Labor And Delivery Nursing

Labor and Delivery Nursing

Introduction of the client

CLIENT NAME: Monica H M

ETHNICITY: Mexican

SOCIAL BACKGROUND:

The client comes from san Francisco where he lives with the husband and her extended family members, she has several friends who help her when the husband is away and the elderly parents chip in where they can and they to provide required support morally especially during the periods of her labor pains which have bee n on for the past two to three weeks.

The environment around in some general terms has been very favorable as everyone has been concerned with her ongoing and very supportive.

Culture influence

The lady having been brought up by immigrant parents who have let her coexist with the rest of the American society is under no serious cultural influence other than the general expectations of proper care for the unborn child the farther of the child has no problems with the method of delivery the mum uses a major debate with some cultures within this area.

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Care choices

She is not so much of the idea of a nanny as she believe she will have enough time to care for the new born plus the family will provide the required assistance incase she is not able to do some of her duties.

Reasons for her admission

The client started experiencing some acute problems in her back twenty hours ago having suffered the same pains earlier on she decided to take some of the medication that had been prescribed earlier in her prenatal sessions. The medication did not work and the pain persisted which led to her being admitted.

Signs of labor

The client has shown at least the following three strong signs of labor

Backache she says she has had backaches for the past two weeks and medication does not seem to have an effect on them, she has tried several of the prescriptions given by the doctor over her prenatal period but non of them has worked this time around.

Loose stool the client has had loose stool for the past couple of days and has had no food

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poisoning or other related issues t hat may lead to loose stool.

Bloody show the client has noticed traces of pink or, brown or red tinged mucous in her inner clothing’s for the past three or so days. She says she has never had those kinds of discharges earlier which is understandable being a first time mother.

With time she says her contractions have become more intense and frequent as compared to the other months of her pregnancy, she also she has heard them get closer and become very strong for the past few days. (Murk off H and Mazel S 2008).

Risks

The mother had earlier on been a smoker though with time she has stopped this she says was after she realized she was pregnant, besides smoking she says she has used sub stances with a high concentration of caffeine in most of her life but says since she started the prenatal sessions she has not taken most of these substances.

The other risk that may affect the child is the mother blood pressure which was quite high in the early days of her pregnancy though tremendous progress has been made in maintaining her blood pressure at the right levels.

The other thing was the baby’s initial position which seemed to have a problem at the seventh month though the posit ion seems okay on the recent examination.

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The stages of labor

First stage this is defined by cervical dilations and contractions that may last for about 30-45 minutes.

1. The symptoms at this stage are mainly

2. Continuous backaches and nesting urges

3. Contractions progress over time by getting longer, stronger and closer.

4. Mild moderate intensity during contractions though in between contractions she may b e able to behave normally.

This stage ends when cervical dilation is complete that is at about 10 centimeters.

Treatment

At this stage electronic fetal heart monitoring is recommended to ensure that the baby’s heart rate is good and look at for the general health of the baby. This can be done during pregnancy, labor and at delivery to keep track of the baby’s heart rate.

-Augmentation process should also be carried out to prevent postpartum hemorrhage and induce labor the methods that may be used in this procedure include pitocin and other natural methods such as walking.

-Amniotomy which involves breaking waters to induce labor can al so be used at this stage of labor.

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-Medicine that may be administered at this stage should only be used to relieve pain unless other complications are present at this stage, pain relievers mainly use are morphine though he use of this would require the use of a counteractive drug to counter the effect s of morphine in both the child and the baby. (McCarthy J 2008)

IV fluids

These are given to mothers through a vein in the hand, the procedure involves a tube injecting a small tube in the vein this tube is taped into place and is connected to a bag containing sline mixture.

Most doctors prefer using IV so that they can give drugs quickly to the mother incase of emergencies. While these fluids maybe necessary to some mothers to others it may not be and may even cause serious drawbacks.

The most common IV fluids are the saline fluids which helps women not to suffer from dehydration. The other common fluid is the pitocin which is common of laboring women, mimics the natural labor-stimulating hormone oxytocin which has been linked to violent labor which is dangerous to both the mother and the fetus; this is resolved with emergency caesarean.

The mother at this point is very distressed and pain is evident in her moves, they also start being emotional at this stage and shout.

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The support person at this stage is essential as he/she helps the mother in relaxing activities such as reading, walking, breathing exercises during contractions as needed. In most case at this stage the mothers can safely stay at home during the early labor checks.

Towards the end of this stage the support people should encourage position changes, vocalizing; other comfort measures that may be needed at this stage include verbal encouragement during every contraction.

The second stage

This happens in three phases which are noted as below

First phase-resting phase

This phase occurs for about 10-20 minutes when the dilation has reached 10 centimeters, it is characterized by minimal or no contractions and no urge to b ear down is seen.

Decent phase

Occurs with contractions 3-5 minutes apart which last for about 60 seconds, major signs are contractions accompanied by a strong urge to bear down several times with each contraction, at this stage the baby’s head descends down with each contraction and then recedes.

This is the last phase and is defined by the baby’s head descending to the opening of the

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vagina and does not recede with contractions.

Signs at this stage include, this stage is the most tense stage for the mother and with a sense of stretching followed by burning.

Treatment at this stage

-Epistomy this is cutting of the skin between the vagina and the anus to enlarge the virginal opening so that the baby can be more easily delivered.

-Lacerations this is the medical term for a cut which may be large or small and may bleed a lot, this would require the person in charge of the delivery to take utmost care so as to ensure that no hemorrhage occurs at delivery furthermore such risky procedures such as lacerations should be avoided if an alternative is available. (Murk off H and Mazel S 2008).

APGAR test this is the very first test that is carried out on the newly born child at the delivery room. The test was designed to quickly evaluate a newborn s physical condition after delivery and to determine any immediate need for extra medical or emergency care. This test is usually given to your baby twice once at one minute after birth and the other after five minutes. Rarely if there are concerns about the baby’s condition and the first two scores are low, the test may be scored for the third time at ten minutes after birth. (Mayo clinic 2004)

There are five factors used to evaluate the baby’s condition and each factor is sc ored as a scale 0-2, with two being the best score.

What the doctors look out in this test is

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1. activity and muscle tone

2. pulse (heart rate)

3. grimace response which is medically known as reflex irritability.

4. appearance which is the check on skin coloration

5. respiration which is the examination on breathing rate and effort.

Support people at this phase should do the following: Encourage rest, review pushing position, remind the mother to empty bladder if un-medicated, drink lots of fluids and wait for the urge to weigh down.

Most doctors consider rectal temperature taking as the most accurate method of taking an infants temperature this is because it gives the best temperatures of the infant where the temperature is not subjected to other influencing factors such as the effect of external temperatures

There are other procedures conducted by the doctor to ensure that the infant’s systems are all functional these include:

Suctioning which involves blowing into the infants system to ensure that the airway of mucus is clear, other reasons that may prompt suctioning are:-

1. to clear congestion heard in nose or throat

2. gurgling heard in throat

3. restlessness, increased breathing rate, blue color, increased heart rate.

Proper suctioning equipments should be used mainly the suction catheter.

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Drug administration at this stage depends on the health of the infant with a large variety of medicine available to cater for the infants health these ran de from antibiotics to paracetamol, other drugs that are not so commonly used in treatment of kids are corticosteroids and penicillin.

-Encourage position changes as mother prefers or if no noticeable progress, rest in between contractions.

-Ask if the mother can have cool compress to perineum for comfort, the mother should be reminded to slow her pushing to ease baby’s head out. (McCarthy J 2008)

The third stage

In most case this is considered as the last stage in lab or and occurs about 20-30 minute after the baby is born the signs at this point include some cramping and slight pushing to deliver the placenta.

The mother at this stage may experience small contractions which are a signal of the placenta separating from the uterine wall and ready to be delivered. Pressure may be applied by massage to the uterus and the umbilical cord may be gently pulled. The result will be the delivery of the placenta also referred to as afterbirth.

Time wise this is the shortest stage of the four stages of labor taking about five to thirty minutes on average.

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The fourth stage of labor

This stage is normally more of the mother getting back to normalcy. At this stage the blood pressure, temperature and heart rate will mostly stabilize.

Contractions will cease the uterus will harden and doing its job to tighten around the blood vessel s that had supplied the placenta and your baby with nutrients.

The doctor’s role at this stage is to ensure that the placenta was expelled and take a look at the umbilical cord, if the mother had an epistomy this is the stage where she gets sutures.

Other procedures will be ensuring that the mother never suffered any tears and if she did will repair them.

Lochia check involves checking on the woman’s bleeding after birth which is a normal thing but which should be controlled if abnormal ,the normal bleeding may take something about two or three weeks with the flow tapering gradually.

Fundal checks (post) is conducted to ensure that the contraction of the uterus is taking place after the child birth, this check on the firmness and position of the uterus. (Mayo clinic 2004)

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Conclusion

The experience in the L&D really helped me conceptualize on the theoretical knowledge I have gathered within my lecture. It has opened up most issues with actual labor process something that was not with the class lessons. Am grateful and feel much ready to help with the labor procedures in the future.

References

Iovine V (2007) Girlfriends guide to pregnancy, Pocket publisher

Mayo clinic (2004) Mayo clinic guide to a healthy pregnancy. Dacapo press.

Murk off H and Mazel S (2008). What to do when expecting, Dacapo press.

McCarthy J (2005). Naked truth about Pregnancy. Dutton Adult publisher

McCarthy J(2008) The truth about motherhood., Dutton Adult publisher.

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