Nursing care for the laboring patient

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  1. symptoms of true labor
    • Strong UC, become longer, frequent and more regular over time
    • UC consist of abdominal tightening or often back pain
    • UC rarely >60 sec
    • not reduced by change in maternal activity
    • GI-frequent bowel movements, nausea, vomiting, diarrhea
    • UC=progressive cervical change(both effacement/dilation changes)
    • intact membranes feel tense on SVE (sterile vaginal exam)
  2. Oxytocin-released by posterior pituitary gland-responsible for UC
    Oxytocin regulatory mech. unknown-nerve impulses from Uterus "may" cause release of oxytocin. Contractions continue after birth to prevent post-partum hemorrhage and to accomplish uterine involution.
  3. Primipara length of labor?
    12-18 hours
  4. Multipara length of labor?
    6-10 hours
  5. Uterine distension theory
    degree of distension causes muscle fibers to release prostaglandin causing cervical ripening and stimulating UC.
  6. Aging theory of the placenta
    • May cause drop in maternal progesterone levels rendering the uterus more sensitive to oxytocin.
    • also the aging placenta may not work as well towards the end of pregnancy which causes the adrenal glands from the fetus to produce labor inducing "substance"
  7. Cervical changes during labor
    • Increased vaginal secretions
    • Loss of mucous plug (bloody Show)
    • Ripening
    • Dilation of cervix
    • effacement-cm of cervical length
    • cervical status: 3/100%/-1—Dilatation/effacement/station
  8. The P's of labor (need to know for test)
    • Power: physical forces of labor
    • passage: maternal pelvis
    • Passenger: fetus
    • Relationship: of passenger and passage
    • Psyche: personality and emotional forces
  9. Latent phase-longest phase of labor 2-9 hours
    • UC-backache, menstrual cramps
    • contractions should be palpated 
    • slowly the UC open the cervix to allow passage
  10. First stage of labor (active labor)
    • 3-4cm-(10cm) of dilation
    • Time of most rapid CD(cervical dilation)
    • Progressive effacement and presentation of part
  11. Minimum rates of cervical dilation?
    • 1.2cm/hr=primipara
    • 1.5cm/hr=multipara
  12. Transitions of labor
    • each phase shorter and more intense
    • UC 60-90 sec long, 1-2 min apart making it hard to cope
    • Do not leave a laboring pt in transition alone
  13. Pain management-Non-pharmacologic
    • Effleurage
    • Massage
    • Water therapy
    • Aroma therapy
    • Hypnosis
  14. pain management žPharmacologic methods
    • IV narcotic administration
    • Epidural anesthesia
    • Spinal anesthesia
    • Local anesthesia
    • General anesthesia
  15. Lumbar Epidural
    • ligamentum flavum and the dura matter of L3-L4 of the spine
    • Medication blocks sodium channels and prevent continuation of nerve impulses to decrease pain and allow lower doses of pain meds.
  16. Physiologic changes of labor
    • BP rises-later recumbent position will help prevent rises in BP
    • Check other parameters of pre-eclampsia
    • Check BP between UC
    • Metabolism increases=increased body temp, respirations, pulse, cardiac output and fluid loss.
    • Renal: Polyuria common, proteinuria 2+ is abnormal. evaluate bladder q2 to insure empty bladder and allow the presenting part of baby to progress.
    • GI: gastric juices severely reduced-inability to digest food during active labor-limit to fluids NV common.
    • Hematological: hemoglobin increases (1.2gm/100ml)-coagulation time decreases-to help prevent post-partum hemorrhage, WBC increase to around 15,000-consider infection if sustained or further elevated. BG drops with muscle activity.
  17. Second stage of labor (pushing) up to one hour
    Also caused rest and descend depending on the mother and baby. waiting on passage to vagina/pelvis
  18. Episiotomy
    surgical incision mediolateral to help with passage.
  19. Third stage of labor 5-20min
    • after birth, waiting on placenta to be delivered should be <30mins.
    • UC continues with less intensity to help with delivery of placenta and to prevent post partum-hemorrhage.
    • Inspect cord and placenta after delivery
    • Critically important that uterus remain contracted after placental delivery, functions as tourniquet(up to 4L loss)-frequent check of fundus for firmness to confirm contraction.
    • Never massage uterus before placental delivery-helps return to contracted state.
  20. Post-partum warning signs?
    • BP stable? pre-eclampsia/hypovolemia?
    • respiratory changes? pulmonary embolism?
    • Vaginal bleeding? just a trickle is considered abnormal
  21. Fourth stage of labor 1-4 hours
    • Close observation of both patients freq. assessments, vitals should stabilize, slight elevated temp-normal is <2 degree.
    • Insure bladder emptied-full bladder can impair uterine contraction.
  22. Fetal Mechanisms of labor
    • Flexion of baby head to chest
    • engagement internal rotation to mothers side
    • descent-throughout first and second stage
    • internal rotation baby facing maternal coccyx
    • extension birth of head
    • restitution-untwists the fetal neck to realign with shoulders
    • external rotation fetal shoulders into the AP diameter of the pelvis
    • expulsion of entire body
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Nursing care for the laboring patient
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Nursing care of prego
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