High Risk Gestational Conditions_Labor and Delivery Birth Processes, Pain Management, Fetal Assessment during Labor_Labor and D

Author(s): Mattson, Rebecca
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Theory Objectives
1. Differential among the various hypertensive disorders: gestational hypertension, preeclampsia, and chronic hypertension.
2. Describe etiologic theories and pathophysiology of preeclampsia.
3. Compare care management of women with mild gestational hypertension or preeclampsia versus severe gestational hypertension or preeclampsia.
4. Discuss the preconception, antepartum, intrapartum, postpartum management of the woman with chronic hypertension.
5. Explain the effects of hyperemesis gravidarium on maternal and fetal well-being.
6. Differentiate among causes, signs and symptoms, possible complications, and management of miscarriage, ectopic pregnancy, cervical insufficiency, and hydatidiform mole/molar pregnancy/gestational trophoblastic disease.
7. Compare and contrast placenta previa, placental abruption in relation to sign and symptoms, complications, and management.
8. Discuss the diagnosis and management of disseminated intravascular coagulation.
9. Discuss signs and symptoms, effects on pregnancy, and management of urinary tract infections.
10. Explain principles of care for the pregnant woman undergoing abdominal surgery.
11. Discuss the implications of trauma on the mother and the fetus during pregnancy and priority assessment and stabilization measures
Theory Objectives
1. Explain the five major factors that affect the labor process.
2. Describe the anatomic structures of the bony pelvis.
3. Recognize the normal measurements of the diameter of the pelvis inlet, cavity, and outlet.
4. Explain the significant of the size and position of the fetal head during labor and birth.
5. Describe the cardinal movements of the mechanism of labor for a vertex presentation.
6. Examine the maternal anatomic and physiologic adaptation to labor.
7. Describe factors thought to contribute to the onset of labor.
8. Describe fetal adaptation to labor.
9. Describe breathing and relaxation techniques used for each stage of labor.
10. Identify nonpharmacologic strategies to enhance relaxation and decrease pain during labor.
11. Compare pharmacologic methods used to relieve pain in the different stages of labor and for vaginal and cesarean births.
12. Describe nursing responsibilities appropriate in providing care for a woman receiving analgesia and anesthesia during labor.
13. Identify typical signs of normal and abnormal fetal heart rate patterns.
14. Compare fetal heart rate monitoring performed by intermittent auscultation with external and internal electronic methods.
15. Explain baseline fetal heart rate and evaluate periodic and episodic changes.
16. Describe nursing interventions to maintain fetal heart rate patterns within normal limits.
17. Recognize alternations in fetal heart rate patterns and describe appropriate nursing measures to correct patterns.
18. Differentiate nursing interventions used for managing specific fetal heart rate patterns including tachycardia, bradycardia, absent or minimal variability and late, prolonged or variable decelerations.
19. Review documentation of fetal monitoring during labor.
20. Review the factors included in the initial assessment of the woman in labor.
21. Describe the ongoing assessment of maternal progress during the first, second, third, and fourth stages of labor.
22. Recognize the physical and psychosocial findings indicative of maternal progress during labor.
23. Describe fetal assessment during labor.
24. Identify signs of developing complications during labor and birth.
25. Incorporate evidence-based interventions into a comprehensive plan of care for each stage of labor.
26. Recognize the importance of support facilitating the progress of labor and birth.
27. Analyze the influence of cultural and religious beliefs on the process of labor and birth.
28. Describe the nurse’s role and responsibilities during emergency childbirth.
29. Evaluate the impact of perinatal trauma on the woman’s reproductive and sexual health.

Theory Objectives
1. Differentiate between preterm birth and low birth weight.
2. Discuss major risk factors associated with preterm labor.
3. Analyze current interventions to prevent spontaneous preterm birth.
4. Discuss the use of tocolytics and antenatal glucocorticoids in preterm labor.
5. Evaluate the effects of prescribed bed rest of pregnancy women and their families.
6. Design a nursing care plan for women with preterm premature rupture of the membranes (preterm PROM).
7. Describe the care of a woman with postterm pregnancy.
8. Explain the challenge of caring for obese women during labor and birth.
9. Summarize the nursing care for a woman experiencing a trial of labor, induction or augmentation of labor, a forceps or vacuum assisted birth, a cesarean birth, or a vaginal birth after a cesarean birth (VBAC).
10. Discuss obstetric emergencies and their appropriate management.