“RESPONSIBILITIES OF ASSIST”
The unsterile student/ wears clean gloves Assistant to the sterile handle student
1. Do labo laborr wat watch ch Monitor Fetal Heart Beat(should not be uterine soufile) * Not during uterine contractions * Any abnormal action abnormality in FHB initial action is to change the * Mother’s position * Latent phase: every hour * Active phase: every 30 minutes * Transitional phase: every 15 minutes Monitor BP of mother every 30 minutes 2. If still in the latent and active phase of stage 1 (up to 7cm dilation), assist patient in ambulating in the area. But now allowed if there is PROM 3. If in the the transitional transitional phase phase (8cm-10cm) (8cm-10cm),, do squatting squatting.. one student will stand in front of the patient will the patient puts her hands on his shoulder, while another student will stay at the back will squat together with the mother 4. Let the patient remove panties before mounting to DR table assist. wear clean gloves and put Kelly pad on DR table 5. Ask watc watcher her to to buy ice and and wrap wrap in cloth cloth 6. if parturient parturient is already mounted mounted to DR DR table, assist in in positioning positioning (lithotomy) • In lithotomy, put both legs up in stirrups at the same together with the ungloved Handle (to prevent injury to the uterine ligament) 7. Do Perin Perinea eall Flu Flushi shing ng Use 3 or more cherry ball with betadine feminine wash and working Forceps • Slowly flush the perineum using tap water 8. If no signs of bulging perineum. perineum. Assist Assist client to a left left lateral lateral decubitus decubitus position. Upon washing Instruct, mother not to push to pant (rapid and shallow Breathing) Instead to prevent rapid expulsion of the baby 9. Get BP and PHB every 30 minutes especially during active labor 10. If head of neonate is delivered. Stay beside the woman woman 11. If the expulsion occurs, note the time and say “baby out (what time)”
12. Handle student/doctor will place the baby on the abdomen while Suctioning and The staff will take the baby and put it in nearby crib 13. Get the BP of the mother immediately after expulsion 14. Palpate the uterus to determine degree of contraction 15. Wait for placental separation. Observe the 3 signs of placental separation (Rising of the fundus to the level of the umbilicus, lengthening of the cord sudden gush of vaginal blood). Take note of the time of placental Separation “placenta out: what time” 16. Get immediately the BP of the mother right after separation 17. Put ice over abdomen, or massage uterus 18. Assist in giving lidocaine holding only the vial and not the syringe (assist will run errands because he is unsterile. He can also do IVF follow ups) 19. Help handle after care 20. Check fundus characteristics and level q 15 minutes for 1 hour q 30 minutes for the next 4 hours 21. Monitor lochia . immediately after delivery, a perennial pad can be saturated after 30 minutes 22. The mother should void within 5-8 hours post delivery 23. Chck mother’s BP q 15 minutes
“RESPONSIBILITIES OF HANDLE” The sterile student Assistant to the midwife/doctor
1. Do labor watch. Help assist in monitoring BP and FHB 2. Make sure to study and familiarize the stage 4 o labor mechanism of labor, 5 P’s, placental expulsion presentation etc 3. Always observe sterile technique 4. Check the mayo table. Complete the instrument needed for delivery One kelly curved One kelly straight (sometimes 2 kelly curved are used) One needle holder One ovum foreceps One mayo scissors One metz scissors One tissue forceps Two sterile leggings Two hypo towel One kidney basin Four pieces OS One suction bulb
1 chromic suture 1 10-cc syringe (for lidocaine) don’t open yet: assist student will open sterile field When the doctor ask 3 cherry balls with betadyne 5. Set aside gloves for doctors (5 ½ for female doctors 7 ½ for male doctors) 6. When the parturient is mounted to the DR table, assist in lithothomy position then do the following Handwashing Air dry hands 7. Watch out for crowning 8. If this occurs, do surgical gloving, then place sterile hypo towel over mothers abdomen (one that was used to cover on the mayo table) 9. Drape the patient using sterile leggings found in the mayo table. Then put another hypo towel under the buttocks, making sure not to contaminate your gloved hads 10. Wait for the head to be delivered hold suction bulb with one hand 11. When the heads is delivered suction the mouth 1 st then suction the nose Handle can perform the ritgen’s maneuver (use sterile cloth or OS) other hand=suction 1 hand= ritgens Episiotomy-may be done EPISIOTOMY- surgical incision of the perineum and to release Pressure of The Fetal head with birth “Advantages” A) Substitutes a clean cut for a rugged tear B) Minimizes pressure on the fetal head C) Shortens the last portion of the second stage of labor 12. Maintain ritgens while the body is being delivered. After being delivered stop the ritgens and drop the cloth on the floor 13. When the baby placed on the abdomen of the mother by the doctor continue to suction the mouth of the nose 14. Give 1 kelly forcep to the doctor the doctor will clump the cord then another Kelly forcep doctor will clamp again then the mayo scissors cord doctor will cut (sometimes the doctors will get the forceps themselves) 15. the staff will take the baby crib 16. Handle continues to assist while the doctor/midwife will do the Brandt Andrew maneuver. Wait for the placenta to come out by observing the 3signs of placental separation (rising to the fundus to the level of the umbilicus, lengthening of the cord sudden qush of vaginal blood ) 17. Once placenta is out get the kidney basin and the doctor will put the placenta there. Some doctors will use the kidney basin to catch the placenta. Note the time of placental expulsion and identify if Duncan or Schultz placenta should be delivered within 20 minutes 18. Inspect cotyledons of placenta. Normal-20 cotyledons 19. Assist doctor/midwife in their needs like offering instruments 20. Assist epistorraphy if to be done Let assist open syringes chromic then drop on the sterile field
Remove needle with cap of syringe, the withdraw lidocaine from the offered Vial by the assist, making sure to touch only the hub and not the vial. Then Reconnect to original needle with cap Knowing what hands is to be used by the doctor Placing suture in the needle holder, offer in the right way, wile Holding the Thread Dominant hand will hold scissor non-dominant will hold 1 OS for sponging Cutting suture (long: half inch short: close to knot Sterile shopping 21. After episiorraphy do not removes your glover yet 22. Do perineal care, wipe off blood strains around the vulva with OS apply betadyne to suture line position mother flat on bed without pillows 23. Provide blankets to keep her warm if complained of chills 24. Do after care. Scrub all instruments with soap and water, dry in towel then soak in deconex solution 25 Carry pail-containing placenta and Kelly pad to the washing area, dispose sharps in one hole and the placenta in another one. Make sure to flush placenta with 5 pails of water 26. Scrub Kelly pad hang it dry 27. Do charting of DR note. Follow format provided
“RESPONSIBILITIES OF CORD CARE” Do labor watch. Get FHB and BP Watch out for crowning. Do clean gloves prepare a sterile ahead of tome get an OB set (sterile) umbilical scissors/ mayo scissors cord clamp (don’t open yet unless baby has been delivered) 3 cotton balls with alcohol 3 cotton balls with betadyne Sterile gloves 5. should be available at he other corner of the table Rectal thermometer Dry cotton Tape measure Vitamin k ampule 1 cc syringe with needle Crede’s prophylaxis ID bracelet Drop light on crib cord dress area 1. 2. 3. 4.
Weighing scale 2 Os (to wipe baby during bath) 1 baby bath tub 6. Prepare bath of baby. Mixed it with baby Johnson’s Baby shampoo. Check if temperature is appropriate (use elbow wrist) 7. Ask clothes baby from parents, and prepare them * Infant shirt * Diapers * Bornet / cloth to wrap baby 8. make sure that the fan is turned off in cord dressing room 9. When neonate is delivered, wait for it to be transferred to the crib with the drop light applied place in side-lying position and stimulate to cry by rubbing and wiping the back then the staff will transport the baby to the cord dressing area 10. Weight baby and say it out loud average 6.5-7.5lbs (3-3.4kgs) make sure to lift the forcep low birth weight 5.5 lbs (2kgs) 11. bath baby * Support the head always, buttocks can stay submerged * Cephalocadual approach last woud be geitalia * Can use OS to wipe the vernix in the head * Don’t mind if the forcep is soaked in the tub * Dry the baby When carrying the baby use a football hold 9. Back to the crib wipe to dry then do the measurements. Get measurements head chest, abdomen circumference length Head 33cm-35cm (slip under the head) (write value immediately in small Notebook) Then slip the tape measure into the abdomen Abdomen: 31cm-33cm (umbilical level) Turn the baby to the side (side lying position) then measure from the Posterior fontanel down to the feet (follow curvature of the baby) Length 45.7cm-53 75cm (average 50 cm) 13. Dress up the baby but expose the umbilical area for cord dressing 14. Do surgical gloving then perform cord care 15. STEPS IN CORD CARE (PUPOSE TO PREVENT TETANUS NEONATORUM) A) Get one cotton ball with alcohol then wipe from base in rotating motion then up the cord with upward sticks (70% alcohol to prevent drying up) use opposite side of cotton ball for another upward strike then use cotton ball with betadyne following the same manner Oserve if 1vein:2arteries
B) Milk the cord to return blood and nutrient to the body C) Camp the cord 1 inch form the base (make sure that cord is in the center of the clamp) D) Cut cord ½ inch above the clamp (or every close to the clamp) E) Wipe stump with another cotton balls with alcohol from the top to the base then finally cotton ball with betadyne 16. Insert rectal thermometer into anus by lifting both legs with one hand (insert only bulb then wait for 1-2 minutes to get the reading (2reasons to check for imperforated anus and is the most accurate route of taking temp) read it loud if-temp is more than 37.5 degrees Celsius turn off the drop light. Must be maintained between 35.5-36.5 degrees Celsius 17. Put on clothes neonate diaper must cover cord stump 18. Administer standing order of media like vitamin k (to prevent bleeding due to deficient clotting factor vitamin k) Best site: vastus lateralis left side (more developed muscle) (follow IM Technique) <2.5 kg = 0.05 ml of vit k >2.5 kg = 0 1 ml of vit k Hold cotton ball against injection sites and press for a while If with heap B give 0.5 ml on opposite leg Don’t throw remaining vitamin k just cover with the plaster and put together with garamycin 19. Administer crede’s prophylaxis to both eyes To prevent opthalmia neonatorum due to gonorrhea Make sure that the drop light is away from the face Apply general appearance sulfate/ gramycin 1 drop in each conjunctival sac If ointment apply in inner cornea to outer canthus (make sure not to touch the Eye) 20. Mummify the baby. Then give to family identifying the sex while giving 21. Do aftercare (no need to remove sterile gloves after cord care since this will be Used to clean the instruments) 22. Wash instruments with soap and water, then let it dry 23. Do DR notes. Follow format Provide 24 Complete Dr forms Complete CER
