Labor & Birth
What are the assessments and nursing actions after the Third Stage of labor?
Add Pitocin (Oxytocin) to IV fluids (stimulates uterine contractions, reduces risk of hemorrhage)
Assess fundus
Check for post-partum bleeding
What is the return of the uterus to a non-pregnant state?
Involution
Why is prophylactic eye care used?
To prevent blindness in babies via gonorrhea infection
How many wet diapers should a baby have?
At least one void in first 24 hours of life
Pink-tinged uric acid crystals can be normal for first week
Day 1-4: 2-6 wet diapers
After Day 4: 6+ wet diapers
How is nitrous oxide administered?
Self-administered! No exceptions!
What are the three types of decelerations and what causes them?
Variable - Cord Compression
Early - Head Compression (associated with contractions)
Late - Placenta Insufficiency (needs immediate intervention)
What are the four traditional positions for breastfeeding?
football/clutch, across the lap/cross-cradle, cradle, or side-lying
Sit infant up
Hold bottle at horizontal angle
Allow breaks when infant pauses and rest lip on nipple until their ready to resume
What are the treatments of jaundice in babies?
Phototherapy, exchange transfusion
What is uteral atony?
When the uterus stops contracting and becomes soft and boggy, can lead to severe bleeding and risk of hemorrhage.
What is some nursing care for patients having an epidural?
- Start with IV fluid bolus
- Assess BP frequently (watch for hypotension, have ephedrine ready)
- Assess bladder (usually need to catheterize foley or I/O)
- Assess fetal well-being; Watch for: bradycardia, decreased variability, decels
- Assess other side effects (N&V, itching, shaking)
- Assess pain
- Reposition! Patient is still in labor
What is RhoGAM and why is given?
Immunoglobulin injection for Rh negative individuals given within 72 hours of birth to prevent complications in future pregnancies
What are expected baby vitals?
HR: 110-160
RR: 30-60 breaths
Temp: 97.5 – 99.3 F (36.5 – 37.4 C)
BP – not usually assessed in normal term infant with no concerns
What happens to the ducts/shunts in the neonate after birth?
Foreman ovale (opening between left and right atria) closes as pulmonary pressure increases
Ductus arteriosis constricts with increased oxygenation in arterial blood
Cord clamping and severing closes the umbilical arteries, veins and the ductus venosus
What does TACO stand for in ROM? How often do you take their temperature after ROM?
Time, Amount, Color, Odor
every 2 hours
What are the complications associated with cesarean birth?
Major abdominal surgery with significant risks when compared to vaginal birth—bleeding, infection
Associated with increased healthcare costs (50% more) and longer hospital stay
Longer postpartum recovery
May impact outcomes of future births
What are the three post-partum psychosocial stages?
Taking In (First 1-2 days): focus on self, meeting basic needs with reliance on others, re-living birth experiences
Taking Hold (Begins 2nd or 3rd day, lasts 10+ days): transition from dependence to independence, increased energy, increased focus on infant, self-care (bowels, bladder, breastfeeding), responds well to instruction and praise
Letting Go/Taking Over (10 days to several weeks after birth): adapting to new role, sees self as separate from newborn, readjustment of relationships
What is the difference between pathologic and physiologic jaundice?
Physiologic: typically resolves without treatment, develops after 24 hours of life, typically benign; Bilirubin levels peak between 3-5 days of life, gradually decreases over a period of 5-14 days
Pathologic: requires treatment, appears within 24 hours of life
Causes:
Excessive production of bilirubin through hemolysis
Hemolytic disease of the newborn
Maternal/newborn blood group incompatibility
What is some patient education about swaddling?
Helps with self-regulation
Reduces infant stress
Calms and promotes rest
Wrap snug: watch for overheating or compromised breathing
Legs flexed, hips neutral and supine
Hands out to self-soothe
Stop swaddling as soon as they can roll (up to 2 months)
What are the components of BUBBLE-HEE?
Breasts, Uterus, Bowel, Bladder, Lochia, Episiotomy, Hemorrhoids, Edema, Emotions
What are some nursing considerations for opioid agonist analgesics? opioid-agonist-antagonist analgesics?
- OA: may lower maternal BP -> decrease fetal oxygenation
- OAA: DO NOT use with opioid dependent patients
What are some benefits of lactation for the baby and the parent?
Baby:
Foundation of health (immune system, brain growth, neurodevelopment)
GI development, function, immunity
Respiratory health, prevent ear infections
Brain development
Long-term – reduced risk of cancer, obesity, diabetes
For Parent
Reduced risk of postpartum hemorrhage
Return to pre-pregnancy weight
Contraceptive benefits ie specifically delayed ovulation
Lower levels of stress hormones and increased bonding
Reduced incidence of ovarian and breast cancers, possibly CVD
Financial benefits – formula, sick days, etc.
What are some breast/chest care for non-breastfeeding/non-lactating individuals?
The woman wears a well-fitted support bra continuously for at least the first 72 hours after giving birth. She should avoid breast stimulation, including running warm water over the breasts, newborn suckling, or expressing milk.
What are some signs of NB complications?
Fever – Temperature >38 degrees Celsius (100.4 F) axillary
Hypothermia – Temperature <36.5 C (97.7 F) axillary
Poor feeding
More than one episode of forceful vomiting
Bright green emesis
Cyanosis
Frequent diarrhea or decreased bowel movement
Fewer than 6-9 wet diapers at 4 days old
Labored breathing
Lethargy
Bleeding or drainage at umbilical cord or circumcision site
Drainage from eyes
What are the five factors of labor?
Passenger, Passageway, Presentation, Position, Psychological