Chap 14 Nursing Management During Labor and Birth PDF

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Summary

Create an outline that traces the progression of labor from the time a pregnant woman is admitted to the perinatal unit until birth. Include appropriate nursing assessments and interventions....

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In Class Assignment Chapter 14

Assignments, Chapter 14, Nursing Management During Labor and Birth Group Assignments

Learning Objective(s )

1. Create an outline that traces the progression of labor from the time a pregnant woman is admitted to the perinatal unit until birth. Include appropriate nursing assessments and interventions.

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1. Assessing the woman upon admission a. determine whether woman is in false or real labor b. determine if she should be admitted or stay at home 2. Admission to labor and birth suite a. highest priorities include assessing FHR, cervical dilation / effacement, and determining if membranes have been ruptured b. ask woman questions about fetal movement & frequency in past days, other signs of labor experiences, time of labor to birth if have previous childbirth experience, characteristics of contractions, membrane status 3. Perform a physical assessment a. including hydration status, body systems, vital signs, height and weight measurements b. determine fetal lie with leopold maneuvers c. fundal height measurement d. cervical dilation, membrane status 4. Obtain laboratory studies to establish baseline a. CBC, blood typing, Rh factor, urinalysis b. also other tests like HIV, syphillis, hep B can also be ordered 5. First stage of labor a. begins with first true contraction and ends with full dilation b. longest stage c. orient woman and support person to room d. assess knowledge and expectations of labor

e. BP, pulse, respirations assessed every hour during latent phase i. active and transition phase they are assessed every 30 min f. vaginal examinations performed periodically & share information with woman to reinforce she is making progress g. monitor contractions for frequency, duration, and intensity h. assess FHR i. provide woman with clear fluids 6. Second stage of labor a. expulsive stage , contractions typically occur every 2-3 minutes b. can last from minutes to hours c. assessment is continuous during second stage d. assess: increased apprehension or irritability, spontaneous rupture of membranes, complaints of rectal or perineal pressure e. ongoing assessments of contraction frequency, duration and intensity f. obtain maternal vital signs every 15 min g. determine progress of labor ex. bulging of perineum, labial separation, crowning h. assess amniotic fluids for color, odor, and amount i. encourage ideal position like one that opens pelvic outlet as wide as possible j. provide pain management if needed k. nurse will prepare for delivery 7. Birth a. once woman prepared for birth, clean the vulva and perineal areas b. assessment of newborn begins at moment of birth c. assess newborn using apgar score d. secure 2 identification badges to newborn that match mothers wrist ID badge

Group Assignments

Learning Objective(s )

2. Working with a partner, develop a list of advantages and disadvantages of external and internal fetal monitoring. From this list, prepare to debate the use of either type of monitoring.

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3. As part of a small group, list ideas for ways to promote increased use of ambulation and position changes during labor and birth. Prepare an oral presentation about your ideas.

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2. - There are three ways to monitor a baby’s heart rate. One way is by auscultating the mothers belly, the second method is called External fetal monitoring (EFM) and the third most invasive method is called internal fetal monitoring(IFM). -

Fetal auscultation is performed using a small hand held device called a transducer. EFM is performed by the L&D nurse, the nurse will wrap two belts around the belly, one will monitor the FHR and the other will monitor the contractions of the mothers uterus. One of the disadvantages of EFM is that it requires the mother to be very still for best results, if the mother moves too much it will result in inaccurate readings. Some medical experts believe that EFM is unnecessary for women and babies who are at low risk, because it has been linked to a higher possibility of delivering the baby via cesarean route. The third method to monitor a baby is through internal fetal monitoring IFM, this method is used if the doctor is unable to get an accurate reading from the EFM. IFM can only be measured internally after the water has broken. For this method the doctor attaches an electrode to the closest part of the cervical opening, usually the baby’s scalp. IFM can be risky because it can be a bit more uncomfortable for the nother, this method can also lead to infection. This method provides the most accurate heart rate results regardless of the mothers movement.

Advantages of measuring FHR (internally) include the fact that it is much more accurate. Also, fetal or maternal movement does not interrupt tracing. The disadvantage of measuring FHR (internally) involves the fact that it barely penetrates the skin. Also, it comes off easily. The prior can also lead to infection and skin integrity interruption of the fetus. (Advantages External) A fetal doppler can detect FHR baseline, rhythm, and changes from the baseline. (Advantages External) A fetoscope can detect FHR baseline, rhythm, and changes from the baseline. It can also detect dysrhythmia. Advantages of measuring FHR (externally) include assisting in intermittent or continuous monitoring Some disadvantages include the fact that obesity makes it difficult to monitor. Also, bands are uncomfortable to the mother, and fetal or maternal movement interrupts the tracing. (External) A toco transducer detects changes in abdominal contour to measure uterine activity.

(External) An advantage of using a toco transducer is the ease of the application. A disadvantage of using a toco transducer, on the other hand, involves the fact that it does not reliably measure intensity or resting tone; furthermore, maternal-fetal monitoring also registers an inaccuracy.

3. List of ideas to promote use of ambulation and position changes during labor and birth. Encourage walking - in 1st stage reduce the length of labor. Gravity directs the weight of the fetus and the amniotic fluid downward, dilating cervix and birth canal. Standing - if you don’t feel like waking, but want to be on your feet, standing or swaying while leaning on a chair is a good option - shortens first stage of labor, reduces likelyhood of cesearean, fewer abnormal fetal heart rate problems Sitting - allows you to be fully upright and helps gravity assist in labor. You do not have to get up if you are in too much pain and it promotes relaxation by allowing you to rest. Leaning forward - It can help you take pressure off your back. We can provide a ball or pillows for the patient to lean over. This also allows for a nurse or partner to rub or massage the patient in order to reduce back pain. Side lying position - this position is gravity neutral and may even slow down the labor or birth. It can be used in conjunction with epidural or anesthesia. It’s important to change positions frequently - 30 minutes They help reduce anxiety, pain, and facilitate labor

i. Administer analgesics as needed 30 minutes before ambulation ii. Instruct the client to perform leg exercises hourly while in bed iii. Maintain sequential compression devices on the lower extremities iv. Deep venous thrombosis (DVT) describes the formation of a thrombus (blood clot) that impedes blood flow in a deep vein and may progress to life-threatening pulmonary embolism (PE). Thrombus formation is associated with venous stasis (blood pooling), which may occur during or after surgery due to immobility. In addition, blood hypercoagulability, a physiologic adaptation during pregnancy, also increases the risk of postpartum thrombus formation. v. The nurse should emphasize interventions that promote blood flow and venous return, especially for clients recovering from a cesarean birth. Interventions to prevent postpartum thrombus formation include: A. Promoting early and frequent ambulation by ensuring adequate pain control (e.g., administer analgesic 30 min before activity) (Option 1) B. Instructing the client to perform leg exercises (e.g., dorsiflexion, plantar flexion) hourly C. The primary nurse maintained prescribed sequential compression devices during sedentary activities. D. The primary nurse had clients ambulate (with assistance) as soon as possible after surgery (i.e., usually on the first postoperative day) if they were in stable condition and could support themselves while standing. E. The primary nurse administered anticoagulant therapy with heparin, as indicated for postpartum DVT/PE prevention in clients with additional risk factors (e.g., history of DVT). vi. Educational objective: Deep venous thrombosis describes the formation of a thrombus that impedes blood flow in a deep vein and may progress to life-threatening pulmonary embolism. Interventions to prevent postpartum thrombus formation include ● promoting early ambulation by ensuring adequate pain control, ● instructing the client to perform leg exercises, and ● maintaining sequential compression devices on the lower extremities....