Page 54 - 33Elctronic Book (3) Normal Labor

- Pulse, blood pressure and temperature

- Urine (volume, protein, acetone)

- Drugs and IV fluids

- Oxytocin regime.
▪ Nursing Diagnosis

• Alteration in comfort: acute pain related to uterine contraction.
• Anxiety related to impending labor and delivery.

• Alteration in tissue perfusion. Placental perfusion to the
• fetus decreases due to supine position.

• Fluid volume deficit related to decreased fluid intake.
• Sleep pattern disturbances related to labor process.

• Knowledge deficit related to process of labor, appropriate relaxation techniques,
and hospital procedures.
• Alteration in oral mucus membrane related to mouth breathing.

• Alteration in nutrition to less than body requirements related to decreased oral
intake.

• Self-care deficit related to immobility during labor.
• Ineffective individual coping related to lack of support system.

Planning and Implementation
Nutrition and Hydration

• During labor, there is an excessive loss of fluids, and increased tendency to
exhaustion and dehydration due to strong muscular exercise.
• The woman's need for energy is met through nourishing oral fluids at frequent

intervals to maintain the fluid balance.
• Sometimes IV fluids are given to provide energy and prevent dehydration in case

of vomiting, ketosis and possible use of anesthesia.
• During early labor, the woman should receive about 75 ml of fluid per hour in
the form of juices, soups, or tea with sugar and digestive biscuits.

• Maintain an intake and output chart.
• Diet should be nutritious, easily digestible, and small in amount.

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