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birth 2 Flashcards

survive test (102 cards)

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1
Q

Why do we not give pregnant women advil/naproxen

A

decreases fetal circulation and oligohydramios where the
amniotic fluid actually decreases

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2
Q

BUBBLE-EE

A

BUBBLE-EE
B = Breasts (rmness) and nipples
U = Uterine fundus (location;
consistency)
B = Bladder function (amount;
frequency)
B = Bowel function (passing gas
or bowel movements)
L = Lochia (amount; colour)
L = Legs (peripheral edema)
E = Episiotomy/Laceration or
Caesarean birth incision
(perineum: discomfort; condition
of repair, if done)
E = Emotional status (mood,
fatigue)

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3
Q

breasr assess

A

Breasts
* Inspect for size, symmetry, contour, engorgement, or erythema,
ask the mom if they are soft or lling
* Check nipple for shape (at, inverted, protruding), any cracking /
bruising / blistering / bleeding, and tenderness
* This assessment can be done when the mom is preparing to
feed her baby, or during / after a feed

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4
Q

uterus assess

A

Uterus
* Assess the fundus to determine degree of involution
* If possible have the mom empty her bladder beforehand
* Use a 2 handed approach with the woman laying completely at (supine)
* To palpate the uterus, the upper hand is cupped over the fundus; the
lower hand stabilizes the uterus at the symphysis pubis
* Document the location and tone.
* The fundus should be rm and midline, roughly at umbilicus during initial
postpartum period, then decreasing by a ngerbreadth below per day

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5
Q

bladder assess

A

Bladder
* Considerable diuresis can occur in the days following birth (up to 3 L)
* Ask the mom if she is voiding, experiencing any burning, diculty voiding / or
emptying her bladder, any urgency or frequency, any leakage of urine
(laughing / coughing)
* The bladder can be palpated for distention, or percussed for dullness
* If a mom hasn’t voided by 6 hours postpartum (or after catheter removal) a
catheter may need to be placed

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6
Q

preventing stress incontinence

A

Preventing Stress Incontinence
* Encourage her to start Kegel exercises after delivery
* Engage appropriate muscles – like trying to stop urine ow
* Start with 10 ve second contractions several times a day
* Weight loss can also help with stress incontinence
* Avoid smoking, caeine, alcohol – they irritate the bladder

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7
Q

bowels assess

A

Bowels
* A spontaneous BM may not occur for 2-3 days postpartum
* Inspect the abdomen for distention, ausculate for bowel sounds (should be
no distention, and active BS)
* Ask the mom if she has had a BM, and if not then ask if she is passing gas
* A stool softener (docusate) is routinely given postpartum
* Encourage intake of high ber foods and adequate fluids

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8
Q

lochia assess

A

Lochia
* Assess the amount – how many pads she
is using, assess amount on pad & when it
was last changed
* Assess the color – is it dark red, pink,
brown?
* Is there any unusual or foul odour?
* Is she passing any clots, and if so what
size are they?
* Larger clots can indicate poor uterine involution
* The amount of lochia is documented as
follows:
* Scant: 2.5-5 cm stain on pad
* Small: up to 10 cm stain on pad
* Moderate: 10-15 cm stain on pad
* Large: the pad is saturate within an hour
* A red flag is if the mom reports that she
is saturating a pad in less than an hour!
* Moms who have a c-section often have
much less lochia

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9
Q

episiotomy or perineum assess

A

Episiotomy or Perineum
* Easiest to assess with the mom on
her side and top leg drawn up
towards waist, then lift upper buttock
* Ensure you have adequate lighting
(ashlight if needed)
* Inspect for swelling, hematoma,
redness, bruising, as well as
presence of hemorrhoids
* Some bruising and swelling is normal

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10
Q

reeda asses episiotomy

A

R- Redness
E - Edema
E - Ecchymosis
D - Discharge
A - Approximation

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11
Q

extremities assess

A

Extremities
* Assess for signs of blood clots in the legs (unilateral edema,
tenderness, and warmth to aected leg)
* Assess legs and feet for edema (normal in immediate postpartum
period)
* Also be aware of signs of pulmonary embolus to watch for (SOB,
diculty breathing, heaviness in chest)

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12
Q

emotional assess

A

Emotional Status
* Assess level of independence with infant care and attention to the
infant’s needs
* Observe how she interacts with her family members
* Observe how she interacts with her baby (holding, feeding, eye
contact, response to cries)
* Nurses can be instrumental in promoting attachment
* Encourage parents to participate in infant care, promote skin to skin
time, build up condence
* Be alert for mood swings, irritability, excessive anxiety, crying
episodes, sleep patterns

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13
Q

postpartum blues

A

Postpartum Blues
* Aects up to 80 % of women in Canada
* The postpartum period is a happy, yet stressful time, marked by huge
changes – adjustment takes time
* The postpartum blues typically resolves without intervention within a
few weeks postpartum
* It’s a transient emotional disturbance characterized by emotional
lability, insomnia, anxiety, and fatigue

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14
Q

Pain Assessment and Comfort Measures

A

Pain Assessment and Comfort Measures
* Postpartum women experience pain from a variety of sources (perineum, incision, breasts /
nipples etc.)
* Assess by using a pain scale (rating her pain from 0-10)
* Ask questions about location and severity
* Perineum can be soothed with: ice packs, peri bottle, sitz baths, analgesics
* Breasts & nipples can be soothed with warm compresses, breastmilk, lanolin cream, ice packs
* Hemorrhoids can be soothed with witch hazel pads or topical creams / ointments
* Note – the pptx presentaon tled, Perinatal Pain Management, covers this topic in more detail

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15
Q

Factors Affecting Labour and Birth
* The five P’s

A

Factors Affecting Labour and Birth
* The five P’s:
1. Passageway (birth canal)
2. Powers (contractions)
3. Passenger (fetus and placenta)
4. Position of mother
5. Psychological response

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16
Q

Intrapartum Factors: Passageway

A

Intrapartum Factors: Passageway
* The birth canal is composed of the following:
* Bony pelvis
* Soft tissue components
* Other factors

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17
Q

Soft Tissue Factors

A

Soft Tissue Factors
* Lower uterine
segment
* Pelvic floor
muscles
* Cervix
* Vagina
* Introitus

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18
Q

Intrapartum Factors: Powers

A

Intrapartum Factors: Powers
* Primary powers (Uterine contractions)
* Involuntary
* Effects:
* Effaces and dilates the cervix
* Decreases blood flow to uterus and placenta
* Raises maternal blood pressure during contractions
* Ferguson reflux
* With bearing-down efforts, expels the fetus and placenta
* Begins involution

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19
Q

Primary Powers

A

Primary Powers
* Characteristics
* Rhythmic with
increasing tone
(increment), peak
(acme), & relaxation
(decrement)
* Intensity - mild,
moderate, strong
* Uterine resting tone
* Maternal coping?

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20
Q

Secondary Powers

A

Secondary Powers
* Voluntary
* The intra-abdominal force provided by the labouring woman
* Aka “pushing” or bearing down
* When to start pushing?
* Technique?

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21
Q

Breathing During Labour

A

Breathing During Labour
* Feelings may change normal breathing pattern to breath holding or
panic breathing (hyperventilation)
* This increases tension and feelings of fear and anxiety, leading to more
breath holding/hyperventilation
* Breathing/relaxation releases endorphins, relaxes the pelvic floor, and
prevents adrenaline and cortisol from blocking the effects of oxytocin
* “SOS” technique

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22
Q

Intrapartum Factors: Passenger

A

Intrapartum Factors: Passenger
* Location of the placenta
* Fetal head
* Fetal position, components include:
* Fetal lie
* Fetal presentation
* Fetal attitude
* Fetal station and engagement
* Fetal orientation in relation to maternal pelvis

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23
Q

Fetal Head

A

Fetal Head
* Bones
* Sutures
* Fontanels
* Moulding

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24
Q

Station and
Engagement

A

Station and
Engagement
* Station - degree of
descent
* Engagement -
when widest
diameter of
presenting part has
descended into
pelvic inlet to the
imagined plane at
level of ischial
spines

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25
Intrapartum Factors: Position
Intrapartum Factors: Position * Affects woman's anatomical and physiological adaptations to labour * Gravity promotes descent of fetus * Frequent changes in position * Relieve fatigue * Increase comfort * Improve circulation * Assist optimal fetal position * Labouring woman should be encouraged to find positions most comfortable to her * What factors can affect a labouring woman’s position?
26
5. Psychological Response
5. Psychological Response * Psychosocial factors that influence the birth experience * Readiness for labour and birth * Level of educational preparedness * Emotional readiness * Ethnicity and cultural influences * Anxiety, fear, fatigue * Previous experiences with childbirth * Labour can trigger memories of sexual abuse
27
Psychological care includes
Therapeutic communication * Support for the birth plan * Advocate as needed * Demonstrate respect * SOGC (2019) recommendations: continuous 1:1 support in labour for: ↓ epidural rates ↓ analgesia/anaesthetic ↓ operative vaginal births ↓ cesarean births ↓ 5 minute Apgars < 7 ↓ postpartum depression
28
Physiological Adaptation to Labour * Fetal
Physiological Adaptation to Labour * Fetal adaptation * Changes occur in the following: * Fetal heart rate * Fetal circulation * Fetal respiration * Fetal head
29
Onset of Labour
Onset of Labour * More than one trigger * Many factors are involved, including changes in the maternal uterus, cervix, and pituitary gland. * Hormonal factors * Mechanical factors * Other factors
30
Signs of Approaching Labour
Signs of Approaching Labour * Lightening * Ripening of the cervix * Spurt of energy * Braxton-Hicks contractions * Backaches * Bloody show * Spontaneous rupture of membrane * Diarrhea * Weight loss * Feelings? Impending labour can be an emotional experience
31
Labour vs Prodromal Labour labour * Contractions begin in the lower back & radiate to abdomen, become regular and increase in frequency, duration and intensity * Position changes ineffective * Progressive cervical changes false * Contractions are irregular, may be more noticeable at night, pain is felt mainly in the abdomen * Relieved by change of position or activity * No cervical changes
32
7 cardinal movements
* 7 Cardinal Movements * Engagement * Ascynclitism * Descent * Flexion * Internal rotation * Extension * Restitution and external rotation * Birth by expulsion
33
First Stage of Labour Latent Phase
First Stage of Labour Latent Phase * 0-3 cm * Contractions mild and short (20-40 sec) * Low-back pain and abdominal discomfort * Cervix thins; some bloody show * Station – nullipara 0; multipara 2 to +1 * Time – nullipara 8-10 hr average; multipara 5-6 hr
34
* 4-7 cm * Contractions stronger (40-60 sec); Q3-5 min * Average time; nullipara 2-4 hrs; multipara 1.5-2 hrs * Membranes may rupture now * Increased bloody show * Station -1 to 0
35
First Stage of Labour Active Phase
First Stage of Labour Active Phase * 4-7 cm * Contractions stronger (40-60 sec); Q3-5 min * Average time; nullipara 2-4 hrs; multipara 1.5-2 hrs * Membranes may rupture now * Increased bloody show * Station -1 to 0
36
Status of Membranes
Status of Membranes * Spontaneous rupture of membranes (SROM) * Diagnosis * Ph * Ferning * Assess: * FHR for at least 1 minute * The umbilical cord could be compressed * Character of the fluid * Colour, amount, clarity, and quantity * Artificial rupture of membranes (ARM)
37
First Stage of Labour Active Phase 2
First Stage of Labour Active Phase * 8-10 cm * Contractions stronger & longer (60-90 sec; Q3-5 min) * Average time; nullipara 1-2 hrs; multipara 1 hr * Increased vaginal show; rectal pressure with beginning urge to bear down * Station: +1 to +2
38
Second Stage of Labour
Second Stage of Labour * Begins with full cervical effacement and dilation and ends with baby's birth * Three phases: 1. Fully dilated with passive descent 2. Descent: active pushing and urges to bear down 3. Crowning: presenting part is on perineum, and bearing-down efforts are most effective for promoting birthSecond Stage of Labour * Mechanism of birth with a vertex presentation * Birth of head * Anteroposterior slit, oval opening, circular shape, crowning * Birth of anterior shoulder * Birth of posterior shoulder * Birth of body and extremities
39
Third Stage of Labour
Third Stage of Labour * Includes placental separation, descent, and expulsion A: Placenta begins the separation process in central portion with retroplacental bleeding. Uterus changes from discoid to globular shape. B: Placenta completes separation and enters lower uterine segment. Uterus is globular in shape. C: Placenta enters vagina, cord is seen to lengthen, and there may be increased bleeding. D: Expulsion (birth) of placenta and completion of third stage
40
Fourth Stage of Labour and Birth
Fourth Stage of Labour and Birth * Birth of the placenta to completion of involution * Psychological, emotional and social adaptations continue beyond 6 weeks
41
Nursing Care: Latent Phase 0-3cm
Nursing Care: Latent Phase 0-3cm * Labour vs prodromal labour? * Teaching * Praise and encouragement * Coach during contractions Keep aware of progress * Provide encouragement, feedback for relaxation, companionship * Monitor progress of labour and maternal-fetal response * Prenatal blood work if unknown * Data base - subjective data collection * Review birth plan * Hydration * Nutrition * Ambulation * Hygiene * Comfort measures: position changes, non medication vs pharmacological measures * Ensuring voiding regularly
42
Nursing Care: Active Phase 4-7 cm
Nursing Care: Active Phase 4-7 cm * Admission - complete data base * Coach during contractions * Support person(s) may need relief (eat, go to the BR, etc) * Comfort measures * Encourage relaxation, focusing on her areas of tension * Minimize distractions from surrounding environment * Administer analgesics as appropriate; * Provide pericare and mouth care (ice chips) * Monitor hydration, nutrition, voiding * Monitor progress of labour and maternal-fetal response * Praise, keep aware of progress * Teaching
43
Nursing Care: Active Phase 8-10cm
Nursing Care: Active Phase 8-10cm * Constant presence and support * Comfort measures * Assist with counter pressure techniques * Coach breathing to quell nausea * Continue to coach with contractions: may need to remind, reassure, and encourage her to reestablish breathing techniques and concentration with each contraction * Coach panting or “he-he” respirations to prevent pushing * Monitor progress of labour and maternal-fetal response * Keep the mother and family aware of progress * Assess bladder for filling * Prepare for birth
44
Fetal Assessment During Labour
Fetal Assessment During Labour * Separate presentation * Components * Fetal activity * Fetal heart rate * Presence of meconium * Fetal blood sampling
45
Signs of Second Stage of Labour
Signs of Second Stage of Labour * Increase in apprehension or irritability * Spontaneous rupture of membranes * Sudden appearance of sweat on upper lip * Increase in blood-tinged show * Low grunting sounds from the woman * Complaints of rectal and perineal pressure * Beginning of involuntary bearing-down efforts * Bulging of the perineum * Labial separation * Advancing and retreating of the newborn’s head during and between bearing-down efforts * Crowning
46
Nursing Care: Second Stage of Labour
Nursing Care: Second Stage of Labour * DO NOT LEAVE THE ROOM * Call for help * Preparing for birth * Constant assessment * Praise, encouragement, coaching * Providing brief, explicit directions throughout this stage * Position changes
47
Secondary Powers: Teaching
Secondary Powers: Teaching * Start pushing when the urge to do so is strong * Use abdominal muscles * Push multiple times (6 to 7 seconds each) with each contraction * Push with an open glottis and slight exhalation * Focusing attention on the perineal area to visualize the newborn * Relaxing and conserving energy between contractions * Stop pushing with crowning - panting technique
48
Third Stage of Labour & Birth
Third Stage of Labour & Birth * Maternal assessment - assessment of hemodynamic stability? * Cord clamping at 1 minute * Immediate newborn care * Stimulate and dry * Apgar at 1/5/10 minutes * Watching for signs of placental separation * Inspection of the placenta for completeness * Collect umbilical cord blood gasses * Placental care
49
Third Stage of Labour and Birth
Third Stage of Labour and Birth * With fundus well contracted and placenta visible at introitus, encourage mother to bear down (push) to expel placenta and amniotic sac * Is it painful? * The contractions may be a minute a part but may be unnoticeable * No bones, will “slide” out
50
maternal oxygenation/ blood flow
Maternal circulation delivers oxygenated blood to placenta, from placenta to umbilical cord, to fetal circulation O2 delivery to the fetus is via the uterine arteries to the uterus, from the uterus through the placenta, and from the placenta to the fetus via the umbilical vein. Uterine and placental blood flow are decreased with each uterine contraction This leads to a temporary decrease in placental O2 exchange Uterine relaxation returns uterine perfusion and placental O2 exchange resumes
51
Intermittent Auscultation of FHR
Utilize Leopold’s Maneuver's to find the fetal back Use doppler, pinard, or transducer to auscultate the fetal heart rate Palpate the maternal pulse Listen for a full minute immediately following a contraction Assess rate, rhythm, presence of accelerations and decelerations
52
Intermittent Auscultation of FHR
Preferred method of FHR assessment, utilized for all pregnant patients unless high risk Assess FHR via IA Q1H in latent labour Q15-30 min in active labour Q5 min in second stage of labour with active pushing After any invasive procedure, or any potential changes in the intrauterine environment, such as rupture of membranes, vaginal examinations, or administration of PRN medications
53
Benefits of IA
Less costly Less restrictive for the woman (permits increased freedom of movement) Adaptable to varied labor positions and practices Lower intervention rates, compared with EFM, without compromising neonatal outcome
54
Continuous Electronic Fetal Monitoring externally
Most common. Uses an ultrasound transducer placed over the fetal back to receive the heart rate and transforms these into wave forms. A pressure-sensitive transducer (tocodynamomter) is placed over the maternal fundus to record uterine activity.
55
Continuous Electronic Fetal Monitoring internally
Scalp electrode is “screwed” onto the fetal presenting part. Can also involve the insertion of a pressure-sensitive catheter through the vagina and into the uterine cavity to asses contractions.
56
baseline FHR during labour
Approximate FHR during a 10 minute segment Rounded to 5 bpm increments Baseline duration- minimum 2 minutes per 10 minutes Normal: 110-160 bpm ( age appropriate ) Changes: must be maintained > 10 minutes to be a baseline change
57
Fetal Heart Rate Tachycardia
Causes: Drugs: amphetamines, cocaine, Maternal Hyperthyroidism Maternal or fetal anemia Fetal supraventricular tachycardia Fetal Cardiac abnormalities or heart failure Acute or chronic fetal hypoxemia Maternal or fetal infections (chorioamnionitis) Catecholamine ( stress )
58
Fetal Heart Rate Bradycardia
FHR < 110 bpm Mild: 100- 110 bpm Marked: < 100 bpm hypoxia
59
absent FHR
Absent: amplitude range undetectable (< 2 bpm)
60
minimal
Minimal: amplitude 2-5 bpm
61
moderate fhr
Moderate or average: amplitude 6-25 bpm
62
marked fhr
Marked , increased, saltatory pattern: > 25 bpm. usually seen in second stage of labour. indicate hypoxia. GET BABY OUT PUSH
63
Baseline Tachycardia
Definition: FHR > 160 bpm for > 10 minutes Mild: 160-180 bpm Marked or Severe: > 180 bpm
64
Accelerations
Abrupt, transient increase in FHR <2 minutes duration <32 wks—10x10—increase of FHR at least 10 bpm above baseline for at least 10 seconds >32 wks—15x15—increase of FHR at least 15 bpm above baseline for at least 15 seconds Are a sympathetic response means the sympathetic nervous system is intact – good news!!! Result of Fetal movement or stimulation (e.g., Scalp stimulation, palpate maternal abdomen) Reaction to contractions
65
if an acceleration lasts longer than 10 minutes....
new baseline fhr
66
fetal accelerations tell us
the cns in intact
67
late decelerations
uterine placental deficiency, prob with uterine perfusion, activity, placenta or both. lead to hypoxia or myocardial depression. Hypoxia can lead to acidosis
68
prolonged decelerations
15beat variation, lasting between 2-10mins but returning to baseline. caused by any mechanism. hypoxia. cord depression, contraction problems, etc. BELOW 100 causes for intervention. below 60 is emergency
69
intrauterine Resuscitation Measures
Improving uterine perfusion Increasing maternal cardiac output will improve uterine perfusion  Lateral positioning of the mother  Correction of maternal hypotension Administration of intravenous fluids Administration of pressor agents (ephedrine 5-10mg IV push Elevation of the legs or Trendelenberg position.  Reduction of uterine activity Increasing oxygen transfer Promoting umbilical cord flow Maternal position change Stop pushing Amnioinfusion Increasing fetal cerebral blood flow Other (e.g. operative or cesarean delivery)
70
as the nurse you will" for intrauterine resus measures
Repositioning or lateral positioning of mother Reversal of hypotension (IV bolus) Stop oxytocin Administer O2 @ 8-10 l/min) Decrease frequency of pushing Vaginal examination to assess labor progress Observe for meconium Maternal V/S and condition Reassure patient Systematic assessment of EFM and whole clinical picture Notify charge nurse Call care provider for immediate re-evaluation of mother Anticipate fetal scalp sampling Anticipate tocolytics Anticipate preparations for urgent or emergent operative birth or cesarean section
71
Fetal blood sampling
done by doc Assess the pH or Lactate build up less than 4.1 lactate and greater than 7.25 ph normal 4.2-4.8 and 7.1-7.24 border line greater than 4.9 and less than 7'20 abnormal
72
documentation and communication intrauterine resus
Consistent, proper terminology Demonstrate nursing process ( ADPIE- assessment, diagnosis, planning, implementation and evaluation). When atypical or abnormal FHR patterns are identified, document the return to normal. Seek clarification Confirm with the RN or your instructor prior to charting Always explore how the FHR correlates with the clinical picture NEVER alter notes later Practice!!
73
How many bones is the newborns skull made up of?
6
74
What is the covering of hair present on the newborn at birth called?
lanugo
75
What is the swelling present in the genitals of both males and female newborns caused by?
maternal hormones
76
What does APGAR stand for?
activity, pulse, grimace, appearance, respiration
77
When does the anterior fontanel close?
12-18 months
78
When does the posterior fontanel close?
4 months
79
When is the APGAR score taken?
1-5 minutes after birth
80
Newborn skull bones are separated by sutures which allow for what to happen during delivery?
molding
81
True or False: Physiological jaundice is common occurrence that happens within 24 hours after birth
48-72
82
What is the startle reflex also known as?
moro
83
It is normal for a newborn to control their head at what age?
2 months
84
What day of life is the greenish-black tarry stool known as meconium passed?
99% first day. up to 2 days
85
What is the normal respiratory rate for a newborn ?
30-60
86
What is the normal BP for a newborn?
60/40
87
At what age can an infant can hold an object, such as a cracker, or a bottle?
6 months
88
At what age can a newborn be able to roll both ways?
6 months
89
At what age can a newborn sit without support?
8 months
90
At what age is it common for an infant to pull themselves up to stand?
10 months
91
At what age does an infant smile in response to a smile?
2
92
What age is it common for an infant to say their first words?
10 months
93
At what age do infants clap hands purposely ?
8 months
94
What is the average age that an infant walks unaided?
12 months
95
At what age does a newborn begin to "coo" and reaches for objects?
4months
96
What age marks the height of stranger anxiety for an infant?
8-10 months
97
What age is it common for an infant to crawl?
8 months
98
Cow's milk can be started at what age?
1 yr
99
When is the first laugh often heard at?
4 months
100
What are two preventative measures recommended by the AAP to prevent SIDS?
1. No quilts or comforters in crib 2. Lay the newborn on their back to sleep
101
The first A in APGAR score stands for Activity, but is technically measuring what?
muscle tone
102

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