Labor and Delivery Preparation for clinical experience

LABOR & DELIVERY OBJECTIVES

Due to the nature of the Labor & Delivery unit, a variety of patients and procedures may be encountered.  The students will be primarily observing laboring women whom may deliver vaginally or by cesarean section.

The students should arrive on the unit to allow time to change into scrubs and be ready for morning report.  The nurse preceptor is ultimately responsible for patient care; however , there are many ways that students can assist.  You may provide support for the patient and family (i.e., be in the room and available for their questions).  While the nurse is responsible for charting, the student should discuss his/her assessments, interventions and evaluation and chart with the preceptor’s supervision. During each clinical day on Labor/Delivery the student will demonstrate fulfillment of the clinical objectives through initiation of discussions with the instructor, focusing on use of the nursing process and theoretical basis for the care given.

Students assigned to the Labor & Delivery Unit with fulfill the following objectives:

1. Relate the client’s prenatal health and care to the current labor process

1. Apply theory to describe the client’s progress through labor.

1. Provide emotional and physical support for the laboring family

1. Use the nursing process as a basis for nursing care

1. Provide patient/family education where appropriate

1. Interact with the family and health care team in a professional manner

1. Demonstrate knowledge of medications used in this area, including indications and side effects.

1. Examine the use of technology to assist with care of the laboring patient

1. Describe the role of a registered nurse in this health care team

1. Learn about the standards of care used in this labor & delivery unit

1. Describe the discharge planning started on the labor/delivery unit

1. Complete and hand in Labor and Delivery worksheet as directed by your clinical instructor.

Preparation for Labor and Delivery Clinical Experiences

Be prepared to perform and/or assist with the following:

____    antepartum assessment

____    intrapartum care – process and coaching

____    auscultation of fetal heart tones

____    preoperative preparation and care

____    female catheterization

____    application of external fetal monitor & toco transducer

____    epidural/spinal anesthesia

____    local anesthesia

____    identify obstetric complications:

                        pregnancy induced hypertension (PIH)

                        preterm labor (POL)

Medication Cards – Due by firs clinical

• name of drug, including generic name
• indications
• side effects
• nursing considerations

Labor and Delivery Medications:

____    oxytocin (Pitocin)

____    magnesium sulfatge (MgSO₄)

____    ritodrine

____    terbutaline

____    nifedipine

____    misoprostil (Cytotec)

            Narcotics:

            ____    morphine

            ____    stadol

            ____    duramorph

            ____    fentanyl

L & D Preparation:                                                  Name: _______________________

            (Due prior to clinical as directed by your instructor)

1. Define cervical DILATION: 

1. Define EFFACEMENT:

1. Describe STAGE ONE LABOR

1. Latent Phase

1. Active Phase

1. Transition Phase

.

1. Describe STAGE TWO

1. Describe STAGE THREE

1. How is DURATION of contractions measured?

1. How is FREQUENCY of contractions measured?

1. Describe each of the following FETAL HEART RATE PATTERNS:

1. Accelerations

1. Early Decelerations

1. Late Decelerations

1. Variable Decelerations

1. List 3 non-pharmacologic methods of pain control for the laboring woman:

1. List 2 nursing diagnoses which may apply to the laboring woman

LABOR AND DELIVERY WORKSHEET

(Due after clinical as directed by your instructor)

Name ­­­­­­­­­­__________________________

Date ___________________________

History:

Patient initials: ­­­­­_________ Age: _______ G _______ T _____ P _____ A ______L ____

EDB: ________

Prenatal Care:  yes ____ no ____

Significant Pregnancy-related Problems & Treatment:

Significant Non-pregnancy Health Problems:

Medications (including pain meds) and indications:

Assessment:

Cervical Dilation _____         Effacement ­­­­______     Station ____

In which stage and/or phase of labor is your client?

Fetal Monitor Evaluation:

1. External monitor (ultrasound) _____         internal (fetal scalp electrode ________

2. What is the baseline fetal heart rate? ______________________

            is it within normal limits? __________________________

3. What is the fetal heart rate variability? ____________________

            is the variability:

1. decreased
2. average
3. increased

4. Are any periodic changes present? ____________________

            If so, are they:

1. accelerations
2. early decelerations
3. variable decelerations
4. late decelerations

Uterine Activity Evaluation

1. External monitor (Toco) ______    Internal  (IUPC) _________

2. Describe the uterine contraction pattern:

            Frequency:___________________________

            Duration: ____________________________

            Intensity: ____________________________

            Is the contraction pattern within normal limits? _________________

Nursing Coventions and Evaluation

Based upon your assessment of the laboring woman and the monitor strip, what nursing care would you administer?