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Background
he diagnosis of breast cancer is devastating and particularly stressful for the lactating
mother and her breastfeeding infant. The mother
must make treatment decisions that often include
having to abruptly stop breastfeeding. Management of breast cancer during lactation requires a
multidisciplinary approach with the nurse and/or
lactation consultant serving as important team
members. Lactating women receiving a diagnosis of breast cancer require immediate referral to
breastfeeding experts who are able to provide
them with support and accurate information on
weaning strategies. This presentation will utilize
a case study of a mothers experience of breast
cancer during lactation. The nurse and/or lactation
consultants role in identifying and referring suspicious breast lumps/infections will be outlined, and
ways to advocate for and support a woman with a
diagnosis of breast cancer during lactation will be
identified.
Paper Presentation
Case
Immediately after receiving a diagnosis of breast
cancer at a breast center, a 39-year-old mother
breastfeeding her 9-month-old infant presented
in the Breastfeeding Clinic, looking for weaning
support. Her infant was still breastfeeding seven
times per day, had started solids, and refused to
take a bottle or sippy cup. The lactation consultant worked with this mother to develop an individualized weaning plan. The mother was able to
gradually wean over a 2-week period without developing mastitis, a complication that could delay
her cancer treatment. In addition, because weaning is often traumatic for the mother/infant dyad,
the lactation consultant provided strategies to support the infant during the difficult transition from the
breast.
The advanced practice nurse, nurse practitioner
and lactation consultants reviewed the current literature on breast cancer diagnosed during lactation at a journal club and developed a pathway for
referring women who present in the breastfeeding
clinic with suspicious breast lumps and/or breast
infections.
Conclusion
r Only 3% of women develop breast cancer
while they are breastfeeding.
r Because of the aggressive nature of breast
cancer in this age group and the breast
changes that occur during pregnancy and
lactation that make detection more challenging, prompt referral of nonresolving suspicious breast lumps and/or breast infections
is imperative.
r Nurses/lactation consultants caring for
women in the postpartum period require
an awareness of diagnostic tests to rule out
or diagnose breast cancer, implications to
breastfeeding, and weaning strategies for
lactating women with a breast cancer diagnosis.
Keywords
womens health
holistic health
wound care
sexual abuse
Womens Health
Poster Presentation
JOGNN
http://jognn.awhonn.org
C 2012 AWHONN, the Association of Womens Health, Obstetric and Neonatal Nurses
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CASE STUDIES
Proceedings of the 2012 AWHONN Convention
Case
A 71-year-old woman has a history of uterine carcinoma for 10 years and breast cancer for 1 year.
She lost two children to cancer: a daughter to
breast cancer and a son to testicular cancer. She
lived with her husband and was admitted to the
hospital with the diagnosis of abdominal pain, nausea, and vomiting. Upon further evaluation she
was diagnosed with advanced metastatic uterine
carcinoma extending into both the bowel and the
liver. During her hospital stay she had multiple procedures, including an exploratory laporatomy and
tumor debulking with the creation of a colostomy.
She subsequently developed an entercutaneous
fistula, a deep vein thrombosis with lower extremity cellulitis, and multiple additional issues resulting from a severely immuno-compromised state.
The woman and her husband were determined to
beat this cancer, and she continued to receive
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chemotherapy during the first two and half months Elizabeth Ann Freund, RN-BC,
BSN, Inova Fairfax Hospital,
of her hospitalization.
Falls Church, VA
Womens Health
Poster Presentation
Conclusion
Nurses are the catalysts for facilitating multidisciplinary teams involving resources from the entire
healthcare arena. These teams assist in meeting
the patients needs and improving outcomes.
http://jognn.awhonn.org
CASE STUDIES
Proceedings of the 2012 AWHONN Convention
Childbearing
pregnancy
myocardial infarction
maternal morbidity
high risk pregnancy
coronary artery disease
Paper Presentation
Case
A 41-year-old multigravida patient presented to labor and delivery at 35 weeks gestation complaining of chest pain radiating down her left arm. A
stat electrocardiogram and cardiac enzymes tests
were obtained, and the patient had a computed
tomography scan (CT scan) to rule out dissecting aortic aneurysm. The initial electrocardiogram
showed normal sinus rhythm, but elevated troponin levels were indicative of an acute myocardial infarction. A cardiac catheterization determined the extent of the infarction, and the patient
was diagnosed with single-vessel coronary artery
disease of the left anterior descending coronary
artery. The patient was treated medically with heparin and scheduled for a repeat cesarean 2 weeks
Conclusion
As the prevalence of obesity and advanced maternal age increase, the incidence of myocardial
infarction during pregnancy is expected to rise.
Recognition of signs and symptoms of myocardial infarction in pregnant patients is essential to
early detection and intervention. Nurses serve a
crucial role in facilitating a multidisciplinary team
approach to promote effective, evidence-based
care of critically ill mothers and their infants.
Childbearing
Paper Presentation
Background
ollowing the 2008 National Institute of Child
Health and Human Development update, our
healthcare system identified the need to educate all members of the perinatal team regarding
changes in electronic fetal monitoring definitions
and to make changes to our current practice for
early recognition and treatment of tachysystole.
Multiple modalities of education were employed,
especially surrounding the effects of tachysystole on the maternal-fetal dyad. Unfortunately,
these efforts did not significantly affect actual
practice.
Using a monthly strip review presenting the unexpected outcome of one patient, the multidisci-
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CASE STUDIES
Proceedings of the 2012 AWHONN Convention
Risk factors for venous thromboembolism in obstetrics should be the basis of a screening tool.
Although there is agreement that universal prophylaxis for venous thromboembolism does not have
a place in obstetrics, there is not agreement regarding the need for risk-based screening despite
a number of published tools. Available screening
tools and their usefulness in selected populations
will be reviewed. With the rising rates of obesity,
diabetes, and cesarean rates (reported in 2007
as 31.8%), the risk for venous thromboembolism
has never been higher. Participants will be given
tools to assist in implementing risk-screening
strategies for obstetric and high-risk obstetric
populations.
Ultimately when a pulmonary embolism is diagnosed, a complex, multidisciplinary response is
essential to mitigate tissue damage and improve
survivability. A flowchart of multidisciplinary re-
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Case
Keywords
Mk was a 31-year-old gravida 2 para1 patient at pulmonary embolism
term presenting in spontaneous labor. Fetal dis- venous thromboembolism
tress was diagnosed during labor requiring an
emergency cesarean. The infant was born without
incident with Apgar scores of 8 at 1 minute and Childbearing
9 at 5 minutes. Approximately 15 hours postcesarean, the patient appeared to have a syncopal Paper Presentation
episode with resulting cardiac arrest. Intensive resuscitative measures were begun, including cardiopulmonary resuscitation and fluid resuscitation.
On trans-esophageal echo, a massive saddle embolus was seen in the right ventricle across the
tri-cuspid valve and into the pulmonary artery.
The patient initially survived surgical embolectomy
with complete cardiac bypass. However, she was
diagnosed with absent brain stem function and
clinical brain death approximately 72 hours postintervention after multisystem failure.
Conclusion
Although all obstetric patients do not require prophylaxis for venous thromboembolism, there is a
need for risk stratification for venous thromboembolism in high-risk populations. It is imperative that
obstetric providers review implementation of risk
based intervention criteria for venous thromboembolism.
http://jognn.awhonn.org
CASE STUDIES
Proceedings of the 2012 AWHONN Convention
Childbearing
Paper Presentation
Background
bdominal pregnancy accounts for up to 1.4%
of ectopic pregnancies. These pregnancies
can go undetected until an advanced gestational
age and often result in severe hemorrhage.
Case
A 29-year-old gravida 1, para 0 White woman was
admitted to the hospital due to a confirmed intraabdominal pregnancy. The patient was approximately 20 6/7 weeks based on ultrasound data.
The patient was seen by her family physician as
an outpatient and then referred to a perinatologist. The patient was found to have implantation
in the right lateral anterior uterus as well as the
right broad ligament and was admitted for additional imaging with potential surgery in 1 to 2
days. A computed tomography angiogram was
performed to assess the blood supply to the placenta for preoperative evaluation. The angiogram
showed the placenta to be implanted within the
right uterine wall and right broad ligament. An
ethics consult was requested by the perinatologist to explore all aspects of this case. The fetus
demonstrated adequate interval growth. Through
ethics case consultation, review of the ethical religious directives, other perinatologist expert opinions, and discussion with family and staff members, the decision was made to undergo uterine
embolization. A nurse from the labor and delivery perinatal loss team met with the patient and
family prior to the magnetic resonance imaging
and would remain with them throughout the remaining tests, surgery, and recovery period. Prior
to the magnetic resonance imaging, the patient
developed hypotension, tachycardia, and severe
intraabdominal and pelvic pain. The labor and delivery nurse initiated the call to the obstetric rapid
response team and directed the members to the
operating room suite. Upon arrival in the operating room, the patient had a severe bradycardic
episode and hypotension with progression to a
lack of pulse, consistent with hemorrhagic shock.
The patient did not require cardiopulmonary resuscitation as she responded to vasopressors.
The fetus was delivered within 5 minutes of arrival in the operating room and was stillborn. After
receiving six units of red blood cells, six units of
fresh frozen plasma, and six units of platelets, she
was moved to the intensive care unit. Estimated
blood loss was 3,500 cc.
Conclusion
Over the next 5 days, the patients condition was
closely monitored. Nursing care was provided by
intensive care unit and labor and delivery staff in
an effort to meet all aspects of the critically ill obstetric patient and her family.
Background
1N1 is known to cause catastrophic complications in the pregnant population. In this
case we review the presentation and sequelae of
such a patient.
were developed for an intensive care unit cesarean if needed. The patient ultimately did require
an emergent delivery and died quickly thereafter.
The case was complicated by the patients age
and culture.
Case
A gravida 1 para 0 17 year old with adequate prenatal care who refused a flu shot presented to labor and delivery with flu like symptoms early in
the third trimester. The patient rapidly progressed
to acute respiratory distress syndrome and plans
Conclusion
Patient education is vital regarding the importance
of flu vaccine. Multidisciplinary efforts were required to try to save this patients life, care for her
extremely preterm infant, and support her grieving
family.
Childbearing
Poster Presentation
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CASE STUDIES
Proceedings of the 2012 AWHONN Convention
Case
The complex trauma case presented involved an
automobile crash in which the victim suffered multiple fractures to her cervical spine and subsequently quadriplegia. The care she received during a 51-day acute care hospital stay involved
many disciplines and coordination of interdisciplinary care. Her care was complex and collaborative until the final transfer of her care to another
facility. Her case study will be used as teaching
points to outline best practice for all trauma patients. A discussion of medications used in her
care will be if interest to the staff and advanced
practice nurse. This case study is the result of severe, life-threatening injury to the woman. A second case will be briefly described in which a
mother sustained serious but not life-threatening
injuries, and the fetus sustained life-threatening
injuries.
Childbearing
Poster Presentation
Conclusion
Care of the obstetric trauma patient is at once
simple and complex. If there is no damage to the
pelvis or fetus, with the proper care the pregnancy
remains intact and the fetus can be expected to
grow and thrive. Conversely, the care for the pregnant patient can become very complex, and the
type of injuries can adversely affect the fetus while
care to the mother remains relatively simple.
Case
A primigravida at term with no complicating factors in her pregnancy suffered an eclamptic
seizure at home and was admitted to the closest healthcare facility in hypertensive crisis. She
suffered another seizure upon her arrival and was
subsequently diagnosed with an intrauterine fetal
demise. She initially received intravenous magnesium sulfate, intravenous hydralazine, and intravenous labetalol to treat her hypertensive crisis.
She was started on oxytocin to induce vaginal
birth and an epidural catheter was placed for labor analgesia. During this time, she underwent a
head computed tomography, which revealed extensive abnormalities in both the cerebral hemi-
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spheres consistent with posterior reversible encephalopathy syndrome. The patient spoke Spanish as her primary language and was lethargic for
most of the first 24 hours of hospitalization, arousing briefly only to answer simple questions. The
patient was transferred prior to active labor to the
intensive care unit where she was monitored for
possible neurologic deterioration. A labor and delivery nurse accompanied the patient, managed
her oxytocin infusion, and supported her through
a vaginal delivery of a stillborn fetus. The patient
had significant but lessening neurologic deficits
by time of discharge.
Conclusion
By analyzing and assessing patient data, observing, and planning, a safe outcome for this patient
was affected. Obstetric and critical care nurses
coordinated patient-specific interventions to direct
outcomes and worked together to re-evaluate patient stability.
Yvonne A. Dobbenga-Rhodes,
MS, RNC-OB, CNS, CNS-BC,
Washington Hospital
Healthcare System, Fremont,
CA
Keywords
eclampsia
posterior reversible
encephalopathy syndrome
fetal demise
Childbearing
Poster Presentation
http://jognn.awhonn.org
CASE STUDIES
Childbearing
Poster Presentation
Case
A gravida 1, para 0, 25-year-old married patient
had multiple encounters with the healthcare system during her first and second trimester until being diagnosed with non-Hodgkins lymphoma at
27 to 28 weeks. An interdisciplinary team was
formed and invites went out to the perinatology,
oncology, obstetrics, spiritual services, palliative
care, and social services departments. The patients initial plan was to start the first round of
chemotherapy to help with her pain and reduce
the nodules in her neck. It was clear to the team
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Keywords
Conclusion
A problem solving method aimed to identify the
root cause of an event, known as a Root Cause
Analysis, was conducted utilizing a multidisciplinary team to review and discuss the case. Opportunities were presented to improve patient care
Poster Presentation
Cases
Mrs. S. was diagnosed with recurrent glioblastoma multiforme at 17 weeks gestation. Her treatment consisted of surgery to debulk the tumor, chemotherapy, physical therapy, cesarean at
30 weeks gestation, and palliative care after birth.
Despite a grim diagnosis she continued postpartum chemotherapy hoping for a cure. She died 3
months after the birth of her child.
Conclusion
Despite the traumatic experience of diagnosis and
treatment of cancer during pregnancy, a favorable outcome may be achieved with the birth of
a healthy newborn. There are many complexities
to be navigated during the treatment of cancer in
pregnancy. Making treatment decisions is a collaborative effort between the patient, oncologist,
surgeon, nurse, and obstetrician. Careful planning
optimizes safety for both the woman and her unborn child.
Childbearing
Poster Presentation
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Case
The patient was admitted prior to her cesarean/hysterectomy to the high-risk perinatal unit.
She then had the opportunity to talk with representatives from nursing, neonatology, perinatology, and anesthesiology, and we answered her
and her husbands questions. She was instructed
to make a living will, which she had done before
admission. She was nervous but also excited to
see her infant.
Conclusion
The cesarean/hysterectomy was performed in a
very deliberate order. Various lines were placed
http://jognn.awhonn.org
CASE STUDIES
Hickey, M. T.
Keywords
placenta percreta
joyous birth
family experience
and the procedure was done under spinal anesthesia. Her husband was at her side during the
cesarean section, and he and the patient were
able to see the infant after birth. The patient
then was put under general anesthesia for the
remainder of the surgery. She had bladder involvement, so the proper surgeons where there
for that part of the surgery. After recovery from
surgery, she was discharged and resumed her
life.
Childbearing
Poster Presentation
Childbearing
Poster Presentation
Background
his presentation discusses the management
of a multiparous HIV positive patient who was
admitted to Baylor University Medical Centers labor and delivery unit with premature rupture of
membranes (PROM) at 28 weeks gestation. A multidisciplinary approach was taken to provide the
best care to the maternal-fetal dyad.
Case
This case involves a gravida 3, para 1 who presented to labor and delivery 28 5/7 weeks gestation with PROM. Her obstetric history included one
spontaneous abortion and one 24-week preterm
delivery of an infant who died at 8 days of life.
Her medical history was complicated by positive
HIV infection, bipolar depression, multifocal demyelination disorder, and advanced maternal age.
Her HIV status was diagnosed during her current
pregnancy, and she was placed on a combination
antiretroviral regimen. Her last viral load prenatally
was undetectable.
At 29 5/7 weeks, she began experiencing cramping, vaginal bleeding, and signs of chorioamnionitis. She was transferred to labor and delivery, where the decision was made to proceed
with a cesarean. Per guidelines of the Centers for
Disease Control and Prevention, intravenous AZT
was started and allowed to infuse for the recommended 3 hours prior to birth. The infant was born
with 8/9 Apgar scores, was bathed and transferred
to the NICU on room air. The infant was started on
antivirals, with a plan to continue for the first 6
weeks of life.
Conclusion
When PROM occurs prior to 37 weeks, decisions
about delivery should be based on gestational
age, duration of rupture, HIV RNA level, current
antiretroviral regimen, and evidence of acute infection. It is essential to provide ongoing training
and the most current recommendations for management of HIV infection for the labor and delivery
staff.
Asthma in Pregnancy
Mary T. Hickey, EdD,
WHNP-BC, New York
University, New York, NY
Background
sthma is a chronic airway disorder affecting
22 million Americans. The pathophysiology of
asthma is complex, involving inflammation, airway
constriction, and airway hyper-responsiveness.
Asthma is one of the most common medical
conditions affecting pregnant women, complicating approximately 8% of all pregnancies. Asthma
may improve or worsen with pregnancy; however, various reports have noted the increased risk
for preeclampsia, intrauterine growth restriction,
preterm birth, and perinatal mortality in pregnancies complicated by asthma. Asthma is classified
by severity of symptoms as well as degree of lung
compromise; various ventilatory studies are used
for diagnosis and treatment planning. Treatment
plans for asthma are aimed primarily at improving oxygenation, preserving lung function, and
reducing symptoms and exacerbations. Pharmacologic management usually includes shortacting bronchodilators, long acting inhaled corticosteroids, occasional histamine blockers, or
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leukotrine modifiers in a step-up approach. During pregnancy, goals of treatment and management of asthma focus on the promotion of fetal
oxygenation, prevention of hypoxia, and ongoing
assessment of fetal well-being.
ula as needed. Fetal monitoring was done intermittently; she had three biophysical profiles during her stay. Fifty hours after admission a fetal
demise was suspected during a routine assessment, which was later confirmed by sonogram.
Case
The patient was a 34-year old gravida 7 para
3033 who presented at 10 weeks gestation. Her
past medical history was significant for asthma
with meds. Her prior obstetric history was unremarkable; her last delivery was 2 years prior.
This pregnancy was uncomplicated until 34 weeks
gestation when she presented with a cough and
shortness of breath; she was treated with antibiotics. At 38 weeks gestation, the patient was hospitalized after complaints of shortness of breath
and a cough for an acute asthma exacerbation
with hypoxia. Her treatment plan included shortacting bronchodilator nebulizer treatments and intravenous corticosteroids and antibiotics. She was
provided with supplemental oxygen by nasal can-
Conclusion
This case highlights the unpredictable course of a
pregnancy complicated by asthma and the complexities of management. It is essential that nurses
working with pregnant patients perform comprehensive assessments and histories and recognize
the implications of identified actual and potential health problems. Nurses using electronic fetal
monitoring must be skilled in assessment and interpretation of data and possess the knowledge
to utilize additional surveillance measures to assess fetal well-being. Communication and collaboration between members of the interdisciplinary
health care team, in a timely effective manner, are
essential to promote the best possible outcomes.
Keywords
asthma
pregnancy
fetal well-being
Childbearing
Poster Presentation
Case
A 25-year-old female patient presented to a tertiary facility with a diagnosis of an abdominal pregnancy. The patient was admitted at 24 weeks,
gravida 2, para 1, and all prenatal labs were within
normal limits. The ectopic pregnancy was confirmed by magnetic resonance imaging and exploratory laparoscopic surgery. Although termination of the pregnancy was recommended, the
patient elected to continue the pregnancy. The
nurses supported her decision and gave her daily
encouragement. The patient remained hospitalized and on bed rest for 8 weeks before giving
birth.
The patients plan of care included collaboration
between multidisciplinary teams from many specialties and clinical experts within the hospital. Because the location of the placenta and how pregnancy was affecting other adjacent organs was
unknown, there was concern regarding the devel-
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opment of the fetus and when delivery should occur. Potential risks included the possibility that the
placenta might grow into the peritoneum, bowel,
bladder, or omentum, possible fetal growth restriction, rupture of membranes, or bleeding. As a result, all abdominal complaints were taken under
serious consideration.
Nurses used an evidence-based approach to
manage the patients physical and emotional concerns. Fear and stress can cause vasoconstriction
and reduce cardiac output. Holistic care was provided by utilizing complementary therapies to help
to reduce anxiety and discomfort,which included
chaplain services, arts/crafts, healing touch, and
pet, music, and hydro therapy. Surgery to deliver
the infant revealed the pregnancy in the cornual
horn. There has been no documentation of a pregnancy exceeding 12 weeks in this location. The
patient gave birth to a 32-week viable boy, weighing 1,400 grams, and we were able to preserve
her uterus for future pregnancies.
Childbearing
Poster Presentation
Conclusion
Collaboration is very important for high-morbidity
risk cases for optimal patient outcomes. Perinatal
nurses must be prepared for the potential intrapartum catastrophe with proactive and anticipatory nursing, critical assessment skills, and psychosocial care to ensure a positive pregnancy and
birth for the mother and fetus.
http://jognn.awhonn.org
CASE STUDIES
Theresa Rollo, BSN, RNC-OB, evated liver enzymes and low platelets syndrome.
Christiana Care Health System, This syndrome occurs in one of 225,000 pregNewark, DE
nancies, and our institution has had three cases
Keywords
liver rupture
collaboration
interventions
Childbearing
Poster Presentation
Case
A 29-year-old 27-week gestation patient arrived in
obstetric triage from her physicians office with elevated blood pressure, trouble focusing, and +2
proteinuria. After evaluation she was admitted to
the antenatal unit for further monitoring. On day
3 she complained of severe epigastric pain and
was transferred to the high-risk obstetric department. General surgery, perinatology, neonatology,
and anesthesia representatives were immediately
consulted. After intervention to treat her hypertension and review of the diagnostic and laboratory
results, a decision was made to proceed with a
cesarean delivery.
Childbearing
Poster Presentation
Case
The patient complained of fever, headache, and
back pain. Vital signs were 37.3 C, 138 heart rate,
20 respiratory rate, 98/50 BP. She had gram negative rods on the gram stain from her urine sample,
so she was admitted for pyelonephritis to our obstetric high-risk unit for continuous fetal monitoring
and antibiotic and analgesic therapy.
Her temperature rose to 39.5 C and she was
tachypneic. Her hemoglobin dropped to 6.8, so
she was transfused. A chest x-ray was used to
diagnose right lower lobe pneumonia. Her oxygen saturation rates (O2 sats) were 70 to 80%,
and adult respiratory distress syndrome was suspected. The patient was transferred to the inten-
Conclusion
A paucity of recent literature has addressed
the relationship between pyelonephritis and
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Case
Fetal tachycardia was evident at 17-weeks gestation, however the patient did not follow-up with
medical recommendations. Fetal SVT was subsequently confirmed by ultrasound, with a fetal heart
rate of 235 to 240 along with ascites. She was admitted to our obstetric high-risk unit under the care
of our maternal fetal medicine physicians, with a
plan for continuous fetal monitoring and digoxin
therapy. The patient had an arrhythmia herself
upon admission, with no prior history. Her electrocardiogram reflected a sinus arrhythmia. The
fetal heart rate was in the 240s until antiarrhythmic
administration to the mother. The patient was informed that there was a 20% risk of therapy failure
and a 25 to 30% risk of fetal mortality.
Daily electrocardiograms and consults with cardiology, pediatric cardiology, and neonatology were
ordered. A 1:1 atrioventricular (A/V) block was
confirmed by fetal echocardiogram. Propranolol
was added to the digoxin plan. In spite of this,
the fetus only converted to sinus rhythm for 4 to
6 beats, 1 to 2 times per minute. The fetus also
developed pericardial effusions. Flecainide was
added, but consent was also obtained for the possible administration of adenosine via a cordocen-
S174
tesis procedure. The addition of flecainide converted the fetus to normal sinus rhythm, and the
ascites resolved. The patient was discharged with
a prescription for flecainide and biweekly ultrasounds.
The only readmission for the patient was at 39
weeks, when she was scheduled for an induction
of labor. The patient was still taking flecainide and
continued this through labor. The fetal heart rate
was 110 to 120 on admission, and the patients
vital signs were normal. The patient had a repeat
neonatology consult prior to delivery, so she was
informed that the newborn would be going to the
neonatal intensive care unit following birth for cardiac monitoring. She had an uneventful birth, and
the newborn had 9/9 Apgar scores. The newborn
had a normal heart rate, but the electrocardiogram
result was questionable for A/V block. The newborn had persistent normal sinus rhythm subsequently and was discharged on no medications
but did have follow-up appointments with a pediatric cardiologist.
Childbearing
Poster Presentation
Conclusion
This was a successful multidisciplinary effort that
resulted in the delay of birth until term for an infant who had refractory SVT, hydrops, heart block,
and pericardial effusions. The morbidity and mortality risks are high with such a combination, so
the patient benefited from a team with a wealth of
experience.
http://jognn.awhonn.org
CASE STUDIES
Wyatt, S.
Childbearing
Poster Presentation
Background
ardiac disease occurs in approximately 1%
of all pregnancies. Tin Man syndrome,
though rare, is a disorder encompassing physical
and/or electrophysiological cardiac mutations that
may present at any time in life. Historically, women
with cardiac anomalies were discouraged from
pregnancy. While medical advancements have increased the possibility of pregnancy in this population, they may also be minimizing the perception
of risk and severity of complications for the mother
and infant. This presentation will cover the challenges of dealing with the multidisciplinary care
of a pregnant woman with an implantable cardioverter defibrillator ICD pacemaker and neonate
with Tetrology of Fallot.
Case
A 41-year-old gravida 7, para 3 with a rare genetic disorder causing cardiac anomalies, NKX2.5
(otherwise known as the Tin Man gene), began
prenatal care at 16 weeks for an unplanned pregnancy with unknown last menstrual period. Maternal complications of pregnancy included severe
itching due to cholestasis, vaginal bleeding, and
suspected chronic abruption. A fetal echocardiogram at 24 weeks confirmed Tetrology of Fallot
with pericardial effusions. She was hospitalized for
vaginal bleeding at 32 weeks and again at 33 to
36 weeks gestation for vaginal bleeding, which
raised suspicions of chronic abruption. The patient was challenged by several test findings and
she struggled to trust herself as well as care
givers. The strong family history of varied cardiac anomalies increased her anxiety. Several social factors, marital discord, family dynamics, financial stress, and spiritual distress presented
unique challenges far exceeding the difficulty of
her physical management. The need for a holistic
approach to care for this patient and her family
became evident as well as the educational needs
of the staff caring for this family.
Conclusion
Regardless of specialty, nurses must be aware
of developing trends in all fields as multifactorial
complications present themselves in complex patients. Both maternal and neonatal complications
may be compounded by the physiological alterations and risks innate to pregnancy. As a trusted
resource and advocate, nurses must take a holistic
approach to care by identifying and providing the
necessary resources. The collaboration of varied
services and medical specialties was necessary
to provide consistent care, comfort and reassurance for this patient and her family. The teamwork
inspired staff to brainstorm and debrief, resulting
trust among caregivers and the patient and providing the basis for safe, compassionate care.
Childbearing
Poster Presentation
Background
ystemic lupus erythematosus (SLE) is an
autoimmune disease with serious consequences affecting mostly women with darker skin
at a rate 2 to 3 times greater than White women.
Management of lupus flares in pregnancy is challenging due to difficulty of the diagnosis and treatment limitations due to fetal effects. Severe flares
can cause damage to the maternal heart, lungs,
brain, and kidneys, requiring medications not acceptable in pregnancy due to teratogenic effects.
The mothers condition may deteriorate such that
birth is necessary despite the gestational age of
the fetus as illustrated in this case report.
Case
The advanced practice nurse met Ms. AK in the
high-risk obstetric clinic at 7 weeks gestation.
She had a prior preterm delivery after a pregnancy complicated by SLE and pancreatitis. Despite 3 years of good health, she had 4+ proteinuria on dipstick but was otherwise asymptomatic
for lupus flare. By 11 weeks, she had 3 grams
of proteinuria, pitting edema, and suspected lupus nephritis. By 14 weeks, she had 7 grams of
proteinuria, and a renal biopsy confirmed Stage
IV lupus nephritis. At 15 weeks she had vaginal bleeding, hypertension, and a malar rash.
The fetus was growing well with a normal heart
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Conclusion
Termination of pregnancy is a complex decision
providing nurses a unique opportunity to help.
Women who terminate report feelings of guilt,
anger, and depression. They value nurses who exhibit caring through acknowledgement of grief and
individualized care. Nurses in this case lent support throughout the pregnancy and puerperium,
providing nonjudgmental, empathetic care with
continuous assessment of psychological health.
Collected mementos and time with the deceased
infant were encouraged as important activities in
the grieving process. At the postpartum visit, the
advanced practice nurse listened as the patient
described her experience, a vital intervention all
nurses can participate in.
Case
A 30-year-old gravida 1 at 22-weeks gestation was
admitted to the hospital for increasing nausea and
vomiting for the past 2 weeks. She had a four
pound weight loss since the beginning of her pregnancy. She stated she had a mild headache and
occasional white spots in vision. She had no other
complaints. Her vital signs on admission were temperature 98.1, blood pressure 111/61, pulse 71,
respirations 16, and fetal heart rate 140. Her physical exam was normal, and multiple laboratory tests
were ordered to rule out causes for hyperemesis.
Her laboratory values came back inclusive for
causes for hyperemesis or preeclampsia. Her
headaches and vision changes continued to
progress along with her nausea and vomiting. The
perinatology team ordered a computed tomography scan to assist in determining the cause for her
symptoms. The computed tomography showed
moderate hydrocephalus. The perinatology team
consulted with the neurologist. The neurologic
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CASE STUDIES
Zauderer, C.
Janet Hooper, RNC, BSN, MA, dizes the lives of the mother and fetus. There is
LCCE, Inova Fairfax Hospital
risk for significant morbidity or mortality. PhysioWomens Services, Falls
logic changes during pregnancy may worsen the
Church, VA
Keywords
lymphoma
brain tumor
Childbearing
Poster Presentation
Case
We recently worked with a 38-year-old gravida 6,
para1 with a lymphoma metastasis to the brain.
On admission at 26 and 4 weeks gestation, she
was anemic from previous chemotherapy with
a hemoglobin of 11.3 and hematocrit of 33.8.
The fetal heart rate was 148. She presented with
an altered mental status, nausea, vomiting, dysnea, and had experienced a seizure at home.
Magnetic resonance imaging showed a herniated
large brain lymphoma with potential for rupture.
The significance of her worsening neurologic status resulted in a collaborative multidisciplinary approach to her care. The goal of medical management was to treat the cause, prevent further neurologic deterioration, provide supportive care, prolong the gestation, and maintain the well-being
of mother and fetus. Interventions included daily
rounds with the medical and nursing team to discuss the status of the mother and fetus. Ongoing
assessment and anticipation of the patients needs
were completed by the nurses. It was critical that
any change in her condition was evaluated for further progression of the disease. Dietary and psychosocial needs were also addressed. Extensive
counseling and planning are already occurring for
postpartum chemotherapy and/or surgery.
Conclusion
The diagnosis of a lymphoma brain tumor requires
planning for the anticipated birth and well-being of
the infant and long-term planning for the mother.
From this case we learned on the spot education for nursing and a multidisciplinary approach to
care. This included multiple physicians and representatives from nursing specialties, dietary, social
work, and case management meeting frequently
to discuss the latest condition of the patient. This
strong collegial relationship focused on the patients and infants welfare and well-being.
Childbearing
Poster Presentation
Case
Felicia was diagnosed with anorexia nervosa during her teenage years. She stated that she could
not remember ever having a normal menstrual
cycle. Felicia claimed successful treatment for
anorexia nervosa after several years of therapy;
however, she still considered her relationship with
food somewhat stressful. Her weight was 110
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Conclusion
Adjusting to pregnancy and motherhood can be
overwhelming. With the recent literature on the
negative effects of an eating disorder in pregnancy, there is an urgent need for nurses to
be aware of the signs and symptoms of an
eating disorder in the pregnant woman. Nurses
need to establish trust with the obstetric patient in order for her to be comfortable in disclosing the disorder. Once this occurs, they and
other healthcare professionals can lower risks
and enhance outcomes for mothers and infants vulnerable to negative effects of an eating
disorder.
The hormonal changes associated with pregnancy often produce unstable emotions characterized by mood swings and feelings of despair.
Unwanted pregnancies cause an increase in anxiety, depression and feelings of powerlessness.
For individuals who have not developed effective coping strategies to deal with these emotional
shifts, previously or newly learned binging behaviors may emerge.
Case
A 38-year-old female, at 24 weeks gestation presented with a 35-pound weight gain and feelings of low self-esteem and guilt, complaining that
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Childbearing
Poster Presentation
http://jognn.awhonn.org
CASE STUDIES
Newborn
Care
Poster Presentation
Case
Studies have shown an association between optimal feeds during initial hospital stay and longer
duration of breastfeeding. The new mother/baby
dyad often has difficulty in the first few days of
life in establishing breastfeeding. Continuation of
poor feeds can lead to a multitude of other breastfeeding problems that can ultimately lead to early
breastfeeding cessation. Observation and subsequent intervention can lead to better breastfeeding at discharge.
In a typical case, a first time mother told her nurse
that breastfeeding was going well. Two days after discharge, the mother returned for an outpatient lactation consult complaining of sore nipples
and decreased output from the infant. Upon observation, the lactation consultant noticed that the
infant had a shallow latch, was not transferring
milk well, and was causing nipple damage. The
lactation consultant corrected the positioning and
latch, resulting in immediate relief of pain. The lactation consultant was able to hear frequent swallows and the infant seemed satisfied afterwards.
Subsequently, the infant began having abundant
wet and dirty diapers and gained weight. If a feeding had been observed during admission, these
problems could have been resolved sooner. Many
mothers in this same situation would have stopped
breastfeeding. This mother can now successfully
breastfeed exclusively for 6 months and continue
breastfeeding for at least a year.
Conclusion
Mothers generally stay in the hospital from
48 hours to 96 hours postdelivery. During this
short time period, nurses often rely on mothers
self-report of breastfeeding sessions. Initially, the
mother may not be able to effectively determine
whether the feed is nutritive. Nurse observation
of breastfeeding during the hospital stay is imperative to ensure a successful start. While lactation consultants are experts, it is the postpartum
nurses who are key to around the clock observation and evaluation of breastfeeding. Observation
should include latch, positioning, and adequate
transfer of milk.
Newborn Care
Poster Presentation
Case
In one case, a primiparous woman with purple
milk required an interdisciplinary approach to determine the safety of her breast milk for her nearterm baby. Nipple discharge was noted in her second trimester of pregnancy and was monitored
without testing. The patient delivered at 35 weeks
gestation. To achieve a full milk supply, pumping was encouraged by the lactation consultant.
Pumping revealed an unusual purple color, and
the milk was withheld from the infant at the discretion of the postpartum nurse until the obstetric
resident could evaluate. A consult with the breast
surgeon was ordered, and the lactation consultant supported the decision and offered continued, daily guidance. An ultrasound revealed slight
ductal prominence in both breasts. A final consult
by the breast surgeon followed on day 4 at which
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time the mothers milk was normal in color. The surgeon concluded the coloration was due to ectatic
ducts and hormonal stimulation. She encouraged
continued breastfeeding.
Conclusion
Emotional support from postpartum nurses who
are often first to notice a variation in the color of
maternal breast milk is imperative. Recognize that
mothers may experience high anxiety and disappointment if not able to accomplish breastfeed-
ing goalseven with only a short-term interruption of breastfeeding. Mothers may experience
stigma associated with unexpected variation of
breast milk color and increased anxiety when a
physician consult and/or testing becomes necessary. Reassurance may be necessary to support
mothers to use breast milk when it is an unusual
color. Lactation consultants are part of the team
that determines the course of action for mothers
with variations in breast milk color. They offer support to the mother and nursing staff.
Case
This poster presentation will provide a case study
of a 28 6/7 week gestation male twin who developed GBS meningitis on day 76 of life. This case
demonstrates the fragility of the neonatal intensive
care unit population even as infants are approaching discharge.
Keywords
GBS Infection
Conclusion
late-onset
Astute nurses in conjunction with the entire care sepsis
Newborn Care
Poster Presentation
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Case
K.P. came to us for care during her fourth pregnancy, and we found that she was carrying an
anencephalic fetus. All of her previous children
were delivered via cesarean at our hospital, and
her physician urged her to terminate this pregnancy to spare her the possible dangers of another cesarean. She was unwilling to do this because of her faith and was praying for a miracle for
this child or at least that his life would be honored
no matter how short. She approached me about
the possibility of having her priest present at birth
to perform extreme unction and also requested to
be recovered in her hospital room so that her other
children and extended family could be present to
have whatever time possible with the infant.
Newborn Care
Poster Presentation
http://jognn.awhonn.org
CASE STUDIES
Monangi, N.
Conclusion
Although some staff were distressed at the additional danger to the mother, there were those who
were glad to help support this family at this difficult
time. We worked with K.P. to meet her requests and
Newborn Care
Poster Presentation
Background
esearchers describe the prognosis for newborns with full trisomy 18 as poor; only approximately 10% survive to their first birthdays.
Cause of death is usually related to complications
due to central apnea and/or cardiac anomalies
such as ventricular septal defect. Several recent
studies described medical interventions for surviving newborns, including provision of supplemental oxygen, continuous positive airway pressure,
and related mechanical ventilation. There needs
to be further examination of the care received
by newborns with full trisomy 18 during the prenatal, neonatal, and immediate perinatal periods.
Professionals must be aware of possible medical
complications as well as strategies to facilitate collaboration to ensure appropriate treatment decisions.
Case
Simon was born on September 7, 2010 at 38
weeks gestation. He weighed 1,900 grams and
presented with patent ductus arteriosus, ventricular septal defect, coarctation and a bilateral cleft
lip. He was diagnosed at 3 days with trisomy 18
and lived 88.5 days in the Level III neonatal intensive care unit of a mid-sized hospital in the
Midwest. Simons team of care providers included
neonatologists, a pediatric cardiologist, a pharmacist, nurses, and respiratory therapists. This group
worked closely with Simons parents to make treat-
Congenital Chylothorax
Nagendra Monangi, MD,
Background
Cincinnati Childrens Hospital
hylothorax is caused by chyle containing
Medical Center, Cincinnati, OH
Keywords
chylothorax
octreotide
pleural fluid
chest tube
Newborn Care
Poster Presentation
lymphatic fluid draining into the pleural cavity. Chylothorax is the most common type of pleural
effusion during the neonatal period, may cause
significant respiratory compromise, and is associated with substantial mortality and morbidity.
This report summarizes the course of a 35 weekgestation neonate with bilateral congenital chylothorax with a review of etiology, radiographic
and laboratory diagnosis, and successful management of chylothorax with octreotide.
Case
A preterm male infant was born weighing 4,695
grams at 35 weeks gestation to a 33-year-old
mother by cesarean due to weight gain of 20
pounds in 2 weeks, limb edema, hypertension,
polyhydramnios, fetal distress, and face presentation. There was no significant maternal medical history and 8 and 20 weeks gestation ultrasounds were reported as normal. Resuscitation at
delivery included intubation with assisted ventilation, placement of umbilical lines, and intratracheal epinephrine and surfactant. Apgar scores
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Conclusion
Congenital chylothorax, an uncommon cause of
respiratory distress in neonates, is diagnosed initially by prenatal ultrasound or postnatal x-ray and
definitely by evaluation of pleural fluid in the pleural space. Standard management of neonatal chylothorax usually entails prolonged hospitalization
requiring multiple procedural or surgical interventions. Nutritional status, along with fluid and electrolytes, needs to be monitored closely. Administration of octreotide in our case led to a more rapid
resolution of pleural drainage, no recurrence, and
early hospital discharge.
Professional
Issues
Case
Women in early pregnancy, before 20 weeks gestation are often triaged and treated in the main hos-
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pital emergency room when presenting for bleeding or threatened spontaneous abortion. This was
true in the case of a young woman at 14 weeks
gestation. Early antepartum hemorrhage (before
20 weeks gestation) can be caused by abortion/miscarriage, ectopic pregnancy, or gestational trophoblastic disease. Early diagnosis and
treatment is essential and often not done urgently
or with the thought of life threatening hemorrhage.
Deterioration can happen suddenly, and underestimation of blood loss and misleading maternal
response can mask the need for an urgent response. The patient may maintain a normal blood
pressure until sudden and catastrophic decompensation occurs. It is essential that the team in
any setting knows how to respond quickly and appropriately as time is of the essence.
Conclusion
A well-coordinated team can mean the difference
between life and death. In this case, the resident initiated the obstetric hemorrhage protocol
and saved this womans life. After the episode, the
team debrief reinforced the importance of quantifiable blood loss education as well as the implementation of the obstetric hemorrhage protocol.
http://jognn.awhonn.org
CASE STUDIES
Pickerel, A. D.
Professional Issues
Paper Presentation
Background
urses are committed to all aspects of
womens health. Although Title IX has prohibited pregnancy discrimination since 1976, discriminatory practices in college athletics continue to include removing pregnant athletes scholarships and athletic participation, requiring female athletes to sign statements that they will
not get pregnant, and shaming pregnant athletes.
These practices create unsafe health environments, which motivate pregnant college athletes
to conceal their pregnancies and worse. In 2007
two college freshmen athletes killed their term infants after delivering in their dorm rooms.
Case
This session summarizes knowledge on intense
exercise during pregnancy and chronicles one
nurses 5-year advocacy for womens health by
changing the National Collegiate Athletic Associations (NCAA) policies on pregnancy. The new
NCAAs guidelines, co-authored by the presenter
and distributed to all NCAA schools, generally protect pregnant athletes scholarships, inform athletes and athletic administrators about safe athletic participation during pregnancy, and create
a safer environment for pregnant athletes to reveal pregnancy and seek health care. Yet the
process remains imperfect. For example, institutions that view pregnancy as a violation of stu-
dent conduct are still permitted to revoke pregnant athletes scholarships. Pregnant individuals
who self-identify (following the new NCAA guidelines) may not realize that they are inviting these
consequences. The NCAA continues to deny new
fathers time away from athletics needed to parent.
The new NCAA guidelines do not carry the authority of bylaws and do not require reinstatement as
Title IX directs.
Title IX, case studies, current research on intense
exercise during pregnancy, and the new NCAA
guidelines will be reviewed to ignite participants
passions to improve outcomes in this vulnerable
population. Pregnancy issues unique to competitive athletes will be presented including the male
model of competitive sports, the culture of risk
which encourages athletes to deny pain and injuries in order to continue competing, pregnancy
as a crisis, and a widespread myth that pregnancy
enhances athletic performance and is a form of illegal blood doping.
Implications for Practice
Recommendations for new directions in nursing research and advocacy will include
nursing research focused on this unstudied
population, breastfeeding in new college athlete mothers, male athletes who father children
during college, high school athletes, and athletes
at faith-based schools.
Professional Issues
Poster Presentation
Background
nitially, two cases of severe obstetric hemorrhage were evaluated to assess current practice
related to obstetric hemorrhage policies. Staff education and practice changes were implemented.
Two additional cases occurred, which allowed another opportunity to assess for improvement in
nursing/collaborative care implementation. During these additional emergency situations, the response of staff and collaborative team members
was evaluated based on the previous clinical recommendations. The final case review is an outlying
case involving multiple nursing units. The severe
obstetric hemorrhage occurred six hours after delivery on a postpartum unit.
Case
All cases involved initiation of the obstetric Severe Hemorrhage Policy, which is initiated at the
request of the obstetric provider. Cases were evaluated for risk factors of postpartum hemorrhage.
Lab results at admissions, during hemorrhage,
and until discharge were assessed for quantification of blood loss versus the stated estimated
blood loss. Cases were also evaluated for timeframe recognition of postpartum hemorrhage to
initiation of the obstetric Severe Hemorrhage Policy. The policy activates collaborative team members including obstetrics, anesthesia, labor and
delivery nursing, intensive care unit resource nursing, nursing supervisor, and laboratory/blood bank
personnel. Cases were reviewed for pharmacologic and nonpharmacologic interventions prior
to any need for surgical interventions as well as
resuscitative measures during interventions. Also
evaluated was the response timeframe for collaborative team members including laboratory, blood
bank, and radiology.
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Conclusion
After completion of the first two case reviews,
recommendations for nursing were brought to labor and delivery clinical practice. Emphasis was
placed on encouraging direct, focused, and early
communication with providers and collaborative
team members and working to quantify blood loss
early in hemorrhage to allow for quicker decision in
initiation of multidisciplinary services in policy. Additional recommendations included improved role
management; communication through centralized
location; organization of quick reference checklist
and nursing documentation worksheets for better
capture of event time lines; and implementation
of obstetric Severe Hemorrhage Cart with determination of centralized location of cart for rapid
access to equipment. The obstetric Severe Hemorrhage Cart is assessable to obstetric focused
nursing units.
It is significant to note that the same nurse was in
attendance for each case, which allowed for critical analysis of practice, focused implementation
of practice changes, and real-time evaluation. Significant decrease in timeframe from recognition of
hemorrhage to actual initiation of policy occurred.
Communication significantly improved resulting in
increased safety for patients and satisfaction from
team members involved.
Case
A 36-year-old gravida 6, para 4 at 28 weeks gestation with twins, presented to labor and delivery.
Her previous history included a successful surrogate pregnancy and delivery. The patient reported
this was also a surrogate pregnancy, and the biologic fathers lived in France. The patient was
supported by her husband and tocolytics were
attempted without success. The patient delivered
via cesarean, and the twins were admitted to the
Level III neonatal intensive care unit. No docu-
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Conclusion
As a result of changing family dynamics and the
growing field of reproductive technology, surrogacy cases will continue to increase in the hospital setting. This case study illustrates the need
for a hospital policy to effectively provide optimal
care. It is vital to understand terminology as it relates to the parents involved. In addition, current
state law as it pertains to surrogacy must be incorporated. Finally, true success resulting in positive
outcomes for the surrogacy situation requires multidisciplinary support and education.
Professional Issues
Poster Presentation
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CASE STUDIES
Smithgall, L.
Professional Issues
Poster Presentation
Background
he current economic recession in the United
States has had a profound impact on the nation healthcare system. One specific population at
risk is the pregnant woman and their infants. The
American College of Obstetricians and Gynecologists reported that uninsured pregnant women
are more likely to experience an adverse maternal
outcome. Uninsured newborns are more likely to
experience adverse health outcome and are more
likely to die than insured newborns. It has been
reported that 18% of uninsured pregnant women
have reported that they did not receive needed
medical care versus 7.6% of privately insured
and 8.1% of Medicaid-enrolled pregnant women.
These uninsured women face barriers such as access to healthcare providers, diagnostic testing,
and alternate insurance coverage.
Case
A 39-year-old gravida 2, para 0100 was seen in the
emergency room prior to delivery and diagnosed
with kidney stones. During that visit, she was found
to be 23 weeks pregnant with elevated blood pressure and blood glucose. She stated that she was
unable to obtain her medications due to a lack of
health insurance, secondary to her spouse losing
Keywords
obstetrics program closure
prenatal care
care transition
Professional Issues
Poster Presentation
Case
The decrease in the population of child bearing
age women in the region, reduced number of
births, increased costs associated with minimum
staffing of multiple interdisciplinary resources for
the provision of the obstetric service, and the
losses related to increased Medicaid covered patients justified the need for a thorough assessment
and evaluation of the inpatient obstetric/newborn
service and the subsequent decision for service
closure. Planning and implementation for the closure of the inpatient obstetric/newborn service
in a rural community hospital presented multiple opportunities and challenges for the nursing
leadership team. The communication plan regarding service closure and education regarding the
plan for care for obstetric patients after service
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Evidence identifies the best management for complications such as these begin with a multidisciplinary team approach. Inclusion of nursing staff,
physicians, anesthesia, transfusion services, laboratory, hematology, respiratory therapy, and administration is necessary for optimal patient outcomes.
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Case
The development of a Massive Obstetric Transfusion protocol was initiated at Baylor All Saints
Andrews Womens Hospital to promote better patient outcomes for the pregnant population experiencing a life threatening hemorrhage at or following birth of an infant. This protocol allows for
proactive, interdisciplinary dynamics, and collaboration for planning patient care, not only when risk
factors are present before birth, but also when a
hemorrhage occurs unexpectedly.
The initial implementation occurred in July 2010
in response to an inpatient with multiple risk factors and diagnosed with percreta placental abnormality. We will present a case study of the scenario that unfolded, ultimately ending in a positive outcome for the patient. Additionally, we will
highlight case specifics of a second patient with
similar risks that did not accept blood products.
Options for this patient population will also be
discussed.
Professional Issues
Poster Presentation
Conclusion
Through collaborative efforts of all members of
the healthcare team using evidence-based practice, this protocol was successfully implemented
in a controlled situation. With lessons learned,
this protocol can be used when planned and
unplanned cases arise to foster positive patient
outcomes for patients experiencing massive OB
hemorrhage.
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CASE STUDIES
Morgan, Q. E.
obstetric first responder program, which was immediately activated. Further evaluation involved a
cardiac catheterization, which diagnosed a spontaneous coronary artery dissection. A team of
nurses, ancillary staff, and physicians met to formulate a plan for delivery of the fetus and care
of the mother. What began as a visit to the
triage area of a community emergency room at
0230 resulted in a term, male infant admitted
to the well-baby nursery following a successful
transition period. The mother was transferred to
the intensive care unit on a ventilator following
surgery. The mother and infant were discharged 5
days after major cardiac surgery following a rare
disease.
Case
A 32-year-old gravida 2, para 1 Hispanic women
presented with a chief complaint of chest pain.
She was immediately seen by a triage nurse who
recognized the critical situation and activated the
cardiac alert algorithm. This allowed her to obtain an electrocardiogram, immediately bypass
triage, and obtain care by an emergency physician. With the information provided, it was suspected that the patient was experiencing an acute
myocardial infarction. This hospital also has an
Conclusion
The culture of nursing care and collaborative practice model allowed a multidisciplinary group of
staff to come together to provide life-saving care to
a mother and her infant. This represented a successful outcome to a rare and often fatal occurrence. Through transformational leadership and
structural empowerment nurses are encouraged
to make decisions based on what is best for patients and implement algorithms and protocols
based on their nursing assessment.
Professional Issues
Poster Presentation
Background
s nurses, often we are faced with many amazing challenges that cause us to be stronger
or allow us to grow. In my presentation I will discuss the importance of teamwork and collaboration between obstetric nurses and intensive care
unit nurses and physicians. Through this collaboration and effective communication we were able
to transform the intensive care unit into a working
operating room.
Case
A 29-year-old female at 30 weeks gestation was
transferred to our hospital in critical condition.
She presented with acute respiratory distress syndrome and was hypotensive. She arrived intubated and in an induced coma. Prior to arriving
in intensive care unit, I was given a report by
my coordinator and asked to run a fetal strip and
assess the current situation. When I arrived the
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Conclusion
After an anesthesiologist arrived, coordination between me and the intensive care unit nurses and
staff was vital. We accumulated supplies from the
womens operating room and intensive care unit.
We discussed needs for maintaining sterile tech-
Case
The rapid design process of a level III NICU had
mutual goals and benefits with considerable constraints. Most importantly, providing a local space
for NICU families would result in healthier families
and better outcomes for the patients of the region.
Previously NICU or antenatal patients would be
flown out of state for a higher level of perinatal
care services. Each stakeholder had competing
and complementary priorities that all needed to
be captured and expressed in an efficient and effective way for patient care as well as process.
A purist type of design did not develop due to
multiple demands and constraints; rather a hybrid
evolved out of focus groups, site visits, and a literature review. The design elements of the four seasons paired with materials from nature resulted
in an environment that was both welcoming and
functional. The best elements of each type of NICU
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Conclusion
Communication and site visits increased all parties understanding of the space design, function,
flow, efficiency, and patient and family outcomes.
Intended outcomes of the space were increased
team satisfaction with flow and function as well
as collaboration with novice and experts within
the staffing mix. The space lends itself to privacy
as well as accessibility of staff by families. The
semi-open space allows for families to interact and
come together to support each other.
Professional Issues
Poster Presentation
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