session 3 Birthing and the nurse's role in postpartum care

Question 1

Factors affecting labour progress

Answer 1

the birth canal
the passager
the physiological forces of labour
the position of the women
the womans psychological considerations

Question 2

What are the two positions a fetus wil lie in relation to the spinal column of the mother

Answer 2

longitudinal or transverse

Question 3

what are the premonitory signs of labour

Answer 3

lightening
braxton hicks contractions
bloody show
rupture of the membranes
sudden burst of energy
backache
nausea and vomiting
diarrhoea

Question 4

What assessment are performed by the nurse during labour

Answer 4

Evaluate the progress of labour
monitor vital signs
listen to the fetal heart rate at regular intervals

Question 5

what is considered true labour

Answer 5

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

Question 6

what is a normal FHR (baseline rate)

Answer 6

110 - 160 beats per minute
tachycardic if more than 160 beats/min
bradycardic if less than 110 beats/min

Question 7

What happens in the first stage of labour

Answer 7

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

Question 8

Nursing care for 1st stage

Answer 8

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

Question 9

Second stage of labour

Answer 9

total effacement

birth of the baby

Question 10

Nursing care for 2nd stage labour

Answer 10

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

Question 11

what happens in the third stage of labour

Answer 11

the placenta is delivered

Question 12

what is the nursing care in the third stage of labour

Answer 12

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

Question 13

what is fourth stage of labour

Answer 13

Palpation of the fundus to assess for uterine firmness

return to pre pregnancy norms

Question 14

Nursing care of woman in fourth stage of labour

Answer 14

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

Question 15

What immediate care is given to a newborn?

Answer 15

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

Question 16

describe common deviations for the normal that can occur during the puerperium stage

Answer 16

shrinking of the uterus and genital tract
the secretion of breastmilk
the psychological adjustment - after 3 days “baby blues”
prevention of infection

Question 17

what is the definition of PPH

Answer 17

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)

Question 18

What are the contributing factors to primary PPH

Answer 18

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

Question 19

What are the 4 causes of PPH

Answer 19

TONE - maintain tone of uterus
TRAUMA - look at the birth tract
TISSUE - check plancenta all there
THROMBIN - get blood test done

Question 20

What is the managent of PPH

Answer 20

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

Question 21

describe the normal physiological changes in a woman after childbirth and the nursing considerations relating to these changes

Answer 21

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

Question 22

describe the philosphy of women centred care during labour

Answer 22

where the woman makes choices in and has control over her care and the relationship with her midwife.

Question 23

describe the uncommon deviations for the normal that can occur during the puerperium

Answer 23

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.