session 3 Birthing and the nurse's role in postpartum care Flashcards
Factors affecting labour progress
the birth canal the passager the physiological forces of labour the position of the women the womans psychological considerations
What are the two positions a fetus wil lie in relation to the spinal column of the mother
longitudinal or transverse
what are the premonitory signs of labour
lightening braxton hicks contractions bloody show rupture of the membranes sudden burst of energy backache nausea and vomiting diarrhoea
What assessment are performed by the nurse during labour
Evaluate the progress of labour
monitor vital signs
listen to the fetal heart rate at regular intervals
what is considered true labour
When the cervix thins with progressive dilation and effacement.
contractions increase in frequency, duration and intensity
pain goes from the back and radiates to the abdomen
pain is not relieved by ambulation or by resting
what is a normal FHR (baseline rate)
110 - 160 beats per minute
tachycardic if more than 160 beats/min
bradycardic if less than 110 beats/min
What happens in the first stage of labour
Latent contractions - short not regular contractions
Active contractions - build up - more regular contractions (2-3 minutes and last for a minute)
Transition stage - fully dilated and has the sensation to push
Nursing care for 1st stage
Continue to assess
-monitor vitals
-FHR
-pain relief
-contractions
-VE
-fluids
* help prevent pushing prior to complete cervical dilation,
encourage them to find a position of comfort
listen to what she wants and involve the partner
Second stage of labour
total effacement
birth of the baby
Nursing care for 2nd stage labour
continue to monitor
encourage them to find a position of comfort
listen to what she wants and involve the partner
provide information of the progress of her labour
Assist midwife in preparation for the birth
what happens in the third stage of labour
the placenta is delivered
what is the nursing care in the third stage of labour
Provide the initial newborn care - place newborn on the mothers stomach or under a radiant heated unit
assist with the delivery of the placenta by giving an IM of oxytocin to assist placental delivery and prevent bleeding
continue to monitor and document
recognise for signs of placental separation
placental delivery
what is fourth stage of labour
Palpation of the fundus to assess for uterine firmness
return to pre pregnancy norms
Nursing care of woman in fourth stage of labour
gentle uterine massage if the uterus is soft (boggy)
cleanse the maternal perineum
ice pack may be placed against the perineum
promote comfort and decrease swelling
What immediate care is given to a newborn?
maintain respirations - check regularly
provide and maintain warmth- rub and dry baby
Apgar score
physical assessment
newborn identification - nameband
facilitate attachment - help mother put baby to breast
vitamin K given after birth - assist in blood clotting abilities that the newborn has not developed yet
describe common deviations for the normal that can occur during the puerperium stage
shrinking of the uterus and genital tract
the secretion of breastmilk
the psychological adjustment - after 3 days “baby blues”
prevention of infection
what is the definition of PPH
blood loss of more than 500mls that can occur in the first 24 hours (primary PPH) or up to 6 weeks (secondary PPH) after the birth ( infection from a piece of placenta that remains)
What are the contributing factors to primary PPH
previous hx -clotting disorder, trauma during delivery, distended uterus, previous PPH
multiparity - more than 1, 2, 3 -after 4 is a higher risk
overdistention - multiple pregnancy, polyhydramnios or large fetus
Fibroids - extra growth that can bleed
APH - bleeding during labour
Prolonged labour
uterine causes
What are the 4 causes of PPH
TONE - maintain tone of uterus
TRAUMA - look at the birth tract
TISSUE - check plancenta all there
THROMBIN - get blood test done
What is the managent of PPH
4Ts
call for help
assess ABCD
massage fundus , administer oxytocic
take bloods - check clotting factor and xmatch
prepare fluid replacement - 2x large bore cannulas 16gauge
monitor fluid volumes - obs, FBC
Bimanual compression - hand in vagina and top of uterus and contracting manually
describe the normal physiological changes in a woman after childbirth and the nursing considerations relating to these changes
Lochia (vaginal discharge)- give oxytocic medication to reduce flow that can increase on ambulation and when breast feeding. Educate that blood will pool when she has been lying, not to alarm her when there is gush of blood when she stands and that it is not haemorrhage. Check for any change in odour that could indicate infection
Incision drainage - c-section
Breast discharge - yellow discharge of colostrum until day three when milk comes in
Breast engorgement- when hormones activate production of mik
Uterine contractions- hormone oxytocin is release to reduce the size of the uterus - encourage with gentle massage of the fundus
Discomfort in the perineal area - check for reduction in oedema, incision site if stitches were needed, any haemroids or haematomas
pelvic muscular support- encourage kegel exercises
Constipation- encourage drinking and redulce any fear of bowel movement with education on relaxing and holding the perineum area during the bowel movement. If a bowel movement has not been achieved by day 3 - suppositories are given
Post partal diuresis- decreased eostrogen levels causes diuresis and women to loose the extra fluid that is accumulated over the pregnancy
Menstruation
describe the philosphy of women centred care during labour
where the woman makes choices in and has control over her care and the relationship with her midwife.
describe the uncommon deviations for the normal that can occur during the puerperium
BP:A low or decreasing blood pressure may reflect hypovolemia secondary to hemorrhage.An increased reading may result from excessive use of vasopressor or oxytocic medications. Because pregnancyinduced hypertension can persist into or occur first in the postpartum period, routine evaluation of blood pressure is needed. If a woman complains of headache, hypertension must be ruled out as a cause before analgesics are administered.
Temp:puerperal sepsis is suggested if a rise in maternal temperature to 38° C is noted after the first 24 hours after childbirth and recurs or persists for 2 days. Other possibilities are mastitis, endometritis, urinary tract infections, and other systemic infections
Pulse:A rapid pulse rate or one that is increasing may indicate hypovolemia as a result of hemorrhage.
Resps:Hypoventilation may follow an unusually high subarachnoid (spinal) block or epidural narcotic after a cesarean birth.
