help OP rotate shorten labor widen pelvic outlet Epidural Anesthesia The Bad

Help op rotate shorten labor widen pelvic outlet

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? help OP rotate, shorten labor, widen pelvic outlet Epidural Anesthesia: The Bad, part 2 Unable to void; may need catheter “Spotty” blocks Mild itching May ↓ neonate’s ability to breastfeed Maternal fever → blood cultures/antibiotics in neonate 103 104 105 106 107 108
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19 Epidural Anesthesia: The Ugly (Contraindications) Bleeding disorders or anticoagulant use Mother low volume (PIH) Thrombocytopenia Infections near site (i.e., herpes) Tattoos are NOT a contraindication More Active Phase Info Check maternal VS hourly; T every 4 hours, unless ROM (hourly, with pulse) Check FHT every 30 minutes in low-risk; every 15 minutes high-risk Note uterine contraction pattern every 30 minutes Transition Phase Patient dilates from 8-10 cm Contractions strong and close together: every 1 ½ - 2 minutes, lasting 60 seconds or more Short phase Nullipara: no >2 hours Multipara: no >1 hour Descent progressive Nullipara: 1 cm/hour Multipara: 2 cm/hour Transition Phase, cont’d… Breathing patterns: pant-blow during contractions & rhythmic chest breathing in- between Head descends; urge to push Patient irritable, discouraged, over-whelmed Give specific instructions Remind her that baby is almost here Encourage her Remain with her Transition Phase, cont’d… Physical sensations: N/V, belching, chills, trembling, sweating, difficulty relaxing Special considerations: Hyperventilation: tingling, dizzy, light-headed Rebreathe exhaled air between contractions Back labor: small of back, difficult to relax, increase in tension Warm or cold compresses Counterpressure to small of back Increase in bloody show Transition Phase, cont’d… Check maternal VS every 30 minutes Check FHT every 30 minutes low-risk; every 15 minutes high-risk 109 110 111 112 113 114
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20 Second Stage of Labor Nullipara: 48-174 minutes, 66 average Multipara: 6-66 minutes, 24 average “precip. packs” Prolonged second stage = >2 hours Pushing sensation: pressure of fetal head on sacral & obturator nerves Woman feels relieved; birth near & actively involved Some fight pushing; fear, loss of control Second Stage of Labor, cont’d… Coach efforts: open glottis pushing Physical sensations: vaginal fullness, rectal pressure, burning, stretching Instruct to stop pushing at birth of head; use pant-blow Second Stage of Labor, cont’d… Check maternal VS every 15 minutes Check FHT every 5-15 minutes (most RNs check after each contraction) Check delivery equipment; O2, suction, Code Pink Team/Code Pink Box, turn on warmer Second Stage: Crowning “Ring of Fire” sensation Episiotomies not performed until this point. Cardinal Movements (Mechanisms) of Labor Engagement Descent Flexion Internal rotation Extension External rotation/restitution External rotation/shoulder rotation Expulsion 115 116 117 118 119 120
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