Chapter 34: Obstetrics & Neonatal Care Mastery Part 4

• Life threats to mom

• Assess adequate breathing

• Provide high flow oxygen

• Pregnancy has increased blood volume, increased heart rate, changes in blood clotting

• Assess skin color, temperature, moisture

• Check pulse too fast or too slow

• Control bleeding, give oxygen, keep patient warm

• Patient's home roomy, warm, comfortable, private or transport to hospital

• Give oxygen

• Last 2 trimesters transport on (L) side

• Spinal Immobilization, put blankets under (R) side to elevate to prevent Supine Hypotensive Syndrome

• Rapid transport

• Obstetric History expected due date, complications, prenatal care.

• Feel anything different in fetus?

• How long contractions occurring + lasting?

• Is water broken?

• Does patient feel like they need a bowel movement?

• History of Medical Problems/Medications

• Focus on prenatal care + complications

• Due date, frequency of contractions, previous deliveries

• Water broken?

• Assess major body systems

• Fetal Movement

• Contractions?

• Delivery Imminent: Check Vagina for Crowing but protect patient's privacy

• Pulse Oximetry, Skin, Blood Pressure

• Pulse, Respirations

• Tachycardia (fast hb) + Hypotension (low bp) = Hemorrhage or compression of Vena Cava

• Hypertension (high bp) indicates serious problems

• Repeat Primary Assessment

• ABC's + vaginal bleeding

• Vital Signs

• Hypoperfusion or decreased blood flow

• Interventions/Treatments

• Patient has low pulse oximeter so does fetus

• Apply oxygen

• Imminent Delivery/notify hospital

• Rapid Transport

• Information: Number of Weeks Gestation, Due Date, Complications, thorough documentation

• Complete two patient care reports Obstetrics + Regular

• Has Patient delivered before?

• Does she feel like she has to move her bowels? Infants head is pressing on rectum, delivery is about to occur.

• Check for crowning where infant's head can be seen in vagina.

• Do not touch vagina without partner present.

• Your job is to help, guide, support.

• Use standard precautions.

• surgical scissors or scalpel

• umbilical cord clamps

• umbilical tape

• small rubber bulb syringe

• towels

• 4x4 gauze 2x10 gauze

• sterile gloves

• infant blanket

• sanitary napkins

• goggles

• plastic bag

• Clothing pushed up to waist, remove underwear

• Pillow under hips to elevate 2' to 4'

• Support head, neck, back with pillows

• Each team members has a job caring for mom/other member care for baby

• At home, place towels on floor

• Put patient on floor, elevate hips

• Support head, neck, shoulders with blankets

• Partner at patient's head to comfort her

• Apply oxygen

• Patient grip someone's hand/nausea/vomit

• Clear airway

• Assess for crowning

• Time contractions to determine frequency

• Duration of contraction: feel abdomen

• Contraction = uterus tightens

• Contraction ends = uterus relaxes

• Take quick short breaths/rest breath deeply through mouth

fast labor + birth

Apply gentle pressure to the infant's head while gently stretching the perineum.

Fetus positioned head first in birth canal

• Support bony parts of head with hands. Suction mouth first then nose.

• Upper shoulder appears, guide head down slight.

• Support head + upper body + lower shoulder delivers

• Handle infant firmly but gently. keep neck in neutral position, maintain airway. Keep at level of vagina until umbilical cord is cut.

• Place umbilical cord clamps 2' to 4' apart + cut.

• Allow placenta to deliver itself. Do not pull on cord to speed up.

• Placenta is attached to umbilical cord coming out of vagina.

• Can be 30 minutes after birth

• Size: 7' diameter 1" thick

• Surface rough/divided into two lobes

• Wrap placenta in towel + place in plastic bag to be examined

• Placenta inside mother will cause infection + bleeding

• Put napkin by vagina, rub abdomen in kneading motion

• Standard precautions

• Newborn breaths spontaneously 15 to 30 seconds

• After birth. Heart Rate 120 beats/min. Flick soles of baby's feet to stimulate breathing

• Not breathing after 15 sec/begin CPR.

• dry towels

• infant blanket

• bag mask device 450 mL

• clear mask

• oxygen tubing

• Cover infant's nose + mouth.

• Ventilate high flow oxygen at rate of 40 to 60 breaths.

• Body part delivered first.

• Greater risk for trauma. Mother needs to deliver 10 minutes after buttocks shows.

• Need ALS.

• Make a "V" with gloved fingers + put inside vagina to keep walls of vagina from compressing airway.

passage of fetus + placenta before 20 weeks.
self-induced

• Twins.45 min after Baby A (Average).

• Baby B born within

• no prenatal care

• affects: premature, low birth weight, severe respiratory depression

• 36 weeks of gestation, weigh less than 5 lbs

• Smaller, thinner than full-term

• Head larger than rest of body

• Missing vernix, less body hair

cheesy white coat found on full term baby

• 42 weeks

• Larger baby, weighing more than 10 lbs

• Difficulty delivery

• Meconium aspiration, infection, stillborn

• Infant who died in mother's womb before labor

• Labor will proceed as normal

• Infection will present foul odor

• Stage of Decomposition: Skin blisters, skin slogging, dark discoloration, head soft

• Eye protection, gloves, mask

• Clean towels

• Wipe inside of newborn's mouth with gloved finger

• Keep placenta + infant at same level. Keep infant warm.

• Excessive bleeding 500 mL

• Massage Uterus

• Muscles of Uterus Contracting

• Treatment:shock position, oxygen, vital signs, transport

• Clot that travels through the bloodstream + becomes lodged in the pulmonary circulation.

• Report difficulty breathing/AMS

• Placenta separates prematurely from wall of uterus from hypertension

• Complaints: Severe pain/vaginal bleeding

• Calm patient

• Signs: Shock

• Treatment: High flow oxygen, put patient on (L) side

• Sterile sanitary napkin, keep napkins + any tissues from vagina

• Trauma is leading cause of abruption placenta.

• Where fetus develops

• Bag of waters 500 mL to 1,000 mL

• Insulates floating fetus

• Seizures that occur from hypertension

• Treatment:

• Put patient on (L) side

• Maintain airway

• Supplemental oxygen

• Suction airway

• Rapid transport

• Call ALS

• fertilized egg implants someone other than uterus

• pregnancy develops outside uterus

• in fallopian tubes

• Firm grapefruit-size mass in lower abdomen

• Controls bleeding, helps uterus to contract

• Stimulates mother's nipples to breastfeed

• Infants born to mothers who have abused alcohol

• Newborn of addicted mother with need CPR right away

• Apply oxygen during transport

• blood glucose level

• treatment:diet/exercise/medication

• signs: hyperglycemia or high blood sugar or hypoglycemia low blood sugar

• Cover vagina with sterile pad.

• Change pads often + keep for hospital.

Keep vagina walls from compressing the infant's airway during breech or to push infant's head away from the cord when the cord is prolapse.

• Increased respiratory rate

• Decreasing minute volume

Infant does not breathe after 15 seconds

delivery which head comes out first