Blood Pressure And Heart Monitors During Pregnancy Assignment

Blood Pressure And Heart Monitors During Pregnancy Assignment

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Exemplar 2

In this exemplar, I used the following Benner’s domains:

• Helping role.
• Teaching-coaching function.
• Diagnostic and patient-monitoring function.
• Effective management of rapidly changing situations.
• Administering and monitoring therapeutic interventions and regimens.
• Monitoring and ensuring the quality of health care practices.
• Organizational and work-role competencies.
  

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Mrs. G. walked into the medical facility with a ruptured membrane. In addition, she had a cord prolapse. She was described as ‘gravida 2, para 1’ (G2P1) since she had a previous pregnancy that she delivered after 20 weeks and is in the 34^th week of her current pregnancy. The maternity unit had a busy night and short staffed. This was not a comforting situation for the patient. It was a concerning situation for the patient because this was a pregnancy complication from the preterm premature risk of the membranes (PPROM)Blood Pressure And Heart Monitors During Pregnancy Assignment. In this case, the amniotic membrane (sac) surrounding the baby ruptured before the 37^th week of pregnancy thereby increasing the risk of infection and chance of having the baby born early. In fact, PPROM can lead to significant perinatal morbidity to include fetal death, placental abruption, umbilical cord prolapse, neonatal sepsis, and respiratory distress syndrome.

In addition to the ruptured membrane, the patient had a cord prolapse with the umbilical cord slipping down in from of the baby after the membrane ruptured. The cord was visible through the open cervix. This presented a concern as it occurred before the labor started thereby presenting an emergency situation for the baby. The baby or the womb could squeeze the prolapsed umbilical cord during a contraction thereby reducing the amount of blood flowing through the cord and reducing oxygen supply to the baby thus causing long-term harm or even death to the patient.

The maternity unit was having a busy night with many patients, and it was overstaffed. As a result, I was assigned the patient with the responsibility of assessing and meeting her care needs. I understood the need for urgency in the situation, especially if I was the save the baby. My first step was to conduct an assessment of the patient. She reported a sudden gush of fluids with continued leakage. I then went on to perform a speculum examination to evaluate if any cervical dilation and effacement were present. I avoided conducting a digital cervical examination as this could increase mortality and morbidity, not to talk of shortening the latent period and thereby increasing the risk of infectious morbidity and sequelae from preterm labor. As such, a speculum examination was the safer and more appropriate test approach for the patient. The speculum examination revealed that dilation occurred after PPROM. Additionally, there was evidence of fluid pooling in the vagina and leakage from the vagina, particularly when fundal pressure is applied or when the patient coughs. Nitrazine paper was used and it turned blue, indicating a pH value above 6.0 in the vagina. The normal vaginal pH is between 4.5 and 6.0 while amniotic fluid has a pH value of between 7.1 and 7.3, indicating that it is more alkaline thereby explaining the slightly higher than normal vaginal pH as amniotic fluid leaks into the vagina. Furthermore, the presence of ferning was checked to rule out a false positive. Although the patient’s history did not suggest PPROM as she had a previous normal pregnancy and delivery, the assessment conducted confirmed the PPROM diagnosis. Blood Pressure And Heart Monitors During Pregnancy Assignment

Once there was a positive diagnosis for PPROM and presence of a cord prolapse, the next step was to develop and apply an appropriate care plan. In this case, there was an understanding that the patient was in the 35^th week of pregnancy, thereby creating a need not to prolong the pregnancy. In addition, the patient had a cord prolapse that increased the risk of the baby not receiving enough oxygen and experiencing birth asphyxia thus creating a significant urgency for birth.

Once I identified the need to have the baby delivered immediately, I informed the patient of the results from my assessment, and the need to have an emergency cesarean section (C-section)Blood Pressure And Heart Monitors During Pregnancy Assignment. She understood that this was an emergency and consented to the procedure with her husband who had accompanied her to the facility signing the consent form for the procedure.

I was present at the C-section procedure, and helped to calm the patient while preparing for the procedure. The procedure involved an epidural (spinal block) that numbed the patient from the breasts down to her feet. The hair in the area around the incision was then shaved/clipped. A catheter was inserted to keep her bladder empty, and blood pressure and heart monitors applied. She had an IV on her had to give her medicine and fluids. During the preparation, she discussed with me what to expect during the procedure. The procedure proceeded as planned with the safe delivery of the baby. The patient was awake during the procedure and she was able to hold her baby shortly after birth. The whole procedure took about 45 minutes with the patient with the patient appreciating that she did not experience much discomfort, and reported feeling a small tug/pull as the baby was removed from her abdomen. The placenta was delivered after the baby was born. The patient stayed in the hospital for three days after the surgery and went home with a healthy baby. I advised her on home care following the surgery and prescribed pain medication Blood Pressure And Heart Monitors During Pregnancy Assignment.

I believe that my presence was a necessary ingredient in turning the patient’s situation around and ensuring a safe delivery with a healthy baby and mother. First, the unit was busy and understaffed. This implied that there were no enough staff to handle the emerging emergency. Second, I was prompt in assessing the patient, identifying the emergency, and providing appropriate care as required. Third, I was keen in continuously monitoring the patient to ensure early detection of any clinical deterioration and thereby allow for timely intervention. Overall, my prompt action in assessing the patient and providing the appropriate care saved the baby and mother.

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This experience had me applying Benner’s domains as explained. First, I undertook a helping role in providing comfort measures for the patient and inviting her to participate in the care. Second, I undertook a teaching-coaching function by educating the patient and enabling her to make informed decisions. Third, I undertook a diagnostic and patient-monitoring function by assessing the patient. Fourth, I ensured effective management of rapidly changing situation by adapting the care plan to the developing emergency, such as emergency C-section as a necessary measure to save the baby. Fifth, I administered and monitored therapeutic interventions and regimens, such as monitoring the patient during the C-section and hospital care after the procedure. Sixth, I monitored and ensured the quality of health care practices by continuously monitoring the patient and revising the care plan as needed. Finally, I applied organizational and work-role competencies in setting care priorities, coordinating care, and providing for continuity of care. In essence, the experience in providing care to Mrs. G. presented an opportunity to apply the seven competencies presented in Benner’s domain Blood Pressure And Heart Monitors During Pregnancy Assignment