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Importance Of Nursing Assessment During Birth

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Nursing assessments during labor: Assessments required during labor include: monitoring fetal heart rate (110-160bpm) and rhythm, observe membranes for rupture assessing color, odor, and clarity of fluid. Fluid should be clear, if green it could indicate fetus has passed meconium before birth, which could indicate problems for fetus. If membranes have ruptured, assess fetal heart rate (FHR) for at least one minute after rupturing. Perform vaginal exams (limit to avoid introducing microorganisms) to determine level of dilation and effacement. Monitor maternal vital signs: blood pressure (BP), pulse (P), respiratory rate (RR), and oxygen saturation (O2). Observe for infection or hypertension by systolic BP being over 140mmHG/90mmHG and temperature above 38C (100.4 F). Monitor mother for contractions, asking how she’s feeling, and facial expressions. Contractions should be every 2-3minutes, lasting 40-90 seconds, with an intensity of 50-80mmHg. Record intake and output (including intravenous therapy). Observe for bladder distention by checking suprapubic area every 2 hours.

Nursing assessments during birth: Assessments during birth includes observing perineum for damage or bleeding. Bleeding is normal, but should not exceed saturation of more than one pad in one hour. Assess birth canal for injuries. Assist with birth of infant and suction nose and mouth to prevent aspiration. Assess infant’s airway. Observe placenta to check for intactness. Monitor FHR during birth and

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