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Volledige Samenvatting-Arbeid en Bevalling 2
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Volledige samenvatting van alle lessen Arbeid en Bevalling 2 (schooljaar ). Totaal van 71 pagina's leerstof.
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ARBEID EN BEVALLING 2EVIDENCE BASED PRACTICE .............................................................................................................................. 4
EBP ...................................................................................................................................................................... 4
RICHTLIJNEN............................................................................................................................................................ 4
LEZEN EN BEOORDELEN VAN (VAK)LITERATUUR............................................................................................................... 6
CTG INTERPRETATIE EN CLASSIFICATIE ............................................................................................................. 6
BASISHARTFREQUENTIE ............................................................................................................................................. 6
VARIABILITEIT .......................................................................................................................................................... 7
SINUSOÏDAAL PATROON ............................................................................................................................................. 7
ACCELERATIES ......................................................................................................................................................... 8
DECELERATIES ......................................................................................................................................................... 8
CONTRACTIES .......................................................................................................................................................... 8
CLASSIFICATIE .......................................................................................................................................................... 9
CTG: BASISFYSIOLOGIE ..................................................................................................................................... 9
INLEIDING ............................................................................................................................................................... 9
PLACENTAIRE DOORBLOEDING .................................................................................................................................... 9
NAVELSTRENG ....................................................................................................................................................... 10
VLIEZEN EN VRUCHTWATER ...................................................................................................................................... 10
FOETALE CIRCULATIE ............................................................................................................................................... 10
PLACENTAIRE GASUITWISSELING ................................................................................................................................ 10
CELMETABOLISME .................................................................................................................................................. 11
BASISDEFINITIES ..................................................................................................................................................... 11
FOETALE BESCHERMINGSMECHANISMEN ..................................................................................................................... 11
CTG FYSIOLOGIE ............................................................................................................................................. 12
INLEIDING ............................................................................................................................................................. 12
WAT REGISTREREN WE? .......................................................................................................................................... 12
AUTONOOM ZENUWSTELSEL..................................................................................................................................... 13
VERANDERING IN DE FOETALE HARTFREQUENTIE ........................................................................................................... 13
INFUUSTHERAPIE ........................................................................................................................................... 15
OSMOSE............................................................................................................................................................... 15
DOEL ................................................................................................................................................................... 15
INDELING INFUUSVLOEISTOFFEN ................................................................................................................................ 15
GEBRUIKTE MATERIALEN .......................................................................................................................................... 15
PLAATSBEPALING ................................................................................................................................................... 16
PROBLEMEN EN PREVENTIE VAN COMPLICATIES ............................................................................................................ 16
BESTRIJDING VAN SHOCK EN TOXISCHE REACTIES.......................................................................................... 16
GROTE GROEPEN SHOCKS ......................................................................................................................................... 16
SYMPTOMEN VAN EEN SHOCK ................................................................................................................................... 16
BEHANDELING ....................................................................................................................................................... 17
ZUURSTOFTHERAPIE................................................................................................................................................ 17
1
, HEMOCULTUREN.................................................................................................................................................... 17
TOEDIENING VAN BLOED EN BLOEDDERIVATEN ............................................................................................. 18
SITUERING ............................................................................................................................................................ 18
1. BLOEDTRANSFUSIES ............................................................................................................................................ 18
PLASMATRANSFUSIE ............................................................................................................................................... 22
BELANG VAN BEST TRANSFUSION PRACTICE ................................................................................................................. 25
VERTRAAGDE ONTSLUITINGSFASE: VERLENGDE 1STE EN 2DE FASE ................................................................... 25
HET EERSTE TIJDPERK: ONTSLUITINGSTIJDPERK OF -FASE ................................................................................................. 25
BARINGSHOUDING CORRIGEREN ................................................................................................................................ 28
PRE INDUCTIE EN INDUCTIE ............................................................................................................................ 28
BEGELEIDINGSSCHEMA ............................................................................................................................................ 28
INDUCTIE & OPTIMALISATIE/STIMULATIE..................................................................................................................... 29
PARTUS, PLACENTAIRE FASE EN POST PLACENTAIRE FASE ............................................................................. 32
DE ACHTERSTE PLAATSING: SPILDRAAISTOORNIS BIJ ACHTERHOOFDSLIGGING ...................................................................... 32
RUPTUREN ............................................................................................................................................................ 33
DE EPISIOTOMIE ..................................................................................................................................................... 33
NAVELSTRENGOMSTRENGELING ................................................................................................................................ 34
AFNAME NAVELSTRENGBLOED VOOR PH-METING ......................................................................................................... 36
PLECENTAIRE FASE .................................................................................................................................................. 36
VAGINALE KUNSTVERLOSSING: VENTOUSE – FORCEPS .................................................................................. 38
INCIDENTIE VAN KUNSTVERLOSSIG ............................................................................................................................. 38
VACUÜM OF VENTOUSE ........................................................................................................................................... 39
FORCEPS .............................................................................................................................................................. 42
VERGELIJKING TUSSEN VENTOUSE EN FORCEPS ............................................................................................................. 42
ABDOMINALE KUNSTVERLOSSING = SECTIO .................................................................................................................. 43
INFILTEREN, EPISIOTOMIE EN HECHTEN ......................................................................................................... 45
POST- PLACENTAIRE FASE: 4E TIJDPERK ....................................................................................................................... 45
WERKWIJZE ........................................................................................................................................................... 45
SCHEMA INTEGRERENDE ZORGVERLENING.................................................................................................................... 45
INFILTREREN (= VERDOVEN) VAN HET PERINEUM........................................................................................................... 45
HECHTEN VAN HET PERINEUM ................................................................................................................................... 47
ANESTHESIE.................................................................................................................................................... 49
STRUCTUUR VAN DE ZENUWVEZELS ............................................................................................................................ 49
IMPULSGELEIDING IN ZENUWVEZELS ........................................................................................................................... 50
WERKINGSMECHANISME LA ..................................................................................................................................... 51
STRUCTUUR VAN LA ............................................................................................................................................... 52
LOKALE ANESTHETICA .............................................................................................................................................. 52
FACTOREN DIE HET BLOK BEÏNVLOEDEN....................................................................................................................... 53
NEVENEFFECTEN .................................................................................................................................................... 53
LAST: CLINICAL SIGNS ............................................................................................................................................. 53
LAST: PREVENTION ................................................................................................................................................ 54
LAST: TREATMENT ................................................................................................................................................. 54
TECHNIEKEN LA ..................................................................................................................................................... 55
NEVENEFFECTEN VAN NEURALE BLOCKS ...................................................................................................................... 56
2
, PIJN TIJDENS DE BEVALLING ...................................................................................................................................... 57
EFFECTEN VAN EPIDURALE PIJNSTILLING ...................................................................................................................... 57
LOCOREGIONALE ANESTHESIE IN DE PRAKTIJK VOOR DE VROEDVROUW. ............................................................................. 57
NEVENWERKINGEN EN COMPLICATIES......................................................................................................................... 59
NEUROLOGISCHE EN CARDIOVASCULAIRE TOXICITEIT (EERDER OOK AL GENOEMD) ............................................................... 61
TEGENINDICATIES ................................................................................................................................................... 62
OUDE EPIDURALE IS NIET DE NIEUWE .......................................................................................................................... 62
DE GEVOLGEN VAN MISBRUIK TIJDENS DE ARBEID EN BEVALLING ................................................................. 62
ARBEID EN BEVALLING ALS TRIGGER ............................................................................................................................ 62
PREVENTIEVE EN EDUCATIEVE ROL IN HET VOORKOMEN VAN VERWIKKELINGEN ................................................................... 63
ARBEIDSTIJLEN VAN VROUWEN MET SEKSUELE GEWELDERVARINGEN ................................................................................. 63
POSTTRAUMATISCHE STRESS (PTSS) ............................................................................................................................ 64
INVLOED VAN SOA’S ...................................................................................................................................... 65
INLEIDING ............................................................................................................................................................. 65
2 BACTERIËLE SOA’S ................................................................................................................................................ 65
VIRALE SOA’S ......................................................................................................................................................... 68
3
, EVIDENCE BASED PRACTICE
EBP
Methodiek van Evidence Based Practice in 5 systematische stappen:
1. Het klinische probleem vertalen in een beantwoordbare vraag: “Wat is het probleem?” PICO
2. Het efficiënt zoeken naar en selecteren van het beste bewijsmateriaal: “Wat bestaat er?”
3. Het beoordelen van het gevonden bewijs op methodologische kwaliteit en toepasbaarheid: “Is wat ik
gevonden heb van goede kwaliteit en kan ik het gebruiken?”
4. Het nemen van een beslissing op grond van de beschikbare ’evidence’
5. Het regelmatig evalueren van het proces en het resultaat
RICHTLIJNEN
• Richtlijnen worden ontwikkeld met als doel de kwaliteit in de gezondheidszorg te verbeteren en
garanderen
• Geven adviezen over hoe het beste gehandeld kan worden in een bepaalde situatie
• Worden vaak opgesteld door een organisatie van beroepsbeoefenaars (Federaal Kenniscentrum voor
Gezondheidszorg KCE of Nederlands Paramedisch Instituut NPI)
• ≠ protocollen
• AGREE-instrument ter beoordeling van richtlijnen
4
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