Week 4 Nursing Care Intrapartum Outline

Week 4 Nursing Care Intrapartum Outline

• Childbirth Education: Relaxation methods such as Dick-Read, Bradley, and Lamaze are used to manage pain during childbirth, focusing on relaxation techniques and breathing exercises. Lamaze emphasizes concentration and relaxation.

• Locations for Birth: Childbirth can occur at home, birthing centers, or hospitals.

• Triage & Admission: Assessments include contractions, maternal history, GTPAL (gravida, term, para, abortions, living), EDD (estimated date of delivery), meds/allergies, last meal, induction of labor (IOL) and C-section considerations, and cultural/partner preferences.

• Triage Assessment: Monitoring includes NST (non-stress test), EFM (electronic fetal monitoring), contraction frequency/intensity, vital signs (VS), temperature, urinalysis (UA), complete blood count (CBC), Rh factor, and sterile vaginal exam (SVE) with dilation, effacement, and station assessment. Amniotic fluid assessment (TACO: time, amount, color, odor) and SROM testing determine if the membranes have ruptured.

• Fetal Monitoring: Monitoring placement using Leopold's Maneuvers, baseline variability (absent, minimal, moderate, marked), accelerations, and decelerations (early, variable, late, prolonged). Internal and external monitoring techniques are used. Category I - Normal (reassuring) and categories II and III (indeterminate and abnormal/non-reassuring, emergency) are used to categorize fetal heart rate monitoring.

• Induction of Labor: Scenarios for induction include non-reactive NST, preeclampsia, placenta previa, history of loss, PROM/PPROM, preeclampsia, fetal demise, post-dates, chorioamnionitis, IUGR, etc.

• Augmentation & Induction: Methods include cervical ripening (Cervidil, Misoprostol, Foley bulb), oxytocin, and rupture of membranes.

• Signs of Labor: Hormonal and physical changes, bloody show, loss of mucus plug, lightening, nesting, and spontaneous rupture of membranes (SROM) are evaluated.

• Pain Management: Non-pharmacological (imagery, hydrotherapy, positioning, massage, ambulation), and pharmacological methods like Meperidine, Fentanyl, Butorphanol, Nalbuphine, and regional anesthesia (epidural, spinal-epidural, pudendal, nitrous oxide) are used.

• Elimination & Nutrition: Urinary considerations include full bladder concerns and catheterization options. Bowel considerations include nausea/vomiting (anti-emetics like Ondansetron and Metoclopramide), and diet (clear liquids) are recommended.

• Stages of Labor: Cardinal movements (engagement, descent, flexion, internal rotation, extension, external rotation, expulsion) during first stage (0–10cm dilation): Latent (0-3cm), Active (4-7cm), Transition (8-10cm). The second stage (dilation to delivery), third stage (placental delivery), and fourth stage (postpartum recovery) are defined. Post-partum assessment of vital signs, fundal checks, and placental assessment are performed.

• Cesarean Section (C-Section): Indications include fetal distress, macrosomia, malpresentation, multiples, failed labor. Pre-op procedures include CBC, blood typing, medications, consents, and antibiotics. Post-op monitoring includes VS, I&Os, incision, pain, response to analgesics, and infection risk assessment.

• TOLAC/VBAC (Trial of Labor After Cesarean): Considerations include previous C-section type, prior history of failed labor, and contraindications.

• Post-Delivery Care: Includes vital signs, fundal assessments, lochia (vaginal discharge), and perineal tissue monitoring.

• True vs. False Labor: Comparison of characteristics, determining if labor is truly underway.

• VEAL CHOP MINE (Mnemonic): Used for fetal heart rate interpretation, categorizing patterns and actions taken by nurses.