Preterm Premature Rupture of Membrane

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Preterm Premature Rupture of Membrane Research Paper


Abstract

Preterm premature rupture of membranes s the rupture of the fetal placenta before the commencement of labor. Preterm premature rupture of membranes complicates around 2-4% percent of singleton pregnancies and 7-20% of twin pregnancies (Caughey, Robinson, & Norwitz, 2008). Preterm premature rupture of membranes stands to me the leading cause for preterm births and around 18-20% of all perinatal mortalities. The medical team caring for expecting mothers should be well versed in the clinical management of preterm premature rupture of membranes because every minute is needed to diagnose, prescribe and treat these women to have the most promising outcome possible.


Preterm Premature Rupture of Membranes

It is commonly thought that with the rupture of membrane or a woman’s water breaking is the start of labor especially with the help of Hollywood it is made out to be this huge dramatic event. In real life it is usually calm with a trickle or gush of fluid that cannot be stopped. When a woman is at full term gestation there is not much to worry about, she knows her delivery is imminent, and she will get to meet her bundle of joy soon. But for a woman who is preterm and has a rupture of membrane, she knows that this is not typical of an average birth and the fear for the safety of her and her unborn baby are at risk. This paper will define preterm premature rupture of membranes, the labs and diagnostic tests to confirm rupture, how this process is clinically treated, the prognosis for those affected by preterm premature rupture of membrane, and a nursing care plan to give a visualization of the care given to a patient with preterm premature rupture of membrane.


Condition Description

Preterm premature rupture of the membrane is defined by the premature rupture of the placenta before 37 0/7 weeks of gestation (Perry, Hockenberry, Lowdermilk, & Wilson, 2018) and while the percentages of incidence differ depending on sources, preterm premature rupture of membrane is one of the biggest reasons for preterm birth (Caughey, Robinson, & Norwitz, 2008). The fetal membrane comes from the union of the amnion and chorion, this union fuses to the decidua capsularis, that turns into the decidua perietalis throughout the length of gestation. The rupture of membrane usually occurs near the internal cervical os but has the possibility of occurring at other sites (Mercer, 2008).

While there is no definitive reason for why preterm premature rupture of membrane occurs, there are many risk factors that make preterm premature rupture of membranes more likely to occur. These risk factors can occur from maternal influences, the placenta itself and its surrounding anatomy, and the fetus. The maternal influences include that of having had preterm premature rupture of membranes with a previous pregnancy, vaginal bleeding during the pregnancy, chronic steroid therapy, direct abdominal trauma, preterm labor, cigarette smoking, illicit drug use such as cocaine, anemia, low body weight, nutritional deficiencies, and low socioeconomic status. The uteroplacental factors include uterine anomalies, placental abruption, advanced cervical dilation, prior cervical conization (cone biopsy is a treatment used to identify and remove abnormal tissue from the cervix (Cooper & Menefee, 2019).), cervical shortening in the second trimester, uterine overdistention related to polyhydramnios or multiple fetal pregnancy, intra-amniotic infection known as chorioamnionitis, and multiple bimanual vaginal examinations. The fetus(es) itself can affect the nature of the placenta by the quantity of fetuses in utero and premature rupture of membranes has proven to complicate 7-10% of multi fetus pregnancies (Caughey, Robinson, & Norwitz, 2008). Since the rupture of membrane can not be reversed it is imperative to be aware of these risk factors and assess pregnant patients for any warning signs.

Signs and symptoms of preterm premature rupture of membranes are varied such as a gush or trickle of fluid that can not be stopped, change in vaginal discharge and pelvic pressure; because these could besymptoms of other complications or disorders, diagnostics are performed to accurately diagnose a patient with preterm premature rupture of membranes.


Diagnostics and Lab Tests

The diagnosis of preterm premature rupture of membranes can be performed multiple ways, once the patient states the presence of a gush or trickle of fluid from their vagina, the confirmation can possibly be seen through visual examination of the perineum with a slight musty odor present or through a sterile speculum examination considered minimally invasive. During this examination the examiner will be able to document the three signs of rupture of membranes considered the gold standard of diagnosing: visual pooling of clear fluid in the vaginal canal, an alkaline pH test with nitrazine paper to test an area that should be more acidic in nature, and microscopic ferning which is the crystallization of the amniotic discharge once dried. This gold standard is not without fault, generally after an hour of the rupture of membranes the pH starts to change back to more acidic and there is a possibility of having a false negative due to cervicitis, vaginitis, or contamination with blood, urine, semen or diagnostic tools such as lubricant, ranging from a 16%-70% accuracy (Caughey, Robinson, & Norwitz, 2008). The visual element may be hindered as well if the patient suffered from oligohydramnios in which there may not be a gush of fluid felt or visualized (Mercer, 2008). The ferning test can show a false positive result by human error of a fingerprint being present or other contaminants such as semen or cervical mucus present on the slide, resulting in a 51%-70% accuracy (Caughey, Robinson, & Norwitz, 2008).

There is a new test that is being used widely throughout the United States, approved by the Food and Drug Administration (FDA) for the diagnosis of premature rupture of membranes called Amnisure. This test recognizes trace amounts of PAMG-1, a glycoprotein that is found abundantly in amniotic fluid. A swab is inserted vaginally for one minute then the swab is placed in a vial of solvent for one minute, a test strip is placed in the same vial, after 5-10 minutes the strip will show a control line and the presence of a line or lack thereof, this new test has yielded approximately 99% accuracy in its results, thereby moving the technology of the rupture of membranes testing and diagnosing into a whole new realm of assurance (Caughey, Robinson, & Norwitz, 2008). With this new state of the art test pregnant women seen with a possible preterm premature rupture of membrane will have a more definite and less invasive way to diagnose this condition.


Clinical Management of Condition

The clinical management of preterm premature rupture of membranes has many spokes to its wheel, because there are so many facets to worry about, treatment must come from many different avenues. With this concept in mind, the longer the baby can stay in utero results in the best outcome, the clinical management takes the approach of modifying its care by gestational age and individually with ongoing assessments of both mom, baby and risks of complications (Mercer, 2008). A priority of care for this situation is ensuring fetal well-being, therefore applying a fetal monitor to the mom to see how the baby is handling the circumstances. Once fetal well-being is assessed and ensured, a plan of action can be determined. The nurses will be performing a biophysical profile test through admission to delivery comprised of a non-stress test (fetal heart monitoring), fetal ultrasound to assess movement, breathing, muscle tone, amniotic fluid level and the baby’s heart rate along with daily kick counts conducted by the mom. The ultrasound that will be performed will assess the amount of amniotic fluid in utero, this fluid is the very life force of the fetus, it is measured and assessed through the amniotic fluid index shown in Table 1.

The loss of too much amniotic fluid (oligohydramnios) can lead to cord compression resulting in unfavorable late decelerations of the baby, hypoxia and intrauterine growth restriction. After well-being of the fetus is assured, the next step if not already done is to initiate IV fluids to hydrate both mom and baby and also increasing the amount of liquids ingested orally is recommended to replace some of the fluid lost. Most often women with preterm premature rupture of membranes are admitted to the hospital until delivery because there are so many risks and complications that could occur when not under the watchful eyes of medical professionals (Caughey, Robinson, & Norwitz, 2008). Along with IV fluids, bed rest and pelvic rest are indicated, including no use of tampons, sexual intercourse, douching or tub baths. Bed rest is used to try and reaccumulate amniotic fluid back into the placenta creating a more stable environment for the fetus (Caughey, Robinson, & Norwitz, 2008).

In these scenarios, the medical team will be preparing for an early delivery, therefore they will try to make the outcome as favorable as possible. This is the reason for administering corticosteroids usually either betamethasone or dexamethasone to mature the lungs of the fetus by increasing the surfactant in the baby’s lung thus stimulating them to work on their own out of utero as soon as a diagnosis has been made. The dosage for betamethasone is 12 mg IM q24hr x 2 doses or dexamethasone 6 mg IM q12hr x 4 doses, with seeing these doses the medical team would prefer to have at least 1-2 days for the steroid to take affect before delivery, if possible (Caughey, Robinson, & Norwitz, 2008).

With the rupture of a placenta the worry of infection is extremely high, administering antibiotics is the first line of defense to stop the growing bacteria that could attack both mom and baby. Once the membrane has ruptured, there is a mental clock started by the medical team but with the administration of antibiotics, it can slow down said clock to allow the baby to stay in utero as long as the mothers body will allow it and the benefits outweigh the risks. Substantial evidence has shown that with the use of aggressive broad spectrum antibiotics such as IV administration of ampicillin 2g q6h and erythromycin 250mg q6h for 48 hours, followed by oral therapy with amoxicillin at 250mg q8hr and enteric-coated erythromycin base at 333mg q8hr for 5 days can show considerable prolonged potential of gestation (Caughey, Robinson, & Norwitz, 2008).

While the plan of clinical management depends on how far along the mom is in gestation, the ultimate goal is to prepare both mom and baby for a favorable delivery. Thus, prescribing bed rest, increased fluid intake, constant monitoring and assessment of mom and baby, the administration of both corticosteroids and antibiotics aids in the well-being and a higher chance of an advantageous outcome.


Prognosis

Preterm premature rupture of membrane has the definitive risk of maternal and fetal demise and morbidity, with that knowledge the medical team will be aware of the risks and complications that could occur, using their experience and judgement of what courses of action to take if this pregnancy is viable or should be terminated (Tavassoli, Ghasemi, Mohamadzade, & Sharifian, 2010). The outcome for patients with preterm premature rupture of membrane is quite dependent on when the rupture occurred in gestation. Patients with preterm premature rupture of membranes between 32-36 weeks have been studied and concluded that expedited delivery is generally the best outcome because the risk of infection outweighs letting the baby stay in utero, once the medications are administered between 1-2 days, the likelihood of survival is more favorable (Mercer, 2008). Between the weeks of viability 23- and 31-weeks’ gestation there is a dramatically higher risk for fetal demise and morbidity (Mercer, 2008). Because of these risks every precaution is taken to prolong pregnancy, thus begins the fine line of balancing between maintaining gestation versus delivery in reference to the presence of labor that is active, vaginal bleeding, infection present in utero, and fetal compromise (Mercer, 2008). Continuous evaluations and assessments are performed while the mother is in the hospital, taking in all the information and making an informed decision on the plan of care on a case by case basis is the best avenue for an optimum prognosis.


Nursing Care

As a woman with preterm premature rupture of membranes, there are many scenarios that play out in her mind, what if the baby comes early, am I going to be able to keep the baby safe but the biggest worry in a nurse’s mind is we have to do everything in our power, so she doesn’t get an infection. The risk of infection is so great that this is thetop priority when we are caring for a preterm premature rupture of membrane patient. Her diagnosis would be risk for infection related to preterm premature rupture of membrane as evidenced by gush/trickle of amniotic fluid with possibility of bacterial transmission. Being taught in lecture as soon as the placenta ruptures, a nurse starts a clock in her mind and with every hour her risk of infection rises. On assessment of the patient after she states that she had a gush or trickle of fluid that she could not stop after ensuring the safety of the fetus by getting them put on the fetal heart monitor, the medical team performs a sterile vaginal exam and diagnostic testing such as a nitrazine test, amnisure test or a ferning test to confirm placental rupture. Prior to this the nurse would have already hooked up a fetal monitor to ensure fetal well-being and a tocodynamometer to measure if she is having any contractions and the frequency. The outcome expected of all preterm premature rupture of membranes patients is that she will be free of infection at delivery of fetus by amniotic fluid staying clear and free of foul odor, the patient’s temperature stays within normal limits of her baseline and the patient shows no sign of elevated white blood cells in her CBC for a pregnant woman. Interventions that would be performed would be a non-stress test (NST), apply the fetal monitor on the baby to ensure health and safety; also have the mom frequently do kick counts to ensure movement of the baby. The nurse would follow providers orders and administer antibiotics to hopefully circumvent the risk of infection and possibly lengthen the pregnancy to a viable due date; and administer glucocorticoid betamethasone to mature the baby’s lungs by irritating the lungs into stimulation and to produce surfactant for breathing out of utero. Also, the nurse would instruct the patient on the importance of good hygiene and peri care ensuring wiping from front to back to reduce the possibility of introducing new bacteria to the environment.

The second concern nurses have for the mother and fetus is having deficient fluid volume in utero related to preterm premature rupture of membranes as evidenced by the loss of fluid volume in the placenta. The outcome that is sought out for patients in this situation is that they will maintain adequate amniotic fluid depending on how many weeks gestation the mom is according to Table 1 to sustain effective gas exchange for fetus until time of delivery. Medical professionals are able to measure this by performing an amniotic fluid index (AFI) by way of ultrasound to determine that there is enough amniotic fluid to withstand life in utero at their gestational age. Fetal heart monitoring will show reassuring signs of life with non-stress test meeting the criteria of a heart rate of 110-160 beats per minute, moderate variability of 5-25 beats per minute, and 2 qualifying accelerations in 20 minutes with no decelerations. The mom will also be given the job of performing kick counts everyday to show no change in movement pattern. The interventions that will be performed is bed rest for the mom, so that there is no unnecessary jostling or loss of fluid, the medical team will hydrate her orally and intravenously to try and aid in returning fluid back into the placenta to create buoyancy for the fetus until delivery, and for the mom to perform a daily routine of kick counts to ensure fetal movement and well-being. All of these actions performed for both the risk for infection and deficient fluid volume are to promote the health and safety of mom and baby throughout gestation and to create the most optimal outcome to an unexpected situation.


Conclusion

In summary the research has shown that while there is no absolute conclusive reason for preterm premature rupture of membranes there are risk factors that make it more likely, thus the physician and their team should closely monitor those at risk. This paper has shown that preterm premature rupture of membranes is a rare complication but one that brings great maternal and fetal risk (Linehan, et al., 2016). There are definitive tools to diagnose a rupture of membrane and various treatments for the myriad of manifestations associated with premature rupture of membranes. While the prognosis of preterm premature rupture of membranes can range from very good to imminent mortality and can be broken down into categories, it basically comes down to gestational age and the viability of the fetus. The nursing care of these patients shows a vast array of care that has to be managed for not just one patient but two. It is the hope and effort of everyone involved to produce a viable, healthy, and safe pregnancy and delivery for both mom and baby.

References

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    BJOG, 124

    , 1698-1707. doi:10.1111/1471-0528.14462
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    Reviews in Obstetrics and Gynecology, 1

    (1), 11-22.
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    Oligohydramnios

    . Teach Me ObGyn: https://teachmeobgyn.com/pregnancy/fetal-abnormality/oligohydramnios/
  • Linehan, L. A., Walsh, J., Morris, A., Kenny, L., O’Donoghue, K., Dempsey, E., & Russell, N. (2016). Neonatal and maternal outcomes following midtrimester preterm rupture of the membranes: a retrospective cohort study.

    BMC Pregnancy and Childbirth, 25

    (16), 1-7. doi:10.1186/s12884-016-0813-3
  • Lorthe, E., Torchin, H., Delorme, P., Ancel, P.-Y., Marchand-Martin, L., Foix-L’Hélias, L., . . . Kayem, G. (2018, September). Preterm premature rupture of membranes at 22–25 weeks’ gestation: perinatal and 2-year outcomes within a national population-based study (EPIPAGE-2).

    American Journal of Obstetrics and Gynecology, 219

    (3), 298.e1–298.e14. doi:10.1016/j.ajog.2018.05.029
  • Mercer, B. (2008, May). Preterm Premature Rupture of the Membranes.

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    . doi:10.3843/GLOWM.10120
  • Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2018).

    Maternal child nursing care

    (6th ed.). St. Louis: Elsevier.
  • Tavassoli, F., Ghasemi, M., Mohamadzade, A., & Sharifian, J. (2010, April). Survey of Pregnancy Outcome in Pretern Premature Rupture of Membranes with Amniotic Fluid Index <5 and greater than or equal to 5.

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    (2), 118-123. doi:10.5001/omj.2010.32

 

The Roper Logan Tierney Model Nursing Essay

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The aim of this study is to demonstrate the care management that a nurse can provide to a patient who had Laparotomy and mesh repair of incarcerated incisional hernia. It also shows how the

Roper Logan

Tierney Model was utilized in assessing, planning, implementing, and evaluating patient’s care. The core of this care study is on infection and wound healing management which was identified as the patient’s main problem. According to NICE (2008), a minimum of 5 out of 100 surgical patients develop infection and that this covers almost a quarter of all infections acquired in a hospital. The patient’s name was altered to uphold confidentiality (NMC, 2008). In this study, health and social care policies affecting the patient care were also considered.

PATIENT PROFILE

Mrs P is a 63 years old lady who was admitted due to symptoms of small bowel obstruction like vomiting, bloating and abdominal pain. She lives with her husband in a privately owned house who also has impaired mobility due to stroke. Mrs P weighs 111 kilograms, 5 feet 7 inches tall and body mass index of 38.

Previous medical history includes Chronic Kidney Disease Stage 2 (2008), Congestive Cardiac Failure (2007), leg cellulitis (2006), Essential Hypertension (2005), Primary repair of Incisional Hernia (1992), Type 2 Diabetes(1991), Repair of Umbilical Hernia(1985), Total Abdominal Hysterectomy NEC (1979) and Cholecystectomy (1976).

After series of examination, she was found to have incarcerated incisional hernia which was repaired with mesh on the emergency list. Post- operatively, she was admitted to ITU for ventilator support and post-op care. When she was stable, she was transferred in the ward and two weeks post- op she developed infection and her abdominal wound dehisced. Patient has to take several medications while in the hospital to help her recover. She had Augmentin (Co- amoxiclav) 625 mg via oral route three times a day, followed by tazocin (Piperacillin with Tazobactam) 4.5 grams intravenously every 8 hours interval, Fragmin (Dalteparin) 7500 units once at 6 pm, senna (7.5mg) two tablets in the evening, bisoprolol 10 mg once daily, furosemide 20 mg daily orally, ramipril 5mg daily orally, amlodipine 10 mg daily oral, paracetamol 1 gram 4-6 hourly oral, domperidone 10mg three times daily orally, insulin Glargine(Lantus) twice a day SC injection, Novorapid three times daily SC injcetion, and oxycodone hydrochloride (oxynorm) 10 milligrams every 4-6 hours orally when needed.

PATHOPHYSIOLOGY

“The development of an surgical site infection depends on contamination of the wound site at the end of a surgical procedure and specifically relates to the pathogenicity and inoculum of microorganisms present, balanced against the host’s immune response”(NICE,2006). Typically, wound infection is caused by migration of patient’s normal flora to the wound site. Another way of surgical site being contaminated is being in contact with contaminated surgical equipments, environment, and hands of staffs. (NICE, 2006).

ASSESSMENT

The Roper- Logan-Tierney Model of Nursing based on activities of living was used in planning the care of Mrs P which is a widely used model in practice areas in the UK(Roper et al 2000).

Maintaining a safe environment

Mrs P was alert and orientated however she is diabetic, hypertensive, uses eye glasses and obese. She has an infected wound that is oozing and painful, poorly healed, dehisced, abdominal wound. She has a urinary catheter in situ which can be a potential site of another infection.

Communicating

Patient can communicate effectively, her primary language is English, can hear and talk without any aids and difficulties, and very conversant but when it comes to her care she tends to stay quiet and just wait for her turn to be look at.

Breathing

Patient is at risk of developing chest infection due to decreased mobility and respiratory depression due to oxynorm medication. Patient has a respiratory rate of 15 breaths per minute, oxygen saturation of 98% on air, no shortness of breath noted, no signs of respiratory distress and no complaints of pain during breathing.

Eating and Drinking

Patient claims to have decreased appetite after operation and risk of poor wound healing since although she is obese, she still needs some important nutrients like protein and vitamins like vitamin A,C, and K. Also patient is scared that when she ate, it will cause more pressure to her abdominal wound. Patient is able to eat and drink independently, no complains of difficulty of swallowing, and she is on normal diet.

Eliminating

Mrs. P has urinary catheter in situ draining adequate amount of urine at present which made her at risk of further infection. She was continent of faeces and uses bedside commode with assistance of two staffs. Because of the pain on her wound when moving and the need of two staffs to help her get out of bed, she keeps refusing her senna tablet and end up opening her bowel on bed.

Personal Cleansing and dressing

Nurses are the one irrigating and changing her wound dressing. Mrs P is unable to wash and dress herself independently due to her current state of health. Did not have any shower since admission because of her difficulty in mobilising.

Controlling body temperature

Although Mrs P got an infection, her temperature during assessment was 36.8 degree Celsius, no sweating noted, skin warm to touch, uses only hospital gown and dressing gown to keep her warm during the day, and uses top sheet and one blanket at night. She has limited mobility which predisposed her to poor blood circulation.

Mobilising

While on bed, Mrs P can turn on her sides but still with assistance of one staff because of her abdominal wound and she’s an obese patient. Patient complains of pain on the surgical site when moving and mobilising. Three days before she was being hoisted from bed to chair and back to bed with assistance of 3 staffs but at this time after referral to physiotherapist, she can transfer to chair with assistance of two staffs and use of a zimmer frame. She was able to stand during the transfer and can make 2-3 steps during transfer.

Working and playing

Patient worked in an office before but had early retirement due to illness. Enjoys knitting and playing with her grandchildren at home. Although she can still do knitting, she cannot run or look after her grandchildren at home in her situation.

Expressing sexuality

Mrs P is 63 years old, menopause, and still lives with her husband. Her abdominal wound makes her anxious about her body image.

Sleeping

Patient says she’s not able to sleep well due to environment change, pain and sometimes bowel urgencies. Mrs P takes two glasses of milk before bedtime.

Death and Dying

Mrs P keeps asking about worst thing that could happen to her regarding her present condition. She is worried for her husband when it happens to her first. Patient does not have a will.

IDENTIFICATION OF PATIENT’S PROBLEM

While in the ward, Mrs P was assessed using the RLT Model based on activities of living. From those activities, all problems identified were related to her infected wound that is not healing normally. She has to stay further in the hospital until her infection is dealt with and that her condition will be manageable by primary care. This is a serious problem that if not attended immediately would cause further injury or problems to Mrs P therefore these problems which are related to each other should be the priority and the focus of her care plan.

GOALS

After nursing interventions, Mrs P will be able to verbalize feelings regarding her condition and understand the course of treatment being done to her. In three to 7 days, patient will be able to mobilize on her own using her zimmer frame and will be infection free.

NURSING CARE PLAN

PROBLEMS

INTERVENTIONS

RATIONALE

REFERENCES

1.Wound Infection

>Monitored patient’s vital signs.

>Assessed wound site daily and documented.

>Maintained aseptic technique when changing dressing and irrigation.

>Administered antibiotic as prescribed.

>Encouraged patient to eat nutritious food and increase fluid intake

>Educated patient about wound infection control and prevention.

>Infection is frequently linked with pyrexia

>As basis for treatment

>To prevent further deterioration in wound

>Inhibits growth and kill microorganisms

>Enhance immune response

>To have an idea on how to manage her surgical wound

Rico et al, 2002

Shultz et al, 2003

MEP,2008

Colier, 2004

Dealey,2012

NICE, 2006

2. Poor wound healing

>Assessed the wound and its surroundings

>Monitored blood glucose regularly

>Maintained strict infection control measures

>Encouraged patient to eat nutritious food and increase fluid intake

>Encouraged diversional activities like knitting and reading papers.

>Maintained a moist wound environment but not saturated

>Managed exudates to ensure that surrounding skin is protected from leakage.

>Referred to tissue viability nurse

>To assess healing and as basis for treatment.

>Associated with delayed wound healing.

* need to expand

>To prevent further infection

>Poor nutrition increases infection risk.

* how does protein, calories affects healing, hydration?

Link poor healing with nutrition.

>To reduce stress caused by pain on the wound surroundings.

>Supports wound healing

>Exudates can damage surrounding skin and is ideal for bacterial growth

>To give advice on appropriate wound dressing for wound healing by secondary intention.

Daugherty and Lister, 2004

Patel, 2008

Pratt et al,2007

Dealey, 2012

Augustine and Maier,2003

Shultz et al,2003

Vowden and Vowden, 2002

NICE, 2006

PART 2

HEALTH AND SOCIAL CARE POLICIES

The basic principle of NHS is that “good healthcare should be available to all, regardless of wealth”(NHS website,2011). In order to maintain it, the NHS is regulated by several policies. DH policies are designed to improve on existing arrangements in health and social care, and turn political vision into actions that should benefit staff, patients and the public (DH 2010b).

Mrs P’s information are compiled in a folder and kept in a secure place so that only members of the Multi-disciplinary team responsible for her care will be able to access it. It is the responsibility of healthcare professionals to safeguard their patient’s information and share it only to appropriate individuals (NMC, 2008). Mrs P’s personal information were handled in accordance with Data Protection Act of 1998.

According to Mental Capacity Act of 2005, “every adult has the right to make his or her decision and must be assumed to have capacity to make them unless it is proved otherwise.” Informed consent was taken from Mrs P before any procedures or treatment was given or done. Doctors, anaesthetists and nurses has the responsibility to explain all tests and procedures being carried out on her and made sure she understood why it is being done or given to her. The consent is not valid when the person did not understand intervention (DH, 2009a).

The vital signs of Mrs P were kept monitored and documented using the National Early Warning Score (NEWS)Chart. It is a new observation chart (implemented July, 2012) used in the ward where Mrs P was admitted. RCP (2012) says that this is also “used as a surveillance system for all patients in hospitals, tracking their clinical condition, alerting the clinical team to any clinical deterioration and triggering a timely clinical response”. Another tool used in Mrs P’s ward is the SBAR Tool. It is a structured method for communicating critical information that requires immediate attention or action(NHS Website, 2008).

The patient was also assessed using the Waterlow Pressure Ulcer Risk Assessment Tool and Malnutrition Universal Screening Tool(MUST). In the chart it says there that although the later was incorporated to Waterlow, they should be assessed individually to ensure patient needs are addressed and their care was implemented (Waterlow 1985, Revised 2005). This tool helps nurses and other healthcare professionals in identifying what measures and equipment are needed for the care of the patient. NICE (2006) recommends that “all hospital inpatients on admission and all outpatients at their first clinic appointment should be screened (weighed, measured and have Body Mass Index (BMI) calculated). Screening should be repeated weekly for inpatients and when there is clinical concern for outpatients”.

The abdominal wound of Mrs P was also assessed and documented on the Wound Management Chart implemented by the trust. Mrs P’s surgical team decided to leave her dehisced wound open and heal by second intention. The team looking after her prescribed antibiotic, and twice a day irrigation and dressing of her wound. Mrs P was referred to the Tissue Viability Nurses (TVN) for advice on appropriate dressings to be used on her wound as it was planned to heal by secondary intention (NICE, 2012).

Another issue to consider in looking after Mrs P was infection control. The fact that she was already infected does not mean healthcare staffs no longer follow Infection control procedures. Infection control should be strictly manifested in order not to aggravate her situation. Hand hygiene is important especially before touching the patient’s wound to minimise introduction of pathogens and also after changing wound dressings to prevent self and cross- contamination of patient. The WHO (2006), provided Five Moments as to when healthcare professionals should perform hand hygiene. Use of appropriate Personal Protective Equipments (PPE) should also be worn when irrigating and renewing the surgical wound dressing of Mrs P to prevent spread of infection. Guidelines on how to put on PPE and how to take it off were also produced by WHO(2007). Proper disposal of sharps used by Mrs P like needles used for her antibiotic, insulin, and fragmin injection should also be observed. They should be thrown directly to designated sharp bins as uncapped and still assembled (RCN,2011).

OVERALL EVALUATION AND CRITIQUE OF FRAMEWORK

The nursing process is an orderly method of designing and providing nursing care which are collecting information and assessing the patient, planning care and defining objectives for nursing care, implementing interventions and evaluating results (Uys & Habermann, 2005,p.3). Roper et al(2000,p.124) pointed out that assessment which is considered to be the first phase of the nursing process should be done regularly and not only once. Being this the case, the use of Roper- Logan-Tierney (RLT) Model based on Activities of Living is preferred for Mrs P’s case. It does assess the patient needs wholly and can determine the impact of infection and poor wound healing to her identified twelve activities of living as recognized by the model. Using RLT model, an overview of Mrs P’s health status was created and from it prioritization of her needs is easier. This model enabled healthcare professionals to produce a care plan which is unique or aligned to her needs. The author of this care study find this framework to be an ideal model in assessing patient and useful for healthcare professionals as they do not miss out any aspect of care.

Looking at the down side of the model, it is a very long process of assessment and it takes time for a healthcare staff to finish all the twelve areas. The author of this study thinks although it is an ideal one that in a ward where Mrs P was confined, there might be an issue in doing this regularly to all patients. It is a very busy ward and if all patients are assessed regularly using this model, problems on other aspect of nursing process will be left untouched and cause additional work to incoming staffs.

CONCLUSIONS AND IMPLICATIONS FOR FUTURE PRACTICE

Health and social care policies are indeed very important and has a great impact to the healthcare system. It serves as the basis for the trusts in making their own policies and it guides healthcare professionals to their practice. Nurses practice in accordance with the NMC Code, Standards of conduct, performance and ethics for nurses and midwives and other laws and guidelines provided by the British government and different departments or agencies like the Department of Health, National Institute of Clinical Excellence, World Health Organization, etc.

After using the Roper-Logan-Tierney Model The care of Mrs P went smoothly during her stay in the hospital. Her post- operative complications have been managed without any major issues. Since the very start, nurses and other members of the MDT reassured her that personal details and all information regarding her care is treated as confidential and that this could only be shared to appropriate people only on her approval. The MDT members based their interventions on the protocol and policies of the trusts which was based on National policies. Mrs P’s problems were managed by the interventions provided in the hospital and was now discharged and back to her home. Long term goals were also taken into account therefore a proper referral to the district nurse was done before she went home.

Knowledge and Skills Hand Hygiene: Reflective Essay

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Knowledge and Skills Hand Hygiene Reflective Essay

This is a reflective essay based on personal experience of hand washing and hand hygiene practices in clinical practice. It focuses on the most recent policy and guidelines from the National Health Service (NHS) England and NHS Improvement which will be discussed in more detail below. Reflective practice is commonly used by nurses and other healthcare practitioners as a learning and development strategy since it facilitates the reviewing of one’s skills, perspectives and actions in order to determine strengths and weaknesses requiring improvement (Miraglia and Asselin, 2015).

This work will use

Rolfe et al’s reflective model

(Rolfe et al., 2001). In the first section of this reflection (What?), details of my personal experience with regards to hand washing practices will be provided. The next section (So What?) will be a discussion of my actions and the consideration of current evidence. The third section (Now What?) will address the implications of this experience for my future practice. Finally, this essay will end with a conclusion that summarises the key points of this work.

As a nurse in training, I had a discussion with my mentor on the NHS’s recently published policy and guidelines for standard infection control precautions (Royal College of Nursing (RCN), 2019; WHO, 2009). I explained to my mentor that to wash my hands correctly, I started with making sure I was bare below the elbow. I would then wet my hands under running water before applying enough soap from the soap dispenser, which is normally placed on the wall in front. I then cover my hands with the soap and start to decontaminate the back of my hand, making sure to rub the palm of one hand over the back of my other hand, with fingers over- laced, repeating the process on my other hand. Next I decontaminate the interdigital space, which is heavily contaminated and often missed. I do this by interlacing my fingers and rubbing them together. Afterward, I interlock my fingers on the opposing palm and rub them together again. I do this to decontaminate the back of my fingers. Following these steps, I rotate my right hand around my left thumb and repeat the sequence. It is also important to decontaminate the fingertips and nails of both hands. I do this by rubbing the fingertips of my left hand in the palm of my right hand and repeating with my other hand. Rotating my right hand around your left wrist and then repeating on the other side. When washing your hands rinse them thoroughly under running water, making sure to wash away all the soap. Some washbasins have a hand moisturizer pump to use, as residual soap can dry skin out. To finish off my hand washing, I then close the tap off using my elbow to prevent my hands from getting contaminated. Finally, I dry my hands with a paper towel and discard it in the provided bin (WHO, 2009).

In a clinical setting, five specific moments are important for when you need to carry out hand hygiene. The NHS England and NHS Improvement (2019) recommend the washing of hands before performing hand hygiene using alcohol-based hand rubs and this should be done before touching a patient, before performing aseptic procedures, after body fluid exposure, after touching a patient, and after touching the immediate surroundings of the patient (NHS England & NHS Improvement, 2019). Furthermore, hand washing should be done before and after using gloves (NHS England & NHS Improvement, 2019).

My mentor explained to me that my hand hygiene practices deviated greatly from current recommendations and the NHS’s policy which emphasises the performing of good hand washing with special care taken to clean the fingertips, thumb and between the fingers. This forms the basis for hand hygiene while alcohol rubs should not be used for hand hygiene when exposure to norovirus is suspected or proven. In this instance hand hygiene should be performed using nonantimicrobial liquid soap and water. Unless carrying out a clean or aseptic procedure, where use of antimicrobial liquid soap is indicated (NHS England and NHS Improvement, 2019).

On reflection, I understand that it is far more important to use good hand washing techniques to stop the spread of infection, than just using gloves and alcohol rub alone. Furthermore, I will always make sure to not use the gloves and alcohol rub provided as a means to replace good hand washing and hygiene practices with the aim of protecting myself from the perceived threat of infection due to contact with patients. This would be classified as an emotional reason for glove use (Loveday et al., 2014) since there is no clear evidence to suggest I would be at risk of contracting an infection from the patients, especially if I practiced a good hand washing technique. However, most hospital-acquired infections occur via direct contact between healthcare professionals and patients (World Health Organisation [WHO], 2009) and this is due to poor compliance among healthcare professionals with hand hygiene guidelines, especially hand washing (RCN, 2019; WHO, 2009).

If good hand washing practise is not used then this could increase the risk of transmitting micro-organisms between patients, myself and other staff (Wilson and Loveday, 2014). These hospital-acquired infections are often due to antibiotic resistant microorganisms and they are thought to affect about 300,000 persons yearly (National Centre for Health and Care Excellence [NICE], 2017) and cause an estimated 9,000 deaths (NHS England, 2011).

After reading the new NHS policy again with my mentor, it became clear to me that gloves and alcohol rub are classed as Personal Protective Equipment (PPE) to be used in addition to good hand washing practices in cases when there could be a possible exposure to blood and/or other body fluids, not-intact skin or mucous membranes (NHS England & NHS Improvement, 2019). This highlights the fact that good hand washing is effective for routine use during interactions with patients.

Moreover, it is the responsibility of the nurses and other healthcare professionals alike, to make sure they adequately wash their hands to protect themselves and others around them from infections around the hospital. If someone is not doing this correctly, it would be good practise for me to demonstrate the correct way to them. Education is key to good hand hygiene and this is why posters are on the hospital walls near the wash basins. Behaviour is influenced by knowledge, belief systems and the circumstances of the situation. Healthcare professionals see themselves positioned differently within the environment depending on the context of the risk; they can either be at risk or be the cause of the risk (Jackson and Griffiths, 2014).

The SCIPs (Standard Infection Control Precautions) are comprised of ten elements and the new policy addresses two of these elements: hand hygiene and PPE. However, good hand hygiene which is based on an effective hand washing technique is seen as the basis for preventing hospital-acquired infections (WHO, 2009).

This experience has taught me just how important adequate hand hygiene practise is within the clinical setting. It can make a big difference to vulnerable patients and even their families during their stay. I have realised just how easy it is to pass infections on from person to person in the hospital, if proper hand washing techniques are not performed correctly. As a student nurse it is my responsibility to ensure that other students and healthcare professionals are doing everything we can to prevent infections. Referring to section 19 of the NMC code: “Be aware of, and reduce as far as possible, any potential for harm associated with your practice” (NMC, 2015). I will carry on this knowledge and experience onto my next placement and report any bad practise I may come across. The patient is the main focus of care and it is my duty to promote good and safe practise within the healthcare setting. Furthermore, I will ensure that I first locate the nearest basin and wash my hands according to the guidelines every time before and after I attend to a patient (RCN, 2019). In addition, I will use alcohol rubs each time after washing my hand in compliance with the NHS guidelines and policy (NHS England and NHS Improvement, 2019).

In conclusion, this reflective essay has helped me analyse a personal experience with regards to hand washing and hand hygiene practices. I understand that knowledge is key for good practise and educating other healthcare professionals and service users is paramount for a safer hospital environment. Furthermore, if bad practise is witnessed, this should be reported to the nurse in charge. Nurses are responsible for their own safety and for the safety of their patients. Potentially allowing infection to be spread through bad hand hygiene would be bad practise. Techniques of hand washing and hand hygiene practices should be studied regularly, according the recent guidelines and policy of the NHS.


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Assignment: Developmental Assessment

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Assignment: Developmental Assessment

Assignment: Developmental Assessment

The needs of the pediatric patient differ depending on age, as do the stages of development and the expected assessment findings for each stage. In a 600-700-word paper, examine the needs of a school-aged child between the ages of 5 and 12 years old and discuss the following:

Compare the physical assessments among school-aged children. Describe how you would modify assessment techniques to match the age and developmental stage of the child.

Choose a child between the ages of 5 and 12 years old. Identify the age of the child and describe the typical developmental stages of children that age.

Applying developmental theory based on Erickson, Piaget, or Kohlberg, explain how you would developmentally assess the child. Include how you would offer explanations during the assessment, strategies you would use to gain cooperation, and potential findings from the assessment.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

The needs of the pediatric patient differ depending on age, as do the stages of development and the expected assessment findings for each stage. In a 600-700-word paper, examine the needs of a school-aged child between the ages of 5 and 12 years old and discuss the following:

Compare the physical assessments among school-aged children. Describe how you would modify assessment techniques to match the age and developmental stage of the child.

Choose a child between the ages of 5 and 12 years old. Identify the age of the child and describe the typical developmental stages of children that age.

Applying developmental theory based on Erickson, Piaget, or Kohlberg, explain how you would developmentally assess the child. Include how you would offer explanations during the assessment, strategies you would use to gain cooperation, and potential findings from the assessment.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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Analyze why knowledge of the legal system is important for healthcare professionals, including the distinctions between the law, ethics, and bioethics.

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Analyze why knowledge of the legal system is important for healthcare professionals, including the distinctions between the law, ethics, and bioethics.

 

 

One of the most important objectives of tcourse is for you to be able to relate the theories in the readings and discussions to situations in real life. We will develop thcritical thinking skills each week via the discussion boards and short writing assignments, which will culminate in the final project, a medical malpractice case study.The purpose of a case study in general is to apply what you learned to a real-life or hypothetical situation where you analyze, test, and propose solutions to the case. You may have a problem to solve and be asked to present potential solutions. Or you may have a situation to analyze and describe why (or why not) certain events were effective or successful. In processing a case study, you will have to apply research, reasoning, critical thinking, and analytical skills to identify underlying problems, causes, and/or related factors and make decisions.For the medical malpractice case study, you will prepare a paper discussing a medical malpractice case using the IRAC (issue, rule, analysis, conclusion) formula. You will discuss any relevant ethical theories involved and analyze the outcome, applying legal concepts from the course.You should be thinking about your case and start your research by Module Three. By Module Five, you should finalize your choice of a reported case for your project. In the Module Five journal activity, you will be asked to briefly discuss your chosen case and provide an outline for your project. The final project is due at the end of Module Seven.In tassignment, you will demonstrate your mastery of the following course outcomes:Analyze why knowledge of the legal system is important for healthcare professionals, including the distinctions between the law, ethics, and bioethicsCompare and contrast ethical theories and discuss decision-making models applicable to healthcare providersExamine the legal environment in healthcare, including the physician-patient relationship, medical records and patient confidentiality, and professional liability and medical malpracticeExplore the laws impacting the delivery of healthcare, including HIPAA, the False Claims Act, the Patient Protection and Affordable Care Act, and laws impacting the workplaceAnalyze the role of professional regulation, the standard of care, and codes of ethics in healthcare providers? accountability to self, their profession, their patients, and the publicAnalyze specific legal, ethical, and bioethical issues faced by healthcare administrators, providers, and researchers, including protection of life, the right to self-determination, and end-of-life issuesPromptThe first step of the project is to locate a medical malpractice case that interests you. The case can involve malpractice or negligence claims against any type of healthcare providerfor example, a doctor, nurse, dentist, or chiropractor or an institutional provider such as a hospital, nursing home, or rehab facility. The case you choose must be from a published decision of the court (rather than a case reported in a secondary source, such as a newspaper or internet article).Published decisions are primary sources of law that create precedent for other courts to follow in similar cases. For more information about judicial decisions, and for help on where to find them, visit the Library of Congress Law Library.Review thmalpractice decisions to get familiar with the structure and forof a typical court decision:Deane v. Mount Sinai HospitalCarpentier v. North Shore University HospitalThcases were found by searching the New York Official Reports website using the terms medical malpractice and wrongful death. To locate the published court decisions in your state, browse the resources available at the Library of Congress Law Library or visit FindLaw?s Cases and Codes section, which contains resources and links for cases by state.It is easier to find medical malpractice cases in state court as opposed to federal court, so you may want to start with cases in your local state court. As you get further into your research, you will discover that some court opinions are short, and some are much longer and contain significantly more detail. For tassignment, it is important to choose a case that not only interests you but also contains a detailed description of the facts and circumstances so you have enough information for your analysis. The two examples provided above are good samples of the kind of opinion you should try to find. When researching cases, make sure the one you ultimately select contains enough information about the case to address each of the bullet points below. Your paper should contain three parts:Part I: IntroductionIn tpart, describe your case, including the parties, the facts, and the claims asserted.Part II: AnalysisTpart is your analysis and should make up the majority of your paper. Tsection should be written in the IRAC format. Click here for a description of the IRAC model. Your analysis should discuss the evidence on both sides of the case and the defenses asserted by the defendant healthcare provider. Tsection should also identify and analyze the ethical theories involved and how they did or did not impact the decision.Part III: VariationIn tpart, discuss how and why the outcome would have changed if the facts or evidence had been different. For example, if the plaintiff won the case, discuss a defense that, if available to the defendant, would have changed the outcome (for example, if the defendant could prove the plaintiff filed claim after the statute of limitations had expired).

1. In light of the ADA, how should employers deal with employees afflicted by alcoholism? How should employers deal with religious advocacy or proselytizing by employees?

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1. In light of the ADA, how should employers deal with employees afflicted by alcoholism? How should employers deal with religious advocacy or proselytizing by employees?

2. Would you advise employers with multi-lingual workforces to adopt English-only rules? Under what circumstances?

3. What are some options for accomplishing this goal in a lawful manner? How should employers who need employees to be on-call structure these arrangements to conform with the law while minimizing overtime liability?

4. Think about a restaurant, store, office or factory where you have worked. What safety and health hazards existed in that workplace? What measures were used to address those hazards? Was safety given sufficient attention?

In health care, change agents are faced with the challenge of engaging both employed staff and physicians in change initiatives.

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In health care, change agents are faced with the challenge of engaging both employed staff and physicians in change initiatives.

Frequently they have different perspectives and different agendas. discuss your thoughts on how this can be managed so that everyone can feel that they are heard and that some common ground can be achieved.

Does a central cause exist with which to explain terrorist violence? Review the “Two Thousand Years of Terror” timeline before drawing your conclusions. Defend your answer.

Contemporary Issues In Nursing Leadership In Nursing Practice Nursing Essay

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Leadership plays an important role in nursing. This essay will define leadership and how leadership qualities relate to nursing practice in order to help nurse leaders to work effectively with in nursing environment. Furthermore, the will discuss how the key characteristics influence followers to work commonly in a group for a specific goal. Moreover, these qualities help them to

Leadership is defined as personal skills which can be helpful to influence other people to the leadership benefits. It can effectively take the people in the same direction, sharing the same goals. (Lansdale, 2003). In this way, the important task of a leader is to make an action plan and encourage the team members to achieve the negotiated goals. Leadership is a major concern to the health care system. Its style is based on personal, professional and organisational value system because leaders provide shape to clinical practice with their qualities. Using their own skills leaders can easily address the needs of patients and colleagues. Leadership reflects the values of people, organizations and societies in which the leaders are working. In order to work effectively and to avoid the risk of conflict, the leaders always need to become acquainted with the values and beliefs of the individuals and organisation with whom they are working. (Stanley, 2008).

Moreover, a leader uses interpersonal skills and specific behaviour for the purpose of effectiveness within profession. Because of this, the quality of leaders has a crucial role in influencing others. These qualities give them authority to work and develop their strategies effectively. (Daly, Speedy, Jackson, 2010). There are ten essential qualities which influence the work of a leader in a professional environment. First of all, a leader must have integrity which means leader should be honest and trustworthy. As, these key values are necessary to promoting a positive attitude and better performance in staff and colleagues. All staff expects these mandatory requirements from a leader. Besides this, courage to take a leadership risk is crucial to attain excellence. It is the ability to confront risk without fear which is sometimes necessary to get success. A leader may have good ideas and strategies in mind but they can not be effective without any action. This is called initiating which is the first step that needs to be taken in order to get the things done successfully. As it is hard task to do, wise use of energy and effort and an optimistic attitude are needed to give role satisfaction in leadership. Along with this, it is very common that rapid success of other colleagues discourage someone easily but positive thinking helps to keep up leaders and their co workers to resolve difficulties. This also led’s to remotivation in staff members. Effective leaders never quit easily, instead, they continuously use their efforts for work. (Tappen, Weiss & Whitehead, 2004).

Balance is another characteristic of leaders. It is essential to make an equal balance between personal and professional life. Paying attention towards the working environment needs to be balanced with attention shown to family and friends, because social activities are as important as professional. The most effective leaders easily balance between work and leisure time. Regardless, there are some stresses in almost every job which puts on work pressure and causes stressful life. In such conditions, leaders should think positively to address the issues and they should act as a role model for others in order to bring about possible solution. (Tappen, Weiss &Whitehead, 2004)

Self awareness is a most valuable key quality that is essential to motivate other people, because people who can not understand themselves they can not change others. In addition of these, according to International Council of Nursing (Sally, 2007) there are some more key elements that could be helpful for leaders. They should have a vision which could be a dream and it helps them to think strategically and differently from the daily schedule. Along with this, awareness about external environment is also crucial because it might affect the organization, its strategies and future planning. Having, confidence about the work one is doing also count a lot, because it helps to influence others. Knowledge related to political skills is another key value for leaders as it teaches them how to cope with conflicts and how to understand goals, values, expectations and behaviour of others. It is also significant to review all strategies to make any change according to the demand of time. Thereafter team work, partnership & alliances and effective communication teach them how to work with others to achieve common goals and how it helps them to share new ideas and information with others. (Sally, 2007)

All these characteristics of leaders play a vital role in nursing practice. They influence and shape the clinical practice. During clinical practice, leaders confront many challenges. To figure them out successfully, they implement strategies which lead out as the result of critical thinking &discussion to improve patient care and outcomes. (Daly et al 2006). Nursing leader always faced challenge to think creatively about the development of critical thinking. This has a powerful impact on the problem solving and decision making. Working as a leader always requires continuous development of skills and regular improvement in them.

In nursing, nurses’ leaders confront many different team workers. To work efficiently nurse leaders must create an environment of trust among their followers. This leads to the involvement of co workers in planning and decision making on issues that will affect them directly or indirectly. Sometimes to get success, leaders have to take risk without any fear. Courage helps them to make some crucial decision strongly, which may be stressful and have to be made while under pressure. It also enables them to have confidence about making judgements. According to Kanter in ICN Nursing Leadership (Sally, 2007) it is the expectation of success which provides a link in between someone’s ideas and performance.

Leaders should have knowledge about interpersonal skills. This means they can motivate or generate others toward shared goals with positive attitudes. To achieve this, nurse leader take initiative steps. Nurse leaders encourage team to work effectively with a range of different people at different levels so that they can feel supported. This will result improvement in health care settings. Along with this, nurse leaders develop new roles and skills regarding any changes and challenges in health organization because all these will result in quality care, efficiency and improvement in equity of access, especially for needy populations. Because nursing provides essential health care services, leaders should alert staff about any changes in policy.

A key quality of leader is to transmit their passion about the future to others. A vision for nursing means what would be the ideas of the leader for organization to happen within a specific period of time. Then to get there, all major programmes, projects and activities are planned strategically to turn toward the same vision. The external environment might affect it. For this purpose external awareness related to health trends, issues, new policies and other factors is necessary. SWOT (strength, weaknesses,) and environment scanning helps them to review the whole situation and creates more opportunities. Regardless, political skill is needed to understand, from all stakeholders and to cope with conflicting situations, values, fears and behaviour of different people. It also means being able to plan creative, proactive and appropriate strategies for various situations. Effective communication means one can easily understand someone’s language. It is crucial for work safely and to give commands to followers. (Sally, 2007)

Public Mental Health Facility

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Public Mental Health Facility

Question 6

Helen was just discharged from a public mental health facility. She went to live with a group of other former patients in a group-living arrangement. There were staff members to help out but the former patients controlled most of the day-to-day activities. Helen’s living arrangement is a:

Answer   A. short-term hospital.

B. halfway house.

C. day center.

D. sheltered workshop.

.1 points

Question 7

Research on therapy for schizophrenics and their families has been shown to:

Answer   A. increase feelings of guilt for family members.

B. increase tension and relapse rates.

C. work only in the absence of drug treatment.

D. help the schizophrenic avoid troublesome interactions with family members.

.1 points

Question 8

Our experience using medication in treating those with schizophrenia teaches us that:

Answer   A. strict biological treatments are not enough to effectively treat schizophrenia.

B. medication does not work any better than other biological treatments.

C. the cause of schizophrenia is biological.

D. biological treatments are the only effective treatments.

.1 points

Question 9

Milieu therapy is based primarily on the principles of ______ psychology.

Answer   A. cognitive

B. humanistic

C. psychodynamic

D. behavioral

.1 points

Question 10

In the late 1950s, patients diagnosed with schizophrenia on one ward in a state mental hospital began making substantial progress. They became more active, their symptoms decreased, and within a few years, almost all of them had moved on to sheltered-care facilities, or other care outside the hospital. Most likely, they had been:

Answer   A. in a token economy.

B. in milieu therapy.

C. receiving atypical antipsychotic drugs.

D. participants in a well-controlled lobotomy study.

.1 points

Question 11

The most successful way to eliminate tardive dyskinesia is:

Answer   A. to increase the dose of antipsychotic medication.

B. to use anti-Parkinsonian drugs to treat the side effects.

C. to ignore it; it will go away eventually.

D. to stop the antipsychotic medication.

.1 points

Question 12

The “revolving door” syndrome in the treatment of mental illness refers to:

Answer   A. the inability to treat mental patients effectively.

B. repeatedly releasing and readmitting patients.

C. an open door policy in which patients may come and go as they please.

D. deinstitutionalization.

.1 points

Question 13

Schizophrenics who are working in a sheltered workshop are receiving:

Answer   A. occupational training.

B. coordinated services.

C. partial hospitalization.

D. halfway house services.

.1 points

Question 14

What was the dominant way of dealing with schizophrenic people during the first half of the twentieth century?

Answer   A. treatment with neuroleptic drugs

B. institutionalization

C. outpatient services

D. individual psychotherapy

.1 points

Question 15

What is the MOST accurate advice you could give someone thinking about taking traditional antipsychotic medication for their schizophrenia?

Answer   A. “Although the drugs will probably work, there are significant side effects.”

B. “Although they work well, you probably won’t see the maximum results until after six months.”

C. “If you have negative symptoms of schizophrenia, you can expect better results from medication.”

D. “Try psychotherapy first; it often works just as well.”

.1 points

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Describe how evidenced based findings can improve patient outcomes related to obstetrical care.

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Describe how evidenced based findings can improve patient outcomes related to obstetrical care.

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.

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.

•QSEN Pre-licensure Competencies
The below is the class room textbook
•Pillitteri, A. (2014). Maternal & child health nursing: Care of the childbearing and childrearing family (7th ed.). Philadelphia: Lippincott, Williams and Wilkins.