Oxytocin: Nursing Considerations (intrapartum)
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- Assess FHR for at least 20 minutes before induction to identify reassuring
or nonreassuring patterns
- Perform Leopold's maneuvers, vaginal exam, or both to determine fetal
presentation
- If nonreassuring FHR patterns are identified or if fetal presentation is
other than cephalic, notify physician and do not begin induction until
ultrasound is done
- Observe uterine activity of effective labor pattern: contraction frequency
every 2-3 minutes duration on 40-90 seconds
- Observe for hyperon uterine activity: contractions less than 2 minutes
apart or more than 5 contractions within 10 minutes with rest internals
shorter than 30 seconds or longer than 90-120 seconds
- Observe for nonreassuring patterns such as tachycardia, bradycardia,
decreased variability and late decels
o If nonreassuring pattern occurs, stop infusion
,Cardiovascular Adaptations: Ductus Venosus
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§ Oxygenated blood enters fetal circulation through the umbilical vein. A
third of the blood is directed away from the liver and into the ductus
venosus, this connects to the inferior vena cava
Internal Fetal Monitoring: Fetal Scalp Electrode
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- Detects electrical signals from fetal heart. Avoid placing on fetal face,
fontanels, and genitals
Internal Fetal Monitoring: Intrauterine Pressure Catheter
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- Measures uterine activity including contraction intensity and resting tone.
Measured using two types:
o A solid catheter with a pressure transducer in tip
o A hollow fluid-filled catheter that connects to a pressure transducer on
bedside monitor
Behavioral stages: Quiet Alert State
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, - This state is an excellent time to increase bonding. Infants focus on
objects or people and seem bright and interested in their surroundings.
Respond to stimuli and interaction with others. Body movements are
minimal as they seem to concentrate on the environment.
mechanisms: 3) flexion
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The fetal head flexes so the smallest part passes through the pelvis
Newborn: Initiation of Respiration: Sensory Factors
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§ Tactile stimuli aids in initiating respirations
Vitamin K (Phytonadione)- AquaMEPHYTON, Konakion, Mephyton
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, Classification- antihemorrhagic, fat-soluble vitamin
Indications- Prevention and treatment of vitamin K deficiency bleeding and
hemorrhaging in the newborn.
Neonatal dosage/route- Given IM in Vastus Lateralis, 5/8” needle and 25
gauge. 0.5-1 mg (0.25-0.5 mL solution containing 1mg/0.5mL) given one
hour after birth or after first breastfeeding for prophylaxis.
Adverse reactions- Erythema, pain, and edema at injection site. Hemolysis
or hyperbilirubinemia in a preterm infant.
Nursing Considerations- Protect drug from light until just before
administration, observe infant for signs of vitamin K deficiency, ecchymosis
or bleeding. Make sure infant is given vitamin K before circumcision
procedure, monitor coagulation factors.
Contraindications- hypersensitivity or intolerance to benzyl alcohol, use
cautiously in use of injection formulations containing benzyl alcohol which
may lead to “gasping syndrome” in the newborn.
Teaching- report any unusual bleeding or bruising, notify HCP of any OTC,
Rx, vitamin, or herbal supplements that the mother takes
Expected outcomes- Prevention of hemorrhagic diseases in the newborn
Internal Fetal Monitoring
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- Requires rupture of membranes and approximately 2 cm cervical dilation.
More accurate than external monitoring
- Slight increase in the risk for infection
Thermoregulation: Hazards of Cold Stress
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- Increased oxygen need
- Decreased surfactant production
- Respiratory distress
- Hypoglycemia
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- Assess FHR for at least 20 minutes before induction to identify reassuring
or nonreassuring patterns
- Perform Leopold's maneuvers, vaginal exam, or both to determine fetal
presentation
- If nonreassuring FHR patterns are identified or if fetal presentation is
other than cephalic, notify physician and do not begin induction until
ultrasound is done
- Observe uterine activity of effective labor pattern: contraction frequency
every 2-3 minutes duration on 40-90 seconds
- Observe for hyperon uterine activity: contractions less than 2 minutes
apart or more than 5 contractions within 10 minutes with rest internals
shorter than 30 seconds or longer than 90-120 seconds
- Observe for nonreassuring patterns such as tachycardia, bradycardia,
decreased variability and late decels
o If nonreassuring pattern occurs, stop infusion
,Cardiovascular Adaptations: Ductus Venosus
Give this one a try later!
§ Oxygenated blood enters fetal circulation through the umbilical vein. A
third of the blood is directed away from the liver and into the ductus
venosus, this connects to the inferior vena cava
Internal Fetal Monitoring: Fetal Scalp Electrode
Give this one a try later!
- Detects electrical signals from fetal heart. Avoid placing on fetal face,
fontanels, and genitals
Internal Fetal Monitoring: Intrauterine Pressure Catheter
Give this one a try later!
- Measures uterine activity including contraction intensity and resting tone.
Measured using two types:
o A solid catheter with a pressure transducer in tip
o A hollow fluid-filled catheter that connects to a pressure transducer on
bedside monitor
Behavioral stages: Quiet Alert State
Give this one a try later!
, - This state is an excellent time to increase bonding. Infants focus on
objects or people and seem bright and interested in their surroundings.
Respond to stimuli and interaction with others. Body movements are
minimal as they seem to concentrate on the environment.
mechanisms: 3) flexion
Give this one a try later!
The fetal head flexes so the smallest part passes through the pelvis
Newborn: Initiation of Respiration: Sensory Factors
Give this one a try later!
§ Tactile stimuli aids in initiating respirations
Vitamin K (Phytonadione)- AquaMEPHYTON, Konakion, Mephyton
Give this one a try later!
, Classification- antihemorrhagic, fat-soluble vitamin
Indications- Prevention and treatment of vitamin K deficiency bleeding and
hemorrhaging in the newborn.
Neonatal dosage/route- Given IM in Vastus Lateralis, 5/8” needle and 25
gauge. 0.5-1 mg (0.25-0.5 mL solution containing 1mg/0.5mL) given one
hour after birth or after first breastfeeding for prophylaxis.
Adverse reactions- Erythema, pain, and edema at injection site. Hemolysis
or hyperbilirubinemia in a preterm infant.
Nursing Considerations- Protect drug from light until just before
administration, observe infant for signs of vitamin K deficiency, ecchymosis
or bleeding. Make sure infant is given vitamin K before circumcision
procedure, monitor coagulation factors.
Contraindications- hypersensitivity or intolerance to benzyl alcohol, use
cautiously in use of injection formulations containing benzyl alcohol which
may lead to “gasping syndrome” in the newborn.
Teaching- report any unusual bleeding or bruising, notify HCP of any OTC,
Rx, vitamin, or herbal supplements that the mother takes
Expected outcomes- Prevention of hemorrhagic diseases in the newborn
Internal Fetal Monitoring
Give this one a try later!
- Requires rupture of membranes and approximately 2 cm cervical dilation.
More accurate than external monitoring
- Slight increase in the risk for infection
Thermoregulation: Hazards of Cold Stress
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- Increased oxygen need
- Decreased surfactant production
- Respiratory distress
- Hypoglycemia
