unit 2 ob intrapartum labor & delivery rev. 2013
TRANSCRIPT
![Page 1: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/1.jpg)
Unit 2 OB Intrapartum
LABOR & DELIVERY
Rev. 2013
![Page 2: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/2.jpg)
Signs of Impending Labor
1. Lightening
2. Bloody Show
3. Braxton Hicks Contractions
4. Energy Spurt
5. Weight Loss
![Page 3: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/3.jpg)
![Page 4: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/4.jpg)
True vs. False Labor
• Regular pattern
• Inc. in duration frequency & intensity
• Inc w/ ambulating
• Rarely follow a pattern
• Vary in duration, frequency and intensity
• Dec w/ ambulating
![Page 5: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/5.jpg)
True vs. False Labor
• Start in back & radiate to abd.
• Dilate & efface cervix
• “show” usually is present
• Often noticed in abdomen
• No cervical changes
• “show” not present
![Page 6: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/6.jpg)
2 Common signs of Active Labor
• 1. Strong, Regular Contractions
• 2. R.O.M.
![Page 7: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/7.jpg)
Monitoring Fetal StatusUterine Contractions
• Involuntary
• Can be felt at uterine fundus
• Documented according to frequency, duration and intensity
![Page 8: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/8.jpg)
Rupture of membranes
• B.O.W. Bag of Waters
• 1000cc or 1 qt. By 40th week
• Prior to delivery sac must break
• Amniotomy (SROM or AROM)
![Page 9: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/9.jpg)
4 Stages of Labor
1. Dilation
* begins w/ onset of true labor
*ends w/ complete dilation of cervix
Primip ~ 10-12 hrs Multip 6-8 hrs
![Page 10: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/10.jpg)
First Stage of Labor
• Has 3 distinct phases:
1. Latent excited
2. Active apprehensive
3. Transitional irritable & frustrated
![Page 11: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/11.jpg)
![Page 12: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/12.jpg)
2 distinct cervical changes
1. Dilation Cervical os begins to open Meas. In cm from 1-10 Complete dilation nec. to expel fetus Solely the result of contractions
![Page 13: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/13.jpg)
2. EffacementRefers to thinning & shortening of
cervixNormally long & thickNow shortens or thinsMeas. in % (100%=complete)
![Page 14: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/14.jpg)
2. Delivery or Expulsion
• Begins w/ complete dilation of cervix & ends w/ birth of newborn
Primip ~ 30 mins.- 2 hrs
Multip ~ 20 mins.- 1.5 hrs.
![Page 15: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/15.jpg)
![Page 16: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/16.jpg)
3. Placental
Begins w/ delivery of newborn & ends w/ delivery of placenta
(usually 5-20 mins.) for both primiparas and multiparas
![Page 17: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/17.jpg)
![Page 18: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/18.jpg)
4. Recovery/Stabilization
begins after delivery of placenta & ends w/ pt. being in stable condition
most crucial time for hemorrhage
(~ 2-4 hrs. After delivery)
![Page 19: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/19.jpg)
Station,Lie,Position & Presentation
1. Station Means level of descent of fetal
presenting part in birth canal Measured in relation to the level of
ischial spines Vertex is most common presentation
![Page 20: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/20.jpg)
At station 0, fetal head is engaged
Other stations are 1-3 cm above (-) or below (+) station 0
![Page 21: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/21.jpg)
![Page 22: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/22.jpg)
2. LieDenotes the position of the
fetal spinal cord (long part) to that of the woman
Normal lie is longitudinalTranverse lie cannot be
delivered
![Page 23: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/23.jpg)
3. Position
refers to the relationship of the presenting fetal part to a quadrant of the maternal pelvis
Most favorable position is LOA
![Page 24: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/24.jpg)
4. Presentation
• Refers to part of fetus that first enters birth canal
• 96% are cephalic or vertex presentation
• Other presentations are breech, face, shoulder
![Page 25: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/25.jpg)
Breech Birth• Notice the foot
6
![Page 26: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/26.jpg)
• It’ a boy
it's
![Page 27: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/27.jpg)
• The body is almost out
Finally
![Page 28: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/28.jpg)
Admission Assessment
Review Box 26-5 Pg. 828
![Page 29: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/29.jpg)
CRITICAL THINKING QUESTION
•What are the 3 most important elements of your Admission Assessment?
![Page 30: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/30.jpg)
Elimination/Activity/Exercise
• Keep bladder empty
• L side lying
• Breathing exercises
![Page 31: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/31.jpg)
Relief of Discomfort
a. Epidural blockb. Saddle blockc. Caudal blockd. Pudental blocke. Paracervical or Cervical block
![Page 32: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/32.jpg)
Fetal Monitoring
• Purpose:
- is to record fetal H.R. with
contractions & relaxation
- is to detect early warning
signs of fetal distress
![Page 33: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/33.jpg)
Monitoring may be:
• External ( Indirect )
• Internal ( Direct )
![Page 34: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/34.jpg)
Evaluation of Monitor Information
• Accelerations Transient inc. of the FHR of 15
BPM or more.Accelerations of 60 BPM or
more is considered a complication
![Page 35: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/35.jpg)
Decelerations
Are slowing of the FHRAre a normal response of the
fetus to labor & should mirror the pattern of contraction.
Caused by head compression
![Page 36: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/36.jpg)
Normal Variability
• Change in FHR from beat to beat
• Normal range is 2-10 beats/min
![Page 37: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/37.jpg)
Decreased Variability
-Little or no fluctuation in FHR
May indicate fetal nervous system abnormality OR
Maternal use of CNS depressants
![Page 38: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/38.jpg)
Signs of Fetal Distress
• Increase or decrease in baseline FHR
• Decrease in baseline variability
• Tachycardia
• bradycardia
![Page 39: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/39.jpg)
Out to the neck
![Page 40: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/40.jpg)
• Persistent late decelerations
• Severe variable decelerations
• Greenish-stained amniotic fluid
• Prolapsed cord
![Page 41: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/41.jpg)
During the 2nd Stage of Labor:
Bearing down feelingRectum dilates, perineum
bulgesCrowning occursPerineal prep
![Page 42: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/42.jpg)
Prepare for Delivery CoachingEpisiotomy done to prevent laceration
or tearingLacerations
![Page 43: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/43.jpg)
Delivery of Newborn
1. Nose & mouth are suctioned
2. Check for nuchal cord
3. Note time of delivery
![Page 44: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/44.jpg)
Response & Care of the Newborn to Birth
Establish & maintain airwayStimulate respirationsPosition to prevent aspirationProvide warmth Determine APGAR ScoreAssess cord for bleeding
![Page 45: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/45.jpg)
Identification
Health Record
EES or Tetracycline to eyes
Vitamin K injection
Bonding
![Page 46: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/46.jpg)
Third Stage of Labor
Extends from the time the newborn is delivered until the placenta & membranes are expelled
Can last up to 30 min., usually takes 5-20 min.
![Page 47: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/47.jpg)
Delivery of Placenta
1. Shiney Schultze Dirty DuncanPlacental examinationOxytocin
![Page 48: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/48.jpg)
Nursing Care during 3rd Stage
Massage fundus Cleanse perineum Remove legs from stirrups Change gown, apply peripad Provide warmth
![Page 49: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/49.jpg)
Fourth Stage of Labor
• Involution begins
• 6 week process
![Page 50: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/50.jpg)
Nursing Care during 4th Stage
1. Assess VS – q 15 min x 1-2 hours
2. Check fundus
3. Check perineum
![Page 51: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/51.jpg)
4. Check lochia
5. Check for 1st void
6. Check for signs of hemorrhage
![Page 52: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/52.jpg)
6. Patient Education Teach….
perineal careFundal massageFluid intake/voidingBreastsconstipation
![Page 53: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/53.jpg)
after painsNursing/breast feeding
![Page 54: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/54.jpg)
Complications of Labor & Delivery
![Page 55: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/55.jpg)
A. Premature Rupture of Membranes
• Small leak in BOW causing a rupture of membranes
• May be difficult to diagnose
• Complications are: Premature labor,Intrauterine infection & malpresentations, prolapsed cord
![Page 56: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/56.jpg)
Treatment
• Hospitalization
• Assessment of woman & fetus
• Determine fetal maturity
• Induce labor if fetus is mature
![Page 57: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/57.jpg)
B. Premature Labor
• Labor that occurs before the 37th week
• Prematurity leading cause of infant mortality
• Tx is Bedrest, Tocolytic drugs
![Page 58: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/58.jpg)
C. Precipitate L & D
Labor is brief < 3 hoursContractions unusually
severeMay be so rapid getting to
delivery room is impossible
![Page 59: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/59.jpg)
Nursing Care
• Never prevent delivery
• Assist with birth
• Make sure neonate is breathing
![Page 60: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/60.jpg)
D. Uterine Rupture
• One of the most serious complications – very rare
• Predisposing factors/causes
1. previous C/S or uterine scar
2. severe tonic contractions
![Page 61: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/61.jpg)
3. Dystocia
4. Injudicious use of oxytocic drugs
5. CPD (Cephalopelvic Disproportion)
![Page 62: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/62.jpg)
E. Dystocia
• Prolonged, difficult & painful labor
• Does not result in dilation or effacement
• Exhausts woman & predisposes to death
![Page 63: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/63.jpg)
Causes of Dystocia
1. Uterine inertia
2. CPD
3. Abnormal fetal positions or presentations
![Page 64: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/64.jpg)
Management for Abnormal Positions & Presentations….
1. Version (Leopold’s Maneuvers)
2. Forceps assisted delivery
3. Vacuum assisted delivery
4. C/S
![Page 65: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/65.jpg)
F. Cord Problems
A. Prolapsed Cord umbilical precedes the baby Serious complication May cut off fetal circulation Requires emer. C/S
![Page 66: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/66.jpg)
Nuchal Cord
• Cord wrapped around neck
• If discovered before labor,
C/S is done
*If not, forceps are used to speed delivery & cord cut immediately
![Page 67: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/67.jpg)
Other Considerations of Labor & Delivery
![Page 68: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/68.jpg)
The Induction Process• Drugs may be administered
parenterally, orally, or vaginally• Oxytocin most common• (PGE) Prostaglandin E
(Cervidil)• Amniotomy
![Page 69: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/69.jpg)
Nursing Care during Induction
1. Note the time of amniotomy, color & amount of fluid
2. Monitor fetus for signs of distress
3. VS q 10-15 min. then q 30 min. fol. Rupture of membranes
![Page 70: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/70.jpg)
Emergency DeliveryNever to be delayedRemain calm & deliver babyFollow aseptic techniqueDouble tie cord Keep baby warm, ensure
breathing
![Page 71: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/71.jpg)
Cesarean Delivery
Post Op
Care
![Page 72: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/72.jpg)
• Assess VS
• Observe lochia, incision & fundus
• I & O for 24-48 hrs
• Advance diet as tolerated
![Page 73: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/73.jpg)
• Perineal care
• Early ambulation & breathing exercises
![Page 74: Unit 2 OB Intrapartum LABOR & DELIVERY Rev. 2013](https://reader033.vdocument.in/reader033/viewer/2022051019/5697c0251a28abf838cd50d5/html5/thumbnails/74.jpg)
CRITICAL THINKING QUESTION
• A patient is in her third trimester and informs the nurse during her prenatal visit that she is experiencing constipation and stress incontinence. The patient asks the nurse how she can manage these problems. What information should the nurse provide for this patient?