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Assessment of women during normal labor and delivery presented by miss:sara. Out line. Assess women during first stage Mechanism of labor. Assess woman during second stage Assess woman during third stage Assess woman during fourth stage . Objectives.
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Assessment of women during normal labor and deliverypresented by miss:sara
Out line • Assess women during first stage • Mechanism of labor. • Assess woman during second stage • Assess woman during third stage • Assess woman during fourth stage
Objectives At the end of this presentation the student able to • List and apply woman assessment during labor in all its stages. • Discuses the mechanism of labor.
assessment during labor • Maternal assessment • Fetal assessment • progress of labor assessment
First stage • Review mother’s profile for ( No of gravida and parous ,first day in LMP, EDD,GA .earlier and latest US ,and problem during pregnancy). • Ask mother about (starting time of labor pain ,its duration and its regularity , if there is PV discharge (show) or bleeding). • Take VS and compare with pregnant and prenatal level and reassess V/S every 2 hours .
First stage • Perform leopoled’s maneuver to determine fetal position, lie , and presentation. • Assess for peripheral edema and reflexes. • Administer enema ,bath is given and trimming of hair after enema if possible., encourage mother to void every 1 to 2 hours and palpate for bladder distention. • Apply external monitors (CTG) note fetal heart base line , variability, acceleration, deceleration with contraction, and reassess the FHR every 30 seconds. • Insert IV catheter , start hydration according to fetal and maternal condition Draw blood for (Hgb), (Hct), and type and X-matching. Obtain clean urine sample for protein, glucose ,and bacteria.
First stage • Assess UCs for regularity, intensity, and duration. • If no PV bleeding ,perform sterile vaginal examination to assess status of membranes, cervical dilatation, effacement, presenting part ,and station, and reassess every 2 hours. (technique) • Inspect the perineum on admission and the time of membranes ruptured , for visible cord in vagina.
First stage • Start partograph and nursing note. • Encourage a lateral or semi-fowler’s position but avoid the supine position. • During the latent phase , the women may be up and walking unless her membranes have ruptured and the fetal head is unengaged. • When the membranes ruptured spontaneously or artificially, note the time ,note the amount , note the color and odor of the fluid ; and assess FHR. • Prepare delivery kit (mother drape, two artery forceps, epsitomy scissors , umbilical cord scissors, metal bowel, sterile gauze………) • Check the suction system , prepare warmer cot for baby, and all immediate newborn care instrument • Administer analgesic drugs. …………………
First stage • Insert IV catheter , start hydration according to fetal and maternal condition. • Start partograph and nursing note. • Encourage a lateral or semi-fowler’s position but avoid the supine position. • During the latent phase , the women may be up and walking unless her membranes have ruptured and the fetal head is unengaged. • When the membranes ruptured spontaneously or artificially, note the time ,note the amount , note the color and odor of the fluid ; and assess FHR. • Prepare delivery kit (mother drape, two artery forceps, epsitomy scissors , umbilical cord scissors, metal bowel, sterile gauze………) • Check the suction system , prepare warmer cot for baby, and all immediate newborn care instrument • Administer analgesic drugs. …………………
Mechanism of labor External rotation
Second stage • Continues reassess the UCs, FHR, progress of labor. • Teach mother how to perform birthing exercise and how to make effective bushing. • Prepare the mother for labor (perennial care) . • Continuous assess the CTG and Partograph.
Second stage • Support perineum during crowning, place the figures lightly on the head t avoid rapid extension. • Apply episitomy if indicate. • Let the fetus’s head to rotate, and check if umbilical cord present around the neck of baby. (loss, tight). • Place the hand in each said of baby’s head, over ears, and gentile downward traction is applied to deliver the anterior shoulder, then gentle upward traction is applied to deliver posterior shoulder. • Inject 5 U of oxytocin IM after delivery of anterior shoulder. • cut umbilical cord. (technique).
Third stage • Delivery of placenta (technique) • Check placenta (technique) • Evacuate the uterus from the clots(technique) • Take cord blood sample (technique)
Fourth stage • Asses V/S every 15 m for one hour , then every 30 for one hour ,and then for 1 hour. • Assess fundal height, position, and its tone on same time as A/S. • Monitor amount of lochia, content, odor on same time as A/S. • Assess the perineum on same time as v/S • Palpate the bladder, encourage mother to void . • Massage the fundus if boggy, stop massaging if the uterus become firm (technique). • Encourage and assist with breast feeding as soon possible. • Monitor Hgb, Hct level. • Encourage the mother to void her bladder after the labor by 1 hour.
References • Text book for midwives , myles , 14 ED • Obstetrics illustrate, A.W.F Miller • Maternity nursing, Cairo 2001. • Nursing care plan of new born and maternaty. ……..
