Nursing 209

N209: Reproductive Health Study Guide

Family-centered care

• • Midwives can be certified nurse midwives (CNMs), certified professional midwives (CPMs), or certified midwives (CMs) Home Births • Attended by midwife • Must have a low risk pregnancy 4.8 The Nursing Process Assessment • Assess health and labor status of patient, including EDC, previous birth history, cervical status, uterine activity pattern and intensity, comfort level, preparedness for labor (i.e., having attended childbirth classes), support during labor, and desire for labor medications. • Assess fetal well-being via fetal monitoring data, response to medications, and position. Analysis/Diagnosis • Identify actual or potential health problems and concerns with patient/family and members of the care team, and establish nursing diagnosis. Plan • Establish nursing interventions and a plan of care based on evidence-based practices and standards of care to help the patient through the labor process. • Educate the patient on the labor process and expected interventions, and inform patient of any changes in the plan of care related to her health status or fetal well-being. Implementation • Implement nursing interventions to achieve expected outcomes. • Assist patient with the labor process by assessing for pain and providing medication as ordered, assisting with regional anesthesia placement, position changes for patient comfort and fetal well-being, monitoring maternal and fetal response to oxytocin, and assisting and supporting the patient through the delivery process. • Revise plan as needed based on reassessment of maternal and fetal status. Evaluation • Assess (or reassess) the patient’s response to nursing interventions and progress towards expected outcomes. That includes pain relief with pain meds/measures and appropriate knowledge regarding procedures and interventions to ensure fetal well-being. Nursing Diagnosis Pertinent to the Intrapartal Period • Risk for disturbed maternal-fetal dyad related to prolonged second stage of labor, cephalopelvic disproportion, or premature rupture of membranes • Impaired urinary elimination related to regional anesthesia • Deficient knowledge related to labor, fetal monitoring, and pain control options

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