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4500 Gender & reproductive health > Class 5 labour and birth part 1 > Flashcards

Class 5 labour and birth part 1 Flashcards

(55 cards)

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1
Q

What are the 2 most important questions when someone comes into triage?

A
  1. do you have bleeding?
  2. is there fetal movement ?
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2
Q

What assessments do we do when someone comes into triage?

A

Height
Weight

Vitals

Leopolds

Vag exam if indicated (dilation)

Fetal heart rate (IA or EFM)

ROM: obvious or needs more tests?

HDP, GDM

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3
Q

When do we want someone to come to triage?

A
  1. Pain management
  2. bleeding
  3. contractions stronger and closer together q5 min for 1 hr.
  4. Membrane rupture ROM
  5. decreased fetal movement
  6. feeling unwell - like something isn’t right
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4
Q

What do we give every person after delivery to ensure there’s no postpartum hemorrhage?

A

oxytocin/syntocinon

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5
Q

What encompases stage 1?

A

start of true labour
to
complete dilation (10 cm) and effacement

Longest stage
includes latent/early phase & active phase.

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6
Q

What encompasses stage 2?

A

complete effacement & dilation
to
birth of baby

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7
Q

What emcompasses stage 3?

A

birth of newborn
to
placenta delivery

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8
Q

What encompases stage 4?

A

first 2 hours post placenta delivery

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9
Q

how much should someone dilate each hour?

A

1 cm per hour

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10
Q

what % of effacement is first stage, early/latent phase?

A

75% effaced

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11
Q

What % of effacement is first stage, active phase?

A

100% fully effaced

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12
Q

What are contractions like for someone in first stage, early/latent phase?

A

5-30 min apart

last 30-45 seconds

Irregular

Mild-moderate

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13
Q

What are contractions like for somone in first stage, active phase?

A

2-5 min apart

40-90 sec

regular

moderate-strong

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14
Q

What are the 5 P’s that can affect labour and birth?

A
  1. passageway
  2. Passenger (fetus)
  3. Powers
  4. Position (birther)
  5. Psychological
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15
Q

What are powers?

A

Primary powers: involuntary uterine contractions

Secondary Powers: bearing down efforts : pushing

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15
Q

What does passenger (fetus) mean?

A

presentation
position
station
lie
attitude

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15
Q

what does passageway mean?

A

birth canal

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16
Q

What fetal position is not ideal?

A

ROP
LOP
(sunnyside up - pressure on mom spine)

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17
Q

How often should the birther change positions?

A

q 20 min

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18
Q

What are the mechanisms of labour?

A

how the fetus adjusts during 1st and 2nd stage of labour

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19
Q

At what point do we determine we have dystocia?

A

> 4 hours with less than 0.5 cm per hour of cervical dilation during active labour

OR

> 1 hour pushing with no descent

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20
Q

What are the causes of dystocia?

A

hypotonic- poo poo contractions

ineffective pushing

passageway isn’t great

birther position isn’t helping

unhelpful psychological response

Issues with fetus position etc. size, cephalopelvic disproportion (head is too big)

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21
Q

What is ECV?

Study These Flashcards
A

external cephalic version
- rotating the baby into cephalic position

22
Q

What are nursing interventions for Dystocia?

Study These Flashcards
A
  1. EFM for 20 min read
  2. Ultrasound for positioning
  3. risk assessment
  4. position changes
  5. assess the cause and timing (which stage/phase)
23
How long do we wait to intervene after water ROM has broken?
12 hours we give oxytocin
24
What 2 things do we NOT want in the ruptured membranes?
meconium (flecks) odour = infection
25
What do we administer if ROM goes over 12 hours?
antibiotics
26
What are the 4 things assessed during vaginal exam?
1. dilation 2. effacement 3. presenting part 4. status of membranes
27
What is chorioamniotnitis?
an infection of the amniotic cavity
28
What are the risks of chorioamnionitis?
- labour dystocia - C-section - pelvic wound abscess Newborn risks: PN, bacteremia sepsis
29
What are 3 things we do to manage chorioamnionitis?
1. Induce labour 2. broad-spect IV abx 3. birth the fetus
30
What can advance to chorioamnionitis?
GBS group B streptococcus
31
how do we treat GBS?
1. IV abx prophylaxis 2. Pen G 5 million units IV- loading 3. Pen G 2.5 million units IV - maintenance 4. q 4 hours until birth
32
What is the nursing assessment for first stage of labour?
1. Vitals 2. FHR - IA or EFM 3. Uterine activity 4. Membranes and vaginal show 5. Vag exam 6. Oral intake & urinate q2
33
How often do we check Vitals in first stage , latent phase and active phase?
q 30-q60 temp- q4 if no ROM q1-2 if ROM
34
How often do we check FHR and uterine activity during latent phase compared to active phase?
latent- q30-60 active- q15-30 (usually 15)
35
How often do we do vag exam and check oral intake during first stage latent phase or active phase?
PRN
36
what stage/phase is the person fully dilated with no urge to push?
seconde stage Passive phase
37
What stage/phase is there pushing and crowning?
Second stage/active phase
38
How often do contractions come in second stage, active phase?
(q2 min) 4-5 contractions in 10 min last 90 sec
39
what stage do people tend to experience N &V?
Second stage, passive phase
40
How often do we assess vitals (BP, HR, RR) during second stage?
Q5-30 min
41
how often do we check FHR & pattern during second stage?
Q5 min during pushing
42
how often do we check vaginal show, fetal decent and changes in status of birther (mood, energy, emotions) during second stage?
ongoing
43
What is really important for the nurse to do at the time of birth?
Write down the time of birth!
44
Why is episiotomy performed?
prevent tearing to the anus midiolateral cut
45
When are forceps indicated?
1. to shorten 2nd stage if dystocia is happening 2. Fetal: - abnormal FHR tracing - abnormal presentation - arrest of rotation - extract the head in breech
46
When is forceps contraindicated?
1. cervix isn't quite dilated 2. water hasn't broken 3. fetal head isn't engaged
47
what do we document when forceps are used?
1. when they are placed 2. number of pulling & timing
48
which do we prefer, vacuum or forceps?
vacuum
49
what do we document with vacuum use?
1. when it is placed 2. number of times it pops off 3. how many pulls 4. max amount of suction used
50
When is third stage of labour?
baby birth to placenta 15 min-1 hr
51
how do we know the placenta is ready to be delivered?
-cramping -umbilical cord gets longer -sudden gush of blood -you can see it -feel pressure again
52
what are nursing interventions in stage 3?
vitals (BP, HR, RR) q 15 min document placenta delivary time cord blood collection (check for Rh status of baby) blood gases & if mom is Rh- then WinRoh pain management check fundus check for PPH make sure placenta is whole
53
What is the fourth stage of labour?
recovery q15 min vitas for first 1 hour 30 min vitals for next hour temp x1 check perineum, fundus, etc pain management hygiene

4500 Gender & reproductive health (11 decks)

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