RNSG 1412 - Nursing Care of the Childbearing and Childrearing Family

Nursing Care of the Individual with Complications of Labor and Delivery

 

Module Objectives:  

Utilizing critical thinking and the nursing process, the student is expected to:

  1. Define dystocia.

Complication of the Psyche:

  1. Analyze the etiology / pathophysiology / risk factors associated with a complication of the psyche.
  2. Analyze the signs and symptoms of a complication of the psyche.
  3. Analyze the following diagnostic tests including purpose, nursing care, normal values and the interpretation of abnormal values.
    • Friedman’s Graph
  4. Formulate relevant prioritized nursing diagnosis that apply to the woman experiencing a need related to a complication of the psyche.
  5. Formulate patient and family centered goals with outcome criteria that assist the childbearing family toward health promotion, maintenance, and or restoration.
  6. Analyze and prioritize nursing interventions considering human and material resources related to: 
    • Psychological support
    • Non-pharmacological measures
    • Keep informed of progress
    • Provide quiet calm environment
    • Assess support available and provide needed support
  7. Discuss methods of evaluating goal attainment and modification to the nursing care plan.

Complications of the Powers / Uterine Dystocia:

  1. Analyze the etiology/ pathophysiology/ risk factors related to uterine dystocia including:
    • Hypertonic uterine contractions
    • Hypotonic uterine contractions
    • Prolonged labor
    • Precipitous Labor and delivery
  2. Analyze the signs and symptoms of hypertonic and hypotonic uterine contractions. 
  3. Differentiate the signs and symptoms of prolonged labor and precipitous labor.
  4. Analyze and prioritize nursing interventions considering human and material resources related to: 

Hypertonic contractions:

  • Comfort measures
  • Non-pharmacological measures
  • Sedation
  • Bedrest

Hypotonic contractions: (how do each of these interventions stimulate contractions to kick back in?)

  • Ambulation
  • Nipple stimulation
  • Enema
  • Amniotomy
    • What is necessary for this to be a viable option?
    • What is the main nursing intervention following?
  • Pitocin
    • what is the difference between induction and augmentation?
    • why is Pitocin not hung as the primary line?
    • what is the criteria for regulation?
  • Cervical ripening agents

Prolonged labor:

  • Pitocin
  • Cesarean delivery

Precipitous delivery:

  • Gain control of the situation – how is this accomplished?
  • Treat it as an emergency delivery
  1. Discuss methods of evaluating goal attainment and modification to the nursing care plan.

Complication of the Passageway / Pelvic Dystocia:

  1. Analyze the etiology / pathophysiology/ risk factors related to a pelvic Dystocia. 
  2. Analyze the signs and symptoms of a pelvic dystocia
  3. Analyze and prioritize nursing interventions considering human and material resources:
    • Surgical therapy
      • Cesarean delivery
  4. Discuss methods of evaluating goal attainment and modification to the nursing care plan.

Complication of the Passenger:

  1. Compare malpositions and malpresentations.
  2. Analyze signs and symptoms of a complication of labor related to the passenger.
  3. Analyze the following therapeutic interventions including criteria for use, procedure and nursing care.

    Special Obstetrical procedures:

    • Forceps delivery
    • Vacuum extraction
    • Episiotomy
    • Version
    • Cesarean delivery
  4. Discuss methods of evaluating goal attainment and modification to the nursing care plan.

Premature Rupture of the Membranes:

  1. Define Premature Ruptures of the Membranes.
  2. Analyze the major risk factors associated with premature rupture of the membranes.
  3. Analyze signs and symptoms of premature rupture of the membranes.
  4. Discuss the following diagnostic tests
    • Nitrazine paper
    • Ultrasound
    • Blood work -- WBC
  5. Analyze and prioritize nursing interventions considering human and material
    • Drug therapy including action, uses, and nursing implications.
      • Betamethasone / Celestone
    • Other nursing interventions
      • Bedrest, no intercourse, shower only with BRP.
      • Check temperature
      • Describe character of any vaginal drainage
      • Provide psychological support

Preterm Labor:

  1. Define preterm labor
  2. Analyze the most common causes of preterm labor.
  3. Analyze the signs and symptoms of preterm labor.
  4. Analyze and prioritize nursing interventions considering human and material resources. 
    • Drug therapy
      • Tocolytic medications
    • Other Nursing Interventions
      • Chest assessment
      • Patient teaching
      • Increasing fluid intake
      • Monitor uterine activity and fetal kick counts
      • Assessing vital signs
  5. Discuss methods of evaluating goal attainment and modification to the nursing care plan.

Prolapse of the Umbilical Cord:

  1. Analyze the types of prolapse of the umbilical cord.
  2. Analyze common causes that lead to a prolapsed umbilical cord.
  3. Analyze signs and symptoms of a prolapsed umbilical cord.
  4. Formulate patient and family centered goals with outcome criteria that assist the client toward health promotion, maintenance, and/or restoration
  5. Analyze and prioritize nursing interventions considering human and material resources:
    • Position changes
    • Monitoring fetal condition
    • Oxygen therapy

Obstetrical Emergencies -- Ruptured Uterus and Amniotic Fluid Embolism:

  1. Analyze the etiology/ pathophysiology/ risk factors related to rupture of the uterus.
  2. Analyze the etiology of an amniotic fluid embolus.
  3. Analyze the common signs and symptoms of a ruptured uterus.
  4. Analyze the signs and symptoms of an amniotic fluid embolus.
  5. Analyze and prioritize nursing interventions considering human and material resources:
    • Surgery
      • Cesarean delivery
    • Cardiopulmonary resuscitation
    • Hemodynamic monitoring and Blood replacement
    • Psychological support
  6. Analyze methods of evaluating goal attainment and modification to the nursing care plan.
  7. Examine associated issues and trends
    • Legal and ethical considerations

 

Learning Activities:

1. Review module objectives.

2. Learning Resources:

  • Read:  McKinney (2009)
    • Chapter 20
    • Chapter 27

3. Complete Critical Thinking Exercises:

  • See Blackboard – complications of labor and delivery

4. Supplemental Learning:

5. Review module objectives and check for knowledge gaps.


6. Complete module quiz

  • “Complications of Labor and Delivery”