ARELLANO UNIVERSITY COLLEGE OF NURSING Callos, Jessica M. NCM 103 RLE 1.

. What are the RULES and RSPONSIBILITIES of a nurse during STAGES of LABOR? STAGE SIGNS AND SYMPTOMS Latent Phase Regular perceived uterine contraction Rapid cervical dilatation begins Tightening sensation in the womans Abdomen Active Phase Cervical dilatation occurs more rapidly EXPECTED BEHAVIOR OF THE MOTHER Feeling of excitement and fear Feeling of loss of control Anxiety Irritability Powerlessne ss Tensed Panic NURSING INTERVENTI ONS Assess couple for contributing factors related to feelings of loss of control Assist couple with using controlled breathing exercises and position changes. Reinforce information learned in childbirth education classes.

Contractions are stronger Increased vaginal secretions Spontaneous rupture of the membrane Transition Phase Contractions reach their peak of intensity,occurr ing every 2 to 3 minutes with a duration of 60 to 90 seconds. Dilatation continues at a rapid rate Rupture of the membrane at full dilatation Mucus plug from cervix is released Nausea and vomiting

First Stage

Slowly and clearly explain the events and changes occurring with the active stage of labor. Inform the couple of things that can and cannot be controlled. Reassure, as appropriate, that labor is proceeding without problems. Allow opportunities for the couple to manipulate the environment. Offer couple options from which they can choose. Emphasize

 A feeling of loss of control, anxiety, panic and irritability Intense sensation in the abdomen

positive aspects of situation and what can be controlled Provide continued emotional support throughout labor and provide privacy as appropriate. Encourage the husband to continue actively support the wife. Respect contraction time Promote change of positions Promote voiding and provide bladder care Offer Support

Secon d Stage

Full dilatation Cervical effacement Overwhelming, uncontrollable urge to push Momentary nausea or vomiting Perineum begins to bulge and appear tense Stool might also expelled Vaginal introitus opens Fetal scalp becomes visible at the opening of the vagina

Feeling to push becomes strong Argumentati ve Angry Crying or screaming Focus on the babies birth

Respect and promote the support persons activities Support the womans pain management efforts Assess and record the temperature, pulse, respirations, blood pressure, FHR, Contractions Provide Support Prepare the place of Birth Convert the room to a birth room by opening the sterile packs of supplies on waiting tables. Open the partition at the end of the

 Crowning Involuntary uterine contraction

room to reveal the baby island or newborn care area. Turn on the radiant heat warmer in advance. Place sterile towels and a blanket on the warmer. Position the woman into the stirrup Raise both legs at the same time. Secure straps holding the legs in the stirrup Pad stirrup with abdominal pads if woman has ankle edema Top portion of the table is raised to 30

60 degrees angle. Place womans leg in a lithotomy position only at the last moment. Make sure that there is always someone at the foot of the broken delivery room table. Promote effective second stage pushing Do perineal cleaning At birth, place a sterile towel over the rectum and press forward on the fetal chin while the other hand is pressed downward on

Third and Fourt h Stage

Uterus resumes contraction Active bleeding on the maternal

Excited Feeling anticlimactic

the occiput. Aspirate the newborns mouth and nose. Cut the cord and place infant to a sterile basket with the radiant heat warmer Cover the infants head with a wrapped towel or cap Take infant to the parents Apply prophylactic eye ointment. Allow mother to breastfeed baby if she wishes. Inspect the placenta to ensure that it is intact and without gross abnormalities

surface of the placenta Placenta sinks to the lower uterine segment or the upper vagina Lengthening of the umbilical cord Sudden gush of vaginal blood Change in the shape of the uterus Bleeding occurs

and check the number of cotyledons. Obtain a baseline blood pressure before handling oxytocic to the patient. Document the administratio n of oxytocics given in delivery or birthing room on the maternal record. Perform perineal stitching. Be certain to include her in explanations and appreciate how anticlimactic she may feel. Obtain vital

signs every 15 minutes for 1 hour and according to the agencys policy. Palpate fundus for size, consistency, and position and observe the amount and characteristic s of the lochia. Perform perineal care Offer a clean gown and a warmed blanket.. 2. FETAL CIRCULATION The fetus is connected by the umbilical cord to the placenta, the organ that develops and implants in the mother's uterus during pregnancy.

Through the blood vessels in the umbilical cord, the fetus receives all the necessary nutrition, oxygen, and life support from the mother through the placenta. Waste products and carbon dioxide from the fetus are sent back through the umbilical cord and placenta to the mother's circulation to be eliminated.

Fetal Structure 1. Foramen Ovale 2. Umbilical Vein (intra-abdominal part) 3. Ductus Venosus

4. Umbilical Arteries and abdominal ligaments 5. Ductus Arteriosum Blood from the mother enters the fetus through the vein in the umbilical cord. It goes to the liver and splits into three branches. The blood then reaches the inferior vena cava, a major vein connected to the heart. Inside the fetal heart: Blood enters the right atrium, the chamber on the upper right side of the heart. Most of the blood flows to the left side through a special fetal opening between the left and right atria, called the foramen ovale. Blood then passes into the left ventricle (lower chamber of the heart) and then to the aorta, (the large artery coming from the heart). From the aorta, blood is sent to the head and upper extremities. After circulating there, the blood returns to the right atrium of the heart through the superior vena cava. About one-third of the blood entering the right atrium does not flow through the foramen ovale, but, instead, stays in the right side of the heart, eventually flowing into the pulmonary artery. Because the placenta does the work of exchanging oxygen (O2) and carbon dioxide (CO2) through the mother's circulation, the fetal lungs are not used for breathing. Instead of blood flowing to the lungs to pick up oxygen and then flowing to the rest of the body, the fetal circulation shunts (bypasses) most of the blood away from the lungs. In the fetus, blood is shunted from

the pulmonary artery to the aorta through a connecting blood vessel called the ductus arteriosus.