Mcn-The American Journal of Maternal-Child Nursing最新文献

Abstract: Young mothers are depicted in the literature as inept parents whose poor decisions and risky behavior lead to early and unprotected sex, a poorly timed birth, and adverse outcomes. This risky conception of teen mothering emerged in the 1970s as social scientists, policy makers, and advocacy groups embraced theories and assumptions of deviance that blame young mothers for jeopardizing their future and their child's well-being. This individualistic framing of young mothering is increasingly debunked by innovative well-designed studies over the last 3 decades. A hypothetical teenage couple is presented to highlight the limitations of the risky conception and to argue for its replacement. The Reproductive Justice movement challenges the individualistic framework by highlighting the socioeconomic conditions that contribute to teen births and health and social disparities among marginalized women and their children. Policies that rectify these conditions are required.

Abstract: The unique physiology of the pregnant and postpartum patient, along with the challenges of the emergency department setting, may increase the risk factors for preventable harm in highly complex care situations. Communication, following standardized processes, and reviewing maternal events to identify improvements are vital to minimize the risk of patient safety events and improve patient care outcomes for pregnant and postpartum patients in the emergency department setting. Implementing a standardized debriefing process will help reduce anxiety about discussing adverse events by making it a formula clinicians can follow and provide valuable real-time insight into barriers and resource needs. Two case studies of pregnant patients who presented to the emergency department at a level 2 trauma center highlight how the debriefing process improved maternity care and helped prevent future safety events. It is the goal that the lessons learned can provide insight to refine processes and improve safety throughout the continuum of care for mothers and babies.

Abstract: Thrombotic thrombocytopenic purpura (TTP) is a rare and serious condition caused by a deficiency in the enzyme ADAMTS-13, leading to abnormal clotting and potential organ damage. Pregnancy can trigger TTP due to physiological changes in coagulation, significantly increasing the risk when ADAMTS-13 levels are severely deficient. The enzyme ADAMTS-13 cleaves vWF multimers, but in TTP, its deficiency leads to abnormal platelet aggregation and microvascular thrombi formation, causing organ damage, hemolytic anemia, and thrombocytopenia. This results in impaired blood flow and significant end-organ perfusion issues. TTP symptoms range from asymptomatic to severe, often mimicking other pregnancy-related complications like HELLP syndrome and preeclampsia, making diagnosis challenging. Clinical signs include thrombocytopenia, hemolytic anemia, neurological deficits, fever, and renal dysfunction, with recurrent fetal loss and intrauterine growth restriction also common. Diagnosis relies on clinical evaluation and laboratory findings, while awaiting ADAMTS-13 activity results. Effective communication and prompt multidisciplinary collaboration are crucial in diagnosing and treating TTP. Nurses play a vital role in assessment, collaboration, and patient and family communication to address complex complications during pregnancy.

Background: Maternal mortality rates in the United States are alarmingly high, especially in rural areas with limited access to care. Clinicians in rural hospitals are challenged to maintain their obstetric knowledge and skills due to low patient volumes and limited educational opportunities. The purpose of this project was to improve maternity care in rural Texas by providing tailored obstetric education and simulations to enhance emergency response and team collaboration.

Interventions: A team of five nurses provided simulation-based perinatal education to clinicians in 10 rural facilities and maternity deserts, including county emergency services. Tailored simulations conducted in situ addressed various obstetric emergencies and were designed to match each facility's staffing ratios. Post-simulation surveys were sent to evaluate participants' understanding, recognition, communication, and collaboration.

Results: Surveys from 48 participants, including nurses, technicians, and other health care professionals, indicated significant improvements in understanding, recognition, communication, and preparedness for obstetrical emergencies after simulation training. Qualitative feedback underscored the project's success, highlighting the increased confidence, knowledge, and multidisciplinary collaboration among the participants. The simulation education effectively addressed facility-specific needs, enhancing overall effectiveness and engagement, despite challenges with participant attendance and group sizes.

Discussion: Perinatal outreach has improved rural health care teams' confidence, preparedness, and competence in managing obstetric emergencies through specialized education and hands-on simulations. To ensure continued success, it is crucial to continually reassess and adapt educational programs to meet the evolving needs of rural health care facilities, thereby enhancing patient care and outcomes.

Abstract: Diabetic ketoacidosis in pregnancy is a rare but serious complication caused by insulin deficiency. Hyperglycemia is considered a hallmark sign of diabetic ketoacidosis; however, physiologic changes of pregnancy predispose pregnant women to developing euglycemic diabetic ketoacidosis, where the plasma glucose level is normal or near normal. Euglycemic diabetic ketoacidosis during pregnancy poses many challenges to diagnosis including signs and symptoms that can be attributed to pregnancy, rapid progression of signs and symptoms, and near-normal glucose levels. Fetal acidosis also develops as a result of the maternal disease process. The fetal heart rate tracing in diabetic ketoacidosis often features minimal to absent variability, fetal tachycardia, or recurrent or late decelerations. Treatment should focus on correcting maternal acidosis and electrolyte imbalances. Despite the state of the fetal heart rate tracing, birth is not typically indicated as fetal status should improve over time after correcting maternal acidosis. To improve outcomes and prevent worsening complications, early diagnosis and intervention is vital for patients with diabetic ketoacidosis. A collaborative, multidisciplinary approach to these patients can facilitate timely diagnosis and initiation of treatment. We present a case study of a patient diagnosed with euglycemic diabetic ketoacidosis secondary to influenza A that required emergency cesarean birth due to worsening maternal and fetal status despite corrective interventions.