妇产科护理学-母婴护理-护理学-02课件

AGLIMPSEATMATERNITYNURSINGinthe21stCENTURYK.L.Ringgenberg,RNC,MSN,WHNPShanghaiJiaoTongUniversitySONApril5,2006MaternityNursinginthe

21stCenturyAntepartumCareIntrapartumCareTechnologyinOB“Partum”Parturition:birthPartum:regardingtimeperiodtothebirthAntepartum:beforebirthorprenatalIntrapartum:duringthebirthprocessPostpartum:afterthebirth(usuallyregardedasthefirst30days)HistoryofAntepartumCarePriorto1925,noformalpracticeofantepartumcare.2ndCentury-warnedagainstviolentmovementstopreventROM,sexualintercourseharmfultopregnancy1513-firstpublishedOBtext(Germany)1700s-forcepsinvented,malemidwifedevelopedtheoriesformidwivesinLondon1700sinto1800s-birthsattendedbyfemalecommunityinUSduetopriceHistory-continued20thCentury-attheturnofthecentury,50%ofbirthsinUSconductedbymidwivesHometoHospital-History1900<5%USAbabiesborninhospital194050%197099%200599%FastFacts-Maternal1900-maternaldeathrate6-9/1000USA40%ofthosedeathswereduetoinfection2004-deathrateat~8-9/100,000USA1989-maternaldeathrateinChina95/100,0002004-48.3/100,00020thCenturyInfluencesHighinfant&maternalmortalityrates1914-coinedterm“nursemidwife”Today-nursemidwifeisdefinedasaRNwithanadvancedcertificationandmaster’sdegreeinmidwifery1925-Children’sBureauintheUSrecommendedantepartumcaretodecreasemortalityrates21stCentury-MajorShiftscausedbyManagedcareRiseofcollaborativehealthcareteamsMalpracticecrisesIncreasedconcernsforantepartumcareandqualityofcareInternetandcomputertechnologyTwins4/1000WestTriplets1/7,000-10,000SkopecQuads1/600,000IntrapartumCareinthe21stCenturyCareprovidedduringthebirthprocessVaginalDeliveryCesareanSection

CesareanSectionsC/Sratesareatanalltimehigh.Ratesvaryfromcountrytocountry.Someexamples:Netherlands<10%GreatBritain20%USA24-27%HK50%inprivatehospitalsChina~50%insomehospitalsThejuryisstillout!!!GlobalLook70%onaverage-birthsattendedbyCNMinWesternEurope85%-Holland(whichWHOdesignatesasidealor#1ranking)10%-UnitedStatesRefertopreviousstatsonmortality/morbidities.CertifiedNurseMidwifeRegisteredNurseAdvancedPracticeNurse(APN)Master’sdegreeinNursingSpecializinginMidwiferyCredentialingnecessaryforstatelicensingDefiningAttributesCNM-providesprenatal&gyncaretonormalhealthy(lowrisk)women;dodeliversandpostpartumcare.Practiceinhospitalsetting,clinics,birthingcentersandhomesMaypracticeindependentlyorincollaborationwithaphysicianCompetenciesObtainadmissionhistory&physicalAssessmentsofmotherandfetusOrderorinitiatetests,medicationsorproceduresPerformongoingexamsoflaborstatusAttendthedeliveryAttendinglaborandbirthProvidesafe,satisfyingcarePatientandfamilyareactiveparticipantsInformedconsentAppropriateuseoftechnologyActivitiesEvaluationComfortAssistanceSupportReassuranceManagementofcomplicationsTechnologyforthe21stCenterBirthingroomsDeliveryroomsOperativesuitesBirthingSuiteC-SectionRoomsLatestTechnologiesElectronicFetalMonitoring(EFM)UltrasonographyInfusionpumpsElectronicmonitoringdevices:1.Non-invasive2.InvasiveFetalSurgeriesElectronicFetalMonitoringIntermittentorcontinuousassessmentoffetalheartrate(FHR)anduterineactivity(UA)Goal-toassistinidentifyingthefetusatriskEFMEFMExternal(indirect)methodInternal(direct)AntepartumtestingwithEFMNST-non-stresstestCST-contractionstresstestBPP-biophysicalprofileAllassessfetalwell-beingIntrapartumEFMExternal-tocodynamometerandtransducerInternal-spiralelectrodeandintrauterinepressurecatheterFetalpulseoximetryEmergingEFMTechnologyComputeranalysisLackofcleardefinitionsandstandardsatthispointoffetalheartratepatterns,however,duetocomeoutthisyearElectronicHealthRecordComputersPaperlesschartsIntegratesallaspectsofassessment,interventionandevaluationDopplerUltrasonographyDoneatallstagesofpregnancyTransvaginalortransabdominalapproachDoneformaternalorfetalindicationsDoneinoffice,clinic,mobilecenters,obunit,L&DIndicationsMaternaldiseasesMultiplegestationsFetalgrowthEstablishmentoffetalagePlacentallocationandgradingAssessfetalwell-being(BPP)Pre-termlabor-cervicallengthsIt’saGirl!!!3-D&4-DUltrasound3-DEarlyGestationS/DRatiosPulseOximetryV/SMonitorsElectronicB/PMonitorCriticallyIllOBContinuouscardiacmonitoringInvasivehemodynamicmonitoringCVPArteriallinesPulmonaryarterylinesVentilatorOBCriticalCareUnitFlightNursesFlightNurseGeneticsHumanGenomeProjectRelationshiptoMaternityNursingAdvancedmaternalagePatternsofinheritancePrenataltestingGeneticcounselingEthicsandotherTelemedicineTelemetryMonitoring-FHRComputerUltrasoundimagesTelephoneInformaticsITComputersPatientaccesstoinformationNursinginformaticsAutomatedMedicationDispensingMachinesCutdownonerrorsBarcodesChartmedicationsLaborsavingAndmore