OB emergencies/loss and greif Flashcards

Question

What is the management of a catastrophic trauma patient?

Answer 1

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

Answer 2

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)

Answer 3

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

Answer 4

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.

Answer 5

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

Answer 6

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.

Answer 7

80%-> DIC in 10 min Nearly 100% within 30 min

Answer 8

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

Answer 9

1. Infertility during the preconception period 2. Fetal death during pregnancy 3. Infant death in the first year of life *Can also include the non-death loss associated with adoption.

Answer 10

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*

Answer 11

inability to conceive after at least 1 year of trying

Answer 12

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

Answer 13

normal internal emotional response to loss

Answer 14

external expression of this grief

Answer 15

No two people grieve or mourn the same event or loss exactly the same way Responses to perinatal loss can range from disappointment to life-altering anguish

Answer 16

Denial Anger Bargaining Depression Acceptance

Answer 17

Attachment begins when planning a pregnancy

Answer 18

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

Answer 19

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

Answer 20

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 can cause significant relationship stress. (stronger or relationship dissolves)

Answer 21

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 than as a vast, all-inclusive menu. Listen to families and be a physical presence. Avoid cliche’s: "you are young, you can have others, Jesus must have needed another angel, it wasn't meant to bed, at least you weren't too far alone, to least you have other children. "

Answer 22

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.

Answer 23

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)

Answer 24

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

Answer 25

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

Answer 26

D&C or medical management Expectant management is not recommended due to excessive blood loss.

Answer 27

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 cesarean section may seem like a "kinder option, but because a vaginal birth has so fewer risks for the mothers, this is almost always the recommended route of delivery.

Answer 28

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

Answer 29

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

Answer 30

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

Answer 31

increases the baby’s social status and personhood

Answer 32

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

Answer 33

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

Answer 34

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.

Answer 35

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.

Answer 36

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

Answer 37

Common responses to 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

Answer 38

high levels of anxiety and fear

Answer 39

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.

Answer 40

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 emergencies/loss and greif Flashcards

(64 cards)