EXAM 1: OB
Chapter 1: 5 items
Risk factors, negligence, maternity nursing care/interventions
RISK FACTORS
● Risk Management
○ Identifies risk, establishes preventative practices, develops reporting mechanisms,
delineates procedures for managing lawsuits
■ Systems of checks and balances that ensure high-quality client care from
preconception until ater birth
● Sentinel Events: any event that is not due to underlying conditions or natural courses of a client’s
condition that afects a client, resulting in death, permanent harm, or severe temporary harm
○ Perinatal events that need 4 or more units of blood and/or ICU admission
■ Example: Kernicterus
● Failure to Rescue: the failure to recognize or act on early signs of distress
○ Key components:
■ (1) careful surveillance and identification of complications
■ (2) quick action to initiate appropriate interventions and activate a team
response
○ For the perinatal nurse, this involves: careful surveillance, timely identification of
complications, appropriate interventions, and activation of a team response to minimize
client harm
○ Maternal complications appropriate for process measurement: placental abruption,
postpartum hemorrhage, uterine rupture, eclampsia, and amniotic luid embolism
○ Fetal complications: nonreassuring fetal heart rate and
pattern, prolapsed umbilical cord, shoulder dystocia,
uterine hyperstimulation
● QSEN: efort to provide nurses with the competencies to
improve the quality and safety of the system of health care in
which they practice
NEGLIGENCE
● Standard of care: level of practice that a reasonably prudent
nurse would provide in the same or similar circumstances
○ If standard was not met and harm resulted, negligence
occurred
ADD BOX 1.8
MATERNITY RN CARE & INTERVENTIONS
Trends in Nursing Practice
,● Nursing Interventions Classification
○ Comprehensive standardized language that describes interventions that are performed
by generalists or specialist nurses.
○ Examples of interventions for childbreaing care to assist in the preparation of childbirth
before, during, and ater the birth included breastfeeding assistance, childbirth
preparation, circumcision care, electronic fetal monitoring, family planning, and
kangaroo care.
● Evidence-Based Practice
○ Providing care based on evidence gained through research and clinical trials
● Cochrane Pregnancy and Childbirth Databases
○ Oversees up-to-date, systematic reviews of randomized control trials of health care and
disseminates these reviews.
○ Studies are ranked in six categories:
■ 1: forms of care that are beneficial
■ 2: forms of care that are likely to be beneficial
■ 3: forms of care with a trade of between beneficial and adverse efects
■ 4: forms of care with unknown efectiveness
■ 5: forms of care that are unlikely to be beneficial
■ 6: forms of care that likely to be inefective or harmful
● Joanna Briggs Institute
○ Uses a collaborative approach for evaluating evidence from a range of sources
○ Uses grades of recommendation for evidence of feasibility, appropriateness,
meaningfulness, and efectiveness
■ A: strong support that merits application
■ B: moderate support that warrants consideration of application
■ C: not supported care
● Outcome-Oriented Practice
○ Outcome-oriented care measures efectiveness of care against benchmarks or standards
○ Did the client benefit or not benefit from the care provided?
○ OASIS: outcomes system
○ NOC: efort to identify outcomes and related measures that can be used for evaluation of
care of individuals, families, and communities across the care continuum
,Chapter 2: 6 items
Family system, culture, cultural competence, risk factors, home health care
FAMILY SYSTEM
● Nuclear family - traditional American family in which husband, wife, and children
(biological/adopted) live as an independent unit, sharing roles, responsibilities, and economic
resources
○ Steadily decreasing in response to societal changes
● Extended family - grandparents, aunts, uncles, etc that live with or close to family
○ Provides social, emotional, and financial support to one another
● Multigenerational families - consist of three or more generations of relatives (grandparents,
children, and grandchildren)
○ Can create some stress of taking care of the older generation
● Nonbiologic-parent families - those in which children live independently in foster or kinship care
such as living with a grandparent
● Married-blended families - formed as a result of divorce and remarriage, consists of unrelated
family members (stepchildren, stepparents, step siblings)
● Cohabiting-parent families - those in which children live with two unmarried biological parents or
two adoptive parents
○ Prevalent in Hispanic households
● Single-parent families - comprise an unmarried biological or adoptive-parent family may result
from the loss of a spouse (death, divorce, etc), unplanned/planned pregnancy, adoption of a child
by an unmarried adult
○ Single parent family tends to be more vulnerable economically and socially, which can
create and unstable and deprived environment
○ Afects health status, school achievement, and high-risk behaviors for children
● Alternative families (LGBTQ+) - may live together with or without children
○ Can be considered nuclear families as they oten consist of two parents with either
biologic or adoptive children
eoretic Approaches to Understanding Families
● Family nursing
○ Plays a pivotal role in health care, representing the primary target of healthcare delivery
for maternal and newborn nurses
, ○ Crucial to help incorporate newborn into family
○ Families are a part of the interprofessional healthcare team and as the unit of care
○ erapeutic communication should be utilized
○ Share information in ways that are: positive, useful, complete, accurate, and timely
Family theories
○ Used to describe families and how the family unit responds to events within and outside
the family
○ Each theory makes assumptions about the family and has inherent strengths and
limitations
○ Use of family theories can
guide assessments and
interventions for the
family
● Family assessment
○ Should be a
health-promoting model
rather than illness-care
model
○ Low-risk family can be
assisted in promoting a
healthy pregnancy,
childbirth, and
integration of newborn
