pptchapter_06
TRANSCRIPT
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc.
Chapter 6Chapter 6
Nursing Care of Mother and Infant During Labor and Birth
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Cultural Influence on Birth PracticesCultural Influence on Birth Practices
Role of woman in labor and delivery Role of father/partner in labor and delivery
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Settings for ChildbirthSettings for Childbirth
Hospitals Advantages Disadvantages
Freestanding Birth Centers Advantages Disadvantages
Home Advantages Disadvantages
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Components of the Birth ProcessComponents of the Birth Process
The Four “Ps” Powers Passage Passenger Psyche
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Factors That Influence the Progress of Labor
Factors That Influence the Progress of Labor
Preparation Position Professional Place Procedures
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Uterine ContractionsUterine Contractions
Effect of contractions on the cervix
Phase of contractions Increment Peak Decrement
Frequency Duration Intensity
Mild Moderate Firm
Maternal pushing
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Cervical Effacement and DilationCervical Effacement and Dilation
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Contraction Cycle
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The PassageThe Passage
Bony pelvis Soft tissues
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The Passenger—Fetal Skull, LieThe Passenger—Fetal Skull, Lie
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Passenger—PresentationPassenger—Presentation
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Classifications of Fetal Presentations and Positions
Classifications of Fetal Presentations and Positions
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PsychePsyche
The woman’s cultural and individual values influence how she will be able to cope with childbirth
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Signs of Impending LaborSigns of Impending Labor
Braxton-Hicks contractions Increased vaginal discharge Bloody show Rupture of the membranes Energy spurt Weight loss
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Mechanisms of LaborMechanisms of Labor
Descent Engagement Flexion Internal rotation External rotation Expulsion
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Birth StationBirth Station
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When to Go to the Hospital or Birth Center
When to Go to the Hospital or Birth Center
Contractions Ruptured membranes Bleeding other than bloody show Decreased fetal movement Any other concern
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Admission Data CollectionAdmission Data Collection
Three major assessments performed promptly on admission: Fetal condition Maternal condition Impending birth
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Admission ProceduresAdmission Procedures
Permits/consents Laboratory tests Intravenous infusion Shave prep Determining fetal position and presentation
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Comparison of False and True Labor
Comparison of False and True Labor
False labor Contractions irregular Walking relieves
contractions Bloody show usually not
present No change in
effacement/dilation of cervix
True labor Contractions gradually
develop a regular pattern Contractions become
stronger and more effective with walking
Discomfort in lower back/abdomen
Bloody show often present
Progressive effacement and dilation of cervix
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Nursing Care Before BirthNursing Care Before Birth
After admission to the labor unit, nursing care consists of: Monitoring the fetus Monitoring the laboring woman Helping the woman cope with labor
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Monitoring the FetusMonitoring the Fetus
Fetal heart rate Intermittent auscultation Continuous electronic fetal monitoring Evaluating fetal heart rate patterns
Accelerations Early decelerations Variable decelerations Late decelerations
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Reassuring and Nonreassuring Fetal Heart Rate and Uterine Activity Patterns
Reassuring and Nonreassuring Fetal Heart Rate and Uterine Activity Patterns
Reassuring Patterns Nonreassuring Patterns
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Monitoring the WomanMonitoring the Woman
Vital signs Contractions Progress of labor Intake and output Response to labor
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Helping the Woman Cope With Labor
Helping the Woman Cope With Labor
Teaching Providing encouragement Supporting the partner
Teach partner how labor pains affect the woman’s behavior/attitude
Teach partner how to adapt responses to the woman’s behavior
Teach partner what to expect in his/her own emotional responses
Teach partner the effects of epidural analgesia
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Stages and Phases of LaborStages and Phases of Labor
First stage—dilation and effacement (4 to 6 hours) Second stage—expulsion of fetus (30 minutes to
2 hours) Third stage—expulsion of placenta (5 to 30 minutes) Fourth stage—recovery
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Nursing Responsibilities During Birth
Nursing Responsibilities During Birth
Preparing the delivery instruments and infant equipment
Perineal scrub Administering medications Providing initial care to the
infant
Assessing Apgar score Assessing infant for
obvious abnormalities Examining the placenta Identifying mother and
infant Promoting parent-infant
bonding
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Immediate Postpartum Period: The Third and Fourth Stages of Labor
Immediate Postpartum Period: The Third and Fourth Stages of Labor
Third stage—Expulsion of placenta Schultze’s or Duncan’s
Fourth stage—Nursing cares include: Identifying and preventing hemorrhage Evaluating and intervening for pain Observing bladder function and urine output Evaluating recovery from anesthesia Providing initial care to the newborn infant Promoting bonding and attachment between the infant and
family
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Nursing Care Immediately After Birth
Nursing Care Immediately After Birth
Care of the mother Observing for hemorrhage Promoting comfort
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Nursing Care Immediately After Birth (continued)
Nursing Care Immediately After Birth (continued)
Care of the infant Phase 1
• From birth to 1 hour (usually in delivery room) Phase 2
• From 1 to 3 hours (usually in transition nursery or postpartum unit)
Phase 3
• From 2 to 12 hours (usually in postpartum unit if rooming-in with the mother)
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Phase 1: Care of the NewbornPhase 1: Care of the Newborn
Initial care includes: Maintaining thermoregulation Maintaining cardiorespiratory function Observing for urination and/or passage of
meconium Identifying the mother, father, and newborn Performing a brief assessment for major
anomalies Encouraging bonding/breastfeeding
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Care of the Newborn (Continued) Care of the Newborn (Continued)
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Apgar ScoringApgar Scoring
Heart rate Respiratory effort Muscle tone Reflex response to suction or gentle stimulation on
the soles of the feet Skin color
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Administering Medications to the Newborn
Administering Medications to the Newborn
Eye care Vitamin K (AquaMEPHYTON)
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Umbilical Cord Blood BankingUmbilical Cord Blood Banking
This type of blood is capable of regenerating stem cells that are able to replace diseased cells
Informed consent is essential Collect blood after cord has been clamped Blood must be transported to blood banking facility
within 48 hours of collection