Evidence-based interventions for neonatal abstinence syndrome.

This review aimed to determine best nursing practice by systematically and critically reviewing the appropriate literature and expert guidelines. Using keyword and literature databases, over 480 journal titles were reviewed. Twenty-four articles and three expert guidelines were chosen. The majority of articles selected as evidence were Level IV--opinions of respected authorities based clinical experiences, descriptive studies, case reports, or reports of experts. Two articles were Level I-II--experimental studies. Results of the review showed that traditional supportive interventions also have a body of evidence for their use. Although there is much research regarding neonatal abstinence syndrome (NAS), the majority of future research needs to be at a higher level of evidence. Nursing applications include obtaining evidence for best practice through diligent searches of the literature and expert guidelines.

Adverse maternal outcomes in women with asthma versus women without asthma.

The purpose of this retrospective cohort study was to examine differences in adverse maternal outcomes between pregnant women with asthma and pregnant women without asthma. A total of 7,777 pregnant patients with asthma were abstracted from a national database. The comparison group was 31,108 women, randomly selected from 541,719 pregnant women without asthma. Logistic regression was used to examine the relationship of asthma to 12 maternal outcome measures. Odds ratios were used to approximate the association of how much more likely pregnant women with asthma were to have adverse maternal outcomes. Pregnant women with asthma were more likely to have adverse maternal outcomes than did the pregnant women without asthma.

Neonatal Abstinence Syndrome: An Uncontrollable Epidemic.

There is an uncontrollable epidemic of drug abuse, with the misuse of opioids the most alarming. Along with the increase in opioid abuse, there exists a concomitant upsurge in the number of neonates experiencing neonatal abstinence syndrome (NAS) due to the effects of the mother's withdrawal from the drug. Neonates experiencing NAS exhibit various nervous system, gastrointestinal, and respiratory untoward symptoms. Diagnosis is determined by taking an accurate maternal history and assessment of clinical signs and symptoms. Clinical management strategies include pharmacologic and nonpharmacologic therapies. Nursing care is evidence based, includes nonpharmacologic therapies, and focuses on prevention and support.

Adverse maternal outcomes in women with asthma: differences by race.

PURPOSE: To examine the relationship between race and adverse maternal outcomes in women with asthma. STUDY DESIGN AND METHODS: This retrospective cohort study examined 11 adverse maternal outcomes across racial groups of 13,900 pregnant women with asthma (age 13 to > or = 40) who gave birth between 1998 and 1999. The data were abstracted from a national database, The National Inpatient Sample (NIS), available through Health Care and Utilization Project (HCUP) maintained and disseminated by the Agency for Healthcare Research and Quality (AHRQ). Maternal age and comorbidities were adjusted in multivariate analysis. RESULTS: For women with asthma, African Americans were more likely than Whites to have preterm labor and infection of the amniotic cavity; Hispanic women had comparable outcomes with the exception that postdate pregnancy was less likely to be 42 weeks; and Asian/Pacific Islander women had a higher risk of having gestational diabetes and infection of the amniotic cavity. CLINICAL IMPLICATIONS: As adverse maternal outcomes for women with asthma were higher in minorities, and as minorities have traditionally had more barriers to healthcare, the study results indicate that more effort needs to be made to educate nurses, consumers, and government officials about the potential adverse maternal outcomes of asthma during pregnancy. Public awareness may assist in overcoming the barriers to healthcare experienced by minorities.

Nursing Care of Women With Interstitial Cystitis/Painful Bladder Syndrome.

Interstitial cystitis/painful bladder syndrome is a chronic condition affecting approximately 3.3 million women in the United States. It is defined by the National Institute of Diabetes and Digestive and Kidney Diseases as "urinary pain that can't be attributed to other causes such as infection or urinary stones." Because of the intimate nature of the symptoms, women are often reluctant to seek treatment. When they do, they require a care provider with specialized nursing skills. Nursing practice based on carefully reviewed literature will result in the provision of comprehensive and compassionate nursing care for women with interstitial cystitis/painful bladder syndrome.

Social support in Mexican American childbearing women.

Because the Mexican American population in the United States is increasing, nurses will inevitably come into contact with members of this cultural group. Social support is essential for women to adapt to the demands of the perinatal period, and Mexican American childbearing women face particular challenges in obtaining social support. In this article, traditional roles and social support in Mexican American families are described, the challenges of delivering prenatal care within these traditions are discussed, and strategies for nursing intervention are offered.

The perinatal: special care unit: expert care for high-risk patients.

Labor and delivery units are often used to provide care for nonlaboring patients requiring intensive medical and nursing care. The utilization of labor beds in this manner, however, can result in a shortage of beds for those patients who are truly in labor. Unfortunately, patient dissatisfaction, use of supplemental staffing, and ill-prepared, overworked nurses can then become the result of this practice. Clearly, an improved, innovative model of providing care for high-risk perinatal patients is needed. The purpose of this article is to describe how one hospital and its interdisciplinary team met the challenge of providing expert care for complex perinatal patients by creating a unique model of patient care delivery, the perinatal special care unit (PSCU). An advanced practice nursing role, the perinatal nurse practitioner (PNNP) was implemented to provide collaborative care for these patients. This article includes a discussion of positive and negative outcomes that occurred after the PSCU became a reality. Overall, housing patients on the PSCU has eliminated inappropriate use of labor and delivery beds and has led to a more satisfying childbearing experience for all involved.

Red alert: perinatal hemorrhage.

The purpose of this article is to help nurses understand how to quickly and effectively manage the nursing care of patients with perinatal hemorrhage. The etiology, symptoms, medical management, and nursing care of the patient experiencing a perinatal hemorrhage are discussed. Hemorrhage during the antepartum, intrapartum, or postpartum period is a life-threatening emergency for the mother and/or fetus. Early antepartum hemorrhage (before 20 weeks gestation) can be related to abortion/miscarriage, ectopic pregnancy, or gestational trophoblastic disease; late antepartum hemorrhage (after 20 weeks gestation) may result from placental abruption and placenta previa. Intrapartum hemorrhage is most commonly due to placental abruption, or to uterine rupture, uterine inversion, invasive conditions of the placenta, or complications of Cesarean birth. Postpartum hemorrhage is defined as blood loss greater than 500 ml in a vaginal delivery or 1000 ml in a Cesarean birth; early postpartum hemorrhage occurs during the first 24 hours after delivery; late postpartum hemorrhage occurs after the first 24 hours after delivery. The most common cause of postpartum hemorrhage is uterine atony; however, lacerations, hematomas, and subinvolution of the uterus can also cause postpartum hemorrhage. Nurses who understand how to assess, plan, intervene, and evaluate outcomes for perinatal hemorrhage are in the position to prevent the major tragedies that can accompany hemorrhage in pregnancy and shortly afterward.

The effect of social support and acculturation on postpartum depression in Mexican American women.

Postpartum depression was studied in 66 multiparous Mexican American women using a prospective longitudinal design. Interviews were conducted at 34 to 36 weeks prenatally and 4 to 6 weeks postpartum. Women expressing prenatal depression were more likely to continue to experience depression postpartum. Other predictors included a high need for postpartum support, specific support network characteristics, acculturation, and poor quality relationships within the family. It is important for the health care provider to assess the presence of depressive symptoms and available social support during the prenatal period and work with Mexican American mothers to increase support and secure help in dealing with daily life stressors.

Perinatal implications of sickle cell disease.

Sickle cell disease (SCD) affects millions of people across the globe. In the United States, approximately 70,000 to 100,000 people have the disease, and 2 million have the sickle cell trait. SCD occurs once in every 500 African American births, and once in 36,000 Hispanic American births. Women with SCD can have more adverse maternal outcomes such as preeclampsia, eclampsia, preterm labor, placental abruption, intrauterine growth restriction, and low birthweight. Providing comprehensive nursing care to women with SCD is a challenge, particularly during labor and birth, with nursing management aimed at attaining healthy birth outcomes while preventing or treating manifestations of the disease. Labor and delivery nurses are responsible for specific knowledge and care practices for these women, including differentiating the pain of sickle cell crisis from contraction pain and monitoring maternal and fetal oxygenation, as oxygenation is jeopardized in laboring sickle cell patients. Intrapartum nursing care also requires vigilance in the need for emergency cesarean birth. Nursing interventions include symptom management, pain management, ensuring patient safety, and educating patients. Coordination of care and clear communication between the members of the healthcare team, patient, and family are essential elements to ensure a positive outcome for perinatal patients with SCD.