Question

1.How did the Affordable Care Act change access to contraception?

2. What assessments are indicated before use of peridural anesthesia for patients in labor?

3. What does the rising number of premature births mean for nurses of neonates?

Answer 1

1. Increased LARC insertions after the Affordable Care Act  of privately insured women indicates the importance of reduced cost-sharing for increasing use of the most effective contraceptives and preventing unintended pregnancy

2. Baseline determination of maternal blood pressure, pulse, and fetal heart rate should be made prior to inserting the epidural catheter. Continuous fetal monitoring is essential to determine any fetal distress which may result from anesthesia-induced hypotension.When the physician is inserting the epidural catheter, the patient should be positioned in either the sitting position or the lateral position. The lateral position is usually more comfortable for the patient. If there is difficulty in inserting the catheter, the sitting position is necessary because in this position the median furrow of the back coincides with the spine, while in the lateral po־ sition the furrow sags due to gravity. The sitting position allows better flexion of the back if the shoulders drop, the lower limbs are bent, the feet are crossed, and the head is flexed. The patient should be asked to arch her back like a cat. This widens the inter-laminar space.If the lateral position is used, the patient lies in the left lateral position if the physician is right-handed. Shoul·ders and pelvis are moved toward the edge of the bed and should be parallel to each other and perpendicular to the bed. A pillow placed under the patient’s head is used to position the shoulders. The patient is instructed to bring her knees toward her chin and arch her back.The nurse should help maintain the patient’s position if either the sitting or the lateral position is used, since proper positioning is essential in administering epidural anesthesia properly. Words of encouragement should be offered by the nurse if the patient finds it difficult to maintain the position, especially during contractions.

3. The Neonatal Intensive Care Unit (NICU) is a spe- cialized environment in the care of newborns at term or preterm in life-threatening conditions that require conti- nuous monitoring and/or specific therapies. In this unit, healthcare professionals addresses all their efforts to care for seriously ill newborns and their needs, as well as the newborns’ family needs.Listening to the fears and concerns of the family before informing them about the routine of the unit, equipment and the care provided to their child is essential to build a relationship of trust between the family and the healthcare team, reducing anxieties and fears.Due to this closer relationship with the newborn and his/her family, professionals in the NICU, in particular the nursing staff, deal with difficult emotional situations. The fragility and suffering of an extremely premature baby, in life-threatening conditions, and feelings of anxiety and inse- curity of family members are constant in their daily work.In addition, complications in the newborn’s clinical evolution are frequent and they require not only technical skills, specific and updated knowledge, but also agility and sensitivity, causing great physical and emotional stress in these professionals.Being part of the process of death and grief in the NICU is particularly challenging for nurses who may pre- sent feelings of failure in their role of health promotion. This is partially due to the way they face the process of dying, which is mainly related to our culture, as well as per- sonal and professional experiences.