正常分娩課件

匯報人：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)開始到全部從母體娩出的過程。定義正常分娩是一個自然的生理過程，需要產(chǎn)婦和胎兒的共同參與和努力。特點定義與特點正常分娩的重要性對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，促進產(chǎn)后恢復(fù)。對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。對家庭和社會的好處正常分娩有助于家庭和諧、減輕社會負擔，提高人口素質(zhì)。以下附贈各項管理制度英文版（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.護理文書書寫制度:

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又稱宮頸擴張期，指臨產(chǎn)開始直至宮口完全擴張（開全）為止。此期產(chǎn)婦出現(xiàn)規(guī)律宮縮，宮口逐漸擴張，胎頭下降。第一產(chǎn)程又稱胎兒娩出期，指從宮口開全到胎兒娩出。此期產(chǎn)婦需要配合宮縮使用腹壓，將胎兒娩出。第二產(chǎn)程又稱胎盤娩出期，指從胎兒娩出到胎盤娩出。此期產(chǎn)婦需要繼續(xù)配合宮縮，將胎盤娩出，同時觀察產(chǎn)后出血情況。第三產(chǎn)程正常分娩的生理過程02產(chǎn)前檢查與評估一般檢查血液檢查尿液檢查超聲檢查產(chǎn)前檢查項目包括身高、體重、血壓、宮高、腹圍等測量，評估孕婦基本健康狀況。檢測尿蛋白、尿糖、尿酮體等，評估孕婦泌尿系統(tǒng)及代謝狀況。包括血常規(guī)、血型、肝腎功能、血糖、血脂等，了解孕婦有無貧血、感染及肝腎功能異常等。通過B超或彩超了解胎兒生長發(fā)育情況、羊水量及胎盤位置等。詢問病史體格檢查實驗室檢查影像學檢查產(chǎn)前評估方法01020304了解孕婦既往病史、家族遺傳病史、生育史等，評估孕期風險。包括心肺聽診、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，綜合評估孕婦及胎兒健康狀況。通過超聲檢查等影像學手段，直觀了解胎兒宮內(nèi)情況。高危因素篩查與處理針對高齡孕婦、既往不良孕產(chǎn)史、慢性疾病等高危因素進行篩查。對篩查出的高危孕婦進行專案管理，制定個性化診療方案。加強孕期監(jiān)護，密切關(guān)注孕婦及胎兒狀況，及時發(fā)現(xiàn)并處理異常情況。針對高危孕婦制定分娩期處理方案，確保母嬰安全。高危因素篩查專案管理孕期監(jiān)護分娩期處理03正常分娩的臨床表現(xiàn)孕婦會感到上腹部輕松，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，yin道會流出少量血性粘液，這是見紅，是分娩即將開始的一個可靠征兆。見紅yin道流出羊水，俗稱“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又稱宮頸擴張期，從臨產(chǎn)開始到宮頸口開全。此期孕婦會感到陣發(fā)性腹痛，隨著宮縮的加強，疼痛逐漸加劇，持續(xù)時間也逐漸延長。第二產(chǎn)程02又稱胎兒娩出期，從宮頸口開全到胎兒娩出。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又稱胎盤娩出期，從胎兒娩出到胎盤娩出。此期一般約5-15分鐘，不超過30分鐘。胎盤娩出后，整個產(chǎn)程結(jié)束。產(chǎn)程分期及特點胎兒娩出后，應(yīng)立即清理呼吸道，保持呼吸道通暢。同時評估新生兒狀況，如阿普加評分等。新生兒處理協(xié)助胎盤娩出檢查軟產(chǎn)道觀察產(chǎn)后出血情況新生兒娩出后，需等待胎盤自然剝離或協(xié)助胎盤剝離，并檢查胎盤胎膜是否完整。檢查宮頸、yin道及外陰有無裂傷，如有裂傷應(yīng)及時縫合。產(chǎn)后2小時內(nèi)應(yīng)密切觀察產(chǎn)婦出血情況，及時發(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，以評估產(chǎn)婦的一般健康狀況。實驗室檢查影像學檢查胎心監(jiān)護如B超等，用于了解胎兒的大小、胎位、羊水量以及胎盤位置等。通過胎心監(jiān)護儀連續(xù)監(jiān)測胎心率，以評估胎兒在宮內(nèi)的狀況。030201輔助檢查項目產(chǎn)婦出現(xiàn)規(guī)律宮縮、宮頸擴張、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。體格檢查實驗室檢查和影像學檢查結(jié)果符合正常分娩的診斷標準。輔助檢查診斷依據(jù)及標準鑒別診斷與難產(chǎn)、胎兒窘迫等異常分娩情況進行鑒別，以及排除其他可能導(dǎo)致分娩異常的疾病。注意事項在診斷過程中，要密切關(guān)注產(chǎn)婦和胎兒的狀況變化，及時發(fā)現(xiàn)并處理異常情況。同時，要尊重產(chǎn)婦的知情權(quán)和選擇權(quán)，充分告知分娩過程中可能出現(xiàn)的風險和并發(fā)癥，讓產(chǎn)婦做出自主決策。鑒別診斷與注意事項05正常分娩的并發(fā)癥及處理加強產(chǎn)前保健，識別高危因素；積極處理第三產(chǎn)程，控制性牽拉臍帶協(xié)助胎盤娩出；產(chǎn)后密切觀察出血量，及時發(fā)現(xiàn)并處理出血。預(yù)防措施針對出血原因迅速止血，補充血容量以糾正失血性休克，并防止感染。對于宮縮乏力引起的出血，可按摩子宮、應(yīng)用宮縮劑；對于軟產(chǎn)道裂傷，應(yīng)及時縫合止血；對于胎盤因素引起的出血，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)防措施加強孕期衛(wèi)生宣教，保持全身及外陰清潔；加強營養(yǎng)，增強體質(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)；會陰部保持清潔干燥，必要時行會陰切開引流術(shù)。評估與監(jiān)護復(fù)蘇后需密切監(jiān)護新生兒生命體征，及時發(fā)現(xiàn)并處理異常情況。藥物治療如情況嚴重，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)程觀察與護理注意宮縮的頻率、持續(xù)時間和強度，評估產(chǎn)程的進展。觀察宮縮定時聽取胎心音，了解胎兒在宮內(nèi)的情況。監(jiān)測胎心觀察宮頸口擴張和胎先露下降情況，判斷產(chǎn)程進展。檢查宮頸鼓勵產(chǎn)婦進食、休息，保持大小便通暢，進行心理支持。產(chǎn)婦護理第一產(chǎn)程觀察與護理要點指導(dǎo)產(chǎn)婦用力在宮縮時指導(dǎo)