NUR2633 I– IMCH I– IStudy IGuide ITest I2: I Module I3 I,4 Iand I5
I I I I I I I I I I I I
I(Labor, IPostpartum Iand INewborn Icare)
I I I I I
1. Know Ithe IStages Iand Iphases Iof Ilabor Iincluding Ithe Iphysiological Ichanges, Ithe Inormal Iprogression
Iand Ithe Ipsychological Iimpact Ito Iyour Ipatient. IKnow Ithe Ilabs Ithat Iare Iessential Ito Ihave Ifor Iyour
Ipatient Iprior Ito Idelivery Iof Ibaby.
Stages Iof Ilabor
First IStage- Ilabor- Ivariable
Second Istage- Idelivery Iof Ibaby- Iup Ito I3 Ihours I(2 Iwithout Ianesthesia) IPushing Iphase.
IThird IStage- Idelivery Iof Iplacenta- I5-30 Iminutes
Fourth IStage- IRecovery I2 Ihours
Within Ithe Ifirst Istage- Iwe Ihave I3 Iphases.
0-4cm- Ilatent- Imost Ivariable. IObjective Isigns: Icervical Ichange, Isome Ieffacement, Icommunicative,
Icontractions I8-10 Imin Iapart, Imild Icontractions
4-8 Icm- Iactive- IIntensity Iin Icontractions; Ibloody Ishow- IThis Iis Iwhere Iwe Imedicate Imom.. I4-6
Ihours. IContractions Iare Igetting Icloser Itogether Iand Istronger. IMembranes Imay Irupture,
Icontractions I2-5 Imin Iapart, Imore Ifocused, Iless Italking, Irisk Ito Ibaby Iis Igreater, Iamount Iof
Iperfusion Ito Ibaby Iis Iless, Ibaby Ican Iget Ihypoxic Iduring Ilong Ilabor Iwith Iprogression
8-10 Icm- Itransitional- Irectal Ipressure- Ineed Ito Ibear Idown Iand Iwant Ito Ipush- Iabout I2 Ihours Ior
Iless., Imay Iscream, Iwrithe Iaround Iin Ibed, Iwill Inot Ifeel Iany Icervix Iaround Ibaby’s Ihead
Make Isure Imom Iis Iin Ia Icomfortable Iposition Iand Iher Isurroundings Iare Icalm Iand Iinviting.ISquatting
Ior Isitting Iis Ithe Ibest Iposition.
CBC, IHep, IRubella, IHIV, ISyphilis, IGroup IB, IBlood Itype, IRH, Idrug Iscreen, Iurine Ianalysis
2. Know Ithe Ireasons Iand Ithe Ifindings Iof Ieach Ivaginal Iexam.
Three Ipieces Iof Iinformation Ithat Iwe Imust Iget Iduring Ia Ivaginal Iexam:
Dilation I(cervix Iis Iopening), Istation I# Iof Icm Iabove Ithe Iischial Ispine Iis Ia Inegative Inumber, IbelowIthe
Iischial Ispine Iis Ia Ipositive Inumber, Iand Ieffacement I(from Ithick Ito Ithin)0%-100%
You Ican Ialso Iget Ithe Ipresentation Iof Ithe Ibaby Iand Ifeel Iis Ithe Imembranes Iare Iintact.
Vaginal Iexams Iare Idone Iat Iadmission Ifor Ibaseline, Iwhen Imembranes Irupture, Iand Iwhen Ishe IasksIfor
Ipain Imeds, Iand Iwhen Ipatient Isays Ishe Iis Iready Ito Ipush.
3. Know Ithe Imedications Iof Ilabor Iand Iwhen Ito Iadminister Ithem.
Pitocin- IPromotes Iuterine Icontractions. IUsed Ito Ibegin Ilabor, Iaugment Ilabor Iand Ipostpartum. IWeIuse
I2 Imilliunits Iper Iminute Iwhich Iis Iequal Ito I6 Iml Iper Ihour Iand Iit Iis Ititrated. ILactated IRingers.
Every I20-30 Iminutes Iwe Imove Iit Iup Idepending Ion Ithe Ipatient. IFrequency Iof Icontractions InoImore
Ithan I2-3 Iminutes Iapart.
Magnesium ISulfate- IPreterm Ilabor Iand Ipre-eclampsia
Nubain Iand IStadol- IAdminister Ifor IPain.
Methergine I(IM Iand IPO Iafter-contraindicated Ifor Ihypertension) Iand IHemabate- IPrevents
Ihemorrhaging
Cytotec- ICauses Iuterine Icontractions.
, 4. Know Ithe Irisks Iof Irupturing Imembranes Iand Iwhat Iis Ithe Inursing Iintervention Iif Ithis Ioccurs
Ispontaneously Ivs Iartificially.
Infection Iis Ithe Ibiggest Irisk. IDecrease Ithe Iamounts Iof Ivaginal Iexams.
Check Ithe Icolor Iand Iodor Iof Ithe Ifluid Ias Iwell Iwhen Ithey Iruptured. IBaby Ishould Ibe Idelivered
Iwithin I24 Ihours Iof Iruptured Imembranes. I18 Ihours Iinto Iruptured Imembranes Iwe Iadminister
Iantibiotics.
AROM- IArtificial Irupture Iof Imembranes- Ifetal Iheart Irate Iprior Ito IAROM Iand Iafter Ito Idetermine Iif
baby Iis Iin Itrouble Ior Inot.
5. Pain Imanagement I– Irecognizing Ithe Irisks Iand Inursing Iinterventions Iof Iregional Ianesthesia
I(epidurals/ Ispinal) I(biggest Irisk Ito Imom Iis Ihypotension I– Iwhich Icauses Ifetal Idecelerations, Iso
Ihow Ido Iwe Iprevent Ithis?)
Nubain Iand IStadol Iare Isystemic Ianalgesics Ithat Iis Igiven Iduring Ithe Iactive Iphase I(peak Iof Ithe
contraction Ibecause Ithere Iis Iless Iperfusion Ihappening Iat Ithat Itime Iso Ibaby Igets Iless Iof Ithe
Imeds). IYou Ido Inot Iwant Ito Igive Iit Ito Iearly Ior Itoo Ilate Ibecause Ithen Iit Iall Igoes Ito Ithe Ibaby. IHave
INarcan Iin Ithe Iwarmer Iin Icase Ithe Ibaby Idoes Inot Ihave Igood IAPGAR Iscore.
6. Preparation Ifor Iepidural Ianesthesia Ialso Ihas Ito Ibe Iconsidered Ias Ia Inursing Iresponsibility.
IEpidural I(regional Ianesthesia)- INeed Iconsent Ifrom Imom Ifirst, ICBC Iw/ Iplatelets, Isit Istill, Iand Igive
Iher IAbout I1 Iliter Iof Ifluids. IWe Igive Ifluids Ito Iprevent Ihypotension. IClient Iis Iplaced Isupine Iafter
Iepidural, Iso Iwe Ineed Ito Iuse Ia Iwedge Iunder Ithe Iright Ihip Ito Idecrease Ithe Ipressure Ion Ithe Ivena
Icava. INO IPREGGO ICAN ILAY ISUPINE IDUE ITO IHYPOTENSION IBECAUSE IIT IWILL IPUT IPRESSURE ION
ITHE IVENA ICAVA.
Vital Isigns Ievery I5 Iminutes Iwatching Iout Ifor Ihypotension.
7. Know Ithe Ireasons, Irisks Iand Inursing Iinterventions Iof Ithe Ineed Ifor Ia IC/section. IThis Iincludes
Ipost-operative Icare. I Also Idiscuss Ithe Ioption Ifor Ia IVBAC Iand Ithe Icriterion Ineeded Ito Istart Ithe
Idiscussion: I incision Iis Ithe Ipriority.
Pre-op IPrep Ifor Ia IC-Section: ILabs, Ifoley, Iconsent Iand Iawake Ito Iparticipate.IAmbulate,
give IPitocin Iif Iclient Iis Inot Iprogressing.
I
Pitocin Ineeds Ito Ibe Ititrated, Iso Iwe Ido Inot Ifinish Iup Iwith Ia Ititanic Icontraction. IFetal Ihypoxia Iand
uterine Ifatigue. IWe Iallow Icontractions Ito Iget I2-3 Ior I2-4 Iminutes Iapart.
When Ido Iwe Ido Ia IC-section? IBreech, Itransverse, Iplacenta Iprevia Ior Iabruption, Iprior IC-section,
Ibaby Iis Itoo Ibig, Icord Iprolapse, Ifailure Ito Idescend, Ifailure Ito Idilate, Inon-reassuring Ifetal Itracing,
Iinfection, Iherpetic Ilesion.
Post IOp Ifor IC-section: IVital Isigns, Ibleeding, ILOC, Ilocate Ifundus, Iurine Ioutput, INo IambulatingIinitially
I(SCD’s Iare Ion), Ipain Imanagement, Iperi Icare, Ilisten Ito Ilungs/abdomen/ Iheart.
VBAC- ILow Itransverse Iincision, Ivertex Ipresentation, Iwhy Idid Ishe Ihave Ithe Ifirst IC-section,
I I I I I I I I I I I I
I(Labor, IPostpartum Iand INewborn Icare)
I I I I I
1. Know Ithe IStages Iand Iphases Iof Ilabor Iincluding Ithe Iphysiological Ichanges, Ithe Inormal Iprogression
Iand Ithe Ipsychological Iimpact Ito Iyour Ipatient. IKnow Ithe Ilabs Ithat Iare Iessential Ito Ihave Ifor Iyour
Ipatient Iprior Ito Idelivery Iof Ibaby.
Stages Iof Ilabor
First IStage- Ilabor- Ivariable
Second Istage- Idelivery Iof Ibaby- Iup Ito I3 Ihours I(2 Iwithout Ianesthesia) IPushing Iphase.
IThird IStage- Idelivery Iof Iplacenta- I5-30 Iminutes
Fourth IStage- IRecovery I2 Ihours
Within Ithe Ifirst Istage- Iwe Ihave I3 Iphases.
0-4cm- Ilatent- Imost Ivariable. IObjective Isigns: Icervical Ichange, Isome Ieffacement, Icommunicative,
Icontractions I8-10 Imin Iapart, Imild Icontractions
4-8 Icm- Iactive- IIntensity Iin Icontractions; Ibloody Ishow- IThis Iis Iwhere Iwe Imedicate Imom.. I4-6
Ihours. IContractions Iare Igetting Icloser Itogether Iand Istronger. IMembranes Imay Irupture,
Icontractions I2-5 Imin Iapart, Imore Ifocused, Iless Italking, Irisk Ito Ibaby Iis Igreater, Iamount Iof
Iperfusion Ito Ibaby Iis Iless, Ibaby Ican Iget Ihypoxic Iduring Ilong Ilabor Iwith Iprogression
8-10 Icm- Itransitional- Irectal Ipressure- Ineed Ito Ibear Idown Iand Iwant Ito Ipush- Iabout I2 Ihours Ior
Iless., Imay Iscream, Iwrithe Iaround Iin Ibed, Iwill Inot Ifeel Iany Icervix Iaround Ibaby’s Ihead
Make Isure Imom Iis Iin Ia Icomfortable Iposition Iand Iher Isurroundings Iare Icalm Iand Iinviting.ISquatting
Ior Isitting Iis Ithe Ibest Iposition.
CBC, IHep, IRubella, IHIV, ISyphilis, IGroup IB, IBlood Itype, IRH, Idrug Iscreen, Iurine Ianalysis
2. Know Ithe Ireasons Iand Ithe Ifindings Iof Ieach Ivaginal Iexam.
Three Ipieces Iof Iinformation Ithat Iwe Imust Iget Iduring Ia Ivaginal Iexam:
Dilation I(cervix Iis Iopening), Istation I# Iof Icm Iabove Ithe Iischial Ispine Iis Ia Inegative Inumber, IbelowIthe
Iischial Ispine Iis Ia Ipositive Inumber, Iand Ieffacement I(from Ithick Ito Ithin)0%-100%
You Ican Ialso Iget Ithe Ipresentation Iof Ithe Ibaby Iand Ifeel Iis Ithe Imembranes Iare Iintact.
Vaginal Iexams Iare Idone Iat Iadmission Ifor Ibaseline, Iwhen Imembranes Irupture, Iand Iwhen Ishe IasksIfor
Ipain Imeds, Iand Iwhen Ipatient Isays Ishe Iis Iready Ito Ipush.
3. Know Ithe Imedications Iof Ilabor Iand Iwhen Ito Iadminister Ithem.
Pitocin- IPromotes Iuterine Icontractions. IUsed Ito Ibegin Ilabor, Iaugment Ilabor Iand Ipostpartum. IWeIuse
I2 Imilliunits Iper Iminute Iwhich Iis Iequal Ito I6 Iml Iper Ihour Iand Iit Iis Ititrated. ILactated IRingers.
Every I20-30 Iminutes Iwe Imove Iit Iup Idepending Ion Ithe Ipatient. IFrequency Iof Icontractions InoImore
Ithan I2-3 Iminutes Iapart.
Magnesium ISulfate- IPreterm Ilabor Iand Ipre-eclampsia
Nubain Iand IStadol- IAdminister Ifor IPain.
Methergine I(IM Iand IPO Iafter-contraindicated Ifor Ihypertension) Iand IHemabate- IPrevents
Ihemorrhaging
Cytotec- ICauses Iuterine Icontractions.
, 4. Know Ithe Irisks Iof Irupturing Imembranes Iand Iwhat Iis Ithe Inursing Iintervention Iif Ithis Ioccurs
Ispontaneously Ivs Iartificially.
Infection Iis Ithe Ibiggest Irisk. IDecrease Ithe Iamounts Iof Ivaginal Iexams.
Check Ithe Icolor Iand Iodor Iof Ithe Ifluid Ias Iwell Iwhen Ithey Iruptured. IBaby Ishould Ibe Idelivered
Iwithin I24 Ihours Iof Iruptured Imembranes. I18 Ihours Iinto Iruptured Imembranes Iwe Iadminister
Iantibiotics.
AROM- IArtificial Irupture Iof Imembranes- Ifetal Iheart Irate Iprior Ito IAROM Iand Iafter Ito Idetermine Iif
baby Iis Iin Itrouble Ior Inot.
5. Pain Imanagement I– Irecognizing Ithe Irisks Iand Inursing Iinterventions Iof Iregional Ianesthesia
I(epidurals/ Ispinal) I(biggest Irisk Ito Imom Iis Ihypotension I– Iwhich Icauses Ifetal Idecelerations, Iso
Ihow Ido Iwe Iprevent Ithis?)
Nubain Iand IStadol Iare Isystemic Ianalgesics Ithat Iis Igiven Iduring Ithe Iactive Iphase I(peak Iof Ithe
contraction Ibecause Ithere Iis Iless Iperfusion Ihappening Iat Ithat Itime Iso Ibaby Igets Iless Iof Ithe
Imeds). IYou Ido Inot Iwant Ito Igive Iit Ito Iearly Ior Itoo Ilate Ibecause Ithen Iit Iall Igoes Ito Ithe Ibaby. IHave
INarcan Iin Ithe Iwarmer Iin Icase Ithe Ibaby Idoes Inot Ihave Igood IAPGAR Iscore.
6. Preparation Ifor Iepidural Ianesthesia Ialso Ihas Ito Ibe Iconsidered Ias Ia Inursing Iresponsibility.
IEpidural I(regional Ianesthesia)- INeed Iconsent Ifrom Imom Ifirst, ICBC Iw/ Iplatelets, Isit Istill, Iand Igive
Iher IAbout I1 Iliter Iof Ifluids. IWe Igive Ifluids Ito Iprevent Ihypotension. IClient Iis Iplaced Isupine Iafter
Iepidural, Iso Iwe Ineed Ito Iuse Ia Iwedge Iunder Ithe Iright Ihip Ito Idecrease Ithe Ipressure Ion Ithe Ivena
Icava. INO IPREGGO ICAN ILAY ISUPINE IDUE ITO IHYPOTENSION IBECAUSE IIT IWILL IPUT IPRESSURE ION
ITHE IVENA ICAVA.
Vital Isigns Ievery I5 Iminutes Iwatching Iout Ifor Ihypotension.
7. Know Ithe Ireasons, Irisks Iand Inursing Iinterventions Iof Ithe Ineed Ifor Ia IC/section. IThis Iincludes
Ipost-operative Icare. I Also Idiscuss Ithe Ioption Ifor Ia IVBAC Iand Ithe Icriterion Ineeded Ito Istart Ithe
Idiscussion: I incision Iis Ithe Ipriority.
Pre-op IPrep Ifor Ia IC-Section: ILabs, Ifoley, Iconsent Iand Iawake Ito Iparticipate.IAmbulate,
give IPitocin Iif Iclient Iis Inot Iprogressing.
I
Pitocin Ineeds Ito Ibe Ititrated, Iso Iwe Ido Inot Ifinish Iup Iwith Ia Ititanic Icontraction. IFetal Ihypoxia Iand
uterine Ifatigue. IWe Iallow Icontractions Ito Iget I2-3 Ior I2-4 Iminutes Iapart.
When Ido Iwe Ido Ia IC-section? IBreech, Itransverse, Iplacenta Iprevia Ior Iabruption, Iprior IC-section,
Ibaby Iis Itoo Ibig, Icord Iprolapse, Ifailure Ito Idescend, Ifailure Ito Idilate, Inon-reassuring Ifetal Itracing,
Iinfection, Iherpetic Ilesion.
Post IOp Ifor IC-section: IVital Isigns, Ibleeding, ILOC, Ilocate Ifundus, Iurine Ioutput, INo IambulatingIinitially
I(SCD’s Iare Ion), Ipain Imanagement, Iperi Icare, Ilisten Ito Ilungs/abdomen/ Iheart.
VBAC- ILow Itransverse Iincision, Ivertex Ipresentation, Iwhy Idid Ishe Ihave Ithe Ifirst IC-section,
