133: Obstetrical Nursing

© 2014

Schools:  Mid-level to Advanced:  OB training

Healthcare Facilities:  Orientation OB unit

Individual program learning objectives

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133.1 Caring for the Antepartum Patient (23 min.)

1. Define viability, pre-term, term, and post-term as related to the fetus.
2. Describe the affects of pregnancy on the mother’s physiology from conception to term.
3. Discuss methods by which the pregnant woman can alleviate some of the discomforts related to advancing pregnancy.
4. Define physiologic anemia of pregnancy.
5. Describe changes in dietary needs as pregnancy progresses.
6. Define “pica.”
7. Record a woman’s obstetrical history using the GTPAL system.
8. State the prenatal visit frequency pattern for a normal pregnancy.
9. Discuss physical assessment of the mother during prenatal visits.
10. List the common screening tests performed during pregnancy.

133.2 Complications of Pregnancy (21 min.)

1. List the known risk factors and common symptoms for preterm labor.
2. Name two actions other than tocolytics used to help control preterm labor.
3. Discuss the use of tocolytics in the treatment of preterm labor and the side effects of these drugs.
4. List six adverse reactions associated with magnesium sulfate tocolysis that must be immediately reported to the physician.
5. Discuss the use of glucocorticoid injection in conjunction with tocolysis.
6. Describe the various causes of bleeding during pregnancy and interventions for each.
7. Differentiate between the four categories of hypertensive disorders during pregnancy.
8. Describe the HELLP syndrome related to pre-eclampsia.
9. List four severe fetal complications related to pre-eclampsia.
10. Differentiate between pre-eclampsia and eclampsia, and explore management options for these hypertension disorders.

133.3 Electronic Fetal Monitoring (25 min.)

1. Differentiate between the terms “reassuring” and “non-eassuring” as related to fetal monitor tracings.
2. Apply the ultrasound and toco transducers to the mother’s abdomen.
3. Differentiate between the uterine activity and the fetal heart rate tracings on the monitor strip.
4. Explain the difference between external and internal monitoring of both the fetal heart rate and the uterine contractions.
5. Take and record the nursing assessment of a labor patient.
6. Describe the frequency, intensity, and duration of contractions.
7. List factors which interfere with affective fetal oxygenation during labor.
8. Discuss when cord compression is a cause for concern.
9. Give the parameters for normal, tachycardic, and bradycardic fetal heart rates.
10. Correctly use the four terms used to describe baseline variability.
11. Define early and late decelerations.
12. Describe interventions for treatment of late decelerations.
13. Discuss actions taken to alleviate the affects of cord compression.

133.4 Pain Control (16 min.)

1. Describe the types of pain experienced during labor.
2. Discuss the physiologic causes of pain during labor.
3. Name the most common response to pain.
4. Discuss non-pharmacologic interventions for pain management, including hydration, breathing, massage, warm water, and distraction.
5. Explain the role of the birth partner in pain management.
6. Discuss the use of pharmacologic agents for management of labor pain including opioids, barbiturates, tranquilizers, and regional anesthetics.
7. Describe the epidural block.
8. List the side effects of analgesics used during labor.
9. Discuss the management of side effects related to the use of analgesics during labor.
10. Describe maternal positioning techniques that promote adequate blood and oxygen flow to the fetus.
11. Discuss how maternal positioning relates to distribution of the epidural medication.
12. Outline how maternal positioning can assist the descent of the fetus through the birth canal.
13. Differentiate between an epidural and an intrathecal block.
14. List the common side effects of an intrathecal block.

133.5 Assisted Delivery and Cesarean Section (17 min.)

1. Differentiate between the use of forceps and vacuum extraction.
2. Discuss the potential complications of forceps delivery.
3. Discuss the potential complications of vacuum extraction.
4. Define dystocia and describe two maneuvers utilized to overcome this complication.
5. Discuss reasons a cesarean delivery may become necessary.
6. List the team members who should be present for a cesarean delivery.
7. Describe the actions of the nurse in preparing a patient for cesarean delivery.

133.6 Labor and Delivery (17 min.)

1. Describe the series of physiologic events known to occur as a woman goes into labor.
2. List factors which can affect the duration of labor.
3. Name the four stages of labor.
4. Differentiate between latent, active, and transition during the first stage of labor.
5. Discuss the role of the nurse during each of the stages of labor.
6. Differentiate between closed and open glottis breathing when pushing.
7. Discuss the advantage of an upright position during active labor and alternative positions when this is not possible.
8. Describe maternal positioning during the actual birth.

133.7 Caring for the Postpartum Patient (18 min.)

1. Describe the primary roles of the nurse during the postpartum period.
2. Describe the process of involution.
3. List factors which can slow the process of involution.
4. Name and describe the three types of lochia.
5. Delineate the hormonal changes that occur immediately following birth.
6. Discuss changes in the breast at the onset of lactation.
7. Discuss the possible changes in intestinal and urinary function following delivery.
8. List the steps in a postpartum nursing exam.
9. Delineate the potential complications related to the postpartum period for both vaginal and cesarean deliveries.
10. List actions which can promote comfort for the new mother.
11. Describe the emotional changes which can occur postpartum.
12. Differentiate between the “baby blues” and postpartum depression.

133.8 Newborn Stabilization and Care (18 min.)

1. List the physiologic changes which must occur for the fetus to make a successful transition to neonate.
2. Discuss the role of surfactant in effective respiration.
3. List the factors that are believed to help initiate breathing in the neonate.
4. Describe the preparations to be made by the nurse for receiving the newborn infant.
5. Discuss the initial assessment and care of the newborn.
6. State the normal ranges for the newborn heart rate and respiration.
7. List the three indicators for resuscitation.
8. State the affects of cold stress on the newly born.
9. Perform an APGAR assessment.
10. Identify disorders that can be diagnosed during routine neonatal screenings.
11. Demonstrate eye and cord care, administration of vitamin K, and drawing blood for newborn screenings.