prof.carole a. devine rn.msn.1 the process of birth
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Prof.Carole A. Devine RN.MSN.3 Immediate Care of the Newborn Assessments: Vital Signs /Color of Infant Apgar Scores Check Cord Assess Infant Weight Assess U/A and G.I. SystemsTRANSCRIPT
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Prof.Carole A. Devine RN.MSN. 1
The Process of Birth
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Prof.Carole A. Devine RN.MSN. 2
Assessment And Responsibilities During Labor and BirthGoal of Care: To provide for a safe
labor and birth of a healthy baby and to promote maternal comfort in the process…..
1. Comfort Measures: 2. Physical Needs: 3. When to call the Physician Responsibilities of the
Attendants at the Birth
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Prof.Carole A. Devine RN.MSN. 3
Immediate Care of the Newborn
Assessments: Vital Signs /Color of Infant Apgar Scores Check Cord Assess Infant Weight Assess U/A and G.I. Systems
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Prof.Carole A. Devine RN.MSN. 4
Assessments (Cont.)
Protect against infection
Identification of Infant
Prevent hypothermia
Promote parental attachment
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Prof.Carole A. Devine RN.MSN. 5
Managing the Pain of Labor and Delivery
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Prof.Carole A. Devine RN.MSN. 6
Labor Pain-Introduction Historical Perspective
Management Strategies:
1.Non- Pharmaceutical Measures 2. Pharmaceutical Choices
The Challenge to Nurses!
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Prof.Carole A. Devine RN.MSN. 7
What Exactly is Labor
Pain ????
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Prof.Carole A. Devine RN.MSN. 8
Factors Affecting The Factors Affecting The Woman in LaborWoman in Labor1.Parity& Age2.Racial/Cultural3.Coping
Strategies4.Relaxation
Measures5.Emotional/
Attitude6.Knowledge base
7.Confidence level8.Support Systems9. Environment10.Fatigue/length
of labor11.N/V & Diarrhea12. Maternal &
Fetal Positions13.Pain Level
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Prof.Carole A. Devine RN.MSN. 9
Non-Pharmacologic Methods of Pain Relief
Hydrotherapy Application of heat
/cold Acupressure Imagery/Visualization Effleurage Comfort Measures Distraction Breathing
Techniques
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Prof.Carole A. Devine RN.MSN. 10
Pharmacological Methods of Pain Relief
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Prof.Carole A. Devine RN.MSN. 11
Goal of Administering Systemic Medication:
Three Factors to be Considered in the use of Systemic Medication
1.Effect on The Mother
2. Effect on the Fetus
3. Effect on Labor contractions
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Prof.Carole A. Devine RN.MSN. 12
Analgesia/Anesthesia
Analgesics: (Opioids,Tranquilizers &Sedatives) Common Ones: Demerol Stadol Nubain Fentanyl Morphine
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Prof.Carole A. Devine RN.MSN. 13
Demerol (Meperidine) Action: Usual dose: Pros : Cons: Maternal Cons: Neonatal
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Prof.Carole A. Devine RN.MSN. 14
Stadol (Butorphanal) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal
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Prof.Carole A. Devine RN.MSN. 15
Nubain (Nalbuphine) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal
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Prof.Carole A. Devine RN.MSN. 16
Fentanyl (Sublimaze) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal
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Prof.Carole A. Devine RN.MSN. 17
Morphine (Duromorph) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal
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Prof.Carole A. Devine RN.MSN. 18
Nursing Considerations with Opioids:
Opioid Antagonist NALOXONE (Narcan) Reverses opioid induced
Resp.Depression Dose: Neonate: 0.01mg/Kg IV,IM
or SC q 2-3min. Mother: 0.1-0.2mg IVQ 2-3min Have Crash Cart Handy!!!!
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Prof.Carole A. Devine RN.MSN. 19
Anesthesia 1. Local Infiltration:
2.Regional:
Pudendal Block
Epidural Block Goal Procedure Complications 1. Maternal
2 .Neonatal
Nursing Considerations
Advantages vs Disadvantages
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Prof.Carole A. Devine RN.MSN. 20
Spinal Block (Subarachnoid)
Intrathecal)
Goal Procedure Pros: Complications: Nursing
Responsibilities/Considerations
General Anesthesia
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Prof.Carole A. Devine RN.MSN. 21
Fetal Response to Labor Intrapartal Fetal Assessment:
Electric Fetal Monitor ( EFM) Purpose Factors that Impact Fetal Oxygenation
1. Maternal Bld. O2 Saturation 2. Normal flow of oxygenated bld. thru the Placenta3. Normal Utero-Placental exchange4. Patent umbilical cord vessels (AVA)5. Normal Fetal circulation and oxygen-carrying
function
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Prof.Carole A. Devine RN.MSN. 22
Types of Intrapartal Fetal Assessments 1. Low -Tech Approach 2. EFM a. Equipment: 1. External ( Indirect)Uses two Transducers: Pressure and
ultrasound 2. Internal (Direct )Uses a Fetal Scalp Electrode
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Prof.Carole A. Devine RN.MSN. 23
Evaluating Fetal Monitoring Strips Fetal Heart Rate: Baseline Tachycardia Causes: Bradycardia Causes: Variability Presence of Periodic Changes: Accelerations? Decelerations?
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Prof.Carole A. Devine RN.MSN. 24
Decelerations/Types: Early,Late or VariableEarly
Decelerations: Characteristics: Pattern: Cause: Rx:
Late Decelerations: Characteristics: Pattern: Cause: Rx:
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Prof.Carole A. Devine RN.MSN. 25
Variable Decelerations: Characteristics: Pattern: Cause Treatment: AN OMINOUS SIGN- LATE DECELERATION and
DECREASED VARIABILITY OF FETAL HEART RATE!!!!
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Prof.Carole A. Devine RN.MSN. 26
Significance of Fetal Heart Patterns:”Reasssuring”vs. “Non-Reassuring” Reassuring Patterns of FHR 1. Show signs of fetal well being 2. Fetus is compensating Non-Reassuring Patterns of FHR 1. Associated with Hypoxia and
Acidosis 2. Suggest some level of Fetal
compromise !
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Prof.Carole A. Devine RN.MSN. 27
THE END
GOOD LUCK To All Of YOU !!!!!