Transcript Document 7369467

The Process of
Birth
Prof.Carole A. Devine RN.MSN.
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Assessment And
Responsibilities During
Labor and Birth
Goal of Care: To provide for a safe
labor and birth of a healthy baby
and to promote maternal
comfort in the process…..
 1. Comfort Measures:
 2. Physical Needs:
 3. When to call the Physician
 Responsibilities of the
Attendants at the Birth
Prof.Carole A. Devine RN.MSN.
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Immediate Care of the
Newborn
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Assessments:
Vital Signs /Color of Infant
Apgar Scores
Check Cord
Assess Infant Weight
Assess U/A and G.I. Systems
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Prof.Carole A. Devine RN.MSN.
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Assessments (Cont.)
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Protect against infection
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Identification of Infant
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Prevent hypothermia
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Promote parental attachment
Prof.Carole A. Devine RN.MSN.
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Managing the Pain of
Labor and Delivery
Prof.Carole A. Devine RN.MSN.
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Labor Pain-Introduction
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Historical Perspective
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Management Strategies:
1.Non- Pharmaceutical Measures
2. Pharmaceutical Choices
The Challenge to Nurses!
Prof.Carole A. Devine RN.MSN.
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What Exactly is Labor
Pain ????
Prof.Carole A. Devine RN.MSN.
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Factors Affecting The
Woman in Labor
1.Parity& Age
2.Racial/Cultural
3.Coping
Strategies
4.Relaxation
Measures
5.Emotional/
Attitude
6.Knowledge base
7.Confidence level
8.Support Systems
9. Environment
10.Fatigue/length
of labor
11.N/V & Diarrhea
12. Maternal &
Fetal Positions
13.Pain Level
Prof.Carole A. Devine RN.MSN.
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Non-Pharmacologic Methods of
Pain Relief
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Hydrotherapy
Application of heat
/cold
Acupressure
Imagery/Visualization
Effleurage
Comfort Measures
Distraction
Breathing Techniques
Prof.Carole A. Devine RN.MSN.
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Pharmacological
Methods of Pain Relief
Prof.Carole A. Devine RN.MSN.
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Goal of Administering
Systemic Medication:
Three Factors to be Considered in
the use of Systemic Medication
1.Effect on The Mother
2. Effect on the Fetus
3. Effect on Labor contractions
Prof.Carole A. Devine RN.MSN.
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Analgesia/Anesthesia
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Analgesics:
(Opioids,Tranquilizers &Sedatives)
Common Ones:
Demerol
Stadol
Nubain
Fentanyl
Morphine
Prof.Carole A. Devine RN.MSN.
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Demerol (Meperidine)
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Action:
Usual dose:
Pros :
Cons: Maternal
Cons: Neonatal
Prof.Carole A. Devine RN.MSN.
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Stadol (Butorphanal)
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Usual dose:
Action:
Pros :
Cons: Maternal
Cons: Neonatal
Prof.Carole A. Devine RN.MSN.
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Nubain (Nalbuphine)
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Usual dose:
Action:
Pros :
Cons: Maternal
Cons: Neonatal
Prof.Carole A. Devine RN.MSN.
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Fentanyl (Sublimaze)
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Usual dose:
Action:
Pros :
Cons: Maternal
Cons: Neonatal
Prof.Carole A. Devine RN.MSN.
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Morphine (Duromorph)
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Usual dose:
Action:
Pros :
Cons: Maternal
Cons: Neonatal
Prof.Carole A. Devine RN.MSN.
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Nursing Considerations with Opioids:
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Opioid Antagonist
NALOXONE (Narcan)
Reverses opioid induced
Resp.Depression
Dose: Neonate: 0.01mg/Kg IV,IM
or SC q 2-3min.
Mother: 0.1-0.2mg IVQ 2-3min
Have Crash Cart Handy!!!!
Prof.Carole A. Devine RN.MSN.
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Anesthesia
1. Local Infiltration:
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2.Regional:
Pudendal Block
Epidural Block
Goal
Procedure
Complications
1. Maternal
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Nursing
Considerations
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Advantages vs
Disadvantages
2 .Neonatal
Prof.Carole A. Devine RN.MSN.
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Spinal Block (Subarachnoid)
Intrathecal)
Goal
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Procedure
Pros:
Complications:
Nursing
Responsibilities/Considerations
General Anesthesia
Prof.Carole A. Devine RN.MSN.
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Fetal Response to Labor
Intrapartal Fetal Assessment:
Electric Fetal Monitor ( EFM)
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Purpose
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Factors that Impact Fetal Oxygenation
1. Maternal Bld. O2 Saturation
2. Normal flow of oxygenated bld. thru the Placenta
3. Normal Utero-Placental exchange
4. Patent umbilical cord vessels (AVA)
5. Normal Fetal circulation and oxygen-carrying
function
Prof.Carole A. Devine RN.MSN.
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Types of Intrapartal Fetal
Assessments
1. Low -Tech Approach
 2. EFM
a. Equipment:
1. External ( Indirect)
Uses two Transducers: Pressure and
ultrasound
2. Internal (Direct )
Uses a Fetal Scalp Electrode
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Prof.Carole A. Devine RN.MSN.
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Evaluating Fetal
Monitoring Strips
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Fetal Heart Rate:
Baseline
Tachycardia
Causes:
Bradycardia
Causes:
Variability
Presence of Periodic Changes:
Accelerations?
Decelerations?
Prof.Carole A. Devine RN.MSN.
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Decelerations/Types:
Early,Late or Variable
Early
Decelerations:
 Characteristics:
 Pattern:
 Cause:
 Rx:
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Prof.Carole A. Devine RN.MSN.
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Decelerations:
Characteristics:
Pattern:
Cause:
Rx:
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Variable Decelerations:
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Characteristics:
Pattern:
Cause
Treatment:
AN OMINOUS SIGNLATE DECELERATION and
DECREASED VARIABILITY
OF FETAL HEART RATE!!!!
Prof.Carole A. Devine RN.MSN.
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Significance of Fetal Heart
Patterns:”Reasssuring”vs.
“Non-Reassuring”
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Reassuring Patterns of FHR
1. Show signs of fetal well being
2. Fetus is compensating
Non-Reassuring Patterns of FHR
1. Associated with Hypoxia and
Acidosis
2. Suggest some level of Fetal
compromise !
Prof.Carole A. Devine RN.MSN.
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THE END
GOOD LUCK
To All Of YOU !!!!!
Prof.Carole A. Devine RN.MSN.
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