L



L



6850


Labor Induction


Definition: Initiation or augmentation of labor by mechanical or pharmacological methods


Activities:



• Determine medical and/or obstetrical indication for induction


• Review obstetrical history for pertinent information that may influence induction, such as gestational age and length of prior labor and contraindications such as complete placenta previa, classical uterine incision, and pelvic structural deformities


• Monitor maternal and fetal vital signs before induction


• Perform or assist with application of mechanical or pharmacological agents (e.g., laminaria and prostaglandin gel) at the appropriate intervals, as needed, to enhance cervical readiness


• Monitor for side effects of procedures used to ready cervix


• Reevaluate cervical status and verify presentation before initiating further induction measures


• Perform or assist with amniotomy, if cervical dilatation is adequate and vertex is well engaged


• Determine fetal heart rate by auscultation or electronic fetal monitoring postamniotomy and per protocol


• Encourage ambulation if no contraindications are present for both mother and fetus


• Observe for onset or change in uterine activity


• Initiate IV medication (e.g., oxytocin) to stimulate uterine activity, as needed, after physician consultation


• Monitor labor progress closely, being alert to signs of abnormal labor progress


• Avoid uterine hyperstimulation by infusing oxytocin to achieve adequate contraction frequency, duration, and relaxation


• Observe for signs of uteroplacental insufficiency (e.g., late decelerations) during the process of induction


• Reduce or increase uterine stimulant (e.g., oxytocin), as needed or per protocol, until birth is imminent


2nd edition 1996



6860


Labor Suppression


Definition: Controlling uterine contractions prior to 37 weeks of gestation to prevent preterm birth


Activities:



• Review history for risk factors commonly related to preterm labor (e.g., multifetal pregnancy, uterine anomalies, prior history of preterm birth, early cervical change, and uterine irritability)


• Determine fetal age, based on last menstrual period, early sonogram, fundal height measurements, date of quickening, and date of audible fetal heart tones


• Interview about onset and duration of preterm labor symptoms


• Ask about activities preceding onset of preterm labor symptoms


• Determine status of amniotic membranes


• Perform cervical exam for dilation, effacement, softening, and position


• Palpate fetal position, station, and presentation


• Obtain urine and cervical cultures


• Document uterine activity, using palpation, as well as electronic fetal monitoring


• Obtain baseline maternal weight


• Position mother laterally to optimize placental perfusion


• Discuss bed rest and activity limits during acute phase of labor suppression


• Initiate oral or intravenous hydration


• Note contraindications to use of tocolytics (e.g., chorioamnionitis, preeclampsia, hemorrhage, fetal demise, or severe intrauterine growth retardation)


• Initiate subcutaneous or IV tocolytics, per physician order or protocol, if hydration does not reduce uterine activity


• Monitor maternal vital signs, fetal heart rate, and uterine activity every 15 minutes during initiation of IV tocolysis


• Monitor for side effects of tocolytic therapy, including loss of deep tendon reflexes, if magnesium sulfate is administered


• Educate the patient and family about normal tocolytic side effects (e.g., tremors, headache, palpitations, anxiety, nausea, vomiting, flushing, and warmth)


• Provide interventions to reduce discomforts of normal side effects (e.g., relaxation therapy, anxiety reduction, and therapeutic touch)


• Educate patient and family about abnormal tocolytic side effects (e.g., chest pain, shortness of breath, tachycardia, or recurrent contractions) to report to physician


• Obtain baseline EKG, as appropriate


• Monitor intake and output


• Auscultate lungs


• Begin oral or subcutaneous tocolysis, per physician order, after achieving adequate uterine quiescence


• Determine patient and family knowledge of fetal development and preterm birth, as well as motivation to prolong pregnancy


• Involve patient and family in plan for home care


• Begin discharge teaching for home care, including medication regimens, activity restrictions, diet and hydration, sexual abstinence, and ways to avoid constipation


• Teach contraction palpation techniques


• Provide written patient education material for family


• Provide referrals to assist family with child care, home maintenance, and diversional activities, as appropriate


• Discuss signs of recurrent preterm labor and reinforce the need to reseek care immediately, if symptoms return and continue for 1 hour


• Provide written discharge instructions, including explicit directions for reseeking medical care


2nd edition 1996




7690


Laboratory Data Interpretation


Definition: Critical analysis of patient laboratory data in order to assist with clinical decision-making


Activities:



• Be familiar with accepted abbreviations for particular institution


• Use the reference ranges from the laboratory that is performing the particular test(s)


• Recognize physiological factors that can affect laboratory values, including gender, age, pregnancy, diet (especially hydration), time of day, activity level, and stress


• Recognize the effect of drugs on laboratory values, including prescription drugs, as well as over-the-counter medications


• Note time and site of specimen collection, as applicable


• Use peak drug levels when testing for toxicity


• Recognize that trough drug levels are useful for demonstrating satisfactory therapeutic level


• Consider influences of pharmacokinetics (e.g., half-life, peak, protein binding, and excretion) when evaluating toxic and therapeutic levels of drugs


• Consider that multiple test abnormalities are more likely to be significant than single test abnormalities


• Compare test results with other related laboratory and/or diagnostic tests


• Compare results with previous values obtained when the patient was not ill (if available) to determine baseline values


• Monitor sequential test results for trends or gross changes


• Consult appropriate references/texts for clinical implication of unfamiliar tests


• Recognize that incorrect test results most often result from clerical errors


• Perform confirmation of grossly abnormal test results with close attention to patient and specimen identification, condition of specimen, and prompt delivery to the laboratory


• Report results of lab tests to patient, as appropriate


• Send split samples to the laboratory for verification of results, if appropriate


• Report sudden changes in laboratory values to physician immediately


• Report critical values (as determined by institution) to physician immediately


• Analyze whether results obtained are consistent with patient behavior and clinical status


2nd edition 1996



5244


Lactation Counseling


Definition: Assisting in the establishment and maintenance of successful breastfeeding


Activities:



• Provide information about psychological and physiological benefits of breastfeeding


• Determine mother’s desire and motivation to breastfeed as well as perception of breast-feeding


• Correct misconceptions, misinformation, and inaccuracies about breastfeeding


• Encourage mother’s significant other, family, or friends to provide support (i.e., offer praise, encouragement, and reassurance, perform household tasks, and ensure that mother is receiving adequate rest and nutrition)


• Provide educational material, as needed


• Encourage attendance to breastfeeding classes and support groups


• Provide mother the opportunity to breastfeed after birth, when possible


• Instruct on infant’s feeding cues (e.g., rooting, sucking, and quiet alertness)


• Assist in ensuring proper infant attachment to breast (i.e., monitor proper infant alignment, areolar grasp and compression, and audible swallowing)


• Instruct on various feeding positions (e.g., cross-cradle, football hold, and side-lying)


• Instruct mother on signs of milk transfer (e.g., milk leakage, audible swallowing, and “let down” sensations)


• Discuss ways to facilitate milk transfer (e.g., relaxation techniques, breast massage, and a quiet environment)


• Inform about the difference between nutritive and nonnutritive sucking


• Monitor infant’s ability to suck


• Demonstrate suck training, if necessary (i.e., use a clean finger to stimulate suck reflex and latch on)


• Instruct mother to allow infant to finish first breast before offering second breast


• Instruct on how to break suction of nursing infant, if necessary


• Instruct mother on nipple care


• Monitor for nipple pain and impaired skin integrity of nipples


• Discuss techniques to avoid or minimize engorgement and associated discomfort (e.g., frequent feedings, breast massage, warm compresses, milk expression, ice packs applied after feeding or pumping, and antiinflammatory medications)


• Instruct on signs, symptoms, and management strategies for plugged ducts, mastitis, and candidiasis infection


• Discuss needs for adequate rest, hydration, and well-balanced diet


• Assist in determining need for supplemental feedings, pacifiers, and nipple shields


• Encourage mother to wear a well-fitting, supportive bra


• Instruct on record keeping of nursing and pumping sessions, if indicated


• Instruct about infant stool and urination patterns


• Discuss frequency of normal feeding patterns, including cluster feedings and growth spurts


• Encourage continued lactation upon return to work or school


• Discuss options for milk expression, including nonelectrical pumping (e.g., hand and manual) and electrical pumping (e.g., single and double; hospital-grade pump for mother of preterm infant)


• Instruct on appropriate handling of expressed milk (e.g., collection, storage, thawing, preparation, fortification, and warming)


• Instruct patient to contact lactation consultant to assist in determining status of milk supply (i.e., whether insufficiency is perceived or actual)


• Discuss strategies aimed at optimizing milk supply (e.g., breast massage, frequent milk expression, complete emptying of breasts, kangaroo care, and medications)


• Provide instruction and support in accordance with healthcare institution’s policy on lactation for the mother of preterm infant (i.e., instruct on frequency of pumping, when to expect milk supply to increase, normal feeding patterns based on gestational age, and weaning from pump when infant is able to nurse well)


• Instruct on signs and symptoms warranting reporting to a healthcare practitioner or lactation consultant


• Provide discharge instructions and arrange for follow-up care tailored to patient’s specific needs (e.g., mother of healthy term infant, multiples, preterm infant, or ill infant)


• Refer to a lactation consultant


• Assist with relactation, if needed


• Discuss options for weaning


• Instruct mother to consult her healthcare practitioner before taking any medications while breastfeeding, including over-the-counter medications and oral contraceptives


• Discuss methods of contraception


• Encourage employers to provide opportunities for lactating mothers to express and store breast milk during the workday


2nd edition 1996; revised 2013




6870


Lactation Suppression


Definition: Facilitating the cessation of milk production while minimizing painful engorgement


Activities:



• Discuss options for milk expression (e.g., hand, manual, and electrical pumping)


• Instruct patient to express enough milk via hand, manual, or electrical pumping to reduce breast pressure but not enough to empty breast


• Assist patient in securing a good quality breast pump for use


• Assist patient in determining schedule (e.g., frequency and duration) for milk expression based on individual factors (e.g., length of time since giving birth, frequency of emptying breasts, and amount of milk currently being produced)


• Monitor breast engorgement and associated discomfort or pain


• Instruct patient on measures to reduce discomfort or pain (i.e., ice packs or cold cabbage leaves applied to breasts and analgesics)


• Administer lactation suppression drug, if appropriate


• Encourage patient to wear supportive, well-fitting bra continuously until lactation is suppressed


• Provide anticipatory guidance on physiological changes (i.e., uterine cramping and presence of scant milk post-lactation suppression)


• Discuss feelings, concerns, or issues patient may have pertaining to lactation cessation

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Dec 3, 2016 | Posted by in NURSING | Comments Off on L

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