Prof.Carole A. Devine RN.MSN.1 The Process of Birth.

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Presentation transcript:

Prof.Carole A. Devine RN.MSN.1 The Process of Birth

2 Assessment And Responsibilities During Labor and Birth Goal 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

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 Woman in Labor 1.Parity& Age 2.Racial/Cultural 3.Coping Strategies 4.Relaxation Measures 5.Emotional/ Attitude 6.Knowledge base 7.Confidence level 8.Support Systems 9. Environment 10.Fatigue/length of labor 11.N/V & Diarrhea 12. Maternal & Fetal Positions 13.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: mg 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 Placenta 3. Normal Utero-Placental exchange 4. 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 Variable Early 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 !!!!!