NS2 Peds: Mod 1 Intro to Maternal

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  1. **Maternity Care
    Focuses of care of childbearing women and their families through the stages of pregnancy and 4 week post partum

    Nurses caring for women have helped the health care system to be more responsive to women’s needs and providing evidenced based practice

    Through professional associations nurses have promoted public policy by educating state and federal officials
  2. **Tremendous Advances
    In the last 150 years there have been many advances in maternal child care: medicaid

    In the United States serious problems exist in maternal child care related to access to pre-pregnancy and pregnancy care

    Sexually transmitted diseases including HIV adversely affect pregnancy outcome

    There are ethnic disparities related to pregnancy outcomes (more with blacks)
  3. **Contemporary Issues and Trends
    Healthy People 2010 Goals http://www.health.gov/healthypeople

    Millennium Development Goals these are 8 Goals that respond to world challenges http://www.un.org/millenniumgoals/goals.htm

    • lIntegrative Health Care
    • Incorporates complementary health with western medicine
  4. **Problems with the US Health Care System
    The American Nurses Association “Health Reform Agenda 2008”

    The ANA believes that access, quality, cost and workforce are important factors

    Care must be directed away from expensive tertiary care to primary health promotion
  5. **Reducing Medical Errors
    Medical errors are the leading cause of death in the US and it is estimated as many as 98,000 deaths per year

    Patients are encouraged to be knowledge about their health care and ask questions of their health care providers
  6. **The High cost of Health Care
    Currently Health care costs accounts for 16% of the US gross domestic product and is growing

    There is an emphasis on high technology

    Caring for preterm infants is also another major factor in the increased costs

    Nurse Midwives has helped to contain costs, but not all health plans cover do not cover these services

    Cesarean Sections are reaching 30% in the US this another factor in increased costs
  7. **Limited Access
    The leading barrier to access to care is the inability to pay for care

    Lack of transport and child care are additional factors

    Lack of providers for indigent care

    • Limited number of providers accepting
    • medicaid or accepting very few patients
  8. **Efforts to reduce disparity
    There are major disparities between different ethnic groups in the US in terms of health outcomes

    We find minorities have more premature birth, shorter life expectancies, higher infant and maternal mortality rates

    These Disparities result from complex interactions between culture, health behaviors, environment, education, etc

    The NIH is committed to equalizing outcomes and training minority researchers
  9. **Trends in Fertility and Birthrate
    • Abortus- legal; an embryo or fetus that is removed or expelled from the
    • uterus at 20 weeks of gestaton or less, weights 500 g or less or
    • measures 25cm or less

    • Birthrate- Number of births per 1000 woman b/w 15-45Fertility Rate: number of births per 1000 women between the ages of
    • 15 and 44

    Infant Mortality Rate: nuber of deaths of infants under 1 yearof age per 1000  live births

    • Neonatal Mortality Rate: Number of deaths
    • of infants under 28 days of age per 1000 live births

    • Perinatal mortality rate: number of stillbirths and number of neonatal deaths per
    • 1000

    Stillbirth: an infant who at birth demonstrates no signs of life..
  10. **Low Birth Weight and Preterm Births
    There is a risk in mortality for infants less thatn 5 lb 8 oz (LBW) Infants

    There is an ethnic disparity in low birth weight infants with increases in blacks and hispanics

    Cigarette smoking is associated with LBW infants

    Preterm infant birth in the US is 12.8%  There are racial variations with this as well

    Multiple births most associated with fertility treatments and older age women giving birth
  11. **Infant Mortality in US
    • This is an indicator of prenatal care and the health of the nation.
    • Infant Mortality Rate-Number of deaths of infants before their
    • first birthday/1000 live births
    • Neonatal Mortality- Death younger than 28
    • days/1000 live births

    Perinatal mortality is the number of still births plus the number of neonatal deaths/1000 live births

    To address there mustbe an emphasis away from high technology to providing access to low income families
  12. **International Trends in Infant Mortality
    The United States is ranked as 29th in the World-reasons is high rate of LBW infants born in the US compared with other countries.

    Serbia and Malaysia have better infant mortality rates than the US
  13. **Maternal Mortality Trends
    There are great disparities between developed between developed and non developed countrie

    In the United States there are significant racial disparities 1 in 3 births born by C-section

    Maternal Mortality rate In US is ranked as 30th In the world
  14. **Increase in High Risk Pregnancies**
    Increase in drug use 11%-27% of pregnant has contributed to prematurity, low birth rate, congenital anomalies and withdrawal symptoms for the newborn

    Alcohol use associated with miscarriage, mental retardation and LBW

    Twin and Multiple Births

    Obesity of the Mother 20%
  15. **High Technology Care
    • Advances in technology and an increased in the number of High Risk
    • Pregnancies have contributed to technology

    Continuous monitoring in labor

    Preconception counseling

    Internet Access


    -measels epidemic  disney
  16. **View of Women
    Practitioners describe women who have incompetent cervixes, failure to progress, fetuses have fetal growth retardation,More positive language should be incorporated in the Maternal  Care
  17. **Safe Motherhood
    THE CDC began working with international groups in 2001 to develop safe motherhood

    The leading causes of mortality in the US are hemorrhage, blood clots, hypertension, stroke, amniotic fluid embolism and heart muscle disease

    It is estimated that we could prevent more than 50% of these with better care
  18. **Childbirth Practices
    • The vast majority of births are attended by physicians with only 8% attended my nurse midwives
    • 99% of women deliver in hospitals

    Family Centered Care

    Neonatal Security

    Adequate stays for moms after births
  19. **Community Based Care
    There is a shift from hospitals to home

    Involving clients in Self Management

    Health Literacy

    Breast Feeding in the Workplace

    International Concerns

    Female genital mutilation
  20. **Trends in Nursing Practice
    • Increasing complexity of care has contributed to specialized knowledge gained through experience, advanced degrees, certification programs.
    • Nurses in Advanced practice
    • Lactation Consultants
  21. **Evidence Based Practice
    Not all practice can be evidence based, but practitioners must use what evidence is available

    Association of Women’s Health, Obstetric and Neonatal Nurses AWHONN http://www.awhonn.org  includes evidenced based standards for maternity nurses
  22. **Cochrane Pregnancy and Childbirth Date
    Oversees studies

    • Studies ranked in six categories
    • Beneficial forms of care
    • Forms of care are likely to be beneficial
    • Forms of care with a trade-off between beneficial and adverse effects
    • Forms of care with unknown effectiveness
    • Forms of care that are unlikely to be beneficial
    • Forms of care that are likely to be ineffective or harmful
  23. **Standard  of Practice and Legal Standards of Care

    Standard of Care ANA AWHONN
    Risk Management
    Sentinel Effects
    Failure to Rescue
    Research in Perinatal Nursing
    • Standard of Care ANA AWHONN
    • Risk Management

    Sentinel Effects: "an unexpected occurence involvin death or serious physical or psychological injury, or the risk thereof. Serious Injury: loss of limb or function

    • Failure to Rescue:
    • key components:
    • 1. careful surveillance and identification of complications
    • 2. Acting quickly to initate appropriate interventions and activating a team response

    Research in Perinatal Nursing
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NS2 Peds: Mod 1 Intro to Maternal
2015-01-27 02:11:32
NS2 PEDS Maternal Exam1

NS2 Peds: Mod 1 Intro to Maternal
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