Special Populations OB exam 1 |45 questions and answers.

Advances and problems in mother and infant care huge advancement shave been made in last 150 years though in the US serious problems exist such as . Lack of access to prepregnancy and pregnancy-related care for all women and the lack of reproductive health services for adolescents are major concerns. -Sexually transmitted infections, including acquired immunodeficiency syndrome (AIDS), continue to adversely affect reproduction. Reduce health disparaties? frican-Americans, Native Americans, Hispanics, Alaska Natives, and Asian/Pacific Islanders experience significant disparities in morbidity and mortality rates compared to Caucasians. Shorter life expectancy, higher infant and maternal mortality rates, more birth defects, and more sexually transmitted infections are found among these ethnic and racial minority groups. promote evidence-based programs, integrated approaches, and best practices to reduce disparities. addressing disparities and health equity through a comprehensive, community-driven approach to achieve health equity through collaboration and synergy Healthy people 2020 goals (1) attaining high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieving health equity, eliminating disparities, and improving the health of all groups; (3) creating social and physical environments that promote good health for all; and (4) promoting quality of life, healthy development, and healthy behaviors across all life stages goals of Healthy People 2020 are based on assessments of major risks to health and wellness, changes in public health priorities, and issues related to the health preparedness and prevention of our nation. BOX 1.2: reduce infant death, reduce child death, reduce maternal mortality, reduce Low birth weight/ VLBW, reduce woman of childbearing potential low RBC folate concentrations, inc infant breastfeeding, reduce fetal alcohol syndrome, reduce occurrence of neural tube defects, inc education/ infant back to sleep -are some specific examples Millennium development goals The United Nations Millennium Development Goals (MDGs) are eight goals that were to be achieved by 2015, responding to the main development challenges in the world -Goals three through five of the MDGs relate specifically to women and children. -2030 Agenda for Sustainable Development. This 2030 agenda consists of 17 Sustainable Development Goals (SDGs), also referred to as Global Goals, which are now replacing the MDGs majority of these SDGs are related to the environment and eliminating poverty, in many ways collectively encompassing social determinants of health, all of which are relevant to childbearing and childrearing. Integrative health care Integrative health care encompasses complementary and alternative therapies in combination with conventional Western modalities of treatment on the whole person, not just on a disease complex. Patients often find that alternative modalities are more consistent with their own belief systems and also allow for more patient autonomy in health care decisions alternative modalities include acupuncture, macrobiotics, herbal medicines, massage therapy, biofeedback, meditation, yoga, chelation therapy, and guided imagery Interprofessional education IPE Interprofessional education (IPE) consists of faculty and students from two or more health professions who create and foster a collaborative learning environment. The underlying premise of interprofessional collaboration is that patient care will improve when health professionals work together. Teamwork and communication are key aspects of IPE. Failure to communicate is a major cause of errors in health care. The Situation-Background-Assessment-Recommendation (SBAR) technique provides a specific framework for communication among health care providers about a patient's condition, reducing the potential for errors evidence base to improve communication and teamwork skills. Problems with the US health care system Structure of the Health Care Delivery System: -US health care delivery system is often fragmented and expensive and is inaccessible to many reducing medical errors: Medical errors are the third leading cause of death in the United States -Institute of Medicine (IOM) released its report- how nurses can decrease interruptions and distractions that contribute to medical errors. high cost of health care: Health care is one of the fastest-growing sectors of the US economy. Currently 17.5% of the gross domestic product is spent on health care -These high costs are related to higher prices, readily accessible technology, and greater obesity. Most researchers agree that caring for the increased number of low-birth weight (LBW) infants in neonatal intensive care units contributes significantly to overall health care costs. limited access to care: Barriers to access must be removed so pregnancy outcomes and care of children can be improved. The most significant barrier to access is the inability to pay. -ACA helps with costs -Lack of transportation and dependent child care are other barriers. In addition to a lack of insurance and high costs, a lack of providers for low-income women exists because many physicians either refuse to take Medicaid patients or take only a few such patients Health care reform: Affordable care act: The Act aims to make insurance affordable, contain costs, strengthen and improve Medicare and Medicaid, and reform the insurance market. There are provisions to promote prevention and improve public health; improve the quality of care for all Americans; reduce waste, fraud, and abuse; and reform the health delivery system. The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) advocated successfully for the inclusion in the ACA of contraceptive methods, services, and counseling, without any out-of-pocket costs to women; preventive services such as mammograms, well-woman visits, and screening for gestational diabetes; and providing breastfeeding equipment and counseling for pregnant and nursing women in new insurance plans. Work continues on implementation Accountable care organizations new rules under the ACA to help health care providers and hospitals better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). An ACO is a group of health care providers and health care agencies that are accountable for improving the health of populations while containing costs. Health Literacy Health literacy involves a spectrum of abilities, ranging from reading an appointment slip to interpreting medication instructions. These skills must be assessed routinely to recognize a problem and accommodate patients with limited literacy skills. Most education materials are written at too high a level for the average adult; e-health literacy has emerged as a concept As a result of the increasingly multicultural US population, there is a more urgent need to address health literacy as a component of culturally and linguistically competent care. Older adults, racial or ethnic minorities, and those whose income is at or below the poverty level are most vulnerable. Lower health literacy is associated with adverse health outcomes contribute to health literacy by using simple, common words; avoiding jargon; and assessing whether the patient understands the discussion. Speaking slowly and clearly and focusing on what is important increase understanding Trends in fertility and birth rate 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 Birth rate: Number of live births in 1 year per 1000 population Fertility rate: Number of births per 1000 women between 15 and 44 years of age (inclusive), calculated on an annual basis Infant mortality rate: Number of deaths of infants younger than 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 Pregnancy-associated deaths: All deaths during pregnancy and within the 1 year following the end of pregnancy Pregnancy-related deaths (subset of pregnancy-associated): Deaths that are a complication of pregnancy, an aggravation of an unrelated condition by the physiology of pregnancy, or a chain of events initiated by the pregnancy Neonatal mortality rate: Number of deaths of infants younger than 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 Low birth weight and preterm birth The risks of morbidity and mortality increase for newborns weighing less than 2500 g (5 lb, 8 oz)—low-birth weight (LBW) infants. Multiple births contribute to the incidence of LBW. - like twins/ triplets Non-Hispanic black infants are almost twice as likely as non-Hispanic white infants to be of LBW and to die in the first year of life. Cigarette smoking is associated with LBW, prematurity, and intrauterine growth restriction, with a higher rate among non-Hispanic white women and non-Hispanic black women Non-Hispanic black and Hispanic black women experienced increased rates of preterm births . Decreases in the infant mortality rate in the United States do not keep pace with the rates of other industrialized countries. One reason for this is the high rate of LBW infants in the United States in contrast with the rates in other countries. Maternal mortality Worldwide approximately 800 women die each day of problems related to pregnancy or childbirth. In the United States in 2011, the annual maternal mortality rate (number of deaths per 100,000 live births) was 17.8; the rate decreased to 15.9 in 2012, and then increased again to 17.3 in 2013 Although the overall number of maternal deaths is small, maternal mortality remains a significant problem because a high proportion of deaths are preventable, primarily through improving the access to and use of prenatal care services. significant racial disparity in the rates of maternal death, which are highest in non-Hispanic black women, followed by non-Hispanic white women In the United States, the three major causes are cardiovascular diseases, non-cardisovascular diseases, and infection -Unsafe abortion Factors that are strongly related to maternal death include age (younger than 20 years and 35 years or older), lack of prenatal care, low educational attainment, unmarried status, and non-Caucasian race. reduce rates:providing postabortion care, improving family planning services, and providing adolescents with better reproductive health services. Maternal morbidity Maternal morbidity includes such conditions as acute renal failure, amniotic fluid embolism, cerebrovascular accident, eclampsia, pulmonary embolism, liver failure, obstetric shock, respiratory failure, septicemia, and complications of anesthesia (pulmonary, cardiac, central nervous system). Maternal morbidity results in high-risk pregnancy. The diagnosis of high risk imposes a situational crisis on the family. Approximately 25% of women who were pregnant in 2014 in the United States were obese -The two most frequently reported maternal medical risk factors are hypertension associated with pregnancy and diabetes, both of which are associated with obesity. decreased fertility, congenital anomalies, miscarriage, and fetal death are also associated with obesity. Regionalization of perinatal health care services Not all facilities can develop and maintain the full spectrum of services required for high-risk perinatal patients. regionalized system focusing on integrated delivery of graded levels of hospital-based perinatal health care services is effective and results in improved outcomes for mothers and their newborns. Basic care is provided by obstetricians, family physicians, certified nurse-midwives, and other advanced practice clinicians approved by local governance. Routine risk-oriented prenatal care, education, and support are provided. specialty care are obstetricians who must provide fetal diagnostic testing and management of obstetric and medical complications in addition to basic care subspecialty care is provided by maternal-fetal medicine specialists and reproductive geneticists and includes the aforementioned in addition to genetic testing, advanced fetal therapies, and management of severe maternal and fetal complications. high technology care Advances in scientific knowledge and the large number of high-risk pregnancies have contributed to a health care system that emphasizes high-technology care. Maternity care has extended to preconception counseling, more and better scientific techniques to monitor the mother and fetus, more definitive tests for hypoxia and acidosis, and neonatal intensive care units. Strides are being made in identifying genetic codes, and genetic engineering is taking place. Women's health has expanded to emphasize care of older women, new cancer-screening techniques, advances in the diagnosis and treatment of breast cancer, and work on an AIDS vaccine. elehealth is an umbrella term for the use of communication technologies and electronic information to provide or support health care when the participants are separated by distance. It permits specialists, including nurses, to provide health care and consultation when distance separates them from those needing care. Social media uses Internet-based technologies to allow users to create their own content and participate in dialog. there are pitfalls for nurses using this technology. Patient privacy and confidentiality can be violated, and institutions and colleagues can be cast in unfavorable lights with negative consequences for those posting the information To help make nurses aware of their responsibilities when using social media, the American Nurses Association (ANA) published six principles for social networking and the nurse Comm based care A shift in settings from acute care institutions to ambulatory settings, including the home, has occurred. Even childbearing women at high risk are cared for on an outpatient basis or in the home. Technology previously available only in the hospital is now found in the home. childbirth practices Prenatal care can promote better pregnancy outcomes by providing early risk assessment and promoting healthy behaviors such as improved nutrition and smoking cessation. Preconception care ideally begins before pregnancy because early decisions lay the foundation for the entire perinatal year. Preconception or early-pregnancy classes also emphasize health-promoting behavior and choices of care. Women who choose nurse-midwives as their primary care providers participate more actively in childbirth decisions, receive fewer interventions during labor, and are less likely to give birth prematurely Involving consumers and promoting self management Self-management of health care is appealing to both patients and the health care system because of its potential to reduce health care costs. Maternity care is especially suited to self-management nutrition education, stress management, smoking cessation, alcohol and drug treatment, prevention of violence, improvement of social supports, and parenting education are appropriate for such encounters. International concerns Access to prenatal care and family planning education, care for women experiencing postpartum hemorrhage, obstructed labors with no access to hospital care or operative birth, fistulas due to obstructed labors, and HIV-positive parents are major international concerns. The high maternal and infant mortality in developing countries is a serious problem Female genital mutilation, infibulation, and circumcision are terms used to describe procedures in which part or all of the female external genitalia is removed for cultural or nontherapeutic reasons Human trafficking is a serious crime, an illegal business that exists in the United States and internationally, in which mostly women and children are "trafficked," or forced into hard labor, sex work, and even organ donation Future of nursing four key messages: (1) nurses should practice to the full extent of their education and training; (2) nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression; (3) nurses should be full partners with physicians and other health care professionals in redesigning health care in the United States; and (4) effective workforce planning and policy-making require better data collection and an improved information infrastructure Trends in Nursing Practice The increasing complexity of care for maternity and women's health patients has contributed to specialization of nurses working with these patients. This specialized knowledge is gained through experience, advanced degrees, and certification programs. Nurses in advanced practice (e.g., nurse practitioners and nurse-midwives) may provide primary care nurses deliver high-quality, comprehensive, and cost-effective care in a variety of settings. Nursing intervention classification all patient records be computerized by 2000, a need for a common language to describe the contributions of nurses to patient care became evident. EBP Evidence-based practice—providing care based on evidence gained through research and clinical trials—is increasingly emphasized. Although not all practice can be evidence-based, practitioners must use the best available information on which to base their interventions Cochrane Pregnancy and Childbirth Database The evidence from these studies should encourage practitioners to implement useful measures and abandon those that are useless or harmful. Studies are ranked in the following six categories: 1. Beneficial forms of care 2. Forms of care that are likely to be beneficial 3. Forms of care with a trade-off between beneficial and adverse effects 4. Forms of care with unknown effectiveness 5. Forms of care that are unlikely to be beneficial 6. Forms of care that are likely to be ineffective or harmful