- Email: [email protected]
Fear Factor: Anxiety Disorders in the Intrapartum Environment
CASE STUDIES Proceedings of the 2010 AWHONN Annual Convention
monitored closely and with the development of HELLP she was delivered by Cesarean. At that time she was also diagnosed with acute renal failure due to acute tubular necrosis. Although rare, preeclampsia can be a cause of acute renal failure.
Etiology of preeclampsia, HELLP, and acute renal failure are discussed as well as management of the patient including interdisciplinary care and lab values. Outcomes and lessons learned are included.
Jan Kabler, RNC, MSN, ARNP-C, Via Christi Regional Medical Center, Wichita, KS
Childbearing
Code Crimson: An Interesting Plan for Obstetric Hemorrhage Poster Presentation bstetric hemorrhage can progress rapidly to a life-threatening emergency that demands immediate interventions to stop the bleeding and prevent the onset of disseminated intravascular coagulation (DIC). A clear, concise plan of action is needed to decrease maternal and fetal morbidity and mortality. The Code Crimson Policy at an academic, community magnet hospital provides a clear action plan for an obstetric hemorrhage. This poster will detail a ‘‘Code Crimson’’ utilizing a case study approach.
O
Case Study: A 31-year-old Jehovah’s Witness with a history of a Cesarean delivery. Due to diagnosed anemia, malpresentation, and previous Cesarean, the patient is high risk for poor outcome in the event of obstetric hemorrhage. This prompted placement
of sheaths by interventional radiology that can be in£ated to block blood £ow to the uterus is case of a hemorrhage during delivery.
Cheryl Kraemer, RN-C, Labor and Delivery Unit, Lehigh Valley Health Network,
This o¡ering will detail the ‘‘Code Crimson’’ procedures followed by the Labor and Delivery team throughout this patient’s delivery, inclusive of noti¢cation of additional surgical and anesthesia team members, availability of an interventional radiology team, procurement of anticipated blood products and/or a contingency plan in the event of a blood shortage or religious beliefs, and centralized location of necessary equipment. In addition, lessons learned throughout the development and implementation of the Code Crimson policy will be shared as well as associated outcomes. Participants will be able to impart these lessons within their own care delivery setting.
Allentown, PA
Childbearing
Fear Factor: Anxiety Disorders in the Intrapartum Environment Poster Presentation his case study describes a nulliparous woman with a history of generalized anxiety who presented to labor and delivery at 40 weeks gestation with spontaneous rupture of membranes without onset of contractions. Although her anxiety was controlled with medication prior to pregnancy, the woman was unmedicated during her pregnancy and had high levels of anxiety at the time of admission to the hospital for labor and birth.
T
Anxiety in pregnancy is common and changes through the course of pregnancy. It has been shown
S128
to be a risk factor for preterm birth (Orr, Reiter, Blazer, & James, 2007) and post partum depression (Lee et al., 2009; S˛derquist, Wijma, Thorbert, & Wijma, 2009). Much attention has been paid to detection of anxiety and other psychiatric disorders during pregnancy, yet little information exists in the literature on how to e¡ectively care for women su¡ering from anxiety in the intrapartum setting. Anxiety during childbirth presents a problem for health care providers because of the resulting physiologic response. When a person experiences stress and anxiety, the body reacts by releasing catecholamines that serve to increase heart rate, respirations, cardiac output, blood pressure, and
JOGNN, 39, S125-S131; 2010. DOI: 10.1111/j.1552-6909.2010.01131.x
Mary T. Paterno, BS, RN, SNM, Franklin Square Hospital Center, Baltimore, MD
Childbearing
http://jognn.awhonn.org
CASE STUDIES
Pratt, M. C.
Proceedings of the 2010 AWHONN Annual Convention
peripheral resistance. Normally this serves to help a person respond to the stressor, but in the case of a person with an anxiety disorder, unnecessary neuronal activity occurs causing ampli¢ed anxiety symptoms. In the case of a pregnant woman, this excessive response has the potential to decrease blood £ow and oxygen to the uterus and fetus. To decrease adverse e¡ects for mother and child, it is important that health care providers utilize psychological interventions during labor to decrease unnecessary anxiety and provide coping mechanisms that promote relaxation. This may present a challenge for nurses, physicians, and midwives who have only basic training in psychiatric care. Furthermore, laboring women presenting with high anxiety may experience low levels of perceived coping self-e⁄cacy and increased pain resulting in an even greater need for reassurance and support.
stressors, resulting in a satisfying birth experience that is safe for mother and baby. This session will use a case study to describe the in£uence of interdisciplinary communication on patient outcomes, examine how anxiety a¡ects the labor process, and discuss speci¢c strategies utilized to promote maternal and fetal well-being while meeting the goals identi¢ed in the patient’s birth plan. The presentation will consist of an outline of the case study, review of the literature, interdisciplinary communication strategies, and implications for future practice.
REFERENCES Lee, A. M., Lam, S. K., Lau, S., Chong, C. S. Y., Chui, H. W., & Fong, D. Y. T. (2009). Prevalence, course, and risk factors for antenatal anxiety and depression. Obstetrics and Gynecology, 110(5), 1102-1112. Orr, S. T., Reiter, J. P., Blazer, D. G., & James, S. A. (2007). Maternal prenatal pregnancy-related anxiety and spontaneous preterm birth in Baltimore, Maryland. Psychosomatic Medicine, 69, 566-570. S˛derquist, J., Wijma, B., Thorbert, G., & Wijma, K. (2009). Risk factors
In such an environment, the Labor nurse has the opportunity to initiate communication with the patient, family, and physician to provide care that will promote e¡ective coping and reduction of external
in pregnancy for post-traumatic stress and depression after childbirth. BJOG: An International Journal of Obstetrics and Gynaecology, 116, 672-680.
Critical Care for the Mother and Fetus With a Rare Condition: A Case Study of a Mother With a Molar Pregnancy Co-Existing With a Live Fetus Poster Presentation Mary Christine Pratt, MSN, RNC, Nursing, Neumann University, Aston, PA
he purpose of the poster is to present a case study of a patient with a molar pregnancy and a co-existing live twin fetus. Because this rare condition threatens the lives of the mother and fetus, it necessitates a multidisciplinary approach. Commu-
T
nication among various specialties is critical to ensure members of the health care team are informed of the detailed plan of care. By being informed of the speci¢c needs of the mother, fetus, and newborn, health care providers can facilitate an optimal outcome.
Childbearing
JOGNN 2010; Vol. 39, Supplement 1
S129
monitored closely and with the development of HELLP she was delivered by Cesarean. At that time she was also diagnosed with acute renal failure due to acute tubular necrosis. Although rare, preeclampsia can be a cause of acute renal failure.
Etiology of preeclampsia, HELLP, and acute renal failure are discussed as well as management of the patient including interdisciplinary care and lab values. Outcomes and lessons learned are included.
Jan Kabler, RNC, MSN, ARNP-C, Via Christi Regional Medical Center, Wichita, KS
Childbearing
Code Crimson: An Interesting Plan for Obstetric Hemorrhage Poster Presentation bstetric hemorrhage can progress rapidly to a life-threatening emergency that demands immediate interventions to stop the bleeding and prevent the onset of disseminated intravascular coagulation (DIC). A clear, concise plan of action is needed to decrease maternal and fetal morbidity and mortality. The Code Crimson Policy at an academic, community magnet hospital provides a clear action plan for an obstetric hemorrhage. This poster will detail a ‘‘Code Crimson’’ utilizing a case study approach.
O
Case Study: A 31-year-old Jehovah’s Witness with a history of a Cesarean delivery. Due to diagnosed anemia, malpresentation, and previous Cesarean, the patient is high risk for poor outcome in the event of obstetric hemorrhage. This prompted placement
of sheaths by interventional radiology that can be in£ated to block blood £ow to the uterus is case of a hemorrhage during delivery.
Cheryl Kraemer, RN-C, Labor and Delivery Unit, Lehigh Valley Health Network,
This o¡ering will detail the ‘‘Code Crimson’’ procedures followed by the Labor and Delivery team throughout this patient’s delivery, inclusive of noti¢cation of additional surgical and anesthesia team members, availability of an interventional radiology team, procurement of anticipated blood products and/or a contingency plan in the event of a blood shortage or religious beliefs, and centralized location of necessary equipment. In addition, lessons learned throughout the development and implementation of the Code Crimson policy will be shared as well as associated outcomes. Participants will be able to impart these lessons within their own care delivery setting.
Allentown, PA
Childbearing
Fear Factor: Anxiety Disorders in the Intrapartum Environment Poster Presentation his case study describes a nulliparous woman with a history of generalized anxiety who presented to labor and delivery at 40 weeks gestation with spontaneous rupture of membranes without onset of contractions. Although her anxiety was controlled with medication prior to pregnancy, the woman was unmedicated during her pregnancy and had high levels of anxiety at the time of admission to the hospital for labor and birth.
T
Anxiety in pregnancy is common and changes through the course of pregnancy. It has been shown
S128
to be a risk factor for preterm birth (Orr, Reiter, Blazer, & James, 2007) and post partum depression (Lee et al., 2009; S˛derquist, Wijma, Thorbert, & Wijma, 2009). Much attention has been paid to detection of anxiety and other psychiatric disorders during pregnancy, yet little information exists in the literature on how to e¡ectively care for women su¡ering from anxiety in the intrapartum setting. Anxiety during childbirth presents a problem for health care providers because of the resulting physiologic response. When a person experiences stress and anxiety, the body reacts by releasing catecholamines that serve to increase heart rate, respirations, cardiac output, blood pressure, and
JOGNN, 39, S125-S131; 2010. DOI: 10.1111/j.1552-6909.2010.01131.x
Mary T. Paterno, BS, RN, SNM, Franklin Square Hospital Center, Baltimore, MD
Childbearing
http://jognn.awhonn.org
CASE STUDIES
Pratt, M. C.
Proceedings of the 2010 AWHONN Annual Convention
peripheral resistance. Normally this serves to help a person respond to the stressor, but in the case of a person with an anxiety disorder, unnecessary neuronal activity occurs causing ampli¢ed anxiety symptoms. In the case of a pregnant woman, this excessive response has the potential to decrease blood £ow and oxygen to the uterus and fetus. To decrease adverse e¡ects for mother and child, it is important that health care providers utilize psychological interventions during labor to decrease unnecessary anxiety and provide coping mechanisms that promote relaxation. This may present a challenge for nurses, physicians, and midwives who have only basic training in psychiatric care. Furthermore, laboring women presenting with high anxiety may experience low levels of perceived coping self-e⁄cacy and increased pain resulting in an even greater need for reassurance and support.
stressors, resulting in a satisfying birth experience that is safe for mother and baby. This session will use a case study to describe the in£uence of interdisciplinary communication on patient outcomes, examine how anxiety a¡ects the labor process, and discuss speci¢c strategies utilized to promote maternal and fetal well-being while meeting the goals identi¢ed in the patient’s birth plan. The presentation will consist of an outline of the case study, review of the literature, interdisciplinary communication strategies, and implications for future practice.
REFERENCES Lee, A. M., Lam, S. K., Lau, S., Chong, C. S. Y., Chui, H. W., & Fong, D. Y. T. (2009). Prevalence, course, and risk factors for antenatal anxiety and depression. Obstetrics and Gynecology, 110(5), 1102-1112. Orr, S. T., Reiter, J. P., Blazer, D. G., & James, S. A. (2007). Maternal prenatal pregnancy-related anxiety and spontaneous preterm birth in Baltimore, Maryland. Psychosomatic Medicine, 69, 566-570. S˛derquist, J., Wijma, B., Thorbert, G., & Wijma, K. (2009). Risk factors
In such an environment, the Labor nurse has the opportunity to initiate communication with the patient, family, and physician to provide care that will promote e¡ective coping and reduction of external
in pregnancy for post-traumatic stress and depression after childbirth. BJOG: An International Journal of Obstetrics and Gynaecology, 116, 672-680.
Critical Care for the Mother and Fetus With a Rare Condition: A Case Study of a Mother With a Molar Pregnancy Co-Existing With a Live Fetus Poster Presentation Mary Christine Pratt, MSN, RNC, Nursing, Neumann University, Aston, PA
he purpose of the poster is to present a case study of a patient with a molar pregnancy and a co-existing live twin fetus. Because this rare condition threatens the lives of the mother and fetus, it necessitates a multidisciplinary approach. Commu-
T
nication among various specialties is critical to ensure members of the health care team are informed of the detailed plan of care. By being informed of the speci¢c needs of the mother, fetus, and newborn, health care providers can facilitate an optimal outcome.
Childbearing
JOGNN 2010; Vol. 39, Supplement 1
S129