its all labour baby!
What is the "normal" progress for a primip in 1st stage of labour?
12 hours
40 week pregnant woman attends MDU with RFM 1st episode.
what do you do?
full set of obs/ urinanysis/ CTG with dawes redman.
Discuss and provide IOL leaflet as this will be offered. Dr review. VE. Call AN ward for bed
What Equipment should be used to intermittently auscultate the fetal heart rate? (1 answer)
Pinnard and handheld Sonicaid doppler
A baby is born of a mother who has had labetalol in labour. What is the process of your care for PN and why?
inform neonates.
Orange hat pathway observations 2 hourly for 12 hours.
pre feed bm's 2nd and 3rd.
Its Day shift on Labour ward - MIC in another room - you have concerns about your client and need support. who do you go to next
Is there another band 7 around?
Speak to dr's/ Matron/ bleep holder/ PDM
Woman calls triage reporting period type pains and thinks labour has started. What are you advising?
monitor uterine activity
pain relief - warm bath/ shower/ mobilise/ breathing techniques
Has she srom'd? what colour is liquor. Is fmf pattern normal.
when contractions are 3:10 lasting 60 seconds, to call back. If sroms/pvb or fmf concerns call back straight away.
Shoulder dystocia has been declared..
What do you do?
emergency bell/ 2222/continuous ctg/ Lie bed flat/ legs into McRoberts/ STOP pushing/ GENTLE axial Traction.
suprapubic pressure/ assess for epis/ internal manoeuvre's/ onto all 4s and repeat internal manoeuvre's/
cleidotomy/ symphysiotomy/ zavinelli
When carrying out Intermittent Auscultation on a Low Risk labouring woman - When should you Listen and Why?
With informed consent, put your hand on the fundus and auscultate as soon as you feel the contraction end
What is considered risk factors for KP pathway?
maternal pyrexia
prom and GBS
preterm - and BMs
GBS with delivery within 2 hours of 1st abx administered.
You feel out of your depth - You are on labour ward and have COU and recovery - 4 women all needing regular observations.
How are you going to manage your workload
ask HCA's to do your observations and to tell you immediately of any abnormal readings.
inform the MIC that you need help, as you are concerned
if any AN women needing ctgs - ask if anyone can assist or can you titrate the timings
Your client is on epidural and Syntocinon infusion. Is fully dilated and has no signs heading into 2nd stage yet. What do you do?
providing ctg and client are well -
allow 1 hour for descent/ continue ctg. escalate if any concerns.
Pregnant woman 29/40 PVB, not in pain, but uterus is "wooden" feeling.
what are you thinking and what are your next steps?
Placental Abruption/ placenta praevia?
CTG
bloods G+S FBC Urgent Dr Review.
preterm passport - mag sulphate for brain protection.
Have we got time for steroids?
According to trust guidance, what gestation do we perform a CTG from?
26+0
A baby is just born via cat 4 CS. you notice Grunting and nasal flaring. what are your thoughts and next steps
TTN (TRANSIENT TACYPNOEA) - where the baby has not had the fluid squeezed from the lungs, as a vaginal birthed baby would.
FULL SET OF OBSERVATIONS - HR/TEMP/RR. ? RECESSION,
put skin to skin
call neonates to review. inform parents
You are on the ward - PN bay
multiple women to discharge - you are being told the ward is bed blocked and you need to hurry up...
wdyd
MIC of the ward needs to know you need support.
If women all speak English - open the curtains and do a discharge talk together - then individually ask if they have any questions.
ALWAYS ask for help!
Your Client has given birth to her baby, it has been 15 mins and placenta has not delivered yet!
Explain what you would do in both physiological and active management - would is your next step.
Coordinator and Doctors should be informed of active management - in case of needing future transfer to theatre. observe EBL, and measure.
Change maternal position if able to, deep squat - birthing stool/ empty bladder
But remember: She has 30 mins in total for active,
1 hour for physiological
Client is in COU post PPH at delivery 3 hours ago.... She has become short of breath, tachycardic, and appears clammy.
what are your thoughts.... wdyd???
Check her pv loss immediatley -
call for help.
full set of observations. Palpate abdomen
check urometer
Dr review - call Parrt team for extra support
STV value is ONLY valid after 60 mins of CTG?
True
A term baby weighing 3.2kg has a Blood glucose reading of 1.0 mmoL - what do you do with this information?
Not normal -
2.0 mls of glucogel to be immediately administered into the inner cheek and massaged. Offer feed straight after.
Full set of observations.
Inform neonates as this will be an immediate admission to NNU
You have a client whose partner is saying no to the epidural - you can clearly see your client wants it. What do you do?
Ask what is his concerns about the epidural - give them the card to read - ask anaesthetist to come talk to them
Explain to the woman herself that this is her labour -her pain - her body. No one will judge her for her decisions.
If partner won't take no for an answer get the MIC
explain the differences between Oxytocin/Ergometrine/ and Syntometrine?
dosages/ how they act/ who can/can't have them
oxy: 10 iu/ intermittent/ EVERYONE!
ergo: 500mcg/ constant/ BP issues/ severe cardiac issues
synto: 5iu/500mcg/ constant - then intermittent/ BP issues/ severe cardiac issues
a pregnant woman is having a seizure on AN ward.
what do you do?
In Hypoxic stress the fetus first attempts to protect its myocardium above everything else. It cannot rapidly increase its oxygen levels through increasing its respiratory rate, therefore it reduces its myocardial workload through...
Decelerations
you are on the ward - a baby is 2 days old, and has just collapsed - stopped breathing - floppy and needs help.
what do you do?
call for help/ 2222/ take baby to resusitaire.
observations C/T/B/HR
Measure mask/ INFLATTION BREATHS FIRST!
In community - you have team sickness and there's multiple visits, clinics and you are day on call. You cannot manage this - what do you do?
call team leader - if they are off - call Community Matron.
Prioritise your work - cancel clinics and call the women, to tell them you will rebook.
Which house visits are priority, day 10- 14 discharges can wait.
Ask to be taken off 'on call'.