handout 7.doc

8/14/2019 handout 7.doc

1/11

NCM 101 Lecture Notes MIDTERMS Handout 7 _____________________

INTRAPARTAL NOTES

A. Admitting the laboring Mother Personal data Baseline data Obstetrical data Physical exams Pelvic exams

B. Basic knowledge in intrapartum: !"#!$

Theories of the Onset of Labor

%terine &tretch 'heory ( any hollow organ once stretched to its maximumpotential will always contract ) expel its content

Oxytocin 'heory ( released by PP*+ contraction e,,ect

Prostaglandin 'heory ( stimulation by Arachidonic acid+ causes contraction o,uterus

Aging Placenta ( -wks /li,espan0 by 12wks placenta begins to degeneratecauses contraction

Progesterone deprivation theory 3 4 level o, progesterone will ,acilitatecontraction o, the uterus

The 4 Ps of Labor1. Passenger fetus OR THE fetal hea

is the largest presenting part

5 o, its length Bones ( 2 bones /sphenoid+ temporal+ ethmoid0 6rontal+ occipital ) parietal

bones

&utures7intermembranous spaces ( allows molding

Molding ( the overlapping o, the sutures o, the skull to permit passage o, thehead to the pelvis

&agittal bones ( connect to parietal bones

8ororonal bones ( connect to parietal ) ,rontal bones

9ambdoidal bones ( connect to parietal ) occipital bones

!ontanels

2 ,ontanels only palpable

anterior ,ontanel7Bregma

diamond in shape

1cm x -cm sie

1 "re#$olfRe%s. A&ril Anne '. (alanon

SECTION2:

In this and the succeeding handouts you will find a few abbreviations and symbols

!lease refer to this table for what they stand for

"OC: drug of choice

#O$: watch out forC%&: common board 'uestion

) then o the follo$ing or inter*ention for this is+.(gt: management

S)s*: signs and sym+toms


2/11

NCM 101 Lecture Notes MIDTERMS Handout 7 _____________________ close ;3;< mos post delivery

= >cm ( hydrocephalus

posterior ,ontanel7lambda

triangular in shape

; x ;cm sie

close 31mos post delivery

%easure,ents of fetal hea )o transverse diameter

Bi3parietal 3 largest transverse diameter3 ?.>cm

Bi3temporal 3 cm0

&ubmentobrgmatic 3 ,ace presentation poor ,lexion-. Passage$a# *agina &el*is

Pelvis- main pelvic types

gynecoid ( round+ wide+ deeper+ most suitable ,or pregnancy

android ( heart shape male pelvisC ( anterior pointed post part ( shallow

Anthropoid ( oval ape3like pelvis AP wider transverse narrow

Platypelloid ( ,lat transverse oval AP narrow transverse ( wider ( c7s ,ordelivery

Problem :

mother who encounter accident 4 -D?C

4 ;


3/11

NCM 101 Lecture Notes MIDTERMS Handout 7 _____________________ Measurement ;;.>3;.> cm

Basis in getting the true conEugate.o True 0onugate20onugate 3era

Measure between the anterior sur,ace o, the sacral promontory )superior margin o, the symphysis pubis.

Measurement: ;;.F cm

Giagonal conEugate: ;.> cm H true conEugate.o Obstetri/al 0onugate

smallest AP diameter o, the pelvis measuring ;Fcm or more.o Tuberois/hii 'ia,eter

transverse diameter o, the pelvic outlet.

Approx by a ,ist3 31 lbs.Bloody show

pinkish vaginal discharge /blood L leucorrhea L operculum H pink in color0upture o, membranes

check 6J'

#! check ,or cord prolapse

a,ter several hrs ( check temp.

Pre,ature Ru&ture of %e,branes 5PRO%6

contraction drop in intensity even though very pain,ul contraction drop in ,reIuency

uterus tense )7or contracting between contractions

abdominal palpitations

Nursing 0are)

, "re#$olfRe%s. A&ril Anne '. (alanon


4/11

NCM 101 Lecture Notes MIDTERMS Handout 7 _____________________a. administer analgesics /morphine0b. attempt manual rotation ,or OP or 9OPc. bear down with contractionsd. adeIuate hydratione. sedation as ordered,. cesarean delivery may be reIuired+ especially i, ,etal distress is noted

0or Prola&sea complication when the umbilical cord ,alls or is washed through the cervix intothe vagina.

'anger Signs)POM

Presenting part has not yet engaged

6etal distress

Protruding cord ,rom vagina ( cerebral palsy ( = > mins.+ irreversible braindamage mgt: 8&

Nursing 0are;. Positioning ( knee chest or trendelenberg+ place wet sterile gaue : to make

it slippery. Observe ,or ,etal distress1. Provide emotional support-. Prepare ,or cesarean section

'uration of Laboro Primipara ( ;- hrs but not more than ;F hrso Multipara ( < hrs but not more than ;- hrs

Nursing Inter*entions in Ea/h Stage of Labor 6irst &tage: onset o, contractions to ,ull dilatation ) e,,acement o, the

cervix stage o, e,,acement ) dilatation

Latent Phase)

Assess,ent);. Gilatations F31 cm. 6reIuency >3;F mins

1. Guration F3-F mins-. #ntensity mild>. Mother is excited+ apprehensive but can communicate

Nursing 0are)a. !ncourage walking : shortens ;st stage o, laborb. !ncourage to void I 31 hrs : ,ull bladder inhibits uterine contractionc. breathing /chest breathing techniIue0

A/ti*e Phase)

Assess,ent)

;. Gilatations -3< cm. 6reIuency I 13> mins lasting ,or 1F32F secs1. Guration 1F32F secs-. #ntensity moderate

Nursing 0are)a. M ( edications ( have meds ready

- "re#$olfRe%s. A&ril Anne '. (alanon


5/11

NCM 101 Lecture Notes MIDTERMS Handout 7 _____________________b. A ( ssessment include: v7s+ cervical dilatation ) e,,acement+ ,etal

monitor+ etcc. G ( ry lips ( oral care /ointment0+ dry linensd. Breathing ( abdominal breathing

Transitional Phase)

Assess,ent);. Gilatations 3?F sec-. #ntensity strong>. Mood o, mother suddenly change accompanied by hyperesthesia

/hypersensitivity o, mother to touch0 o, the skin

%anage,ento sa/ral &ressure7 /ol /o,&ress

Nursing /are)a. ' ( tiresb. # ( in,orm o, progress /to relieve emotional support0c. ( restless support her breathing techniIued. ! ( encourage ) praisee. G ( discom,ort,. Pelvic !xams

Effa/e,ent 'ilatation &tation ( relationship o, the presenting part to the ischial spine

> 3 3; H the presenting part is above the ischial spine !ngagement ;F H the presenting part is in line with the ischial spine

/30 ,etus is ,loating

/L0 below the ischial spine Presentation

the relationship o, the long axis o, the ,etus to the long axis o, the mother.

spine relationship o, the spine o, the mother ) the spine o, the ,etus

T$o T#&es;. 9ongitudinal 9ie /Parallel07 "ertical

8ephalic ( when the ,etus is completely ,lexed

o "ertexo 6aceo Browo 8hin

Breecho 8omplete breech ( thigh rest on abdomen while legs

rest on thigho #ncomplete breech

6rank ( thigh resting on abdomen while legsextend to the head

6ootling

neeling

. 'ransverse 9ie /Perpendicular07Joriontal lie Position ( relationship o, the ,etal presenting part to speci,ic

Iuadrant o, the motherDs pelvis.

. "re#$olfRe%s. A&ril Anne '. (alanon


6/11

NCM 101 Lecture Notes MIDTERMS Handout 7 _____________________o OA79OA

le,t occipito anteriormost common ) ,avorable position

o O'79O' ( le,t occipito transverseo OP79OP ( le,t occipito posterior

973 side o, maternal pelvis

Middle ( presenting part

o OP7O' ( most common malpositiono OP79OP ( most pain,ul mgt: pelvis sIuatting

o Breech ( sacroo 8hin ( mentumo &houlder ( acromnio dorso

%onitoring the /ontra/tions fetal heart tone

spread the ,inger lightly over the ,undus to monitor the contraction

PO#K'& 'O !M!MB!:;. #ncrement78resendro 3 beginning o, contraction until it increases. Apex7Acne ( height o, contraction1. Gecrement7Gecresendro ( ,rom height o, contraction until it decreases-. Guration ( beginning o, contraction to the end o, the same contraction>. #nterval ( ,rom end o, contraction to the beginning o, the next contraction2. 6reIuency ( ,rom the beginning o, ; contraction to the beginning o, next

contraction@. #ntensity ( strength o, contraction


7/11

NCM 101 Lecture Notes MIDTERMS Handout 7 _____________________1. est on le,t side lying position

>. Prevent supine vena cava syndrome or supine hypotension

#, membrane doesnDt rupture per,orm: amniotomy

,etal thrashing 3 hyperactivity o, ,etus due to lack o, Oxygen

2. 6or Paino &ystemic analgesic

GO8: G!M!O9 /Meperidine J8l0

Karcotic and antispasmonic

GonDt give during latent phase

*iven N 23< cm dilated

$O6 : espiratory depression

Karcan /Kaloxone+ nalor,an+ nalline0: Antidote ,or toxicity

@. !pidural Anesthesia

$O6 : Jypotension

Prehydrate the client to prevent hypotension #n case o, Jypotension: !levate leg and 6ast Grip #"

SE0ON' STA"E O! LA(OR 5!ETAL STA"E6 8omplete dilatation and e,,acement to birth 8rowning occurs

P#M# ( trans,er to G N ;F cm dilatation

M%9'# ( trans,er to G N @ ( < cm dilatation Position in lithotomy both legs at the same time B%9*#K* O6 P!!K#%M surest sign o, delivery initiation

PAK' ) B9O$ Breathing+ ,etal pushing should be done on an open glottis espiratory alkalosis

8B: Gue to incorrect breathing $O6 Jyperventilation

&7sx;. #K8!A&!G . 9ightheadedness1. 'ingling sensation-. 8arpopedal spasm>. 8ircumoral numbness

!pisiotomy Prevent laceration $iden the vaginal canal &hortens the nd stage o, labor

types;. M!G#AK

9ess bleeding

9ess pain

!asy repair

Possible urethroanal ,istula which is a maEor disadvantage

. M!G#O9A'!A9

More bleeding

More pain

Jard to repair and slow healing

#roning the Perenium prevent laceration



8/11

NCM 101 Lecture Notes MIDTERMS Handout 7 _____________________

%e/hanis, of Labor 5E' !IRE ERE6!ngagementGescent6lexion#nternal otation!xtension

!xternal otation!xpulsion

P!9"#&1 Partso #nlet ( AP diameter narrow+ transverse widero 8avity ( between inner and outero Outlet ( AP diameter wider+ transverse narrow9#K!A '!M#KA9i&

Nursing 0are

;. MOG#6#!G #'*!KD& MAK!%"!a. Gone by supporting the perenium with a towel during deliveryb. 6acilitates complete ,lexionc. Avoids laceration

. 6irst intervention: &upport the head and suction secretion1. Go not milk the cord+ wait ,or pulsation to stop be,ore cutting

Milking may cause too much blood going to the baby that may causecardiac overload-. $hen there is still birth+ let the mother see the baby to accept the ,inality o,death

THIR' STA"E O! LA(OR 5PLA0ENTAL STA"E61 ( ;F minutes a,ter child birth;st sign 6undus rises 8A9#KD& *K

Signs of Pla/ental Se&aration

6undus becomes globular and rises calkinDs sign

9engthening o, the cord &udden gush o, blood

8B: BAK' ( AKG!$D& MAK!%"!a. slowly pulling the cord and wind at the clampb. rapidly may cause uterine inversion

'ypes Placental Gelivery&J%9' /&hiny0

6rom center to the edges

Presenting ,etal side

G%K8AK& /Girty0

6orm edges to center

Presenting the maternal side

Nursing 0onsierations uring &la/ental eli*er#a. 8heck placental completeness

"re#$olfRe%s. A&ril Anne '. (alanon


9/11

NCM 101 Lecture Notes MIDTERMS Handout 7 _____________________b. &hould be >FF gc. 8heck 6undus ( Massage i, Boggyd. BP 8hecke. Methergine+ methylergonovine mallate /#M0,. Oxytocin /#"0 i, methergine is not presentg. 8heck perenium ,or lacerationsh. Assist in episioraphy

i. "aginoplasty7 "aginal 9andscape ( "irgin again

!O8RTH STA"E O! LA(OR 5Re/o*er# Stage66irst ; ( hours a,ter delivery o, placenta

%aternal obser*ation body system stabilie;st hour ( I;> min nd hour 3 I 1F min

Pla/e,ent of funus#n between umbilicus and pubis symphysis8heck bladder+ assist in voiding+ May lead to uterine atony hemorrhage

Lo/hiaPerineum8heck !!GA

edness

! dema

! cchymosis

G ischarge

A pproximation

6ully saturated ( 1F ( -F cc8B: $eighing ( ; cc H ; gram

Nursing 0onsieration uring Re/o*er#a. 6lat on bed to prevent diinessb. #, with 8hills give blanket due to dehydrationc. *ive nourishment /progression o, meal0

8lear liIuids ( gatorade+ ginger Euice+ gelatins

6ull liIuid ( milk+ ice cream

&o,t diet

egular dietd. 8heck "&7 Paine. Pychic &tate,. Bonding ( interaction between mother and newborn

&trict ( - hours with mother

Partial ( morning with mother+ night nursery

0O%PLI0ATIONS O! LA(OR'#sto/iaGi,,icult labor related to mechanical ,actorPrimary cause is %terine #nertia

8terine Inertia&luggishness o, contraction

'ypeso Primary7 Jypertonic

#ntense contraction resulting to ine,,ective pushing

Management : &edation

"re#$olfRe%s. A&ril Anne '. (alanon


10/11

NCM 101 Lecture Notes MIDTERMS Handout 7 _____________________o &econdary7 Jypotonic

&low+ irregular contraction resulting toine,,ective pushing

Management : Oxytocin Augmentation

Prolonge LaborQ F J ,or primiQ ;- J ,or multi

proper pushing should be encourage i, inappropriate:

may cause ,etal distress

caput succedaneum

cephalhematoma

maternal exhaustion monitor contractions and 6J'

Pre/i&itate Labora. labor less than 1 hours

b. causes excessive laceration leading to pro,use bleeding hypovolemic shockc. s7sx o, hypovolemic shock JRPO 'A8JR 'A8JR

JRPOtension

'A8JRpnea

'A8JRcardia

%anage,ent

Modi,ied trendelenburg

6ast Grip #"

In*ersion of 8terus&ituation in which uterus is turn inside out due to:a. &hort cordb. Jurrying o, placental deliveryc. #ne,,ective ,undal push

8ause pro,use bleeding hypovolemicJysterectomy

8terine Ru&tureupture o, uterus 8aused by

a. Previous classical 8&

b. "ery large babyc. #mproper use o, oxytocin

&7sxa. &udden painb. Pro,use bleeding

Prepare ,ore 'AJB&O

8B: Physiologic etraction ing boundary between upper and lower uterinesegment

8B: BandlDsPathologic ing suprapubic depression sign o, uterine rupture

A,nioti/ !lui2 Pla/ental E,bolis,Anaphylactic syndrome o, pregnancy&ituation in which placental ,ragment and amniotic ,luid enters maternal circulation



11/11

NCM 101 Lecture Notes MIDTERMS Handout 7 _____________________&7&x

Gyspnea

8hest Pain

6rothy &putum

!nd &tage ( G#8 Prepare ,or 8P+ &uction and emergency etc

Preter, Laborlabor a,ter F weeks and be,ore 1@ weeks

'riad signsa. Premature conditions every ;F minuetsb. !,,acement o, 2F (

handout 7.doc

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