SCHOOL OF HEALTH AND ALLIED HEALTH SCIENCES Nursing Department SELF-DIRECTED LEARNING 2 (CLINICAL AREA) Name: YBASAN, JHAZMINE L. Group: 3 Date: OCTOBER 15, 2023 I. Complete the needed data on Stages of Labor and Delivery. STAGES OF LABOR I. Dilation of the cervix (mouth of the uterus) II. Delivery of the baby III. Afterbirth where you push the placenta IV. Recovery/Postpartum Period • 1 st Stage Dilation of the cervix (mouth of the uterus) Measured from 3 phases the Latent, Active and the Transition Phase Phases Latent mild and short Active stronger and longer true discomfort Duration of Contractions Cervical Dilatation Duration 20-30 seconds 0-3 cm Nullipara: 6 hours Multipara: 4.5 hours 40-60 seconds 4-7 cm Nullipara: 3 hours Multipara: 2 hours 8-10 cm Until full cervical dilatation Interval: 3-5 minutes Transition at peak intensity 60-90 seconds Interval: 2-3 minutes 2 nd Stage Delivery of the baby • from full dilation and cervical effacement to birth of the infant • CROWNING – fetal head pushes against the perineum, the vaginal introitus opens and the fetal scalp appears at the opening to the vagina Cardinal Movements of Labor • E - ENGAGEMENT • D - DESCENT • F - FLEXION • I - INTERNAL ROTATION • E - EXTENSION • E - EXTERNAL ROTATION 1 • E • 3 rd Stage Afterbirth where you push the placenta Duration: 3-5 MINS UP TO 10 MINUTES - EXPLUSION Types of Placental Separation: Placental Separation - separation begins in the center and fold unto themselves - appears shiny and glistening from the fetal membranes Placental Expulsion - placenta separates at its edges, delivered with maternal surface exposed - appears red, raw and irregular from the ridges that separate the blood collection spaces Signs of Placental Separation: 1. LIGHTENING OF THE UMBILICAL CORD 2. SUDDEN GUSH OF VAGINA 3. Calkin’s sign – FIRM CONTRACTION OF THE UTERUS 4 th Stage Recovery/Postpartum Period • • • • 1 to 4 hours after delivery Monitor vital signs every 15 minutes for 1 hour Primary activity is stabilizing the status of the neonate and mother Focus is on promoting maternal-neonatal bonding Maneuver First Maneuver Second Maneuver Third Maneuver LEOPOLD’S MANEUVER Procedure With both hands, palpate upper abdomen and fundus for: Consistency- head is round, hard, breech is well defined. Mobility- head moves independently, breech less mobile A. With both hands moving down: Palpate the sides of the uterus from the top to bottom. 1. One side- smooth, hand, resistant, surface (back) 2. Other sideangular modulation (knees and elbows) A. With the right hand over the symphysis, identify the presenting part by grasping the lower abdomen with thumb and fingers. B. Assess whether the presenting part is engaged in the pelvis. The nurse alters position by turning toward the patient’s feet, with both Purpose To determine the fetal lying in the fundus. To determine the fetal back for fetal heart tone, usually found in the left lower quadrant. To determine engagement of the presenting part. To determing the degree of flexion of the fetal head. 2 Fourth Maneuver hands; assess the descent of the presenting part by locating the cephalic prominence of brow. A. Place your finger on both sides of uterus, about two inches above inguinal ligament. Press downwards and inward. B. If the fetal back is palpated, it meets no onstruction. C. The other hand will meet obstruction, the fetal brow is palpated. II. Explain the possible indications to the following: Fetal danger signs of labor: a. High or low Fetal Heart Rate • Dehydration: Maternal dehydration can lead to a temporary increase in the fetal heart rate • Fetal heart defects: Some congenital heart abnormalities in the baby can cause a low heart rate. b. Meconium Staining • Fetal distress: One of the primary reasons for meconium staining is fetal distress. When a baby experiences stress or oxygen deprivation in the uterus, they may pass meconium into the amniotic fluid. This can be a sign that the baby is not getting enough oxygen. c. Hyperactivity • Attention-Deficit/Hyperactivity Disorder (ADHD): One of the most common reasons for hyperactivity in children is ADHD. Symptoms include difficulty sustaining attention, impulsivity, and hyperactivity. It often begins in childhood and may persist into adulthood. d. Low Oxygen Saturation • Hypoxemia: A condition where there is an abnormally low level of oxygen in the blood, often due to lung problems such as pneumonia, acute respiratory distress syndrome (ARDS), or chronic obstructive pulmonary disease (COPD). Maternal danger signs of labor: a. High or low blood pressure • Severe Headaches: Persistent, severe headaches that do not respond to OTC pain relievers can be a sign of high blood pressure. • Dizziness or Fainting: Feeling lightheaded, dizzy, or actually fainting, especially when standing up, is a common sign of low blood pressure. b. Abnormal pulse • Chest Pain: Pain or discomfort in the chest, which may be a sign of cardiac issues. c. Inadequate or prolonged contractions • Slow Progress in Labor: Inadequate contractions may result in slow cervical dilation or the failure of the cervix to efface properly. d. Abnormal lower abdominal contour • Bloating or Distention: Abnormal lower abdominal distension or bloating may be caused by issues such as: Gastrointestinal Disturbances, Uterine or Pelvic Abnormalities, Ascites, and Ectopic Pregnancy. e. Increasing apprehension 3 • Depression: Increasing apprehension and persistent feelings of sadness or depression can be a sign of antenatal or postpartum depression. Depression during pregnancy can affect the mother’s health and have implications for the baby’s development. 4 SCHOOL OF HEALTH AND ALLIED HEALTH SCIENCES Nursing Department SELF-DIRECTED LEARNING 1 (CLINICAL AREA) Name: YBASAN, JAHZMINE L. A. Group: 3 Date: OCTOBER 15, 2023 Discuss the following: 1. How is an oral glucose challenge test adm inistered and describe how you will categorize a pregnant wom an to be given such a blood serum examination. An oral glucose challenge test is adm inistered to pregnant women for gestational diabetes. Here’s how it’s typically done: Preparation, Arrival, Baseline Blood Sam ple, Glucose Solution, Wait Tim e, 1-Hour Blood Sam ple, and Interpretation. Categorizing a pregnant woman for an OGCT is typically done between weeks 24 to 28 of pregnancy. However, the exact criteria can vary, and it’s often based on the healthcare provider’s recommendations and the woman’s m edical history. 2. For each of the following activities, explain why it is im portant to discuss this with the pregnant wom an: bathing, breast care, perineal hygiene, dressing, sexual activity, exercise, sleep and travel. BATHING: Discussing bathing is im portant to ensure that the pregnant woman is using safe water tem peratures and avoiding extrem ely hot baths or saunas. Excessive heat can be harm ful to the developing fetus. BREAST CARE: Breast care discussions are crucial because changes in the breasts are common during pregnancy. Proper support and care can help with com fort, especially as the breasts m ay become m ore sensitive and increase in size. PERINEAL HYGIENE: This topic is im portant to m aintain good hygiene to prevent infections or discomfort. Discussing proper perineal care can help a pregnant woman avoid issues like urinary tract infections or irritation. DRESSING: Addressing dressing is about ensuring the woman is comfortable and choosing clothing that accommodates her changing body. It’s also a chance to discuss maternity wear and options for comfort. SEXUAL ACTIVITY: Discussing sexual activity is im portant to address concerns, comfort, and safety. It’s an opportunity to explain in cases of com plications or m edical advice against sexual activity. EXERCISE: Discussing exercise is vital to prom ote a healthy pregnancy. It’s an opportunity to recommend appropriate exercises that can alleviate common discomforts and prepare the body for childbirth. It’s also essential to know the wom an’s physical lim itations and tailor exercise advice accordingly. SLEEP: Adequate sleep is critical for the well-being of both m other and the developing baby. Sleep ensures that the wom an knows how to m anage discomforts, use proper sleeping positions, and deal with sleep disturbances during pregnancy. TRAVEL: Travel discussions focus on safety during pregnancy. It is im portant to address issues like seatbelt use, the tim ing of travel in relation to the due date, and destinations to ensure the woman’s well-being and m inimize risks. 5 3. Describe five categories of potential teratogenic drugs. CATEGORY X: Drugs in this category are considered the most dangerous and should be avoided during pregnancy at all costs. They have clear evidence of teratogenicity and the potential for causing significant harm to the fetus. An exam ple is thalidom ide, which caused severe birth defects in the 1950s and 1960s. CATEGORY D: Drugs in this category have shown evidence of causing harm to the fetus, but their potential benefits m ay outweigh the risks in certain situations. Careful consideration and consultation with a healthcare provider are necessary before using these drugs during pregnancy. An exam ple isotretinoin (Accutane), used to treat severe acne. CATEGORY C: These drugs have demonstrated potential teratogenic effects in anim al studies, but there m ay be situations where the benefits outweigh the risks in hum ans. These drugs are often prescribed during pregnancy when there are no safer alternatives. However, their use should be closely m onitored. An exam ple is some antiepileptic m edications. CATEGORY B: Drugs in this category have shown no evidence of teratogenicity in anim al studies, but there is lim ited data available from hum an studies. These drugs are considered safer choices during pregnancy, but their use should still be carefully considered and discussed with a healthcare provider. Exam ples include som e antibiotics like am oxicillin. CATEGORY A: This is the safest category of drugs during pregnancy. These drugs have been extensively studied in pregnant women, and there is no evidence of harm to the fetus. They are considered safe for use during pregnancy. An exam ple is folic acid, com monly recommended during pregnancy to prevent birth defects. 4. Discuss the relationship between m aternal dietary intake and fetal growth and development. A m other’s diet plays a critical role in fetal growth and development. Adequate nutrition, including essential nutrients, and a balanced diet are essential for a healthy pregnancy and the well-being of the baby. Pregnant wom en should consult with healthcare professionals to ensure they are m eeting their specific dietary requirem ents during pregnancy. B. Develop a teaching plan for the techniques of perineal exercises. Include a proposed time schedule for implementing the exercises for a woman who works from 8:00 am to 5:00 pm. DURATION: 4-WEEK PROGRAM FREQUENCY: 3-4 tim es a week WEEK 1-2: UNDERSTADNING AND AWARENESS WEEK 1 Day 1-2 (Evening-After Work) • Introduction to perineal exercises • Explain the im portance of strong pelvic floor m uscles • Identify the pelvic floor m uscles by stopping the flow of urine while urinating • Discuss the “squeeze and lift” technique Day 3-4 (Evening-After Work) 6 • • • Provide written and visual m aterials on perineal exercises Dem onstrate proper technique for Kegel exercises Instruct to perform 5 sets of 5-second holds, with 5-second rests in between, for a total of 10 repetitions. WEEK 2 Day 1-2 (Evening-After Work) • Review the im portance of consistency • Rem in about the benefits of strong pelvic floor m uscles • Encourage daily practice • Instruct to increase repetitions to 15 sets of 5-second holds with 5-second rests Day 3-4 (Evening-After Work) • Provide feedback on technique • Clarify any questions or concerns • Discuss potential challenges or discomfort and how to address them WEEK 3 Day 1-2 (Evening-After Work) • Introduce a m ore advanced technique: “quick flicks” • Instruct to perform 10 sets of quick flicks with 210-second rest Day 3-4 (Evening-After Work) • Discuss the im portance of m aintaining proper technique • Address any discomfort or pain, em phasizing that exerc ises should not cause pain WEEK 4 Day 1-2 (Evening-After Work) • Sum m arize the benefits and progress achieved • Encourage regular practice beyond the 4-week program Day 3-4 (Evening-After Work) • Discuss lifestyle factors that support pelvic floor health • Em phasize the im portance of continuing exercises for long-term health C. Outline the main features of the popular Lamaze method of birthing. What behavioral characteristics would you look for in the family that would be most appropriate for this method? PRENATAL EDUCATION: Lam aze encourages comprehensive prenatal education, helping expectant parents understand the birthing process, the various stages of labor, and relaxation techniques. NATURAL CHILDBIRTH: The m ethos promotes natural childbirth, focusing on m inimizing m edical interventions and the use of pain relief m edication whenever possible. BREATHING TECHNIQUES: Lam aze teaches various breathing techniques to help m anage pain and discomfort during labor. These include slow, rhythmic, and patterned breathing to stay relaxed. MOVEMENT AND POSITIONING: Lam aze m ethod emphasizes the im portance of staying active and m obile during labor. Wom en are encouraged to m ove, walk, change positions, and use birthing balls to help facilitate labor progress. SUPPORTIVE BIRTH PARTNER: Lam aze encourages active participation of a supportive birth partner, often the father, in the labor process. The birth partner is taught to provide emotional support, offer m assage, and assist with relaxation techniques. RELAXATION: Relaxation techniques, including visualization, guided im agery, and progressive m uscle relaxation, are taught to help m anage pain and reduce tension during labor. 7 8
