Labor and Delivery Process Chapter 11 PDF

- Labor and delivery process: - ASSESSMENT OF MOTHER, FETUS, AND THE FAMILY - PREMONITORY SIGNS (PHYSIOLOGIC CHANGES BEFORE LABOR) - Back pain -- constant low, dull backache caused by pelvic muscle relaxation. - Weight loss -- 1 -- 3.5 lb. -...

- Labor and delivery process: - ASSESSMENT OF MOTHER, FETUS, AND THE FAMILY - PREMONITORY SIGNS (PHYSIOLOGIC CHANGES BEFORE LABOR) - Back pain -- constant low, dull backache caused by pelvic muscle relaxation. - Weight loss -- 1 -- 3.5 lb. - Lightening - fetal head descends into the true pelvic about 14 days before labor. - Easier to breath, but more pressure on bladder. - Contractions - begins with irregular uterine contractions (Braxton Hicks) that will progress in strength and regularity. - Increased vaginal discharge or bloody show. - Energy burst -- nesting - Gastrointestinal change - Less common; including N&V, and indigestion. - Cervical ripening - Soft (opens) and partially effaced and can begin to dilate. - Rupture of membranes: - Labor usually occurs within 24 hr. of the rupture. - Prolong rupture greater than 24 hr. can lead to infection. - Immediately following the rupture, a nurse should assess the FHR for abrupt decelerations, which is indicative of fetal distress or to rule out cord prolapse. - MONITORING DURING LABOR, PROGRESS OF LABOR, PSYCHOSOCIAL FACTORS, AND CULTURAL FACTORS - ASSESSMENT OF AMNIOTIC FLUID - Should be watery, clear, and have a slightly yellow tinge. - Odor should not be foul. - 700 to 1000 mL - Use nitrazine paper to confirm that amniotic fluid is present. - Amniotic fluid is Alkaline: pH of 6.5 to 7.5 - Urine is slightly acidic. - FIRST STAGE: - LATENT PHASE (0cm -- 5cm) - Contractions - Irregular, mild to moderate - Frequency: 5 to 30 min - Duration: 30 to 45 seconds. - Maternal Characteristics: - Scant amount of brownish discharge, pale pink mucus, or mucus plug. - Talkative or calm - Thoughts are focused on labor, self, and baby - Ability to talk and walk through most contractions. - Easily follows direction - Can be apprehensive. - ACTIVE PHASE (6cm -- 10cm) - Contractions: - More regular, moderate to strong - Frequency: 3 to 5 min - Duration: 40 to 90 seconds. - Complete dilation - Maternal Characteristics: - Becomes more serious - Feeling of helplessness, anxiety, apprehension, and attention are more of a inward focus. - Pain may be more severe and may feel out of control, irritable, and doubt ability to continue - Can have N&V, urge to push, rectal pain and feelings of needing to have a BM. - Increased blood show. - Most difficult part of labor. - TRANSITION PHASE - SECOND STAGE - Full dilation - Pushing and fetal descent. (?? -- 30 min long) - Birth of the newborn. - Maternal Characteristics: - Pushing results in birth of newborn. - THIRD STAGE - Delivery of the placenta - Maternal Characteristics: - Placental separation and expulsion - Schultze presentation: - Shiny fetal surface or placenta emerges first. - Duncan presentation - Dull maternal surface of placenta emerges first. - FOURTH STAGE - Maternal stabilization of VS - Maternal Characteristics: - Achievement of VS homeostasis - Five P's of Labor - Passenger (Fetus and placenta) - Presentation: - Occiput -- back of the head - Mentum -- chin - Scapula -- shoulder - Sarum or feet -- breech - Lie: - Transverse - Parallel or Longitudinal - Attitude - Fetal flexion - Fetal extension - Fetopelvic or fetal position: - Right (R) or Left (L) - Occiput (O), Sacrum (S), Mentum (M), or Scapula (Sc) - Anterior (A), Posterior (P), or Transverse (T) - Station - Measurements of fetal descent in cm with station 0 being at the level of an imaginary line at the level of the ischial spines, minus stations superior to the ischial spines, and plus stations inferior to the ischial spines. - Passageway - Birth canal - Bony pelvic - Cervix - Pelvic floor - Vagina - Introitus (vaginal opening) - Powers - Contractions - Shortening and thinning of the cervix - First stage of labor - Enlargement or widening of the cervical opening and canal - Occurs once labor has begun. - Involuntary urge to push and voluntary bearing down - Second stage of labor - Position - The client engages in frequent position changes. - Increase comfort - Relieve fatigue - Promote circulation. - Position during second stage is determined by maternal preference, provider preference, and the condition of the mother and the fetus. - Gravity can aid in the fetal descent in upright, sitting, kneeling, and squatting position. - Psychological Response - Stress, emotions, anxiety - Characteristics of a Contraction: - Duration - How long it last. - From start to finish of contractions. - Don't want it to go more than 90 seconds. - Frequency - How often the contractions are happening. - Start of the first contraction to the start of the second contraction. - Intensity or Strength - Strength of the contraction at its peak. - Measured by monitor or by palpating the belly. - Increment - Start of the contraction - Decrement - The peak of the contraction - ACME - The end of the contraction - True Versus False Labor: - Cervical Position, Dilation, and Effacement - CONTRACTIONS (DURATION, FREQUENCY, STRENGTH, RHYTHM) - True labor: - Duration gets longer - Frequency gets closer - Strength gets stronger - Rhythm gets organized - PAIN - True labor - Entire belly hurts - ACTIVITY EFFECT ON CONTRACTION - Does activity level change the contraction? - True labor will not change - False labor will change - OTHER SIGNS AND SYMPTOMS - Nursing Care: Pre-procedure - LEOPOLD MANEUVERS - ABD palpate of the fetal presenting part. - Lie, Attitude, Descent, and the probable location of FHR. - FETAL AND UTERINE MONITORING - External electronic monitoring (Tocotransducer) - Displays uterine contraction patterns. - Easily applied but must be repositioned with maternal movement. - External Fetal Monitoring (EFM) - Applied to the ABD to asses FHR patterns during labor - LAB VALUES ANALYSIS - UA - Blood Test - CBC - ABO typing and Rh-factor - CLIENT EDUCATION - Nursing Care: Intra-procedure: - MONITOR VITAL SIGNS AND FETAL HEART RATE - MONITOR LABOR PROGRESS AND CONTRACTIONS - VAGINAL EXAMINATION - FETAL PROGRESSION THROUGH BIRTH CANAL - Nursing Care: Post-procedure: - NURSING ASSESSMENTS - FUNDUS ASSESSMENT AND MASSAGE; LOCHIA ASSESSMENT - Lochia - Vaginal bleeding - Access every 15 min for the first hr. - Massage: - Uterine and/or administer oxytocics as prescribed. - PROVIDE COMFORT MEASURES - Ice packs - Calm quiet environment - ENCOURGAE VOIDING, AMBULATION - Encourage voiding to prevent bladder distention - ASSIST WITH BREASTFEEDING AND NEWBORN CARE