Nursing lectures is proud to share with you a comprehensive review about the Intrapartal period. Included in this lecture are the following 1. A. Admitting the laboring Mother: Personal Data: name, age, address, etc Baseline Data: v/s especially BP, weight 2. Obstetrical Data: gravida # preg, para- viable preg, – 22 – 24 wks Physical Exams,Pelvic Exams 3. B. Basic knowledge in Intrapartum . 4. A. Theories of the Onset of Labor o 1.) uterine stretch theory o -( any hollow organ when stretched, will always contract & expel its content). o – contraction action. 5.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Nursing lectures is proud to share with you a comprehensive review about the Intrapartal period. Included in this lecture are the following
1. A. Admitting the laboring Mother: Personal Data: name, age,
address, etc Baseline Data: v/s especially
BP, weight2. Obstetrical Data: gravida #
preg, para- viable preg, – 22 – 24 wks
Physical Exams,Pelvic Exams3. B. Basic knowledge in Intrapartum .4. A. Theories of the Onset of Labor
o 1.) uterine stretch theoryo -( any hollow organ when stretched,
will always contract & expel its content).
o – contraction action.5.o 2.) Oxytocin Theoryo – post pit gland releases oxytocin.
Hypothalamus produces oxytocin6.
o 3.) Prostaglandin Theoryo – stimulation of arachidonic acid.o – prostaglandin- contraction7.o 4.) progesterone theoryo – before labor, decrease progesterone
will stimulate contractions & labor.8.o 5.) Theory of Aging placentao – life span of placenta 42 wks. At 36
wks degenerates (leading to contraction – onset labor).
9. B. The 4 P’s of laboro Passengero a. Fetal heado – is the largest presenting parto – common presenting parto ¼ of its length.
118. Monitoring the Contractions and Fetal heart Tone
o Spread fingers lightly over fundus – to monitor contractions
119.120. Parts of contractions
o Increment or crescendoo – beginning of contractions until it
increases.o Acme or apexo – height of contraction.121.o Decrement or decrescendo – from
height of contractions until it decreases
o Duration – beginning of contractions to end of same contraction
o Interval – end of 1 contraction to beginning of next contraction
122.o Frequency – beginning of 1 contraction
to beginning of next contractiono Intensity - strength of contraction123.o Contraction – vasoconstrictiono Increase BP, decrease FHTo Best time to get BP & FHT just after a
contraction or midway of contractions124.o Duration of contractions shouldn’t >60
seco Notify MD
125.126.o 5. Fetal Heart Patternso a. Early Decelerations – head
compressiono 1. begins early in contractiono 2. ominouso 3. continue monitoring127.
o b. Late decelerations – uteroplacental insufficiency
o 1. begins late in contractiono 2. ominouso 3. turn mother to the left lateral
recumbento 4. administer oxygeno 5. d/c oxytocin128.o c. Variable decelerations – umbilical
cord compressiono 1. not related to contractionso 2. not ominous, but requires
interventionso 3. change maternal positiono 4. administer oxygeno 5. assess for prolapsed cord129.o Mom has headache – check BP, if same
BP, let mom rest. If BP increases , notify MD -preeclampsia
130. Health teachingso 1.) Ok to showero 2.)NPO – GIT stops function during
labor if with food- will cause aspiration131.o 3.)Enema administer during labor
o a.) To cleanse bowelo b.) Prevent infectiono c.) Sims position/side lyingo 12 – 18 inch – ht enema tubing.132.o Check FHT after adm enemao Normal FHT= 120-160
globular “ Calkins sign ”o 2.Lengthening of the cordo 3.Sudden gush of blood
152. Types of placental delivery153.
154.o a. Shultze “shiny”o – begins to separate from center to
edges presenting the fetal side shiny155.o b. Duncan “dirty”o – begin to separate form edges to
center presenting natural side – beefy red or dirty.
156.o Slowly pull cord and wind to clamp.o – BRANDT ANDREWS MANEUVER.
157. Nursing care for placenta Check completeness of placenta. Check fundus
Check bp158. Administer methergine IM
(Methylergonovine Maleate) “Ergotrate derivatives
Monitor hpn (or give oxytocin IV) Check perineum for lacerations159. Assist MD for episiorrhapy Flat on bed Chills-due dehydration. Blanket,
give clear liquid-tea, ginger ale, clear gelatin. Let mom sleep to regain energy.
160.o Fourth Stageo -the first 1-2 hours after delivery of
placenta.o – recovery stage. Monitor v/s q 15 for 1
hr. 2nd hr q 30 minutes.o Check placement of fundus at level of
umbilicus.161. If fundus above umbilicus, deviation of
funduso Empty bladder to prevent uterine
atonyo Check lochia
o a.Maternal Observations – body system stabilizes
162.o b. Placement of the Funduso c. Lochia163.o Fully soaked pad : 30 – 40 cc weigh
pad. 1 gram=1cc164.o d.Perineumo R - ednesso E- demao E – cchymosiso D – ischargeso A – approximation of blood loss. Count
pad & saturation165.o Fully soaked pad : 30 – 40 cc weigh
pad. 1 gram=1cc166.o e. Bonding – interaction between
mother and newborn – rooming in types
o 1.Straight rooming in baby: 24hrs with mom.
o 2.Partial rooming in: baby in morning , at night nursery.
167.168.169. Complications of Labor
170.o Dystociao – difficult labor related to:o Mechanical factoro – due to uterine inertiao – sluggishness of contraction171.o 1.hypertonic or primary uterine inertia
Intense excessive contractions resulting to ineffective pushing
172.o Interventions with Hypertonic
Dysfunctiono Short-acting barbiturateso IV fluidso If CPD – c/s.o Provide emotional support.o Provide comfort measures.o Prevent infectiono Prepare patient for c/s if needed.173.o 2. hypotonic secondary uterine inertia
Slow irregular contraction resulting to ineffective pushing.
Give oxytocin.174.o Management:
Amniotomy (artificial ROM). Oxytocin augmentation of labor. If CPD, prepare for c/s. Emotional support, comfort
measures, prevent infection.175. Normal length of Labor
o Primi 14 – 20 hrso Multi 10 -14 hrs
176. Prolonged Laboro > 14 hrs in multi &o > 20 hrs in primio Maternal effect – exhaustion.o Fetal effect – fetal distress, caput
succedaneum or cephalhematoma177. Precipitate Labor
o Labor of <>o extensive lacerations, profuse
bleeding, hypovolemic shock if with bleeding.
178.o Outstanding Nursing dx: fluid volume
deficito IV: fast drip due to fluid volume def
179. Signs of Hypovolemic Shock:
o Hypotensiono Tachycardiao Tachypneao Cold clammy skin
180. Inversion of the uteruso Situation: uterus is inside out.
181. Factors leading to inversion of uterus short cord hurrying of placental delivery ineffective fundal pressure
182. Uterine Ruptureo Causes:
1.)Previous classical CS 2.)Large baby 3.) Improper use of oxytocin (IV
drip)183. Uterine Rupture
o Sx: Sudden pain Profuse bleeding Hypovolemic shock TAHBSO
184. Physiologic retraction ringo Boundary bet upper/lower uterine
segmento BANDL’S pathologic ring – suprapubic
depression
185. Amniotic Fluid Embolism or Placental Embolism
o Amniotic fluid or fragments of placenta enters natural circulation resulting to embolism
186. Amniotic Fluid Embolism or Placental Embolism
o Sx:o dyspnea, chest pain & frothy sputum
187. Trial Laboro Measurement of head & pelvis falls on
borderline.o Mom given 6 hrs of laboro Multi: 8 – 14, primi 14 – 20
188. Preterm Laboro Labor Abortion: <20>
189. Preterm Laboro Sx:
1. premature contractions q 10 min 2. effacement of 60 – 80% 3. dilation of 2-3 cm
190. Preterm Laboro Home Mgt:
1. complete bed rest 2. avoid sex 3. empty bladder 4. drink 3 -4 glasses of water
5. consult MD if symptoms persist191. Preterm Labor
o Hosp:o 1. If cervix is closed
dilation is saved by administering Tocolytic agents
219. INFECTIONo Gen mgt:o supportive careo inflammation of perineum
o 2 to 3 stitches dislocated with purulent discharge
220. INFECTIONo Mgt:
Removal of sutures & drainage, saline, between & resulting.
Endometriosis – inflammation of endometrial lining
221. INFECTIONo Sx:
Abdominal tenderness,222.223. Family Planning
o determine one’s own beliefs 1sto never advise a permanent method of
planningo method of choice is an individual’s
choice.224. Family Planning
o Natural Method – the only method accepted by the Catholic Church
o Billings / Cervical mucus – test spinnbarkeit & ferning (estrogen)
o clear, watery, stretchable, elastic – long spinnbarkeit
225.
o Basal Body Temperature 13th day temp goes down before ovulation – no sex
o get before arising in bed226.227. Family Planning
o LAM – lactation amenorrhea method – hormone that inhibits ovulation is prolactin.
228. Family Planningo Symptothermal – combination of BBT &
cervical. Best methodo Social Method – 1.) coitus interruptus/
withdrawal - least effective methodo coitus reservatus – sex without
ejaculation –o calendar method
229. OVULATIONo count minus 14 days before next mens
(14 days before next mens)o Origoknause formula – monitor cycle
for 1 yearo get shortest & longest cycle from Jan –
Deco shortest – 18o longest – 11
230. OVULATION
o June 26 Dec 33o - 18 - 11o 8 - 22 unsafe dayso 21 day pill- start 5th day of menso 28day pill- start 1st day of menso missed 1 pill – take 2 next day
231. Pillso Combined oral contraceptives prevent
ovulation by inhibiting the anterior pituitary gland production of FSH and LH which are essential for the maturation and rupture of a follicle.
o 99.9% effective.232. OCP Alert
o If a new oral contraceptive is prescribed the mother should continue taking the previously prescribed contraceptive and begin taking the new one on the first day of the next menses.
233. Pillso Signs of hypertensiono Immediate Discontinuationo A – abdominal pain C – chest pain H -
headache E – eye problemso S – severe leg crampso If mom HPN – stop pills STAT!
o Adverse effect: breakthrough bleeding234. Pills
o If forgotten for one day , immediately take the forgotten tablet plus the tablet scheduled that day.
o If forgotten for two consecutive days , or more days, use another method for the rest of the cycle and the start again.
IM q 3 monthso Never massage injected site, it will
shorten duration236. DMPA
o Norplant – has 6 match sticks – like capsules implanted subdermally containing progesterone.
237. Mechanism and Chemical Barrierso IUDo Condomo Diaphragmo Cervical capo Foams, Jellies, Creams
238. Intrauterine Device (IUD)
o Action: prevents implantation – affects motility of sperm & ovum
o right time to insert is after delivery or during menstruation
o primary indication for use of IUDo parity or # of children, if 1 kid only
don’t use IUD239.240. Intrauterine Device (IUD)
o ALERTS:o prevents implantationo most common complications:
excessive menstrual flow and expulsion of the device (common problem)
241. Intrauterine Device (IUD)o OTHERS:o P eriod late (pregnancy suspected)o Abnormal spotting or bleedingo A bdominal pain or pain with
intercourseo I nfection (abnormal vaginal discharge)o N ot feeling well, fever, chillso S trings lost, shorter or longero Uterine inflammation, uterine
perforation,ectopic pregnancy242. CONDOM
o – latex inserted to erected penis or lubricated vagina
o Adv: gives highest protection against STD – female condom
o Alerts:243.244.245. Diaphragm
o – rubberized dome shaped material inserted to cervix preventing sperm to get to the uterus. REVERSIBLE
o S/effect: Toxic shock syndromeo Alerts: Should be kept in place for
about 6 – 8 hours246.247.248. Cervical Cap
o – more durable than diaphragm no need to apply spermicide
o C/I: abnormal pap smearo Foams, Jellies, Creams
249. Surgical Methodo BTL , Bilateral Tubal Ligation – can be
reversed 20% chance. HT: avoid lifting heavy objects
o Vasectomy – cut vas deferens.o HT: >30 ejaculations before safe sex
o O – zero sperm count , safe250.o High Risk Pregnancy
251. Hemorrhagic Disorderso General Managemento CBRo Avoid sexo Assess for bleeding (per pad 30 – 40cc)
(wt – 1gm =1cc)252.o Ultrasound to determine integrity of
saco Signs of Hypovolemic shocko Save discharges – for histopathology
253. First Trimester Bleedingo Abortiono Ectopic pregnancy
254. Abortiono – termination of pregnancy before age
287. Abruptio Placentao Nursing Care:o Infuse IV, prepare to administer bloodo Type and crossmatch
o Monitor FHRo Insert Foley catho Measure blood loss; count padso Report s/sx of DICo Monitor v/s for shocko Strict I&O288.o Placenta succenturiatao Placenta Circumvallatao Placenta Marginatao Battledore Placenta289.o Placenta Bipartitao Velamentous Insertion of cordo Vasa Previa
290. Hypertensive Disorderso I. Pregnancy Induced Hypertension
(PIH )291. Pregnancy Induced Hypertension (PIH )
o HPN after 20 wks of pregnancy, solved 6 weeks post partum.
o Gestational hypertension - HPN without edema & proteinuria
o Pre-eclampsia – HPN with edema & protenuria or albuminuria HE P/A
o HELLP syndrome – hemolysis with elevated liver enzymes & low platelet count
292. Chronic or pre-existing Hypertensiono – HPN before 20 weeks not solved 6
weeks post partum.293. Three types of pre-eclampsia
o Mild preeclampsia – earliest sign of preeclampsia
o a.) increase wt due to edemao b.) BP 140/90o c.) proteinuria +1 - +2
294. Three types of pre-eclampsiao Severe preeclampsiao Signs present: cerebral and visual
disturbances, epigastric pain and oliguria
o BP 160/110o Proteinuria +3 - +4
295. Three types of pre-eclampsiao Eclampsia – with seizure!o Increase BUN – glomerular damage.o Provide safety.
296. Cause of preeclampsiao Idiopathic or unknown common in
primio Common in multiple pregnancy (twins)
o Common to mom with low socioeconomic status
297. Nursing care: PPPEACEo P – romote bed resto P – prevent convulsions by nursing
measures or seizure precaution298. Nursing care: PPPEACE
o turning to side is done AFTER seizure! Observe only!
o E – ensure high protein intake ( 1g/kg/day)
Na – in moderationo A – anti-hypertensive drug Hydralazine
(Apresoline)299. Nursing care: PPPEACE
o C – convulsion, prevent! – give Mg So4 – CNS depressant
o E – evaluate physical parameters for Magnesium sulfate
300.o DIABETES MELLITUS
301. Diabetes Mellituso Absence of insulin (Islet of Langerhans
of pancreas)o is an endocrine disorder in which the
PANCREAS cannot produce adequate insulin to regulate body glucose levels
302.o Classifications of Diabetes Mellitus
( American Diabetes Association)o Type 1 Insulin-dependent DMo Type 2 Non-insulin- dependent DMo Gestational Diabeteso Impaired Glucose Homeostasis -A state
between normal and diabeteso
303.o Dx: 1 hr 50gr glucose tolerance test
GTTo 80 – 120 mg/dl;Normal glucose o <>o > hyperglycemia120 o 3 degrees GTT of > 130 mg/dL304.o 3 hour oral glucose tolerance testo 100 g oral glucose solutiono fasting 95mg/dLo 1 hour 180mg/dLo 2 hour 155mg/dLo 3 hour 140mg/dL
308. Diabetes Mellituso Insulin requirement: decrease in
insulin by 33% in 1st tri; 50% increase insulin at 2nd – 3rd trimester.
o Post partum decrease 25%309. Fetal effect: DM
o hyper & hypoglycemiao macrosomia – large gestational age –
baby delivered > 4000g or 4kgo preterm birth to prevent stillbirth
310. Newborn Effect : DM
o hyperinsulinismo hypoglycemiao hypoglycemic <>o Heel stick test – get blood at heel
311. Newborn Effect : DMo Hypoglycemia: high pitch shrill cry
tremors, administer dextroseo Hypocalcemia - <>
Calcemia tetany Trousseau sign Give calcium gluconate if decrease
calcium312.o HEART DISEASE
313.314. Heart disease
o Class I – no limit to physical activityo Class II – slight limitation of activity.
315. Heart diseaseo Class III - moderate limitation of
physical activity.o Class IV - marked limitation of physical
activity.316. Recommendation
o Therapeutic abortiono If push through with pregnancy
Antibiotic therapy
Anticoagulant317. Recommendation
o Class I & II- good progress for vaginal delivery
o Class III & IV- poor prognosis, for vaginal delivery, not CS!
318.o RH INCOMPATIBILITY
(ISOIMMUNIZATION)o Occurs when an Rh-negative mother
(one negative for a D antigen or one with a dd genotype) is CARRYING A FETUS WITH AN Rh-positive blood type (DD or Dd genotype).
319.o Subsequent exposure to Rh-positive
blood can cause a serious reaction that results in agglutination and hemolysis of red blood cells
o * A fetus can become so deficient in red blood cells that sufficient O2 transport to the body cannot be maintained=HEMOLYTIC DISEASE OF THE NEWBORN or ERYHTROBLASTOSIS FETALIS
320.o CAUSES:
o 1. SEPARATION OF PLACENTAo 2. AMNIOCENTESISo 3. PERCUTANEOUS UMBILICAL BLOOD
SAMPLING321.
322.o ANTIBODY SCREENING TEST (indirect
Coomb’s test) -done on the mother’s blood to
measure the number of Rh-positive antibodies
323.o DIRECT COOMBS’ TEST
-done on the infant’s blood to detect antibody-coated Rh-positive RBC’s
324.325. ASSISTED BIRTH
326.o Cesarean Deliveryo Indications:o Multiple gestationo Diabeteso Active genital herpes IIo Severe toxemiao Complete Placenta previao Abruptio placenta
o Prolapse of the cord327.o UTERINE INCISIONSo a. kerro b. sellheim- vertical incision in the
Membranes must be ruptured Type of pelvis should be known Maternal bladder should be empty
and adequate anesthesia given No degree of CPD can be present
333.o VACUUM- ASSISTED BIRTHo used to facilitate the birth of a fetus by
applying suction to the fetal heado Composed of soft suction cup attached
to a suction bottle (pump) by tubingo Suction cup is placed against the fetal
occiput.334.335.336. INFERTILITY
o Inability to achieve pregnancy. Within a year of attempting it
o Manageable337.o In order to get pregnant:o 1. A woman must release an egg from
one of her ovaries (ovulation).o 2. The egg must go through a fallopian
tube toward the uterus (womb).o 3. A man's sperm must join with
(fertilize) the egg along the way.
o 4. The fertilized egg must attach to the inside of the uterus (implantation).
338.o Is infertility a common problem?339.o Is infertility just a woman's problem?
340. NO
341.o What causes infertility in men?342.o Infertility in men is most often caused
by:o problems making sperm -o problems with the sperm's ability to
reach the egg and fertilize ito Sometimes a man is born with the
problems that affect his sperm. Other times problems start later in life due to illness or injury.
343.o What increases a man's risk of
infertility?o The number and quality of a man's
sperm can be affected by his overall health and lifestyle.
344.
o What causes infertility in women?345.o Problems with ovulation account for
most cases of infertility in women. Without ovulation, there are no eggs to be fertilized.
346.o Less common causes of fertility
problems in women include:o blocked fallopian tubes physical
problems with the uteruso uterine fibroids347.o What things increase a woman's risk of
infertility?o Many things can affect a woman's
ability to have a baby. These include: 1.age 2.stress 3.poor diet 4.athletic training
348.o How long should women try to get
pregnant before calling their doctors?349.o Some health issues also increase the
risk of fertility problems. So women
with the following issues should speak to their doctors as soon as possible :
o irregular periods or no menstrual periods
o very painful periodso endometriosiso pelvic inflammatory diseaseo more than one miscarriage350.o How will doctors find out if a woman
and her partner have fertility problems?
351.o For a woman, the first step in testing is
to find out if she is ovulating each month.
352.o Some common tests of fertility in
women include :o Hysterosalpingography : In this test,
doctors use x-rays to check for physical problems of the uterus and fallopian tubes.
353.o Laparoscopy:
o During this surgery doctors use a tool called a laparoscope to see inside the abdomen.
354.o How do doctors treat infertility?o Infertility can be treated with
medicine, surgery, artificial insemination or assisted reproductive technology.
355.o Doctors often treat infertility in men in
the following ways:o Sexual problems: Behavioral therapy
and/or medicines can be used in these cases.
o Too few sperm:, doctors can surgically remove sperm from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.
356.o Intrauterine insemination (IUI) - is
known by most people as artificial insemination.
IUI is often used to treat:o mild male factor infertility
o women who have problems with their cervical mucus
o couples with unexplained infertility357.o What medicines are used to treat
infertility in women?358.o Some common medicines used to treat
infertility in women include:o 1.Clomiphene citrate ( Clomid ): This
medicine causes ovulation by acting on the pituitary gland.
o 2.Human menopausal gonadotropin or hMG ( Repronex, Pergonal ): This medicine is often used for women who don't ovulate due to problems with their pituitary gland.
359.o 3.Follicle-stimulating hormone or FSH (
Gonal-F, Follistim ): FSH works much like hMG..
o 4.Gonadotropin-releasing hormone (Gn-RH) analog : These medicines are often used for women who don't ovulate regularly each month.
360.
o 5. Metformin ( Glucophage ): Doctors use this medicine for women who have insulin resistance and/or Polycystic Ovarian Syndrome (PCOS) . This drug helps lower the high levels of male hormones in women with these conditions.
o 6. Bromocriptine ( Parlodel ): This medicine is used for women with ovulation problems due to high levels of prolactin.
361.o Many fertility drugs increase a
woman's chance of having twins, triplets or other multiples.
(ART) is a term that describes several different methods used to help infertile couples.
363.o How often is assisted reproductive
technology (ART) successful?o age of the partnerso reason for infertility
o clinico type of ARTo if the egg is fresh or frozeno if the embryo is fresh or frozen364.o What are the different types of
assisted reproductive technology (ART)?
365.o Common methods of ART include:o 1. In vitro fertilization (IVF) . Once
mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.
366.o 2. Zygote intrafallopian transfer (ZIFT)
or Tubal Embryo Transfer - Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.
367.o 3.Gamete intrafallopian transfer (GIFT)
involves transferring eggs and sperm into the woman's fallopian tube.
368.o 4. Intracytoplasmic sperm injection
(ICSI)o In ICSI, a single sperm is injected into a
mature egg. Then the embryo is transferred to the uterus or fallopian tube.
369.370.371.372. 2 types of infertility
o 1.) primaryo 2.) Secondaryo Sims Huhner test
373. Infertilityo Normal: cervical mucus must be
stretchable 8 – 10 cmo Best criteria- sperm motility for
impotency374. Infertility
o Mgt:o GIFT= Gamete Intra Fallopian Transfer
for low sperm count375.o Mom: anovulation – no ovulationo hyperprolactinemia376.