Upload
steven-waters
View
216
Download
3
Embed Size (px)
DESCRIPTION
Prof.Carole A. Devine RN.MSN.3 Immediate Care of the Newborn Assessments: Vital Signs /Color of Infant Apgar Scores Check Cord Assess Infant Weight Assess U/A and G.I. Systems
Citation preview
Prof.Carole A. Devine RN.MSN. 1
The Process of Birth
Prof.Carole A. Devine RN.MSN. 2
Assessment And Responsibilities During Labor and BirthGoal of Care: To provide for a safe
labor and birth of a healthy baby and to promote maternal comfort in the process…..
1. Comfort Measures: 2. Physical Needs: 3. When to call the Physician Responsibilities of the
Attendants at the Birth
Prof.Carole A. Devine RN.MSN. 3
Immediate Care of the Newborn
Assessments: Vital Signs /Color of Infant Apgar Scores Check Cord Assess Infant Weight Assess U/A and G.I. Systems
Prof.Carole A. Devine RN.MSN. 4
Assessments (Cont.)
Protect against infection
Identification of Infant
Prevent hypothermia
Promote parental attachment
Prof.Carole A. Devine RN.MSN. 5
Managing the Pain of Labor and Delivery
Prof.Carole A. Devine RN.MSN. 6
Labor Pain-Introduction Historical Perspective
Management Strategies:
1.Non- Pharmaceutical Measures 2. Pharmaceutical Choices
The Challenge to Nurses!
Prof.Carole A. Devine RN.MSN. 7
What Exactly is Labor
Pain ????
Prof.Carole A. Devine RN.MSN. 8
Factors Affecting The Factors Affecting The Woman in LaborWoman in Labor1.Parity& Age2.Racial/Cultural3.Coping
Strategies4.Relaxation
Measures5.Emotional/
Attitude6.Knowledge base
7.Confidence level8.Support Systems9. Environment10.Fatigue/length
of labor11.N/V & Diarrhea12. Maternal &
Fetal Positions13.Pain Level
Prof.Carole A. Devine RN.MSN. 9
Non-Pharmacologic Methods of Pain Relief
Hydrotherapy Application of heat
/cold Acupressure Imagery/Visualization Effleurage Comfort Measures Distraction Breathing
Techniques
Prof.Carole A. Devine RN.MSN. 10
Pharmacological Methods of Pain Relief
Prof.Carole A. Devine RN.MSN. 11
Goal of Administering Systemic Medication:
Three Factors to be Considered in the use of Systemic Medication
1.Effect on The Mother
2. Effect on the Fetus
3. Effect on Labor contractions
Prof.Carole A. Devine RN.MSN. 12
Analgesia/Anesthesia
Analgesics: (Opioids,Tranquilizers &Sedatives) Common Ones: Demerol Stadol Nubain Fentanyl Morphine
Prof.Carole A. Devine RN.MSN. 13
Demerol (Meperidine) Action: Usual dose: Pros : Cons: Maternal Cons: Neonatal
Prof.Carole A. Devine RN.MSN. 14
Stadol (Butorphanal) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal
Prof.Carole A. Devine RN.MSN. 15
Nubain (Nalbuphine) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal
Prof.Carole A. Devine RN.MSN. 16
Fentanyl (Sublimaze) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal
Prof.Carole A. Devine RN.MSN. 17
Morphine (Duromorph) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal
Prof.Carole A. Devine RN.MSN. 18
Nursing Considerations with Opioids:
Opioid Antagonist NALOXONE (Narcan) Reverses opioid induced
Resp.Depression Dose: Neonate: 0.01mg/Kg IV,IM
or SC q 2-3min. Mother: 0.1-0.2mg IVQ 2-3min Have Crash Cart Handy!!!!
Prof.Carole A. Devine RN.MSN. 19
Anesthesia 1. Local Infiltration:
2.Regional:
Pudendal Block
Epidural Block Goal Procedure Complications 1. Maternal
2 .Neonatal
Nursing Considerations
Advantages vs Disadvantages
Prof.Carole A. Devine RN.MSN. 20
Spinal Block (Subarachnoid)
Intrathecal)
Goal Procedure Pros: Complications: Nursing
Responsibilities/Considerations
General Anesthesia
Prof.Carole A. Devine RN.MSN. 21
Fetal Response to Labor Intrapartal Fetal Assessment:
Electric Fetal Monitor ( EFM) Purpose Factors that Impact Fetal Oxygenation
1. Maternal Bld. O2 Saturation 2. Normal flow of oxygenated bld. thru the Placenta3. Normal Utero-Placental exchange4. Patent umbilical cord vessels (AVA)5. Normal Fetal circulation and oxygen-carrying
function
Prof.Carole A. Devine RN.MSN. 22
Types of Intrapartal Fetal Assessments 1. Low -Tech Approach 2. EFM a. Equipment: 1. External ( Indirect)Uses two Transducers: Pressure and
ultrasound 2. Internal (Direct )Uses a Fetal Scalp Electrode
Prof.Carole A. Devine RN.MSN. 23
Evaluating Fetal Monitoring Strips Fetal Heart Rate: Baseline Tachycardia Causes: Bradycardia Causes: Variability Presence of Periodic Changes: Accelerations? Decelerations?
Prof.Carole A. Devine RN.MSN. 24
Decelerations/Types: Early,Late or VariableEarly
Decelerations: Characteristics: Pattern: Cause: Rx:
Late Decelerations: Characteristics: Pattern: Cause: Rx:
Prof.Carole A. Devine RN.MSN. 25
Variable Decelerations: Characteristics: Pattern: Cause Treatment: AN OMINOUS SIGN- LATE DECELERATION and
DECREASED VARIABILITY OF FETAL HEART RATE!!!!
Prof.Carole A. Devine RN.MSN. 26
Significance of Fetal Heart Patterns:”Reasssuring”vs. “Non-Reassuring” Reassuring Patterns of FHR 1. Show signs of fetal well being 2. Fetus is compensating Non-Reassuring Patterns of FHR 1. Associated with Hypoxia and
Acidosis 2. Suggest some level of Fetal
compromise !
Prof.Carole A. Devine RN.MSN. 27
THE END
GOOD LUCK To All Of YOU !!!!!