12 Nursing care of Laboring and Delivering ext

第　12　章 待產及分娩的護理 (Nursing care of Laboring and Delivering) 黃美惠 助理教授 ext. 3060 0973 -359 -612 mhhuang@tajen. edu. tw

Routine Care Interview： Frequency? Duration? Dilation? Effacement? Station? Bloody show? Rupture of membrane? General health assessment Discomfort when contraction happens（ e. g. low back pain）

Routine Care Labor preparation shaving enema T Reasons for enema: • 避免第二產程排便，汙染無菌區 T 避免enama之狀況： • 急產、bloody show 、安胎的個案、破水、 胎兒窘迫

Routine Care Fetal health assessment FHR Variation of FHR v. s. Uterus contraction Tacceleration Tdeceleration Monitor for 20～ 30 min

LABOR PAIN

Pain transmission Fear anxiety and pain Labor pain and management Stage one of labor: T Uterus contraction, lower back and abdomen pain T pain transmission: from T 10～ 12, L 1 into spinal cord Stage two of labor: T Perineum area (會陰部) T Pain transmission: S 2～ 4

PAIN CONTROL Tranquilizer Narcotic analgesics Anesthesia

Pain relief medication Tranquilizer help relieving anxiety may reduce FHR variation, e. g. Diazepam(valium) Narcotic analgesics Meperidine（Demerol®）最常用的麻醉性 鎮痛劑，作用時間持續3～ 4 hrs Fentanyl（Sublimaze®）

Regional anesthesia (區域麻醉) Medication: Lidocaine（Xylocaine®） Types: T Lumber Epidural anesthesia T Spinal anesthesia

Regional anesthesia Lumbar Epidural Anesthesia Painless labor(無痛分娩) 產痛正式開始 T intensity 50～ 70 mm. Hg T dilation 4 cm 產婦能維持清醒，運動神經只有部分阻斷， 因此可以配合用力來加速產程

Anesthesia Nursing care for Epidural Anes. ： T Monitor V/S, FHR T IV infusion 500～ 1000 c. c. NS or Ringer’s solution to prevent hypotension T不使用含 glucose的溶液，免影響胎兒之blood sugar T low dose PCA (Patient-controlled analgesia): 運動神經阻斷較輕微，新生兒呼吸抑制的機 會較低

Regional anesthesia Side effects T Hypotension – most common • BP 20% lower than before anes. • Systolic pressure under 100 mm. Hg • Intervention: 左側躺、IV infusion、O 2 supply、ephedrine inj. 、monitor v/s T Respiration suppression • RR under 14/min • Intervention: Naloxone inj.

Regional anesthesia Spinal Anesthesia for C-Section inject medication into spinal cord onset within 1～ 2 min last 1～ 3 hrs

Regional anesthesia Nursing care for spinal anes. T Monitor V/S, FHR T IV infusion 500～ 1000 c. c. NS or Ringer’s solution to prevent hypotension T不墊枕頭平躺約6～ 12小時，生產後亦需仰臥 T給予大量水分(約3000 c. c. /天)，預防麻醉後頭 痛

Complications of anes. Hypotension Respiratory depression Total spinal anesthesia (全脊髓麻醉) Epidural 導管誤植入脊髓腔, 引起過度脊髓 麻醉 Spinal headache(脊髓性頭痛) 硬腦膜穿刺後，腦脊髓液漏出引起

NURSING CARE FOR LABOR STAGES

Stage one of labor Definition and time 潛伏期(0 -3 cm) 、活動期(4 -7 cm) 、過渡期(810 cm) Mother and fetus assessment Encourage father’s participation

Nursing care for stage 1 引導呼吸運動 T 避免 hyperventilation (respiratory alkalosis)

Stage two of labor definition and time delivery preparation newborn care preparation delivery position 產婦的生產姿勢 T臥位、辛氏左側臥式、半坐臥式、坐姿、蹲姿 mother and fetus assessment

LDR 三合一產房 labor-deliver-recover

Stage three of labor definition and time assess newborn’s physical condition T newborn care assess mother’s physical condition T v/s、胎盤剝離與排出的過程、出血量 T prevent PPH medication T Oxytocin, Methergine, Ergonovin BP ，do not use on H/T p’t

Stage four of labor definition aim: monitor mother’s v/s T Prevent PPH(產後出血)：assess v/s, fundus of uterus, uterine contraction, lochia & ep w’d T Mild fever (>37. 5, <38) is normal T Keep warm T Orthostatic hypotension (姿位性低血壓) • 採漸近式下床 • 有人陪伴

NEWBORN CARE

Apgar score 新生兒出生後1分鐘和5分鐘時 T 7～ 10: good兒的狀況良好， T 4～ 6: clear airway, O 2 supply and further observation T 4 & under: need intensive care