Maternal Levels of Care
Maternal Level of Care verification that Covenant Birth Center is seeking.
What is: Level 3
The definition of a severe range BP.
what is: BP >/= 160 systolic and/or >/= 110 diastolic
Signs of PPH.
What is: Tachycardia, hypotension, boggy uterus displaced left or right of midline, expressed clots with fundal massage or constant flow of lochia.
The rhythm of delivering PPV by T-piece with and without chest compressions.
What is: Breathe-2-3, Breathe-2-3; 1and2and3andbreatheand,1and2and3andbreatheand
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What is: The override number for the glucometer.
This is designed to help ensure facilities have the right resources, right staff, right equipment, and right processes in place for a patient’s specific needs and risk level. It verifies that a hospital has what’s needed to mitigate and respond to risks that lead to higher morbidity and mortality in mothers and infants.
What is: Maternal Levels of Care Verification
Your patient's initial BP at 0800 was 176/90, the repeat at 0815 is 180/102. This is the latest time you would treat the patient for hypertension.
what is: 0900 (60 minutes after initial severe BP)
The initial steps we take when our patient has more postpartum bleeding than we would expect.
What is: call for RN help (team leader, recorder), check BP & pulse, fundal assessment, fundal massage, call provider, ensure IV access, ensure bladder is draining, increase IV fluid rate (LR or NS), call for PPH cart, weigh pads/linen for accurate blood loss assessment, determine stage of PPH to guide need for blood products and labs
The steps of MR SOPA
What is: Mask adjustment, Reposition head, Suction mouth and nose, Open mouth, Pressure increase, Airway alternative
Resources to guide us through the care and documentation for patients experiencing perinatal loss
What is: Bereavement room and policies
These are standardized tools used in patient assessments that help guide care.
What is: Pain score; PPH assessment, newborn and maternal sepsis screening, Braden, fall risk, PPD screening, VTE risk assessment, nutrition screening, SDOH inquiry
The 3 fast-acting antihypertensive medications we give to treat severe range BPs.
what is:
Oral Nifedipine
IV Labetalol
IV Hydralazine
The etiology of increased bleeding, also known as the "Four T's" of PPH.
What is: Tone (atony), Tissue (retained placenta/products), Trauma (laceration), Thrombin (coagulation dysfunction)
How long we dry, stimulate, and/or suction before starting positive pressure ventilation
What is: 30-60 seconds
Notify the provider if this many doses of 40% glucose gel are administered in 24 hours.
What is: 3.
Where or how we find data to help identify if the patient we're caring for is considered high risk.
What is: H&P, prenatal records, policies, SDOH questions, results review, observation/assessment, report
Muscle weakness, facial flushing or hot flash, nausea, vomiting, dizziness, somnolence, dry mouth, slurred speech, and double vision; loss of consciousness, absent DTR activity, and a respiratory rate below 12 breaths per minute.
What are signs of magnesium toxicity?
The 4 uterotonic medications we administer to hemorrhaging patients.
What is: pitocin, cytotec, methergine, hemabate
The 4 questions that help us plan for the personnel that should be present at birth.
What is: EGA? Fluid color? Additional risk factors? Cord management plan?
Risks to assess for in infant following shoulder dystocia delivery.
What is: respiratory distress (asphyxia), fractured humerus, clavicle, or signs of brachial plexus injury
Units or services we collaborate with to meet patient care needs.
What is: dietary, lab, pastoral care, EVS, ICU, RNICU, VOB, CMU, MFM, social work
Our patient has a new complaint of headache paired with BP 172/103. These are examples of other preeclamptic signs we will assess for.
What is: vision changes, difficulty breathing, nausea/vomiting, RUQ pain, swelling, sudden weight gain, hyperreflexia (DTR, clonus), decreased urine output.
This medication is an antifibrinolytic, limiting the dissolution of clots and therefore decreasing bleeding caused by trauma or surgery
What is: tranexamic acid
The equipment that must be available at the radiant warmer for most neonatal resuscitations and checked prior to every birth.
What is:
Warm- Preheat, towels/blankets, temp probe and cover, hat, plastic wrap/thermal mattress for <32w; Airway- bulb syringe, suction catheter connected to wall suction @ 80-100 mmHg, tracheal aspirator; Auscultate- stethoscope;
Ventilate- flowmeter @ 10 L/min, blender @ 21% for term, 21-30% for preterm, PPV device (t-piece), term & preterm masks, 8F orogastric tube and 20 mL syringe, Laryngeal mask, 5F or 6F orogastric tube for laryngeal mask, Cardiac monitor and leads; Oxygenate- free-flow O2, Pulse ox sensor & cover, Saturation Table;
Intubate: Laryngoscope and blades (size 0, 1; 00 for preterm), stylet, endotracheal tubes, CO2 detector, measuring tape, waterproof table or tube-securing device, scissors
Medicate- access to epinephrine, NS, supplies for placing emergency UVC and medication administration, table of pre-calculated emergency medication dosages for babies weighing 0.5-4kg
Risks to assess for in mother following shoulder dystocia delivery.
What is: