Birth-Related Procedures Chapter 20

Induction of labor Definition Labor Readiness

Table 20-1: p 429

Methods of Induction

Chemical Oxytocin infusion

Labor augmentation

Prostaglandin E2 Misoprostol

Mechanical amniotomy

Nursing management

Assisted delivery

Augmentation – Oxytocin (Pitocin) Episiotomy Forceps –assisted birth Vacuum-assisted birth Cesarean birth TOLAC (Trial of labor after c-section) VBAC (Vaginal birth after cesarean)

Assisted DeliveryAmniotomy & Episiotomy

Assisted Delivery - Forceps

Assisted Delivery C-Section

Assisted Delivery C-Section

Managing Discomfort:Chapter 18

Considerations Cultural

influences Anxiety and Fear Preparation Alternative

methods

Pharmacologic Analgesia and Nursing Management

Narcotic analgesic Stadol

Opiate antagonist: Narcan

IM or IV: peaks 30-60 min, duration 3-4 hrs

SE: maternal/fetal: resp depression; urinary retention; contraindicated for known/suspected opiate dependency

Antagonist: for respiratory depression r/t fentanyl, morphine, meperidine, butorphanol (Stadol) and nalbuphine (Nubain)

Regional Anesthesia and Analgesia

Definition Agents/types Epidural Continurous Epidural infusion

Regional Anesthesia and Analgesia

Epidural Narcotic after birth Spinal Block Pudendal Block Local infiltration Pudendal block

General Anesthesia

Definition Complications Nursing

management

Questions?

Test Question:

At about 38 weeks gestation a client experiences lightening. Lightening refers to the:

A. First feeling of fetal movementB. First perceptions of labor

contractionsC. Settling of the fetal head into the

pelvisD. Frequency of urination in the 3rd

trimester

Another test question:

When assigning points on the Apgar score a HR of 130 BPM should receive a score of:

A. OB. 1C. 2D. 3

Let’s try again:

Immediately after observing late Dcels, the L&D nurse should first:

A. Initiate oxytocin augmentation of laborB. Perform a quick vaginal exam to assess

the situationC. Turn the client on her left side and

administer O2

D. Have the client assume a position of comfort after sedating her

OK, last try:

A client delivers a 7 lb 7oz boy by vaginaldelivery. One hour after delivery the client’s vital signs are T 100.3°F, P 78, R

18. Her nurse is aware that the elevation in temperature is likely caused by:

A. VaginitisB. Nosocomial infectionC. A urinary tract infectionD. Exhaustion and dehydration