NURSING CARE OF MOTHER AND BABY DURING LABOR AND BIRTH

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how to use the nursing interventions for mother and baby in uncomplicated pregnancies and some complications

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  • Refer to table 6-1, pages 116-118
  • Discuss position too; refer to box 6-1, Classifications of fetal presentations and positions
  • Discuss Skill 6-1: assisting with an emergency birth
  • Review box 6-2 on page 133 and Skill 6-3 on page 133
  • Review box 6-3, page 136 on Reassuring and nonreassuring fetal heart rate and uterine activity patterns
  • Review skills 6-6 and 6-7 on page 151
  • NURSING CARE OF MOTHER AND BABY DURING LABOR AND BIRTH

    1. 1. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Chapter 6 Nursing Care of Mother and Infant During Labor and Birth
    2. 2. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 2 Cultural Influence on Birth Practices  Role of woman in labor and delivery  Role of father/partner in labor and delivery
    3. 3. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 3 Settings for Childbirth  Hospitals  Advantages  Disadvantages  Freestanding Birth Centers  Advantages  Disadvantages  Home  Advantages  Disadvantages
    4. 4. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 4 Components of the Birth Process  The Four “Ps”  Powers  Passage  Passenger  Psyche
    5. 5. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 5 Factors That Influence the Progress of Labor  Preparation  Position  Professional  Place  Procedures
    6. 6. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 6 Uterine Contractions  Effect of contractions on the cervix  Phase of contractions  Increment  Peak  Decrement  Frequency  Duration  Intensity  Mild  Moderate  Firm  Maternal pushing
    7. 7. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 7 Cervical Effacement and Dilation
    8. 8. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 8 Contraction Cycle
    9. 9. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 9 Nursing Tip  Provide emotional support to the laboring woman so she is less anxious and fearful  Excessive anxiety or fear can cause greater pain, inhibit the progress of labor, and reduce blood flow to the placenta and fetus
    10. 10. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 10 The Passage  Bony pelvis  Soft tissues
    11. 11. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 11 The Passenger—Fetal Skull, Lie
    12. 12. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 12 Passenger—Presentation
    13. 13. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 13 Classifications of Fetal Presentations and Positions
    14. 14. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 14 Psyche  The woman’s cultural and individual values influence how she will be able to cope with childbirth
    15. 15. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 15 Normal Childbirth
    16. 16. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 16 Signs of Impending Labor  Braxton-Hicks contractions  Increased vaginal discharge  Bloody show  Rupture of the membranes  Energy spurt  Weight loss
    17. 17. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 17 Mechanisms of Labor  Descent  Engagement  Flexion  Internal rotation  External rotation  Expulsion
    18. 18. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 18 Birth Station
    19. 19. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 19
    20. 20. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 20 Admission to the Hospital or Birth Center
    21. 21. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 21 When to Go to the Hospital or Birth Center  Contractions  Ruptured membranes  Bleeding other than bloody show  Decreased fetal movement  Any other concern
    22. 22. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 22 Admission Data Collection  Three major assessments performed promptly on admission:  Fetal condition  Maternal condition  Impending birth
    23. 23. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 23 Admission Procedures  Permits/consents  Laboratory tests  Intravenous infusion  Shave prep  Determining fetal position and presentation
    24. 24. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 24 Comparison of False and True Labor  False labor  Contractions irregular  Walking relieves contractions  Bloody show usually not present  No change in effacement/dilation of cervix  True labor  Contractions gradually develop a regular pattern  Contractions become stronger and more effective with walking  Discomfort in lower back/abdomen  Bloody show often present  Progressive effacement and dilation of cervix
    25. 25. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 25 Nursing Care Before Birth  After admission to the labor unit, nursing care consists of:  Monitoring the fetus  Monitoring the laboring woman  Helping the woman cope with labor
    26. 26. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 26 Monitoring the Fetus  Fetal heart rate  Intermittent auscultation  Continuous electronic fetal monitoring  Evaluating fetal heart rate patterns  Accelerations  Early decelerations  Variable decelerations  Late decelerations
    27. 27. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 27 Reassuring and Nonreassuring Fetal Heart Rate and Uterine Activity Patterns  Reassuring Patterns  Nonreassuring Patterns
    28. 28. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 28
    29. 29. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 29 Monitoring the Woman  Vital signs  Contractions  Progress of labor  Intake and output  Response to labor
    30. 30. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 30 Helping the Woman Cope With Labor  Teaching  Providing encouragement  Supporting the partner  Teach partner how labor pains affect the woman’s behavior/attitude  Teach partner how to adapt responses to the woman’s behavior  Teach partner what to expect in his/her own emotional responses  Teach partner the effects of epidural analgesia
    31. 31. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 31 Stages and Phases of Labor  First stage—dilation and effacement (4 to 6 hours)  Second stage—expulsion of fetus (30 minutes to 2 hours)  Third stage—expulsion of placenta (5 to 30 minutes)  Fourth stage—recovery
    32. 32. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 32 Nursing Responsibilities During Birth  Preparing the delivery instruments and infant equipment  Perineal scrub  Administering medications  Providing initial care to the infant  Assessing Apgar score  Assessing infant for obvious abnormalities  Examining the placenta  Identifying mother and infant  Promoting parent-infant bonding
    33. 33. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 33 Immediate Postpartum Period: The Third and Fourth Stages of Labor  Third stage—Expulsion of placenta  Schultze’s or Duncan’s  Fourth stage—Nursing cares include:  Identifying and preventing hemorrhage  Evaluating and intervening for pain  Observing bladder function and urine output  Evaluating recovery from anesthesia  Providing initial care to the newborn infant  Promoting bonding and attachment between the infant and family
    34. 34. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 34 Nursing Care Immediately After Birth  Care of the mother  Observing for hemorrhage  Promoting comfort
    35. 35. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 35 Nursing Care Immediately After Birth (continued)  Care of the infant  Phase 1 • From birth to 1 hour (usually in delivery room)  Phase 2 • From 1 to 3 hours (usually in transition nursery or postpartum unit)  Phase 3 • From 2 to 12 hours (usually in postpartum unit if rooming-in with the mother)
    36. 36. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 36 Phase 1: Care of the Newborn  Initial care includes:  Maintaining thermoregulation  Maintaining cardiorespiratory function  Observing for urination and/or passage of meconium  Identifying the mother, father, and newborn  Performing a brief assessment for major anomalies  Encouraging bonding/breastfeeding
    37. 37. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 37 Care of the Newborn (Continued)
    38. 38. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 38 Apgar Scoring  Heart rate  Respiratory effort  Muscle tone  Reflex response to suction or gentle stimulation on the soles of the feet  Skin color
    39. 39. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 39 Administering Medications to the Newborn  Eye care  Vitamin K (AquaMEPHYTON)
    40. 40. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 40 Umbilical Cord Blood Banking  This type of blood is capable of regenerating stem cells that are able to replace diseased cells  Informed consent is essential  Collect blood after cord has been clamped  Blood must be transported to blood banking facility within 48 hours of collection
    41. 41. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 41 Question for Review  State the primary fetal risk during the first and second stage of labor and the primary maternal risk during the fourth stage of labor.
    42. 42. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 42 Review  Objectives  Key Terms  Key Points  Online Resources  Critical Thinking Questions  Review Questions

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