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Exam 1: labor lecture 2 Flashcards

Stages of labor Care of the laboring patient Pain management Fetal assessment/monitoring complications of pregnancy GBS Cord Prolapse Maternity Nursing

1
Q

What are the stages of labor?

A

Stage 1: dilation
Stage 2: pushing
Stage 3: placenta delivery
Stage 4: recovery

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2
Q

What occurs in stage 1 of labor ?

A
  • Dilation!
  • This stage takes the longest
  • Consist of phases (1st) late & (2nd) active.
  • In the (1st) latent phase the pt is still excited and able to talk. She will become 2-3cm dilated in this phase.
  • In the (2nd) active phase the pt is focused on contractions, in pain. She will become 10 cm dilated
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3
Q

Stage 1 of labor Admission assessments labs done

A
  • H&H (for baseline)
  • CBC (for infx)
  • Type & screen for blood type and Rh status (if hemorrhage)
  • Platelet count
  • RPR (for sepsis)
  • assess amniotic fluid
  • Group B strep status
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4
Q

Stage 1 of labor caring for pt/nursing implications:

A
  • admission assessment
  • Labs
  • Continuous assessments (Maternal & fetal)
  • Positioning
  • Support
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5
Q

What occurs in the 2nd stage of labor?

A
  • Pushing! & Ends in delivery of baby!
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6
Q

Stage 2 of labor caring for pt/ nursing implications

A
  • support: Encouragement, breathing
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7
Q

What occurs in the 3rd stage of labor?

A

Placenta delivery!
- Once baby is delivered, now time to delivery the placenta
- Important stage & time of delivery should be recorded

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8
Q

Stage 3 of labor caring for pt/ nursing interventions

A
  • Pitocin!!
    Watching for hemorrhage
  • Immediate newborn care
  • education
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9
Q

What to watch for and nursing intervention during the 3rd stage of labor?

A

once the placenta is out NEED to watch for hemorrhage!
- Pt will receive Pitocin!!!!
- Hormone change instantly.
- Pregnant hormones: estrogen & progesterone
- PP hormones: Prolactin (breastfeeding) and Oxytocin (to make uterus contract=blood vessel constrict=no/stop bleeding)

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10
Q

What occurs in the 4th stage of labor?

A

Recovery! 1st 4 hrs
- Bonding and breastfeeding right away
- Fundus checks (want to be firm)

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11
Q

How to care for a patient in the 4th stage of labor?

A
  • PP assessments
  • observe for hemorrhage
  • bonding and breastfeeding
  • education
  • voiding!!!
  • firm fundus
  • measuring amount of blood coming out
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12
Q

5 factors affecting labor (5 P’s)

A
  • passenger
  • Passageway
  • Powers:
  • position of mother
  • psychologic response
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13
Q

Factor affecting labor-Passenger

A

-size of baby
-size of fetal head
-presentation- 97% vertex presentation
- Fetal attitude
-Fetal lie
- Fetal position & station

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14
Q

Factor affecting labor-Passenger
- what is fetal attitude?

A

relation of fetal body to each other

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15
Q

Factor affecting labor-Passenger
- what is lie?

A

Longitudinal or vertical

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16
Q

Factor affecting labor-Passenger
- what is presentation?

A

vertex

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17
Q

Factor affecting labor-Passageway
- includes what?

A

pelvis (more narrow=harder to go through)
soft tissues (related to cervical effacement & dilation)

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18
Q

Factor affecting labor-Powers
- includes what kind of forces?

A

(contractions that will make cervix thin out & dilate)
-primary force: involuntary contractions
- secondary force: voluntary pushing

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19
Q

Factor affecting labor-Psychologic Response dependent on what factors?

A

!!!!Support!!!
- Passed experiences
-pain tolerance & coping abilities
- culture
- emotional readiness
- self-confidence
- childbirth education

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20
Q

Status of membranes- What does TACO mean ?

A

status membranes status dependent on BOW (ROM)
T - time of rupture
A - amount of amniotic fluid
C - color of fluid want clear; meconium (1st bm) stained water will be yellow=fetal distress
O - odor
assessment tool to remember to assess when water breaks

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21
Q

Status of membranes- Important to always assess for?

A

Always assess for fetal heart tones- cord prolapse (emergency that occurs when the umbilical cord drops in front of the baby and passes through the cervix before the baby)

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22
Q

Tests done to confirm ruptured membranes

A

-Fern Test: Vaginal fluid swabbed & placed on a microscope slide. Fern pattern confirms amniotic fluid

  • Amnisure test
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23
Q

Perineal trama- lacerations

A

Perineal lacerations usually occur when head is being delivered

  • extent defined in terms of depth: 1st -4th degree
  • Skin (1st) through rectal wall (4th)
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24
Q

Perineal trama- Episiotomy

A

Incision made in the perineum to enlarge the vaginal opening

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25
Introduction of labor- cervical ripening agents/meds
Softens the cervix - Prostaglandin - Misoprostol (cytotec)
26
Augmentation/ Induction of labor- hormone/med
-Oxytocin - Pitocin (artifical)
27
Caring for/ nursing implications of laboring client
- clear fluids/food only - hydration/IV - Voiding/ catheterization - Bowel elimination -Ambulation/ positioning -supportive care
28
What does BRAIN stand for?
B- benefits R- risks A- alternative I- intuition N- no, not now
29
What does BURP stand for?
B- breath U- urinate R- relax P- position BURP your patients!
30
Maternal assessment
- maternal vital signs - review prenatal record if available - GTPAL - Assess for bleeding & rupture of membrane (ROM) - Assess pain - Reassess pain
31
Vaginal examination- done to assess?
-assess progression of labor (dilation, percentage of cervical effacement, fetal presentation, position, station, and fetal membrane status)
32
Vaginal examination- important to provide what to the client?
Privacy Dignity Education
33
What does ROM stand for?
Rupture of membrane
34
ROM priority nursing action?
Before TACO - listen to the baby's heart tones; see if there is a prolapsed cord, or any fetal distress THEN TACO
35
What is Leopold Maneuver ?
done to look for fetal presentation/position
36
Labor pain is self-limiting Meaning what?
Self- limiting meaning the pain will stop once you have your baby
37
Labor pain can be prepared for by?
Prepared for by -breathing -relaxation -water birthing -music therapy -even kissing can help
38
Best position to rotate a baby from posterior to anterior position ?
Hands and knees position
39
What is the Gate Control Theory?
Reducing or blocking the capacity of nerve pathways to transmit pain
40
Interventions used the Gate control theory
- massage -stroking - music - focal points - imagery
41
non-pharmacologic measures
* relaxation & breathing techniques * *position changes/motion* - support person - Effleurage (message on tummy) - hydrotherapy - Counter pressure (for back pain, massage) -music -imagery - attention focusing
42
Pharmacologic measures: Analgesia/Opioids meds
-Dilaudid (Hydromophone) - Fentanyl (sublimaze) - Stadol (Butorphanol) - Nubain (Nalbuphine) - Route: IV (drugs in ()s will be used on exam)
43
Pharmacologic measures: Analgesia/Opioids indication
-Can still contractions but takes the edge off them - gives patient a break for that 1st hour -Fast and effective
44
when/how to administer opioids
- give through IV w/contraction (to allow more to go to mom than baby) - administer slowly **timing is important* -given to early: could slow down process or get rid of labor -given to late: baby can born w/med in them= baby not allowed to breath, move, or eat (give baby narcan) -give at least a couple hrs before delivery
45
Opioids effects on mom
Will do the same to baby - decrease maternal maternal HR & RR - crosses placenta - Normal finding in this case: absent or minimal FHR variability -
46
Pharmacologic measures: Antiemetics
(drugs in ()s will be used on exam) -Phenergan (Promethazine) -zofran (Ondansetron) -Reglan (Metoclopramide) Bicitra (Sodium vitrate/citric acid)
47
Pharmacologic measures: Antiemetics- ADEs & indications
(Promethazine) - can also give relaxation feeling - ADE:has sleepy& foggy effect (Ondansetron) -Most common -Given during labor!! -Given preOp Metoclopramide) -given preOp -for full stomach; med will move the food down, so it doesnt come back up (Sodium vitrate/citric acid) -given preOp (preventative med) - neutralizes the gastric acids of throw up
48
med given for episiotomy/laceration repair
Local - 1% Lidocaine
49
pudendal
local pain relief for second stage
50
Epidural administration and MOA
injection of a local anesthetic into the epidural space -pain relief ; 0-4 pain rate throughout birth -turn off after delivery
51
Epidural Nursing interventions after administration
right after administration -BP taken every couple mins, then Q15mins, Q10mins, Q15mins until turned off -& close eye on BP of the baby as well. -monitor for bladder distension
52
Nursing interventions prior to administration Epidural
to prevent Hypotension: give 1000ml or 1 L bolus of LR
53
Epidural advantages
-Remains alert -more comfortable + able to participate/move around -can go from 10/10 pain to little to none -can still empty bladder/bowels
54
Epidural disadvantages
**Hypotension** -urinary retention (will be straight cath due to not knowing when have to pee) -pruritus *Longer second stage* -feeling of fuzziness/HA -It is a "drug"/opioid (effecting baby potential chance)
55
Maternal hypotension with epidural major s/sx
1st: 20%decreased of BPP from the pre-block baseline (if mom's BP drops=decreased perfusion/oxygenated blood to baby=fetal distress) 2nd: fetal bradycardia 3rd: absent or minimal FHR variability
56
Maternal Hypotension with epidural- Nursing interventions
1:lateral position 2:increase IV rate (to increase perfusion) and give 1000ml bolus IV prophylactic Lactated Ringer or even BP med 3: O2 @ 8-10 L/min via face mask 4: ***notify anesthesiologist + provider if 1-3 didnt work*** -monitorBp and FHR at bedside - IV vasopressor as ordered (ephedrine)
57
Complications of epidural and nursing interventions
-Hypotension leading to fetal bradycardia (POISON) -"total spinal" -Spinal HA (when pt has HA the day after-educate to call provider) -infx -impotent block or "spotty" block (*encourage position changes*) -Epidural hematoma
58
Spinal injection indication and MOA
-used for c/s (planned) -provides anesthesia from the nipple down to the feet -
59
Spinal injection Nuring interventions prior to administration
PRIOR give 2 Liters LR boluses
60
General anesthesia used for what kind of birth?
Necessary for emergency c/s -keeping anesthesia time to a minimum to decrease side effects for/from mother to fetus

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