Labor Delivery Newborn

Gravida- number of pregnancy regardless of the outcome of pregnancy Nulli Gravida- never been pregnant st

MEDICATIONS: HNBB- Hyoscine Butyl Bromide (amp)

Primi Gravida- 1 time pregnancy

-soften the cervix

Multi Gravida- 2 or more pregnancies

EVEPRIM- soft gel tab

Para- number of deliveries that reach the age of  delivery

OXYTOCIN- uterine contraction

Term infant- 38-42 weeks of gestation

-mixed with the IVF

Preterm- less than 38 weeks

3. TRANSITION PHASE- 1-2 minutes 45-60 seconds

Post term- more than 42 weeks

- Strong contractions

Still birth- baby born without signs of life

7-10cm with bloody blood y show, show, highly emotional, leg tremors, nausea, vomiting, feeling of natatae of natatae

IUFD- intra uterine Fetal Death SGA- small for gestational age

- less than 2.5Kg birth weight

EPISIOTOMY- cutting of hymen

LGA- Large for gestational age

CROWNING- can see the head of the baby

-more than 4Kg birth weight PRIMI SET: 1ST STAGE OF LABOR 

2 kelly pads

-Assessment is on Cervix.

 Needle holder 

-Cervical stage- true labor contraction (naninigas  yung tiyan, tumitigas ang uterus)

Mayo scissors 2 Gauze Cotton balls with betadine

3 PHASES

3cc syringe

1. LATENT PHASE- Mild to moderate contraction

Suture Lidocaine

- Pain tolerated, cervix dilated from 0-3cm - Still able to follow instructions

2. ACTIVE PHASE- 4-7cm dilated cervix with  bloody show

2ND STAGE OF LABOR 

-expulsive stage - full cervical dilation (10cm- birth of baby)

-moderate to strong contraction -membrane may rapture (Amniotic Fluid)

CHARACTERISTICS:

-advice patient to push during contraction

Ø bulging

- IVF of 10gtts/min

Øleg

Painless Delivery- less pain on normal delivery

Ø pushing

of Perineum

cramps with contraction

Zero station- ischeal spine (head of baby) ( - ) station- above the ischeal spine

SIGNS OF PLACENTAL SEPARATION

(+) station- below ischeal spine

1. uterus moves upward

+1- fetal stage

2. uterus is globular in shape

+2- fetus engages

3. lengthening of the cord

+3- Perineum

4. sudden gush of fluid or blood

MECHANISM OF LABOR:

Medications given:

1. Engagement

1. Methergin and oxytocin- uterine contraction

2. Internal Rotation- head reaches ischeal spine

2. oxytocinase- for inhibition of smooth muscles

3. Extension- head extends

3. Progesterone- relaxes the smooth muscles

4. External Rotation- head comes out 5. Expulsion

ADMITION OF MOTHER 

1. orient to unit NURSING INTERVENTIONS

2. obtain history

1. prepare mother to D.R 

GTPAL

2. transfer to D.R 

Gravida

3. Prepare D.R table, instruments

Term

4. legs of mother positioned simultaneously

Abortion

5. monitor fetal heart rate

Live birth

6. prepare mother for birth Øexpected

STAGES OF LABOR 

date of birth (EDB) due date

-ask for last menstrual period

1. Cervical stage

January- March LPM+9+7+0

2. Full dilation

April- December LMP-3+7+1

3. delivery of baby

Østatus

4. delivery of placenta

More than 1000mL- Polyhydramnios

of membrane (1000mL)

Less than 1000mLTYPES OF PELVIS

Øthese

may cause congenital effect

1. Gynecoid

Øallergies

2. Android

Ø breast

3. Anthropoid

Ø prenatal

4. Plathyteroid

feeding care

3. Obtain vital signs

Assess body fluids

4. perform Leopold’s maneuver 

> Monitor abnormal signs

5. time and assessment

1. prolonged strong contractions

6. assist in vaginal exam

2. board like abdomen

7. collect blood (CBC) and urine

3. increase in pulse rate (infection) 4. hypertension (preeclamsia)

Precipitate delivery- delivery outside the D.R  Ømaintain Ømonitor

aseptic technique

the following:

5. bright red vaginal bleeding (placenta previa) >NPO Post partum

a. frequency- beginning of contraction to the beginning of next contraction

1. check uterus- must be contaminated and firm

 b. interval- end of contraction to  beginning of contraction

2. check vital signs for baseline for HPT

c. duration- beginning of contraction to end of same contraction d. intensity- strength of uterine contraction

3. assess for PV loss 4. Assess 2 arteries, 1 umbilical vein, and umbilical cord. 5. check bladder and bowel movements 6. check baby interaction (breast feeding)

3 characteristics: 1. Mild contraction- slight dense fundus

7. check incision site (episiotomy/ CS) 8. check immunization of baby (BCG, Vit K)

2. Moderate contraction- firm fundus 3. Strong contraction- rigid boardlike fundus, and cannot be indented

OB WARD CHECKING (2 ND DAY)

1. Lochia/ rubia 2. serosa

Ømonitor

fetal heart rate - 120-160 bpm (normal)

Øinterpret

3. alba

data of fetal heart rate

If it is tachycardia- maternal fever  -dehydration

NEWBORN CARE ASSESS:

-drugs

1. ABC’s

Amnionitis- infection of amniotic fluid

2. Apgar scoring- to determine if the baby is well or not

If it is bradycardia- less than 110 bpm -fetal hypoxia (anesthesia) -maternal hypotension -prolonged umbilical cord compression -give analgesic for pain

3. Characteristic of cry. The cry of baby is the tool for communication with baby to know if the baby is well or not 4. monitor nasal flaring for abnormal respiration 5. obtain vital signs

6. signs of hypothermia- the client has sepsis or infection 7. check anomalies

Normal values:

1. length- 45-55 2. weight- 5.5-9.5kg

IMPLEMENTATION

1. prevent aspiration of secretion (trendelenburg)

3. chest circumference- 30-33cm 4. head circumference- 33-35.5cm

2. bulb syringe for suctioning

French 8 catheter  1. mouth

Fontanel- (anterior and posterior fontanels) ossified membranous tissue at the junction of  sutures. ØPosterior

fontanel is 0.5-1cm wide. It closes nd rd 2. rub back of baby or hit the soles of the foot during the 2 -3 month of the baby. 3. secure the tag of client and bring baby to ØAnterior fontanel is 2-3cm and closes during 1218mos. cord dressing room 4. get measurement, weight, height etc 5. Bathe the baby- clean the baby with luke warm water. If the baby still has vernix casosa, (cheesy white secretion) use baby oil to remove. Pinch ears to prevent otitis

Caput succedaneum- edema soft tissue over the  bone crosses suture Cephal hematoma- swelling caused by bleeding  between areas

Clamping- clamp 1in above the umbilical cord

Lanugo- tiny hair of the body (balbon)

Cutting- cut 1in above the clamp

Milla- white spots Dry pealing skin- cyanosis with hypothermia

Contents of the umbilical cord:

1. arteries (2)

Petechiae- red spots Echymosis- bluish violet

2. vein (1)

Øopthalmic

neonatorum- prophylactic treatment Meds given: if the mother has gonorrhea 1. Vitamin K- 0.1ml, on the middle 3rd of the Øget temperature via rectal 2-3 mins. To check the vastus lateralis of the left thigh (for blood  patency of the anus. clotting)

2. Hepatitis B- 0.5 at the right thigh APGAR SCORING

7-10- needs resuscitation 3-6- dry clean, provide oxygen 0-2- intensive resuscitation, use of ambubag, ventilate 100% oxygen, 40-60 bpm, full cpr