Ch 13-14 Nursing management during labor & birth Flashcards Preview

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Flashcards in Ch 13-14 Nursing management during labor & birth Deck (13)
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1

what is included in an OB assessment

fundus, fetal, pain, vag, rectum, breast

2

Maternal Status

Vaginal examination (cervical dilation, effacement, membrane status, fetal descent and presentation)

Rupture of membranes

Uterine contractions

Leopold’s maneuvers

3

Fetal assessment

Amniotic fluid analysis

Fetal heart rate monitoring
Handheld vs. electronic;
intermittent vs. continuous;
external vs. internal

Fetal heart rate patterns
Baseline,
baseline variability,
periodic changes

Other assessment methods
Fetal scalp sampling,
pulse oximetry,
stimulation

4

How frequently do you assess for pain?

Q1H

5

instead of holding their breath, what should moms do to decrease pain in the long run r/t ischemia?

What stage is this primarily in?

paced breathing

1st stage

6

Distention of cervix

Distension of lower uterine segment

Uterine ischemia - occurs bc muscles contract

Referred pain

Visceral pain

Stage 1

7

Distention of pelvic floor, vagina, perineum

predominant in which stage b/c presenting part is going through birth canal?

Presenting part descending

Lacerations of soft tissue

Somatic pain

stage 2

8

should you give fentanyl in the first stage of labor? why or why not

no, short half life

9

who gets general anesthesia?

what drugs do you get for general anesthesia

Emergency cesarean birth or woman with contraindication to use of regional anesthesia

Commonly, first thiopental IV to produce unconsciousness

Next, muscle relaxant

Then intubation, followed by administration of nitrous oxide and oxygen; volatile halogenated agent also possible to produce amnesia

10

General measures
Obtain admission history
Check results of routine laboratory tests and any special tests
Ask about childbirth plan
Complete a physical assessment

Initial contact either by phone or in person

Maternal health hx

Physical assessment of mom

Fetal assessment

Lab studies

Assessment of psychological status

1st stage management

11

Assessment
- Contraction frequency, duration, intensity
- Maternal vital signs
- Fetal response to labor via FHR
- Amniotic fluid with rupture of membranes
- Coping status of woman and partner

Interventions
- Supporting woman & partner in active decision making
- Supporting involuntary bearing-down efforts; encouraging no pushing until strong desire or until descent and rotation of fetal head well advanced
- Providing instructions, assistance, pain relief
- Using maternal positions to enhance descent and reduce pain
- Preparing for assisting with delivery

Stage 2 management

12

Assessment
- Placental separation; placenta and fetal membranes examination; perineal trauma; episiotomy; lacerations

Interventions
- Instructing to push when separation apparent; giving oxytocin if ordered; assisting woman to comfortable position; providing warmth; applying ice to perineum if episiotomy; explaining assessments to come; monitoring mother’s physical status; recording birthing statistics; documenting birth in birth book

stage 3 management

13

Assessment
- Vital signs, fundus, perineal area, comfort level, lochia, bladder status

Interventions
- Support and information
- Fundal checks; perineal care and hygiene
- Bladder status and voiding
- Comfort measures
- Parent–newborn attachment
- Teaching

Stage 4 management