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 4.3: Nursing Management of the Intrapartum Family
Lesson Outcomes: Upon completion of this lesson the learner will:
1.
Explain the physiological and psychosocial nursing care of the maternal
and/or fetal clients during each stage and phase of labor. (C 1, 4)
2.
Discuss the nurse's role in providing support for the intrapartum client's
designated support person. (C 1, 4)
3.
Explain the nurse's role in providing labor support. (C 10)
4.
Discuss the use of doulas for providing labor support. (C 5, 6, 10)
5.
Formulate maternal/fetal intrapartum nursing diagnoses based on the
analysis of maternal and fetal prenatal and intrapartum assessment data.
(C 2, 8, 10)
6.
Utilize intrapartum standards of care (CareMaps, Clinical Pathways,
Protocols) when planning and implementing nursing carefor intrapartum
clients. (C 1, 2, 3, 5, 7, 10, 12, 13, 15, 16, 18)
7.
Evaluate maternal and fetal responses to nursing interventions implemented
during labor. (C 2, 12)
8.
Evaluate maternal and fetal clients responses for attainment of desired
outcomes. (C 2, 12)
9.
Evaluate maternal and/or fetal signs assessment data for evidence of
developing complications and determine nursing what nursing interventions
are required. (C 2, 10, 12, 13)
10.
Explain nursing actions required when umbilical cord prolapse occurs.
(C 5, 8, 10, 12)
11.
Describe the nursing management of childbirth nurse when medical
assistance (MD or CNM) is not available. (C 5, 10, 12, 13)
12.
Discuss protocols for the induction and augmentation of labor including the
action, side effects, and nursing implications for dinoprostone gel (Prepidil,
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dinoprostone vaginal insert (Cervidil), misoprostol (Cytotec) and oxytocin
(Pitocin). (C5, 10).
13.
Discuss selected nursing research findings related to labor and childbirth.
(C 6)
Content Outline:
1.
Nursing and collaborative management during first stage of labor
1.1. Ongoing maternal and fetal assessments
1.1.1. Maternal vital signs
1.1.2. Fetal heart rate
1.1.3. Contraction pattern
1.1.4. Labor progress
1.1.4.1. Cervical status
1.1.4.2. Fetal descent
1.1.5. Bladder status
1.2. Therapeutic nursing interventions
1.2.1. Comfort measures
1.2.2. Teaching and pyschosocial considerations
1.2.3. Hydration and calories
1.2.4. Activity and positioning
1.2.5. Monitoring intake and output
1.2.6. Pain management
1.2.7. Implementing Group B Strep protocols
1.2.8. Supporting and coaching
1.2.9. Supporting family members
1.3. Induction and/or augmentation of labor
1.3.1. Indications for induction or augmentation
1.3.2. Cervical ripening methods
1.3.3. Amniotomy
1.3.4. Oxytocin
1.3.6. Nursing responsibilities
1.4. Related research findings
2.
Nursing and collaborative management during the second stage of labor
2.1. Ongoing maternal and fetal assessments
2.1.1. Contraction pattern
2.1.2. Bloody show
2.1.3. Pushing with contractions
2.1.3.1. Spontaneous vs. "directed" pushing (research
findings)
2.1.3.2. Positioning for effective pushing
2.1.3.3. Open glottis vs. closed glottis pushing
2.1.4. Maternal behavior
2.1.5. Fetal heart rate changes
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2.2.
2.3.
2.4.
2.5.
Preparations for the delivery
Nurse's role
Obstetric procedures
2.4.1. Episiotomy
2.4.1.1. Benefits
2.4.1.2. Risks
2.4.1.3. Nursing responsibilitis
2.4.2. Forceps and Vacuum Extraction
2.4.2.1. Benefits
2.4.2.2. Risks
2.4.2.3. Nursing responsibilities
Immediate newborn care [Covered under Lesson Plan 5 - Holistic Care
of the Neonatal Client]
3.
Nursing care and collaborative management during the third stage
3.1. Maternal assessment
3.1.1. Signs of placental separation
3.1.2. Maternal physical status
3.1.2.1. Vital signs
3.1.2.2. Bleeding
3.2. Oxytocin administration
3.3. Placental assessment
4.
Nursing management of childbirth when MD or CNM is not available.
5.
Nursing and collaborative management during th fourth stage of labor
(immediate postpartum period) [Covered under Lesson Plan 6 - Holistic Care
of the Postpartal Client and Family]
6.
Cultural considerations during the intrapartum period
7.
Common nursing diagnoses during the intrapartum period
Teaching/Learning Activities:
1.
Classroom presentation/discussion
2.
Selected audiovisual media
3.
Assigned readings
4.
Clinical experience in labor and delivery setting
Critical Thinking Activities:
1.
2.
3.
Formulate nursing diagnoses for selected intrapartum clients.
Prioritize nursing diagnoses for selected intrapartum clients.
Modify plan of care based on the client's birth plan and/or cultural beliefs.
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Required Readings:
Murray, S. S., & McKinney, E. S. (2006). Foundations of maternal-newborn nursing
(4th ed., pp. 266-305, 365-372, 374-378 [operative vaginal birth and
episiotomy], ). Philadelphia: W. B. Saunders.
Suggested Readings:
Ballen, L. B., & Fulcher, A. J. (2006). Nurses and doulas: Complimentary roles to
provide optimal maternity care. JOGNN: Journal of Obstetrics,Gynecologic,
Neonatal Nursing, 35, 304-311.
LaMaze International (2007). Position Paper: Supporting, promoting, and protecting
normal birth. Journal of Perinatal Education, 16(3), 11-15
MacKinnon, K., McIntyre, M., & Quance, M. (2005). The meaning of the nurse’s
presence during childbirth. JOGNN: Journal of Obstetrics,Gynecologic,
Neonatal Nursing, 34, 28-36.
Ruhl, C, [Moderator]. (2006). Labor support: Exploring its role in modern and hightech birthing practices. AWHONN Lifelines, 10, 58-65.
Sauls, D. J. (2006). Dimensions of professional labor support for intrapartum
practice. Journal of Nursing Scholarship, 38(1), 36-41.
Simpson, K. (2005). The context & clinical evidence for common nursing practices
during labor. MCN: The American Journal of Maternal Child Nursing, 30, 356365..
Simpson, K., & Knox, G. (2005). Priority #1: safety. Essential criteria to promote safe
care during labor and birth. AWHONN Lifelines, 9, 478-483
Trammer, J. E., Hodnett, E. D., Hannah, M. E., & Stevens, B. J. (2005). The effect
of unrestricted oral carbohydrate intake on labor progress. JOGNN: Journal
of Obstetric, Gynecologic, and Neonatal Nursing, 34, 319-328.
"LP4-3IntraNsgcare" 1/98 SKR
Revised: 5/99 SKR; 10/01 SKR; 5/02 SKR; 6/03 SKR;12/04 SKR; 12/05SKR;
12/06 SKR; 2/08 SKR
Reviewed: 5/00 SKR.
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