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Topic 2 OB
Nursing Care of the Childbearing Family (NSG-432)
Grand Canyon University
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Topic 2 OB Pain Management in Labor Nonpharmacologic-music, meditation, massage, warm baths Spinal Anesthesia-local anesthetic or combined with opioid analgesic, positioning, marked hypotension. Epidural 18 G Spinal 25G Correct space located “Loss of resistance” Spinal fluid Onset 10 - 20 minutes Immediate Volume 10 - 30 ml Small amount- generally 2 ml Medication Bupivicaine Marcaine with Dextrose (isobaric) Nursing Considerations for Epidurals- baseline maternal vital signs, and FHR, have patient void, hydrate with 500-100ml LR or NS, O2 ready, position patient either side lying or sitting up on edge of bed, vital signs after procedure per protocol Side effect of epidural- bladder distention, elevated temperature, short or long term backache, disruption of labor, increased use of oxytocin, increased use of instrumentation, increased incidence of cesarean. Complications of Epidural- hypotension leading to fetal bradycardia or late decelerations, intravascular infection, total spinal, spinal headache, impotent block or spotty block, epidural hematoma, Contraindications of Regional anesthesia- active or anticipated maternal hemorrhage, maternal hypotension, coagulopathy, infection at injection site, increased ICP, allergy, maternal refusal or inability to cooperate, some types of maternal cardiac conditions, abnormal(non reassuring) FHR and pattern requiring immediate birth Nitrous oxide- mixed with oxygen, reduces pain, 1st and 2nd stage, remains awake, self-administered, observe for N/V, drowsiness, dizziness, hazy memory, loss of consciousness. True labor False Labor Contractions regular Pain felt in back radiating to front Cervical changes Fetus engages Change of position doesn’t matter. Bloody show Contractions irregular Lie down or move make them stop No change in cervical dilation, effacement, bloody show Fetus not engaged often posterior Physical exam- general, vital signs, assessment of FHR, assessment of contractions, vaginal examination
Lab and Diagnostic Test- urine, blood, membranes, leopolds Stages of Labor Early or latent phase 1-5cm Active phase 6-10cm Cervical Exam stages 1. Dilation 2. Effacement 3. Station- relation of the presenting part of the fetus in an imaginary line drawn between the maternal ischial spines 4. position First Stage of Labor Latent Phase=Excitement Dilation 0-5cm Effacement-100% Station 0(nullip) to -2 (multip) Contraction q 5-30minutes About 6-8hrs Distraction Rest-relax Ambulation Slow paced breathing Active Phase=serious Dilation 6-10cm Contractions every 2-3 minutes Length 3-6hrs Change positions frequently Empty bladder frequently Use hydrotherapy Needs encouragement Don’t distract her Feel like your losing it Irritable 8-10cm Length 20-40 minutes Contractions 2-3 minutes Trembling Nausea
- Post delivery care
- Recovery
- Care of the family
- Family newborn relationships Factors affecting Labor Passenger: Fetus and placenta Passageway: Birth canal Powers: Contractions and maternal voluntary pushing effort Position of mother Psychologic response
Maternal adaptation in labor CO increases WBC increase Renal proteinuria up to 1+ may occur Integumentary stretching of vaginal introitus Musculoskeletal- diaphoresi, fatigue, increase in temperature, joint aches and leg cramps Neuro- euphoria, then seriousness then amnesia, elation/fatigue GI- digestive changes occur Endocrine- blood glucose level decreases with the workload of labor Induction Methods Prostaglandins-cytotec/cervdil Balloon catheters Laminaria Amniotomy-article Rupture of membrance (ROM) with an amnihook Pitocin- synthetic form of oxytocin, Given IV Fetal Assessment Basics for monitoring- uterine activity, fetal well-being measured by response of FHR, uterine contractions, fetal compromise, goal of FHR monitoring is to identify non-reasssuring patterns that indicate potential compromise Fetal HR patterns- Baseline 110-160bpm Accelerations- 15 beats above baseline x 15 seconds either periodic or episodic
Early Decelerations- start early and end early, caused by head compression, mirrors the contraction, document and continue to monitor
Variable Decelerations- occurs with or without contractions, caused by cord compression, requires intervention Late Decelerations- caused by uteroplacental insufficiency. occurs with maternal supine hypotension, epidural or spinal anesthesia, placentia previa, placental abruption, hypertensive disorders, post maturity, IUGR, diabetes mellitus, intraamniotic fluids.
O-oxytocin off N-notify provider Three Tier FHR classification Category 1 Baseline 110- Moderate variability Absent variable and late decelerations May have early decelerations Accelerations may or may not be present Category 2 Baseline- rate bradycardia or tachycardia Variability- minimal baseline variability, absent baseline variability without recurrent decelerations, marked variability Acceleration- no accelerations in response to fetal stimulation Periodic or episodic decelerations- recurrent variable decelerations with minimal or moderate variability, prolonged deceleration, recurrent late deceleration with moderate variability. Variable deceleration with other characteristics such as slow return to baseline, overshoots or shoulders Category 3 Absent variability and any of the following Recurrent late decelerations Recurrent variable decelerations Bradycardia Sinusoidal pattern
Topic 2 OB
Course: Nursing Care of the Childbearing Family (NSG-432)
University: Grand Canyon University
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