4th satge labor.pptx

it explains the 4th stage and the detail

1. FOURTH STAGE OF LABOR , ASSESSMENT & MANAGEMENT

2. INTRODUCTION OF FOURTH STAGE OF LABOR The fourth stage of labor begins with the birth of the placenta and ends one hour later .This stage marks the completion tasks associated with the first three stage of labor. The mother have expression of relief and accomplishment ,intermingled with excitement.

3. Definition This is the period from the delivery of the afterbirth to the time when the women is examined and then transferred to her room. It is stage of observation for at least one – two hour after child birth.

4. ASSESSMENT : Initial assessment – Vital sign Pain Location and Firmness of the Fundus Amount and color of lochia Perineum Intravenous Infusion Urinary output    

5. VITAL SIGN – Temperature : is taken atleast once during the 4 th stage. Temperature more than 38 degree celsius is normal during 1 st 24 hour. Pulse ,blood pressure and respiration are evaluated every 15 min . Hypotension may indicate Dehydration & Hypovolemia   PAIN – Assess the type , location and intensity of pain Look for sign for discomfort.  

6. FUNDUS - The fundus remain firm and at or near the umbilical level A boggy uterus may indicate uterine atony or retained placenta fragments. Boggy refers to being inadequately contracted and having a spongy rather than firm feeling. LOCHIA – Excessive lochia in presence of contracted uterus indicates laceration of birth canal’ A constant trickles ,dribble or oozing of lochia indicates excessive bleeding.  

7. PERINIUM – The acronym REEDA is used as reminder to asses the episiotomy or perineal site. R- redness E- edema E- ecchymosis D- discharge A –approximation of wound edges     URINARY OUTPUT – Look for bladder distention as the mother usually don’t feel the urge to void .

8. INTRAVENOUS INFUSION – Type of IV fluid Rate of fluid administration Type and amount of medication Patency of IV Lines   NEONATAL OBSERVATION –   Apgar score taken at 1 and 5 minutes after birth. Heart rate and respiratory rate, and color used as the basis for resuscitation need totals ; 0-2 =severe distress 3-6= moderate distress 7-10=minimal distress Vital sign & General measurement (general appearance & other finding)

9. Nursing care- Assist the patient move from the table to the bed. Provide care of perineum . An ice pack may be applied to the perineum to reduce swelling from episiotomy . Apply clean perineal pad between the legs. . Monitor the patient vital signs and general condition. Take BP ,P and R every 15 min for an hour , then every 30 min for an hour , and then every hour as long as patient is stable. Document thick,foul -smelling lochia. Document lochia flow when the fundus is , massaged Observe for uterine atony or hemorrhage. Observe for any untoward effects from anesthesia. Orient the patient to the surrounding (bathroom ,call bell,lights etc )

10. Cont. .. Allow the patient time to rest. Encourage the patient to drink fluids . Observe patients urinary bladder for distention. Bulging of the lower abdomen. Full bladders may actually cause postpartum hemorrhage because it prevents the uterus from contracting. Ambulate the patient to the bathroom. Evaluate the perineal area for signs of develop edema. Apply ice pack to the perineum to decrease the amount of developing the edema . Look for discoloration of perineum area

11. Thank you