maternal Newborn 2

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jtisby
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211545
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maternal Newborn 2
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2013-04-06 22:54:56
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maternal Newborn
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maternal Newborn 2
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  1. Identify the components of childbirth education classes
    • •    Expectations during labor & delivery  
    • •    Managing discomfort during labor    
    • •    Conscious relaxation    
    • •    Controlled breathing    
    • •    Cutaneous stimulation    
    • •    Focusing     
    • •    Medications
  2. Componets of Stage 1 Labor
    • Dilation and effacement
    • Latent Phase    
    • Active Phase
    • Transition
  3. Describe Stage 1 - Latent Phase of Labor
    • Stage 1: Latent Phase
    • • 4-6 hours
    • • Cervix 1-4 cm
    • • Amniotic membranes intact or ruptured
    • • May be bloody show
    • • Contractions Frequency: Every 20 min
    • • Duration: 15-40 seconds 
    • • Intensity: mild to moderate
    • • Cooperative, talkative, thirsty, urinaryfrequency
  4. Nurse's role: Stage 1 - Latent Phase
    • -Interventions
    • -Therapeutic nurse/pt. relationship
    • -Encourage rest/activity; may shower
    • -Assess FHR, contractions, vaginal discharge
    • -Assess for urinary retention, encourage void
    • -Provide lollipops for carb and fluid intake
    • -Assess vital signs every 2 hours
    • -Review birth plan; breathing patterns
  5. Describe Stage 1 - Active Phase of Labor
    • Stage 1 - Active Phase of Labor
    • • 2-6 hours
    • • Cervix 4-7 cm
    • • Amniotic membranes may rupture
    • • Effacement occurs
    • • Contractions Frequency: Every 2-5 min 
    • • Duration: 40-60 seconds 
    • • Intensity: moderate to firm
    • • Apprehensive, anxious, introverted, lesssocial, facial flushing, requests pain relief,may need epidural, fears losing control, focused on breathing, perspiring
  6. Nurse's role: Stage 1 - Active
    • -Interventions
    • -Assist coach
    • -Reassure and praise
    • -Back massage, position changes, moisten mouth, maintain comfortable temp, shower?
    • -Monitor IV, urinary retention, assess vaginal fluid
  7. Describe Stage 1 - Transition Phase of Labor
    • Stage 1 - Transition Phase of Labor
    • -30 min - 2 hours
    • -Cervix 7-10 cm
    • -Amniotic membranes ruputure
    • -Effacement complete
    • -Contractions:
    • frequency: every 2-3 min
    • duration: 60-90 seconds
    • intensity: firm
    • -irritable, rejects support person, introvert, restless, wants to give up, trembling legs, requests medication, vomits
  8. Nurse's role: Stage 1 - Transition Phase
    • -Interventions
    • -Firm coaching/support coach
    • -Reassurance and praise
    • -Monitor FHR & contractions
    • -Accept negative comments from mom
    • -Maintain positive approach
  9. Describe Stage 2 of Labor - Fetal Expulsion
    • -30 minutes to 2 hours
    • -Cervix 10 cm / bulging perineum
    • -Contractions:
    • Frequency: every 1.5 - 3 min
    • Duration: 60-80 sec
    • Intensity: firm
    • -May pass stool, uncontrollable urge to push, States:"baby is coming", exhaustion after each contraction, difficulty following instructions, excitement concerning imminent birth
    • -Episiotomy performed if necessary
  10. Nurse's role: Stage 2 - Fetal Expulsion
    • -Interventions
    • -Positioning for pushing
    • -Support coach
    • -Monitor contractions & FHR
    • -Assess perineum and vaginal resuscitation
    • -Prepare sterile supplies and equipment
    • -Give mom and support person feedback
  11. Describe Stage 3 - Placental Expulsion
    • -5-30 minutes
    • -contractions: intermittent & mild to moderate
    • -signs of placental separation
    • lengthening of the cord
    • Uterine fundus rises and becomes firm
    • fresh blood expelled from vagina
    • -Mom's side : dull and rough
    • -Baby's side : shiny and smooth
    • -Episiotomy is sutured is applicable
  12. Nurse's role: Stage 3 - Placental Expulsion
    • -Interventions
    • -Observe & document blood loss
    • -Document delivery of placenta; examine
    • -Vital signs every 15 minutes
    • -Assess vaginal discharge/fundus & massage
    • -Administer Oxytocin prn
    • -Monitor Temp & Heart
    • -Dry newborn; apply hat; place in radiant warmer
    • -Proper id to mom, partner, infant
  13. Describe Stage 4 - Recovery
    • -Uterus is midling, firmly contracted above, at or below umbilicus
    • -Lochia rubra staturates peripad (no more than 1 per hour)
    • -Cramping
    • -Shaking chills
    • -Bonding time for family
    • -Mom may breastfeed
  14. Nurse's Role - Stage 4 - Recovery
    • -Interventions
    • -Continue interventions from stage 3
    • -Encourage breast feeding
    • -Assess for urinary retention
    • -Assess baby for anomalies
    • -Assess lochia (no more than 1 pad per hr)
    • -Change Mom's gown and pads
  15. Care for Mom Immediately After Delivery
    • -Observe for hemorrhage
    • -VS
    • -Skin color
    • -Location and firmness of uterine fundus
    • -lochia
    • -Pain
    • -Promoting comfort
    • -Keep warm and dry
    • -Ice to perineum to help reduce swelling and brusing
  16. Pharmacologic considerations related to pain control measures
    • -Pregnant woman at higher risk for hypoxia
    • -Sluggish GI tract can result in increased risk of vomiting and aspiration
    • -Aortocaval compression increases risk of hypotension and shock
    • -Effect on fetus must be considered
  17. Medications related to pain control
    • Narcotics:
    • -Fentanyl, Demerol (least preferred)
    • Opioid Agonist-Antagonist:
    • -Stadol (preferred)
    • Opioid Antagonist:
    • -Naloxone (Narcan): must always be available
    • Ataractics/Anti-emetic(analgesic potentiators)
    • -Hydroxyzine (Vistaril): may be given in early labor to help mom rest
    • -Zofran & Reglan
  18. Types of Anesthesia for Childbirth
    • -Local infiltration
    • -Pudendal block
    • -Epidural block
    • -Subarachnoid (spinal) block
    • -General anesthesia
  19. Non-pharmacological pain relief measures
    • -Relaxation techniques
    • -Positioning
    • -Diversion & Distraction
    • -Breathing
    • Skin stimulation (3 kinds):
    • -Effleurage: stroking/massage of abdomen
    • -Skin stimulation
    • -Sacral pressure
  20. Name the 4 components of the birth process
    • Powers: contractions
    • Passage: pelvis
    • Passenger: fetus
    • Psyche: mental state
  21. Describe Powers component of birth
    • Powers: contractions
    • -regular, rhythmic, and uncontrolable
    • -uterine muscle shorten with each contraction
    • -have increment, peak (acme), decrement
    • -mild moderate and firm
  22. Assessment/Documentation of contractions
    • Frequency: begining of contraction to begining of next
    • Duration: length of one contraction in seconds
    • Intensity: firmness of contraction
    • Interval: the amt of time uterus is relaxed between contractions (Important: b/c O2 rich blood needs to resupply the uterus)
  23. Describe the Passage component of birth
    • consists of:
    • -bony pelvis
    • False pelvis: upper flaring
    • True pelvis: lower part
    • -soft tissues
    •  cervis
    •  muscles
    •  ligaments
    •  fascia
  24. Describe the Passenger component of birth
    • Passenger = Fetal Head, amniotic fluid, ambilical cord
    • -the bones of head are not fused
    • -Ant. fontanelle/ Post. fontanelle
    • -Skull can change shape as it passes thru birth canal
    • -Molding
    • -fetal head is largest part of fetus
  25. Describe 4 positons of the Passenger
    • Lie: how fetus is oriented to mom's spine
    • Attitude: flexion (chin2chest, arms/legs flexed)
    • Presentation: fetal part that enter pelvis 1st
    • Position: reference pt. on fetal oriented (LOA/ROA)
    • Station: the level of presenting part in the pelvis.
    • -est in cm at the level of Ischial spines.
    • -minus stations are above the ischial spines
    • -plus stations are below the ischial spines
  26. Describe the Psyche component of birth
    • Psyche: emotions/understanding
    • -well prepared couple learned/work= best
    • -anxious mother has more difficult labor and slow progress
  27. ID the signs of impending labor
    • Braxton Hicks contractions:
    • -irregular,
    • -begin early in pregnancy, increases as delivery date approaches
    • -False Labor (but prepares the cervix to adjust)
    • -Increased vaginal discharge
    • -Lightening
    • -Bloody Show:mix of blood and mucus
    • -Rupture of membranes (SROM)
    • -Energy Spurt
    • -Weight Loss
    • Cervical Changes:
    • -effecement: thinning
    • -dilation: open
  28. Signs of False labor
    • -contractions irregular
    • -walking relieves contractions
    • -no Bloody Show
    • -No change in effacement/dilation of cervix
  29. Reassuring Patterns
    • -stable FHR
    • -Moderate variability
    • -Accelerations
    • Uterine contraction:
    • -frequency: 2 minutes or more
    • -duration: less than 90 sec
    • -interval: at least 60 sec

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