A 15 min video regarding the treatment form flow sheet was developed to provide a means for consistent documentation of wound assessment and treatment.
You may also be interested in the Wound Care series
WHMIS Training
For community staff… WHMIS training workbook and quiz.
WHMIS Quiz – Carefully read each question and match or circle the letter of the correct answer.
Vitamin K Deficient Bleeding (VKDB)
Information in this self-learning package regarding signs and symptoms of VKDB, diagnosis, risk factors and treatment.
It is imperative we educate our clients about the importance of the neonate receiving Vitamin K. Since
the introduction of Vitamin K injections to the neonate, incidences of VKDB have decreased
dramatically.
Check with your educator or designate for access to sign-in sheets if required.
Post Quiz
- Name three reasons why Vitamin K is deficient in the neonate.
- At what age is the neonate able to use the vitamin K in breast milk?
- What dosage/route of Vitamin K should be given?
- Name three signs & symptoms of VKDB
- Name three risk factors associated with VKDB.
- Why is it so important that neonates receive Vitamin K prophylaxis?
Vacuum Assisted Delivery
Objectives for this package – you will:
be able to define indications, prerequisites and contraindications to a vacuum assisted birth
be able to identify proper technique for the procedure
be able to list the risks/complications to the procedure
know what to do if the vacuum attempt fails
be able to appropriately document a vacuum assisted delivery
Check with your educator or designate for access to sign-in sheets if required.
Critical Thinking
- What constitutes inadequate progress?
Answer
Nulliparous women – No progress made in second stage for two hours (without regional analgesia) or three hours (with regional analgesia)
Multiparous – No progress made in the second stage for one hour (without regional analgesia) or two hours (with regional analgesia)
*If progress is being made, then the length of time is flexible
- Why would a vacuum delivery predispose a fetus to jaundice?
Answer
A cephalohematoma is a complication of a vacuum delivery. Any bleeding can cause jaundice in the newborn. Jaundice is caused by the breakdown of red blood cells in the neonate. This breakdown increases when there is a sequestering of blood within a closed space, such as a cephalohematoma.
- How can you tell the difference between a cephalohematoma and a subgaleal hematoma?
Answer
A cephalohematoma will not cross the suture line. It rarely increases in size after birth and is a fluctuant mass. It usually resolves spontaneously and is self limiting.
A subgaleal hematoma will cross the suture lines and feel firm and fluctuant. It may shift with movement and continues to expand post delivery. The neonate may exhibit symptoms of pallor and tachycardia due to blood loss. Blood loss from these hemorrhages can be extensive and life threatening. The hemorrhage can extend from the brow to the nuchal ridge and from ear to ear in severe cases. Common contributing factors include excessive attempts and high pelvic station/CPD.
- Which is the most serious complication?
Answer
A subgaleal hematoma can cause the neonate to bleed to death (a loss of 50 – 100 mLs can be fatal to a neonate as it is 20 – 40% of their blood volume).
- How do you maintain situational awareness?
Answer
Maintain verbal communication – communicate verbally in regards to the number of application, how many pop offs have occurred, the pressure used with each application, the length of time involved (e.g. Vacuum on at 12:10, pressure at 450 mm Hg. Pop off #1 at 12:11.
Vacuum reapplied at 12:12, pressure at 470 mm HG. Pop off #2 at 12:14, head descending well (if not moving may state the station instead as to not worry the client), at 4 minutes since initial application etc…)
- Why might a newborn not adequately feed after a vacuum delivery?
Answer
A newborn may not adequately feed for several reasons. Initially, the newborn may have trouble establishing a coordinated suck due to the discomfort from the delivery and cerebral irritation. (If you had a bad headache, would you be able to suck a thick milkshake through a straw?). Later, issues such as jaundice or a hemorrhage might cause lethargy.
Post self-learning Quiz
- Name three requirements that have to be met in order to proceed with a vacuum delivery attempt.
Answer
Any of the following: Full dilation, ROM, Empty bladder, maternal ability to push, fetus is engaged, informed consent, estimated. Fetal weight of less than 4000 gram, vertex presentation, no brow or face presentation, experienced operator, known position of the fetus, no suspicion of CPD, adequate pelvis, adequate staff, awareness of policies/guidelines, back up plan.
- Name three indications to proceed with a vacuum delivery attempt
Answer
Any of the following: Abnormal FHR or fetal compromise, maternal exhaustion, inability to push effectively, prolonged second stage, inadequate uterine activity, maternal conditions that inhibit her from pushing, inadequate pushing in the second stage.
- Name three absolute contraindications to a vacuum delivery.
Answer
Any of the following: incomplete dilation of the cervix (except in extreme circumstances), intact membranes, breech or face/ brow presentation, fetus not engaged, known bleeding disorders in the neonate, operator inexperience, inability to assess fetal station/position, evidence of CPD,
- What should you prepare for in the immediate postpartum period in regards to the maternal care? Newborn Care?
Answer
Maternal – You should prepare for a PPH
Newborn – You should prepare for a neonatal resuscitation
- What do you need to assess post delivery on the newborn and why?
Answer
Newborn assessment should include head to toe assessment with careful consideration given to the scalp (formation/injuries), observe for brachial plexus injury, hemorrhages (retinal/subgaleal), cephalohematomas, VS, HC, Umbilical cord gases.
- How frequently do you assess the newborn?
Answer
Assess the newborn (VS and HC) as per routine (at birth and q 1 hour x 3), then q 3 hours until 24 hr of age, then q shift x 48 hours. Assessments also need to include colour, scalp, activity level, feeding patterns.
- A G1P0 has been pushing for 2 hours. The fetus has been moved down to +2 station. The client is tired and demanding that you ‘just pull it out’. Her pushing is ineffective as she is uncontrolled and yelling with the contractions. The fetal heart rate post contraction is 70 bpm and then recovers to baseline. Variability is unknown as you are auscultating. Is this a case for a vacuum delivery? Why or why not?
Answer
No. The first action attempted would be to help the client gain control and push effectively. Good progress has been made and the FHR is recovering from the contractions/pushing. Should the FHR worsen then a vacuum might be considered.
- You have been pushing with a client for over 2 ½ hours. You check to see the descent of the fetus and find that an anterior lip is present, station is -1. The client is exhausted and the fetal heart rate is atypical. The MD wants to do a vacuum, as she is a multip he feels he can get the fetus past the cervix. What do you do? Why?
Answer
You would need to advocate for the client against a vacuum attempt. The client needs to have a C/S given the fetal heart rate/fetal station. If the fetal heart rate recovers when the client is no longer actively pushing, then you may be able to wait awhile, possibly try syntocinon, to see if the cervix completely dilates and the fetus descends.
- A G4P3 client comes in and is complaining of decreased fetal movement all day. C/S coverage is not available. When you check the heart rate, it is at 60 bpm and not recovering. PV is 8 cms and the client is a multip. The FHR does not increase with any intrauterine resuscitation techniques. What should you do? Why?
Answer
A vacuum attempt might be warranted in this situation, given that the decreased fetal movement has been occurring all day and you do not know how long the FHR has been low. The choice is between maternal trauma (e.g. cervical tear) and possible fetal demise as a C/S is unavailable.
Translating Emergency Knowledge for Kids (TREKK)
For all clinical staff – access recorded sessions. Topics include: respiratory conditions, acetaminophen poisoning, compartment syndrome and pediatric sepsis.
Pre-recorded resources (2023) (currently not available).
Other topics in (2020) pre-recorded session include: tips for pediatric assessment, diabetic ketoacidosis, sepsis and what’s new in pediatric emergency medicine.
Syphillis: Then, Now and into the Future
Access the video with Dr. P Plourde, MOH of the Winnipeg Regional Health Authority.
Supplementation for term newborn
Supplemental feedings provided in place of breastfeeding. This may include expressed breastmilk or banked breastmilk and/or breastmilk substitutes/formula. Exclusive breastfeeding is recommended for the first 6 months. Supplemental feeding should not be given to breastfed infants unless there is a medical indication for such
feedings.
Check with your educator or designate for access to sign-in sheets if required.
Suicide Prevention in Acute Care
Access the 20 min self-learning module – you must complete this module in its entirety; there is no possibility of recovering partially completed modules – you must submit before exiting.
Stroke & Transient Ischemic Attack
Access the 15 min video and self-learning module on stoke and transient ischemic attack.
Skin-to-Skin
Immediate mother-infant contact after birth is firmly established as an evidence-based practice that supports breastfeeding and the physical and developmental transition of the infant to extra-uterine life. The Baby friendly Initiative (BFI) lists this practice as a recommended standard of immediate post-delivery care.
Check with your educator or designate for access to sign-in sheets if required.