按一下以編輯母片標題樣式,按一下以編輯母片(節),第二層(黃),第三層(綠),第四層(藍),第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,Interview,：,Frequency?Duration?,Dilation?Effacement?Station?,Bloody show?Rupture of membrane?,General health assessment,Discomfort,when contraction happens,（,e.g.low back pain,）,Routine Care,Interview：Routine Care,Admission note,陳小花女士,30 y/o,102,年,4,月,23,日因破水入院,羊水顏色正常,最後一次月經為,101,年,8,月,1,日,有兩個小孩,皆,NSD,AA,一次,懷孕狀況正常,無不良合併症狀,子宮底高度,36cm,腹圍,108cm,vital signs:36.8;80;20;128/86mmHg,-Please fill in the information sheet-,Admission note陳小花女士,30 y/o,辛氏左侧卧式课件,Labor preparation,shaving,enema,Reasons for enema:,避免第二產程排便，汙染無菌區,避免,enama,之狀況：,急產、,bloody show,、安胎的個案、破水、胎兒窘迫,Routine Care,Labor preparationRoutine Care,Routine Care,Fetal health assessment,FHR,Variation of FHR,FHR v.s.Uterus contraction,acceleration,deceleration,Monitor for 20,30min,Routine Care Fetal health asse,Labor Pain,Labor Pain,Pain transmission,Fear anxiety and pain,Labor pain and management,Stage one of labor:,Uterus contraction,lower back,and,abdomen,pain,pain transmission:from,T10,12,L1,into spinal cord,Stage two of labor:,Perineum area(,會陰部,),Pain transmission:,S2,4,Pain transmission Fear anxiet,圖,13-2,產痛的神經傳導路徑,圖13-2產痛的神經傳導路徑,Pain control,Tranquilizer,Narcotic analgesics,Anesthesia,Pain controlTranquilizerNarcot,Non-medication pain relief,集中注意力與具像法,音樂治療,水療法,指壓、針灸、治療性觸摸、芳香療法,Pain Control,Non-medication pain reliefPai,Pain relief medication,Tranquilizer,help relieving anxiety,may reduce FHR variation,e.g.Diazepam(valium),Narcotic analgesics,Meperidine,（,Demerol,）最常用的麻醉性鎮痛劑，作用時間,持續,3,4hrs,Fentanyl,（,Sublimaze,）,Pain relief medication Tranqu,Pain relief medication,Meperidine,（,Demerol,）,Indication,產痛正式開始以後使用,解除產婦的焦慮與部分疼痛感，矯正子宮收縮的不調和性，縮短後期產程,dosage:25mg iv;50mg im,Side effects,產痛初期使用會使產程延長,造成產婦的呼吸抑制，注意,v/s,造成姿態性低血壓,、,dizziness,nausea,Pain relief medication Meperid,Pain relief medication,effect on fetus,會迅速通過胎盤造成,新生兒呼吸抑制,須注意分娩期間與初生時的胎兒監視,timing,嬰兒出生的時間最好在使用之後的,1,小時以內或,4,小時以後，則呼吸抑制機會較小,解毒劑,（拮抗劑）,：,naloxone,0,1,2,3,4,Pain relief medication effect,Regional anesthesia,Regional anesthesia(,區域麻醉,),Medication:,Lidocaine,（,Xylocaine,）,Types:,Lumber Epidural anesthesia,Spinal anesthesia,Regional anesthesia Regional,Regional anesthesia,Lumbar Epidural Anesthesia,Painless labor(,無痛分娩,),產痛正式開始,intensity,50,70 mmHg,dilation,4cm,產婦能維持清醒，,運動神經只有部分阻斷,，因此可以配合用力來加速產程,Regional anesthesia Lumbar Epi,Anesthesia,Nursing care for,Epidural Anes,.,：,Monitor V/S,FHR,IV infusion 500,1000 c.c.,NS or Ringers solution to prevent,hypotension,不使用含,glucose,的溶液，免影響胎兒之,blood sugar,low dose,PCA,(,P,atient-,c,ontrolled,a,nalgesia):,運動神經阻斷較輕微，新生兒呼吸抑制的機會較低,Anesthesia Nursing care for Ep,Regional anesthesia,Side effects,Hypotension,most common,BP 20%lower than before anes.,Systolic pressure under 100mmHg,Intervention:,左側躺、,IV infusion,、,O,2,supply,、,ephedrine inj.,、,monitor v/s,Respiration suppression,RR under,14,/min,Intervention:,Naloxone,inj.,Regional anesthesia Side effe,Regional anesthesia,Spinal Anesthesia,for,C-Section,inject medication into,spinal cord,onset within 1,2 min,last 1,3 hrs,Regional anesthesia Spinal Ane,Regional anesthesia,Nursing care for,spinal anes,.,Monitor V/S,FHR,IV infusion 500,1000 c.c.NS or Ringers solution to prevent hypotension,不墊枕頭平躺約,6,12,小時,，生產後亦需仰臥,給予,大量水分,(,約,3000 c.c./,天,),，預防麻醉後頭痛,Regional anesthesia Nursing ca,Complications of anes.,Hypotension,Respiratory depression,Total spinal anesthesia,(,全脊髓麻醉,),Epidural,導管誤植入脊髓腔,引起過度脊髓麻醉,Spinal headache,(,脊髓性頭痛,),硬腦膜穿刺後，腦脊髓液漏出引起,Complications of anes.Hypoten,Nursing care for labor stages,Nursing care for labor stage,Stage one of labor,Definition and time,潛伏期,(0-3cm),、活動期,(4-7cm),、過渡期,(8-10cm),Mother and fetus assessment,Encourage fathers participation,Stage one of labor Definition,辛氏左侧卧式课件,表,13-12,根據弗里德曼的產程分期、產婦行為反應及護理措施,表13-12根據弗里德曼的產程分期、產婦行為反應及護理措施,表,13-12,根據弗里德曼的產程分期、產婦行為反應及護理措施,表13-12根據弗里德曼的產程分期、產婦行為反應及護理措施,Nursing care for stage 1,Aim,：協助待產婦放鬆、減輕不適,orientation,test,treatments,enhancing comfort,下床走動及改變姿位,使用生產球,補充液體及熱量,(,待產時腸道消化過程會減慢，可進食含熱量的流質或液體,),、,定期排空膀胱,(,每,1,2hrs,提醒待產婦解尿,),盡可能休息、按摩及重壓、冷熱敷,Nursing care for stage 1 Aim：協,Nursing care for stage 1,引導,呼吸運動,避免,hyperventilation(respiratory alkalosis),Nursing care for stage 1 引導呼吸運,Stage two of labor,definition and time,delivery preparation,newborn care preparation,delivery position,產婦的生產姿勢,臥位、辛氏左側臥式、半坐臥式、坐姿、蹲姿,mother and fetus assessment,Stage two of labor definition,表,13-12,根據弗里德曼的產程分期、產婦行為反應及護理措施,表13-12根據弗里德曼的產程分期、產婦行為反應及護理措施,舊式產科設計,移動產婦,:,待產室,-,產房,-,產後病房,舊式產科設計,LDR,三合一產房,labor-deliver-recover,LDR 三合一產房labor-deliver-recove,生產姿勢,生產姿勢,會陰消毒,會陰消毒,新生兒處理檯,新生兒處理檯,Nursing care for stage 2,aim:,教導產婦使用腹壓將胎兒娩出,打開聲門用力法,vs,傳統憋氣用力法,Episiotomy,：,performed when,crowning,median/mediolateral episiotomy,優點,缺點,失血量多、會陰傷口疼痛、增加感染機會、產後排尿和排便困難、產後性交困難,縮短第二產程,Nursing care for stage 2 aim:,會陰撕裂傷的程度,會陰撕裂傷,經常發生於急產、難產時,會陰撕裂傷的程度 會陰撕裂傷,Stage three of labor,definition and time,assess newborns physical condition,newborn care,assess mothers physical condition,v/s,、胎盤剝