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Improving Obstetric Patient

1.Identify at least one (1) risk factor from the patient’s obstetrical history associated
with the primary problem. Describe why this piece of obstetrical history places the
patient at risk for the identified problem.
2.Early identification of emergencies in the obstetric setting is essential to save lives.
Four (4) approaches are identified in the literature that can be utilized to positively
impact patient outcomes: simulations, drills, protocols, vital sign alerts. Select one of
these approaches and address the following: ?Discuss two (2) benefits and two (2)
limitations of the selected approach.
?Describe two (2) ways by which this approach will improve patient outcomes in the
perinatal setting.

Improving Obstetric Patient Outcomes Paper

Labour complications are the leading cause of long term disabilities, mortalities and
morbidity for both the mother and the babies. One of the approaches is to assess the patient
obstetrical history to identify if the pregnancy is a high risk or not. Certain maternal risks
factors are associated with risk factors and are identified by assess the outcomes of previous
pregnancies. In this context, the patient had suffered from spontaneous abortion during her
first pregnancy. Additionally, the patient had undergone other pregnancies (multiple
delieveries), and this could have had an impact with her delivery. This is the main factor that
could be associated with the prolonged labour and increased bleeding post-delivery. The
excessive may result due to the opened blood vessels during the caesarean delivery (Pillitteri,
2014). This is because a pregnant uterus has the most blood supplies as compared to any

Improving Obstetric Patient Outcomes Paper
other body organ. Therefore, the walls of the uterus are cut wide open to access the baby.
Although most of the women have the ability to tolerate the blood loss without presenting
any health complications, in some few people, some complications could arise. This is severe
especially in patients who have difficult in clotting; making it difficult to stop bleeding even
with minor cut or even shears. Research indicates that postpartum haemorrhage is common
and affects about 6% of the women undergoing caesarean delivery(Kee, Hayes, &
McCuistion, 2015).
To save the lives of both the child and the mother, it is important to identify emergencies in
the obstetric settings early enough. This is because emergencies can lead to the permanent
disabilities or even death of the mother, the infant or both. The main approaches identified by
the evidence based practice that can be utilized includes, drills, protocols, simulation and vital
sign alerts. In this case study, the best approach that should be used is the protocols. The most
strategic approach in this case is use of protocols. Protocols refer to set of rules and
procedures that must be followed based on the conventions that have been proven to work in
such incidences (Kee, Hayes, & McCuistion, 2015).
The main advantage is that it helps the healthcare provider make the most ethical decision as
required by the organization and their professional standards (Kee, Hayes, & McCuistion,
2015). Secondly, because the information in the protocols are written according to the
evidence based research, it provides the most effective remedy to patients irrespective of
where or who delivers the care i.e. makes quality care the standard. The main challenge is the
possibility of err in healthcare protocols, because the judgement value made by guideline
could be the wrong choice for this particular patient. Secondly, effective use of protocols is
determined by the nurse experience and clinical opinions, and thus, for an inexperienced
nurse can pick the most inferior options due to misconceptions or misrepresented community
norms (Hinkle & Cheever, 2013).

Improving Obstetric Patient Outcomes Paper
In this context, the protocol of postpartum assessment includes the assessment of patient’s
vital signs, the assessment of breasts, bladder, fundus, perineum, lochia, legs as well as any
other incision in the body. The patient pain must be assessed including the location, the type
of pain, quality and degree of severity. If necessary, pain medications can be administered to
reduce the irritation as well as the swelling. From the assessment records, the postpartum
condition of the patient was normal. However after one hour, the patient calls for help, as she
feels that she are bleeding a lot (Pillitteri, 2014).
The nurse assessment notices the vaginal bleeding, the patient if diaphoretic, pale and her
fundus is boggy even with a firm massage. This is an indicator of postpartum haemorrhage,
which could be due to uterine atony and trauma. Postpartum haemorrhages are grouped as
emergency complications, and must be treated by a qualified physician. According to the
protocols, the patient should be administered oxytocin IV or IM. If the intravenous oxytocin
is unavailable, or the bleeding still continuous, then the following medication should be
used, including the intravenous ergometrine, prostaglandin (sublingual misoprostol, 800 µg)
or combination of oxytocin-ergometrine is strongly recommended. With effective treatment
as indicated by the protocol, 90% of the patients make recovery few weeks. In some cases,
blood transfusion can be administered to patients who have lost a lot of blood. Other
supplements such as iron supplements, vitamins and nutritious dietary could facilitate
improve the patient strength and increase patients’ blood supply. The approach will reduce
the bleeding rate and improve the patients’ quality of life (Kee, Hayes, & McCuistion, 2015).
The protocol also helps in the identification of the risk factors associated with postpartum
haemorrhage including history of post-partum, prolonged labour, fetal macrosomia, multiple
deliveries. However, it can also occur in patients not presenting the risk factors. The
healthcare plan must be identified and designed before delivery. This coupled with

Improving Obstetric Patient Outcomes Paper
assessment of vital signs can improve the patient’s delivery process and help in the detection
of both slow and steady bleeding (Kee, Hayes, & McCuistion, 2015).

Improving Obstetric Patient Outcomes Paper
Hinkle, J., & Cheever, K. (2013). Brunner and Suddarth’s textbook of medical-surgical
nursing (13th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Kee, J., Hayes, E., & McCuistion, L. (2015). Pharmacology: A nursing process approach (8th
ed.). Philadelphia, PA: Elsevier.

Pillitteri, A. (2014). Maternal & child health nursing: Care of the childbearing and
childrearing family (7th ed.). Philadelphia: Lippincott, Williams and Wilkins.

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