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The Family in Childbirth: Needs and Care

The Family in Childbirth: Needs and Care. Chapter 19. Nursing DX. Pain Fear Knowledge deficit Stressors Previous experience. When do I come to the hospital?. ROM- leaking? Q 5 minutes X 1hr, 10-15 Q 1 hr Vaginal bleeding Decrease fetal movement How fast was your last labor?.

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The Family in Childbirth: Needs and Care

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  1. The Family in Childbirth: Needs and Care Chapter 19

  2. Nursing DX • Pain • Fear • Knowledge deficit • Stressors • Previous experience

  3. When do I come to the hospital? • ROM- leaking? • Q 5 minutes X 1hr, 10-15 Q 1 hr • Vaginal bleeding • Decrease fetal movement • How fast was your last labor?

  4. Admission • Orient to birthing room • Gown and urine sample • Get history as applying monitors • Position L lat • Assess FHT, UC, VS and VE • Determine priority of assessment and interventions

  5. Nursing Support During Labor • Support • Comfort • Information and advice • Advocacy • Support for partner

  6. Appreciation of Cultural Diversity • Cultural responses to labor differ • Modesty-gender of HCP • Expression of pain • Values and self control • Hot and cold foods

  7. Adolescent Support • At risk if no PNC • Evaluate support system • Establish trusting, non-judgmental, supportive relationship • Evaluate coping mechanisms • Babies for adoption (BFA)

  8. Comfort in First Stage • Evaluate emotional response to pain • Physiological manifestation- pulse, BP, resp., muscle tension, dilated pupils • Tension may impede labor progress • Use touch • Encouraged control breathing • Pain meds

  9. Comfort Measures • Encourage ambulation, sitting in chair. • Use pillows, wear socks. • Keep linen clean, pericare. • Void frequently • Anxiety- mod. increases coping ability • Anticipatory patient education • Touch, distraction as relaxation techniques

  10. Breathing Techniques • Three levels of breathing • Patterned rhythmic breathing for control, relaxation and oxygenation • Hyperventilation-paper bag • Experience tingling and spasms • Encourage to pace breathing

  11. Care in First Stage • Latent- V/S, temp q 4 hrs. ice chips and food okay • Active- V/S every hr for low risk, 30 min high risk • L lat, pericare, assess fluid, prolapsed cord • Transition- V/S q 30 minutes, need assurance, recognize pushing

  12. Second Stage • V/S q 5-15 min. • Pushing • Rectal pressure indicates urge to push • Use pillows, squatting bars, side lying • Use of natural urge to push • Cool cloths, ice, loss of modesty

  13. Newborn Care • To warmer or Mom, keep tendelenburg • Keep dry- keep newborn exposed to radiant heat • Suction • Give Apgar score • 7 or below give 10 minute • Cord clamp- can be removed in 24 hrs.

  14. Newborn Evaluation • Respirations • Pulse • Temperature • Skin color • Cord • EGA • Creases • Apply tags

  15. Delivery of Placenta • 30 minutes to deliver • Uterus rises • Cord lengthens • Spurt of blood • Uterus gets round • Give pitocin after delivey

  16. Recovery Period • Assess fundus, s/s of hemorrhage, observe closely • B/P q 5-15 min • Temp • Bladder • Perineum • Give food and water if stable

  17. Attachment • Promote attachment by early contact • Quiet and alert during first hour • Encourage breastfeeding • Darken room • Touch and inspect baby • Respect parental wishes

  18. Precipitous Delivery • Remain calm • Get vag pack • Apply gentle pressure, don’t let head “pop” • Support perineum • Check for cord • Suction mouth and nose • Gentle downward traction • Cut cord

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