CARE OF THE PARTURIENT Flashcards

1
Q
  1. LATENT PHASE
    ○ Cervical Dilation:
A

0 – 4 cm

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2
Q

LATENT PHASE
○ Nature of Contraction:
Duration:
Interval:

A

< 30 secs

3 – 5 mins

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3
Q

○ Length of Latent Phase

A

Primis – 6 hours
Multis – 4 – 5 hours

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4
Q
  1. LATENT PHASE
    ○ Attitude of mother:
A

feel comfortable, walking and sitting at this time

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5
Q

Latent phase
Nursing Responsibilities:

A
  1. Encourage walking - shorten 1st stage of labor
  2. Encourage to void q 2 – 3 hrs. – full bladder inhibits contractions
  3. Breathing – chest breathing
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6
Q

Active Phase
○ Cervical Dilation:

A

: 4 – 7 cm

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7
Q

ACTIVE PHASE
○ Nature of contractions:

A

Duration: 30 – 50 secs
Intensity: moderate to strong

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8
Q

ACTIVE PHASE
○ Length of Active Phase:

A

Primis – 3 hours
Multis – 2 hours

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9
Q

. ACTIVE PHASE
○ Attitude of mother:

A

prefer to stay in bed, withdraws from her environment and self – focused

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10
Q

ACTIVE PHASE
Nursing Responsibilities:
CLue:
M
A
D
B

A
  1. M – edications – have meds ready
  2. A – ssessment include: vital signs, cervical dilation and effacement, fetal monitor, etc.
  3. D – dry lips – oral care (ointment) dry linens
  4. B – abdominal breathing
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11
Q

. TRANSITION PHASE
○ Cervical Dilatation:

A

8 – 10 cm

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12
Q

TRANSITION PHASE
○ Nature of Contractions:

A

Duration: 50 – 60 secs
]Interval: 2 -3 mins
]Intensity: moderate to strong

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13
Q

Transition Phase:
○ Length of Transition Phase:

A

Primis – 1 hour (baby delivered within 10 contractions or 20 mins)
Multis – 30 mins (baby delivered within 10 contractions or 20 mins)

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14
Q

TRANSITION PHASE
○ Attitude of mother

A
  • feel discouraged, ask midwife/nurse repeatedly when labor will end, not in control of her emotions and sensations, irritated, may not want to be touched
    ○ There is an uncontrollable urge to push with contractions, a sign of impending second stage of labor. Profuse perspiration and distention of neck veins are seen.
    ○ Nausea and vomiting are a reflex reaction due to decreased gastric motility and absorption.
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15
Q

TRANSITION PHASE
Nursing Responsibilities: RRE

A
  1. Reassure woman that labor is nearing end & baby will be born soon
  2. Reinforce breathing and relaxation techniques
  3. Encourage fast-blow breathing to remove the urge to bear down
  4. Emotional support
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16
Q

SECOND STAGE or

A

EXPULSIVE STAGE

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17
Q

SECOND STAGE – EXPULSIVE STAGE

MECHANISM OF LABOR:
A

EDFIEEE

 Engagement
 Descent
 Flexion
 Internal Rotation
 Extension
 External Rotation
 Expulsion

18
Q

entrance of the greatest biparietal diameter of the fetal head to the pelvic inlet

A

 Descent

19
Q

the chin of the fetus touches his chest enabling the smallest diameter (suboccipitobregmatic) to be presented to the pelvis for delivery

A

Flexion

20
Q

when the head reach the level of the ischial spine, it rotates from transverse diameter to AP diameter so that its largest diameter is presented to the largest diameter of the outlet. This movement allows the head to pass through the outlet.

A

 Internal Rotation

21
Q

the head of the fetus extend towards the vaginal opening. As the head extend, the chin is lifted and then it is born.

A

Extension

22
Q

when the head comes out, the shoulder which enters the pelvis in transverse position turns to anteroposterior position for it become in line with the anteroposterior diameter of the outlet & pass through the pelvis.

A

External Rotation

23
Q

when the head is born, the shoulder & the rest of the body follows without much difficulties.

A

Expulsion

24
Q

 Duration of Second Stage:

A

Primis – 50 mins
Multis – 20 mins

25
Q

2nd stage  Assessment:

A

monitor FHT q 15 mins in normal case and every 5 mins in high-risk cases if not yet delivered

26
Q

2nd stage  Transfer to the DR:

A

Primis – cervix fully dilated
Multis – cervix is 8 cm dilated

27
Q

Delivery Position used when forceps delivery & episiotomy are to be performed.

A
  1. Lithotomy
28
Q

– head of the bed is 35 – 45˚ elevated, knees are flexed & feet flat on bed. This position facilitates the pushing effort of the mother.

A
  1. Dorsal Recumbent
29
Q

indicated for woman with heart disease

A
  1. Left Lateral Position
30
Q

Thirds stage or

A

PLACENTAL DELIVERY

31
Q

METHODS OF PLACENTAL SEPARATION:

A
  1. Schultz Mechanism –if placenta separates first at its center and last at its edges, it tends to fold on itself like an umbrella and presents the fetal surface which is shiny (“Shiny” for Schultz); 80% of placentas separate in this manner.
  2. Duncan Mechanism – if placenta separates first at its edges, it slides along the uterine surface and presents with the maternal surface which is raw, red, beefy, and irregular and “dirty” (“Dirty” for Duncan). Only about 20% of placentas separate this way.
32
Q

MANAGEMENT: Third stage

A
  1. Watchful waiting.
  2. Inject oxytocin (Methergine = 0.2 mg./ml. or Syntocinon = 10U/ml) IM to maintain uterine
  3. Never leave the client unattended.
  4. Oxygen & emergency equipment made available.
33
Q

b) Wait for signs of placental delivery

A
  • Calkin’s sign
  • Sudden gush of blood from vagina
  • Lengthening of the cord
34
Q

uterus is firm, globular & rising to the level of umbilicus; earliest sign of placental separation

A
  • Calkin’s sign
35
Q

c) Track the cord slowly, winding it around the clamp until the placenta spontaneously comes out, slowly rotating it so that no membranes are left inside the uterus, a method called

A

Brandt – Andrew’s maneuver.

36
Q

THE FOURTH STAGE or

A

PUERPERIUM

37
Q

4th stage MANAGEMENT:

A
  1. Repair of lacerations
38
Q

CLASSIFICATION OF PERINEAL LACERATIONS
involves the vaginal mucous membranes and perineal skin

A

First degree

39
Q

CLASSIFICATION OF PERINEAL LACERATIONS
– involves not only the muscles, vaginal mucous membranes, and skin, but also the muscles.

A

2nd degree

40
Q

CLASSIFICATION OF PERINEAL LACERATIONS
involves not only the vaginal mucous membranes and skin, but also the external sphincter of the rectum

A

3rd degree

41
Q

CLASSIFICATION OF PERINEAL LACERATIONS
involves not only the external sphincter of the rectum, the muscles, vaginal mucous membranes, and skin, but also the m mucous membranes of the rectum.

A

4th degree