Podcast
Questions and Answers
What is the primary focus of nursing management during the first stage of labor?
What is the primary focus of nursing management during the first stage of labor?
- Ensuring constant fetal monitoring
- Assessing maternal pain and vital signs (correct)
- Preventing maternal fatigue
- Providing medication for pain relief
Which action is NOT a component of nursing management in the first stage of labor?
Which action is NOT a component of nursing management in the first stage of labor?
- Room environment adjustment
- Performing a vaginal examination immediately (correct)
- Providing emotional support
- Nutritional counseling
What should nurses evaluate to manage maternal pain effectively during labor?
What should nurses evaluate to manage maternal pain effectively during labor?
- Maternal vital signs and pain management effectiveness (correct)
- The patient's previous pain thresholds
- Fetal heart rate patterns primarily
- The family's influence on pain experience
Why is advocacy considered important in nursing management during labor?
Why is advocacy considered important in nursing management during labor?
What is the role of the partograph in the first stage of labor?
What is the role of the partograph in the first stage of labor?
Which of the following components should NOT be part of the full history taken during the first labor stage?
Which of the following components should NOT be part of the full history taken during the first labor stage?
What should be assessed if there is no vaginal bleeding upon admission during the first stage of labor?
What should be assessed if there is no vaginal bleeding upon admission during the first stage of labor?
Which comfort measure is recommended during the first stage of labor?
Which comfort measure is recommended during the first stage of labor?
What is the appropriate timeframe for the delivery of the placenta after the infant's birth?
What is the appropriate timeframe for the delivery of the placenta after the infant's birth?
Which sign indicates placental separation during the third stage of labor?
Which sign indicates placental separation during the third stage of labor?
What is an essential observation during the fourth stage of labor?
What is an essential observation during the fourth stage of labor?
What is the main purpose of administering oxytocin after placental expulsion?
What is the main purpose of administering oxytocin after placental expulsion?
What should be assessed regarding the bladder during the fourth stage of labor?
What should be assessed regarding the bladder during the fourth stage of labor?
What is the significance of checking the fetal neck once the fetal head has emerged?
What is the significance of checking the fetal neck once the fetal head has emerged?
During the management of the second stage of labor, which method of pushing is generally encouraged?
During the management of the second stage of labor, which method of pushing is generally encouraged?
What should be done to the placenta after delivery to ensure its completeness?
What should be done to the placenta after delivery to ensure its completeness?
Which of the following is NOT part of the abdominal examination during the first stage of labor?
Which of the following is NOT part of the abdominal examination during the first stage of labor?
What is the purpose of assessing amniotic fluid after rupture of membranes?
What is the purpose of assessing amniotic fluid after rupture of membranes?
Which of the following is a recommended non-pharmacologic intervention during the first stage of labor?
Which of the following is a recommended non-pharmacologic intervention during the first stage of labor?
What key element should be monitored continuously during the second stage of labor?
What key element should be monitored continuously during the second stage of labor?
Which assessment is NOT performed on the fetus during labor management with a partograph?
Which assessment is NOT performed on the fetus during labor management with a partograph?
In the context of labor management, what does 'continuous coaching and support' refer to?
In the context of labor management, what does 'continuous coaching and support' refer to?
What is the main concern when membranes are ruptured during labor?
What is the main concern when membranes are ruptured during labor?
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Study Notes
Examination Findings
- Assess for pallor, edema, and abdominal scars.
Management of 1st Stage of Labor - Assessment
- Abdominal examination includes checking fetal presentation, position, engagement, and auscultating the fetal heart.
- Monitor uterine contractions during the assessment.
- Pelvic examination to evaluate cervical dilatation (in cms) and effacement (in %), membrane status (intact or ruptured), and amniotic fluid characteristics post rupture (clear, meconium stained, or blood stained).
- Determine the presenting part's position and station.
Investigations
- Conduct urine tests for protein, sugar, and ketones.
- Blood tests include Complete Blood Count (CBC), Random Blood Sugar (RBS), blood grouping, and cross-matching for high-risk patients.
Management of 1st Stage of Labor - Preparation and Care
- Recommend light nutrition such as frozen berries, dried fruit, jelly, and water.
- Support continuous labor support techniques including hydrotherapy, ambulation, slow-dancing, and changes in maternal position.
- Implement therapeutic touch, massage, breathing techniques, and encourage bladder emptying every 1-2 hours.
- Prioritize non-pharmacologic interventions before pharmacologic ones.
Management of 1st Stage of Labor - Partograph
- Assess fetus condition using Fetal Heart Rate (FHR) monitored by Doppler or CTG, as well as amniotic fluid status.
- Monitor labor progress through cervical dilatation and contractions.
- Evaluate maternal condition, including medications (e.g., oxytocin), intravenous fluids, and vital signs.
Management of 2nd Stage of Labor
- Conduct delivery preparation with continuous coaching and support, and ongoing assessment of FHR.
- Allow maternal choice for labor positions ranging from lithotomy to side-lying or kneeling.
- Cleanse perineum with antiseptic solution and create a sterile field around the vagina.
Nursing Management of Labor Objectives
- Expect students to understand the appropriate nursing management for each labor stage.
- Recognize the labor and birthing process as a transformative experience for women.
- Emphasize the necessity for nurses to be respectful, available, supportive, and professional.
Management of 1st Stage of Labor - Nursing Interventions
- Conduct a full maternal history including obstetric history, current pregnancy details, and labor progression.
- Monitor vital signs and pain as primary components of physical examination.
- Identify risk factors affecting uteroplacental circulation during labor.
Management of 2nd Stage of Labor - Observation
- Observe maternal, fetal, and uterine conditions with vital signs and progress monitored hourly or every 30 minutes.
Management of 2nd Stage of Labor - Conduct of Delivery
- Delay pushing and encourage spontaneous (non-directed) pushing.
- Perform episiotomy if indicated.
- After fetal head emerges, check for cord around the neck; ensure adequate suctioning of the baby’s mouth and nose.
- Promote skin-to-skin contact and encourage breastfeeding post-delivery.
Management of 3rd Stage of Labor
- Deliver placenta within 5 to 30 minutes post-infant delivery. Signs of separation include cord lengthening, shape change of the uterus, and vaginal bleeding.
- Examine placenta, membranes, and umbilical cord for completeness and anomalies; check for perineum, vulval outlet, and vaginal lacerations.
Management of 4th Stage of Labor
- Observe the two hours post-delivery as a critical period for postpartum hemorrhage risks.
- Monitor bleeding, blood pressure, and pulse every 15 minutes.
- Ensure uterus is firm and bladder is empty to aid uterine retraction.
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