Nursing Care During Labor

Nursing Care During Labor
Chapter 7 Nursing Care During Labor Review chapter objectives. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Birthing Centers and Nursing Care
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
Objectives Define key terms listed. Describe three variations in cultural practices. Compare alternative birth settings. Outline three nursing assessments and interventions during each stage of labor. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Birth Settings Traditional hospital Independent birthing centers Home birth services With alternative birth settings, the woman and her family have more control over the events surrounding the birth experiences. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

In-Hospital Birthing Rooms
Woman stays in the same room for labor, delivery, and recovery (LDR room) Some settings have woman stay in same room throughout entire stay; called LDRP—labor, delivery, recovery, postpartum Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Freestanding Centers Out-of-hospital birthing facilities Combine homelike environment with a short-stay, ambulatory health facility with access to in-hospital obstetric and newborn care Advantage over a home birth: this type of setting has quick access to a hospital Typically provide comprehensive prenatal, birth, and postpartum care Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Home Birth Community-based nurse-midwife usually manages home births Advantages Woman is in familiar, comfortable surroundings Less expensive Risks Lack of emergency equipment May be too far from hospital or medical care if complications arise Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Cultural Considerations
Modesty Pain Position Female care provider Support person Refer to Table 7-1 (pp ). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Pain Expressions vary based on cultural background Some women are stoic and silent to avoid bringing shame on the family Others are expressive and loud Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Cultural Sensitivity Will assist nurses in being nonjudgmental and less likely to impose their own values and beliefs on the women they care for Refer to Nursing Care Plan 7-1 (pp ). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

When to Go to the Hospital or Birth Center

Contractions Have a pattern of increasing frequency, duration, and intensity First child: comes when contractions have been regular (every 5 minutes) for 1 hour Second or later child: comes when contractions are regular and 10 minutes apart for 1 hour Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Other Reasons to Go to the Hospital
Ruptured membranes Bleeding other than bloody show (e.g., active bleeding that is not mixed with mucus) Decreased fetal movement Any other concern If woman states “something is different,” do not ignore her. Investigate! When does the nurse-patient relationship begin with a woman who suspects she is in labor? Answer: Upon first contact, whether by phone or face-to-face. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Preadmission Forms May have been completed before admission Prenatal record includes Nursing and medical parameters Laboratory results Nutritional guidance already provided Psychosocial and cultural factors, including birth plan, may also be included Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Care Plan Reflects Where the labor and delivery process will take place Degree to which the partner will participate Teaching aspects Incorporates what the woman can expect Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Data Collection and Admission Procedures
Three priority assessment questions should be completed when the woman is admitted to the labor and delivery unit What is the condition of the mother and fetus? Is the birth imminent? Does the labor appear to be uneventful? May be helpful to obtain various forms used at the clinical sites for students to review either in class or as part of their care planning process. Review Box 7-1 (p. 116). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

On Presentation to L&D Unit
Women who have had prenatal care and have preregistered will likely require verification of information, including recent clinical laboratory results Women who have not had prenatal care will require the nurse to obtain as much information as possible, depending on situation, and have clinical laboratory tests such as CBC, hematocrit, drug screen, STI, and others as indicated Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Nursing Care of the Woman in False Labor
Prodromal labor Helps prepare woman’s body and fetus for true labor Usually observed for 1 to 2 hours Fetal monitoring is performed Woman usually can walk about when not being monitored If it is true labor, walking often helps to intensify contractions and aids in cervical effacement and dilation Refer to Chapter 6, Table 6-1 (p. 99) and here in Chapter 7, Legal and Ethical Considerations—The Woman in False Labor (p. 116). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Factors to Consider with False Labor
Number and duration of previous labors Distance from the health care facility Availability of transportation Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Data Collection on Admission
What three priorities should the nurse’s data collection upon admission focus on? Condition of mother and fetus Whether birth is imminent Labor appears to be uneventful Discuss with the class what the nurse should do if one of these three indicate a problem. What nursing actions should be taken? Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Priority Assessment Questions
There are three priority assessment questions that should be answered when the woman is admitted to the labor and delivery unit. They are: 1. What is the condition of the mother and fetus? 2. Is the birth imminent? 3. Does the labor appear to be uneventful? Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Fetal Assessment and Monitoring

Objectives Compare external and internal fetal monitoring during labor. Compare the advantages and disadvantages of electronic fetal monitoring during labor. Describe the cleansing of the woman’s perineum in preparation for birth. Compare reassuring and nonreassuring fetal heart rates. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Objectives (cont.) Relate the nurse’s role in fetal monitoring. Describe the purpose of amnioinfusion. Discuss the role of the doula in the delivery room. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Focused Data Collection
First and Second Stages of Labor Priority assessments are performed to assess the condition of the woman and the fetus. They are related to the safety of the woman and fetus and need to be carried out in a consistent time frame. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Warning Signs: Potential Complications
Maternal fever greater than 38° C (100.4° F) Contractions lasting more than 90 seconds Contractions less than 2 minutes apart Meconium-stained amniotic fluid Foul-smelling vaginal discharge Excessive bleeding and hypotension Fetal bradycardia or tachycardia Loss of baseline variability on fetal monitor Fetal heart rate (FHR) <110 or >160 bpm Departures from normal should be documented and reported according to facility policy and protocols. Ask the class what each of the potential complications could indicate and what nursing responsibilities or interventions would be needed for each one. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Monitoring Fetal Heart Rate
Assess by auscultation if woman not on electronic fetal monitoring Best heard over fetal back FHR should be taken immediately after ROM FHR should also be taken after Vaginal examination Administration of medications Notation of abnormal fetal activity FHR—fetal heart rate ROM—rupture of membranes Review Figure 7-2 (p. 117) for the best locations for hearing fetal heart tones. Why is it important to assess FHR immediately after ROM? Answer: because any prolapse of the umbilical cord is likely to occur at this time. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

What are the advantages of continuously monitoring FHR?
Ask this question of the class. See if they can provide the correct answer. If not, see next slide. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Continuously Monitoring FHR
Continuously monitoring FHR allows the nurse to Evaluate FHR variability Identify abnormalities in FHR patterns So that appropriate interventions can be instituted in a timely manner. Review Skill 7-1 (p. 117) for auscultating fetal heart rate and Safety Alert—Nonreassuring Fetal Heart Rate (p. 121) for nursing interventions for nonreassuring fetal heart rate. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Signs of Fetal Distress
EFM signs to observe for and report, if they do not resolve after verifying placement of monitoring devices or repositioning woman, are A loss of baseline variability Variable or late decelerations that persist after maternal position change Persistent fetal tachycardia EFM—electronic fetal monitoring Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Other Signs of Fetal Distress
Meconium in amniotic fluid when fetus is in a vertex position Requires immediate reporting to health care provider Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Intermittent Fetal Heart Monitoring During Labor
Low-risk technology Intermittent auscultation with hand-held Doppler or fetoscope Assess at 15-minute intervals during first stage Assess at 5-minute intervals during second stage Refer to Box 7-2 (p. 118) and Skill 7-2 (p. 119). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Reassessment of FHR ROM Vaginal examination Ambulation (before and after) Change in infusion rate of oxytocin Administration of drugs (before and after) Urinary catheterization Expulsion of enema Recognition of abnormal uterine activity Decrease in fetal activity These assessments would also apply to continuous fetal monitoring. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Continuous EFM During Labor
Can detect changes in FHR May indicate inadequate oxygenation of fetus Allows for immediate interventions Provides visual display of FHR Uterine activity measured and displayed Can be electronically transmitted to monitors at nursing station so woman and fetus can be assessed even if nurse is not at bedside See Figure 7-4 (p. 120). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Documentation of EFM Some facilities still use paper to maintain medical records, whereas others now employ computerized charting called electronic medical record Regardless of method, the EFM tracings are part of the medical record and must be correctly labeled with the woman’s name, date of birth, date of admission, date of tracings They are a part of the permanent record and must be stored for a specific time by the hospital. See Figure 7-5 (p. 121). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Nurse’s Role in EFM Continually assesses whether the FHR pattern is Reassuring: reflects adequate fetal oxygenation Nonreassuring: reflects fetal distress Appropriate interventions must be taken Refer to Figure 7-6 (p. 121). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Monitor Strips It is important to document on the strip (or in the computer) each time anything is done, such as a vaginal examination, voiding, etc. This is important in the assessment of the tracing strips and provides permanent documentation of care provided Also important to record time EFM discontinued and restarted Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Emergency Interventions
Nonreassuring heart rate Administer oxygen to woman 8 to 10 L/min by face mask Turn woman to side-lying position Stop oxytocin infusion Keep IV line open Notify health care provider Review Evidence-Based Practice—External Fetal Monitoring (p. 122). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Types of Electronic Fetal Monitoring

External Fetal Monitoring
Ultrasound transducer and tocodynamometer to woman’s abdomen Secured with elastic strips, belts, or stockinette Sound waves are picked up by monitor Uterine contractions Can be monitored for frequency and duration Cannot be monitored for uterine intensity Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Internal Fetal Monitoring
Accuracy is main advantage Requires ruptured amniotic membranes Cervix must be dilated to at least 2 cm Spiral electrode is attached to fetal presenting part Pressure transducer introduced into uterine cavity Review Evidence-Based Practice—Internal Fetal Monitoring During Labor (p. 123). Review Table 7-3 (pp ). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Reassuring and Nonreassuring Fetal Heart Rate Patterns

The Normal Pattern Heart rate 110 to 160 beats/min Beat-to-beat variability between 6 and 25 beats/min No decelerations but may see accelerations Fetus born with normal reassuring heart rate pattern is virtually always normally oxygenated. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Accelerations Brief, temporary increases in FHR At least 15 beats/min above baseline Usually occur with fetal movements May also occur with Vaginal examinations Uterine contractions Fundal pressure Breech presentations Accelerations are a reassuring FHR pattern and a sign of well-being. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Early Deceleration Typically starts with contraction Ends when contraction is over Stays within normal range of FHR Produces a V-shaped pattern Common cause Compression of fetal head No intervention necessary Fetal head compression stimulates a vagal response of fetal parasympathetic nervous system. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Late Deceleration Usually begins at peak of contraction Ends after contraction has ended Often associated with uteroplacental insufficiency Depth and time it takes to return to baseline is important Persistence, or recurrence, usually indicates hypoxia (lack of oxygen to fetus) A drop of 30 beats/min or change in baseline variability is significant indicator of fetal distress Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Cause of Late Deceleration
Maternal hypotension Excessive uterine activity Deficient placental perfusion Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Repetitive Late Decelerations
Require immediate intervention Repositioning Administering oxygen Discontinuing oxytocin Increasing IV fluid Evaluating vital signs Prompt reporting to health care provider Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Variable Decelerations
Transient drop in FHR before, during, or after uterine contraction Related to brief compression of umbilical cord Decelerations are abrupt and often associated with accelerations before or after deceleration Rare association with hypoxia Requires change in position of woman If become more prolonged and repetitive, may indicate tight cord around fetal neck, which may require emergency cesarean birth. Variable decelerations occurring early in labor are often a result of what? Answer: oligohydramnios (decrease in amniotic fluid) Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Fetal Pulse Oximetry Value remains controversial Transcervical catheter is positioned against fetal cheek to measure oxygen saturation Amniotic membranes must have ruptured, cervix dilated to at least 2 cm, fetus in vertex presentation at the cervix Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Fetal Pulse Oximetry Readings
Normal term fetus during labor: 40% to 70% Levels less than 30% may indicate fetal metabolic acidosis Would indicate hypoxia and require rapid delivery of fetus Can be used to continue with labor and try to avoid cesarean birth, especially if nonreassuring FHR is present in term fetus Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Monitoring Uterine Contractions
20- to 30-minute baseline electronic monitoring of uterine contractions and FHR is usually performed Palpating contractions Nurse places fingertips on woman’s abdomen over uterine fundus Review Skill 7-4 (p. 127) for guidelines to assessment of contractions by palpation. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Determining Fetal Position by Abdominal Palpation
Leopold’s maneuvers May reveal if multifetal pregnancy exists (especially in woman without prenatal care) By doing this, can help locate best position for auscultating FHR See Skill 7-5 (p. 128). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Monitoring Status of Amniotic Fluid
If amniotic membrane is ruptured, assess for Time of rupture Color, amount, and odor Fluid that is clear and pale with little odor is normal Greenish suggests meconium Wine-colored indicates presence of blood with possible separation of placenta Foul or unpleasant odor indicates infection It is important for the nurse to document what is found. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Nitrazine Paper Test Test strip is sensitive to pH Turns deep blue if amniotic fluid is present Turns yellow if urine is present Review Skill 7-6 (p. 128) for testing for the presence of amniotic fluid (nitrazine paper test). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Ferning Characteristic pattern of crystallization in amniotic fluid when it dries Place fluid on glass slide, allow to dry, observe under microscope Urine and other vaginal discharge will not show this type of pattern Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Amnioinfusion Infusion of warmed normal saline or lactated Ringer’s solution into uterine cavity after amniotic membranes have ruptured Performed to Decrease compression of umbilical cord Increase fluid when oligohydramnios is present Dilute meconium in uterine cavity Decrease risk of fetus aspirating meconium Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Contraindications to Amnioinfusion
Prolapsed cord Vaginal bleeding Severe fetal distress Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Physical Care and Psychological Support During Labor and Birth

The Nurse’s Role Documents progress of labor Reports abnormal findings Provides measures of support, prevention of infection, and promotion of comfort See Health Promotion—Technology and the Nurse (p. 129). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Vaginal Examinations Performed with sterile gloves and a water-soluble lubricant Done to determine status of cervical dilation and effacement Contraindicated if vaginal bleeding is present Review Figure 7-9 (p. 131) related to vaginal examination; Evidence-Based Practice—Reassessment of Fetal Heart Rate (p. 129); and Evidence-based Practice—Using Infection Prevention and Control in Labor and Delivery (p. 129). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Documentation Vital signs every hour in latent phase and every 30 minutes in active phase of labor FHR patterns are monitored Contractions are monitored, and nurse documents in medical record the Frequency, intensity, and duration Intake and output Assess for urinary bladder distention. Some women may require catheterization to empty the bladder. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Supporting the Partner
Some truly coach and take the lead in helping woman cope with labor Others will assist if shown Some only want to provide encouragement and support, but nothing more Partners should be permitted to provide the type of support they’re comfortable with Should be encouraged to take a break Nurse remains available See Patient Teaching—Teaching the Father or Partner (p. 132). See Figure 7-10 (p. 132). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Doula A doula is a person other than a family member or friend who is trained to provide labor support May be hired by mother to provide labor support, guidance, and encouragement to mother Acts as an advocate for the family See Figure 7-11 (p. 132). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Psychological Support
Goal is to Make the labor and delivery process a more pleasant and satisfying experience Allow more family participation Refer to Table 7-4 (pp ) for woman’s response to each stage of labor and the nursing interventions for each stage. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Teaching Ongoing tasks of intrapartum nurse Positions or breathing techniques different from those learned in class may need to be taught to and tried by the laboring woman Encourage her to try a change in technique or position for 2 or 3 contractions before abandoning it for another Refer to Health Promotion—Changing Positions (p. 132). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Teaching (cont.) Avoid pushing before cervix is fully dilated Teach to blow out in short puffs when urge to push is strong If pushing done before dilation is complete, can cause Maternal exhaustion Fetal hypoxia Ultimately slows progress of laboring process Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Pushing Take deep breath and exhale it at beginning of each contraction Take another deep breath and push with abdominal muscles while exhaling Push for 4 to 6 seconds If woman is in semi-sitting position, encourage her to pull back on her knees, behind her thighs, or use the handholds on the bed. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Water Births Experimental procedure that requires signed, informed consent See Figure 7-12 (p. 133) for water birth, and review Table 7-5 (p. 133). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Discussion Question What are the routine auscultations and documentation of fetal heart rate during the following phases and stages of labor? Latent phase Active phase of first stage of labor Second stage of labor Latent is every hour Active in first stage is every 30 minutes after a contraction Second stage of labor is every 15 minutes Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Nursing Care During Labor and After Delivery

Objectives Explain the common nursing responsibilities during birth. Identify nursing priorities when assisting in an emergency (precip) delivery. List four items important to record about the infant’s birth. Discuss the immediate care of the newborn. Explain the reason the neonate requires administration of vitamin K at birth. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Objectives (cont.) Describe the nursing assessments important in the woman’s recovery period after birth. Illustrate two ways to encourage maternal-newborn bonding after birth. Discuss fetal pulse oximetry. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Provision of Care During the Four Stages of Labor

Signs of Impending Birth
Sitting on one buttock Making grunting sounds Involuntarily bearing down with contractions States “the baby is coming” Bulging of the perineum Do not leave woman alone; prepare for precipitate birth and summon help Review Box 7-3 (p. 133). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Birth of the Baby Cleansing breath before each contraction Keeps oxygen and carbon dioxide levels in balance Use open-glottis method for pushing After head delivered, woman is asked to stop pushing Baby’s nose and mouth are suctioned; health care provider checks baby’s neck to ensure nothing is wrapped around it Woman is asked to continue pushing, and rest of baby’s body is delivered. Newborn is quickly dried and, if all appears to be okay, baby is placed on mother’s abdomen and the umbilical cord is cut. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Nursing Care During Delivery
Once positioned for delivery, cleanse vulva and perineum Prepare delivery table Continue to monitor FHR every 5 to 15 minutes All health care team members don appropriate personal protective equipment Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Expulsion of Placenta Third stage of labor begins after birth of baby and ends with expulsion of placenta The uterus shrinks in size; the placenta does not Placenta insertion site buckles, and it separates as uterus contracts Usually takes place about 5 to 30 minutes after delivery Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Signs of Imminent Delivery of Placenta
Lengthening of umbilical cord Gush of blood from vagina May come after placenta delivered if fetal side of placenta is expelled first (Schultze mechanism) May come just before delivery of placenta if maternal side is expelled first (Duncan mechanism) Elevation of uterine fundus Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Immediate Recovery Period
Sometimes referred to as fourth stage of labor Physical recovery of mother Usually lasts between 1 and 4 hours Vital signs are monitored Location and firmness of uterine fundus Massage fundus and assess for amount and color of lochia Ice bag may need to be placed on perineum Assess for bladder distention This assessment is usually done every 15 minutes for 1 hour and then according to hospital protocol thereafter. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Third Stage of Labor Risks
Hemorrhage Therefore nursing assessment should include Amount of bleeding Blood pressure Pulse rate Oxytocin may be given to help control bleeding. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Phase 1: Immediate Care of the Newborn

Nursing Care of the Newborn in the Delivery Room
Divided into three phases Phase 1: birth to 1 hour of age Phase 2: 1 hour to 4 hours after birth Phase 3: from 4 hours after birth until discharge from hospital Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Phase 1 Care of the Newborn
Maintain thermoregulation Maintain cardiorespiratory function Identify mother, partner, and newborn Perform a brief assessment for anomalies Observe for and document passage of meconium and urine Facilitate parent-newborn bonding Initiate first breastfeeding Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Thermoregulation Hypothermia forces newborn to use glucose to warm body Hypoglycemia associated with development of neurologic problems Cold stress increases basal metabolic rate Results in an increased need for oxygen consumption; leads to hypoxia See Figure 7-16 (p. 139) on the newborn in a radiant warmer. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Cardiorespiratory Obligate nose breathers Bulb suctioning of mouth prevents aspiration of mucus and amniotic fluid Once in radiant warmer, apply heart monitoring leads If cyanotic, supplemental blow-by oxygen is given What is the most reliable indicator that resuscitation is needed? Answer: the heart rate below 100 beats/min. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Cyanotic Newborn If heart rate less than 100 beats/min Tactile stimulation is provided Suctioning Oxygen If cyanosis does not resolve quickly Bag and mask resuscitation may be needed Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Apgar Scoring System Numeric value (0, 1, 2) is given to Heart rate Respiratory effort Muscle tone Reflex irritability Color A score of 7 to 10 is a good score and indicates baby has a good cardiorespiratory function with minimal bulb suctioning needed. Scores less than 7 sometimes require transfer to the NICU for closer observation and/or more aggressive interventions. See Table 7-7 (p. 140) on Apgar and Box 7-5 (p. 140) on signs of respiratory distress. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Identification In delivery room Mother, newborn, and partner are all given ID bands that have the same number on them This band is checked whenever the baby is given to or taken from the mother, and at discharge Some facilities even have an alarm device attached to the bands to prevent infant abduction Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Other Nursing Interventions
Document first urine and passage of meconium Administer medications such as vitamin K (assist with blood clotting) and prophylactic eye ointment (to prevent ophthalmia neonatorum) Observe for abnormalities Promote infant-parent bonding See Skill 7-8 for intramuscular injection (p. 141), Skill 7-9 for prophylactic eye ointment (p. 142), and Figure 7-18 on parent bonding (p. 143). Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Umbilical Cord Blood Banking
Contains large amounts of stem cells that can help treat assorted diseases or conditions Requires informed consent of mother and special collection supplies Blood must arrive at storage center within 48 hours of collection Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Emergency Delivery by the Nurse
Called precipitate delivery Major nursing interventions include Remain calm and supportive Provide cleanliness as much as possible Control the birth of the baby Do not attempt to hold back the fetus’ head to prevent the delivery Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

Audience Response System Question 1
During the fourth stage of labor, the postpartum woman has a soft, boggy uterus. The nurse knows this is likely due to: Full bladder displacing uterine fundus Lochia flow needs 1 or more pads per hour Poorly contracted uterus Widening pulse rate and falling BP Answer: C. A soft, boggy uterus is caused by poor contractions; thus increasing risk of hemorrhage. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.

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