Week 10

17問 • 1年前

問題一覧

• Intrapartal care • Full dilatation and cervical effacement to birth of an infant

SECOND STAGE

(De-F-IR-E-R-ER-E) 1. _____ - fetal head enters the maternal inlet in the occiput transverse or oblique position 2. Flexion- fetal chin flexes downward onto the chest. 3. _____ - Occiput usually rotated from left to right and the sagittal suture aligns in the anteroposterior pelvic diameter. 4. _____- head is born in extension as the occiput slides under the symphysis pubis. 5. _____- once the head is born and free from pelvic resistance, the neck untwists, turning the head to one side and aligns with the position of the back of the birth canal. 6. ______- head rotates back to the diagonal or transverse position. This brings the shoulders into an anteroposterior position. 7. ______ - Anterior and posterior shoulders are born, quickly followed by the rest of the body

1. Descent 2. Flexion 3. Internal rotation 4. Extension 5. Restitution 6. External rotation 7. Expulsion

DOC: Nalbuphin HCI (nubain) /Meperidine • Demerol - given 2 to 3 hours before delivery (time to reach fetal blood) WOF: respiratory depression Contraindicated: Pre-term labor due to immaturities of fetus Antidote: Naloxone

Analgesic

2. ______ - Pudendal block for episiotomy ______ - side lying position WOF Hypotension; Give: Ephedrine, side-lying, 02 and fluids, (+) leg compression _____ - sitting with back arch WOF Headache, hypotension - same management but flat on bed for 10-12 hours (X) pillow

1.Anesthesia 2. Epidural 3. Spinal

- the placental stage - Placental separation/expulsion/delivery - Begins with the birth of the infant and ends with the delivery of the placenta

THIRD STAGE

Sudden gush of blood from the vagina Lengthening of the umbilical cord Calkin's sign: change in uterus shape Firm contraction of uterus Appearance of the placenta at the vaginal opening

Placental separation

Placental expulsion/ delivery Techniques used to facilitate delivery: • _________: placing fingers of one hand at lower uterine segment and uterus is pushed upwards in to the abdomen at the same time maintaining gentle traction on clamped umbilical cord • ________ - gentle pressure is applied on the fundus of the contracted uterus, separated placenta is pushed downward to the vagina. Uterine fundus is grasped with 4 fingers at the back and the thumb anteriorly • _________ - placenta separates from the inside to the outer margins, and itis delivered with the fetal side presenting first and most common method of placental expulsion

• Brandt-andrews • Modified crede's • Schultze

Presentation 1. Shiny = _____ - side: fetal; separation: center 2. Dirty = _____ - side: maternal; separation: edges

1.Schultze 2. Duncan

Placental Examination No indention = complete __ - ___ cotyledons

15 - 20 cotyledons

BP Degrees of perineal lacerations • __ degree- limited to the fourchette and superficial perineal skin or vaginal mucosa • __ degree- beyond fourchette, perineal skin and vaginal mucosa to perineal muscles and fascia, but not the anal sphincter •__ stage- fourchette, perineal skin, vaginal mucosa, muscles, and anal sphincter are torn • __ degree-fourchette, perineal skin, vaginal mucosa, muscles, anal sphincter, and rectal mucosa are torn.

• Ist degree- • 2nd degree •3rd stage •4th degree

Third Stage Nursing Responsibilities:

1. Placental delivery may take 5 to 10 minutes (maximum 20 minutes). Either by Duncan (dirty presentation of uterus) or Schultze (shiny and glistering). 2. Evaluate placental completeness (up to 30 cotyledons, weighing about 400 to 600 grams (1lb) and is 1/6 of fetal weight. 3. Observe for signs of placental separation (appear 5 mins after birth) 4. Palpate uterus for ballooning 5. Vagina and cervix are inspected for lacerations and any necessary repairs are made, take BP Degrees of perineal lacerations 6. Give oxytocin as ordered. Oxytocin (Pitocin) 10-20 u may be added to an IV infusion or 10 units IM • Assess and record BP before and after administration of oxytocin and assess the amount of bleeding

- 6 weeks after childbirth; mother's reproductive organ returns to normal prepregnancy state

FOURTH STAGE

Fourth Stage Nursing Responsibilities:

1. Places clean absorbent pad beneath her and apply maternity pads. 3. Apply cold pack over the perineum 4. Palpate uterus q15 for first 1-2 hrs. Monitor VS q15. 5. Inspect the lochia 6. A heated bath blanket/warm drink 7. Encourage to rest 8. Systemic medications

Duration: 1 - 3 days Feature: FOCUS: self Passive dependent Management: FOCUS: mother Assist with ADL's

Taking in

Duration : 4- 10 days Feature: FOCUS: baby Readiness to learn Management: FOCUS: NB teaching (BF and cord care)

Taking hold

Duration: >10 days Feature: FOCUS: New Role Management: Support guidance, Family planning

letting-go

1. ______ Postpartum blues: 50%-85% Postpartum depression: 10%-15% Postpartum psychosis: 0.1%-0.2% 2. _____ Postpartum blues: 2-3 days, resolves within 10 Postpartum depression: 2 weeks to 12 months Postpartum psychosis: Variable (typically 4-6 weeks postpartum)

1.Incidence 2.Duration

Latin Abbreviations

JULLIANNE DANDAN · 43問 · 2年前

Latin Abbreviations