Chapter 6 Nursing Care of Mother and Infant During Labor and Birth PDF

Chapter 6 Nursing Care of Mother and Infant During Labor and Birth  Lesson 6.1 Objectives 1. Define each key word listed. 2. Discuss specific cultural beliefs the nurse may encounter when providing care to a woman in labor. 3. Compare the advanta...

Chapter 6 Nursing Care of Mother and Infant During Labor and Birth  Lesson 6.1 Objectives 1. Define each key word listed. 2. Discuss specific cultural beliefs the nurse may encounter when providing care to a woman in labor. 3. Compare the advantages and disadvantages for each type of childbearing setting: hospital, freestanding birth center, and home. 4. Describe the four components (“four Ps”) of the birth process: powers, passage, passenger, and psyche. 5. Describe how the four Ps of labor interrelate to result in the birth of an infant.  Cultural Influences on Birth Practices Role of woman in labor and delivery Cultural preferences require flexibility Role of father or partner in labor and delivery May be driven by cultural practices Components of the Birth Process The four “Ps” Powers Passage Passenger Psyche  Factors that Influence the Progress of Labor Preparation Position Professional Place Procedures People  Uterine Contractions Effect of contractions on Duration the cervix Intensity Efface Mild Dilate Moderate Phase of contractions Firm Increment Maternal pushing Peak Decrement Frequency  Psyche Mental state can influence the course of labor. The woman’s cultural and individual values influence how she will cope with childbirth.  Lesson 6.2 Objectives 6. Explain the normal processes of childbirth: premonitory signs, mechanisms of birth, and stages and phases of labor. 7. Explain how false labor differs from true labor.  Signs of Impending Labor Braxton Hicks contractions Increased vaginal discharge Bloody show Rupture of the membranes Energy spurt Weight loss  Mechanisms of Labor Descent Station Engagement Flexion Internal rotation Extension External rotation Expulsion When to Go to the Hospital or Birth Center Contractions Ruptured membranes Bleeding other than bloody show Decreased fetal movement Any other concern  Admission Data Collection Three major assessments performed promptly on admission Fetal condition Maternal condition Impending birth  Admission Procedures Permits and consents Laboratory tests Intravenous infusion Perineal prep Determining fetal position and presentation  Comparison of False and True Labor False Labor True Labor Contractions Contractions irregular gradually develop a Walking relieves regular pattern contractions Contractions become Bloody show usually stronger and more not present effective with walking No change in Discomfort in lower effacement or back or abdomen dilation of cervix Bloody show often present Progressive effacement and dilation of cervix  Lesson 6.3 Objectives 8. Determine appropriate nursing care for the intrapartum patient, including the woman in false labor and the woman having a vaginal birth after a cesarean birth (VBAC). 9. Explain common nursing responsibilities during labor and birth. 10.Describe the care of the newborn immediately after birth.  Nursing 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  Monitoring the Fetus Fetal heart rate (FHR) Monitor every 30 minutes in active, first phase of labor. Monitor every 15 minutes in second stage and preferably before each contraction. Risk factors present Monitor every 15 minutes in active first stage. Monitor every 5 minutes during second stage. Intermittent auscultation Continuous electronic fetal monitoring Fetal Heart Rate Outside of Normal Limits Any FHR outside the normal limits and any slowing of the FHR that persists after the contraction ends is promptly reported to the health care provider.  Evaluating Fetal Heart Rate Patterns Baseline FHR Moderate 110 to 160 variability beats/min Marked variability Fetal bradycardia Absent variability 160 beats/min Variable Baseline variability decelerations Late decelerations  Reassuring and Nonreassuring Fetal Heart Rate and Uterine Activity Patterns Reassuring patterns Nonreassuring Stable FHR patterns Moderate variability Accelerations Tachycardia Uterine contraction Bradycardia frequency greater Decreased or absent than every 2 variability; little minutes; duration fluctuation in rate less than 90 seconds; Late decelerations relaxation interval of at least 60 seconds Variable decelerations  Inspection of Amniotic Fluid Color Normal is clear fluid; may have flecks of Odor white vernix Should not smell Green-stained may indicate fetus passed If it does, it may indicate infection meconium (first stool but before birth) Can lead to fetal compromise Amount Scant: trickle Moderate: ~500 mL Large: ≥1000 mL  Monitoring the Woman Vital signs Contractions Progress of labor Intake and output Response to labor Breathing and relaxation techniques  Stages and Phases of Labor First stage—dilation and effacement (can last 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  Helping the Woman Cope with Labor Labor support Teaching Providing encouragement Supporting and teaching the partner Teach how labor pains affect the woman’s behavior and attitude How to adapt responses to the woman’s behavior What to expect in his or her own emotional responses Effects of epidural analgesia  Vaginal Birth After Cesarean Main concern Uterine scar will rupture Can disrupt placental blood flow Lead to hemorrhage Woman may need more support than other laboring women Nurse provides empathy and support  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  Immediate Postpartum Period: Third and Fourth Stages of Labor Third stage—expulsion of placenta Schulze or Duncan Fourth stage—nursing care includes 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 Nursing Care Immediately After Birth (1 of 2) Care of the mother Observing for hemorrhage Vital signs Skin color Location and firmness of uterine fundus Lochia Pain Promoting comfort Keep warm and dry Ice to perineum to help reduce swelling and bruising Nursing Care Immediately After Birth (2 of 2) Care of the newborn 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)  Phase 1: Care of the Newborn Initial care includes Maintaining thermoregulation Maintaining cardiorespiratory function Observing for urination and passage of meconium Identifying the mother, father, and newborn Performing a brief assessment for major anomalies Encouraging bonding and breastfeeding  Apgar Scoring Heart rate Respiratory effort Muscle tone Reflex response to suction or gentle stimulation on the soles of the feet Skin color Administering Medications to the Newborn Eye care Vitamin K (Aqua MEPHYTON)  Observe for Major Anomalies Head trauma from delivery Symmetry and equality of extremities Are they of equal length? Do they move with same vigor on both sides? Assess digits of hands and feet Any evidence of webbing or abnormal number of digits