正常分娩課件

匯報(bào)人：xxx20xx-03-15正常分娩ppt課件目錄正常分娩概述產(chǎn)前檢查與評(píng)估正常分娩的臨床表現(xiàn)正常分娩的輔助檢查與診斷正常分娩的并發(fā)癥及處理正常分娩的產(chǎn)程觀察與護(hù)理正常分娩的健康教育與心理支持01正常分娩概述正常分娩是指妊娠滿28周及以上，胎兒及附屬物從臨產(chǎn)開(kāi)始到全部從母體娩出的過(guò)程。定義正常分娩是一個(gè)自然的生理過(guò)程，需要產(chǎn)婦和胎兒的共同參與和努力。特點(diǎn)定義與特點(diǎn)正常分娩的重要性對(duì)母體的好處正常分娩可以減少產(chǎn)后出血、感染等并發(fā)癥的發(fā)生，促進(jìn)產(chǎn)后恢復(fù)。對(duì)胎兒的好處正常分娩可以使胎兒逐漸適應(yīng)外界環(huán)境，減少新生兒窒息、肺炎等并發(fā)癥的發(fā)生。對(duì)家庭和社會(huì)的好處正常分娩有助于家庭和諧、減輕社會(huì)負(fù)擔(dān)，提高人口素質(zhì)。以下附贈(zèng)各項(xiàng)管理制度英文版（不需要可刪）急救藥品、器材管理制度:1.Rescuedrugsandequipmentshouldbe"fivefixed"(fixedquantityandvariety,designatedplacement,designatedpersonstorage,regulardisinfectionandsterilization,regularinspectionandmaintenance)and"twotimely"(timelyinspectionandmaintenance,timelyreceiptandsupplementation).Theitemisclearlymarkedandcannotbeusedarbitrarily.2.Thenecessaryrescueequipmentiscomplete,ingoodperformance,andinstandbycondition.3.Therescuedrugsarecomplete,withcleardruglabelsandnodiscoloration,deterioration,expiration,ordamage.Theyshouldbeplacedandusedintheorderofdrugexpirationdates(fromrighttoleft).4.Emergencydrugsanditemsforeachdepartment'srescuevehicleshallbeuniformlyequippedaccordingtorequirements.Specializedemergencydrugsanditemsmustbereviewedandapprovedbythedepartmentdirectortodeterminethetype,quantity,specifications,anddosagetobeequipped.Rescuevehiclesmustbeplacedindesignatedlocationsandmanagedbydesignatedpersonneltoensuresafetyandeaseofuse.5.Afterusingrescuedrugsandequipment,theyshouldbefullyreplenishedwithin24hours.Iftheycannotbereplenishedduetospecialreasons,theyshouldbenotedonthehandoverregistrationformandreportedtotheheadnurseforcoordinationandresolutiontoensuretimelyuseduringpatientrescue.6.Thereisaregistrationbookfortheprovisionofdrugsandequipment.Ensureconsistencybetweenaccountsandmaterials,andhandoverbetweenshifts.7.Managementofsealedrescuevehicles:Beforesealing,theheadnurse(ornurseincharge)andanothernurseshallcountthedrugsandequipmentaccordingtotheregistrationbookofdrugandequipmentequipment,verifytheiraccuracy,andsealthemwithaseal.Twopeopleshallsignandfillinthesealingtime.Nurseschecktheconditionofthesealsoncepershiftandcompletethehandover.Theresponsiblenursescheckonceaweek,andtheheadnurseandresponsiblenursesopenthesealsandinspectthedrugsandequipmentintheambulanceonceamonth,withrecordskept.8.Nonsealedrescuevehiclemanagement:Eachshiftshallcountthedrugsandequipmentaccordingtotheregistrationbookandcompletethehandover.Theresponsiblenurseshallinspectonceaweek,andtheheadnurseshallinspectonceeverytwoweeksandkeeprecords,ensuringthattheaccountsmatchthematerials.護(hù)理文書(shū)書(shū)寫(xiě)制度:

1.Nursingstaffstrictlyfollowthelatestrequirementswhenwritingnursingmedicalrecords.2.Thecontentofnursingrecordsshouldbeobjective,truthful,accurate,timely,complete,andstandardized.3.Allnursingdocumentsshouldbewrittenwithablueblackorcarboninkpen.4.AllnursingdocumentsshouldbewritteninArabicnumeralsfordateandtime,withdatesinyears,months,anddays,usinga24-hoursystem,specifictominutes.5.WritingshoulduseChinese,medicalterminology,andcommonlyusedforeignlanguageabbreviations;Completerecorditems;Thetextisneat,thehandwritingisclear,andthelayoutisclean;Accurateexpression,fluentsentences,simpleandconcise:correctformatandpunctuation,notypos.6.Whenerrorsoccurduringthewritingprocess,doublelinethemonthewrongwords,keeptheoriginalrecordclearanddistinguishable,signthemodifier,indicatethemodificationtime,continuetowritethecorrectcontent,anddonotusescraping,sticking,paintingorothermethodstocoveruporremovetheoriginalhandwriting.Eachpageshouldbemodifiednomorethantwotimes,otherwisetheoriginalrecorderwillpromptlycopyagain(exceptformodificationsmadebysuperiors).7.Nursingrecordswrittenbyinternnurses,probationarynurses,orunregisterednursesshouldbereviewedandsignedbynurseswithlegalprofessionalqualificationsinthismedicalinstitution.8.Furthertrainingnursescanonlywritenursingdocumentsafterbeingrecognizedbythemedicalinstitutionreceivingthetrainingfortheirworkability.9.Superiornursingstaffhavetheresponsibilitytoreviewandmodifythewrittenrecordsofsubordinatenursingstaff.Whenmakingmodifications,reddoublelinesshouldbeusedtomarkerrors,writethemodifiedcontent,signandindicatethemodificationtime.10.Temperaturerecords,medicalorders,patientcarerecords,andsurgicalinventoryrecordsshouldbearchivedontime.123又稱(chēng)宮頸擴(kuò)張期，指臨產(chǎn)開(kāi)始直至宮口完全擴(kuò)張（開(kāi)全）為止。此期產(chǎn)婦出現(xiàn)規(guī)律宮縮，宮口逐漸擴(kuò)張，胎頭下降。第一產(chǎn)程又稱(chēng)胎兒娩出期，指從宮口開(kāi)全到胎兒娩出。此期產(chǎn)婦需要配合宮縮使用腹壓，將胎兒娩出。第二產(chǎn)程又稱(chēng)胎盤(pán)娩出期，指從胎兒娩出到胎盤(pán)娩出。此期產(chǎn)婦需要繼續(xù)配合宮縮，將胎盤(pán)娩出，同時(shí)觀察產(chǎn)后出血情況。第三產(chǎn)程正常分娩的生理過(guò)程02產(chǎn)前檢查與評(píng)估一般檢查血液檢查尿液檢查超聲檢查產(chǎn)前檢查項(xiàng)目包括身高、體重、血壓、宮高、腹圍等測(cè)量，評(píng)估孕婦基本健康狀況。檢測(cè)尿蛋白、尿糖、尿酮體等，評(píng)估孕婦泌尿系統(tǒng)及代謝狀況。包括血常規(guī)、血型、肝腎功能、血糖、血脂等，了解孕婦有無(wú)貧血、感染及肝腎功能異常等。通過(guò)B超或彩超了解胎兒生長(zhǎng)發(fā)育情況、羊水量及胎盤(pán)位置等。詢(xún)問(wèn)病史體格檢查實(shí)驗(yàn)室檢查影像學(xué)檢查產(chǎn)前評(píng)估方法01020304了解孕婦既往病史、家族遺傳病史、生育史等，評(píng)估孕期風(fēng)險(xiǎn)。包括心肺聽(tīng)診、腹部觸診等，了解孕婦身體狀況及胎兒體位。結(jié)合血液、尿液等檢查結(jié)果，綜合評(píng)估孕婦及胎兒健康狀況。通過(guò)超聲檢查等影像學(xué)手段，直觀了解胎兒宮內(nèi)情況。高危因素篩查與處理針對(duì)高齡孕婦、既往不良孕產(chǎn)史、慢性疾病等高危因素進(jìn)行篩查。對(duì)篩查出的高危孕婦進(jìn)行專(zhuān)案管理，制定個(gè)性化診療方案。加強(qiáng)孕期監(jiān)護(hù)，密切關(guān)注孕婦及胎兒狀況，及時(shí)發(fā)現(xiàn)并處理異常情況。針對(duì)高危孕婦制定分娩期處理方案，確保母嬰安全。高危因素篩查專(zhuān)案管理孕期監(jiān)護(hù)分娩期處理03正常分娩的臨床表現(xiàn)孕婦會(huì)感到上腹部輕松，呼吸順暢，胃部受壓感減輕。子宮底下降分娩前數(shù)周，孕婦會(huì)感到腹部一陣陣變硬，伴有輕度墜脹感，這是子宮在收縮。子宮收縮分娩前24-48小時(shí)，yin道會(huì)流出少量血性粘液，這是見(jiàn)紅，是分娩即將開(kāi)始的一個(gè)可靠征兆。見(jiàn)紅yin道流出羊水，俗稱(chēng)“破水”，是臨產(chǎn)的可靠征兆。破水后，孕婦應(yīng)立即平臥，防止臍帶脫垂，并盡快送往醫(yī)院。破水先兆臨產(chǎn)癥狀第一產(chǎn)程01又稱(chēng)宮頸擴(kuò)張期，從臨產(chǎn)開(kāi)始到宮頸口開(kāi)全。此期孕婦會(huì)感到陣發(fā)性腹痛，隨著宮縮的加強(qiáng)，疼痛逐漸加劇，持續(xù)時(shí)間也逐漸延長(zhǎng)。第二產(chǎn)程02又稱(chēng)胎兒娩出期，從宮頸口開(kāi)全到胎兒娩出。此期孕婦需在產(chǎn)床上配合宮縮用力，將胎兒娩出。第三產(chǎn)程03又稱(chēng)胎盤(pán)娩出期，從胎兒娩出到胎盤(pán)娩出。此期一般約5-15分鐘，不超過(guò)30分鐘。胎盤(pán)娩出后，整個(gè)產(chǎn)程結(jié)束。產(chǎn)程分期及特點(diǎn)胎兒娩出后，應(yīng)立即清理呼吸道，保持呼吸道通暢。同時(shí)評(píng)估新生兒狀況，如阿普加評(píng)分等。新生兒處理協(xié)助胎盤(pán)娩出檢查軟產(chǎn)道觀察產(chǎn)后出血情況新生兒娩出后，需等待胎盤(pán)自然剝離或協(xié)助胎盤(pán)剝離，并檢查胎盤(pán)胎膜是否完整。檢查宮頸、yin道及外陰有無(wú)裂傷，如有裂傷應(yīng)及時(shí)縫合。產(chǎn)后2小時(shí)內(nèi)應(yīng)密切觀察產(chǎn)婦出血情況，及時(shí)發(fā)現(xiàn)并處理產(chǎn)后出血。胎兒娩出后的處理04正常分娩的輔助檢查與診斷包括血常規(guī)、尿常規(guī)、凝血功能、肝腎功能等，以評(píng)估產(chǎn)婦的一般健康狀況。實(shí)驗(yàn)室檢查影像學(xué)檢查胎心監(jiān)護(hù)如B超等，用于了解胎兒的大小、胎位、羊水量以及胎盤(pán)位置等。通過(guò)胎心監(jiān)護(hù)儀連續(xù)監(jiān)測(cè)胎心率，以評(píng)估胎兒在宮內(nèi)的狀況。030201輔助檢查項(xiàng)目產(chǎn)婦出現(xiàn)規(guī)律宮縮、宮頸擴(kuò)張、胎頭下降等正常分娩的臨床表現(xiàn)。臨床表現(xiàn)產(chǎn)婦的血壓、脈搏、呼吸等生命體征平穩(wěn)，腹部觸診可捫及胎背、肢體等。體格檢查實(shí)驗(yàn)室檢查和影像學(xué)檢查結(jié)果符合正常分娩的診斷標(biāo)準(zhǔn)。輔助檢查診斷依據(jù)及標(biāo)準(zhǔn)鑒別診斷與難產(chǎn)、胎兒窘迫等異常分娩情況進(jìn)行鑒別，以及排除其他可能導(dǎo)致分娩異常的疾病。注意事項(xiàng)在診斷過(guò)程中，要密切關(guān)注產(chǎn)婦和胎兒的狀況變化，及時(shí)發(fā)現(xiàn)并處理異常情況。同時(shí)，要尊重產(chǎn)婦的知情權(quán)和選擇權(quán)，充分告知分娩過(guò)程中可能出現(xiàn)的風(fēng)險(xiǎn)和并發(fā)癥，讓產(chǎn)婦做出自主決策。鑒別診斷與注意事項(xiàng)05正常分娩的并發(fā)癥及處理加強(qiáng)產(chǎn)前保健，識(shí)別高危因素；積極處理第三產(chǎn)程，控制性牽拉臍帶協(xié)助胎盤(pán)娩出；產(chǎn)后密切觀察出血量，及時(shí)發(fā)現(xiàn)并處理出血。預(yù)防措施針對(duì)出血原因迅速止血，補(bǔ)充血容量以糾正失血性休克，并防止感染。對(duì)于宮縮乏力引起的出血，可按摩子宮、應(yīng)用宮縮劑；對(duì)于軟產(chǎn)道裂傷，應(yīng)及時(shí)縫合止血；對(duì)于胎盤(pán)因素引起的出血，應(yīng)根據(jù)情況采取相應(yīng)措施。處理方法產(chǎn)后出血的預(yù)防與處理產(chǎn)褥感染的防治策略預(yù)防措施加強(qiáng)孕期衛(wèi)生宣教，保持全身及外陰清潔；加強(qiáng)營(yíng)養(yǎng)，增強(qiáng)體質(zhì)；妊娠晚期避免盆浴及性交；產(chǎn)后注意休息。治療方法根據(jù)病情選用廣譜高效抗生素，進(jìn)行抗感染治療；取半臥位以利惡露排出，使炎癥局限于盆腔內(nèi)；會(huì)陰部保持清潔干燥，必要時(shí)行會(huì)陰切開(kāi)引流術(shù)。評(píng)估與監(jiān)護(hù)復(fù)蘇后需密切監(jiān)護(hù)新生兒生命體征，及時(shí)發(fā)現(xiàn)并處理異常情況。藥物治療如情況嚴(yán)重，可使用腎上腺素等藥物治療。胸外按壓如心率仍低于60次/分，則進(jìn)行胸外按壓。初步復(fù)蘇保暖、擺正體位、清理呼吸道、刺激呼吸。正壓通氣面罩或氣管插管正壓通氣，給予氧氣支持。新生兒窒息的復(fù)蘇技術(shù)06正常分娩的產(chǎn)程觀察與護(hù)理注意宮縮的頻率、持續(xù)時(shí)間和強(qiáng)度，評(píng)估產(chǎn)程的進(jìn)展。觀察宮縮定時(shí)聽(tīng)取胎心音，了解胎兒在宮內(nèi)的情況。監(jiān)測(cè)胎心觀察宮頸口擴(kuò)張和胎先露下降情況，判斷產(chǎn)程進(jìn)展。檢查宮頸鼓勵(lì)產(chǎn)婦進(jìn)食、休息，保持大小便通暢，進(jìn)行心理支持。產(chǎn)婦護(hù)理第一產(chǎn)程觀察與護(hù)理要點(diǎn)指導(dǎo)產(chǎn)婦用力在宮縮時(shí)指導(dǎo)