Intrapartal Unit HandoutLINCOLN MEMORIAL UNIVERSITYCAYLOR SCHOOL OF NURSINGNURS 246SPRING 2008LESSON PLAN: CARE OF WOMEN DURING THE INTRAPARTALPERIODDATES & TIMES: SEE SYLLABUSOBJECTIVES: Upon completion of this unit, the student will demonstrate inthe clinical/community setting, in individual and group conferences, and on written material an understanding of thefollowing:1. Define the key terms found in each assigned chapter.2. Recognize the premonitory signs of labor and relate these to the proposed theories that explain the onset of labor.3. Describe the psychosocial and cultural considerations and communication techniques utilized when caring for the laboring client.4. Discuss the maternal and fetal system responses to labor and birth. 5. Differentiate the signs and symptoms of true versus false labor.6. Discuss the significance of the critical factors that affect labor and delivery: Powers, Passageway, and Passenger.7. Relate the importance of the cardinal movements to the progress of labor and fetal response.8. Describe the relationship between the fetus and the maternal pelvis, as well as the impact of this relationship on the progress of normal labor.9. Identify characteristics of the stages and phases of normal labor. Provide appropriate nursing interventions for each.10. Differentiate the normal characteristics between nulliparous and parous clients in labor.11. Develop a plan of care that maintains and promotes the well-being of the mother and fetus throughout each stage and phase of labor.12. Recognize warning signs that indicate alterations from normal progress during labor and delivery.13. Describe the procedure for Leopold’s Maneuvers and the implications of the information obtained.14. Differentiate between internal and external methods of monitoring uterine activity and fetal heart rate (FHR).15. Recognize various patterns in fetal heart rate and appropriate nursing interventions for each pattern.16. Identify methods of cervical ripening and induction of labor.17. Identify the use, side effects, action, and nursing implications for drugs used in cervical ripening and induction of labor.118. Explain the nurse’s responsibilities following spontaneous or artificial rupture of membranes.19. Describe findings of vaginal examinations of laboring patients.20. Discuss nursing strategies to address fluid and elimination needs during labor.21. Describe the two major theories related to pain.22. Outline the nursing interventions and implications for nonpharmacological and pharmacological methods of pain management during labor.23. Compare and contrast the different methods used to achieve analgesia and anesthesia during labor and delivery. 24. Identify uses, side effects, action and nursing implications of drugs used in pain management during labor and delivery.25. Discuss the role of the nurse during obstetrical procedures: forceps assisted delivery, vacuum assisted delivery, cesarean birth, and vaginal birth after cesarean delivery (VBAC)26. Explain the mechanism of placental separation and expulsion.27. Discuss the nursing management of common problems that may occur during labor and delivery: hypotonic / hypertonic labor, malpresentations, occipitoposterior position (OP), shoulder dystocia, cephlopelvic disproportion, Preterm labor, post-termpregnancy, hemorrhagic problems, cord prolapse, amniotic fluid embolism, and maternal obesity.REQUIRED READINGS:Orshan, S. A. (2008). Maternity, newborn, & women’s health nursing: Comprehensive care across the life span. Philadelphia: Lippincott,Williams & Wilkins. Chapters 12, 15, 16, 17.TOPICAL OUTLINE:I. Processes of Labor & DeliveryA. Physiology of Labor & Delivery1. Etiology of Labora. progesterone withdrawalb. oxytocin productionc. prostaglandin productiond. estrogen stimulatione. fetal influencesf. other2. Premonitory Signs of Approaching Labor3. True Versus False Labor4. Maternal Responses to Labor5. Fetal Responses to Labor6. Critical “P’s” in Labor & Deliverya. Powersb. Passageway2c. Passengerd. PsycheB. Nursing Management During Stages of Labor & Delivery1. Stages & Phases of Labor2. Admission Assessmenta. Historyb. Physical Assessmentc. Psychosocial/Cultural Assessmentd. High Risk Screening3. Nursing Assessment of Maternal Labor Progressa. Cervical Assessmentb. Contraction Assessment4. Nursing Assessment: The Fetus Experiencing the Labor Processa. Determination of Fetal Position/Presentationb. Auscultation of Fetal Heart Rate (FHR)c. Electronic Fetal Monitoring (EFM)1. external2. internald. Nursing Assessment: FHR Patterns & ChangesII. Nursing Implications: Care of the Woman Undergoing Analgesia/AnesthesiaA. Basics of Pain1. Physiology of Labor Pain2. Pain in Stages of Labor3. Theories of Pain4. Influences on Pain ManagementB. Types of Pharmacologic Pain Management1. Sedative Hypnotics2. Analgesic Compoundsa. Opioidsb. narcotic agonist-antagonist3. Anesthesiaa. localb. pudendalc. epidurald. combined spinal epidural anesthesiae. Spinalf. generalIII. Nursing Care of Women Experiencing Complications during Labor & DeliveryA. Dysfunctional Labor1. arrest disorders/CPD2. dysfunctional powersa. hypertonic contractionsb. hypotonic contractionsc. precipitous labor/delivery33. Problems with the Passengera. breech/malpresentationb. OP/malpositionc. shoulder dystociad. macrosomia/fetal abnormalities4. Problems with Passagewaya. dysfunctional pelvic shapeB. Premature rupture of membranes C. Preterm Labor & DeliveryD. Postterm Pregnancy & DeliveryE. Bleeding Disorders/Obstetrical Emergencies1. Spontaneous AB 2. Hydaitaform mole 3. placenta previa4. abruptio placenta5. placental abnormalities6. uterine rupture7. umbilical cord prolapse F. Multiple GestationIV. Role of the Nurse During Obstetrical ProceduresA. Cervical Ripening/Labor InductionB. AmnioinfusionC. Forceps-Assisted/Vacuum-Assisted BirthD. Cesarean BirthE. VBACSKILLS: The following skills would be appropriate for N246 students in the clinical or community setting:1. Observe/assist in the admission of a patient for possible labor/labor induction.2. Assess a patient for true versus false labor.3. Complete a Psycho-socio-cultural assessment of a labor patient and family.4. Observe/assist in the assessment of “rupture of membranes” via the utilization of nitrazine paper and slide for ferning.5. Observe/assist in placing a patient on the fetal monitor.6. Assess for baseline fetal heart rate, as well as periodic changes.7. Determine frequency,