Labor & Delivery Clinical Cheat Sheet

Labor & Delivery clinical Clinical cheat sheet Mom's Vital Signs Blood Pressure (bp) Systolic Diastolic Heart Rate (hr) 60 – 100 bpm * Respiratory rate (rr) baby's Vital Signs 120 mmHg 80 mmHg Systolic 60 -80 mmHg Diastolic 40 - 50 mmHg Heart Rate (hr) 110 - 160 bpm can be 180 if crying can be 100 if sleeping Respiratory rate (rr) 30 - 60 breaths/min temperature (t) (Axillary) 97.7 – 99.5°F (36.5 - 37.5°C) Map Equal to the # of weeks gestation or higher 12 – 20 breaths/min temperature (t) 97.8 – 99°F (36.5 - 37.2°C) oxygen (o!) 95 – 100% COPD pts are expected to have lower O2 levels * PRO TIP: After you are done taking the patient's HR, keep your finger on their pulse while assessing respiratory rate. (When the patient knows you are taking their respiratory rate, they may breathe differently). Stages of Labor Regular contractions ! Complete dilation (10 cm) 2nd Stage Complete dilation (10 cm) ! Baby is delivered Signs of Respiratory Distress To count breaths, place your hand on their abdomen 3 Stage Baby is delivered ! Placenta is delivered 4th Stage Placenta is delivered ! Recovery (4 hours postpartum) • Retractions • Nasal flaring • Grunting Count for a full minute! Fetal Monitoring normal non-reassuring LATE DECELERATIONS VARIABLE DECELERATIONS V Fetal heart rate EARLY DECELERATIONS E Mom's contractions A L Obstetrical Emergencies description treatment Preeclampsia / Eclampsia Eclampsia is when a woman with preeclampsia has seizures BP control, MgSO4, delivery of the baby Postpartum Hemorrhage (PPH) Massive blood loss (vaginal birth: >500 mL in 24 hours) (cesarean birth: >1000 mL in 24 hours) Surgical ligation, hysterectomy, removal of leftover placenta, adm. hemabate & misoprostol Uterine Rupture When the uterus ruptures (wall of the uterus breaks open, commonly caused by pressure) STAT delivery, blood transfusions, possible hysterectomy medications OXYTOCIN (Pitocin) Stimulates uterine contractions MISOPROSTOL (Cytotec) Cervical ripening agent TERBUTALINE (Brethine) HALTS uterine contractions NIFEDIPINE (Procardia) HALTS uterine contractions MAGNESIUM SULFATE Take apical p u for 1 full lse min Breathing pattern is IRREGULAR. Newborns are Abdominal breathers. 1st Stage rd Blood Pressure (bp) (Not done routinely) Preventing & controlling seizures in mothers with preeclampsia/eclampsia Always follow your facility protocol. This guide is meant to inform. It's not meant to be used to diagnose or treat patients. A tool to help interpret fetal strips ! C Variable Decelerations Cord Compression Early Decelerations Head Compression Accelerations OK (normal fetal ! H ! O ! P Late Decelerations oxygenation) Placental Insufficiency apgar A P G A R 0 points 1 point 2 points (Muscle tone) Absent Flexed arms & legs Active Pulse 0 < 100 > 100 Floppy Minimal response to stimulation Prompt response to stimulation Blue / pale all over Pink body Blue extremities (acrocyanosis) Pink No breathing Breathing slow & irregular, weak cry Vigorous cry Activity Grimace (Reflex irritability) Appearance (Skin color) Respiration (Effort) assessment of apgar 1 minute and 5 minutes after birth. Scoring & Interventions 7-10 4-6 No interventions, Some resuscitation baby's doing well. assistance needed: oxygen, Only routine post suction, stimulate the baby, delivery care needed rub baby's back 0-3 Needs full resuscitation