RNSG 1327 – Transition to Professional Nursing
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part B – Intrapartum (Labor)
1.
2.
Behavioral Objectives
Define the terms in the content
column as related to the patient in the
intrapartum cycle.
Content Outline
I. Terms
A. Acceleration
B. Active phase
C. Amniotomy
D. Cervical dilation
E. C-section
F. Deceleration (early, late, variable)
G. Duration
H. Effacement
I. Engagement
J. Epidural
K. Episiotomy
L. Fetal attitude
M. Fetal lie
N. Fetal position
O. Fetal presentation
P. Forceps delivery
Q. Frequency
R. Intensity
S. Laceration
T. Latent phase
U. Lightening
V. Pudendal block
W. Station
X. Transition phase
Y. Tubal ligation
Z. Vacuum extraction
AA. Variability
BB. V-BAC
Describe the physiologic changes and
the premonitory indicators of labor.
II. Indicators of labor
A. Physiological changes
B. Psychological changes
C. Hormonal changes
Clinical Objectives
See Unit IVA
Learning Opportunities
See Unit IVA
RNSG 1327 – Transition to Professional Nursing
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part B – Intrapartum (Labor)
Behavioral Objectives
Content Outline
3. Identify factors included in the
III. Intrapartal assessment
assessment of the patient and family
A. Patient history
during the intrapartal phase (labor),
1. Obstetrical history
including developmental and cultural
a. Gravida and para
considerations.
b. Estimated Date of Conception
(EDC)
c. Risk factors
2. True vs. false labor
3. Allergies
4. Current or recent illness (patient &
family)
5. Last ingestion of food/fluids
6. Special physical problems / disabilities
/ discomfort
7. Risk screening
B. Physical status
1. Maternal
a. Vital signs
b. Contractions
c. Vaginal discharge
(1) Type, amount, character
d. Status of membranes
(1) Time of occurrence, amount
and character of amniotic
fluid
e. Contour and size of abdomen
f. Cervical effacement and dilation
2. Determination of fetal status
a. Fetal heart rate (FHR)
b. Presenting part
a. Station
b. Position
C. Psychosocial cultural developmental and
across the life span
1. Knowledge and attitude toward labor
a. Expectations and perceptions
b. Childbirth preparation
Clinical Objectives
Learning Opportunities
RNSG 1327 – Transition to Professional Nursing
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part B – Intrapartum (Labor)
Behavioral Objectives
Content Outline
2. Cultural attitudes toward labor
3. Family Relationships
a. Marital status
b. Desire for presence of family
members
c. Support system
4. Coping behaviors
5. Spiritual concerns
6. Review labor plan with patient
7. Have permits signed
D. Diagnostic studies
1. Vaginal exam
2. Nitrazine test
3. Electronic fetal monitoring
a. Indications
b. External
c. Internal
d. Determination of contraction status
(1)
Frequency
(2)
Duration
(3)
Intensity
(4)
Resting tone
e. Fetal heart rate pattern
(1)
Baseline
(2)
Variability
(3)
Periodic changes
(a) Bradycardia
(b) Tachycardia
(c) Accelerations
(d) Decelerations
 Early
 Late
 Variable
(4)
Pattern determination
(a) Reassuring
(b) Nonreassuring
Clinical Objectives
Learning Opportunities
RNSG 1327 – Transition to Professional Nursing
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part B – Intrapartum (Labor)
Behavioral Objectives
Content Outline
4. Identify the clinical manifestations
and emotional/behavioral changes
experienced in each stage of labor.
IV. Stages and characteristics of labor
A. Stage I (dilation and effacement)
1. Latent (early)
2. Active
3. Transition
B. Stage II (complete – delivery of baby)
C. Stage III (baby – placenta)
D. Stage IV (first hour after delivery)
5. Discuss analysis and planning,
implementation and evaluation of the
nursing management of patients
during the intrapartum cycle.
V. Selected nursing diagnoses / implementation
/evaluation
A. Pain R/T ineffective coping during labor
process
1. Independent interventions
a. Personal hygiene
b. Positioning
c. Psychoprophylactic methods
(1) Relaxation techniques
(2) Breathing
(3) Distraction techniques
d. Comfort measures
e. Environmental control
f. Therapeutic touch
g. Praise and encouragement
h. Observation of cultural influences
i. Complete explanations
j. Support person
2. Collaborative interventions
a. Use of analgesics/anesthetics
(1) Narcotics/sedatives
(2) Epidural block
(3) Spinal block
(4) Pudendal block
(5) General
Clinical Objectives
Learning Opportunities
RNSG 1327 – Transition to Professional Nursing
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part B – Intrapartum (Labor)
Behavioral Objectives
Content Outline
b. Induction methods
(1) Mechanical methods
(a) Nipple stimulation
(b) Amniotomy
(2) Medications
(a) Prostaglandins
(b) Oxytocin therapy (Pitocin)
(c) Cytotec
(d) Methergine
(e) Hemabate
3. Recognition of complications
a. Malpresentation/position
(1) Persistent occiput posterior (OP)
(2) Breech
(3) Other
b. Cephalopelvic disproportion (CPD)
c. Dysfunctional labor patterns
(1) Prolonged labor
(a) Hypotonic labor
(b) Hypertonic labor
(2) Precipitous labor/delivery
(a.) Fetal distress
4. Evaluation of outcomes: The patient will
demonstrate effective coping techniques
for pain during the labor process as
evidenced by:
a. Use of relaxation and breathing
techniques during labor.
b. Requesting appropriate pain relief
measures for the various stages of
labor.
(1) Narcotics – active phase
(2) Regional blocks – active and
transition phases
c. Verbalization of tolerable pain levels
during labor.
Clinical Objectives
Learning Opportunities
RNSG 1327 – Transition to Professional Nursing
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part B – Intrapartum (Labor)
Behavioral Objectives
Content Outline
B. Fluid volume deficit
1. Independent interventions
a. Ongoing assessment of:
(1) Hydration status
(2) V/S & electronic fetal
monitoring
(3) Labor progress
(4) Intake and output
(5) Positioning (lateral)
b. Maintain NPO or clear liquid status
c. Maintain skin integrity
d. Maintain safety – side rails,
positioning for delivery
e. Note the time of delivery of the infant
f. Note the time and method of
placental delivery
g. Note approximate blood loss at time
of delivery
h. Recovery room duties during stage
IV
2. Collaborative interventions
a. Administer replacement fluids – IV
b. Administer medications and monitor
for desired effect/adverse effect/side
effect
(1) Bowel evacuation
(2) Antiemetic
3. Evaluation of outcomes: The patient will
maintain fluid balance as evidenced by:
a. Demonstration of no signs/symptoms
of dehydration.
b. Maintenance of urinary output during
and after labor.
c. Vital signs and Fetal Heart Rate
(FHR)
Clinical Objectives
Learning Opportunities
RNSG 1327 – Transition to Professional Nursing
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part B – Intrapartum (Labor)
Behavioral Objectives
Content Outline
C. High risk for infection
1. Independent interventions
a. Sterile vaginal exams
b. Minimize vaginal exams after
Rupture of Membranes (ROM)
2. Collaborative interventions
a. Shave prep
b. Minimize use of internal monitoring
c. Sterile perineal scrub prior to delivery
3. Evaluation of outcome – The patient will
not experience infection as evidenced by:
a. Vital signs
b. Vaginal bleeding
c. Uterine involution
D. High risk for operative complications
1. Surgical modalities
a. External version
b. Amniotomy/induction
c. Amnioinfusion
d. Episiotomy/laceration repair
e. Forceps delivery
f. Vacuum extraction
g. Cesarean section
h. V-BAC (Vaginal birth after delivery)
i. Tubal ligation
2. Independent interventions
a. Review pertinent assessments
b. Vital signs, fetal monitor pattern
c. I & O
d. Positioning
e. Safety considerations
f. Observe labor progress
Clinical Objectives
Learning Opportunities
RNSG 1327 – Transition to Professional Nursing
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part B – Intrapartum (Labor)
Behavioral Objectives
Content Outline
3. Collaborative interventions
a. Urinary output every 2 hours
b. Administer medications and monitor
for desired effects/side effects
4.
5.
Clinical Objectives
Learning Opportunities
(1) Oxygen
(2) Oxytocic agents
(3) Tocolytics
Recognition of complications
a. Fluid volume deficit – hypovolemia
b. Perineal/rectal lacerations
c. Incisional infection
d. Urinary tract infection
e. Respiratory tract infection
Evaluation of outcome – The patient will
not experience operative complications as
evidenced by:
a. Vital signs
b. Vaginal bleeding
c. Uterine involution
d. Wound healing
e. Bowel sounds
f. Toleration of diet
g. Laboratory studies
N/ADN/Summer12/RNSG 1327 Unit IV Part B Intrapartum (Labor)
Reviewed 03/12
Reviewed 03/13
RNSG 1327 – Transition to Professional Nursing
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part B – Intrapartum (Labor)