Intrapartum Flashcards

Question

Vaginal exams | Dilatation

Answer 1

Progress of labor Plan interventions Success of treatments -- pitocin If she is demonstrating changes in attitude or approach we don't need to do a vaginal exam

Answer 2

Palpate the sagittal suture Identify the posterior fontanel Identify the occipital bone Identify the the anterior fontanel

Answer 3

Full dilation through birth of infant Urge to push Nursing interventions: Promote effective pushing Position of comfort

Answer 4

``` Position Abdominal palpation (early labor) or Vaginal examination Ultrasound ``` ``` Fetal heart sounds (FHR) Auscultation Doppler or Electronic Fetal Monitor ```

Answer 5

Contractions Frequency Intensity FHR Reassuring and non-reassuring (dips, brady, tachy changes above 25 bpm) 1 full minute -- comparing peak to baby HR

Answer 6

``` Establish positive relationship Collect admission data Initiate admission interventions Physical assessment – mother and fetus Psychosocial assessment Cultural assessment Laboratory tests Initiate care plan in EMR Ongoing focused assessment and interventions ```

Answer 7

``` Promote comfort Personal hygiene Elimination Environment Presence Support relaxation ``` Women during labor are best supported by an RN Shorter labors Decreased pharmacologic use Decreased operative vaginal or cesarean births Decreased need for oxytocin Increased satisfaction with birthing experience

Answer 8

Emotional: encouragement, distraction, reassurance Physical: touch, position change, heat or cold applications Information: provide education, coaching, interpret medical jargon Advocacy: support decisions, let other’s know her wishes Support family: role model support, encouragement, provide breaks

Answer 9

``` Hands and knees -- back labor Recumbent Upright Standing Sitting Side-lying -- back labor ```

Answer 10

``` Bulging of the perineum and rectum Flattening and thinning of the perineum Increased bloody show Labia begin to separate “Crowning” Burning sensation Intense pressure in rectum ```

Answer 11

Cord clamped by HCP or father Collect cord blood sample for laboratory analysis -- test for baby blood type, cord blood for sampling Cord blood storage arranged by parents

Answer 12

``` Airway Breathing Circulation Warmth Appraisal—Apgar score Identification of newborn ```

Answer 13

``` Birth of baby to complete delivery of placenta Lengthening and protrusion of cord Gush of blood from vagina Smaller, spherical uterus Elevation of uterus in abdomen ``` Nurse expects to admin oxytocin after expulsion of placenta to... Stimulate contractions Reduce incidence of post partum hemhorrage

Answer 14

From delivery of placenta through 1 to 4 hrs Monitor position and firmness of uterus --> “Boggy,” soft uterus --> Initiate fundal massage Assess bleeding -- lochia Hypotension + Tachycardia -- INDICATE BLEEDING* Facilitate bonding Initiate breastfeeding

Answer 15

Recognize the right: appropriate assessment and management of pain. Screen patients: during initial assessment and reassessed appropriately. Educate patients: pain management options and their family.

Answer 16

``` Assessing pain Physiological, psychological indicators Increased catecholamines Increased blood pressure and heart rate Altered respiratory pattern Patient responses May be intensified by fear, anxiety, fatigue… Shaped by past experiences Cultural competence ```

Answer 17

``` Complex Multidimensional Pain management Non-pharmacologic Pharmacologic Goal: manage pain without interruption of labor or doing harm to mom or fetus Pain scale: Coping with Labor Algorithm ```

Answer 18

First stage – visceral pain: deep, dull and aching, poorly localized, felt only during contractions Second stage - somatic pain: sharp, intense, well localized, burning, or prickling caused by stretching of perineal body, distention and traction, and soft tissue lacerations.

Answer 19

Dilatation of cervix Stretching of the lower uterine segment Pressure on adjacent structures Hypoxia of uterine muscle cells during contractions

Answer 20

Dilatation of cervix Stretching of the lower uterine segment Pressure on adjacent structures Hypoxia of uterine muscle cells during contractions Pain is really localized; can refer down to knees -- localized around perineum

Answer 21

Pain Hypoxia of uterine muscle cells during contractions Distention of the perineum and vagina Pressure on adjacent structures

Answer 22

``` Position changes and movement Standing Walking Slow dancing or leaning Rocking on hands and knees Pelvic rocking Side lying Squatting Bellydancing Massage Effleurage Counter Pressure Intuitive touch / therapeutic touch ``` ``` Aromatherapy Breathing techniques Lamaze, Bradley Hypnobreathing Safety: valsava Compresses: warm or cold Relaxation techniques Visualization Focal point Imagery ``` ``` Music Hydrotherapy Immersion Shower Biofeedback Tens unit ```

Answer 23

``` Evidence based practice Meets woman at delivery Performs clinical tasks Consults and advocates Intermittent labor support Keeps patient informed Documents Legal accountability Minimal contact after delivery ``` ``` Trained, may be certified Relationship during pregnancy Supportive role not clinical No communication with HCP Provides continuous support Informs pt using lay terms Assists in articulating questions or concerns to the nurse or HCP May document to share later Follow-ups after ```

Answer 24

Sedatives – for anxiety -- not commonly given; anxiety will slow down Barbiturates – rarely used secobarbital (Seconal) Benzodiazepines diazepam (Valium) lorazepam (Ativan) Antiemetics – H1 Receptor Agonists promethazine (Phenergan) hydroxyzine (Vistaril) diphenhydramine (Benadryl)

Answer 25

Analgesics: Drugs that relieve pain without loss of muscle function. They lessen pain, but do not stop it completely. RELIEF FROM PAIN Anesthetics: Drugs that relieve pain through loss of sensation. They block all feeling. LACK OF SENSATION

Answer 26

Increase pain threshold; reduces the perception of pain Provide maximum relief of pain with minimal risk Help patient relax and sleep between contractions

Answer 27

Systemic Medications can cross the placental barrier Analgesics used in labor: Stadol, Nubain - 2-3 hr half-life (cross placenta, respiratory depression for baby, opioid preferred) If given two hours before baby born -- needs neonatologist Dilaudid, Demerol - long half-life in neonate Fentanyl, short-acting (needs repeated doses), may not cross placenta May still cause respiratory depression Analgesic Potentiaters Decrease anxiety and increase effectiveness of analgesics (Phenergan, Vistaril)

Answer 28

Side effects Nausea; Vomiting Itching Dizziness More serious but not likely Loss of protective airway reflexes Hypoxia due to respiratory depression Psychosocial concerns “natural” birth Hx of addiction

Answer 29

``` Systemic Analgesia – Opioids hydromorphone (Dilaudid) meperidine (Demerol) fentanyl (Sublimaze) butorphanol (Stadol) nalbuphine (Nubain) ``` Opiate Antagonist Naloxone (Narcan) Reverses effect – if sx of respiratory depression present Can be used for mom or baby DO NOT GIVE TO parent who has hx of addiction Can cause seizures and can affect baby

Answer 30

Different spaces Spinal into subarachnoid Epidural into dura Different locations Spinal below L2 to avoid hitting spinal cord Epidural into C T L spaces Different onset Spinal – faster acting Epidural – slower acting Epidural can be anesthesia and analgesia Spinal only anesthesia

Answer 31

Regional spinal anesthesia block ``` Complications: Maternal hypotension Decreased placental perfusion Ineffective breathing pattern Spinal Headache -> tx with autologous blood patch --> Leakage of CSF ``` ``` Regional epidural analgesia in labor, anesthesia in c/s Complications: maternal hypotension bladder distention prolonged second stage ``` Contraindication: Low Platelet count for BOTH

Answer 32

``` Advantages PCEA! Relieves discomfort during labor Fully awake during birth Fewer fetal effects --> no respiratory depression Mom rests before 2nd stage Fetus can labor down Access for LA morphine ``` ``` Disadvantages Maternal hypotension Monitor VS; respiratory Bolus before insertion Epinephrine available Limited mobility Can slow fetal descent Less effective pushing Urinary retention – insert foley Blood coagulation ```

Answer 33

Health literacy – an interaction between system demands and people’s skills reading, writing, numeracy, listening, speaking, and conceptual knowledge

Answer 34

1st trimester = 1-12 weeks 2nd trimester = 13-27 weeks 3rd trimester = 28-40 weeks

Answer 35

any pregnancy delivery after 20 weeks regardless if born alive or stillborn, or how many infants

Answer 36

gravida -- how many times pregnant Term -- infants before 37 weeks or more Preterm -- infants born at 20-36 (6) weeks Abortion -- elective or spontaneous before 20 weeks Living children -- survived neonatal period

Answer 37

baby turns when coming out to get head and shoulders out effectively

Answer 38

Assess FHR/pattern Document characteristics and notify HCP Palpate/auscultate abdo Intervention PRN before documenting Further orders -- call HCP and then document Quick assessment of ABCS initiate rapid response

Intrapartum Flashcards

(62 cards)