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no references needed it, just briefly the stages of labor in the table that I just sent, maternal phases, abortion and Epidural ( side effects, adverse effects and nursing interventions) like 5 or 6 slides

Stages of labor . First Stage The first stage of labor is defined as the progression of cervical changes. This stage is divided into three phases: latent phase, active phase, and transition. Characteristics of the first stage of labor are: ▪ It begins with onset of true labor and ends with complete cervical dilation (10 cm) and complete effacement (100%). ▪ Stage 1 is longest stage, typically lasting 12 hours for primigravidas and 8 hours for multigravidas. ▪ There are normally tremendous variations in lengths of labor (Cunningham et al., 2010). ■ The bag of waters or fetal membranes usually ruptures during this stage. ■ The woman’s cardiac output increases. ■ The woman’s pulse may increase. ■ Gastrointestinal motility decreases, which leads to increase in gastric emptying time (Mattson & Smith, 2011). ■ The woman experiences pain associated with UCs that result in the dilation and effacement of the cervix. ■ The first stage has three phases: the latent, active, and transition phases (see Table 8-1). Assessment Assessment during all phases of the first stage of labor includes: ■ Maternal vital signs ■ The woman’s response to labor and pain ■ FHR and UCs ■ Cervical changes ■ Fetal position and descent in the pelvis Nursing Actions Nursing actions during all phases of the first stage of labor are related to: ▪ Diet and hydration ▪ Typically once admitted to the hospital, medical orders limit oral intake to clear liquids ▪ The WHO recommends women dictate their oral intake of carbohydrates to decrease maternal ketosis. (Sharts-Hopko, 2010) ▪ Activity and rest ■ Encouraging frequent position changes and upright posi- tions assists labor progression, facilitates fetal descent, and decreases pain perception. ▪ Elimination ■ Frequent emptying of bowel and bladder assists in comfort of the mother, provides more pelvic room as baby descends, and decreases pressure and injury to the urethra and bowel. ▪ Comfort ■ Providing comfort measures and therapies facilitates labor progress, decreases pain perception, and supports maternal coping mechanisms to manage the labor process. See Critical Component: Non-pharmacologic Strategies for Nurses and Comfort Measures in Labor. ■ Support and family involvement ■ Shown to provide emotional and physical support to the laboring mother, decreasing stress and possibly facilitates labor progress. See Critical Component: Non-pharmacologic Strategies for Nurses and Comfort Measures in Labor. ▪ Education ■ Providing education and information about labor, procedures, and hospital policies will decrease maternal and family anxiety and fear. Empowers the women to make informed decisions. ▪ Safety ■ Providing a safe friendly environment will enhances the birthing experience. ▪ Documentation of labor admission and progression (Figs. 8-22 and 8-23) ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ STAGES OF LABOR 1st 2nd 3rd 4th Phases Latent Active Transition ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Expulsive Placenta Immediate Postpartum Length Primip: average 9 hours up to 19 hours Primip: average 5 hours or 0.5 cm/hr Primip: average 2 hours Primip: average 1–2+ hours 1–20 minutes First 2–4 hours after delivery Cervix Effacing; dilating to 4 cm Effacing; dilating to 7 cm Effacing; dilating to 10 cm Fully dilated and effaced Closing Closing Cramping Uterine Contractions Frequency: 5–15 min Duration: 10–30 sec Intensity: mild Frequency: 3–5 min Duration: 30–45 sec Intensity: mod/strong Frequency: 1–2 min Duration: 40–60 sec Intensity: strong Frequency: 1–2 min Less painful contractions Show Membranes Station None or some Usually intact Primip: 0 Multip: –2–0 Cramps, backache Increasing Heavy Heavy Biological Response May become restless, have labored respiration and tendency to hyperventilate Leg cramps, nausea, vomiting, hiccups, belches, perspiration on forehead and upper lip, a pulling or stretching sensation deep in pelvis Intra-abdominal pres- sure is exerted (bearing down), urge to push, perineum bulges and flattens, perineal burn- ing and stretching Uterus rises and becomes globular shape, gush or flood as placenta sepa- rates, umbilical cord lengthens, cramping Postpartum chills, hunger, thirst, drowsy, moderate to heavy lochia, usu- ally painless uterine contractions Personal System Thoughts centered on self, labor, and baby Needs human presence Becomes limited, losing control, thoughts are on self, uncooperative, amnesic between con- tractions, dependent Slow to react, focus on delivery Relieved Multip: average 6 hours up to 14 hours ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Multip: average 2–3 hours or 1.2 cm/hr Multip: average 1–2 hours Multip: average less than 1 hour Excited, anxious, happy, relief, curious, quiet or talkative, needs information and reassurance Increasing fears, increas- ing anxieties, serious, feels threatened Panic, emotional, irrita- ble response to exter- nal environment stimuli Desires to sleep between contractions, amnesic between contractions May want to sleep, proud, happy, relief, may or may not dis- play emotions Intact or ruptured Usually ruptured Ruptured Primip: 0 – + 2 Primip: 0 – + 2 Primip: progress to + 4 Multip: 0 – + 2 Multip: 0 – + 2 Multip: progress to + 4 May be more serious and inwardly focused Duration: 50–90 sec Intensity: less painful, expulsive C H A P T E R 8 ■ Intrapartum Assessment and Interventions 201 ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Maternal Biological System 1. B/P, pulse, resp. temp q 1–2 hour 1. B/P, pulse, resp. temp q 1–2 hour 1. B/P, pulse, resp. temp. q 1 hour 1. B/P, pulse, resp. q1hour 1. B/P, pulse, resp. q 15 minutes 1. VSq15min 1 hour the Pain 1. Initiate non- pharmacological pain management strategies 1. Relaxation and con- trolled breathing 1. Relaxation and con- trolled breathing 1. Support leg, chest, arms, and back 1. Relaxation breathing 1. Positioning 2. Begin Friedman graph 2. Friedman graph 3. Assess cervical 2. Friedman graph 3. SVE to assess 2. SVE to assess posi- tion, station and progress 2. Assess for bleeding 3. Assess for placen- ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ q 30 minutes 3. Assess cervical changes by SVE changes by SVE PRN cervix, fetal position tal detachment 2. Assess fundus, lochia q 15 min- utes  1 hour, then 30 minutes 4. Assess FHR and UC’s 30 minutes or per protocol 4. Assess FHR and UCs q 15–30 minutes or per protocol 4. Assess FHR and UCs q 15 minutes or per protocol 3. Assess FHR & UC q 5–15 min or per protocol 4. Encourage relaxation 3. Inspect perineum q 15min1hour, then q 30 minutes 5. Ascertain presence of bloody show and ROM 6. Relaxing environment 6. Relaxing environment 5. Prepare primip for delivery at 10 cm 4. Check for bladder distention 6. Encourage relaxation 7. Clear liquids or intake per protocol 7. Clear liquids or intake per protocol 6. Assist in comfort- able position for pushing, encourage upright positions 5. Position of comfort 7. Clear liquids or intake per protocol 8. Encourage void q 2 hours 8. Check bladder distention 6. Diet and fluid as tolerated 8. Encourage void q 2 hours 9. Side or semi- Fowlers position 9. Encourage slow breathing 7. Use squatting bars and birthing balls 9. Position of comfort 10. Wet washcloth, mouth care, per8. Teach and utilize open glottis pushing 2. Assist in diversional activities pain management 3. Pharmacological pain management pain management pharmacological pain management strategies 3. Encourage control breathing 4. Position changes and ambulation 4. Position changes 5. Use non- pharmaco4. Relaxation breathing between contractions 4. Position changes and ambulation 5. Use non- pharmaco- logical pain manage- ment strategies logical pain manage- ment strategies 5. Assist with breathing and pushing ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ 5. Use non- pharma- cological pain man- agement strategies 6. Use nonpharmaco- logical pain manage- ment strategies 5. Assess vaginal secre- tions and for ROM 5. Assess vaginal secretions and for ROM 4. Assess patients readiness and urge to push 5. Ice chips or intake per protocol ineal care, clean dry linen 10. Relieve muscle leg cramps 9. Supportandfacilitate patient’s sponta- neous pushing efforts 2. Back rub 3. Pharmacological 2. Palpate contractions lightly 2. Positioning 3. Pharmacological 2. Positioning 3. Use non3. Use non- pharmacological pain management strategies 11. Multip—prepare for delivery at 8 cm 10. Encouragetorest between contractions 11. Ice chips or intake per protocol 2. Analgesics Continued 202 U N I T 3 ■ The Intrapartal Period ▪ ▪ CRITICAL COMPONENT ▪ Nonpharmacological Strategies for Nurses and Comfort Measures in Labor ▪ Labor support is a repertoire of techniques used to help women with the process of childbirth (Wood & Carr, 2003). Providing support and comfort is one of the primary activities of nurses and includes: ▪ Emotional Support ▪ Sustaining physical presence, eye contact ▪ Verbal encouragement, reassurance, and praise ▪ Listening to woman and family ▪ Distraction ▪ Physical Support ▪ Comfort measures such as ice chips, fluids, food, and pain medications ▪ Hygiene including mouth care, pericare, and changing soiled linens ▪ Assistance with position changes and ambulation ▪ Reassuring touch, massage ▪ Application of heat and cold ▪ Hydrotherapy in shower and tub. Hydrotherapy is safe and ▪ effective as a complementary pain management therapy (Stark & Miller, 2009). ▪ (Wood & Carr, 2003; Burke, 2013) ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Calm environment (dim lighting, quiet, music, minimize inter- ruptions) Informational Support Provide information on the progress of labor. Explain all procedures. Communicate in lay language so the woman and her family understand. Offer advice Use interpreters as needed. Advocacy Support decisions made by the woman and her family. Ensure respect for the woman’s decisions. Manage the environment, which includes visitors. Translate the woman’s wishes to others Support of the Partner and Family Offer support and praise. Role model therapeutic behaviors. Assist the partner with food and rest. Provide breaks if desired or needed. ■ Contraindications for epidural or spinal anesthesia . The woman’s refusal or inability to cooperate with the procedure . Increased intracranial pressure . Infection at the site of needle insertion . Low platelet count . Uncorrected maternal hypovolemia (Chestnut, 2006) ■ Administration of anesthesia by the anesthesiologist or CRNA ▪ Bupivacaine is the preferred anesthetic agent for spinal and epidural blocks. ▪ Preservative-free morphine is administered intrathecally to provide postoperative analgesia (Kuczkowski, Reisner, & Lin, 2006). ■ Position patient with a left tilt to maintain a left uter- ine displacement before, during, and after administra- tion of anesthesia to decrease the risk of aortocaval compression related to compression on the aorta and inferior vena cava due to weight of the gravid uterus (Chestnut, 2006). ■ Monitor vital signs and oxygen saturation. ■ Expected findings ▪ Vitalsignsandoxygensaturationwithinnormallimitswith potential mild increase in blood pressure due to anxiety ▪ Hypotension following administration of the anesthetic agent ■ Monitor level of anesthesia and effectiveness of anesthesia. ■ Estimate blood loss (EBL). An EBL of up to 1,000 cc is expected in a cesarean birth. ■ Administer oxytocin after the delivery of the placenta. ■ Administer antibiotics when indicated. . Abortion Abortion is the spontaneous or elective termination of preg- nancy before 20 weeks’ gestation. Abortions are referred to as induced, elective, therapeutic, and spontaneous. Induced abortion is the medical or surgical termination of pregnancy before fetal viability. Elective abortion is termination of pregnancy before fetal viability at the request of the woman but not for reasons of impaired health of the mother or fetal disease. Termination of pregnancy is done transcervically through dilation of the cervix, then evacuation of the uterus mechanically by curettage, scraping of the contents, or vacu- um. Legally induced abortions have an extremely low com- plication rate. Early medical abortion with medications such as mifepristone and misoprostol can be highly effective. Therapeutic abortion is termination of pregnancy for serious maternal medical indications or serious fetal anomalies. This section focuses on spontaneous abortion as it is associated with hemorrhage. Spontaneous abortion (SAB) is abortion occurring with- out medical or mechanical means, also called miscarriage. Hemorrhage in the decidua basilis followed by necrosis of the tissue usually accompanies abortion. Approximately 10%–30% of pregnancies end in spontaneous abortion. The majority (80%) occur in the first 12 weeks of gestation and are termed early abortion, and more than half of those are a result of chromosomal abnormalities (Cunningham et al., 2010). Early spontaneous abortions typically are related to an abnormality of the zygote, embryo, fetus, or at times the placenta. Late spontaneous abortions are between 12 and 20 weeks’ gestation. Risk Factors for Spontaneous Abortion . Increased parity . Increased maternal and paternal age . Endocrine abnormalities such as diabetes or luteal phase defects . Drug use or environmental toxins . Immunological factors such as autoimmune diseases . Infections . Systemic disorders . Genetic factors . Uterine or cervical abnormalities Assessment Findings for Spontaneous Abortion ▪ Clinical manifestations and categories are listed in Table 7-4. ▪ Uterine bleeding first then cramping abdominal pain in a few hours to several days later ▪ Ultrasound confirms diagnosis. Medical Management for Spontaneous Abortion Medical management depends on classification and signs and symptoms and is presented in Table 7-4. Nursing Actions Related to Care after Spontaneous Abortion ■ Monitor vital signs per protocol and PRN. ■ Monitor bleeding. ■ Review labs. ■ Give RhoGAM if indicated. ■ Follow agency guidelines and facilitate and support the family’s decisions about disposition of the products of conception. ■ Assess significance of loss to woman and family (Gilbert, 2011). ▪ Acknowledge feeling of sadness, distress, or relief toward pregnancy loss. ▪ Give parents’ choices and opportunities for decision making. ▪ Provide family with information on miscarriage, preg- nancy loss, and support groups. ■ Provide psychological support appropriate to family’s response. ■ Discharge teaching related to self-care and warning signs including: ▪ Teach pericare. ▪ Pelvic rest includes no tampons, douching, or sexual inter- course for several weeks. ▪ Teach patient to monitor for excessive bleeding and signs and symptoms of infection such as fever and uterine ten- derness or foul-smelling discharge. ▪ Teach about diet high in iron and protein for tissue repair and red blood cell replacement. ▪ Review plan for follow-up with care provider. Maternal phases, as defined by Rubin (1963, 1967), is a three-phase process that occurs during the first few weeks of the postpartum period (Table 13-2). A delay in transitioning through the phases may indicate that the woman is experiencing difficulty in becoming a mother.

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School: New York University

Hello there,I just finished the presentation you requested. In total it has 7 slides + cover page. ...

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Only issue was the guy's response time which was a bit long, which made me a bit anxious. Reached out to the help desk and they helped me out, turns out the tutors aren't all from US which meant there was a time difference. No issues on the quality.

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