Pregnancy Induced Hypertension

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Pregnancy Induced Hypertension

• Frances Williams, RN, BSN
• Carla Whaley, RN, BSEd

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Acknowledgement

• 2 simulators, 100 students, What next?
• Scenario from Texas Womens University at
  National METI Conference in 2007

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Objectives

• Participants will
• Apply simulation in your curriculum
• Demonstrate scenario writing relative to your
  targeted goals expectations
• Recognize signs symptoms of pregnancy induced
  hypertension
• Identify nursing actions for pregnancy induced
  hypertension
• List specific props moulage for scenario
• Reenact a scenario with multiple roles

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Leading causes of Maternal Mortality

• Hemorrhage
• Pregnancy Induced Hypertension (toxemia)
• Embolism
• Infection in third world countries

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Use of HPS

• HPS feminized for scenario-
• Stanette programmed for 40 week IUP
• Wig, Bra (better if padded)
• Peripads made to simulate bleeding
• Soft breast form to simulate fundus
• IV labeled Pitocin
• IV Blood Bag (optional)

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Roles

• Students are assigned roles to play
• Charge nurse, primary nurse, recording nurse,
  medication nurse, nurse specialists
• Support roles i.e., pharmacist, lab tech, Doula
  (labor coach) lactation consultant, family
  members, birth registrar

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• You are the nurse taking care of Lynette Stanton,
  a 29 year old woman who has just delivered a 7 lb
  8 ounce boy. She had a normal course of labor
  and delivery, received a 1st degree episiotomy
  and is coming to floor from the labor/delivery
  suite. She has an IV hanging with pitocin in the
  bag.
• She is exhausted from the labor and just wants
  to rest. Her BP is 138/89. Her fundus is at the
  umbilicus and is firm to the touch with a small
  amount of blood noted on the peripad.
• What are the nursing actions you will take?
• Notify Dr. re BP. Keep IV going, Have Mag SO4
  available. Check frequent VS. Prepare for
  seizure precautions. Cont with post partum
  checks peripad, fundus, lochia. etc
• Her BP is now 148/94. She is complaining of a
  headache and is seeing spots before her eyes.
• What nursing action will you now take and what
  actions can you expect the Dr. to order.
• Notify Dr. re BP. Frequent VS. Do Not Leave pt.
  Alone. Expect order for MagSO4. Start IV if one
  not running. Pad siderails, stock with plastic
  airway and padded tongue blade if policy allows.
  Have O2 and suction equipment available. Once
  MagSO4 started or if pt already on MagSO4 check
  DTRs. Turn pt to side if she tolerates it.
• Your patient has suffered a seizure. What
  actions will you now take and what might you
  expect the Dr. to order?
• Seizure precautions. See above, Mag SO4 if not
  started. Seizure protocol. Neuro consult.your

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Difficulties

• Problems within groups reflect in cooperation
  within scenario
• Possible Solution Assign roles breaking up
  known conflicts
• Random draw from hat
• Number off 1,2,3,4, etc.

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Challenges

• Not enough Staff
• Need at least 2 staff per simulator
• 1 to run simulator, other to supervise group
• Ideal 3 staff per simulator/scenario

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Bibliography

• How can we reduce death rates from childbirth?
  Population Research Bureau, April 2007, Online
  discussion
• Tampa Bay Times newspaper, March, 2007
• 2 simulators, 100 students, What next?
  presentation at METI 2006 conference, Tampa,
  Florida

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• Thank you for attending today