Chapter 17.docx - Chapter 17 Intrapartum Nursing Assessment...

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Chapter 17: Intrapartum Nursing Assessment Maternal Assessment History Maternal and fetal vital signs are immediately assessed. Begin the interview with a statement such as “I am going to be asking you some very personal and specific questions so that we can provide the best care for both you and your baby”. This conveys a nonjudgmental approach. Admission Form: Name/age, LMP and EDB, attending physician, personal data such as blood typing, history of previous illnesses, problems in the prenatal period, pregnancy data (gravida, para etc.), method chosen for newborn feeding, type of childbirth education received, pervious newborn experience, additional data (NST, BPP), and status of fluid. Psychosocial Considerations The parent’s psychosocial readiness can be critical factors in a successful birth experience. It is helpful for women to realize that the pain of labor is natural. Assurance that labor is progressing normally can go a long way. Empowerment and having control over one’s body play key roles in determining whether the woman views her labor and birth positively. How the woman views the birth experience in hindsight may affect her mothering behaviors. Studies have shown that when women are disappointed with their birth experience or are disappointed with their attempts at breastfeeding, they may be more prone to postpartum mood disorders. Laboring woman’s support system also influence the course of labor and birth. Social support tends to have a positive effect. A partner’s presence at the bedside provides a means to enhance communication and to demonstrate feeling of love. Psychosocial Risk Factors Untreated depression can also have potentially lethal adverse effects. Other mental illnesses that may occur in pregnancy include bipolar disorder, anxiety, and schizophrenia. No uncommon for women to be diagnosed with eating disorders, autism, learning disabilities, and attention deficit/hyperactivity disorders. Woman with disorders will need ongoing assessment during the labor and birth. They are at greatest risk for postpartum mood disorders. Woman should be questioned upon admission about intimate partner violence, sexual abuse, and assault without others present. Intrapartum High-Risk Screening The nurse notes the presence of any potential risk factors that may be considered high risk conditions. For example: Woman who reports a physical symptom such as intermittent bleeding needs further assessment to rule out abrupt placenta or placenta previa. It is important to determine the difference between vaginal bleeding and bloody show. o Vaginal Bleeding: Is bright red and more like the type of bleeding from a cut. o Bloody Show: Is brown to reddish brown in color with a tinged vaginal discharge that has a consistency similar to mucus.
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If there is an abnormal fetal presentation, the nurse understands that the labor may be prolonged, prolapse of the umbilical cord is more common, and the chance of a C section incres
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