge because care must be provided for two patients, the mother and the fetus. It is vital that the nurse know and understand the anatomical and physiological changes that occur during pregnancy. She must be aware of these changes, and how they can mask or mimic injury, and very importantly that fetal distress or loss can occur even when the mother has incurred no abdominal injuries.
• Get proper medical care during pregnancy. Your health care provider may be able to prevent preeclampsia or diagnose and treat it early.
Magnesium sulfate (MgSO4) is used extensively for prevention and treatment of eclamptic seizure (1, 2) and is considered as the ideal anti–convulsant drug in preeclampsia and eclampsia (3). The effect of Magnesium sulphate in vitro and in vivo on relaxing human uterine contractility was widely reported. Magnesium has a calcium antagonist effect that decreases calcium intracellular concentration and inhibits contraction process (4-6).