Nursing management during labor and birth two dunn

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Second power point for B24, Christine Dunn.

Transcript of Nursing management during labor and birth two dunn

  • 1. Nursing Managementduring Labor and BirthChristine Dunn

2. Healthy People 2020Childbirth 1. Reduce maternal deaths 2. Reduce maternal illness and complications dueto pregnancy 3. Increase the proportion of pregnant women whoreceive early and adequate prenatal care 4. Increase the proportion of pregnant women whoattend a series of prepared childbirth classes 3. Maternal Assessment Determine the womans response and her progressin labor Maternal Vital Signs, uterine contractions Review the prenatal record Uteroplacental circulation Vaginal exam upon admission, then when necessaryto identify progress in labor ( Infection) Discomfort along with strategies at regularintervals ( Pharm and nonpharm) Psychological status of patient and family 4. Leopolds Maneuvers Method for determining thepresentation,position and lie of thefetus using 4 steps. Each maneuver answers a question: See text. 5. Analysis of FHR One of the primary evaluation toolsused to determine fetal oxygen statusis the analysis of fetal heart rate. Fetoscope- intermittently Doppler- intermittently Electronic fetal monitor-continuously/intermittently 6. Childbirth Discomfortis Different WHY? Childbirth discomfort is part of the process oflabor, a physiologic process, not from an injury orillness. The pregnant woman has several months toprepare for the discomfort of labor and to acquireskills to help cope. Labor discomfort has a foreseeable end; and thefirth of the newborn brings a rapid decrease in thediscomfort. Intermittent discomfort; labor ends with the birthof a newborn this is an emotional signifcance thataffects the response to the discomfort. 7. Sources of Discomfort Tissue ischemia- Tissue hypoxia, uterus Cervical dilation- Causes discomfort, dilation andstretching of the cervix. See text. Pelvic Structures- referred pain in back and legsfrom pulling and pressure on pelvic structures. Distention of the vagina and perineum- As the fetusdescends into the pelvis distention of the vaginaand perineum occurs which causes discomfort. 8. Factors Influencing the Perception or tolerance of Pain: Intensity of labor Cervical readiness Fetal position Characteristics of the pelvis Fatigue Intervention of caregivers 9. Psychosocial Factors Culture- Influence how she perceives, interpretsand responds to pain during childbirth. Anxiety and Fear- Magnify sensitivity to pain andimpair a womans ability to tolerate it. Previous experiences with painFear andwithdrawal natural reactions. Knowledge of thenormal sensations of labor helps her to suppressher natural reactions of fear and withdrawal. Preparation and support- Reduces anxiety and fearof the unknown, rehearse. Family and friends aresources of comfort and assistance; realistic info. 10. NonpharmacologicTechniques Relaxation Cutaneous stimulation- Massage, thermalstimulation, acupressure. Hydrotherapy Mental stimulation- imagery, breathing techniques Application of heat or cold Advantage: No side effects or risk to the fetus!!! 11. Pharmacologicinterventions duringlabor Anesthesia- can be a combination ofanalgesia, amnesia, relaxation andreflex activity. Abolishes painperception by interrupting the nerveimpulses to the brain, may involveloss of consciousness. Analgesia-Alleviation of the sensationof pain or the raising of the thresholdfor pain perception without loss ofconsciousness 12. Pharmacologic PainManagement Systemic Analgesia Side Effects to the fetus: RespiratoryDepression!!!See textbook. 13. Pharmacologic PainManagement Regional pain management- reliefwithout LOC.EpiduralIntrathecal(Subarachnoid)LocalPudendalGeneral 14. I Want My Epidural!! Adverse Effects hypotension bladder distention catheter migration N/V Pruritus delayed resp depression prolonged second stage 15. I Want My Epidural !! Nursing Care preload with IV fluids(LR) assist anesthesiologist frequently assess FHR/MVS observe for bladder distention observe for side effects & report 16. Spinal Anesthesia Anesthesia ofchoice for CesareanSection More rapid onsetthan epidural forC/S More completeblock than epiduralfor C/S Requires much lessconcentration ofdrugs than epidural Potential spinalheadache Hypotension Bladder distention 17. Local Infiltration Injection of a local anesthetic such as lidocaineinto the superficial perineal nerves to nemb theperineal area. Performed just before performing an episiotomy orbefore suturing a laceration. Does not alter the discomfort of the uterinecontractions. No side effects to fetus! Or mother! 18. Pharmacologic PainManagement Special considerationseffects on fetusmaternal physiologic alterationseffects on course of laboreffects of complicationsinteractions with othersubstances. 19. Nursing Care duringthe stages of labor First Stage- Key Nursing Interventions see text Summary of assessments during first stage: Latent Active Transition Positioning during the first stage of Labor: See text Teaching guidelines. 20. Nursing Care Second Stage : Supporting the woman and herpartner in making active decisions about her careand labor management. Support her choice of pushing method Give feedback on her progress See Text summary. Perineal Lacerations Episiotomy 21. Nursing Care Third and Fourth stage Third- gradual decrease in the size of the uterusthis helps to shear the placenta away from itsattachment site. Immediate newborncare/assessment, assist with the delivery of theplacenta inspect for intactness. Fourth- Observation for hemorrhage, comfortmeasures, promotion of family attachment. 22. Application of theNursing Process Primary risks associated withEPIDURAL analgesiaMaternal hypotension with secondaryfetal hypoxiaInjury related to reduced sensationand movement 23. NCLEX Questions A patient, age 22 is a G1 T1 P0 A0 L1.During the 1st 24 hours after delivery, shedoes not show consistent interest in herneonate. How should the nurse interpretthis behavior? A. The patient is experiencing PPD (postpartum depression) B. The patient is questioning her role as amother C. The patient is showing expectedbehaviors for the taking in period D. The patient is failing to attach to her 24. NCLEX Questions A pregnant patient arrives at the healthcare facility stating that her bed linenswere wet when she woke up this AM. Shesays no fluid is leaking but complains ofmild abdominal cramps and lower backdiscomfort. Vaginal exam reveals 2 cmdilated with positive ferning noted. Whatstage of labor is this patient in? A. Latent B Active C. Transition D. Explosive stage 25. Questions A patient in labor tells the nurse midwife that shefeels a strong urge to push. Vaginal exam revealsthat her cervix is not completely dilated. Themidwife tells her not to push yet. What is therationale for this instruction? A. Early pushing may cause edema and impedefetal descent B. The nurse midwife is not ready to assist thepatient at this time C. The fetus has not rotated to the proper position D. Pushing at this time may cause ROM (rupture ofmembranes)