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

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.

Background: Placenta accreta spectrum disorder is a condition that is rare but is becoming more common due to the increase in cesarean rates. Placenta accreta spectrum disorder is known to have high morbidity and mortality rates due to its increased risk of hemorrhage. These surgical cases are complex and need to have a robust multidisciplinary team to decrease the risk of potential complications. Due to the complexity of this diagnosis, the plan of care must involve coordination of several specialties and roles as well as ensuring the patient has adequate education and explanation regarding the plan of care.

Methods: A placenta accreta spectrum disorder navigator was implemented to ensure optimal communication, equipment and team readiness, and a standardized approach to planning for patients with this diagnosis. An anonymous survey was sent to team members following placenta accreta spectrum disorder cases to evaluate their experiences, comparing results from before and after the implementation of the nurse navigator role.

Results: The survey included responses from 11 team members in pre implementation and 21 post implementations. Post-implementation data showed improvements in communication, role clarity, and teamwork.

Conclusions: Reviewing pre- and post-survey data, along with feedback from discussions and debriefs, revealed that implementing a placenta accreta spectrum disorder navigator improved communication and team efficiency. Data showed enhancements in provider experiences and a reduction in action items from debriefs.

Purpose: Less invasive surfactant administration (LISA) uses a thin catheter that allows infants to breathe spontaneously throughout surfactant administration. The procedure potentially reduces adverse effects and enhances clinical outcomes compared to the INtubate, SURfactant, Extubate (INSURE) method, which requires transient intubation with an endotracheal tube and positive pressure ventilation. The purpose is to share how the Plan-Do-Study-Act (PDSA) cycle method can identify improvement opportunities, guide interventions, and improve outcomes in a LISA quality improvement (QI) initiative via interprofessional collaboration.

Methods: A QI project was implemented via an interprofessional team using PDSA cycles in a 63-bed level III neonatal intensive care unit. Compliance rates, infant outcomes, and clinician feedback were analyzed and discussed monthly. An interprofessional team developed a step-by-step LISA checklist and LISA video, improved equipment storage, standardized charting, and rolled out re-education.

Results: Implementation of this quality project increased compliance levels of LISA (16 infants pre-project, 43 infants post-project) in place of INSURE (16 infants pre-project, 4 post-project) from 47% to a consistent 100% for eligible infants by 2 months after the project implementation. It also improved multiple outcome measures for the LISA procedure, including a reduction of grade III and IV intraventricular hemorrhage (IVH), a decrease in the percentage of infants requiring a second surfactant dose, and a decrease in chronic lung disease (CLD). LISA was expanded to other hospitals in the physician group's network.

Introduction: Perinatal mood and anxiety disorders can have lasting negative impacts on maternal and child health. The aim of the quality improvement project was to determine if home-based psychosocial interventions for perinatal mood and anxiety disorders using volunteers affect patient outcomes and expand evidence-based treatment options.

Methods: We used a logic model to outline the program's key inputs and outputs, and to guide ongoing implementation; outline what did or did not occur as intended in the volunteer program; clarify for organization stakeholders how program activities bring about desired changes or outputs; and to determine if the program brings about desired outcomes in relation to perinatal mental health. The major outcomes of interest were pre and post measures of perinatal mood and anxiety disorders symptoms, stress, and level of reported support in the parents.

Results: Data were obtained from two subsamples, 152 parents prior to receiving the intervention and from 36 parents after receiving the intervention. Before receiving the services, 33.0% of the parents endorsed clinically significant symptoms of anxiety and depression. At the end of the intervention, 66.7% of parents reported experiencing symptoms of perinatal mood and anxiety disorders, and 75.0% of those experiencing symptoms agreed the support from the program helped alleviate those symptoms.

Discussion: Our results highlight the program as an effective and accessible option to mitigate perinatal mood and anxiety disorders in the community. There is need for more effective, evidence-based interventions in the community setting.