Ch1 - NUR318 - Maternal Health Nursing - EXAM 1 CONTENT

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MATERNITY NURSING, EIGHTH EDITION ISBN: 978-0-323-06661-7 Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. (Lowdermilk) Lowdermilk, Deitra Leonard. Maternity Nursing, 8th Edition. Mosby, 012010.

binuclear family

Family after divorce in which the child is a member of both the maternal and the paternal nuclear households

Cochrane Pregnancy and Childbirth Database

Database of up-to-date systematic reviews and dissemination of reviews of randomized controlled trials of health care

continuum of care

Range of clinical services provided for an individual or group that reflects care given during a single hospitalization or care for multiple conditions over a lifetime

cultural competence

Awareness, acceptance, and knowledge of cultural differences and adaptation of services to acknowledge and support the culture of the patient

cultural context

Setting in which one considers the individual's and the family's beliefs and practices (culture)

cultural knowledge

Knowledge that includes beliefs and values about each facet of life and is passed from one generation to the next

cultural relativism

Learning about and applying the standards of another person's culture to activities within a particular culture

ethnocentrism

Belief in the rightness of one's culture's way of doing things

evidence-based practice

Practice based on knowledge that has been gained through research and clinical trials

extended family

Family that includes the nuclear family and other people related by blood

family dynamics

Interaction and communication among family members

genogram

Pictorial representation of family relationships and health history

home health care

Care that is provided within the home

homosexual (lesbian or gay) family

Family that consists of same-sex adults and children from previous heterosexual unions, conceived through therapeutic insemination, or adopted

integrative health care

Complementary and alternative therapies in combination with conventional Western modalities of treatment

low-birth-weight (LBW) infants

Babies born weighing less than 2500 g (5.5 lbs)

nuclear family

Family that consists of parents and their dependent children

preterm infants

Infants born before 37 weeks of gestation

reconstituted family

Also called blended, combined, or remarried family; includes stepparents and stepchildren

single-parent family

Family in which a child lives with one parent because of divorce, separation, desertion, or death of a parent; birth to a single parent; or adoption

standard of care

Level of practice that a reasonable, prudent nurse would provide

telehealth

Use of communication technologies and electronic information to provide or support health care when participants are separated by distance

vulnerable populations

Groups who are at increased risk of developing physical, mental, or social health problems or who are more likely to have worse outcomes from these health problems than the population as a whole

walking survey

Technique of using one's senses while traveling through a community to obtain information about sociocultural characteristics and the environment, housing, transportation, and local community agencies

Abortus

An embryo or fetus that is removed or expelled from the uterus at 20 weeks of gestation or less, weighs 500 g or less, or measures 25 cm or less

Birthrate

Number of live births in 1 year per 1000 population

Fertility rate

Number of births per 1000 women between the ages of 15 and 44 (inclusive), calculated on a yearly basis

Infant mortality rate

Number of deaths of infants under 1 year of age per 1000 live births

Maternal mortality rate

Number of maternal deaths from births and complications of pregnancy, childbirth, and puerperium (the first 42 days after termination of the pregnancy) per 100,000 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 live births

Stillbirth

An infant who at birth demonstrates no signs of life such as breathing, heartbeat, or voluntary muscle movements

Box 1-2: United Nations Millennium Development Goals

Goal 1—Eradicate extreme poverty and hunger
Goal 2—Achieve universal primary education
Goal 3—Promote gender equality and empower women
Goal 4—Reduce child mortality
Goal 5—Improve maternal health
Goal 6—Combat HIV/AIDS, malaria, and other diseases
Goal 7—Ensure environmental sustainability
Goal 8—Develop a global partnership for development

Source: UN millennium development goals. Internet document available at www.un.org/millenniumgoals/goals.html (accessed February 25, 2009).

BOX 1-3: National Quality Forum "Never Events" Pertaining to Maternal and Child Health

• Infant discharged to the wrong person
• Maternal death or serious disability associated with labor or birth in a low risk pregnancy while being cared for in a health care facility
• Death or serious disability (kernicterus) associated with failure to identify and treat hyperbilirubinemia in neonates
• Artificial insemination with the wrong donor sperm or donor egg

Source: The National Quality Forum: National Quality Forum updates endorsement of serious reportable events in healthcare. Internet document available at www.qualityforum.org (accessed February 25, 2009).

BOX 1-4: Selected Safe Practices for Better Health Care

• Create and sustain a health care culture of safety.
• Ask each patient or legal surrogate to "teach back" in his or her own words key information about the proposed treatments or procedures for which he or she is being asked to provide informed consent.
• Ensure that care information is transmitted and appropriately documented in a timely manner and in a clearly understandable form to patients and to all of the patients' health care providers or professionals, within and among care settings, who need that information in order to provide continued care.
• Standardize methods for the labeling and packaging of medications.
• Comply with current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.

Source: National Quality Forum. (2006). Safe practices for better healthcare—2006 update. Internet document available at www.qualityforum.org (accessed February 25, 2009).

Standards that Define The Nurses Responsibility to The Patient

Assessment—Collection of health data of the woman or newborn
Diagnosis—Analysis of data to determine the nursing diagnosis
Outcome Identification—Identification of expected outcomes that are individualized
Planning—Development of a plan of care
Implementation—Performance of interventions for the plan of care, including coordination of care and health teaching and promotion
Evaluation—Evaluation of the effectiveness of interventions in relation to expected outcomes

Standards of Professional Performance that Delineate Roles and Behaviors For Which the Professional Nurse is Accountable

Quality of Practice—Systemic evaluation of nursing practice
Education—Participation in educational activities to maintain knowledge and competencies that reflect current evidence-based practice
Professional Practice Evaluation—Self-evaluation of own nursing practice in relation to professional standards and guidelines, legal responsibilities, and current evidence-based practices
Ethics—Use of ethical decision making guide such as the ANA Code of Ethics for nurses to guide practice
Collegiality—Contribution to the development of peers, students, and others
Collaboration and Communication—Involvement of women, families/significant others, health care providers, and the community in the provision of patient care
Research—Use of research findings in practice; participation in research activities that are appropriate to the education, position, and practice of the nurse
Resource and Technology—Consideration of factors related to safety, effectiveness, and costs in planning and delivering patient care
Leadership—Participation in a variety of leadership roles within the work setting including role model, consultant, and change agent; participation in professional organizations

• Maternity nursing care focuses on women and their families during pregnancy and childbirth and for 4 weeks after childbirth.

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• Healthy People 2010, the United States' agenda for improving health, provides goals for maternal and infant health.

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• Integrative health care includes conventional and alternative therapies.

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• Nurses can help shape health care systems to make them more responsive to the needs of contemporary women.

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• Nurses can develop strategies to improve the well-being of women and their infants.

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• Perinatal practice increasingly emphasizes evidence-based practice.

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• Neonates weighing less than 2,500 grams (5 pounds, 8 ounces) are called low-birth-weight (LBW) infants. Neonates born before 37 weeks of gestation are called preterm infants.

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• Maternal factors associated with infant mortality include limited education, young age, unmarried status, poverty, lack of prenatal care, poor nutrition, smoking, alcohol use, and health problems.

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• In the United States, the maternal mortality rate for African-American women is four times higher than the maternal mortality rate for non-Hispanic white women.

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• High-technology care results in part from advances in scientific knowledge and the increased number of high risk pregnancies.

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• In the United States, the leading causes of pregnancy-related deaths are hemorrhage, blood clots, hypertension, infection, stroke, amniotic fluid embolism, and heart muscle disease.

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• Prenatal care includes early risk assessment and the promotion of healthy behaviors, such as better nutrition and smoking cessation.

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• Women can choose physicians or nurse-midwives as primary care providers.

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• With family-centered care, fathers, partners, grandparents, siblings, and friends may be present for labor and birth.

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• Family theories provide nurses with guidelines for understanding family function.

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• A culture's reproductive beliefs and practices are embedded in the economic, religious, kinship, and political structures.

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• Cultural competence involves acknowledging, respecting, and appreciating ethnic, cultural, and linguistic diversity.

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• To provide culturally competent care, a nurse must assess the beliefs and practices of patients.

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• Much of acute care nursing has been transferred to home-based nursing services in communities.

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• A nurse working in the community uses these data collection methods: walking surveys, analyses of existing data, informant interviews, and participant observation.

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• With telephonic nursing care, a nurse uses services such as warm lines, nurse advice lines, and telephonic nursing assessments to manage health care problems and bridge the gaps among acute, outpatient, and home care services.

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1. The nurse understands the importance of a walking survey because this tool:

A. Determines how much exercise expectant mothers have been getting to help inform patient care decisions.
B. Usually takes place on the maternity ward but can be expanded to other areas of the hospital.
C. Is a method of observing the resources and health-related environment of the community.
D. Is performed by government census takers as part of their canvas.

C. Is a method of observing the resources and health-related environment of the community.

A walking survey has nothing to do with exercise. It is an observational method used to assess the health environment of the community. A walking survey takes place in the community, not the maternity ward. The walking survey is a valuable tool for the nurses in the community; while visiting various locations in the community, the nurse notes characteristics of the population, economy, environment, transportation, health care, and other resources. A walking survey is not part of the census; it is conducted by nurses in the community.

2. The term used to describe legal and professional responsibility for practice for maternity nurses is:

A. Evaluation.
B. Accountability.
C. Ethics.
D. Collegiality.

B. Accountability.

Evaluation refers to examining the effectiveness of interventions in relation to expected outcomes. Accountability refers to legal and professional responsibility for practice. Ethics refers to a code that guides practice. Collegiality refers to a working relationship with one's colleagues.

3. The family structure consisting of parents and their dependent children living together is known as a(n):

A. Binuclear family.
B. Reconstituted family.
C. Nuclear family.
D. Extended family.

C. Nuclear family.

Binuclear refers to the family after divorce. Reconstituted includes stepparents and stepchildren. Nuclear family includes parents and children (natural or adopted) who live in a common household. Extended family includes the nuclear family and other people related by blood.

4. A woman is giving birth to her third child in a setting that allows her husband and other two children to be actively involved in the process. The nurse caring for the woman must also consider the husband and family as patients and work to meet their needs. This type of setting is termed:

A. Family-centered care.
B. Emergency care.
C. Hospice care.
D. Individual care.

A. Family-centered care.

Family-centered care is any setting in which the pregnant woman and family are treated as one unit. The nurse assumes a major role in teaching, counseling, and supporting the family. In emergency care settings, the nurse deals primarily with the patient who is having difficulty. In hospice care settings the nurse deals with patients who have terminal illnesses. Individual care deals only with the patient and does not include the family.

5. What has had the greatest impact on reducing infant mortality in the United States?

A. Improvements in perinatal care
B. Decreased incidence of congenital abnormalities
C. Better maternal nutrition
D. Improved funding for health care

A. Improvements in perinatal care

The improvements in perinatal care, particularly care of the mother-baby dyad before birth, have had the greatest impact.
There has been a decrease in some congenital anomalies such as spina bifida, but this has not had the greatest impact. Better maternal nutrition has had a positive influence but has not made the greatest overall impact. Changes in funding have not had the greatest impact.

6. The nurse admits Amanda to the labor unit. During the admission procedure, the nurse obtains Amanda's blood pressure, pulse, respirations, temperature, and fetal heart rate. The nurse is using which part of the nursing process?

A. Assessment
B. Planning
C. Implementation
D. Evaluation

A. Assessment

The assessment step of the nursing process is a collection of health data of the woman or newborn. Vital signs are considered health data of the patient. The planning step includes the development of a plan of care. Implementation is the performance of interventions for the plan of care. Evaluation determines the effectiveness of interventions in relation to the expected outcomes.

7. After admitting a new patient to the maternity unit, the nurse writes a plan of care. This process of determining outcomes and interventions is which stage of the nursing process?

A. Assessment
B. Planning
C. Implementation
D. Evaluation

B. Planning

The assessment stage involves collecting the patient data. During the planning stage, the nurse establishes outcomes and writes nursing interventions. The implementation stage is the active phase; it is carrying out the plan of care. The evaluation stage determines how well the plan worked.

8. A Native-American woman gave birth to a baby girl 12 hours ago. The nurse notes that the woman keeps her baby in the bassinet except for feeding and states that she will wait until she gets home to begin breastfeeding. The nurse recognizes that this behavior is most likely a reflection of:

A. Delayed attachment.
B. Embarrassment.
C. Disappointment that the baby is a girl.
D. A belief that babies should not be fed colostrum.

D. A belief that babies should not be fed colostrum.

The mother's behavior is a reflection of her cultural belief, not a delay in attachment. The mother's behavior is a reflection of her cultural belief, not an expression of embarrassment. In this case, delaying breastfeeding does not indicate that there is disappointment regarding the sex of the baby. Native Americans often use cradle boards and avoid handling their newborn often; they believe that the infant should not be fed colostrum.

9. The nurse is planning care for a patient with a t cultural background different from her own. What would be an appropriate goal?

A. Strive to keep the patient's cultural background from influencing health needs
B. Encourage the continuation of cultural practices in the hospital setting
C. In a nonjudgmental way, attempt to change the patient's cultural beliefs
D. As necessary, adapt the patient's cultural practices to her health needs

D. As necessary, adapt the patient's cultural practices to her health needs

The cultural background is part of the individual. It would be very difficult to eliminate the influence of the patient's background. The cultural practices need to be evaluated within the context of the health care setting to determine whether they are conflicting. It is not appropriate to attempt to change someone's cultural practices. Whenever possible, the nurse should facilitate the integration of cultural practices into health needs.

10. Which statement is descriptive of the family systems theory?

A. The family is viewed as the sum of individual members.
B. When the family system is disrupted, change can occur at any point in the system.
C. Change in one family member cannot create change in other members.
D. Individual family members are readily identified as the source of a problem.

B. When the family system is disrupted, change can occur at any point in the system.

Although the family is the sum of the individual members, the family systems theory focuses on the number of dyad interactions that can occur. The family systems theory describes an interactional model. Any change in one member will create change in others. Change in any family member will affect other members of the family. The interactions are considered to be the problem, not the individual family members.

11. What care would be included in the perinatal continuum of care available in a community?

A. Family planning, prenatal care, and newborn care
B. Alternative birthing centers, spiritual needs, and telephonic nursing care
C. Insurance reimbursement from prenatal to postpartum care
D. Infant care through adolescence period of childhood

A. Family planning, prenatal care, and newborn care

A continuum of care is defined as a range of clinical services provided for an individual or group that reflects care given through a period of care in a person's life. The perinatal continuum of care includes family planning; prenatal, newborn care and preconception care; intrapartum and postpartum care; and care of the infant through 1 year of age. Alternative birthing centers, fulfillment of spiritual needs, and access to telephonic nursing care are not part of the continuum of perinatal care. Insurance reimbursement for perinatal services are not included in the continuum of perinatal care. The continuum of perinatal care ends when the infant turns 1 year of age; the care of a child through adolescence would be a pediatric continuum of care.

12. Which statement made by the nurse would indicate that she or he is practicing appropriate family-centered care techniques? Choose all appropriate responses.

A. The nurse allows the mother and father to make choices when possible.
B. The nurse informs the family about what is going to happen. The nurse instructs the patient's sister, who is a nurse, that she cannot be in the room during the birth.
C. The nurse commands that the mother do as instructed.
D. The nurse provides time for the partner to ask questions.

A. The nurse allows the mother and father to make choices when possible.
D. The nurse provides time for the partner to ask questions.

It is important to allow the couple to make choices whenever possible. Unless there is an institutional policy prohibiting the number of attendees at a birth, the patient should be allowed to have whomever she desires with her (unless the birth is emergent and the guests are requested to leave). Family-centered care involves collaboration between the health care team and the patient. It is important to include the partner in the care process.

Maternal Deaths

- With 99% of maternal deaths occurring in developing countries, it is too often assumed that maternal mortality is not a problem in wealthier countries.
- Yet, statistics released in September of 2010 by the United Nations place the United States 50th in the world for maternal mortality — with maternal mortality ratios higher than almost all European countries, as well as several countries in Asia and the Middle East.
- Even more troubling, the United Nations data show that between 1990 and 2008, while the vast majority of countries reduced their maternal mortality ratios for a global decrease of 34%, maternal mortality nearly doubled in the United States.
- For a country that spends more than any other country on health care and more on childbirth-related care than any other area of hospitalization — US$86 billion a year — this is a shockingly poor return on investment.

Contemporary Issues and Trends

Problems with U.S. health care delivery system:
- Structure of the system
- Reducing medical errors
- High cost of health care
- Limited access to care
- Efforts to reduce health disparities

Contemporary Issues and Trends

- Amnesty International's report Deadly Delivery: The Maternal Health Care Crisis in the USA, urges action to tackle a crisis that sees between two and three women die every day during pregnancy and childbirth in the USA.
- A total of 1.7 million women a year, one-third of all pregnant women in the country, suffer from pregnancy-related complications.
- The report also revealed that severe pregnancy-related complications that nearly cause death -- known as "near misses" -- are rising at an alarming rate, increasing by 25 percent since 1998.
- Minorities, those living in poverty, Native American and immigrant women and those who speak little or no English are particularly affected.
- Obstacles to care are widespread, even though the US A spends more on health care than any other country and more on pregnancy and childbirth-related hospital costs, $86 billion, than any other type of hospital care.
- Nearly 13 million women of reproductive age (15 to 44), or one in five, have no health insurance. Minorities account for just under one-third of all women in the USA (32 percent) but over half (51 percent) of uninsured women.
- One in four women do not receive adequate prenatal care, starting in the first trimester. The number rises to about one in three for African American and Native American women.
- A shortage of health care professionals is a serious obstacle to timely and adequate care, especially in rural areas and inner cities. In 2008, 64 million people were living in "shortage areas" for primary care (which includes maternal care).
- Many women are not given a say in decisions about their care and the risks of interventions such as inducing labor or cesarean sections. Cesarean sections make up nearly one-third of all deliveries in the USA - twice as high as recommended by the World Health Organization.

Cause of Maternal Death

- The leading complications causing maternal deaths in the United States overlap with the main global causes; hemorrhage, pregnancy-related hypertensive disorders and infection are among the top causes of death in both the United States and the developing world.
- Other leading causes of maternal death in the United States are thrombotic pulmonary embolism, cardiomyopathy, cardiovascular conditions, and other medical conditions, whereas in developing countries, other leading causes of death are obstructed labor and unsafe abortions.

Assessing the Community

Critical indicators of perinatal health:

Access to care
Maternal mortality
Infant mortality
Low birth weight
First-trimester prenatal care
Rate for mammography
Rate for Pap tests

Healthy People 2010

- Eliminate preventable disease, disability, injury and premature death
- Achieve health equity, eliminate disparities and improve the health of all groups
- Create social and physical environments that promote good health for all
- Promote healthy development and health behaviors across every stage of life

Integrative health care

- Encompasses complementary and alternative therapies
- Values patient's input, beliefs, values and desires
- Focuses on the whole person, not just the disease process
- Allows for more patient autonomy in health care decisions

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