The Family in Childbirth Flashcards
When is the patient advised to arrive at the birthing center?
Rupture of membranes (ROM)
Decreased fetal movement
Regular, frequent contractions
- 5 mins apart for 1 hour for nulliparas
- 6-8 mins apart for 1 hour for multiparas
Any vaginal bleeding
Headache that won’t go away
How do you provide care and comfort in the first stage of labor?
Monitor vital signs, contractions and FHR
Vaginal exams only as needed
Encourage ambulation, unless contraindicated
Offer clear liquids, ice chips, IV fluids for hydration
Encourage voiding
Support breathing and relaxation techniques
Position for comfort and safety
Offer hygiene measures and dry linens
Inform about pain relief options
How do you provide care and comfort in the second stage of labor?
Do not leave the patient alone
Position for effective pushing
Explain sensations of pushing
- strong urge to bear down
- May feel need to have bowel movement
- May feel burning or splitting sensation
Coach pushing efforts
Continue to monitor FHR
Offer comfort measures
Include the support persons
Prep for delivery
- cleanse perineum
- assist physician
What is the nursing care during the third stage of labor?
Provide initial newborn care
-Maintain respirations
-Provide and maintain warmth
Anticipate the birth of the placenta
-prepare oxytocin to be given after delivery of placenta
What are the nursing care at delivery
Weigh the baby
Place ID bracelets on baby and parents
Initiate attachment behaviors by encouraging skin to skin and breast-feeding
Document
What are the nursing care during the fourth stage of labor?
Administer oxytocin to help uterus contract at direction of healthcare provider
May need to provide sutures and local anesthesia to HCP for episiotomy repair
Clean perineum and provide ice pack as needed
Reposition for comfort
Provide clean linens and warm blankets
What are some additional care during the fourth stage?
Every 15 minutes monitor mom’s:
Vital signs
Location of fundus
Bladder fullness
Perineum for bleeding
Report to HCP:
-hypotension
-Tachycardia
-uterine atony
-Excessive bleeding
-temp above 38°C
What is the purpose of the Apgar score?
To evaluate the physical conditions of the newborn at birth
The newborn is rated one minute after birth, and again at five minutes and receives a total score, ranging from 0 to 10
What is the first criteria of the Apgar score?
The heart rate is ausculated or palpated at the junction of the umbilical cord and skin. This is the most important assessment. A newborn heart rate of less than 100 bpm indicates the need for immediate resuscitation.
If the heart rate is absent: score 0
If heartbeat is slow and less than 100 bpm: score 1
If heart rate is greater than 100 bpm, then: score is 2
What is the second criteria for the Apgar scoring system?
Respiration. The respiratory effort is the second most important Apgar assessment. Complete absence of respirations is termed apnea. A vigorous cry indicates good respirations.
If respiration is absent : 0
Respirations slow and irregular : 1
If respiration is good, breathing with crying : score it 2
What is the third criteria of the Apgar scoring system?
The muscle tone is determined by evaluating the degree of flexion and resistance to straining of the extremities
If muscle tone is flaccid : 0
if muscle tone has some flexion of extremities : 1
If muscle tones has active movement of extremities : 2
What is the fourth criteria of the Apgar scoring system?
The reflex response. The reflex irritability is evaluated as the newborn is dried or by lightly rubbing the soles of the feet. A cry is a score of two a grimace is one point, and no response is zero.
What is the fifth criteria of the Apgar scoring system?
Skin color. The skin color is inspected for cyanosis and pallor. Newborns generally have blue extremities, and the rest of the body is pink, which merits a score of one. This condition is termed, acrocyanosis and is present in 85% of normal newborns. A completely pink newborn scores, a two and a totally cyanotic, pale baby scored zero
What does a score of 7 to 10 indicate in the Apgar scoring system
Indicates a newborn is in good condition, and requires only nasopharyngeal suctioning
What does a score between four and seven indicate on the Apgar scoring system
Indicates the need for stimulation
