Ward Class Ppt

8/6/2019 Ward Class Ppt

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CARE OF A WOMAN DURING

THE THIRD AND FOURTHSTAGES OF LABOR



Oxytocin

Once the placenta is delivered, Oxytocin is

generally ordered to be administered IM or IV. This

medication increases uterine contractions and

therefore minimizes uterine bleeding.

Ex. Oxytocin (Pitocin)

Methylgoergonovine maleate (Methergine)



Nursing Responsibilities:

These medications should not be given until the

physician or nurse-midwife indicates that it is

appropriate.

Oxytocics cause hypertension by vasoconstriction. Be

sure to obtain the baseline BP. They should not be

used in women with elevated BP.

Document the administration of oxytocics given in thedelivery or birthing room on the maternal record.

The next dose of medication to maintain contraction

cannot be given closer than 3 or 4 hours.



Placenta Delivery

The third stage of labor consists of separation and expulsionof the placenta. Contraction begins 3-5minutes after thedelivery of the infant, but may not be painful

If the placenta does not deliver spontaneously, the physicianor the nurse-midwife will need to remove it manually.

After the delivery, the placenta is inspected to be certain itis intact and normal in appearance and weight.

Expulsion can occur by Shultz mechanism (shiny, membranous

fetal side first) or Duncan mechanism (meaty, bloodymaternal side first).





Do·s and Don·t·s During Placental Delivery

Do not pull on the umbilical cord.

Do not try to deliver the placenta

unless you are sure that it hasseparated.

Always deliver the placenta with a

contraction, using the mother·s effortto expel it.



The safest way for an EMS provider to deliver the

placenta is to let the mother expel it.

Without massaging or stimulating the uterus, the

member, not responsible for the baby, should place onehand on the abdomen to feel for the fundus to change

shape and position, signaling placental detachment.

Observe her for signs of placental separation, and then

help her into an upright position, such as squatting.

When she says that she feels as contraction, ask her to

push.



Sometimes the amniotic membranes follow the

placenta. These are very fragile and can break off

inside the mother, creating the potential for

infection.

After the placenta is out, immediately place your

hand on the uterus through the abdominal wall.

.If the uterus is ´boggyµ (soft and doughy), massageit vigorously between your two hands until it is firm.





Immediate Postpartum Assessment and

Nursing Care

Obtain V/S every 1 5 minutes for 1 hour and thenaccording to the agency·s policy.

Palpate fundus for size, consistency and position

Observe the amount and characteristics of thelochia.

Perform perineal care and apply perineal pad

Offer a clean gown and a warmed blanket.

Reassure your mother that this is a normal transitorysensation.



Postpartum Period

Because the uterus may be so exhausted for labor

that it cannot maintain contraction, there is a high

risk for hemorrhage.

The woman often is exhausted that she may be

unable to assess her own condition or report any

changes.

Specific assessments done during this time arecontinued throughout the postpartal period.



Psychological Preparations of

Pregnant Woman during Labor

Reducing Anxiety

Communication - Effective communication between thewoman and health care providers during labor and

delivery should be there to address any healthrelated concerns.

Expectant mothers· concerns center on the health ofthe baby to handle labor and birth.

Remind mother·s knowledge from classes in preparedchildbirth which help them in performing better waysduring labor process.



Providing Comfort Measures

Relaxation ² keeps the abdominal wall frombecoming tense, allowing against the hardabdominal wall.

- It also serves as distraction technique because, whileconcentrating on relaxing, a woman cannotconcentrate on pain.

Focusing and Imagery ² concentrating intently on

an object is another methods distraction, or anothermethod of keeping sensory input from reaching thecortex of the brain.



Breathing Techniques ² the advantage is it helps to

relax a woman·s abdomen. They are largely

distraction techniques because a woman

concentrating on slow-paced breathing cannotconcentrate on pain.

Herbal Preparations ² several herbal preparations

have traditionally been used to reduce pain withdysmenorrheal or labor, although there is little

factual support for their effectiveness.



Aromatherapy and Essential Oils ² the use ofaromatic oils to complement emotional and physicalwell-being. Their use is based on the principle that

the sense of smell plays a significant role in overallhealth.

Heat and Cold Application ² it has always beenused for pain relief after injuries such as minor

burns and strained muscles. Lately, they found outthat it is also effective in relieving pain of laborcontractions.



Bathing or Hydrotherapy ² standing under a warm

shower or soaking in a tub of warm water, jet

hydrotherapy tub, or whirlpool is another way to

apply to help reduce the pain of labor.

The temperature of water used should be between

95 to 100F (35-37.8C) to prevent hyperthermia.

Not recommended for woman whose membraneshave ruptured because of the risk of infection.



Therapeutic Touch and Massage ² the use of touch

to comfort and relieve pain. It is base on the

concept that the body contains energy fields that,

when plentiful, lead to health and when in lesssupply, result in ill health.

Touch and Massage (effleurage) probably works to

relieve pain by increasing the release ofendorphins. It is also form of distraction.





Reflexology ² practice of stimulating their hands,

feet and ears as form of therapy. This is by

applying pressure to specific areas of the hands,

feet and ears to restore energy to the body,improve the overall conditions and to alleviate

common ailments such as headaches, back pain,

sinus colds and stress.



Crystal or Gemstone Therapy ² some gemstones orcrystals are thought to have healing powers andwomen may bring this into a birthing room to use

during labor. Hypnosis ² a woman who wants to use this

modality needs to meet with her hypnotherapistduring pregnancy. At these visits, she is evaluated

for and further conditioned for susceptibility tohypnotic suggestion and this provides a verysatisfactory drug-free method of pain relief.



Transcutaneous Electrical Nerve Stimulation (TENS) ²

relieves pain by counter irritation on nociceptors.

With two pairs of electrodes attached to a

woman·s back to coincide with T10-L1 nervepathways, low intensity electrical stimulation is

given continuously or is applied by the woman

herself as a contraction begin.



Acupressure and Acupuncture ² base on the conceptthat illness results from an imbalance of energy tocorrect the imbalance, needles are inserted into the skinat the designated susceptible body points (tsubos) located along meridians that force throughout the bodyto supply the organ of the body with energy.

Accupressure is the application of pressure or massageat these points. A common point use for a woman in

labor is CO4 (Hoku or Hegu point) located betweenfirst and second metacarpal bones on the back of thehand.



Intracutaneous Nerve Stimulation - Intracutaneous

Nerve Stimulation is a technique of counter irritation

involving the intradermal injection of sterile water

or saline along the borders of the sacrum to relievelow back pain during labor. Some women find the

technique helpful, others prefer to bear back pain

rather than submit to injections.



Encourage Comfortable Position

An upright, sitting or wealking postiioon maybe most comfortable for a woman in early

labor. Contractions also are most efficient inthis position.

After the membranes have ruptures and if the

fetal head is not engaged, there may bedanger in walking about because the cordmight prolapsed and impedes fetal circulation.



Labor and support by the:

Nurse ² Reducing anxiety with explanations of the

labor process, helping the woman identify coping

strategies, providing comfort measures, encouraging

comfortable positioning, assisting the woman with

prepared child birth methods and providing

pharmacologic pain reliefs are the care

management that the nurse needs to implement and

accomplish satisfactorily.



Father Or Partner ² In late pregnancy, the concerns

of the expectant fathers tend to focus most on the

health of the unborn child and the safety of the

mother. During labor and delivery, the husband orpartner can be with the expectant mother per

institutions policy. Having his presence makes the

woman felt secure and loved.



Siblings - During the pregnancy, older children shouldbe introduced to a new baby for short periods to getan idea of what a new baby is like. The introduction ofa new baby into the family is often the beginning ofsibling rivalry. Sibling rivalry result·s from children·s fearof change in the security of their relationships with theirparents.

Grandparents ² The first relatives told about a

pregnancy are usually the grandparents. This period ina family·s life most often promotes a closer relationshipbetween the expectant couple and their parents.



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Ward Class Ppt