maternity-and-pediatric-nursing summary

Key Terms Related to Fetal Heart Rate • Accelerations • Baseline fetal heart rate • Baseline variability • Deceleration • Electronic fetal monitoring • Periodic baseline changes Nursing Management of Laboring Women • Assessment • Comfort measures • Emotional support • Information and instruction • Advocacy • Support for the partner Maternal Assessment During Labor and Birth • Maternal status (vital signs, pain, prenatal record review) § Vaginal examination ¨ The recommendation is to do digital vaginal examinations at intervals of 4 hr. for routine assessment and identification of a delay in active labor ¨ Prepare the woman by informing her about the procedure o Cervical dilation and effacement à key assessment of vaginal examination, subjective ¨ The width of the cervical opening determines dilation and the length of the cervix assesses effacement ¨ The information yielded by this examination serves as a basis for determining the stage of labor the woman is in o Fetal descent (station) and presentation ¨ If progressive fetal descent does not occur, a disproportion between the maternal pelvis and the fetus might exist and needs to be investigated o Membrane status ¨ To determine the integrity of the membranes ¨ If intact, it will be felt as a soft bulge that is more prominent during a contraction ¨ If ruptured, the woman may report a sudden gush of fluid but it may also occur as a slow trickle of fluid § Rupture of membranes ¨ When rupture, the priority focus is assessing the FHR first to identify a deceleration, which may indicate cord compression secondary to cord prolapse ¨ If rupture when admitted to the hospital, ask when it happened ¨ Prolonged rupture of membranes increase the risk of infection because of ascending vaginal organisms for the mother and fetus ¨ Be alert for s/s of intrauterine infection: maternal fever, fetal and maternal tachycardia, foul odor of vaginal discharge and an increase in WBC count Downloaded by Giselle Ramos () lOMoARcPSD| OB Exam 2 Intrapartum Susset H. Alcover ¨ Confirm rupture of membrane by taking a sample of fluid from the vagina via a Nitrazine tallow dye swab to determine the fluid’s pH à turns blue ¨ False positive can occur, especially when woman is experiencing a large amount of bloody show, because blood is alkaline ¨ If it remains yellow to olive green à the membranes are most likely to be intact ¨ If test is inconclusive, a fern test is done § Uterine contractions (see Figure 14.2) ¨ Primary power of labor ¨ Uterine contractions increase intrauterine pressure, causing tension on the cervix what leads to cervical dilation and thinning, which eventually forces the fetus through the birth canal ¨ To palpate for contraction intensity, place the pads of your fingers on the fundus and describe how it feels: o Forehead – strong o Nose – mild o Chin – moderate ¨ Second method is electronic monitoring either external or internal ¨ The external fetal monitor is sometimes used to estimate the intensity of uterine contractions – not an accurate assessment tool § Leopold’s maneuvers (see Nursing Procedure 14.1) ¨ Method for determining the presentation, position, and lie of the fetus using four specific steps ¨ Involves inspection and palpation of the maternal abdomen as a screening assessment for malpresentation – longitudinal lie is expected ¨ Each maneuver answers a question: o Maneuver 1: what fetal part is located at the fundus? o Maneuver 2: on which maternal side is the fetal back located? o Maneuver 3: what is the presenting part? o Maneuver 4: is the fetal head flexed and engaged in the pelvis? ¨ Note: If the hands move together easily, the fetal head is not descended into the woman’s pelvis inlet If the hands do not move together and stop because of resistance, the fetal head is engaged into the woman’s pelvic inlet Leopold’s Maneuver (SATA question on the exam or picture) - For determining fetal position and presentation 1. Leopold’s maneuvers for determining fetal position and presentation. B, Second maneuver: Moving the hands on the pelvis, palpate the abdomen with gentle but deep pressure. The Downloaded by Giselle Ramos () lOMoARcPSD| OB Exam 2 Intrapartum Susset H. Alcover fetal back, on one side of the abdomen, feels smooth, and the fetal extremities on the other side feel knobby. 2. Leopold’s maneuvers for determining fetal position and presentation. C, Third maneuver: Place one hand just above the symphysis. Note whether the part palpated feels like the fetal head or the breech and whether it is engaged – check to see if the head is floating or engaged 3. Leopold’s maneuvers for determining fetal position and presentation. D, Fourth maneuver: Facing the woman’s feet, place both hands on the lower abdomen and move hands gently down the sides of the uterus toward the pubis. Note the cephalic prominence or brow. • As the labor progresses, contractions increase in frequency, duration and strength • Primiparas take longer than multiparas