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Care of the Client During Childbirth - Current Issues in Newborn Nursing - Lecture Slides, Slides of Nursing

Care of the Client during Childbirth, Maternal Assessment, Present Complaint, Vital Signs, Labor Status, Sterile Vaginal Examination, Fetal Status, Psychosocial Assessment represent lecture layout.

Typology: Slides

2011/2012

Uploaded on 11/21/2012

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Lecture Eight: Care of the
Client During Childbirth
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Download Care of the Client During Childbirth - Current Issues in Newborn Nursing - Lecture Slides and more Slides Nursing in PDF only on Docsity!

Lecture Eight: Care of the

Client During Childbirth

Maternal Assessment

  • Review prenatal Hx
  • Present complaint
  • Vital signs
  • Weight
  • Lungs
  • Fundus
  • Edema
  • Hydration
  • Perineum
    • Labor/ Fetal status
    • Laboratory evaluation
    • Cultural assessment
    • Preparation for childbirth
    • Response to labor
    • Anxiety
    • Sounds during labor
    • Support system

Vital signs

  • BP < 130 systolic and < 85 diastolic or no more than 15-20 mm Hg rise in systolic pressure over baseline BP in early pregnancy
  • Pulse 60 – 90 bpm
  • Respirations 14 – 22
    • Pulse ox 95% or greater
    • Temperature 98 – 99.6 F
    • Weight: 25 – 30 lbs greater than pre- pregnant weight (weight gain > 30 lbs edema, obesity)

System Assessment

  • Lungs: auscultate, normal breath sounds

clear and equal

  • Fundus: Measure in cms, at 40 weeks’

gestation located just below xiphoid

process

  • Edema: Slight amount dependent edema
  • Reflexes: Check deep tendon reflexes for

hyperactivity, check clonus

  • Hydration: Normal skin turgor

Sterile Vaginal Examination

  • Perineum: Assess for leaking fluid or

ruptured bag of water (BOW), vaginal

bleeding, bloody show

  • Assess cervical dilatation (fingertip to 10

cms), effacement (0% to 100%), station

(-4 to +4), Ballotment, position (ROA,

ROP, etc.).

  • Assess membranes: Intact, leaking, or

ruptured.

Assess Membranes

  • If rupture BOW is suspected, do a nitrazine and fern test prior to vaginal examination.
  • Nitrazine tape will not turn if not ruptured or leaking. Nitrazine will turn blue or blue green if fluid is leaking. Checks pH-amniotic fluid is alkaline. Ferning will appear under microscopic exam.
  • Check color and odor: Green means meconium; foul odor means amnionitis

Laboratory Evaluation

  • CBC: Hgb…12-16 g/dL; Hct.. 38% - 47%
  • RBC: 4.2 – 5.
  • WBC: 4500 – 11,000 ( may be 20,000)
  • Platelets: 150,000 – 400,
  • Urinalysis: WNL
  • Serologic testing: Positive may require

follow-up titre

  • Rh factor

Cultural Assessment

  • Do you have a birth plan?
  • Who would you like to remain with you

during your labor and birth?

  • What would you like to wear during labor?
  • What activity would you like during labor?
  • What position would you like for birth?
  • Is there anything special you would like?
  • Remember privacy.

First Stage of Labor: LATENT Phase

  • 0 – 3 cms dilation
  • Q 3 – 30 min, contraction (ctx) frequency
  • 20 – 40 sec, ctx duration
  • Mild to moderate intensity on palpation;

25 – 40 mmHg with Intrauterine Pressure

Catheter (IUPC)

  • Baseline Sterile Vaginal Exam (SVE)

Care During the First Stage: Latent Phase

  • May ambulate if membranes intact
  • Evaluate physical parameters: Maternal temperature every 4 hrs unless the temperature is > 99.6 or RBOW
  • BP, P & R every 1 hr. If abnormal, increase monitoring and notify MD/CNM
  • Evaluate FHR every 30-60 minutes
  • Encourage frequent change of position
  • Encourage to void every 2 hrs
  • Offer fluid in the form of ice chips, clear liquids

Care During the First Stage: Active Phase

  • Encourage side-lying position, pillows for support
  • Evaluate physical parameters: Maternal temperature every 4 hrs unless the temperature is > 99.6 or RBOW.
  • BP, P & R every 30 min - 1 hr. If abnormal, increase monitoring and notify MD/CNM
  • Evaluate FHR every 30 minutes
  • Encourage breathing patterns, back rubs, sacral pressure, effleurage.
  • Encourage to void every 2 hrs
  • Offer fluid in the form of ice chips, clear liquids
  • Change chux frequently.
  • Pharmacologic support may be administered.

First Stage of Labor: TRANSITION Phase

  • 8 – 10 cms dilation
  • Q 1 1/2 – 2 min, contraction (ctx)

frequency

  • 60 – 90 sec, ctx duration
  • Moderate to strong intensity on palpation;

70 – 90 mmHg with Intrauterine Pressure

Catheter (IUPC)

  • If BOW ruptures, assess FHR

The Second Stage of Labor

  • 10 cms dilation (Complete)
  • Pushing with contractions
  • Q 1 1/2 – 2 min, contraction (ctx) frequency
  • 60 – 90 sec, ctx duration
  • Moderate to strong intensity on palpation; 70 – 90 mmHg with Intrauterine Pressure Catheter (IUPC)
  • SVE increase to check progress
  • Nullipara’s ready with a bulge, Multips sooner

Care During the Second Stage (pg.567- 568)

  • Encourage side-lying position, pillows for support
  • Evaluate physical parameters: BP, P & R every 5 - 15 min. If abnormal, increase monitoring and notify MD/CNM
  • Evaluate FHR every 5 - 15 minutes.
  • Assist with positioning ; Left lateral, Squatting, Semi Fowlers, & Hands and knees.
  • May need straight catheterization
  • Offer fluid in the form of ice chips, ointment for lips.
  • Perineal massage with lubricant may be used.
  • Encouragement and assurance is important.
  • Pushing begins.