NUR 113: Intrapartum Care Notes
Amniotomy – a procedure that intentionally ruptures the amniotic sac to induce labor
o NOT delegated to UAP but can request the UAP to report pt observations for follow up
o Must review MD’s orders and obtain signed informed consent from pt
o Explain to the pt about the procedure - why it is necessary & how the pt can participate
*Assess fetal heart rate prior to, during, and following amniotomy because rupturing the amniotic
membranes changes the pressure inside the uterus and causes risk of a prolapsed cord
During procedure – IMPORTANT!
o Once the membranes are ruptured and fluid is seen – note the color, amount, odor, and
presence of meconium or blood
amniotic fluid should be clear or slightly cloudy & without any odor
meconium stained or bloody amniotic fluid places the fetus at risk for
complications
foul smelling fluid may indicate an infection
absent, decreased, or increased amounts of amniotic fluid may indicate fetal
stress
o Maternal temperature should be assessed every 2h or more frequently if febrile and/or
ordered
high temp might indicate intrauterine infection (chorioamnionitis)
Post-procedure: Document
, Epidural anesthesia – used to lessen sensation in the lower body by blocking nerve impulses from the
lower spine
o NOT delegated to the UAP but can request the UAP to report pt observations for follow
up
o Must review MD’s order and notify anesthesia personnel & obtain signed informed
consent from pt
o Explain about potential side effects (headache, hypotension)
Inform the pt that they should report the onset of a headache
Inform the pt of frequent blood pressure assessments
o Explain to the pt about the procedure - why it is necessary & how the pt can participate
During procedure – IMPORTANT!
o Obtain maternal baseline VS, fetal heart rate, and variability
o Administer an IV fluid bolus per facility policy before the epidural is begun to avoid
hypotension
o Assist and support the woman in position = side-lying with knees flexed or sitting up on
side of bed with back flexed
o BP, HR, and fetal HR are assessed before the test dose, every 5 min during the test dose
and at the end of the test dose
o Have ephedrine at bedside in case of hypotensive or fetal bradycardia episode
o Assess the bladder for distention every 30 min because a full bladder can slow the
descent of the fetus and risk damage to the bladder
o Change positions at least every hour to maximize uteroplacental blood flow, increase
circulation, promote comfort, and avoid a one-sided block
Post-procedure: Document
Amniotomy – a procedure that intentionally ruptures the amniotic sac to induce labor
o NOT delegated to UAP but can request the UAP to report pt observations for follow up
o Must review MD’s orders and obtain signed informed consent from pt
o Explain to the pt about the procedure - why it is necessary & how the pt can participate
*Assess fetal heart rate prior to, during, and following amniotomy because rupturing the amniotic
membranes changes the pressure inside the uterus and causes risk of a prolapsed cord
During procedure – IMPORTANT!
o Once the membranes are ruptured and fluid is seen – note the color, amount, odor, and
presence of meconium or blood
amniotic fluid should be clear or slightly cloudy & without any odor
meconium stained or bloody amniotic fluid places the fetus at risk for
complications
foul smelling fluid may indicate an infection
absent, decreased, or increased amounts of amniotic fluid may indicate fetal
stress
o Maternal temperature should be assessed every 2h or more frequently if febrile and/or
ordered
high temp might indicate intrauterine infection (chorioamnionitis)
Post-procedure: Document
, Epidural anesthesia – used to lessen sensation in the lower body by blocking nerve impulses from the
lower spine
o NOT delegated to the UAP but can request the UAP to report pt observations for follow
up
o Must review MD’s order and notify anesthesia personnel & obtain signed informed
consent from pt
o Explain about potential side effects (headache, hypotension)
Inform the pt that they should report the onset of a headache
Inform the pt of frequent blood pressure assessments
o Explain to the pt about the procedure - why it is necessary & how the pt can participate
During procedure – IMPORTANT!
o Obtain maternal baseline VS, fetal heart rate, and variability
o Administer an IV fluid bolus per facility policy before the epidural is begun to avoid
hypotension
o Assist and support the woman in position = side-lying with knees flexed or sitting up on
side of bed with back flexed
o BP, HR, and fetal HR are assessed before the test dose, every 5 min during the test dose
and at the end of the test dose
o Have ephedrine at bedside in case of hypotensive or fetal bradycardia episode
o Assess the bladder for distention every 30 min because a full bladder can slow the
descent of the fetus and risk damage to the bladder
o Change positions at least every hour to maximize uteroplacental blood flow, increase
circulation, promote comfort, and avoid a one-sided block
Post-procedure: Document
