Skills Delivery Teaching

7/21/2019 Skills Delivery Teaching

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METHODS OFDELIVERY


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METHODS OF DELIVERY

Forceps Assisted Delivery

Vacuum Extraction

Cesarean DeliveryVaginal Birth After

Cesarean

Normal SpontaneousDelivery


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DESCRIPTION

Delivery of the ayusing ostetrical

instruments


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1. FORCEPS ASSISTED

DELIVERY assist the

irth of afetus yprovidingthe means torotate thefetal head to

an occiput!anterior"poste!riorposition#


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$%o doule!

crossed&spoon li'earticulatedlades thatare used toassist in thedelivery of

the fetalhead


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Indicators

(#FE$A) FAC$*+Sa# second stage of laor fetaldistress

# anormal presentation orarrested descent

c# ,reterm laor to protectfetal head from in-uries

d# premature placentalseparation


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Indicators

.# /A$E+NA) FAC$*+Sa# to shorten the secondstage of laor

# ine0ective expulsivee0ort"poor progress

c# exhaustion

d# medical diseases li'ecardiac arrest


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CRITERIA/PREREQISITE

1# Full dilatation of thecervix

.# +uptured B*12# Engaged head

3# No C,D

4# Episiotomy

5# Anesthesia


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TYPES

1.LOW/OUTLET FORCEPS

6 fetal head on

parietal 7oor2. MIDFORCEPS 6 fetal

head at the level of

ischial spines


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COMPLICATIONS

(#/A$E+NA)

a# lacerations

# hemorrhage

c# uterine rupture

d# uterine prolapse


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COMPLICATIONS

(# FE$A)a# facial paralysis 8Bell9s ,alsy:# increased perinatalmoridity

and mortalityc# intracranial hemorrhaged# rain damage

e# s'ull fracturef# tissue traumag# cord compression


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N!onata" Ris#s1. !cc$%&osis and/or !d!&a a"on'

t$! sid!s o( t$! (ac!

). Ca*+t Sacc!dan!+& or c!*a"$!&ato&a and s+,s!-+!nt"%$%*!r,i"ir+,in!&ia &a% occ+r

. Transi!nt (acia" *ara"%sis

. Lo0 IQ (or c$i"dr!n


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NRSIN IMPLEMENTATION

(#,repare client and family

.#,rovide psychological

support to allay"decreaseanxiety

2#/onitor F;$ continuously

3#Assess mother and infantfor complication


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INDICATIONS

1. Condition2 t$r!at!n t$! &ot$!r or(!t+s and t$at can ,! r!"i!3!d ,%,irt$

). conditions2 $!art ds!4 ac+t!*+"&onar% !d!&a4 intra*arta"in(!ction4 !5$a+stion

. F!ta" conditions2 *r!&at+r!*"ac!nta" s!*aration4 (!ta" distr!ss


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). Vac++& !5traction

A ca* "i#!s+ctiond!3ic! is

a**"i!d tot$! (!ta"$!ad to(aci"itat!!5traction


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. CESAREAN BIRTH


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Cesarean Birth

Birth accomplished through

an abdominal incision into

the uterus.

ne o! the oldest t"pes o!

surgical procedures #no$n.


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%ore ha&ardous than 'aginal

birth

ne o! the sa!est t"pes and

one $ith !e$ complications

$hen compared $ith other

surgical procedures.

most o!ten used as a

proph"lactic measure to

alle'iate problems o! birth.


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A. %ATERNA( )ACTRS*

C+,+,

Acti'e genital herpes or

cti'e genital herpes or

papilloma

apilloma

+re'ious CS b" classicre'ious CS b" classic

incision

ncision

,isabling condition *

isabling condition *

Se'ere H+N o! pregnanc"

e'ere H+N o! pregnanc"

Heart dse that pre'enteart dse that pre'ent

pushing

ushing


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B. +lacental

)actors*

+lacenta pre'ia+lacenta pre'iaAbruptio placentaAbruptio placenta


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C. )etal )actors*

Trans'erse lie

rans'erse lie

presentation

resentation

E-treme lo$ birth $eight-treme lo$ birth $eight

)etal distress

etal distress

Compound conditions

ompound conditions

macrosomic !etus in amacrosomic !etus in a

breech lie/

reech lie/


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Types of Cesarean Birth

1. Sc$!d+"!d CS6 t$!r! is ti&! (or t$oro+'$6 t$!r! is ti&! (or t$oro+'$

*r!*aration*r!*aration). E&!r'!nc% CS

6 *r!*aration &+st ,! don!6 *r!*aration &+st ,! don!&+c$&+c$ &or! ra*id"%&or! ra*id"%E72E72

6 *"ac!nta *r!3ia6 *"ac!nta *r!3ia

6 a,r+*tio *"ac!nta6 a,r+*tio *"ac!nta6 (!ta" distr!ss6 (!ta" distr!ss6 (ai"+r! to *ro'r!ss6 (ai"+r! to *ro'r!ss


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0. (o$ Segment Incision1

Tran'erse

%ade hori&ontall" across the

abdomen2ust abo'e the

s"mph"sis pubisacross the

uterus2ust o'er the cer'i- A.#.a. p!annenstielor 3bi#ini4

incision

%ost common t"pe o! CS


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Ad'antages*

5 less li#el" to rupture in

subse6uent labor

5 less blood loss

5 easier to suture

5 decreases postpartal uterine

in!ections

5 less 7I complications

,isad'antage*

5 it ta#es longer to per!orm 8

impractical !or ECS


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T%*!s o( C!sar!an Incisions

9. C(ASSICA( CESAREAN INCISIN8

made 'erticall"through

both the abdominal s#in and the

uterus5 The scar could rupture during

labor

5 :ill not be able to ha'e a

subse6uent 'aginal birth


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. Va'ina" 8irt$ A(t!r

C!sar!an 8irt$ 9V8AC:Pati!nt 0$o $as $ad a *r!3io+sPati!nt 0$o $as $ad a *r!3io+s

"o06trans3!rs! c!sar!an ,irt$."o06trans3!rs! c!sar!an ,irt$.

No &!dica" or o,st!tricNo &!dica" or o,st!triccontraindication to "a,orcontraindication to "a,or

No $istor% o( *rior +t!rin!No $istor% o( *rior +t!rin!

r+*t+r! !5istsr+*t+r! !5istsIncid!nc! o( d!$isc!nc!2 1;Incid!nc! o( d!$isc!nc!2 1;


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NORMAL SPONTANEOSDELIVERY 9NSD:

act+a" !3!nt o( t$!!5*+"sion o( t$! *rod+ctso( conc!*tion (ro& t$!

&at!rna",od%


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PURPOSE:

To &aintain t$! *$%sio"o'icsta,i"it% o( t$! 0o&ant$ro+'$o+t t$! sta'!s o( "a,or

To *r!3!nt co&*"ications,!(or!4 d+rin' and a(t!r "a,or

and d!"i3!r% ,ot$ t$! &ot$!rand to t$! ,a,%


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GENERAL

CONSIERATIONS: H!"* t$! *art+ri!nt *artici*at!

to t$! !5t!nt s$! 0is$!s in t$!d!"i3!r% o( t$! in(ant4 to &!!tt$! 0o&an


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Cons!r3! t$! 0o&an


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R!"a5ation and r!d+ction o(str!ss incr!as!s 0o&an


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T$! c"i!nt s$o+"d ,!assist!d in contro""!d c$!st,r!at$in' d+rin'contractions and r!"a5,!t0!!n contractions.


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T$! c"i!nt is disco+ra'!d to,!ar +nti" c!r3ica" di"ationis co&*"!t!.


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Monitor c"os!"% t$!*ro'r!ss o( "a,or and ,!a0ar! o( t$! 0arnin' si'ns(or t$! s!cond sta'! o("a,or.


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R!s*!ct and *ro&ot! t$!0o&an and $!r s+**ort*!rson


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NORMAL SPONTANEOS

DELIVERY


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MECHANISM OF LA8OR

a!"!a! as #ar$ina% &o'e&ents of

%a(or are the $ifferent

&o'e&ents or positiona%

#han)es that the fet*s &a"es$*rin) the first an$ se#on$ sta)e

of %a(or in or$er to pass

s*##essf*%%y thro*)h theirre)*%ar shape of the (irth

#ana%!


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EQIPMENTS/ARTICLES NEEDEDEQIPMENTS/ARTICLES NEEDED

1! + Peritonea% ,or#eps Strai)ht

+! 1 Peritonea% ,or#eps C*r'e

-! 1 Th*&( for#eps

.! 1 Tiss*e ,or#eps

/! 1 Nee$%e 0o%$er

! 1 2ayo S#issor Strai)ht

3! 1 2ayo S#issor C*r'e

4! + Petri ish


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Pr!*ar! D!"i3!r% Pac#

5! Tray 6ith %inin)

17!Nee$%e 8 #*ttin) 9 ro*n$11!;e%%y Pa$

1+!Le))in)s

1-!OR 2as"

1.!OR Cap1/!Pai%

1!Green To6e%

13!OR )o6n

14!0ypo tray


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+! 2aintain S*r)i#a% Asepsis+! 2aintain S*r)i#a% Asepsis


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-! O(ser'es 6arnin) si)ns-! O(ser'es 6arnin) si)ns

of the +of the +n$n$ sta)e ofsta)e of

%a(or%a(or


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.! S#r*(s $*rin) a#t*a%.! S#r*(s $*rin) a#t*a%

$e%i'ery$e%i'ery


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/! Gi'e e&otiona% s*pport/! Gi'e e&otiona% s*pport

to the &otherto the &other


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3! oes pro#e$*re in a3! oes pro#e$*re in a

syste&ati# &annersyste&ati# &anner


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PROCEDREACTIONACTION RATIONALERATIONALE

1.Position the woman1.Position the womanin lithotomy on thein lithotomy on thedelivery table,delivery table, legs tolegs to

be put up slowly atbe put up slowly atthe same time on thethe same time on thestirrup.stirrup. Same shouldSame shouldbe done whenbe done when

straightening the legsstraightening the legsor putting them downor putting them downafter delivery.after delivery.

To preventTo preventtrauma to thetrauma to theuterineuterine

ligaments,ligaments,andandbackaches orbackaches or

leg crampsleg cramps


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2. Encourage2. Encouragethe woman tothe woman todo strongdo strongpushing withpushing withcontractionscontractions

Best timeBest time

to performto performstrongstrongpush topush to

facilitatefacilitatedescent ofdescent ofthe fetuthe fetuss


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Tell the womanTell the woman

to use lowto use lowreathingreathingpatternpattern

etween eachetween eachcontractionscontractions

To pre!entTo pre!ent

pushingpushingetweenetweencontractioncontraction


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As soon asAs soon asthe headthe head

crowns,crowns,instruct theinstruct thewoman notwoman notto pushto push

insteadinsteadshe isshe isadvised toadvised topantpant

ToTopreventprevent

rapidrapiddelivery ofdelivery ofthe fetus.the fetus.

ToTo

preventpreventdural/subddural/subdural tearsural tears

ToTo

preventpreventvaginal orvaginal orperinealperineallacerationslacerations


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"erform Ritgen#s"erform Ritgen#smaneu!er $maneu!er $supporting withsupporting with

the palm againstthe palm againstthe rectumthe rectum


laceration of thelaceration of thefourchettefourchette

To ring fetal chinTo ring fetal chindown the chest sodown the chest so

that thethat the smallestsmallestdiameter of thediameter of thefetal headfetal head is theis the

one presented atone presented atthe irth canalthe irth canal


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Assist in !*isioto&% as n!!d!d2

"rimaril$ to pre!ent"rimaril$ to pre!entlacerationlaceration

"re!ent prolonged"re!ent prolonged

and se!ere stitchingand se!ere stitchingof the muscleof the musclesupporting thesupporting theladder and rectumladder and rectum

Reduce duration ofReduce duration ofthe 2the 2ndndstage of laorstage of laor

Enlarge !aginalEnlarge !aginaloutlet in reechoutlet in reechpresentation ofpresentation offorcep deli!er$forcep deli!er$

%pare the%pare theinfant#s head frominfant#s head from

prolongedprolongedpressure whichpressure whichma$ result toma$ result torain damage&rain damage&

especiall$ inespeciall$ in

premature a$.premature a$.


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As soon as the headAs soon as the head

is orn& suction oral'is orn& suction oral'phar$n( with smallphar$n( with smallul s$ringe.ul s$ringe.

%uction nares ne(t.%uction nares ne(t.

To e(pedite drainageTo e(pedite drainage

and pre!entsand pre!entsaspiration of amnioticaspiration of amnioticfluid& mucus andfluid& mucus andmaternal lood.maternal lood.

To pre!ent inspirationTo pre!ent inspirationfollowing stimulationfollowing stimulationof nares efore naresof nares efore naresis clear.is clear.


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As soon as the headAs soon as the headhas een deli!ered&has een deli!ered&

inspect if a loop ofinspect if a loop ofcord is around thecord is around thenec). If present& slip itnec). If present& slip itdown the shoulder* ifdown the shoulder* if

too tight& appl$ 2too tight& appl$ 2clamps an inch apartclamps an inch apartefore cutting theefore cutting thecord etween thecord etween the

clamps.clamps.

To a!oid cordTo a!oid cordcompression whilecompression while

the a$#s od$ isthe a$#s od$ iseing deli!eredeing deli!ered

To pre!ent accidentalTo pre!ent accidentalpulling of the cordpulling of the cord

resulting to detachingresulting to detachingof the cord from theof the cord from thease of the placentaase of the placentaor from the a$#sor from the a$#s

na!el.na!el.


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After e(ternalAfter e(ternalrotation& gi!e arotation& gi!e a

gentle stead$gentle stead$downward pulldownward pulland then a gentleand then a gentle

upward liftupward lift

To deli!er theTo deli!er theanterior andanterior and

posterior shouldersposterior shoulders

Lateral traction toLateral traction to

deli!er the shoulderdeli!er the shouldershould ne!er eshould ne!er edone to pre!entdone to pre!entner!e in+uries.ner!e in+uries.


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,hile supporting,hile supporting

the a$#s headthe a$#s headand nec) withand nec) withone hand& glideone hand& glide

the other handthe other handtowards the od$towards the od$then grasp oththen grasp oth

of the a$#sof the a$#san)le.an)le.


in+ur$ as thein+ur$ as thea$#s od$ isa$#s od$ isslipper$.slipper$.


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Ta)e note ofTa)e note of

thethe timetimethethea$ isa$ isdeli!ereddeli!ered

..

-or proper-or proper

documentation.documentation.


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Immediatel$Immediatel$afterafter

deli!er$& thedeli!er$& thea$ is helda$ is heldelow theelow thele!el of thele!el of the

mother#smother#s!ul!a!ul!a

The loodThe loodfrom thefrom the

placentaplacentacan entercan enterthetheinfant#sinfant#s

od$ onod$ onthe asisthe asisof gra!it$of gra!it$

flow.flow.


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"lace the"lace thea$ ona$ on

top oftop ofmother#smother#sadomenadomen

%timulates%timulatesthe releasethe release

of o($tocinof o($tocinfrom thefrom the" thus" thusstimulatingstimulating

uterineuterinecontractioncontractionwhich aidwhich aidinin

placentalplacentalseparation.separation.


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Appl$ 2Appl$ 2clamps toclamps to

thetheumilicalumilicalcord as itscord as itspulsationpulsationceases.ceases.

Cutting ofCutting ofthe cord isthe cord ispostponedpostponeduntiluntil

pulsationpulsationisisstoppedstopped

It isIt iselie!edelie!ed

that/0'100that/0'100mL ofmL oflood islood isflowingflowingfrom thefrom the

placentaplacentato the NBto the NBat thisat thistime.time.


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Inform theInform themothermotheraout theaout these( of these( of thea$ anda$ andhelp tohelp tohold andhold andinspectinspecther a$her a$as sheas shewishes.wishes.

aternalaternaland infantand infantondingondingis initiatedis initiatedas soonas soonas theas themothermotherhas e$e'has e$e'to'e$eto'e$econtactcontactwith herwith hera$.a$.


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,ait for the signs,ait for the signsthat placenta hasthat placenta hasseparated eforeseparated eforeattempting toattempting to

deli!er thedeli!er theplacenta.placenta.

a$ tear thea$ tear thecordcord

%eparate the%eparate theplacentaplacenta

In!ert the uterusIn!ert the uterus


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Once placenta isOnce placenta is

out it is carefull$out it is carefull$inspectedinspected

"lacental"lacental

fragments ma$fragments ma$causecausesuse3uentsuse3uent

hemorrhage.hemorrhage.


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4etermine the degree4etermine the degreeof uterine contractionof uterine contraction

and perform initialand perform initialnursing inter!entionnursing inter!entionfor signs of nonfor signs of noncontracting orcontracting or

5ogg$6 uterus.5ogg$6 uterus. gentle massagegentle massage

Appl$ ice capAppl$ ice cap

To stimulateTo stimulatecontractioncontraction


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Administer o($tocicsAdminister o($tocics

as ordered.as ordered.

Assess or monitor B"Assess or monitor B"of the motherof the mother

To ensure contractionTo ensure contraction

to pre!entto pre!enthemorrhagehemorrhage

A common sideA common sideeffects of o($tocicseffects of o($tocicsspecificall$ ergotspecificall$ ergotderi!ati!es isderi!ati!es is78"ERTEN%ION78"ERTEN%ION


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Inspect perineumInspect perineum

for lacerations.for lacerations.

An$time theAn$time the

uterus is firmuterus is firmand leedingand leedingcomes out incomes out in

spurts& suspectspurts& suspectfor lacerations.for lacerations.


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Assist theAssist the

doctordoctorduring theduring theepisior'episior'rhaph$rhaph$

LaceratioLaceratio

ns if notns if notrepairedrepairedcan leadcan leadto oo9ingto oo9ing

red loodred loodfrom thefrom thelaceratedlaceratedpart of thepart of the

perineum.perineum.


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E!acuate loodE!acuate loodclots and watchclots and watch

for signs offor signs ofplacentalplacentalfragments.fragments.

Non'contractionNon'contractionof uterus afterof uterus after

placentalplacentaldeli!er$ ma$ edeli!er$ ma$ ecaused of eithercaused of either

lood cuts orlood cuts orretainedretainedplacental tissues.placental tissues.

-undus chec)-undus chec) To monitorTo monitor


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-undus chec)-undus chec)is done e!er$is done e!er$1/ mins1/ mins

"erform"erformperineal careperineal careaspeticall$ andaspeticall$ andappliesappliesperipadperipad

appropriatel$.appropriatel$.

To monitorTo monitoruterineuterinecontractioncontraction

To pro!ideTo pro!idecomfortcomfort

%er!es as%er!es asasis forasis formonitoringmonitoringlochiallochialdischarge.discharge.


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A POSITION


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A! POSITION

LIT0OTO2Y POSITION: The %e)s sho*%$ (eLIT0OTO2Y POSITION: The %e)s sho*%$ (e

p*t *p s%o6%y at the sa&e ti&e!p*t *p s%o6%y at the sa&e ti&e!

RATIONALERATIONALE1!1! To pre'ent tra*&a to the *terine %i)a&entsTo pre'ent tra*&a to the *terine %i)a&ents

+!+! To Pre'ent (a#"a#hes an$ or %e)s #ra&psTo Pre'ent (a#"a#hes an$ or %e)s #ra&ps

T$! sa&! s$o+"d ,! don! 0$!n *+ttin'T$! sa&! s$o+"d ,! don! 0$!n *+ttin't$! "!'s do0n (ro& t$! stirr+*s a(t!rt$! "!'s do0n (ro& t$! stirr+*s a(t!r

d!"i3!r%d!"i3!r%


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8. 8EARIN DO=N TECHNIQE

T$! s!condT$! s!condsta'! is t$!sta'! is t$!,!st ti&! to,!st ti&! to

!nco+ra'!!nco+ra'!stron'stron'*+s$in'*+s$in'

0it$0it$contractionscontractions!


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PSHINPSHIN

Vo"+ntar% ,!arin'6do0nVo"+ntar% ,!arin'6do0n!((ort!((ort

S!condar% *o0!r in3o"3!d inS!condar% *o0!r in3o"3!d in

"a,or."a,or.N!!d!d to $!"* t$! *ri&ar%N!!d!d to $!"* t$! *ri&ar%

*o0!r > t!rin! Contraction?*o0!r > t!rin! Contraction?

in *ro&otin' !5*+"sion o( t$!in *ro&otin' !5*+"sion o( t$!(!t+s(!t+s

=HEN TO PSH @


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=HEN TO PSH @

1! ++NN Sta)e of La(or or fro& theSta)e of La(or or fro& the&o&ent the #er'i< is f*%%y&o&ent the #er'i< is f*%%y

$i%ate$ or 17 #&! open$i%ate$ or 17 #&! open

+!+! Uterine Contra#tionUterine Contra#tion

=HEN NOT TO PSH @


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=HEN NOT TO PSH @

1! Int!r3a" o( ContractionInt!r3a" o( Contraction9 P!riod ,!t0!!n9 P!riod ,!t0!!n

contractions: and incontractions: and in

cro0nin'.cro0nin'.

).). 8!(or! co&*"!t! c!r3ica"8!(or! co&*"!t! c!r3ica"

di"atationdi"atation


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CONSEQENCES

1! r!at!r &at!rna" (ati'+!r!at!r &at!rna" (ati'+!).). Add!d (!ta" strainAdd!d (!ta" strain

.. Possi,"! In+r% to t$! (!ta"Possi,"! In+r% to t$! (!ta"

*r!s!ntin' *art*r!s!ntin' *art

.. Ca+s!s &or! strain to t$!Ca+s!s &or! strain to t$!

dis!as!d $!art in 0o&!n 0it$dis!as!d $!art in 0o&!n 0it$

cardiac ai"&!ntcardiac ai"&!ntB.B. Possi,"! In+r% in t$! c!r3i5Possi,"! In+r% in t$! c!r3i5

In+r% in t$! c!r3i5


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In+r% in t$! c!r3i5

1.1. CERVICAL EDEMA d+! to c$ronicCERVICAL EDEMA d+! to c$ronic

*assi3! con'!stion*assi3! con'!stion

EFFECTS2EFFECTS2

D!"a% in c!r3ica" di"atationD!"a% in c!r3ica" di"atation

Pr!dis*os!s to c!r3ica" "ac!rationPr!dis*os!s to c!r3ica" "ac!ration

). CERVICAL 8RISIN / TRAMA as it is). CERVICAL 8RISIN / TRAMA as it is

(orc!d a'ainst t$! s%&*$%sis *+,is d+rin'(orc!d a'ainst t$! s%&*$%sis *+,is d+rin'*+s$in'*+s$in'

TIPS RELATED TO PSHIN


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TIPS RELATED TO PSHIN

1! PROPER POSITION2PROPER POSITION2

ros! to B d!'r!!s i( not contraindicat!dros! to B d!'r!!s i( not contraindicat!d

). HO= TO PSH@). HO= TO PSH@ As 0o&an ,!'ins to (!!" a contraction As 0o&an ,!'ins to (!!" a contraction

ta#! a d!!* ,r!at$ and ,"o0 it a"" o+tta#! a d!!* ,r!at$ and ,"o0 it a"" o+t

=o&an ta#!s a )=o&an ta#!s a )ndndd!!* ,r!at$ 0$ic$ s$!d!!* ,r!at$ 0$ic$ s$!$o"ds as s$! c"os!s $!r &o+t$4 *+ts $!r$o"ds as s$! c"os!s $!r &o+t$4 *+ts $!r

c$in on $!r c$!st and ,!ars contin+!c$in on $!r c$!st and ,!ars contin+!*+s$in'*+s$in'

TIPS RELATE TO PUS0ING


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TIPS RELATE TO PUS0ING

=o&an r+ns o+t o( air ,!(or! t$!=o&an r+ns o+t o( air ,!(or! t$!contraction !nds4 ta#! anot$!r d!!*contraction !nds4 ta#! anot$!r d!!*

,r!at$ and contin+! *+s$in',r!at$ and contin+! *+s$in'

S$ort *+s$!s ar! in!((!ct+a"4 ,+tS$ort *+s$!s ar! in!((!ct+a"4 ,+t

*ro"on'!d *+s$in' so t$at 0o&an is*ro"on'!d *+s$in' so t$at 0o&an is

$o"din' $!r ,r!at$!s FOR MORE THAN B$o"din' $!r ,r!at$!s FOR MORE THAN BSECONDS IS NOT RECOMMENDEDSECONDS IS NOT RECOMMENDED


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=ALSAL=A 2ane*'erpro%on)e$ (reath ho%$in) 6hi%e (earin) $o6n

1!1!i&inishe$ ,eto> P%a#enta% )asi&inishe$ ,eto> P%a#enta% )as

e


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NO PSHIN IN CRO=NINNO PSHIN IN CRO=NIN

Instr+ction s$o+"d ,! SIMPLE4 CLEAR4Instr+ction s$o+"d ,! SIMPLE4 CLEAR4

and co&in' (ro& ONE COACH to a3oidand co&in' (ro& ONE COACH to a3oidcon(+sioncon(+sion

Nor&a% Spontaneo*s


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Nor&a% Spontaneo*s

e%i'ery1! Prepares $e%i'ery roo&@Prepares $e%i'ery roo&@

&other@ pa#"s@ instr*&ents@&other@ pa#"s@ instr*&ents@e*ip&ents!e*ip&ents!

+! 2aintains s*r)i#a% asepsis!+! 2aintains s*r)i#a% asepsis!-! O(ser'es 6arnin) si)ns in the-! O(ser'es 6arnin) si)ns in the

se#on$ sta)e of %a(or!se#on$ sta)e of %a(or!

.! S#r*(s $*rin) a#t*a% $e%i'ery.! S#r*(s $*rin) a#t*a% $e%i'ery/! Gi'es e&otiona% s*pport to/! Gi'es e&otiona% s*pport to

&other&other


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! Do!s *roc!d+r! in a s%st!&atic &ann!r.Do!s *roc!d+r! in a s%st!&atic &ann!r.. A**"i!s Rit'!n


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11. ras* ,a,%


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1.1.O,s!r3!s (or si'ns o( *"ac!nta"O,s!r3!s (or si'ns o( *"ac!nta"

s!*aration.s!*aration.1. A(t!r !5*+"sion o( *"ac!nta41. A(t!r !5*+"sion o( *"ac!nta4ins*!ct (or co&*"!t!n!ss.ins*!ct (or co&*"!t!n!ss.

1. R!&o3! ,"ood c"ots.1. R!&o3! ,"ood c"ots.

1G. C"!an *!rin!+&4 a**"i!s1G. C"!an *!rin!+&4 a**"i!s

antis!*tic.antis!*tic.

). P"ac! *!rin!a" *ad.). P"ac! *!rin!a" *ad.

)1. A(t!r car! o( instr+&!nts4)1. A(t!r car! o( instr+&!nts4!-+i*&!ntJs.!-+i*&!ntJs.

)). Do!s c$artin'.)). Do!s c$artin'.


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THANK YOUTHANK YOU

ANDANDGOOD LUCK!GOOD LUCK!

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