Care of Mother, Child, Adolescent (Well Clients)

NCM 207 RLE / DELIVERY ROOM ROTATION

Goals 6. Document to include reporting up-to-

date client care accurately and
 Strengthening spirituality and values comprehensively.
formation 7. Work effectively in collaboration with
 Promoting global competitiveness inter-, intra- and multi- disciplinary and
through better outcomes -based multicultural teams.
education 8. Practice beginning management and
 Sustaining the culture of academic leadership in the delivery of client care
excellence skills using a system approach.
 Upgrading student Sarre services and 9. Conduct research with an experienced
programs researcher.
 Advancing programs through 10. Engage in lifelong learning with a
curriculum review and development passion to keep current with national
 lmproving generation of knowledge and global developments in general
through quality research and and nursing and health developments
publication in particular.
 Creating an environment through better 11. Demonstrate responsible citizenship
customer relations and satisfaction and pride of being a Filipino.
 Strategizing human resource 12. Apply techno-intelligent care systems
management and development and processes in health care delivery.
 Intensifying college-community 13. Adopt the nursing core values in the
engagement practice of the profession.
 Building partnership and linkages 14. Apply entrepreneurial skills in the
 Working continuously towards delivery of nursing care
institutional development both material
or physical and human infrastructures.
Concept: of Delivery Room Nursing
Core Values
 Truth and wisdom LENGTH OF EXPOSURE
 Pursue excellence and quality
 Respect the uniqueness of persons - RLE: Skills Lab- 2 units (102 hours),
 Social responsibility among our people Clinical – 3 Units (153 Hours)
 Family spirit and sense of caring
LEVEL OF STUDENT
Program outcomes - Second year , First Semester
1. Apply knowledge of physical, social,
METHOD OF TEACHING
natural and health sciences, and
humanities in the practice of nursing. 1. Skills Laboratory
2. Provide safe, appropriate, and holistic a. Lecture discussion
care to individuals, families, population b. Demonstration
group and community utilizing nursing c. Return demonstration
process. 2. Orientation conferences (physical set-
3. Apply guidelines and principles of up, routines, rules and regulations,
evidence-based practice in the delivery personnel)
of care. 3. Actual clinical practice with supervision
4. Practice nursing in accordance with 4. Pre and post conferences
existing laws, legal, ethical and moral 5. Incidental teaching.
principles. 6. Individual conferences
5. Communicate effectively in speaking, 7. Ward class ( sharing of drug studies,
writing and presenting using culturally reading and analysis of NCP)
appropriate language. 8. Evaluation conferences (quizzes,
critiquing of NCP, Shifting exam.

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 TEACHING FACILITIES AND HUMAN HISTORY TAKING AND DATA
RESOURCES GATHERING
Related Learning Experiences
1. Teaching Facilities
a. San Pedro Hospital Demographic data
b. Southern Philippines Medical 1. Complete Name
Center 2. Age
c. MM Perez Lying-in 3. Address
d. Nurse Mid Maternity Clinic 4. Reason or chief complaint
e. Bajada Domicillary 5. Time uterine contraction started
2. Human Resources  Duration
a. Clinical Instructors  Frequency
b. Nursing Staff  IntervaL
c. Medical staff
 Intensity
REQUIREMENTS 6. Passage of watery stool or bloody
VRwn mucoid vaginal discharge { thin
1. Checklist of procedures light or white jelly like, red, brown)
2. Manual of Nursing procedures 7. Including vital signs
3. .Complete paraphernalias
4. Complete type B and C uniforms
5. Reading (1)
6. Drug study (1) oy
7. NcP / I
8. .Stool culture
9. Exhibit Forms (3 handled delivery/ 3
assisted delivery’ 3 newborn Gare)

ADMISSION CARE ROUTINE

1. Receive he patient and introduce
yourself Obstetrical Data
2. Don’t allow the patient to walk (SOP
wheelchair), If RROW, LBOW, Severe 1. Gravida Para Abortion ( GPA)
vaginal, bleeding, increase BP, preterm - Number of pregnancies
labor, severely in pain, with bearing 2. Term, Preterm, Abortion and Living
down sensation and etc. (TPAL)
- number of births

GPA
 Gravida- number of the mother got
pregnant- including the present
3. Change with DR slippers/ change pregnancy
wheelchair.  Para- number of pregnancy that has
4. Change slippers Change outside reached the age of viability which is 28
clothes, remove underwear jewelries weeks
and provide privacy, if not  Abortion- number of pregnancy below
contraindicated let patient void or the age of viability
urinate at CR or offer bedpan
5. Bring the patient to receiving area (IE TPAL
room)  Term Births- number of times the
6. Assist in Lithotomy position on IE table. mother has carried a pregnancy to at
7. Do perineal flushing or shaving. least 38-42 weeks gestation and
8. If patient is ready, call on ROD. delivered
9. Assist in attachment of EFM.  Preterm birth- 28 to 37 weeks
10. Assist the patient in the labor room. gestation and delivered

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  Abortion- below the age of viability
 Living children – number of live
births, presently living with the mother
 Post Term – beyond 42 weeks- large
babies

2. EDC/ EDD- Expected date of

confinement/ delivery
- Using Naegele’s Rule

1. GPA= G-3
TPAL= T-2 P-0 A-0 L-2
2. GPA= G-4 P-3 A-0
TPAL= T-2 P-1 A-0 L-3

3. EFW= Estimated Fetal Weight

- Using Johnson’s Rule

1. GPA= G-7 P-2 A-5

TPAL= T-2 P-1 A-5 L-3
2. GPA= G-4 P-2 A-1
TPAL= T-1 P-2 A-0 L-3

4. EFL = Estimated Fetal Length

SUMMARY OF OBSTETRICAL DATA - Using Haases’ Rule
 Gravida - # of pregnancies
 Para - # of pregnancies (28w or above
gestation)
 Abortion - # of pregnancies (below
28w gestaion)
 Term births - # of births (37w or above
gestation)
 Preterm birth - # of births (between
28w - 37w gestation)
 Living children - # of live births
 Post term- # beyond 42 weeks Birth weight Classification

OBSTETRICS COMPUTATION 1. Low birth weight= less than 2500 g

2. Very low weight= less than 1500g
1. AOG = AGE OF GESTATION 3. Extremely low birth weight = less
- 3 METHODS than 1000g
- Computation in weeks based on LMP
- Using Mc’donalds rule. (months)
- Using Bartholomews rule.
(Landmarks)

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 HYPEREMESIS GRAVIDARUM (NAUSEA AND
VOMITING)
- Severe nausea and vomiting during
pregnancy. Symptoms can be
severely uncomfortable
- Can be lead to hydration

VAGINAL BLEEDING
- Bleeding during pregnancy is
common especially during the first
trimester, and usually it’s no cause
for alarm.
- But because bleeding can
HISTORY GATHERING DATA sometimes be a sign of something
 Pregnant develop high blood pressure: serious, it’s important to know the
- Gestational Hypertension possible causes and get checked
out by your doctor to make sure you
 Gestational Diabetes Millitus
and your baby are healthy.
 Laboratories
- Normal during 1st trimester
- CBC (hct,hgt: 12-16 gm/dl
- Excessive bleeding indicates
- Urinary Analysis - to know if the
miscarriage
pregnant woman has bladder
- Common question if there is VB:
infections, diabetes, UTI,
- Consider how much blood
 Sugar
 Ketones
 ABSENCE OF FETAL HEART RATE
 Bacteria
- BPM Moderate= 6 to 25 BPM.
 Proteins
Marked => 25 BPM. The tracing to
- Blood type the right shows an amplitude range
- Rh factor - if parents don’t have the of – 10 BPM moderate Variability.
same rh factor (RH incompatibility) - Image result for absence of FHR
absent variability= amplitude range
HISTORY OF PREVIOUS PREGNANCIES
undetectable. Minimal = <
 Method of delivery intrapartum fetal heart rate
- CS monitoring
- NSVD- Normal Spontaneous - Absence indicates problem inside
Vaginal Delivery the womb or baby
- VBAC - Vaginal Birth After
Cesarean Delivery  SWELLING OF FACE AND LOWER
 Place of delivery EXTREMITIES
 Risk involved or complications - As pregnancy progresses, fluid may
accumulate in tissues, usually in the
feet, ankles, and legs, causing them
to swell and appear puffy. This
condition is called edema.
- Occasionally, the face and hand
also swell. Some fluid accumulation
during pregnancy is normal,
particularly during the 3rd trimester.
It is called physiologic edema.

 SEVERE CONTINUOUS HEAD ACHE

- Tension headaches are common in
first trimester of pregnancy. May
happen because body is
undergoing several changes at this
PRESENT PREGNANC SIGNS time

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 - Hormonal changes - Cervical dilatation and degree of
- Higher blood volume effacement.
- Weight changes - Fetal status, including heart rate,
 PALENESS/ PALLOR DURING PREGNANCY position, and station
- One of the most common causes of - Pain level
paleness is anemia, a condition in
which your body doesn’t have
enough red blood cells to transport
and circulate oxygen
- Particularly susceptible during
pregnancy since blood flow has
increased and need extra iron and
folate to produce enough healthy
RBC.
- Paleness could also be a result of
general fatigue, inadequate sleep,
or vomiting, all common symptoms
of pregnancy.
 PRETERM PREMATURE RUPTURE OF THE
MEMBRANES (PPROM)
- is a pregnancy complication. In this
condition, the sac (amniotic
membrane) surrounding your baby
breaks (ruptures) before week 37 of LEOPOLD’S MANEUVER
pregnancy. Once the sac breaks,
you have an increased risk for - are four specific steps in palpating
infection. You also have a higher the uterus through the abdomen
chance of having your baby born - This method of abdominal palpation
early. is of low cost, easy to perform, and
 IMPLANTATION BLEEDING non-invasive
- Implantation bleeding — typically - It is used to determine the position,
defined as a small amount of light presentation, and engagement of
spotting or bleeding that occurs the fetus in uterus
about 10 to 14 days after - named after the German ©)
conception — is normal. obstetrician and gynecologist
- Implantation bleeding is thought to Christian Gerhard Leopold (1846-
happen when the fertilized egg 1911)
attaches to the lining of the uterus. - part of the physical examination of
pregnant women
BASELINE MATERNAL AND FETAL - Leopold’s Maneuver is oy
STATUS performed after 24 weeks
gestation when fetal outline can be
MATERNAL HEALTH HISTORY
already palpated.
- -Name and age
- Prenatal record data Preparation
- Estimated date of birth
1. Instruct the client to empty the bladder
- History of current pregnancy
first
- Lab results @.g, Blood type and Rh
2. Place the client in dorsal recumbent
status position, supine with knees flexed to
- Past pregnancy and obstetric relax abdominal muscles. Place a small
history pillow under the head for comfort
GENERALIZED ASSESSMENT
3. Drape properly to maintain privacy.
- Fundal ht. measurement 4. Explain procedure to the patient
- Uterine activity, including 5. Warms hands by rubbing together
contraction frequency, duration, and ( cold hands can stimulate uterine
intensity. contractions)

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 6. Use the palm for palpation, not the - Determiners the cephalic
fingers prominence, and the brow should
be on the opposite side of the back.
The Maneuvers - Determines fetal attitude, if head if
1. FUNDAL GRIP flex etc, determines cephalic
- Determines which part of the baby prominence, the brow should be on
is in the fundus, either the head or the opposite side of the back
the buttocks. & Head are firm and -
move independently, buttocks are
soft and move with the body.

FETAL HEART RATE MONITORING

2. UMBILICAL GRIP - process of checking the condition of
- Clinician’s hands are, placed flat the fetus during labor and delivery
and parallel to each other along the by monitoring your fetus's heart rate
abdominal wall at the level of the
umbilicus.
- Determines the location of the back.
The back feels firm and smooth, Q
extremities are small and bent.

INTERNAL EFM
- The doctor will attach an electrode
to the part of the baby’s body that is
closest to the cervical opening. This
is usually the baby's scalp.
3. PAWLICK’S GRIP
- Determines the part in the pelvic FETAL HEART TONE
outlet . Head may or may not be - at the fetal back normal range: 120
engage. — 160 beats/min
- determines the engagement of fetus - instruments used: Stethoscope,
from the pelvic inlet fetoscope, Doppler, Electronic fetal
monitor -should not be taken during
uterine contraction.

PELVIC EXAMINATION

INTERNAL EXAMINATION
- elps determine cervical dilatation,
4. PELVIC GRIP effacement, BOW (bag of water),
- involves the examiner placing the fetal presentation & station
palms of both hands on either side - to monitor the progress of labor.
of the lower abdomen, with the tips
of the fingers facing downward the PREPARATION
pelvic inlet. 1. let the patient void and explain the
procedure.
2. Place the client on lithotomy position.
3. Shave halfmoon.

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 4. Do perineal flushing.
5. Call the OB resident or obstetrician.
6. Assist the Doctor.
7. Get sterile glove from the patient’s
basket.
8. Serve KY jelly

WHAT WILL BE CHECKED DURING AN IE?

1. DILATATION
- opening of the cervical os
- from 1cm to 10 cm
- due to uterine contraction and
amniotic fluid

2. EFFACEMENT
- gradual thinning of the cervical
canal
- Expressed in an Cena fay
percentage (100% is a fully
effaced cervix)

3. BOW ( BAG OF WATER)

- IBOW - Intact Bag of Water
- RBOW - Ruptured Bag of Water UTERINE CONTRACTION MONITORING
- LBOW - Leaking Bag of Water
4. PRESENTATION
EARLY CONTRACTION
- Fetal body part that is in contact - stretching of the ligaments
with the cervix around the uterus dehydration,
constipation and gas pains
- spotting bleeding and abdominal
pain-direct report to the
physician
BRAXTON HICKS CONTRACTION
- second trimester
- false contraction
5. STATION - generally not painful last
- Relationship of the fetal anywhere from 30 seconds to 2
presenting ischial spine © part to minutes and happen randomly
the level of the mother's ischial - can be triggered by things like
spine. exercise and intercourse
PRE-TERM CONTRACTION
- before 37 weeks of pregnancy

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 - contractions that come regularly - A method in which electronic
(every 10 minutes or less) may instruments are used to record
signal preterm labor the heartbeat of the fetus and
LABOR CONTRACTION contractions of the mother's
- True labor contractions might uterus.
start out as an occasional
uncomfortable twinge of the
stomach
- They ll slowly build to something
more like really bad menstrual
cramps or gas pains
- As labor progresses these
contractions will become
stronger more intense and close
together.

FALSE LABOR TRUE LABOR

Irregular interval Regular interval
contractions contractions
Pain in abdomen Starts at back to
abdomen
Intensity remains Contractions are
the same intensified
Intervals remain Intervals gradually
long shorten
Walking gives relief Intensified by
walking
No bloody show With bloody show
No cervical Cervical dilatation
changes and effacement
Contractions stop Does not stop with
with sedation sedation

TOCO TRANSDUCER

- A pressure-sensitive device
called a tocodynamometer is
placed on the mother s abdomen
over the area of strongest
contractions to measure the
length frequency and strength of
uterine contractions

ELECTRONIC FETAL MONITORING

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