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woman
T0
P0
A1
L0
She
She is
is complaining
complaining of:
of:
pain
pain in
in her
her back
back that
that
radiates
radiates to
to the
the front
front of
of her
her
stomach
stomach
occasional
occasional nausea
nausea
when
when she
she saw
saw the
the physician
physician 4
4
days
days ago
ago she
she was
was 1cm,
1cm, soft
soft
membranes
membranes intact
intact
The
The fetus
fetus was
was noted
noted to
to be
be in
in
vertex
vertex position
position by
by Leopolds
Leopolds
maneuvers.
maneuvers.
Assessment
Lightening
Lightening
Contractions
Contractions
Leopolds
Leopolds
Maneuver
Maneuver
Gravida
Gravida
Parity
Parity
Sterile
Sterile
Vaginal
Vaginal
Exam
Exam
Membranes
Membranes
Stages
Stages of
of
Labor
Labor
True
True vs.
vs.
False
False Labor
Labor
True or False?
28 yo 1-0-0-1-0 @ 37 wks.
Symptoms:
pain in her back (radiating to
front of her stomach),
occasional nausea, 1cm, soft
(4 days ago), membranes
intact, and vertex position.
What is that?
Four maneuvers for diagnosing fetal position by external palpation.
Leopold Maneuvers?
Leopold Maneuvers
How is it done?
1. Fundal Grip
2. Umbilical
Grip
3. Pawliks
Grip
4. Pelvic
Grip
Ultrasound
Transducer
(FHR)
Tocotransducer
(Contractions)
Nursing Assessment
ROM
FHR
Color
Odor
Amount
Viscosity
4cm dilated
80% effaced
the fetus is in vertex
position and at +1 station
FHR is noted to be 150
with moderate variability
If the US transducer detects
the FHR best at the PMI, then
why would this one be placed
here?
Passenger
Passage Way
Powers
Position of mother
Passenger
Fetal Presentation
Fetal lie
Fetal Attitude
Fetal Position
Fetal Station
Passageway
bony pelvis and soft tissues
4 types of Bony pelvis [table 16-2, pg.376] - Gynecoid
Android
Anthropoid
Platypelloid
Soft tissues -- lower uterine segment, cervix, pelvic
floor muscles,
vagina, & introitus.
Lower uterine segment -- distends to
accommodate
intrauterine contents
cervix -- thins and opens to allow descent into the
vagina
pelvic floor muscles -- helps rotate the fetus as it
passes
through birth canal
vagina and introitus -- dilate to accommodate the
fetus and permit passage.
Powers
Primary/Secondary
Stages/Phases of Labor
Stage 1 - Labor
Latent Phase
Active Phase
Transition Phase
Stage 2 - Baby
Stage 3 - Placenta
Stage 4 - Recovery
Stage 1 - Labor
4-7cm
1-3cm
8-10cm
1. Anxiety
6. Pain
2. Knowledge Deficit
3. Infection
Stage 2 -- Baby
Stage 2 -- Pushing
During a vaginal
exam, the nurse
determines that the
patient is
Complete.
She instructs the
patient to push
effectively with each
contraction.
The patients spouse
Internal
Internal
rotation
rotation
External
External
rotation
rotation
(restitution)
(restitution)
Expulsion
Expulsion
Case Example
During the next
nursing
assessment the
patient appears
tense,
irritable and
pushes her
spouse away
from the bed.
She tells
the nurse I
want this baby
out NOW! I am
going to
PUSH!!!
Nursing Assessment
Period of Relaxation
Waves
Increment
Frequency
Acme
Duration
Decrement
Intensity
Stage 2 - Baby
5minVaginalDelivery (1).wmv
Stage 3 -- Placenta
Stage 3
Lengthening cord
Vaginal
fullness
changes from
oval to globular
Stage 3
Stage 4 -- Recovery
uterine
hemorrhage
atony
Stage 4
urinary retention
Psychological Response
Questions?