GEORGIA BAPTIST COLLEGE OF NURSING
OF MERCER UNIVERSITY
NUR 330 Nursing Care of the Childbearing Family
Unit 4: Holistic Care of the Intrapartum Client
Lesson Plan 4.2: Intrapartum Assessment of the Maternal and Fetal Clients
Lesson Outcomes: Upon completion of this lesson the student will:
1.
Summarize intrapartal physical, psychosocial, and cultural assessments
necessary to assure optimum maternal-fetal outcomes. (C 1, 2, 5, 14)
2.
Describe components of labor status assessment. (C1, 2, 4, 5, 6)
3.
With supervision, perform physical, psychosocial, and cultural assessments
on selected intrapartum clients in various stages of labor and delivery. (C1, 2,
4, 5, 15)
4.
Describe Leopold’s maneuvers. (C 1, 10)
5.
Explain fetal heart baseline characteristics: baseline rate and variability. (C5,
6, 10, 13)
6.
Differentiate between baseline and periodic changes in the fetal heart rate.
(C5, 6, 10, 13)
7.
Describe the characteristics, physiologic basis , and significance of the
following periodic fetal heart rate changes: acceleration, early deceleration,
late deceleration, and variable deceleration. (C5, 6, 10, 13)
8.
Describe appropriate nursing actions for each of the following periodic fetal
heart rate changes: accelerations, early decelerations, late decelerations, and
variable decelerations. (C 2, 5, 6, 10, 12, 13, 16)
9.
Utilize fetal monitor tracings to evaluate baseline fetal heart rate and
variability and the frequency and duration of uterine contractions. (C5, 10, 12)
10.
Identify reassuring and nonreassuring fetal heart rate patterns. (C2, 5, 10, 13)
11.
Describe parameters for use for assessment of uterine contractions. (C2, 5,
10, 16)
12.
Assess the frequency, duration, and intensity of uterine contractions by
palpation and by use of fetal monitor tracing. (C2, 5, 10, 13)
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13.
Discuss the unique nature of pain during labor and birth and variables
influencing a woman’s pain response during labor and birth. (C5, 6, 8, 10)
14.
Describe common nonpharmacological approaches to pain management
during labor. (C1, 2, 5, 10, 12)
15.
Compare the major types of regional analgesia and anesthesia used for pain
management during labor and delivery including area affected, advantages,
disadvantages, techniques for administering, and nursing implications. (C2, 5,
6, 8, 10)
16.
Discuss the narcotic analgesics most commonly used for pain management
during labor including maternal and fetal/newborn effects and nursing
implications. (C2, 5, 6, 8, 10)
Content Outline:
1.
Admission Assessments
1.1. Review of prenatal records
1.1.1. Obstetric history
1.1.2. Current pregnancy
1.1.3. Medical problems
1.1.4. Prenatal screening & diagnostic tests
1.3. Current labor history
1.3.1. Contractions
1.3.2. Amniotic membranes (bag of water)
1.3.3. Bloody show/bleeding
1.4
Health history & physical assessment
1.5. Psychosocial cultural assessment
1.6. Labor status assessment
1.7
Fetal status assessment
1.8. Lab tests
1.8.1. Blood work
1.8.2. Urine
1.9. Risk assessment and risk classification
1.10. CareMaps/Clinical Pathways
2.
Fetal assessment
2.1. Fetal heart rate assessment methods
2.1.1. Auscultation
2.1.2. Electronic fetal monitoring
2.1.2.1. Physiologic basis
2.1.2.2. External mode (ultrasound transducer-US)
2.1.2.3. Internal mode [fetal scalp electrode(FSE) or internal
scalp electrode (ISE)]
2.2. Evaluating electronic fetal monitor tracings
2.2.1. Baseline fetal heart rate characteristics
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3.
2.2.1.1. Rate
2.2.1.2. Variability
2.2.1.3. Factors that can effect baseline characteristics
2.2.2. Periodic changes of the fetal heart rate
2.2.2.1. Accelerations
2.2.2.2. Early decelerations
2.2.2.3. Late decelerations
2.2.2.4. Variable decelerations
2.2.3. Reassuring and nonreassuring FHR patterns
Maternal assessment
3.1. Contractions assessment parameters
3.1.1. Frequency
3.1.2. Duration
3.1.3. Intensity
3.1.4. Resting uterine tone
3.2. Contraction assessment method
3.2.1. Palpation
3.2.2. Electronic monitoring
3.2.2.1. External - tocotransducer
3.2.2.2. Internal - IUPC (Intrauterine pressure catheter)
3.3. Factors that can affect the contraction pattern
3.4. Labor progression (vaginal exam)
3.4.1. Cervical status
3.4.1.1. Position of cervix
3.4.1.2. Dilation
3.4.1.3. Effacement
3.4.2. Amniotic membranes
3.4.2.1. Methods for assessing rupture
3.4.2.2. Assessment of color
3.4.2.3. Documentation of date and time of rupture
3.5.2. Fetal parameters
3.5.2.1. Presentation
3.5.2.2. Station
3.5.2.3. Position
3.6. Coping
3.7. Hydration
3.8. Urinary elimination
3.9. Comfort/Pain
3.9.1. Factors affecting pain response in labor
3.9.2. Pain perception during labor
3.9.3. Nonpharmacologic approaches to pain management)
3.9.4. Pharmacological approaches to pain management
3.9.4.1. Narcotic analgesics
3.9.4.2. Epidural block
3.9.4.3. Pudendal block
3.9.4.4. Local
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Teaching/Learning Activities:
1.
2.
.
Classroom presentation/discussion.
Required reading assignments
Clinical learning experiences with selected intrapartum clients.
Critical Thinking Component:
1.
Utilize maternal assessment data to determine the stage of labor for selected
client's.
2.
Determine the fetal baseline heart rate and variability.
3.
Evaluate fetal heart rate monitor tracings for reassuring and nonreassuring
signs.
Required Readings:
Murray, S. S., & McKinney, E. S. (2006). Foundations of maternal-newborn nursing
(4th ed., pp. 266-284; 306-333; 335-348, 349-351, 353-362). Philadelphia:
W. B. Saunders.
Suggested Readings:
Hindley, C., Hinsliff, S., & Thomson, A. (2006). English midwives' views and
experiences of intrapartum fetal heart rate monitoring in women at low
obstetric risk: conflicts and compromises. Journal of Midwifery & Women's
Health, 51(5), 354-360
Nageotte, M. P. (2007). Avoiding 5 common mistakes in FHR monitoring.
Contemporary OB/GYN, 52(5), 50, 52, 54-55.
Simpson, K. R. (2004). Perinatal patient safety. Standardized language for
electronic fetal heart rate monitoring. MCN: American Journal of
Maternal/Child Nursing, 25, 336..
Wood, S. H. (2003). Should women be given a choice about fetal assessment in
labor? MCN: The American Journal of Maternal Child Nursing, 5, 292-300.
of Advanced Nursing, 32, 1168-1177.
"LP4-2IntraAssess" SKR
Developed 12/99
Reviewed: 5/00 SKR
Revised: 6/01 SKR; 5/02 SKR; 6/03 SKR; 12/04 SKR;12/05 SKR; 12/06 SKR;
1/08:SKR
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