Ch 13-14 Nursing management during labor & birth

Question 1

what is included in an OB assessment

Answer 1

fundus, fetal, pain, vag, rectum, breast

Question 2

Maternal Status

Answer 2

Vaginal examination (cervical dilation, effacement, membrane status, fetal descent and presentation)

Rupture of membranes

Uterine contractions

Leopold’s maneuvers

Question 3

Fetal assessment

Answer 3

Amniotic fluid analysis

Fetal heart rate monitoring
Handheld vs. electronic;
intermittent vs. continuous;
external vs. internal

Fetal heart rate patterns
Baseline,
baseline variability,
periodic changes

Other assessment methods
Fetal scalp sampling,
pulse oximetry,
stimulation

Question 4

How frequently do you assess for pain?

Answer 4

Q1H

Question 5

instead of holding their breath, what should moms do to decrease pain in the long run r/t ischemia?

What stage is this primarily in?

Answer 5

paced breathing

1st stage

Question 6

Distention of cervix

Distension of lower uterine segment

Uterine ischemia - occurs bc muscles contract

Referred pain

Answer 6

Visceral pain

Stage 1

Question 7

Distention of pelvic floor, vagina, perineum

predominant in which stage b/c presenting part is going through birth canal?

Presenting part descending

Lacerations of soft tissue

Answer 7

Somatic pain

stage 2

Question 8

should you give fentanyl in the first stage of labor? why or why not

Answer 8

no, short half life

Question 9

who gets general anesthesia?

what drugs do you get for general anesthesia

Answer 9

Emergency cesarean birth or woman with contraindication to use of regional anesthesia

Commonly, first thiopental IV to produce unconsciousness

Next, muscle relaxant

Then intubation, followed by administration of nitrous oxide and oxygen; volatile halogenated agent also possible to produce amnesia

Question 10

General measures
   Obtain admission history
   Check results of routine laboratory tests and any special tests
   Ask about childbirth plan
   Complete a physical assessment

Initial contact either by phone or in person

Maternal health hx

Physical assessment of mom

Fetal assessment

Lab studies

Assessment of psychological status

Answer 10

1st stage management

Question 11

Assessment

• Contraction frequency, duration, intensity
• Maternal vital signs
• Fetal response to labor via FHR
• Amniotic fluid with rupture of membranes
• Coping status of woman and partner

Interventions

• Supporting woman & partner in active decision making
• Supporting involuntary bearing-down efforts; encouraging no pushing until strong desire or until descent and rotation of fetal head well advanced
• Providing instructions, assistance, pain relief
• Using maternal positions to enhance descent and reduce pain
• Preparing for assisting with delivery

Answer 11

Stage 2 management

Question 12

Assessment
- Placental separation; placenta and fetal membranes examination; perineal trauma; episiotomy; lacerations

Interventions
- Instructing to push when separation apparent; giving oxytocin if ordered; assisting woman to comfortable position; providing warmth; applying ice to perineum if episiotomy; explaining assessments to come; monitoring mother’s physical status; recording birthing statistics; documenting birth in birth book

Answer 12

stage 3 management

Question 13

Assessment
- Vital signs, fundus, perineal area, comfort level, lochia, bladder status

Interventions

• Support and information
• Fundal checks; perineal care and hygiene
• Bladder status and voiding
• Comfort measures
• Parent–newborn attachment
• Teaching

Answer 13

Stage 4 management