| Term | Definition | Key Nursing Implication |
|---|---|---|
| Precipitous Labor | Labor lasting 5 cm/hr for primigravida, >10 cm/hr for multigravida). | Prepare for delivery immediately. Monitor for maternal trauma (lacerations, hemorrhage) and fetal distress. |
| Primigravida | A woman experiencing her first pregnancy. | Labor is typically longer. Rapid progression is more abnormal and alarming than in a multigravida. |
| Cervical Dilation | The opening of the cervix, measured from 0 to 10 centimeters. | The rate of change, not a single measurement, is critical for diagnosing labor abnormalities. |
| Effacement | The thinning of the cervix, expressed as a percentage (0% to 100%). | Effacement often precedes significant dilation, especially in primigravidas. |
| Labor Stage/Phase | Typical Duration (Primigravida) | Cervical Findings | Contraction Pattern |
|---|---|---|---|
| Latent Phase | Up to 20 hours | 0 to 5 cm/hour is too fast.
All stages completed in 임상 시나리오Nursing Clinical Practice Guide
Clinical Scenario: You are the nurse in triage. Maria, a 25-year-old primigravida at 39 weeks, arrives stating her water broke 1 hour ago and she just started having "very strong pains" 30 minutes ago. She appears anxious and is breathing heavily with contractions. Your initial vaginal exam reveals she is 6 cm dilated, 100% effaced.
Nursing Intervention Strategy: 1. Assessment: Immediately reassess cervical status in 15-20 minutes. Monitor contraction pattern (frequency, duration, intensity) continuously via tocodynamometer and fetal heart rate (FHR) via electronic fetal monitoring (EFM). Rapid cervical change confirms precipitous labor. 2. Planning & Implementation: - Key Point! Do not leave the client alone. Call for additional staff and notify the provider STAT. - Transfer the client directly to a delivery room—bypass the standard labor room. - Prepare the delivery tray, neonatal resuscitation equipment, and oxytocin (Pitocin) in case of postpartum hemorrhage. - Provide calm, clear coaching for breathing techniques to prevent pushing before full dilation. 3. Patient Safety and Precautions: - Risk of Delivery in Unprepared Location: Never attempt to transfer a client who is actively pushing or has an imminent urge to push. - Neonatal Resuscitation: Have the warmer on and the neonatal team notified due to risk of rapid birth and potential depression. - Maternal Monitoring: After delivery, monitor for signs of uterine atony (boggy uterus, heavy bleeding) and lacerations every 15 minutes for the first hour. Nursing Procedure & Medication Flow Procedure for Managing an Imminent Precipitous Delivery: 1. Stay with the client. Use the call bell to alert others. 2. If delivery is unavoidable, don sterile gloves. 3. Support the perineum with a sterile towel to control the head's emergence and prevent lacerations. 4. After head delivery, check for nuchal cord. If present, reduce it (slip it over the head) or clamp and cut if tight. 5. Deliver the shoulders, then the rest of the body. 6. Dry, stimulate, and place the newborn skin-to-skin on the mother's abdomen. Clamp and cut the cord. 7. Deliver the placenta. Critical: Massage the fundus firmly to stimulate contraction and prevent hemorrhage. Medication Alert: Oxytocin is typically administered IV or IM after placental delivery to promote uterine contraction. In precipitous labor, be prepared to administer it promptly as ordered. A Word from Your Senior Nurse "Precipitous labor can be one of the most adrenaline-filled moments on the unit. Your knowledge and calm demeanor are the patient's anchor. Remember, the textbook definition is about centimeters per hour, but in real life, it's about the pace of change. Trust your assessment. If you see rapid progression, act decisively—your priority is to ensure a safe delivery environment for both mom and baby. This isn't just about passing the NCLEX; it's about being the competent, prepared nurse that a terrified first-time mom needs in that moment." 핵심 개념
학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요. |