Birth-Related Procedures Chapter 20

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Birth-Related Procedures Chapter 20

• Induction of labor
• Definition
• Labor Readiness
• Table 20-1 p 429

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Methods of Induction

• Chemical
• Oxytocin infusion
• Labor augmentation
• Prostaglandin E2
• Misoprostol
• Mechanical
• amniotomy
• Nursing management

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Assisted delivery

• Augmentation Oxytocin (Pitocin)
• Episiotomy
• Forceps assisted birth
• Vacuum-assisted birth
• Cesarean birth
• TOLAC (Trial of labor after c-section)
• VBAC (Vaginal birth after cesarean)

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Assisted DeliveryAmniotomy Episiotomy
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Assisted Delivery - Forceps
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Assisted Delivery C-Section
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Assisted Delivery C-Section
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Managing DiscomfortChapter 18

• Considerations
• Cultural influences
• Anxiety and Fear
• Preparation
• Alternative methods

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Pharmacologic Analgesia and Nursing Management

• Narcotic analgesic
• Stadol
• Opiate antagonist
• Narcan

• IM or IV peaks 30-60 min, duration 3-4 hrs
• SE maternal/fetal resp depression urinary
  retention contraindicated for known/suspected
  opiate dependency
• Antagonist for respiratory depression r/t
  fentanyl, morphine, meperidine, butorphanol
  (Stadol) and nalbuphine (Nubain)

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Regional Anesthesia and Analgesia

• Definition
• Agents/types
• Epidural
• Continurous Epidural infusion

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Regional Anesthesia and Analgesia

• Epidural Narcotic after birth
• Spinal Block
• Pudendal Block
• Local infiltration
• Pudendal block

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General Anesthesia

• Definition
• Complications
• Nursing management

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Questions?
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Test Question

• At about 38 weeks gestation a client
  experiences lightening. Lightening refers to the
• A. First feeling of fetal movement
• B. First perceptions of labor contractions
• C. Settling of the fetal head into the pelvis
• D. Frequency of urination in the 3rd trimester

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Another test question

• When assigning points on the Apgar score a HR of
  130 BPM should receive a score of
• A. O
• B. 1
• C. 2
• D. 3

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Lets try again

• Immediately after observing late Dcels, the
  LD nurse should first
• A. Initiate oxytocin augmentation of labor
• B. Perform a quick vaginal exam to assess the
  situation
• C. Turn the client on her left side and
  administer O2
• D. Have the client assume a position of comfort
  after sedating her

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OK, last try

• A client delivers a 7 lb 7oz boy by vaginal
• delivery. One hour after delivery the
• clients vital signs are T 100.3F, P 78, R 18.
• Her nurse is aware that the elevation in
• temperature is likely caused by
• A. Vaginitis
• B. Nosocomial infection
• C. A urinary tract infection
• D. Exhaustion and dehydration