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N352: Practice of Nursing I > OB Module 3: Labor and Delivery > Flashcards

OB Module 3: Labor and Delivery Flashcards

1
Q

___ is one of the most vulnerable periods in a woman’s life

A

labor

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2
Q

What are two things you need to respect in a labor and delivery situation

A
  1. Respect vulnerability in the situation they are in
  2. Respect the way that woman is coping with the situation they are in
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3
Q

What are the 5 factors that effect the duration, success, and intensity of labor and delivery?

A

The 5 “P”s:

Passenger
Passageway
Powers
Position of the Laboring Woman
Psychological Response

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4
Q

Who is the “Passenger”

A

the infant

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5
Q

What is the “Passageway”

A

Both the bony pelvis and the soft tissues

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6
Q

What are the “Powers”

A

the intensity of the contractions and the ability to push in the second stage of labor

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7
Q

Passenger

A

The fetus

there are several variables related to the fetus that can impact and influence the labor and delivery

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8
Q

What variables of the Passenger can influence the labor and delivery

A
  1. Size of the fetus
  2. Fetal presentation
  3. Fetal Lie
  4. Fetal Attitude
  5. Fetal position
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9
Q

The head is not like soft tissues. What does this mean

A

it cannot allow total manipulations, but if can elongate and narrow to allow delivery and also rapid brain growth once born

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10
Q

What is the largest and hardest part of the body

A

the head

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11
Q

What is the skull composed of and why

A

the skull is composed of a series of plates with sutures and fontanels between them to allow for shifting and overlapping during labor and rapid infant brain growth in the first year and a half of life

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12
Q

Fetal shoulders can also create ____

A

dystocia

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13
Q

Dystocia

A

Seen in very larger babies and diabetic mothers

the babies have taken on a lot of body fat, and this disproportion makes it difficult to deliver the babies shoulders after the head has come out

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14
Q

Fetal Presentation

A

refers to the PRESENTING PART of the infant in the birth canal

What is the lowest part of the infant

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15
Q

What is the most common fetal presentation

A

Most infants have head first (cephalic) and usually it is the occiput vertex

So this is the occiput and then vertex that present first anteflexed to the neck

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16
Q

What is called if the babies fetal presentation is head first?

A

Cephalic Presentation

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17
Q

Occiput

A

The back of the babies skull

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18
Q

The Vertex

A

The foremost (posterior top) of the babies skull

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19
Q

Breech

A

a fetal presentation where the lower half of the infant is presenting

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20
Q

Frank Breech

A

When the infants buttocks are the presenting part

Buttocks down and legs up

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21
Q

Single or Double Footling Breech

A

Fetal presentation when a foot or both feet are the presenting parts

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22
Q

If the fetal presentation is the shoulder, what part is presenting

A

the scapula

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23
Q

Anteflexed

A

babies chin is flexed to the chest

this is why the occiput comes through first in a head presentation

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24
Q

Why does the infant commonly come out with the head anteflexed

A

Because it can allow the head through in the narrowest diameter

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25
Q

What are some concerns regarding breech presentations

A

Potential for prolapsed cord

Asphyxiation

C Section need

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26
Q

Why is there concern for a prolapsed umbilical cord in a breech presentaiton?

A

The breech position does not fill and cork off the pelvis like the head usually does, so when the water breaks there is a greater chance the umbilical cord will slip down between the baby and pelvis and prolapse

When the baby descends, this prolapsed cord can mean no O2 is going to the baby and the baby can asphyxiate

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27
Q

Other than the potential prolapsed cord, what else can cause asphyxiation in the child ?

A

The head does no shift or elongate quickly, so if there head is first we can see arrest of descent usually and do interventions

However, in breech if the head is too big the head can get stuck and cause asphyxiation from the cord being pinched too

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28
Q

Arrest of Descent

A

when the delivery and descent of the baby is hindered and slowed and stopped due to the size of the head

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29
Q

What is not too uncommon to have to do if a child is ion the breech presentation

A

A Cesarean Section

This is particularly true in the first child and can be avoided if former babies were large and can allow breech delivery

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30
Q

Fetal Lie

A

refers to the longitudinal orientation of the fetus

So this is the spine of the infant in relation to the spine of the mother

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31
Q

What are the two types of fetal lie

A

Longitudinal Lie

Vertical Lie

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32
Q

Longitudinal Lie

A

Cephalic or breech presentation

infant spine is parallel to the mother’s spine

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33
Q

Transverse Lie

A

when the infant spine is perpendicular to the mother’s spine

a shoulder presentation

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34
Q

Fetal Attitude

A

Refers to the flexion of the infant

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35
Q

General Flexion

A

When the infant is somewhat curled up with chin flexed onto its chest

The arms and legs are flexed toward it’s abdomen

This is the ideal flexion

Gives the smallest diameter for delivery

sometimes called “Vertex Presentation” - complete flexion

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36
Q

What kind of flexion can cause problems in delivery?

A

Extended head or arms

it can cause increased diameter

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37
Q

Flexion allows the smallest ___

A

diameter

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38
Q

What sort of flexions can compound with breech position to make delivery harder

A

Military Flexion/Presentation

Brow Flexion/Presentation

Face Flexion/Presentation

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39
Q

Military Flexion/Presentation

A

The head is not anteflexed with arms flexed toward the head causing slight neck extension

This is only moderate flexion

The more anterior portion of the skull rather than vertex and occiput present in this

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40
Q

Brow Flexion/Presentation

A

less flexion of arms and legs with head more dorsiflexed

the eyebrows present and the anterior skull

it is poor flexion and has extension

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41
Q

Face Flexion/Presentation

A

full extension of the neck making the face present fully

full extension and no flexion

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42
Q

Fetal Position

A

refers to the relationship of the presenting part to the maternal pelvis (not the spine)

done in 3 letter codes

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43
Q

What do the 3 letter codes of the fetal position mean?

A

First Letter - Presenting Part’s Right or Left Orientation (the mothers L or R)

Second Letter - The presenting part

Third Letter - represents the presenting part’s location related to an anterior, posterior, or transverse orientation

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44
Q

Are there optimal and non optimal positions?

A

Yes

The baby does need to rotate as well in delivery

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45
Q

What would ROP mean

A

Right Occiput Posterior

The babies occiput is oriented to the right posterior side of the mother

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46
Q

What are the optimal fetal positions

A

ROA or LOA

Right or Left Occiput Anterior Position

This is because the curve and contour of the sacrum allowing the baby to descend easily

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47
Q

What would M mean in a fetal position

A

mento

it means the babies face is presenting

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48
Q

What would S mean in a fetal position

A

sacrum

it means the babies bottom is presenting

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49
Q

Passageway

A

the mother’s bony pelvis and soft tissue

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50
Q

What is the more significant part of the passageway and why?

A

The bony pelvis is the more significant of the two

there are multiple contours to the inner pelvis that are important

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51
Q

___ delivery is a rare occurrence

A

posterior

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52
Q

What is needed to get through the pelvis in case of obstruction in vaginal delivery

A

rotation

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53
Q

What is included among the passageway soft tissues that can affect labor and delivery

A

scar tissues in the case of female circumcision

body fat of an obese woman

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54
Q

The pelvis is comprised of…

A

pieces of bone joined by cartilage

it is NOT one full bone

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55
Q

What are the bones of the pelvis?

A

Ilium

Ischium

Pubis

Sacral Bones

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56
Q

Ilium

A

The large wings / hip bones you can feel in the posterior sides of the pelvis

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57
Q

Ischium

A

the anterior lower segment of the pelvis below the pubis bones

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58
Q

Pubis

A

the upper part of the pelvis anteriorly above the ischium

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59
Q

Sacrum

A

the piece connecting the ilium

comes forward toward the coccyx (the bottom of the sacrum) in a scooping form

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60
Q

Another name for the pelvis

A

coxal bone

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61
Q

For OB Purposes, what are the two segments of the pelvic canal?

A
  1. The upper pelvis
  2. the lower pelvis
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62
Q

The Upper Pelvis

A

above the brim

it is the “false” pelvis and plays no part in childbearing

it is mostly the outer and upper canal that is mostly made up of the ilium

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63
Q

The lower pelvis

A

the true pelvis

this is the inner more canal and lower bones

divides into 3 planes

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64
Q

What are the three planes of the lower pelvis

A

The inlet

the mid pelvis

the outlet

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65
Q

The arc of the sacrum is important …

A

in the true pelvis

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66
Q

The inlet

A

the upper most portion of the true pelvis that is the start of the downward descent toward the vaginal canal

it has some constriction to it

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67
Q

The mid pelvis

A

the middle portion of the true pelvis

has a greatest and least diameter

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68
Q

Where is the greatest diameter to the true pelvis

A

about 2/3 of the way down the true mid pelvis between S2 and S3

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69
Q

Where is the lead diameter to the true pelvis

A

near the end of the mid pelvis between S4 and S5

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70
Q

Ischial Spines

A

boney projections inward in the true mid pelvis

differs in how prominent it is between different people

causes the smallest diameter of the pelvis

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71
Q

What area of the true pelvis does the baby have to work hardest to get past in any pregnancy?

A

The ischial spine area in the mid pelvis (true pelvis plane)

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72
Q

4 Types of Female Pelvis

A
  1. Gynecoid
  2. Android
  3. Anthropoid
  4. Platypelliod
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73
Q

50% of woman have a ___ pelvis type

A

Gynecoid

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74
Q

The optimal pelvis type for labor and delivery is

A

Gynecoid

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75
Q

Gynecoid Pelvis

A

1 pelvis type

the most frequent and best for birth pelvis shape

it gives a heart shaped true pelvis canal (interior aspect)

it is GENEROUS IN THE ANTERIOR ASPECT to encourage anterior descension

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76
Q

Android Pelvis

A

1 Pelvis type

a more narrow and vertically stretched interior aspect (like a more elongated heart shape than gynecoid but less than anthropoid)

it is narrow and has a transverse diameter of the interior aspect giving more GENEROUS POSTERIORLY

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77
Q

It is difficult to rotate with ___ pelvises

A

android

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78
Q

What pelvis tends to encourage a baby in the posterior presentation

A

android

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79
Q

Anthropoid

A

1 pelvis type

resembles ape pelvis shape

a difficult shape for delivery

its very even transverse and antpost and looks like a heart stretched out more so than android

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80
Q

Platypelloid

A

1 pelvis type

a flat pelvis that is very difficult for delivery

not generous anteriorly or posteriorly

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81
Q

What pelvis shapes are less generous and make birth harder

A

Anthropoid and Platypelloid

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82
Q

What two shapes are more V shaped and narrow at the upper aspect and make it harder for the head to get through

A

android

anthropoid

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83
Q

How is the descent of the baby measured?

A

It is the position of the baby during labor and it is where the head is relative to the ischial spines (narrowest part of the pelvis) in centimeters

It is estimated

this station can be noted during labor and should be

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84
Q

Other than the pelvis, what else are important parts related to labor and delivery

A

soft tissue

cervix

pelvic floor muscles

vagina and introitus

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85
Q

What does the cervix do during labor and delivery

A

effaces and dilates to allow passage

86
Q

What do the pelvic floor muscles do during labor and delivery

A

assist the infant in rotating as it descends

87
Q

What do the vagina and introitus (opening) do during labor and delivery

A

dilate to accommodate passage

88
Q

Powers of Delivery

A

refer to both the involuntary contracting of the uterine muscle and the voluntary efforts of the mother to expel the fetus at the time of delivery

89
Q

What is the pacemaker of the uterus?

A

It is an area near the fundus that sends impulses in late developing receptors to cause contractions

The contractions will start here and then move down the top half of the uterus

90
Q

Where is the pacemaker of the uterus located

A

near the fundus, not necessarily midline, more anterior or posterior

91
Q

How do contractions of the uterus actually work?

A

The top half contracts and the muscle fibers shorten progressively and draw up the lower half toward the top half thus causing the cervix to efface/thin and then dilate

92
Q

Which part of the uterus contracts and which part does not

A

the upper part contracts

the lower part does not contract

93
Q

The uterus contracts and relaxes every few ___ in a __ manner

A

few minutes in a rhythmic manner

94
Q

Asa labor progresses, what happens to contractions

A

contractions tend to grow closer, longer and more intense

95
Q

Frequency of contractions refers to…

A

how often they are happening

96
Q

What does intensity of contractions depend on

A

depends on the monitor

depends on where the intensity and monitor is

depends on what position the mother is in

depends on the amount of adipose tissue

97
Q

What is the best judge of contraction intensity? What is the exception

A

the mother is the best judge of contraction intensity than an electric monitor

However the exception is an internal monitor watching the contractions

98
Q

Contraction characteristics are described with what 3 terms

A

frequency

duration

intensity

99
Q

When are contractions timed from?

A

Duration of contraction is from the onset of one to the onset of the next contraction

we do this due to variability of contraction timings (mother may count from end of one to start of another)

100
Q

IV Pitocin

A

a drug to induce labor

it can cause contractions that feel much more intense

101
Q

Why are the resting periods between contractions important

A

During contractions the blood vessels through muscle fibers squeeze and get diminished blood flow (but the baby has good reserve), but the resting period allows blood flow reestablishment

contractions too close when induced can impact the baby

102
Q

What impact does position of the laboring woman have on L&D?

A

has an impact on both the intensity and effectiveness of the contractions and on the ability of the infant to navigate the contours of the pelvis

103
Q

Historically physicians deliver in the ___ position

A

lithotomy

104
Q

How can the upright position benefit L&D

A

it increases the potential for the presenting part to act as a dilating wedge

it is a more natural position for birth

105
Q

How can knee chest and lateral lying positions benefit L&D?

A

it can assist in rotating posterior positions

106
Q

Why is the lithotomy / lying on back position not actually the best birthing position?

A

the baby can obstruct blood flow by sitting on it and also stimulate mother nerve responses

107
Q

Psychological Response (P 5)

A

the woman’s emotional response to labor can have dramatic effects on her ability to accept labor and work with it to deliver her infant

108
Q

How can anxiety and fear impact psychological response and L&D

A

anxiety and fear increases the release of catecholamines

109
Q

How do catecholamines impact L&D

A

they release with anxiety and fear and can slow down labor by impeding contractions (frequency and intensity)

110
Q

If a baby needs rotation and labor has been obstructed, what may this have on the psychological impact of the woman

A

if we need to rotate and measurements stop too long we may tell them they need a C Section which can increase anxiety and fear leading to catecholamines and further obstructing progress and causing higher likelihood of C Section

111
Q

What are some factors that can influence emotional response during labor?

A

culture (may make no or more noise - Mediterranean cultures believe noise is good for the child)

anxiety and fear (maybe from a past preg.)

previous experience (childbirth, sexual abuse and molestation, etc)

childbirth preparation

support

birth environment (can be traumatic to birth in an unexpected place)

some may simply be more stoic in tolerance and presentation

112
Q

True Labor v False Labor

A

false labor involves contractions more irregular and not close together while true labor has contractions at regular intervals and get closer as time goes on

113
Q

How do contractions differ in intervals between true and false labor

A

true labor has contractions at regular intervals while false labor has contractions that are irregular

114
Q

How do the interval timings of contractions change between true and false labor

A

true labor has contractions where the interval between then gradually shorten while there is no real change in false labor

115
Q

How may duration and intensity change over time for contractions between true and false labor

A

true labor contractions increase in duration and intensity over time while false labor usually has no change

116
Q

Where is discomfort in true labor

A

begins in the back and radiates around the abdomen

117
Q

Where is discomfort in false labor

A

usually just in the abdomen

118
Q

How does contraction intensity change with walking between true and false labor

A

true labor contraction intensity increases with walking usually

walking has no effect on or lessens contractions in false labor

119
Q

How does cervical dilation and effacement differ between true and false labor

A

true labor has cervical dilation and effacement that are progressive, but there is none of this in false labor

120
Q

What does -3 cm mean when measuring the infant

A

it means its 3 centimeters above the ischial spines (the presenting part)

121
Q

What does 2 cm mean when measuring the infant

A

it means the presenting part is 2 cm below the ischial spines

122
Q

False labor may or may not…

A

become a general labor pattern (so it can become false labor in time)

123
Q

The uterus goes through __ ___ throughout pregnancy that intensify toward the end of pregnancy

A

toning exercises

124
Q

The definitive sign of true labor over false labor si

A

cervical dilation and effacement

cervix changes definitely tell us it is true labor

125
Q

SROM

A

Spontaneous rupture of membranes

this occurs when the “water” (amniotic sac and fluid) break on their own

126
Q

When can SROM occur

A

PROM prior to onset of labor, during labor, or at delivery (baby can come out in an intact sac)

127
Q

PROM (L&D)

A

Premature rupture of the membranes (before the onset of delivery

128
Q

How can the nurse assess for SROM/ROM

A

Nitra zine Paper or Nitra zine Sterile Swab

129
Q

How is Nitra Zine used

A

if it detects the presence of amniotic fluid from membrane rupture it will turn indigo blue

If put on a slide it will show ferning

130
Q

Ferning

A

the characteristic drying pattern of amniotic fluid on a slide

131
Q

What color will nitra zine turn in presence of amniotic fluid

A

indigo blue

132
Q

AROM

A

artificial rupture of membranes

This occurs when an MD or midwife intentionally break the bag of water

133
Q

When is the only time AROM should be done during delivery?

A

When the presenting part (head in this case) is at the 0cm mark (at the level of the ischial spines)/ narrowest part to minimize the potential for the cord to move down beyond the infant’s head and cause asphyxiation/prolapse

134
Q

Amniohook

A

a device that is used through the cervix to cause AROM

135
Q

What is the 2 fold purpose for the water to rupture

A
  1. Water escaping the uterus will make the uterus decrease in mass allowing it to get smaller and let the muscles get dense to do effective contraction
  2. The rupture leads to prostaglandin release which is a contractile hormone that causes an increase in intensity and frequency of contractions
136
Q

Cardinal movements of labor

A

these are the the movements/maneuvers the fetus does while navigating the contours of the pelvis

137
Q

What are the 7 cardinal movements of labor

A

engagement

descent

flexion

internal rotation

extension

restitution and external rotation

expulsion

DIE REEF - Descent, Internalrotation, Engagement, Restitutionandexternalrotation, extension, expulsion, flexion

138
Q

Engagement Movement

A

This movement occurs when the baby is coming down the false pelvis to the inlet

it will ante flex the head and the soft tissue contours encourage this

139
Q

Internal Rotation Movement

A

as the baby goes from false to true pelvis is will rotate from a transverse anterior posterior lie to an anterior posterior orientation of the head

140
Q

Extension Movement

A

Once the head is visible and seen in the vaginal opening, this movement occurs where the contours of the sacrum allow the head to come up and out at the heads narrowest diameter

141
Q

Restitution and External Rotation movement

A

When the head is out, it will rotate slightly to one side or another as the shoulders rotate in the lower part of the pelvis

142
Q

Why must restitution and external rotation occur

A

the head has its widest diameter anterior posteriorly, but the shoulders are widest transversely so once the head is out the shoulders must rotate to come out at the widest diameter

AKA the head will come out with the face either up or down, and then will rotate so the shoulders also are up and down rather than side to side

143
Q

What are the 4 stages of Labor

A
  1. Onset of Regular Uterine contractions until full dilation of the cervix
  2. Full dilation until delivery of the infant
  3. from delivery of infant to the delivery of placenta
  4. from delivery of placenta until 2 hours later
144
Q

When is the cervix completely/fully dilated

A

at 10 cm

this is the end of stage 1 of labor

145
Q

At what stage of delivery can we no longer palpate the cervix

A

stage 2 of labor

146
Q

At what stage of delivery is the potential for postpartum hemorrhage heightened

A

stage 4

147
Q

How many parts does the first stage of labor have

A

3 (latent, active, transitional)

148
Q

Stage 1 Latent Phase

A

starts with the onset of regular uterine contractions

lasts until labor progress starts to accelerate at about 3 cm dilation

149
Q

Stage 1 Active Phase

A

lasts from the initial acceleration at round 3 cm dilation to about 8 cm dilation

150
Q

Stage 1 Transitional Phase

A

intense period of more rapid progress which lasts until full dilation of the cervix at 10 cm

151
Q

What is the specific time table for labor

A

there is no specific time table - it differs among people

there is no predicting the length of any given stage

152
Q

What is usually the longest phase of the first stage of labor

A

the latent phase is usually longest but there are multiple variables that can impact any stage of labor

153
Q

What is usually the shortest phase of the first stage of labor

A

the transitional stage in general is faster, but this is not a hard and fast rule

154
Q

Average labor for first child is about ___ hours while subsequent babies is ___ hours. However…

A

14.5 hours; 8 hours

However sop many variables impact these times

155
Q

What does the second stage of labor involve…

A

both voluntary and involuntary forces at play together to work toward delivery

again the length of this stage is highly variable and varies from one contraction to several hours - HIGHLY VARIABLE TIME

156
Q

How can the third stage of labor be allowed to happen?

A

it can either be done spontaneously or encouraged to happen in a timely manner to minimize blood loss - placenta birth

157
Q

Why must more care be taken if an active approach to placental birth (labor state 3) is performed?

A

If more active management approach is taken, make sure not to shear off the cord, leave placental fragments behind, or invert the uterus in the process

158
Q

Episiotomy

A

intentional cut made by the provider between the vagina and rectum (off to one side so a tear does not extend to the rectum)

not too common anymore

159
Q

Why are episiotomies rarer nowadays

A

it causes muscle layer extension and this extension makes muscle integrity worse than if we just allowed skin tear that only harms skin

160
Q

How long does the third stage of labor generally take

A

30 minutes

161
Q

Signs that the placenta is separating (Stage 3 Labor)

A

Advancing of the cord

Change in the shape of the uterus

Change in the location of the fundus

Sudden increase in vaginal flow

Patient complaints of cramping

162
Q

What is normal placenta delivery like

A

it detaches centrally with a clot forming behind it and the edges after

the shiny fetal part is then what presents

163
Q

Shiny Schultz

A

when a normal placental delivery occurs with the shiny fetal part presenting first

164
Q

Dirty Duncan

A

delivery of the placenta that is abnormal

the placenta attempted to adhere and stay on the lining and the maternal side is the presenting side

165
Q

Why is Dirty Duncan Concerning

A

placenta delivered this way may have placental fragments remaining and we need to make sure they are removed to prevent a post partum hemorrhage

166
Q

What does the fourth stage of labor involve

A

it involves minimizing the bleeding and the repair of any lacerations or incisions

from the delivery of the placenta until 2 hours later

167
Q

What are some medications used to promote uterine contraction during the fourth stage of delivery

A

Pitocin (Oxytocin)

Methergine

Cytotec

Hemabate

Tranexamic Acid

168
Q

How does the uterus control bleeding post-delivery

A

to control bleeding from the open bleeding vessels of the placental site the muscle will contract to act as a tourniquet on those vessels

169
Q

Pitocin

A

a fast acting and effective commonly used medicine given either IV or IM in order to promote uterine contractions

170
Q

Methergine

A

IM only medicine that causes longer contractions but is the second choice to pitocin

it is contraindicated in HTN hx because it can cause HTN crisis

Also a BP must be taken before giving

171
Q

Cytotec

A

an older originally used medicine

sometimes used to also ripen cervix for labor and induce contractions rather than just stage 4 use

Used to control hemorrhage of large amounts

Tablets inserted rectally in half

172
Q

Hemabate

A

Injectable contraction inducing med - IM

give if there is apnea or lack of tone to the uterus

highly effective

contraindication of asthma

side effects of nausea, vomiting, diarrhea near the fresh incision, and oozing stool

173
Q

Tranexamic Acid

A

more currently used in postpartum hemorrhaging

historically it was used for dysfunctional uterine bleeding in non pregnant women but is now a continuous IV infusion for stage 4

174
Q

Visceral L&D Pain

A

refers to the internal body areas enclosed within a cavity

visceral pain comes from infiltration, compression, extension, or stretching of the viscera

occurs in the first stage of labor

175
Q

What causes visceral pain in the first stage of labor

A

cervical changes

distention of the lower uterine segment

uterine ischemia

176
Q

Origins of L&D pain can come from what 2 systems

A

visceral pain

somatic pain

177
Q

Somatic L&D Pain

A

caused by the activation of pain receptors in either the cutaneous (body surface) or deep tissues (musculoskeletal tissues)

occurs in the second stage of labor

178
Q

Somatic pain in the 2nd stage of labor comes from what things

A

stretching and distention of the perineum and pelvic floor

distention and traction on the peritoneum and utero/cervical supports during contractions

lacerations of soft tissue

179
Q

Pain creates both __ effects and ___ & ___responses

A

physiological effects and sensory and emotional responses

180
Q

Physiological Effects of Pain Include…

A

SNS activation

Increased catecholamine levels

BP and heart rate increases

RR changes

Pallor

Diaphoresis

181
Q

How does Pain differ between L&D women

A

different women or different pregnancies can have vastly different pain sensations they perceive

182
Q

What are some of the sensory perceptions women have in L&D

A

prickling

stabbing

burning

busting

aching

heavy

pulling

throbbing

sharp

stinging

shooting

cramping

183
Q

Emotional Responses to the L&D Pain include…

A

increased anxiety with lessened perceptual field

writhing

crying

groaning

gesturing

excessive muscular excitability

During labor she may become less focused and want to rest between contractions rather than talk to anyone

184
Q

What are some physiological factors that impact pain and pain management

A

hormones

position

fetal size and pelvic dimensions

endorphin levels

185
Q

How do endorphins change during a pregnancy

A

they increase at the very end of pregnancy and try to help with the pain

however, a preterm baby mother may not get this

186
Q

Non Pharmacological Management Methods for Pain in L&D

A

relaxation

touch and massage

breathing

effleurage and counter pressure (posteriorly)

music

hypnosis

water therapy

biofeedback

acupressure

imagery and visualization

aromatherapy

intradermal water block

transcutaneous electrical nerve stimulation (TENS)

187
Q

Effleurage

A

a special type of abdominal massage

188
Q

Intradermal water block

A

an injection into the lower back to help with posterior positioning pain

189
Q

Pharmacological Management Methods for Pain in L&D

A

sedatives

analgesia

anesthesia

190
Q

___ specifically addresses pain

A

analgesia

191
Q

Fentanyl

A

a short acting and clean drug for pain relief with minimum side effects

does not tend to cause respiratory depression

drug of choice

opioid agonist analgesic (an opiod)

192
Q

Co-Drugs

A

drugs sometimes coupled with pain medicine

ex: transquilizers, antemetics

193
Q

What are some co drugs seen in L&D commonly

A

vistaril

phenergan

194
Q

Visteral & Phenergan

A

IM

sedative and anti emetic effect

tranquilizers often used to potentiate opioid effects with a lower dose

195
Q

Narcan

A

an opioid antagonist

given to counteract the effects of narcotics such as CNS depression in the mother or baby

196
Q

What are some examples of Anesthesia

A

local nerve blocks

regional nerve blocks

pudendal block

spinal anesthesia

epidural anesthesia

general anesthesia

197
Q

Local nerve Blocks

A

may be given in anticipation of an episiotomy

blocks pain in a localized area

anesthesia

198
Q

Pudendal Block

A

a bilateral regional anesthetic injection of the pudendal nerves that innervate the sides of the vaginal vault to the cervix

mostly only midwives do this

199
Q

When may spinal anesthesia be used?

A

when there will be a C Section because it is immediate acting and a complete block allowing for the surgery to occur

the needle is put in the subarachnoid space with the patient either sitting or lying on her side

effects are immediate and profound

effects are gradual in onset and can be complete or patchy

200
Q

Epidural

A

anesthesia used for both labor and C section births

sometimes used in labor as a continuous fusion from 1 to 24 hours use in order to give release

given via catheter and pump in the epiural space while the patient is sitting or lying on her side (like spinal), but the catheter is left in place until after delivery to allow for continuous or intermittent dosing

the dose must be controlled by the anesthesiologist

201
Q

General Anesthesia

A

Rarely used in L&D when we do not have time to give spinal anesthesia or when the epidural or spinal anesthesia is contraindicated like with coagulation issues

202
Q

Why is general anesthesia a problem in OB

A

it only takes 3 minutes for it to cross the placenta and potentially depress the babies respirations

This means you have to be ready to cut the cord immediately when given and the surgeon is already scrubbed and ready for surgery

203
Q

When is pudendal block done?

A

in transitional labor or in the second stage of labor

204
Q

Why may a woman develop a headache after spinal anesthesia?

A

leakage of cerebral spinal fluid

205
Q

What is the most common side effect from a spinal or epidural anesthetic?

A

Significant hypotension from vasodilation of the effected region

The mid torso down has this massive vasodilation where most circulation is now tied up

206
Q

What can the anesthesia induced hypotension lead to?

A

can result in poor placental perfusion

207
Q

What can minimize the anesthesia induced hypotension

A

increased IV fluids and positioning

sometimes medications like ephedrine can be used to increase BP

208
Q

Why do fluids help treat anesthesia induced hypotension

A

we give a bolus of IV fluids before anesthesia to increase circulating volume to prevent the drop and perfuse the placenta upper body and organs, or we continue to give IV fluids during use with a med for vasoconstriction o keep blood flowing everywhere

209
Q

Fetal assessment is done by …

A

either electronic fetal monitoring (doppler during contraction and for 30 seconds after)

or

fetal heart rate auscultation (listening)

210
Q

Intermittent auscultation protocol calls for auscultation every ___ minutes for low risk patients in the active phase of labor, every ___ minutes in the second stage of labor, and every __ minutes when pushing

A

30
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N352: Practice of Nursing I (14 decks)

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