MCN MIDTERMS_UNIT 2 LESSON 2.pdf

Unit 2 (Lesson 2): Admitting and Assessing a Woman in labor Admitting and Assessing a Woman in Labor 1. Initial Contact & Rapid Assessment Objective: Immediately determine if the woman requires urgent referral or emergency car...

Unit 2 (Lesson 2): Admitting and Assessing a Woman in labor Admitting and Assessing a Woman in Labor 1. Initial Contact & Rapid Assessment Objective: Immediately determine if the woman requires urgent referral or emergency care, or if labor is progressing normally. Key Considerations: Is there any immediate danger? Check for signs like heavy vaginal bleeding, severe headaches, blurred vision, convulsions, loss of consciousness, difficulty breathing, or severe abdominal pain. Active labor criteria: At least 4 cm cervical dilation and 2-3 contractions every 10 minutes. If the woman does not meet the criteria for admission, she may be advised to return home or wait near the facility. 2. Preparation Before Admission Essential Equipment: Prenatal record: Important to gather relevant history about previous pregnancies, complications, and current status. Gloves: Ensure cleanliness and infection control during assessments. Doppler: Used to listen to the fetal heartbeat. Thermometer: To check for fever. Timer: To monitor the duration and frequency of contractions. Unit 2 (Lesson 2): Admitting and Assessing a Woman in labor 1  Blood Pressure Cuff: To monitor maternal blood pressure, which should be in the range of 90/60 mmHg to 120/80 mmHg. Bedpan: For voiding if necessary before procedures like Leopold’s maneuver. 3. Focused Admission Assessment Labor Progression: Contractions: Ask about the frequency (how often contractions occur), duration (how long each contraction lasts), and intensity (mild, moderate, or strong). Membrane Rupture: If the woman’s water has broken, assess the color, odor, and amount of amniotic fluid (normally colorless and oderless). A greenish tint may indicate meconium, which requires immediate attention. Fetal Movement: A decrease in fetal movement may indicate distress and should be evaluated promptly. Fetal Heart Rate (FHR): Use a Doppler to assess the fetal heart rate. The normal range is 120- 160 bpm. Abnormalities below 120 bpm or above 160 bpm indicate fetal distress. Vital Signs: Blood Pressure: Check for elevated blood pressure, which could indicate pre-eclampsia (a serious pregnancy complication). Pulse Rate: Normal maternal pulse is 80-100 bpm. Temperature: A temperature of 36.5°C to 37.4°C is normal. A fever may signal infection. 4. Detailed History Taking Unit 2 (Lesson 2): Admitting and Assessing a Woman in labor 2  Sociodemographic Information: Obtain the woman’s name, age, address, occupation, and other relevant personal details. Labor Status: Record her main complaints (e.g., labor pains, ruptured membranes). Contractions: Note the pattern of contractions (frequency, intensity, duration). Pregnancy History: Record GPTPALM (Gravidity, Parity, Term births, Preterm births, Abortions, Living children, Multiple pregnancies). Determine the gestational age by calculating the Estimated Date of Confinement (EDC) or Expected Date of Delivery (EDD) based on the Last Menstrual Period (LMP) or fetal quickening (first fetal movements). 5. Physical Examination Inspection of the Abdomen: Use the 3 S’s mnemonic: Size: Is the abdomen too large or too small for the gestational age? A large abdomen could indicate twins or excess amniotic fluid, while a small size may suggest intrauterine growth restriction (IUGR). Shape: An oval shape is typical for a head-down (cephalic) presentation. A round shape may indicate an abnormal fetal position, such as breech. Scarring: Look for any scars from previous cesarean sections, as these pose a risk of uterine rupture during labor. Palpation of the Abdomen: Perform Leopold’s Maneuver to assess fetal position and lie. Feel for the fetal head, the presenting part, and the orientation of the fetus. Check fundal height to gauge the baby’s development. A discrepancy between the fundal height and gestational age could suggest Unit 2 (Lesson 2): Admitting and Assessing a Woman in labor 3  complications. Auscultate the fetal heart rate using a Doppler immediately after a contraction. Listen carefully for at least 60 seconds. 6. Monitoring Uterine Contractions Duration: Time from the beginning to the end of a single contraction. Interval: Time from the end of one contraction to the beginning of the next. Frequency: Time from the beginning of one contraction to the beginning of the next. Assessing Intensity: Mild: Feels like the tip of your nose. Moderate: Feels like your chin. Strong: Feels like your forehead. 7. Vaginal Examination Purpose: To determine if labor has started and assess its progress. Cervical Dilation & Effacement: Measure how far the cervix has opened and thinned (effacement) to allow the baby’s passage. Fetal Presentation: Check if the baby is head-first (cephalic) or another presentation like breech. Fetal Station: The baby's position relative to the ischial spines in the pelvis. Negative numbers (-3, -4): Baby is high in the pelvis. Zero (0): Baby is fully engaged in the pelvis. Positive numbers (+1, +2): Baby is descending into the birth canal. Station Assessment: Station is critical in determining whether the baby is moving down the birth canal effectively. For example, a station of +3 means the baby’s head is nearly crowning. Unit 2 (Lesson 2): Admitting and Assessing a Woman in labor 4  Vaginal exams should be performed every 4 hours to limit infection risk. 8. Documenting the Admission Process Essential Information: Patient’s name, age, and other demographic data. Gravidity and parity: (GPTPALM). Gestational age and Estimated Date of Delivery (EDD). Labor status: Frequency, duration, and intensity of contractions. Cervical Dilation & Effacement: Record the stage of labor. Fetal Presentation and Station. Status of the Membranes: Intact or ruptured, and the characteristics of the amniotic fluid. Vital Signs: Blood pressure, pulse, temperature. Fetal Heart Rate (FHR): Record the response to contractions. Maternal Coping: Document the woman’s ability to manage the pain and stress of labor. 9. Admission Criteria Admit if the woman is in active labor (4 cm dilation, regular contractions). Document all findings in the patient record. Notify the attending physician or midwife and transfer the woman to the labor room for further monitoring and care. If Not Ready for Admission: Advise the woman to return once labor is more active, or if from a distant location, allow her to stay near the facility for further observation. 10. Patient Care During Admission Provide continuous monitoring for labor progression, focusing on: Cervical dilation and fetal descent. Unit 2 (Lesson 2): Admitting and Assessing a Woman in labor 5  Fetal heart rate and movement patterns. Maternal vitals to assess any signs of distress. Prepare for Delivery: Once full dilation (10 cm) is achieved, prepare the woman for the second stage of labor, the delivery of the baby. Unit 2 (Lesson 2): Admitting and Assessing a Woman in labor 6