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In such instances, having a sound skill base in physical assessment is paramount, as the collection of data by which to identify physiological predic to rs and 1717 thus determine urgency becomes our primary triage method. Remember, to o, that in some instances communication through a third person, such as a relative, caregiver or interpreter, may contribute to the assessment process. In such cases communication may also be challenging, as the message sent from the third person is their own interpretation of events, which provides another potential barrier. Communication is a process of sending and receiving messages between individuals within a dynamic context. The entire communication encounter is infuenced by a range of fac to rs and stimuli. This means that the Triage Nurse will often carry the responsibility of recognising and managing the infuencing fac to rs for both themself and the patient. The more the Triage Nurse understands these fac to rs that infuence the effectiveness of communication, the better the communication and the quality of data gathered. It is often the effort displayed by the Triage Nurse that will overcome these barriers, and reassure the patient that their communication with the nurse is private, thorough and confdential. The avoidance of key terms and the use of euphemisms may lead to dis to rtion of the messages sent and received. These expectations are infuenced by their perception of the urgency of the health concern and by their past health care experiences, and may at times be unrealistic. Although such infuences can aid in early symp to m recognition, they can also potentially lead to inappropriate assumptions and bias. Developing a basic strategy to interpret communication behaviour quickly may assist in minimising the effects of challenging communication behaviours upon the triage assessment. To feel welcome Looking around before Provide a warm and friendly entering; looking lost welcome.
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The most important source of microorganisms responsible for post-caesarean section infection is the genital tract, particularly if the membranes are ruptured preoperatively. Even in the presence of intact membranes, microbial invasion of the intrauterine cavity is common, especially with preterm labour. Infections are commonly polymicrobial and pathogens isolated from infected wounds and the endometrium include Escherichia coli, other aerobic gram-negative rods and group B strep to coccus. General principles for the prevention of any surgical infection include careful surgical technique and skin antisepsis; prophylactic antibiotics should be administered to reduce the incidence of pos to perative infection. Venous thromboembolism Deaths from pulmonary embolism remain an important direct cause of maternal death, and caesarean section is a major risk fac to r. The signs and symp to ms of pulmonary emboli and deep vein thrombosis are detailed in Chapter 6, Antenatal obstetric complications. The incidence of such complications can be reduced by adequate hydration, early mobilization and administration of prophylactic heparin. Early recognition and prompt initiation of treatment will reduce the consequences of venous thromboembolism. Psychological All difficult deliveries carry increased maternal psychological and physical morbidity. The psychological wellbeing of women delivered by emergency caesarean section may be compromised by delayed contact with the baby, a fac to r that in most cases should be amenable to remedy. The obstetrician who performed the delivery should review the woman prior to hospital discharge to discuss the indication for delivery, the potential for complications, the implications for the future and to answer any questions she or her partner may have. Consequently, the problem of managing a woman with a previous caesarean section in a subsequent pregnancy is common. It is a vital part of antenatal care that women be given a clear understanding of the plan of management from early on in their pregnancy, with the caveat that this may need to be adapted if the pregnancy presents unexpected problems. The management in pregnancy following a caesarean section should be to review the previous delivery, assess the available options and to select the appropriate choice through a shared decision making process with the woman. The predominant fac to rs to be weighed when determining the recommended mode of delivery depend on the balance between the preferences of the mother, the risks of a repeat operation, the risks to her child of labour and the risk of labour on the integrity of the uterine scar. Clinical risk management Operative delivery whether by vacuum, forceps or caesarean section has never been free from controversy, and is certainly not without risks. Litigation occurs more frequently following brachial plexus injury, cerebral palsy and maternal pelvic floor damage. Common allegations against practitioners include inadequate indication for operative delivery, excessive use of force with vacuum or forceps, lack of informed consent, delayed delivery by caesarean section and inadequate supervision. It is essential, however, that opera to rs are appropriately trained in decision-making, that they operate within their competencies, have access to senior support and are effective communica to rs.
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N Family his to ry A woman reported a family his to ry of aortic dissection at booking, but the signifcance of this was not recognised, partly because of confusion in interpretation of a prior genetic assessment which had excluded known genetic aor to pathies but had noted there was still a 50% risk of an unknown inherited aor to pathy. In the late stages of pregnancy, she developed severe back pain and sys to lic hypertension and was assumed to have pre-eclampsia. She subsequently developed abdominal and lower limb symp to ms at which time the aortic dissection from which she died was diagnosed. In this instance, it indicated the likelihood of an inherited, albeit unknown, aor to pathy. Recent assessments have shown that there are clinically relevant cardiac gene mutations detectable in at least a quarter of children and young adults who died from sudden unexplained cardiac death (Bagnall et al. A family his to ry of sudden death of young relatives must be elicited at booking, potentially by inclusion within booking checklists, its signifcance should be recognised and appropriate referral for further assessment made. A family his to ry of sudden death of a young relative (aged less than 40) is important and may be an indica tion of inherited cardiac conditions. N When aortic dissection occurs in a young woman, the underlying diagnosis should be assumed to be an inherited aor to pathy until proven otherwise. New genetic aor to pathies are regularly discovered, but it seems likely that there are many more still to be found (Regitz-Zagrosek et al. Therefore, the exclusion of known aor to pathies or genetic mutations does not exclude the possibility of a genetic syndrome. This woman was advised she had a 50% risk of an undiagnosed inherited aor to pathy and should have been managed as if she had Marfan or a similar syndrome. Her back pain should have led to the consideration of aortic dissection; subsequent abdominal and neurological symp to ms are also recognised presentations of aortic dissection. Genetic counselling should state for women known to be carriers of any inherited condition, whether the associated genetic mutation is known or unknown, and whether they need a cardiovascular risk assess ment in pregnancy. Women with Vascular Ehlers-Danlos syndrome are at high risk of dissection of major arteries and veins during pregnancy. Turner syndrome is associated with an increased risk of aortic dilatation, and, notably, aortic dissection is six times more common than in the general popu lation (Regitz-Zagrosek et al. Many conditions which are uncommonly encountered in obstetric practice have cardiovascular manifestations, and expert advice should always be sought to guide management during pregnancy. Documenting the presence of a syndrome is not a substitute for fnding out whether there are particular cardiovas cular considerations in pregnancy and making appropriate referral. Specifc guidance on lifetime cardiovascular screening for women and girls with Turner syndrome is available (Mortensen et al. Bystander cardiopulmonary resuscita tion was undertaken for 20 minutes until the arrival of paramedic staf. On arrival at hospital, perimortem caesarean section was not undertaken because of the prolonged resuscitation time. Perimortem caesarean section is an important part of the resuscitation of a pregnant woman.
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Try to rest for an hour or nightmares about the baby the extra water tends to gather in a day with your feet higher and about the birth. Stretch marks y r fe t u s these are pink or purplish lines which usually occur on your abdomen or sometimes on your upper thighs or breasts. You are more likely to get stretch marks if your weight gain is more than average. After your baby is born, the marks should gradually pale and become less noticeable. During pregnancy, hormonal changes in your body can cause plaque to make your gums more infiamed. Make sure you may feel tired or even you are pregnant and for a year that you get plenty of rest. Make time to sit with replacement fillings should be your feet up during the day and delayed until after your baby accept any offers of help from is born. High blood pressure However, you can have severe and pre-eclampsia pre-eclampsia without any Placenta praevia During pregnancy your blood symp to ms at all. Placenta praevia (or a low-lying pressure will be checked at placenta) is when the placenta is Although most cases are mild and every antenatal appointment. Treatment may start with If the placenta is still low in the uterus, there is a higher chance that you could bleed during your pregnancy or at the time of birth.
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The first few days Each time your baby feeds, they are letting your body know how much milk it needs to produce. Finding one amount of milk you produce will that is comfortable for both of settle. Your baby will be happier if you will help your baby feed as you keep them near you and feed well as possible. At night, your baby baby lying on your tummy, they the nose level with your nipple. If you are very You can try feeding lying on your uncomfortable or sore, ask for help. This will make it easier to hold your baby so their neck, shoulders and back are supported and they can reach your breast easily. Some parents worry the head tipped back so that the to ngue that breastfeeding will make it harder for their partner to bond can reach as much breast as possible. You have an important role to play in supporting your partner, for example by preparing meals or providing extra help so she can get some rest. You can do small, practical things like making sure she has a cool drink to hand while she is feeding, and later you can even give some feeds yourself, 4 using expressed milk. Babies (although the first few sucks often pause after the initial quick may feel strong).