Problems with psyche Perceived threat of pain, fear, nonsupport, body responds to stress via fight or flight Shoulder dissociate and what is role as a nurse? Shoulder dissociate is head is born and retracts against the perineum (like a turtle) Intervention is required to prevent cord compression: Micrometer’s maneuver: Women flexes her thighs against abdomen Supersonic pressure: Done by an assistant to push fetal shoulder downward to displace it from the mothers pubis symposia Assessment: After delivery palpate infants clavicles, assess for fracture, assess to identify creepiest or deformity, if present, follow-up is required What is the position that is most uncomfortable and prolongs labor? Cockpit posterior or transverse position (delays decent) What pelvis shape is best for vaginal delivery?
Confide pelvis – pelvis is round and cylinder-shaped, has a wide pubic arch, rigorous for vaginal birth is GOOD Know what is preterm labor and your actions if a pregnant woman complains of low back pain that is intermittent Preterm labor defined: after 20th week, before 37th week Risk to mother – hemorrhage and infection** Low back pain that is intermittent could be an indicator of preterm labor and needs to be assessed by bob/gym Adequate hydration is important when uterine activity occurs before pregnancy is at term Teach: Any activity by mother can increase recurrence of contractions** What medications are used for stopping preterm labor?
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Magnesium sulfate IV, then oral Attributable Assessment – Fetal Heart Rate, maternal pulse, maternal blood pressure Magma sulfate is a CNN depressant and smooth muscle relaxant – can be used short and long term Attributable is a bronchiolar and smooth muscle relaxant – only used for short term Know about Mothering: actions and when it should not be used Exotic drug Produced uterine contractions, increases BP, should not be given in Clamps** Loophole’s maneuver: Why is it done? Determines the presentation and position of the fetus and to aid in locating fetal heart tones. Less likely to yield information if the woman has a thick abdomen fat pad, excessive amniotic fluid, or a very preterm fetus After delivery and unable to find uterus, what is your action?
If uterus is found above expected level or shifted from the midlines the bladder may be distended (have mom void) recheck after voided If funds is difficult to locate or is soft and boggy, the nurse should stimulate the uterine muscle to contract by gently massaging – massage until firm Hemorrhage is a potential complication of labor and delivery, what are the s/s for a postpartum mom? Funds is difficult to locate, funds is soft and boggy, saturation of one pad per 15 minutes, severe perinea or rectal pain, tachycardia, excessive clots expelled What is atone? Absence or lack of usual muscle tone that results in failure of the uterine muscle fibers to contract firmly around blood vessels when the placenta separates. This prevents the relaxed muscle to stop rapid bleeding which can cause hemorrhaging. With fast deliveries, what trauma may occur?
Fast deliveries occur within three hours within onset of labor Abruptly placenta, teal encomium, postpartum hemorrhage, and low PAPPAS may occur from rapid delivery** If the mom you are caring for has a firm funds, but you note a steady trickle of blood, what is happening? A continuous trickling of blood can lead to significant blood loss that can become life threatening; it is often a sign of early postpartum hemorrhage What are the s/s of hypoglycemic shock? Increased pulse rate, falling BP, increase respiratory rate Weak, diminished, or “threads’ peripheral pulses Cool, moist skin, pallor, or occasions (late sign) Decreased urinary output (