LABOR Induced_Augmented - LABORInduced/Augmented

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LABOR Induced/Augmented This plan of care concerns the induction of labor for maternal health problems, fetal compromise, or postmaturity  (medically indicated inductions), and the augmentation of labor in uterine dysfunction. For optimal use of this plan of  care, combine it with the previous plans of care in this chapter, concerning the normal stages of labor and dysfunctional  labor, as appropriate. CLIENT ASSESSMENT DATA BASE Circulation BP elevation (possibly anxiety or pregnancy-induced hypertension [PIH]); decrease (suggests supine hypotension or  dehydration) Food/Fluid Maternal weight loss of 2.5–3 lb (may be associated with postmaturity or fetal weight loss) Neurosensory Deep tendon reflexes may be brisk 3+ with PIH; presence of clonus indicates severe excitability. Pain/Discomfort Uterine palpation may reveal dysfunctional contractile pattern. Safety May experience SROM without contractions. Elevated temperature (infection in presence of prolonged rupture of membranes). FHR may be greater than 160 bpm if preterm, hypoxic, or septic. Fetal size may indicate weight loss; fetal demise. Greenish amniotic fluid (fetal distress in vertex presentation). Presenting part below the pelvic inlet. Fundus may be lower than anticipated for term, with intrauterine growth retardation/restriction (IUGR) associated with  maternal vascular involvement. History/presence of Rh isoimmunization, chorioamnionitis, diabetes, PIH not controlled by medical therapy, chronic  hypertension, postmaturity, cyanotic maternal cardiac disease, or renal disease; or previous cesarean delivery  with low transverse incision (vertical incision is contraindication). Sexuality Precipitous (or rapid) labor with previous pregnancy; client lives a distance from the hospital. Cervix may be ripe (approximately 50% effacement and 2–3 cm dilated). Uterine inertia may occur. Bloody show may be present with dilation. Increased vaginal bleeding (placenta previa or abruptio placentae are contraindications). May be 42 weeks’ gestational age or more. DIAGNOSTIC STUDIES Complete Blood Count with Differential (CBCD):  Determines presence of anemia and infection, as well as level of  hydration. Blood type and Rh factor,  if not previously done. Urinalysis:  Reveals urinary tract infection, protein, or glucose. Lecithin to Sphingomyelin Ratio:  Determines fetal maturity. Nitrazine Paper and/or Fern Test:  Confirms rupture of membranes.
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LABOR Induced_Augmented - LABORInduced/Augmented

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