Page 764 - ACCCN's Critical Care Nursing

Pregnancy and Postpartum Considerations 741

Learning activities
1. List the key physiological adaptations of the cardiovascular 7. Outline the minimum postnatal assessment that Carly should
and respiratory systems during pregnancy. have each day she is in ICU.
2. Interpret the following ABG with reference to the normal ranges 8. John tells you that Carly breastfed their first child and was
−
for pregnancy. PaO 2 = 79; PaCO 2 = 45; pH = 7.31; HCO 3 = 18 planning to breastfeed this child. What can you do to support
3. Outline the key management priorities when caring for a the process of lactation? What milk production would you
woman in ICU with severe preeclampsia. expect over the first 2 days in ICU?
4. Explain to a colleague what placenta praevia and placenta 9. Consider the support that John and their first child might need
accreta are. whilst Carly is in ICU. How would you support the integration
Activities 5 to 11 relate to the case study. of the new family member?
5. You are assigned to Carly when she is admitted to ICU. Outline 10. Write a transfer letter that will accompany Carly back to the
the key elements of your admission assessment including tertiary obstetric hospital for the midwives who will be con-
those related to midwifery assessment. tinuing her care. Ensure that you include relevant details of
6. Within an hour of Carly’s admission to ICU, her husband John her ICU stay, including midwifery progress.
arrives and asks to see his wife. John wants to know what has 11. Discuss the potential implications of this unexpected serious
happened and is very worried about her. What would you say event for Carly and her family as she recovers and ‘life goes
to John? What can John expect over the next couple of days? back to normal’.

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11. Fraser D, Cooper M, eds. Myles’ textbook for midwives, 15th edn. Oxford:
FURTHER READING 12. Pairman S, Tracy S, Thorogood P, Pincombe J, eds. Midwifery preparation for
Churchill Livingston/Elsevier; 2009.
practice, 2nd edn. Chatswood: Churchill Livingstone, 2010.
Belfort MA, Saade GR, Foley MR, Phelan JP, Dildy GA, eds. Critical care
obstetrics, 5th edn. Hoboken: Wiley-Blackwell; 2010. 13. Norwitz, ER, Edusa V et al. Maternal physiology and complications of
Foley M, Strong T, Garite T, eds. Obstetric intensive care manual, 3rd edn. Columbus: multiple pregnancy. Seminars in Perinatology 2005; 29(5): 338–48.
McGraw-Hill; 2010. 14. Robson SC, Dunlop W, Moore M, Hunter S. Haemodynamic changes during
Fraser D, Cooper M, eds. Myles’ textbook for midwives, 15th edn. Oxford: Churchill the puerperium: a Doppler and M-mode echocardiographic study. BJOG
Livingstone/Elsevier; 2009. 1987; 94(11): 1028–39.
Pairman S, Tracy S, Thorogood C, Pincombe J, eds. Midwifery preparation for prac- 15. Crapo, RO. Normal cardiopulmonary physiology during pregnancy. Clinical
tice, 2nd edn. Chatswood: Churchill Livingstone, Elsevier; 2010. Obstetrics and Gynecology 1996; 39(1): 3–16.
Pearlman M, Tintinalli J, Dyne P, eds. Obstetric and gynecologic emergencies: diagnosis 16. Hunter S, Robson S. Adaptation of the maternal heart in pregnancy. British
and management. Chicago: McGraw-Hill Professional Publishing; 2004. Heart Journal 1992; 68(6), 540–43.
17. Norwitz E, Robinson J, Malone F. Pregnancy-induced physiologic alterations.
In Dildy GA, Belfort MA, Saade GR et al, Eds. Critical care obstetrics, 4th edn.
Massachusetts: Blackwell Science; 2004. p. 19–42.
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