NTRAPARTAL/DELVERY/POSTPARTUM CARE

SAFE AND QUALITY NURSING CARE

My role as a student nurse in labor and delivery are:
1. Start every procedure with hand washing to avoid spread of microorganism and
break the chain of infection. Especially in insertion of catheter upon placing the
patient in the delivery room. Considering that it is one of the procedures that
contribute to the nosocomial infection
2. During the intrapartal stage we should help the client ease her anxiety by staying
with the client and frequent talking to her.
3. Give dry crackers during her morning sickness to avoid excessive vomiting.
4. will use my knowledge in proper health and physical assessment that will serve
as the baseline data for prioritization of problems needed in providing quality
care.
5. Provide proper health teaching about diet, activities and medications to be
observed to avoid difficulty in delivery.
6. Monitor and record vital signs of the pregnant mother including the FHT to know
the condition of both mother and neonate and to avoid circumstances such as
respiratory distress.
7. Having a baseline data is important to have a safe and quality care, being a
student nurse in a patient experiencing labor we should assess and document
baseline temperature, BP, Pulse and respiration procedure and before and after
administration of .M or .V medication. For comparison of results and evaluation
of effectivity of treatment.
8. n able to have good outcomes to patient care we must provide a nursing care
plan which includes assessment, nursing diagnosis, planning, implementation,
and evaluation. This can be applied for patient having labor pains to relieve pain
and alleviate the feeling of anxiety.
9. As a student nurse to prevent intrauterine infection we must periodically change
linens when wet or soiled include to this we must discourage the use of perineal
pads or folded towels against perineum because they create a warm, moist
environmental environment for bacteria.
10. During the delivery process we must make sure that the patient is positioned in
lithotomy position with both legs on the top of foot handle with head on the pillow.
Buttocks must be placed near the end of the table to promote better pushing and
for better access on the neonate to more safer birthing procedure.
11. Practice standard precautions during labor and delivery. One example of this is
cleaning of the perineal care to avoid infection and transmission of ST to
neonates. Follow the rules of 7 during the perineal cleaning and the aseptic
technique.
12. Position the woman for delivery using large cushion for head, back and
shoulders. Stirrups or foot rest may be used for foot support. Pad the stirrups
place both legs at the same time this is to avoid ligament strain, backache or
injury.
13. Place all side rails up before moving to the labor room going to the delivery room.
nstruct patient to keep her hands off the rails, and move from the bed to the
delivery table between contractions. When the patient is primigravida transfer
immediately to the D.R table when the head is crowning.
14. Being a student nurse we should ensure accurate measurement of intake and
output maintained through labor and delivery to prevent further hemorrhage and
fluid imbalances.
15. Upon the delivery of the neonate dry it immediately to promote thermoregulation,
remove wet towels, and place infant on warm dry towels under a radiant warmer.
A wet, small neonate loses up to 200 cal/kg/minute in the delivery room through
evaporation, convection, conduction and radiation. Drying infant cuts heat loses
by 50%.
16. Avoid over suctioning infant to avoid hypoxia and dryness of mucus membranes
that can cause trauma.
17. Monitor the patient subsequently to avoid postpartum complications, take note for
signs of infection such as fever, pain and discomfort.
18. Maintain .V fluids until the client return to its normal fluid status for fluid
replacement and hydration. The primary duty of the student nurse is to monitor
and regulate V fluids of the patient.
19. Notify physician for excessive bleeding, expulsion of clots which may indicate
hemorrhage that could lead to shock.
20. Provide health teachings about breathing exercises, ambulation, safety
measures and signs of infection.
21. Provide health teaching about breastfeeding and encourage this procedure for
the benefit of mother(LAM) and her neonate(milk have increase nutrients than
formula milk)



ANAGEENT OF RESOURCES AND ENVIRONENT
1. will perform bed making, to provide comfortable environment for the patients.
2. will adhere to the principles of saving for future purposes; this includes keeping
V bottles, keeping the remaining Fluids for emergency purposes.
3. When am in the OB ward will follow the proper segregation of garbage throw
my garbage on infectious, non-biodegradable and biodegradable.
4. As a student nurse we are included in preparing the birthing room or delivery
room using sterile technique, allowing an ample time for setup before delivery. n
batangas regional hospital we mop the floor for blood remains and wipe the DR
table so that it will be maintained clean.
5. When you we are assigned to scrub we should arrange the equipments in the
mayo table according to its use. Some of the equipments are mayo scissors,
kellys straight and curve, bandage scissors, ovum forceps. These also ncludes
the syringe with lidocaine and the chromic needle for suturing.
6. Prepare the infant's warmer or basket for faster transferring of infant, prepare
also for suctioning machines to avoid aspiration.
7. Perform precise counting of instruments to avoid leaving instruments in the
perineum. The instrument that must be ensured includes sponges and needles.
This will also avoid missing objects that might be misplaced.
8. Be resourceful in every situation, when tourniquet is not available look for clean
gloves and cut its end. Being resourceful is an important aspect of a student
nurse because this will lead to a better managing of situation per se.
9. As a student nurse will change soiled and wet linens to avoid contamination and
spread of infection. Practice proper bed making technique to ensure cleanliness.
10. Practice standard precaution in preparation of medication and materials for
suturing to avoid mistakes and avoid wasting of hospital equipments.
11. will make sure that every sharp that is used in every procedure will be thrown in
the sharps container to avoid pricking and spreading of infection in the hospital.

LEGAL RESPONSIBILITIES
1. As a student nurse will maintain the confidentiality of the hospital records
including the delivery room charting. will keep every information about the
patient and avoid spreading it to other hospital personnel. will spill out the
information only for legal purposes and for other special cases where it can
harm other patient ex. ST's.
2. will ensure and check the chart if the client had signed the informed consent
so that would know if she knows the procedure that the health care will do to
her. f not will remind to the Nurses that informed consent is not yet carried
out and signed.
3. will do all my duties in the bedside and this includes vital signs taking and
proper positioning of the client, taking intake and output and proper
administration of medication together with my clinical instructor to avoid
negligence.
4. will adhere to the special considerations and precautions of the hospital to
avoid malpractice. This includes proper handling of patient and proper
administration of medication using the 10 rights. To avoid malpractice.
5. will avoid hurting and threatening the client and will always respect his
decisions. This is to avoid assault and battery
6. will not say bad words and humiliate clients and treat them as a patient that
needs care during labor and delivery.
7. ntegral part of practice of any profession is the inherent need to be
responsible for action taken and for omission. will be accountable to every
action take, any mistakes that will do will report it to my clinical instructor
and will prepare an incidental report. So that the patient will not be
compromised
8. will be a patient's advocate where in will ensure that her needs are met
during intrapartal and all her labor pains and fear is listened upon until her
recovery process.
9. understand that in the Ob ward, delivery room and recovery room my clinical
instructor will be held liable for every action do, will be reporting every
action that will do to avoid harming the patient.
10. will record and report all about the activities made for the patient so as if
problems may arise there is a quick intervention that can be done.

ETHICO-ORAL PRINCIPLES
1. Always provide privacy for the patient, which includes proper putting of coverings
and respecting personal activities of the client including bladder emptying, assist
and give privacy when doing the shaving process.
2. Respect the autonomy of the patient, being a student nurse we should always
respect for our patent's right for decision making. Their opinions must be
respected accordingly and they have the right to refuse the treatment and
procedures. We must always adhere to their request and needs.
3. Respect their decision in choosing their preferred way of giving birth such as
cesarean or normal spontaneous delivery.
4. Being a student nurse we must also practice beneficence or promoting good.
Changing positions frequently to increase comfort and promote fetal descent is
one form of doing good.
5. As a student we must always practice veracity or saying the truth to the patient.
nforming about her true condition and the condition of her neonate is one way to
alleviate her anxiety. Education will lead us to the truth that is why as student
nurse we shall provide health teachings to give them knowledge and provide
truth.
6. We as student nurse also must practice fidelity to the hospital. We should always
follow and stick to the rules and regulations of the hospital and other institutions
we are affiliated. One example of this is following the rules, regulations and
guidelines in providing nursing care for our maternal patients.
7. The principle of non-malificence must be practiced in the hospital; this can be
done by following the 10 R's of the client receiving medication for pre eclampsia
and eclatmpsia such as magnesium sulfate to avoid further complication to both
mother and their neonate and avoid medical errors that could harm the client.
8. n the ward treat everyone with fairness and equality. We must give fair treatment
to the patients in the ward regardless of their socioeconomic status. This will lead
us to justice.
9. Confidentiality of the information in the patient's chart must be considered. We
should keep every information in ourselves only and avoid spreading it out to
others except for legal purposes and in such situation that this may harm others
such as ST's.
10. We must treat our patient with care love and respect, so they would be willing to
do so intheir neonates and others.

PERSONAL AND PROFESSIONAL DEVELOPENT
1. Being a beginner in the nursing career and for preparation for the future Job, as a
student nurse will attend seminars about maternal health and child health
nursing which would give me knowledge about the said practice especially for
patients with undergoing maternal complications.
2. will adhere and follow the trends and updates about the current protocol of
department of health regarding maternal and child health nursing. This includes
the unang yakap protocol wherein latching is implemented.
3. will improve my self by the use of evaluation tool of the clinical instructors; will
base my actions in the evaluation tool to improve my personal development that
can use in giving interprersonal relationship with my patient.
4. will attend to some nursing student's organization for advance trainings about
the labor and delivery. This can be use to enhance my skills in leopold's
maneuver, placental expulsion, back rubbing that may promote comfort.
5. will have an open communication with my group mates so that would know if
am doing appropriate actions in handling my patient. To improve the way
interact with my patient considering that they are concern.
6. Being a student nurse will ask my patient if they are satisfied with the care am
giving and what are the actions that need to improve more. Besides must be
an open minded person ready for critisms and can healthily adapt to it.
7. will attend trainings regarding proper handling of pregnant patient and her
neonates. This will improve my skills and help me to attain professional growth.
8. will volunteer my self in the community programs regarding maternal and child
health to help people undergoing pregnancy and labor.
9. Provide safe and satisfying primary health care that supports individual rights and
self-determination in a variety of settings, with emphasis on underserved and
rural client populations which includes mothers, neonates and family.
10. will treat the patient professionally and will provide high standards of care
during the intrapartal, delivery and postpartum care.

QUALITY IPROVEENT
As a student nurse will adhere to the standards of care universally implemented in
nursing practice.
Standards of care involves the ff:
1. During the intrapartal period we should always monitor the client's vital signs and
clinical status so that if any deviations may arise we could notify the physician.
2. will clean the bedside of the client which includes dusting and cleaning of tables
to promote a clean environment.
3. As a student nurse will monitor and observe for my patients clinical status
adequately, to avoid any complications during labor and delivery.
4. will assess for further allergies and adverse reaction of drug to the client, to
avoid anaphylactic shock during administration of anesthesia.
5. will cooperate in quality assurance program in the hospital. will always think of
patient's satisfaction to services rendered in the hospital. This includes providing
a safe and conducive environment for labor. Proper ventilation and do not
overcrowd the patient in the labor room.
6. will adhere to the DOH protocol on delivery procedures to provide quality care.
7. wil be focusing on nursing process in giving care for my patient undergoing
intrapartal, delivery and postpartal client.
8. will maintain open lines of communication to the client to ease her anxiety
during labor and give diversional activities.
9. will implement consistent application of new policies and procedures for quick,
easy and if possible anonymous self reporting errors with protection of
disciplinary actions to minimize harm to client.
10. will ensure proper infection control to avoid postpartal complications.
RESEARCH
1. will provide evidence based nursing care that could benefit a lot for my patient
in the intrapartal, delivery and postpartum stage.
2. Being a student nurse will try to contribute to the nursing research regarding
maternal health and child health nursing. Some of the possible research that will
propose are:

Factors affecting complications during pregnancy

The effectiveness of unang yakap implementation in the bonding of the mother
and her baby.

Factors affecting labor pains and fear of the mothers undergoing the delivery.

3. As a student nurse will read more articles about labor and delivery to be applied
in the nursing practice for providing care.
4. will cite some journal review and publish it through internet to spread some
knowledge for student nurse like me.
5. will satisfy my curiosity by gathering vast information about labor and delivery
that could help me improves my skills and can contribute to my knowledge.
6. dentify the influence of economic, social, and political trends on the
effectiveness of health care delivery to women and infants.
7. Using my Nursing books will analyze theoretical and empirical knowledge from
the sciences and humanities, and apply this knowledge to the care of women and
their infants within a family and community context.
8. Recently we are conducting a research to improve parenting practices among
mothers and their child. will share this to my postpartum client to help her
prepare in raising her child.
9. Study more on postpartal management using researches and articles. This help
us to deal with client having postpartal depression.
10. Provide health teachings to client undergoing breastfeeding which can be based
on evidence base sources.
RECORDS ANAGEENT
1. Being a student nurse will record all the data and information about the client,
this will serve as the basis for continuity of care.
2. During the intrapartal period will take, monitor and record the vital signs of the
client.
3. will avoid errors in charting that could lead to misperceptions in carrying out
doctor's order.
4. will data all the actions and activities that did for the patient for my personal
safety and for the patient as well.
5. will attend the endorsement to know the condition of my patient and for me to
decide to what will do for continuity of care. This would help for the fast
progress of the client.
6. will sort the chart properly to avoid missing file and tearing of the medical
records of the client.
7. will make sure that every doctor's orders are made and carried out; the data
that will input about my patient should be signed by my clinical instructor.
8. n port partal stage will record the patients assessment according to
BUBBLERS (breast,uterus, bladder, bowel, lochia, episiotomy, e,otional
response, homan's sign)
9. Record all unnecessary signs and symptoms of the client which may be an
indicator of infection
10. Endorse patient for continuity of care. For proper recording cycle in the chart.

COLLABORATION AND TEAORK
1. During the intrapartal stage always collaborate with the nurse and clinical
instructor to provide proper procedure in the bedside.
2. will create collaborative relationships with other health team members and with
community groups for the planning, management, and provision of health care
for women and their infants.
3. For patient with respiratory problems because of labor and delivery will be
coordinating to the respiratory therapist and suggest about the patients condition.
4. will help the nurse in providing care for the patient undergoing labor.
5. Notify necessary obstetric personnel and primary practitioner to prepare for
delivery. Because it is often difficult to predict delivery time, err on the side of
safety and call early order to limit deliveries without a primary provider
6. Prepare the infant resuscitation area; notify pediatric personnel, if appropriate per
facility policy; if category pattern have 2 practitioners available to administer
neonatal resuscitation as indicated
7. Assist in giving instruments to the obstetric personnel and assist in suturing for
faster and efficient procedure during delivery.
8. Notify physician if we had assessed postpartum complications especially signs of
infection such as fever, chills, tenderness and pain.
9. Refer for family psychologist for counseling and advices to avoid postpartal
depression.
10. Ask for the help of my group mates or othe nursing assistant especially when
doing proper lifting and transferring to avoid fractures to client and to the nurses
as well.