Paralyzed Together: The Pregnant Stroke Patient and Her Nurses

Background: Nurses work in specialty areas often become compartmentalized in the skills that they use on a routine basis. As intrapartum nurses are increasingly presented with pregnancies that are complicated by medical issues, and they may question their abilities to care for the medical or surgical condidtion of the patient. This presentation will serve as evidence to remind nurses of the inherent overall nursing skills they possess, and how to manage complex medical-surgical patients in the intrapartum setting.

Case:

A woman is walking her child to the school bus stop and has a stroke. On evaluation in the emergency department it is noted that she is 10 weeks pregnant with twins. At 28 weeks she is admitted to labor and delivery with abdominal pain and multiple colonization of pseudomonas, MDRO and VRE. The pregnancy is considered uncomplicated; although it is now known that both fetuses have Down’s syndrome. The patient has both a tracheotomy and PEG tube. Her ability to communicate is limited, and she is paralyzed with the exception of limited movement of her left hand.

            Through interdisciplinary collaboration patient care became more efficient with each subsequent admit. Nurses with differing levels of medical and obstetric experience mentored each other on the different components of patient care. The infection control nurse provided in-services ars related to the spread of infection to other OB patients. Respiratory therapists educated tored the OB nurses in care of the tracheotomy. All the nurses collaborated together to devise ways for the patient to communicate.

            The greatest lesson learned was that all nurses have the basic background to care for patients that may not necessarily be within their comfort zones. As the OB nurses gained more confidence in their abilities, communication with the patient improved; she learned to recognize her nurses and her episodes of anxiety and crying decreased. At the institutional level, policies and procedures within the hospital were modified to account for placement of patients who may be pregnant, but whose pregnancy is not the reason for admit.

Conclusion:

As labor and delivery and antenatal units are bombarded with patients whose medical conditions are ever more complicated, future practice must focus on advanced planning. While not all conditions and situations can be predicted, the reinforcement of medical-surgical nursing skills based on current evidence-based practice on an annual basis, can alleviate the anxiety OB nurses may experience when faced with a pregnant patient with medical complications.

Keywords: stroke, intrapartum, pregnancy,