DR Power Point

8/8/2019 DR Power Point

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Delivery RoomDelivery RoomCare StudyCare StudyDelivery RoomDelivery RoomCare StudyCare Study

Group 31Group 31


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Pregnancy is the state of carrying a developingembryo or fetus within the female body. Thiscondition can be indicated by positive results onan over-the-counter urine test, and confirmedthrough a blood test, ultrasound, detection offetal heartbeat, or an X-ray. Pregnancy lasts forabout nine months, measured from the date ofthe woman's last menstrual period (LMP). It isconventionally divided into three trimesters, eachroughly three months long.


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Deliveryisthepassageof thefetusandplacenta(afterbirth)fromtheuterustotheoutsideworld.

Fordeliveryinahospital, awomanmaybemovedfromalaborroomtoabirthingordeliveryroom,

aroomusedonlyfordeliveries. Usually, thefather, partner, orothersupportpeopleareencouragedtoaccompanyher. IfsheisalreadyinanLDRP (forlabor, delivery, recovery, andpostpartum), sheremainsthere. Theintravenouslineremainsinplace.


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Deliveryof the Baby:As delivery progresses, the doctor ormidwife examines the vagina to determine the position ofthe fetus's head. When the cervix is fully open (dilated)

and thinned and pulled back (effaced), the woman is askedto bear down and push with each contraction to help movethe fetus's head down through her pelvis and to widen thevaginal opening so that more and more of the head appears.When more than 1 inch (3 to 4 centimeters) of the headappears, the doctor or midwife places a hand over thefetus's head during a contraction to control the fetus's

progress. As the head crowns (when the widest part of thehead passes through the vaginal opening), the head and chinare eased out of the vaginal opening to prevent the woman'stissues from tearing.

Vacuum extraction can be used to assist in delivery of the

head when the fetus is in distress or the woman is havingdifficulty pushing. Forceps are sometimes used for thesame reasons but are used less often than vacuumextractors.


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Episiotomy is an incision that widens the opening ofthe vagina to make delivery of a baby easier. It isno longer done routinely. It is used only whennecessary for immediate delivery. For thisprocedure, the doctor injects a local anestheticto numb the area and makes an incision in the areabetween the openings of the vagina and anus(called the perineum). If the muscle around theopening of the anus (rectal sphincter) is damaged

during an episiotomy or is torn during delivery, itusually heals well if the doctor repairs itimmediately.

After the baby's head has emerged, the body isrotated sideways so that the shoulders canemerge easily, one at a time. The rest of the baby

usually slips out quickly after the first shouldercomes out. Mucus and fluid are suctioned out ofthe baby's nose, mouth, and throat. The umbilicalcord is clamped and cut. The baby is then dried,wrapped in a lightweight blanket, and placed onthe woman's abdomen or in a warmed bassinet.


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Delivery of the Placenta:After delivery of thebaby, the doctor or midwife places a hand gentlyon the woman's abdomen to make sure the uterusis contracting. After delivery, the placenta usuallydetaches from the uterus within 3 to 10 minutes,and a gush of blood soon follows. Usually, thewoman can push the placenta out on her own. Ifshe cannot and particularly if she is bleedingexcessively, the doctor or midwife applies firmdownward pressure on the woman's abdomen,causing the placenta to detach from the uterusand come out. If the placenta has not been

delivered within 45 to 60 minutes of delivery, thedoctor or midwife may insert a hand into theuterus, separating the placenta from the uterusand removing it.


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PATIENTPROFILE (Mother)Patients Name: FACitizenship: FilipinoAge: 31Address: Serina st., Cagayan de Oro CityBirthday: October 13, 1977Religion: Roman Catholic

Occupation: HousewifeCivil Status: MarriedHeight: 5 feetWeight: 45 kg.

Vital SignsBlood Pressure: 130/90 mm HgRespiratory Rate: 30Pulse Rate: 80

Temperature: 36.5 C


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Obstetric History

Gravida: 5Parity: 5Number of Full Term Infants Born: 5Number of Preterm Infants Born: 0Abortion: 0Number of Living Children: 5Date of Delivery: April 21, 2009Time of Delivery: 1: 57 pmType of Delivery:(NSVD) Normal Spontaneous Vaginal DeliveryPlace of Delivery: JR Borja Hospital (City Hospital)Last Menstrual Period: July 10, 2008

Estimated date of Confinement: April 7, 2009Age of Gestation: 40 4/7 weeksFetal Presentation: Cephalic


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PATIENTPROFILE (Infant)

Patients Name: Baby GirlMothers Name: FACitizenship: FilipinoAge: NBAddress: Serina st., Cagayan de

Oro City

Birthday:A

pril 21, 2009Religion: Roman Catholic


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STAGES OF

LABOR/PHYSIOLOGYOFLABOR


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First StageThe first stage of labor is usually the longest part of labor where you

are having contractions and your cervix is dilating. This stage isbroken down into three phases. The early phase of labor is marked

by very light contractions that may be 20 minutes or more apart,gradually becoming closer, possibly up to five minutes apart. Thekey to this stage is to go about your normal schedule or if its themiddle of the night go back to bed! Most women will be verycomfortable during this stage and with a few exceptions thosehaving a hospital birth will not be in the hospital at this point.

The active phase of labor is where many women are getting seriousand withdrawing to do the hard work of labor. Contractions

generally are four or five minutes apart and may last up to 60seconds long. Remember this still gives you a big break in between.For women who desire medication in labor they will usually go tothe hospital in this stage of labor, while those desiring little or nomedications will go towards the end of this stage or the beginningof transition. Mobility and relaxation are the keys to gettingthrough active labor.

Later, your contractions may be two or three minutes apart, lasting upto a minute and a half. Some women will shake and may vomitduring this stage. This is normal. Remember that this stage usuallydoesnt last more than an hour or two. Partners, your support iscrucial here. Remind her how well she is doing, and help her find acomfortable position, use cold rags for her face and give her sipsof water or ice in between contractions.


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Second Stage

Pushing usually feels better for most women. They have spentthe first stage of labor relaxing and letting their body doall the work, now they can actually do something to help.This stage can last three or more hours, but for manywomen it will not. The length of this stage is dependentupon the positioning of the mother (upright = faster), thepositioning of the baby, whether medications have been

used, etc. The contractions will usually space out a bit, goingback to about four minutes apart. This stage ends with thebirth of your baby!

Now is the time to start your breathing exercises. Also, makea concerted effort to relax between contractions. This willbecome difficult yet important as the delivery proceeds.The most important aspect of this stage is to forget aboutthe fatigue, and stay focused on the wonderful end resultof this stage.


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Third StageAfter you are holding your beautiful baby, you may

be asked to push again at some point, and youmight be puzzled. This stage involves the passingof the placenta. Delivery of the placenta may takeanywhere from five minutes to thirty, but mostdeliver within a few minutes. Dont worry about it,

this is the time you can spend bonding with yournew little one.Fourth StagePostpartum is generally accepted as the fourth

stage of labor. Your body is going through many

changes now that the baby has been born. Not tomention the large changes your family is goingthrough adding a new person to your family. Besure to ask for help. Your body will slowly changeand become more like your pre-pregnancy self,

but not exactly.


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IDEALNURSING

CAREPLAN


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(Mother)

N

ursingDiagnosis:Painrelated toeffectsof uterine contractionand pressure ofpelvic structures.

Interventions Assesslevel of clientspainfrom uterine contractionsand

pelvic pressure Assessdegree of discomfort through verbal and nonverbalcues. Assesspersonal and cultural implicationsof pain.

Encourage client toassume different positionsand changethem regularly.

Assessforverbal and nonverbal indicatorsof painandevaluate response totechnique use

Respect the need forfocusingduringcontractions- refrainfrom interveningwith the client duringacontraction


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NursingDiagnosis:Powerlessnessrelated todurationand intensity of

labor

Interventions Assesspatient with usingcontrolled breathing

exercisesand positionchanges.

Slowly and clearly explainthe events and changesoccurringwith the active stage of labor Reassure, asappropriate, that laborisproceeding

without problems Emphasize positive aspectsof situationand what

canbe controlled Assesspatient forconditioningfactorsrelated tofeelingsof lost control.


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NursingDiagnosis:Fatigue related tooverwhelming

psychological emotional demandsandincreased energy requirements

Interventions

-Assessdegree of fatigue.-Keep client informed of progressof labor.-Provide comfort measures.-Encourage client toclose eyes, extend

legs, and relax betweencontractions.-Monitorurine forketones.


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(Newborn)

NursingDiagnosis:Ineffective airway clearance related topresence of mucusoramniotic fluid inairway

Intervention

Suctionoral prn. Monitorinfant forfeedingintolerance, abdominal distention

and emotional stressor Positionhead midline with flexionappropriate forcondition Auscultate chest forcharacterof breath soundsand

presence of secretions


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NursingDiagnosis:Body temperature risk foraltered

Intervention

Maintainambient temperature withinestablished thermoneutral (TNZ) consideringneonatesweight,gestational ageand usual clothingprovides.

Monitorneonatesaxillarysskin(abdominal)ortympanic andenvironmental temperature at least every 30-60 min. duringstabilizationperiod ormore frequently perprotocol.

Initiatesearly oral feeding. Collaborative: Make arrangement fortransfertoNICU, if indicated.


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Nursing Diagnosis

Risk for infection related to compromised immune systemINTERVENTIONS

-Provide isolation and monitor visitors as indicated.-Wash hands before or after each care activity, even gloves

are used.-Limit use of invasive devices, or procedure as possible.

COLLABORATIVE

-Administer antibiotics as prescribed.


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ACTUALNURSING

CAREPLAN


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(Mother)

S:Maam tabang ka anakon na kaayo ko! Sakit na kaayo akong tiyan, kaanakon na ko! verbalized by the patient.

O:Regular contractions

Increased bloody showRuptured of the membraneFacial grimaceBulging of the vagina

A:Acute pain related to strong uterine contraction, compression ofthe nerves by presenting part of the fetus, and bladder distention.

P:A

t the end of 30 minutes, the patient will be able to verbalized painis relieved or controlled.I: > Monitor and record uterine activity with each contraction.

> Monitor vital signs- usually altered in acute pain.> Evaluate bladder fullness.> Provide comfort measures like backrub, changing of position, useof heat or cold and provide no pharmacological pain management.

> Encourage client to relax all muscles and rest betweencontractions.

E:At the end of 30 minutes, the patient was able to verbalized painwas controlled.


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S:Maam tabang!! nigawas na gyud ang ulo sa bata as verbalized bythe patient.

O;Facial grimaceSits up while lying on bed during crowning

A:Coping ineffective related to pain and stress in the labor process.P:At the end of 30 minutes the patient will be able to demonstrate

coping abilityI: a.Call client by name

-Using clients name enhances sense of self and promotesindividuality / self esteem.b. Explain process / procedures / events in simple, concise manner.

-May help client to express emotions, grasp situation, andfeel more in controlc. Allow client to express in own way without judgment.

-To encourage client to express feelings, anxiety and fears.d. Provide for gradual implementation and continuation ofnecessary behavior.

-Enhances commitment to plan.E:After the intervention is given the patient was able to demonstratecoping ability.


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S:Hapdos man ang akong tahi sa akong bilahan., as verbalized by thepatient.

O:Episiotomy repaired

A:Risk for infection related to the episiotomy repaired and tissuetrauma.P:At the end of 30 minutes the patient may understand the cause of

pain on her vaginal opening and at the same time she will know theproper way in taking care of her wound.

I: -Explain the causes of her pain.Explanation can help your patient at ease. It will also increase her

knowledge about her condition so she could actively participate.-Teach the patient the proper perineal care.Proper cleaning can prevent infection and facilitate early wound

healing.-Provide early ambulation.

To promote proper circulation and prevent any complications likebedsores.

-Explain the treatment as prescribed by the physician.To prevent any infections and complications.E:After the intervention is given the patient was able to expressed

the feeling of understanding on what health teaching imparted toher.


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(Newborn)

S:Not applicableO:Difficulty of breathingBluish color of lower extremities

A:Ineffective Breathing Pattern related toimmaturity of the respiratory center.

P:At the end of 3 minutes the neonate will be ableto establish an effective respiratory pattern.I: > Suction airway as needed to clear secretions.

> Wipe the mucus with OS from the face, mouthand nose

> Note emotional responses: gasping, crying,tingling fingers.E:After 3 minutes of rendering the nursing

interventions, the neonate was able to breatheproperly by manifesting absence of bluishextremities and breathing thoroughly.


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S:Not Applicable

O:difficulty of breathingA:Ineffective airway clearance related to presenceof mucus or amniotic fluid in airway.

P:At the end of 3 minutes, the neonate will be ableto breathe properly.

I: > Suction oral prn.> Position head midline with flexion appropriatefor condition>Auscultate chest for character of breath soundsand presence of secretions

E:At the end of 3 minutes, the neonate was able tobreathe properly.


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S:Not ApplicableO:increased temperature

A:Risk for infection related to compromised immunesystem

P:At the end of 3 minutes, the neonatestemperature will decreaed to normal bodytemperature.

I: > Wash hands before and after each care activity> Provide tepid sponge bath>Monitor for signs of deterioration of condition.

E:At the end of 3 minutes, the neonates

temperature decreased to normal bodytemperature


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DRUG STUDY


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DISCHARGE

PLANNING


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END

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