Maternity nursing care to patients inpartu

Maternity nursing care to patients inpartu

A. BASIC CONCEPTS
I. Definition
Childbirth is a series of events that ended with babies spending enough or nearly enough in the month followed by removal of placenta and fetal membranes of the mother's body (obstetrics & gynecology FK UPB, 2000). Childbirth is a process of conception of the results which can live in the uterus through the vagina into the world outside (Mansyor Arief, 1999).

II. Etiology
The cause of the onset of labor until now not known with certainty, there are several theories, among others (Rustam Muhtar, 1998)
1. Declining levels of progesterone
Progesterone raises relaxasi muscles of the uterus, whereas estrogen elevate humility uterine muscle
2. Theory oxitosyn
In late pregnancy increases levels oksitasnya, pleh therefore arise uterine muscle contraction.
3. Muscle tenseness
With the advance of pregnancy increasingly stretched muscles of the uterus more vulnerable.
4. Effect of fetal
Hyposife and Fetal suprarenal gland apparently also plays a role because the anecephalus pregnancy is often much longer than usual
5. Theory of prostaglandin
Prostaglandins are produced by the decidua, alleged to be one reason for the beginning of labor.

III. The signs of the onset of labor
Prior to the delivery was several weeks before she entered the "monthly" or "weekly" or "day" is called when the preliminary (pre paratory stage of labor), it's about providing the following signs:
1. Lightening or setting or droping the head down into the pelvic especially in primigravida
2. Look more dilated stomach, fundus down
3. Feelings frequent or difficult urination (polakisuria) because the bladder pressure by the lowest part of the fetus
4. Pain in the abdomen and waist by a dai weak contractions of the uterus, sometimes called "False pains width"
5. The cervix becomes soft, wide ranging and can increase blood mixed with secretions (blood show)

IV. Factors that play a role in labor
1. force push the fetus out (power)
2. fetal birth (passage)
3. fetus (Passager)
4. helper
5. maternal psychological

V. Kala labor
1. Kala I
Starting from the time of delivery start until complete opening (10 cm). The process is divided into two phases, namely:
a. Latent phase (8 hours)
Cervical opening to 3 cm
b. The active phase (7 hours)
Cervical opening bucket until the Count of 4 cm 10 cm, contraction is stronger and more frequently during the active phase
2. Kala II
Starting from a full opening until the baby is born. This process usually takes 2 hours in primigravida, and 1 hour on multigravida.
3. Kala III
Beginning shortly after birth until the birth of the placenta, which lasted no more than 30 minutes.
4. Kala IV
Beginning at birth the placenta through the first 2 hours past partum



B. NURSING CARE
Is the method used to solve the problem in an effort to improve or maintain optimal client until ketahap through a systematic approach to identify the client to comply with the requirement.

I. Pengakajian
a. The data collection
1. Identity
Includes name, age, gender, occupation, religion, education, ethnicity, address
2. The main complaint
In general, the client complains of pain in the lumbar region radiating keperut, his presence often and regularly, mucus and blood.
3. Medical history
a. Medical history now
His nascent, pain and discharge of blood and mucus
b. Medical history before
There is a disease that can lead to high risk during delivery, such as heart disease, HT, TB, diabetes, venereal disease, and others
c. Family history of disease
The possibility of degenerative diseases, such as diabetes, etc.
4. Obstetric history
a. Menstrual History
Covering early menstruation, cycles, order number, day of First Instance last period
b. History of midwifery
Includes a history of delivery before the multigravida
5. Psychosocial spiritual and cultural history
Kx feel feminine again due to changes in her body, the fear and anxiety of losing the baby during labor is


6. The pattern of daily necessities
1. Nutrition
The existence of his influence on the desire or decreased appetite
2. Rest sleep
Clients can sleep on your back, tilt left / right depending on the location of the fetal spine and sleeplessness kx especially when I - IV
3. Activity
Kx can perform such activities are usually limited to mild activity does not require a lot of power does not make kx tired emotion
4. Elimination
There is a feeling of frequent / difficult urination during pregnancy and childbirth. At the end of the third trimester constipation can occur
5. Personal hygiene
Body hygiene, especially hygiene pubic area and breast area
7. Inspection
* General examination covering
a. Height and weight
Pregnant women whose height is less than 145 cm prior to the first pregnancy, classified as high risk because it is likely to have a narrow pelvis.
Maternal weight should be controlled regularly with weight gain during pregnancy is between 10-12 kg.
b. Blood pressure
Blood pressure was measured at the end of stage II is after the child is born, usually blood pressure will rise approximately 10 mm Hg
c. Temperature, Nadi, respiratory
Under ordinary circumstances the body temperature between 36-37 oC. When the body temperature of more than 375 is considered no abnormalities except for kx postpartum body temperature 355 ° C - 378 ° C is considered normal because of slow pulse condition usually follows the ambient temperature, when the temperature rises, the state rate will increase as well, may be due to bleeding. At kx are in labor breathing a little short due to exhaustion. And will return to normal after delivery and check every 4 hours.
* Physical Examination
1. Head and neck
Usually there are doasma gravidarum, sometimes there is swelling eyelids, pale conjunctiva, sclera yellow, stomatitis etc.
2. Chest
There are breast enlargement, hyperpigmentation areora protrusion on mammary and mammary papilla, discharge colostrom
3. Stomach
The existence of longitudinal abdominal enlargement, hyperpigmentation linea alba / nigra, there Strie gravidarum
Palpation: gestational age at term 3 fingers below the processus xypoideus. Preterm gestation process of the mid-central and xypoideus, or have not yet entered the PAP head, his presence might frequent and strong.
Auscultation: There is no normal frequency of FHR and 120 -160 x / min.
4. Genetalia
Spending mucus mixed blood, there is the opening of the cervix, as well as the flexibility of the cervix
5. Extremity
Edema usually occurs in the legs and sometimes varices due to venous pressure and an enlarged abdomen
* Investigations
Investigations include hemoglobin, factor Th, and sometimes serological examination for syphilis

II. Nursing Diagnosis
The nursing diagnoses that appear are:
1. Impaired sense of comfort (acute pain) associated with uterine contractions
2. High risk of fluid volume deficits associated with spending / excessive bleeding
3. Sheep care deficits associated with mobility during labor
4. Anxiety associated with childbirth
5. The changing role

III. Intervention
Nursing Diagnosis: Impaired sense of comfort (acute pain) associated with uterine contractions
Objective: client receives and is able to adapt to pain arising
Criteria results: - Kx can control myself during contractions and among his
- Kx typing signs of labor
Plan of action:
1. Approach the client and family
2. Assess the degree of pain through verbal or non-verbal cues
3. Encourage relaxation and distraction techniques on the client
4. Help clients get into a comfortable position
5. Monitor or observation of vital signs
6. Calculate and record the frequency, intensity and duration of construction patterns uterus every 30 minutes
7. Assess the nature and amount of vaginal appearance, cervical dilation, bulging, and decreased fetal placental location
8. Collaboration with the medical team
Rational
1. Creating an atmosphere of trust so that the nurses and cooperative
2. Knowing the scale, pain intensity kx
3. The muscles will Rilex thus reduced pain
4. Kx feel comfortable with the position of the selected
5. Knowing the state of kx and allows for further action
6. Monitor the progress of labor
7. As interdependent functions and accuracy to therapy
IV. Implementation
The implementation of an embodiment of the plan of treatment and nursing that were prepared in the planning stage. In operation the nurse is a team work together on an ongoing basis with different teams. The entire nursing activities in this stage are written in detail according denagan nursing actions or nursing notes (Nasrul Efendi, 1995)

V. Evaluation
The evaluation is the final stage of a process of care and a systematic comparison of the patient's health and well-planned and co-workers (Nasrul Efendi, 1995)

REFERENCESEfend Nasrul, Introduction to Nursing Process, EGC, Jakarta, 1995
Faculty of medicine UNPAD 2000, Obstetrics Physiology, London
Sell ​​Lynda Carpenito, 2000 "Nursing Diagnosis", EGC, Jakarta
Muhtar Rustam, 1998, Synopsis of Obstetrics Issue 2, EGC, Jakarta
Mansyoer Arief 2001, Issue 3 Capita Selekta Medicine, Faculty of Medicine, Jakarta