Improving Obstetric Patient Outcomes

Improving Obstetric Patient Outcomes
Improving Obstetric Patient Outcomes

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Improving Obstetric Patient Outcomes

Labour complications are the leading cause of long term disabilities, mortalities and morbidity for both the mother and the babies. One of the approaches is to assess the patient obstetrical history to identify if the pregnancy is a high risk or not. Certain maternal risk factors are associated with risk factors and are identified by assess the outcomes of previous pregnancies.

In this context, the patient had suffered from spontaneous abortion during her first pregnancy. This is the main factor that could be associated with the prolonged labour and increased bleeding post-delivery. The excessive may result due to the opened blood vessels during the caesarean delivery (Pillitteri, 2014).

 To save the lives of both the child and the mother, it is important to identify emergencies in the obstetric settings early enough.  This is because emergencies can lead to the permanent disabilities or even death of the mother, the infant or both. The main approaches identified by the evidence based practice that can be utilized includes, drills, protocols, simulation and vital sign alerts.

Improving Obstetric Patient Outcomes

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In this case study, the best approach that should be used is the protocols. The most strategic approach in this case is use of protocols. Protocols refer to set of rules and procedures that must be followed based on the conventions that have been proven to work in such incidences  (Kee, Hayes, & McCuistion, 2015).

The main advantage is that it helps the healthcare provider make the most ethical decision as required by the organization and their professional standards. Secondly, because the  information in the protocols are written according to the evidence based research, it provides the most effective remedy to patients irrespective  of where or who delivers the care i.e. makes quality care the standard.

The main challenge is the possibility of err in healthcare protocols, because the judgement value made by guideline could be the wrong choice for this particular patient. Secondly, effective use of protocols is determined by the nurse experience and clinical opinions, and thus, for an inexperienced nurse can pick the most inferior options due to misconceptions or misrepresented community norms (Hinkle & Cheever, 2013).

Improving Obstetric Patient Outcomes

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In this context, the protocol of postpartum assessment includes the assessment of patient’s vital signs, the assessment of breasts, bladder, fundus, perineum, lochia, legs as well as any other incision in the body. The patient pain must be assessed including the location, the type of pain, quality and degree of severity. If necessary, pain medications can be administered to reduce the irritation as well as the swelling. From the assessment records, the postpartum condition of the patient was normal. However after one hour, the patient calls for help, as she feels that she is bleeding a lot (Pillitteri, 2014).

The nurse assessment notices the vaginal bleeding, the patient if diaphoretic, pale and her fundus is boggy even with a firm massage. This is an indicator of postpartum haemorrhage, which could be due to uterine atony and trauma. According to the protocols, the patient should be administered oxytocin IV or IM.

If the intravenous oxytocin is unavailable, or the bleeding still continuous, then the  following medication should be used, including  the intravenous ergometrine, prostaglandin (sublingual misoprostol, 800 µg)  or combination of oxytocin-ergometrine is strongly recommended. The approach will reduce the bleeding rate and improve the patients’ quality of life (Kee, Hayes, & McCuistion, 2015).

References

Hinkle, J., & Cheever, K. (2013). Brunner and Suddarth’s textbook of medical-surgical nursing (13th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Kee, J., Hayes, E., & McCuistion, L. (2015). Pharmacology: A nursing process approach (8th ed.). Philadelphia, PA: Elsevier.

Pillitteri, A. (2014). Maternal & child health nursing: Care of the childbearing and childrearing family (7th ed.). Philadelphia: Lippincott, Williams and Wilkins.

Improving Obstetric Patient Outcomes

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