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33 Cards in this Set
- Front
- Back
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Perinatal loss
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Death of a fetus/infant from conception ending with 28 days after birth
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Grief
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An individual's total repsonse to a loss
Physical, thoughts, feelings, functional limits, spiritual reactions |
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Mourning
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Rituals during the grief process that help the family adjust to the loss
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Bereavement
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Period of adjustment to the loss
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Etiologies of a perinatal loss
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Chromosomal abnormalities
Other congenital anomalies Infection Renal disease Cord accidents Teratogen exposure Paternal exposure to pesticides causing anomalies Preeclampsia Abruptio Placentae Placental previa Diabetes Fetal growth restriction |
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Clinical therapy for perinatal loss
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Treatment of choice: induction of labor within a few days
Pitocin Laminara tents Prostaglandin agents Misoprostol Prostaglandin E2 if less than 28 weeks Cesarean (If had previous c/s due to fear of pitocin causing uterine rupture) If delayed, often times spontaneous labor will occur within 2 weeks |
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Risks of delayed delivery
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Infection resulting in endometritis or sepsis
Longer the delay the higher the risk DIC or Consumption Coagulation If the dead fetus remains in utero for a prolonged period of time, the release of thromboplastin from the dead fetal tissue into maternal circulation will activate the extrinsic clotting system to trigger formation of tiny blood cloths. Fibrinogen and factors V and VII are then depleted and the symptoms of DIC manifest |
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Conceptual Model of Parental Grief
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Acute Distress
Intense Grief Reorganization (may overlap-not in 'stages') |
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Phase of Acute Distress
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Shock
Numbness Intense Crying Depression |
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Phase of Intense Grief
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Loneliness, yearning
(Arms may ache, wake to crying baby) Guilt (trying to identify cause, punishment) Anger, resentment, biterness, irritability (to health care team, God) Fear, anxiety (future pregnancies) Sadness, depression with full awareness (Disorganization accompanies) Physical symptoms (headaches, backaches, fatigue) |
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Phase of Reorganization
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Searching for meaning ("Why me", "What does it mean")
Reduction of stress Reentering normal life activities-better able to function Future pregnancy planning |
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Nursing interventions during hospitalization
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Facilitate open communication, encourage questions
Identify family support systems Identify cultural beliefs Provide privacy Place a private room away from other laboring/postpartum patients Assess preferences: Laboring, placing infant on mom's chest, father cutting umbilical cord, bathing of newborn Stay with the couple and provide clear explanations about procedures Explain what they will expect when they see their baby If in morgue, place under warmer for approx. 20 min. prior Early loss: Always refer as miscarriage Stillbirth: Always refer to as "dead" or "died" to help initiate grief process and the reality Avoid "lost" or "gone" |
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Nursing interventions after perinatal loss
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Report of Fetal Death:
(In SC, it is law that the death must be reported if the fetus is passed 20 weeks gestation or weighs 350 grams or more) Discuss organ donation & obtain consent Offer autopsy & obtain consent Photograph newborn Discuss final disposition & obtain consent Notify funeral director Postmortem care Flag patient's room Offer spiritual care Record weight, length, head circumference Complete footprint record |
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Offer the parents after perinatal loss:
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Offer to see and hold the infant
Reduces painful fantasy, makes real, offers closure "Some parents find it helpful to see their baby, would you..." Sex of the baby Autopsy Funeral arrangements Offer to name the baby (if culturally acceptable) Bathe and dress the baby Allow the family and friends to spend time Take their own pictures |
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Cultural and spiritual needs
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Assess needs as culture will impact
Cultural meaning of children Decision making: (Muslim: made by husband) (Hispanic: made by family) Autopsies may not be allowed Picture taking may be taboo (American Indian, Eskimo, Amish, Hindu, Muslim) |
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Customs following death
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Roman Catholic: baptism
Expressions of grief Muslim mother may cry but not loudly Hispanic: very demonstrative crying |
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Nursing interventions on discharge
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Think about timing of bringing patient to car
Provide clear postpartum discharge instructions (written and verbal) (Including milk production prevention) Problems with sleep Provide information on the grieving process Make necessary referrals (Wee Remember) Provide the parents with the memory box of their baby Phone calls, grief conferences after discharge |
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Memory box
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Usually includes:
Footprint sheet Crib card Indentification band Clothing and blanket worn by infant Lock of hair Photographs If the parent does not wish to take the memory box, store it |
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Relationships with family members
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Prepare the couple that family will not know wha tto say or do
Often feel uncomfortable May make inappropriate comments Encourage them to express their needs/feelings Some couples isolate to avoid being hurt Survivor guilt: (Some grandparents may feel an intense grief response beacuase the death is out of sequence) (This can cause a delay in their grief process) Encourage them to allow their other children to verbalize their feelings (Children and grandparents grieve as well) (They may not understand) |
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Relationships with friends and colleagues
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Studies have shown:
Some couples reported that others expected them to "get back to normal" in a couple of weeks May not listen or change the subject due to being uncomfortable Often refrain from seeing them to avoid their uneasiness |
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Healthcare professionals advice
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Studies show couples want:
The freedom to make choices on future pregnancy No advice, just facts about future pregnancy Recognition of the father's need to grieve Time to make decisions about the baby's body, not to be rushed |
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Caring framework for communication
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Knowing:
the nurse takes the time to understand the meaning of loss to families Being with: the nurse conveys acceptance of the families feelings Doing for: provide for physical care, comfort, safety Enabling: offers options for care Maintaining belief: empower the fmaily that they have inner strength and coping skills to pick up the pieces |
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Suggestions for communicating
Do: |
Listen more than you talk & allow for silence
Answer their questions Be geniune and caring Refer to the baby by name Allow them to express & experience their feelings Ask what you can do to help them Don't forget the father |
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Suggestions for communicating
Don't: |
Dominate the conversation
Ask one question after another without a break Use cliches (i.e. At least you have other kids) Pass judgment Avoid them Change the subject Give advice Suggest their baby received inadequate care |
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Basic principles of listening
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Establish a trusting atmosphere
Imagine yourself in their place Listen closely about feelings Allow for pauses and periods of silence Be comfortable in listening to their story Don't try to solve their problem |
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Cardinal rules of grief support
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Silence
Admit we are helpless Be with the person in grief Do not judge another's grief Be clear on your own issues on grief Know your limitations |
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Care of the pregnant couple with a previous loss
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Have learned that pregnancy isn't guaranteed
Be patient, compassionate as the nurse Couples typically report: Increased anxiety, fear, worry Vigilance Guarded attachment |
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Interventions to ease expectant family anxieties
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Early ultrasound to detect presence of fetal heart
Initially have weekly prenatal visits Subsequent ultrasounds to determine appropriate growth & development Fetal kick counts starting at 28 weeks Nonstress & BPP testing weekly after 32 weeks Deliver on expected due date & not after |
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Loss with multiples
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Joy accompanied by guilt, sorrow
May be grieving but the remaining siblings require care Risk for altered parenting Well-meaning family, friends may say "At least you still have another child." Encourage them to say, "That is not how I feel." Special issues: How to tell the living child Child's survivor guilt Celebration of birthday, death day, etc. |
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Adolescent pregnancy loss
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Many think, "It's best. Now she can be a teen."
May not have support of father of baby Often times, this is their first experience with loss Create an environment of support and trust Use nonverbal cues to convey Eye contact, touch, facial expressions May need additional information to understand what has happened May need pictures/diagrams/drawings Adults often assume conveyed physical symptoms are atributed to not normal adolescence, when it is really grief |
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Complicated bereavement
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Extremely intense grief reactions that last for a very long time
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Signs of complicated bereavement
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Loneliness, yearning, intense guilt, depression/anxiety, drug/alcohol abuse, suicidal thoughts, low self esteem, relationship difficulties
Refer to counselor that specializes in grief counseling Get assistance from family as it may be difficult for the person to make the call or attend |
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Nursing diagnoses for perinatal loss
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Anticipatory grieving
Powerlessness Ineffective denial Compromised family coping Interrupted family coping Hopelessness Risk for spiritual distress |
