Labor Flashcards
(29 cards)
What is the meaning of VEAL CHOP?
the number for each word goes together
VEAL:
1) V → Variable decels
2) E → Early decels
3) A → Acceleration
4) L → Late decels
CHOP:
1) C → Cord insufficiency
2) H → Head
3) O → Oxygen (Okay!)
4) P → Placental insufficiency
what should fetal HR be? what else should we see on FHM?
Fetal heart rate should be between 110-160 bpm w/ variability & 2 accelerations within 20 min
Early decelerations mirror what?
the contraction
Early decelerations:
1) when do they start?
2) when do they reach lowest point?
3) when do they recover?
1) start at the beginning of the contraction
2) reach lowest point at the peak of the contraction when the pressure on the head is most intense
3) recover at the end of the contraction
are early decels something to be very worried about?
Not a horrible thing → we know she is making progress if it’s 7-8 cm, if it is 3 cm then I might be worried that the baby’s head is getting pressed a little too early
why are variable decelerations called a variable? what do they always have?
Called a variable bc it varies in shape & timing
always has an abrupt descent (can be dramatic)
do variable decels happen with the contraction?
No, it is not happening with the contraction, it is just happening whenever the baby gets squished
what should the nurse do first if she sees a variable decel on the FHM? what could be done after?
ALWAYS turn the patient first → b/c it’s cord compression & the baby is sitting on a cord somewhere
Give fluids → this will increase blood flow through the umbilical cord
Late decelerations:
1) when do they start?
2) when do they reach lowest point?
1) Start after the contraction begins (usually midway point)
2) have gradual descent to lowest point (nadir), which happens after the peak of the contraction
If there is a late decel with minimal variability, what is this telling us?
Not enough blood & oxygen getting to fetus
how can uterine contractions contribute to late decels?
they do restrict some blood flow to the baby; if the baby is stressed their HR will go down because of using all its energy during the contraction
late decels are a sign of ____________ insufficiency
uteroplacental
when do late decels require interventions?
If they are recurrent or if they are accompanied by minimal variability
What can be done if the nurse observes late decels? (6)
1) turn the pt
2) stop pitocin
3) give fluids
4) call provider
5) consider internal exam (decision making will change based on result)
6) maybe internal fetal monitoring (to get most accurate info)
Where are you going to place the fetal monitoring ultrasound?
on the baby’s back
Leopold’s maneuvers:
1) what does the head feel like?
2) what does the breach or buttocks feel like?
3) what are small knobby things?
4) what is the smooth, long, firm surface?
1) hard, round, bump
2) soft & squishy → does not move independently of the trunk
3) hands, elbows, knees, feet
4) back
First stage, latent phase:
1) cervical dilation?
2) effacement?
3) what are contractions like?
4) how does pt cope?
5) how long is it?
1) dilation → 0-5 cm
2) effacement → 0-50%
3) contractions → uncomfortable but bearable
4) usually copes well → may be talkative & excited
5) longest phase → may take 12 hrs or more in primigravidas
what can the nurse do/encourage during the first stage latent phase? (3)
1) distraction
2) ambulation
3) education about normal labor
in the first stage, latent phase, when might some pts look like they are in active phase?
at 3 or 4 cms
First stage, active phase:
1) cervical dilation?
2) effacement?
3) what are contractions like?
4) how does pt cope?
5) when might they become overwhelmed?
6) what sx might she show? (4)
7) what does this phase end with?
1) dilation → 6-10 cm
2) effacement → progressive to 100%
3) contractions → moderate to strong immediately, get closer together
4) Pt needs to focus in order to cope → will not usually talk through contractions, use of prepared childbirth techniques
5) At ~ 8 cm, patient may be overwhelmed
6) Sx → Shaky, nauseous, may be unable to cope well, Increase in “bloody show”
7) ends → with complete cervical dilation & effacement
Second stage of labor:
1) when does it begin?
2) what does “laboring down” mean?
3) what are contractions like?
4) what is occurring and how?
5) what does it end with?
1) begins → when cervical dilation is complete
2) “Laboring down” → wait for spontaneous urge, especially with epidurals/ primips
3) Contractions → become stronger, longer, closer together
4) Fetal descent through the vagina → contractions, pushing, cardinal movements (fetus rotates to align with the pelvis)
5) ends → with birth of the baby
what should the nurse keep in mind during second stage of labor? (3)
1) Position & coordination of pushing with contractions is important
2) Instruct mom in pushing efforts
3) WATCH THE FETAL HEART PATTERNS – this stage is challenging to the fetus
Third stage of labor:
1) when does it begin?
2) what is beneficial to the baby?
3) prolonged 3rd stage = ?
4) what does it end with?
1) begins → with delivery of newborn
2) delayed cord clamping is beneficial to the baby
3) prolonged 3rd stage → increased maternal bleeding
4) ends → with the expulsion of the placenta
List the signs that the placenta is about to deliver (3)
1) Change in uterine shape (globular)
2) Sudden gush of bright red blood
3) Sudden lengthening of cord
