第七章异常分娩妇女的护理Nursingcareduringabnormalchildbirth.pptVIP

Nursing assessment Health history: fetal lie, pelvis’ measurement, plancenta previa, uterine malformation, polyhydramnios, oligoamnios Present physical status Woman can self feel round and firm fetal head under ribs Ob check show round and firm part in fundus ,FHT is above the umbilicus Vaginal/anal check find soft and irregular part Uterine contraction is hypotonic labor progress is slow Maternal fetal Effects Effects on mother: b/c breech small, irregular, can’t closely attach cervix, →hypotonic contraction, prolonged labor process, postpartum hemorrhage, infection, cervical injury Effects on infant: b/c breech irregular, pressure is unbalanced, → premature membrane rupture, prolapse of umbilical cord, fetal distress, intracranial hemorrhage, brachia plexus injury, fracture Nursing intervention 矫正异常胎位correct abnormal fetal position：若30周后仍为臀先露者 胸膝卧位knee-chest position: 激光照射laser exposure或艾灸moxibustion至阴穴 外倒转术abdominal version ：32-34wks,under ultrasound monitor, dangerous Nursing care during labor General care: nutrition, rest, no anal check, no enema, prevent premature rupture of membrane Observation: uterine contraction, FHR, labor process, if membrane rupture, lift bottom up Cooperative tx: administering oxytocin antibiotics If cervix not completely opened, use aseptic towel to push fetal foot or bottom back and call doctor; if umbilicus shows, delivery within 2-3mins. 胎儿发育异常 巨大胎儿 macrosomia: 4000g 胎儿畸形 fetal malformation 1. 脑积水 hydrocephalus 2. 无脑儿 anencephalus 第四节 过度焦虑与恐惧 Anxiety is a negative psychological reaction Anxiety in labor and plasma epinephrine肾上腺素 were related to FHR pattern in active labor Duration of labor was related to plasma epinephrine and norepinephrine levels in multiparas肾上腺素分泌增加，引起心跳加快、心排出量增加、BP↑。同时去甲肾上腺素↑，引起血管收缩，血供减少，胎儿缺氧 Longer labors were associated with higher catecholamines儿茶酚胺, which r/t measures of anxiety Anxiety →extreme pain * * * 第八章 异常分娩妇女的护理Nursing care during abnormal childbirth Review 影响分娩的四个因