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The Childbearing Family (NUR 4334) Intrapartum

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John Marsh
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Baylor University

The Childbearing Family (NUR 4334)

Intrapartum Nursing Care

Intrapartum Nursing Care
Admission Assessment
o Critical assessment on admission to L&D:
 Is this true labor, & if so, how far has she progressed?
 Is birth imminent?
 Weeks of gestation?
 What is the current status of the mother & fetus?
 General survey of mom, +/- fetal movement, BOW, uterine activity
 Usual order of assessments as greeting woman & escorting her to her room
 Pain (observe posture, breathing, nonverbal messages)
 Gravidity & parity (> 5?)
 Gestational age (38-40 week = term)
 Patient report of membrane status (ruptured, leaking, intact)
 Vaginal bleeding?
 Patient report of contraction frequency, intensity, & duration; when
did the contractions start?
 Presence of medical/OB problems
 Is there a high-risk condition present?
 Risks:
 Age, G, P, > 8 years or < 1 year since last birth, history of
abnormal
 Maternal medical condition (hypertension, DM, surgeries,
obesity, malnourished, labs, expected H/H, infections)
 Genetic diagnosis, fetal diagnosis, fetal/placental anomalies
 Maternal size/fetal size
 Gestational age
 Symptoms of fetal stress (oligo, MSF, decreased FM)
 Complications from this pregnancy or previous pregnancies?
 What support systems are available to assist her?
o Assessment & nursing diagnosis:
 Determination of whether the woman is in true labor or false labor:
 True:
 Regular contractions, gradual increase in frequency & increase
duration & intensity
 Pain increase, intensity w/ walking
 Back discomfort that spreads to abdomen
 Feeling of baby “balling up”
 Cervical changes (dilation/effacement), fetal decent
 ROM, bloody show, rectal pressure, need for BM
 Cervix:
 Progressive change
 Moves to anterior position
 Fetus:
 Presenting part becomes engaged in pelvis
 Engaged in pelvis
 Compresses bladder
 False:
 Discomfort localized in abdomen
 No lower back pain
 Contractions decrease intensity/duration w/ ambulation
 Cervix:
 No cervical change in effacement/dilatation
 Is often in posterior position

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The Childbearing Family (NUR 4334) Intrapartum

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