OB Exam #4: Perinatal Loss

Term
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what is the term used for fetal death that occurs after 20 weeks gestation, but before birth?
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Terms in this set (44)
what is the term used for fetal death that occurs after 20 weeks gestation, but before birth?
intrauterine fetal demise
what term is used for any pregnancy loss and/or neonatal death up to 1 month of age; fully encompassing; includes delivery experiences prior to 20 weeks; still births and life infants that did not survive?
perinatal loss
what is a traumatic experience that is processed as a loss and the rule of thought is that if a patient considers it a loss then we should too since It in itself can be represented in physical and symbolic ways and at any gestation can represent both and role that infant could have played is lost; 7 million perinatal losses worldwide annually; >1 million fetal deaths in the US annually?
perinatal loss
what is known as the reaction to loss and experiencing psychosocial, behavioral, social, and physical reactions and is an internal experience; a lot what the person undergoes is their personal reaction to the loss of the experience?
grief
what is known as the process through which the resolution of greed may be accomplished and cultural and/or physical display of grief through one's behavior and this is known as an external experience; funerals and social rituals for example; outward expression of grief that patient might be experiencing in reaction to the loss?
mourning
what is known as the entire process/event precipitated by the loss; means to be torn apart and have special needs; entire fried or loss journey?
bereavement
five of the ten potential causes for what includes pre-mature/post-term delivery (prior to viability of infant and if the baby does not get appropriate O2 and blood supply), substance abuse/smoking, infection, HTN (disorders and HELLP and Preeclampsia), and uterine rupture (massive blood loss)?
perinatal loss
five of the ten potential causes for what include diabetes (poorly controlled), congenital anomalies (genetic disorders), trauma/abruptiuon (2 separate things but related; detachment of the placenta), hemorrhage and unknown cause (idiopathic - sometimes we have an answer and other times we do not)?
perinatal loss
What does IUFD stand for?
intrauterine fetal death
a spontaneous abortion is prior to how many weeks?
20 weeks
what includes spontaneous abortion (prior to 20 weeks), induced abortion, IUFD (after 20 weeks of a still born infant), and NICU (can be born but could not survive later on and had several days on the earth but did not make it due to complication??perinatal lossthe warning signs/diagnosis of what includes decreased fetal movement, loss of fluid, bleeding situation or can have no warning signs and no anticipation is involved (huge range of emotion involved and it is devastating - variety of emotional reaction)?perinatal lossrelated to perinatal loss, what includes accepting the reality of the loss, getting over suffering from the loss, adapting to the new environment without the deceased, and emotionally relocating the deceased and getting on with life?grief progressionrelated to perinatal loss, what is known as a framework of how patient's go through stages of grief and not every patient experiences this in the same way, accepting the reality of loss (acknowledging the event - getting over the suffering from that loss - processing the event and getting to a new normal with understanding the meaning), adjusting to what the future will look like without them (might not mean getting on by forgetting - comes a place where it is specially carved out for the infant and how the parent and the one who is grieving will be able to carry on in the future), emotional response, deep sadness and sorrow?grief progressionwhat is not completed within a specific time frame and from some, may never be complete, and emotional healing often takes longer than physical healing, some people take days and others take years and for some it may never go away - ongoing, medical management is minor and It is important to talk about emotional healing?griefpossible s/s of what includes decreased fetal movement, UCs, SROM (leaking fluid), bleeding (warnings - something may be wrong with this baby), no fetal heart tones (if baby old enough), but confirming diagnosis with US (patient may pick up on this and may start to become anxious due to the long pause and silence so it is important to explain it away and pretend this is normal for the moment and everyone in the room may understand that something is wrong but respond with "I'm not sure I'm having difficulty finding the heart tones"?perinatal losswhat does the plan of care after perinatal loss diagnosis includes that is done in order to facilitate the delivery?Induction Of Labor (IOL)what does the plan of care after perinatal loss diagnosis includes the healthcare team not being ready to intervene yet, and taking some time to make decisions and then sending the patient home?expectantwhat does the plan of care after perinatal loss diagnosis includes, if the fetus is small enough then evacuation/curettage (D&E) is done?surgical managementfor what diagnosis is it important to provide accurate and understandable information, create an accepting, caring environment (promote open communication), moving towards the best plan of care depending on what the status of the baby is (parents may not be able to absorb what is happening) ( we may need to repeat ourselves in the most easy to understand terms, competing information will be formed in the patient's head so reach out for assistance and make clear communication lines)?perinatal lossrelated to perinatal loss, what upon arrival to the hospital includes making introductions and acknowledging/validating loss with a simple, "I am so sorry for your loss", Identification on the door; ideally a room away from the floor's center, and establish the beginnings of a trust relationship with the family?nursing managementrelated to perinatal loss, what upon arrival to the hospital includes plan of caring being established, delivery will be at the hospital, do not try and cheer up the patient by saying "time will heal" or "it could be worse" since these things do not validate the current experience, stick to "I don't know what to say and Im sorry for your loss", communicate with the patient early and be honest, make sure the patient can contact you so it can comfort them, and let them know up front there will be many decisions to make but you will also be there to guide them, and must create a realistic picture of what may lie ahead but they are NOT alone?nursing managementwhat must the nurse function as for the family which includes organizing interdisciplinary involvement, maintaining continuity of care, offering the opportunity for open communication, and ensuring the family's wishes regarding their loss experience are honored, medical and pain management with doctors and physicians, think about working with social workers and chaplains, maintain continuity of care (one nurse for the duration of the shift might be traded out), familiar with patient and a chance to meet them, and understand that the family wants to care for the baby as much as the mother?advocatewhat must be explained for the patient when preparing for the birth and death of the infant which involves IOL agents (Pitocin and Cytotec), pain management, and medical management during delivery/recovery (what kind of pain may be experienced, epidural or long-term epidural, others, understand and respect the patient's option, let her know she has many options, will still have to push, and baby may be delivered spontaneously so give the patient the notification)?plan of carewhen preparing the family for the brith and death of the infant, you must help the couple explore what which involves guiding with decisions needed, quiet, supportive presence, and respect cues to be left alone?feelingswhat period during the birth and death of the infant includes checking for bleeding and making sure the fundus and uterus is clamping down and medical management done but make sure to give her space and don't be in the room all of the time?recovery periodwhat emotions during the birth and death of an infant may be directed towards the nurse and it is important to not take it personally, and if the emotion is threatening or impeding care then you must let the charge nurse know since the nurse should not be the punching bag of the family since you are only trying to help?angerwhen preparing the family for the birth and death of the infant, what includes dying infant? (presented as if the baby has already died), disposition of remains (private vs. hospital burial), autopsy/fetal; testing, wishes to see/hold baby (photos/momentos), and birth preferences (reassure no right or wrong feelings and involves cultural wishes) (baptism, no pressure to do something, out of our control it is up to the patient)?decision makingwhen preparing the family for the birth and death of the infant, what includes the instance where a baby is born with a heart race and is resuscitation appropriate - how does the patient want the infant to pass, how is the baby disposed or is the baby taken home, would an autopsy be comforting, fetal testing (genetics, placental examination) to identify the cause, coaching the patients that sometimes these do not result in answers all the time (not always definitive - culturally may not be appropriate to perform autopsy)?decision makingwhen preparing the family for the birth and death of the infant, what includes deciding if the baby wants to see and hold the baby, moving the baby to space behind the curtain if census allows for it, photos or moments (memory box and hand prints and footprints of the baby, measurements, lock of hair, hat and blanket - make sure that the patient want them before you take them - may not be culturally appropriate)?decision makingwhen preparing the family for the birth and death of the infant, preparation for what includes allowing unlimited time (as long as they need), gasping and movement, cold/maceration (may be disturbing but this is normal, if born dead and passed a long time in utero - warning of appearance - cold, macerated, modeled skin start to sloth off, purple and bloated), use baby's chosen name, providing care (accommodating to the patients needs so if mom want to hold baby but not look at baby then cover baby with blankets), point out positive features of the baby (perfect feet, lips, hands)?preparation for being and holdingwhen preparing the family for the birth and death of the infant, preparation for what includes doing measurements, giving the first bath, therapeutic way of bonding and saying goodbye?preparation for being and holdingwhen preparing the family for the birth and death of the infant, what includes acknowledging the siblings and making sure they aren't in any way to be blamed for this death since they did not do this, making sure that the extended family is comforted too since their own child is grieving and hurt due to baby loss (double loss), and make sure you provide culturally appropriate care?family considerationswhen is it expected to meet with the social worker (for good resources for helping the patient with getting in tough with resources that may be useful, and death certificates)?aftermath of the perinatal deathwhat must be contacted after the perinatal death which includes grief counselors and support groups in the community and it is perfectly up to the patient to decide if that is useful for them or not and since not everyone is on the same page with the same grief experience and it is important to monitor physical healing?community support informationwhen must a medical follow up be established and should not just involve the physical portion of it but also the emotional?aftermath of the perinatal deathallow the patient to review their what and take cues from their reaction and when listening to the patient story ask them what happened to their birth experiences and listen to them since they may still be grieving and we must validate and let them talk about it (for patients who are trying to get pregnant again)?birth history (OB history)couples experiencing pregnancy following a loss can be expected to have higher levels of what and will need to be treated with care and concern and will need greater amount of reassurance, patience, support, and teaching may be required (especially if the current baby is around the gestational age of when the last baby had died)?fear and anxiety (due to PTSD possibly)what does the RESPONDING Model stand for (includes some good key points but doe snot only pertain to perinatal loss and is a good framework for anyone experiencing loss in any population - best practices for taking care of patients)?Recognition of the loss Emotional availability Spiritual/cultural accomodation Physical presence Open communication Normalization of grief reactions Decision-making assistance Interdisciplinary involvement Nonjudgemental attitude Genuine caringwhen caring for grieving families, be aware of what two personal things about loss?personal beliefs and feelingsallow for time for staff to what after caring for the patient and her family (may have had a close bond with the family, talk with coworkers and get a handle on your own experiences) and take time to communicate your feelings as well (evaluate yourself - responses may be stoic and that is okay - it is okay to have your own feelings about this)?debriefdepending on the level of the relationship with the family, what appropriate therapeutic behaviors may be possible if it does not interfere with the work schedule and you have created a close bond with the family and patient?- may attend service for the newborn - make a charitable donation in their honor (neonatal care group, offer to the family)what is a good resource available at any hospital mostly, counselors here to make sure nurses are well taken care of - and it is a good guide and resource they can listen to and talk to - important to remember "you cannot pour from an empty cup" - give our best selves to the patient not our worst?Employee Assistance Program (EAP)many of the same techniques used for caring for patients can be used for care for who as well?nurses