Labor and Delivery(HD) Flashcards Preview

VEEB > Labor and Delivery(HD) > Flashcards

Flashcards in Labor and Delivery(HD) Deck (90):
1

Labor

-process by which the baby is expelled
-4 stage process or sequence of events that begin with progressive consistent uterine contractions and ends 1hr after delivery of baby

2

Stage 1 of Labor

rhythmic contractions to 10cm cervix dilation
1-latent phase-slow/mild
2-active phase-alot of activity
3-transition phase-from baby being inside to out

3

Stage 2 of Labor

-dilated cervix to birth of baby

4

Stage 3 of Labor

-birth of baby to delivery of placenta

5

Stage 4 of Labor

-1-4 hrs after delivery of placenta

6

how long stage of labor 1-4

-16-36hrs

7

Factors Effecting Labor(Passageway)

-the structure the fetus passes through(size) of pelvis
-size of pelvis, cervix, vagina, baby

8

Factors Effecting Labor(Passenger)

-size and position of fetus

9

Factors Effecting Labor(Power)

-intensity of contractions

10

Factors Effecting Labor(placenta)

-can separate to early where placenta is attached

11

Factors Effecting Labor(Psyche)

-moms emotional status

12

Factors Effecting Labor(Position)

-maternal position and gravity

13

Passageway

-True vs False pelvis- linea terminals
-True pelvis: pelvic inlet, cavity, outlet
-size and shape of pelvis has effect on delivery of baby

14

Soft tissue(passageway)

-vagina cervix

15

Effacement(passageway)

-dilation of internal os
-shorteining/flattening
-measured in percentage

16

Dilation(Passageway)

-cervix thins out
-0-10cm
-how open it is

17

vagina(passageway)

-rugae is going to stretch as baby is coming through

18

Fetal Skull(passenger)

-molding
-cephalo pelvic relationship(CPD)
-size of head/size of pelvis is disproportion

19

Fetal lie(passenger)

-how baby is lieing in mother uterus
-position of fetus long axis in relation to moms long axis
-longitudinal transverse,oblique
-how do the vertebrae line up
-if the baby vertebrae lines up with mothers=longitudinal lie
-tranverse= -------
-oblique= baby at an angle

20

Fetal Presentation(passenger)

-what part of the fetus is coming into the pelvis first
-ideally we want head first
-cephalic
-vertex=ideal presentation=tip of head
-military=top head
-brow=forhead coming first= chance for neck injury
-face=face first=least preferable
-breech=any other part of the body=feet,buttock,shoulder

21

Fetal Attitude

-relationship of fetal parts to its self/ one another
-flexion-head down, arms and legs up, smallest part of head entering first

22

Fetal Position

-relationship of the presenting parts to moms pelvic 4 quadrants
-3 letters used
-side of moms pelvis (L or R)
-reference point of presenting part
-O=ossiput(head first)
-M=mentum(face first)
-S Sacrum(back first)
-anterior or posterior quadrant(A or P)

23

Fetal station/engagement

-relationship of presenting part to ischial spine
-measured in cm
-represents descent
-negative to positive
-engaged at zero station
-how up high the fetus is
- -5-+5
-+5 you get to see fetus

24

Powers(contractions)

-involuntary contractions of the uterus

25

Phases of contractions(Increment)

-build up of contractions

26

Phases of contractions(Acme/Peak)

-peak of contractions

27

Phases of contractions(Decrement)

-letting up phase of contractions

28

Frequency

-how often from beginning of one to start of the next
-period of relaxation
-o2 goes down during contraction

29

Duration

-how long from beginning to end of one contraction
-how long each contraction last
-beginning very short
-ready for delivery if a min or more
-lasting 90secs is too long fetus is without oxygen

30

Intensity

-how strong contractions are
-subjective
-relying on what mom tells us
-document by feeling the uterus
-stiff/hardening during contraction
-increase as birth becomes iniment
-fhr decrease 110, fetal distress during a contraction

31

Placenta

-upper portion of uterus
-detaches from wall with contractions

32

Position(Maternal)

-prior to delivery standing/walking
-traditional lithatomy position
-using gravity to assist with descent
-left side lying(fetal distress)-off of blood vessels
-knee chest(prolapse cord)
-birthing beds
-water delivery

33

Psyche

-can lengthen /shorten behavior
-mothers emotional state
-support system
-previous history
-can interfere with progression
-keep mom calmn and focus and trust

34

Pain control(natural alternative)

-postitioning
-relaxation techniques
-control breathing w/ effleurage(massaging circular motion in abdomen
-positive imagery
-distractions
-accupressure
-massage
-individual comfort measures
-cultrual implications

35

Pain control(Analgesics)

-provides emotional and physiological benefits but can interfer with resp. system of newborn. not given if birth is anticipated within one hour
-opiates=decrease perception of pain
-sedatives-used in latent phase(allows mom to rest)
-tranquillizer-relaxes mom
-narcotics-given during active phase
-cultural implications-some culures view medication as sign of maternal weakness

36

Anesthesia(general)

-mom is completely asleep

37

Anesthesia(pudenal block)

-local in the perinieum
-good for episiotomy

38

Anesthesia(Epidural)

-blocks pain sensation
-catheter in epidural space(med dripping in)
-must have i/v
-potentential for hypotension(monitor bp)

39

Anesthesia(spinal)

-injection in the 3,4,5 space
-must lie flat
-potential for headache

40

Continuous Fetal Monitoring

-FHR decreases during contraction
-temporary lack of oxygen
-HR should return to 120 btw contractions
-monitoring gives ongoing fetal status

41

External Assessment of fetus

-fetal heart rate(120-160)
-intensity of contractions
-permanent record
-frequent adjustments needed

42

Internal assessment of fetus

-ruptured membrances
-accurate assessment
-monitor FHR
-intensity of contractions
-risk of infection
-permanent record

43

Variable FHR deceleration

-deceleration begins and ends abruptly
-not consistent
-umbilical cord compression

44

Late FHR deceleration

-delay in decrease
-does not go back to baseline
-uteroplacental insufficiency=not enough oxygen to placenta

45

Maternal Response to Labor
(Cardiovascular)

-BP and HR increase during first and second stage
-Return to pre-labor levels during the 3rd and 4th stage
-increase in HR during secong stage

46

Maternal Response to Labor
(Respiratory)

-increase in respiration rate prine to blood gas disturbances

47

Maternal Response to Labor
(Renal)

-trace of protein as a result of muscle breakdown during labor
-potential for derease urinary flow due to postition

48

Maternal Response to Labor
(GI)

-peristalsis and absorption decreases
-NPO: except ice chips

49

Maternal Response to Labor
(Fluid balance)

-muscle activity increase body temp
-increase sweating and fluid evaporation
-increase rate can alter balance

50

Signs and Symptoms of Impending Labor

-lightening=baby drops into pelvic cavity
-Braxton Hicks contractions
-cervical changes=effacement and dilation
-increased energy(nesting)
-weight loss(fluid shift)
-rupture of amniotic membranes
-1000ml of fluid
-nitrazine to determine ph of
-amniotic=alkaline
-urine is acidic

51

Characterisitcs of True Labor

-regular intervals
-located in the back
-increase frequency,duration,intensity
-walking intensifies
-cervica; changes
-sedation doesnt decrease number

52

Characteristics of False Labor

-irregular intervals
-located in abdomen
-NO increase of frequency,duration,intensity
-walking eases
-no cervical changes
-sedation decreases number

53

Mechanism of Labor(cardinal movements)
pg. 128

1-Engagement
2-Descent
3-Flexion
4-Internal Rotation
5-Extension
6-External Rotation
7-Expulsion

54

First stage of Labor

-Starts with onset of contractions and ends at 10cm dilation
-longest stage of labor(10-16hrs)
-higher the parity(number of births) shorter the labor
-has 3 stages: Latent,Active,Transition

Latent Stage:
-sedative may be given
-0-3cm
-longest stage
-effacement starts
-contractions q20-q5
-15-40secs/mild

Active Stage:
-4-7cm
-amniotic rupture
-contractions 2-5mins
-40-60secs/mild-moderate
-pain med can slow down contraction
-pain medication given end of the latent phase
-once get to 7cm no more pain medication

Transition Stage:
-8-10cm; fully effaced and completly dilated
-difficult for mom
-moody,argumentive,combative
-contractions q2mins
-60-90secs/firm
-shortest phase of first stage but most difficult for mom

55

Nursing care for First stage of Labor

-Monitor FHR
-Time and assess contractions; beginning of one end to next, feeling uterus tightening
-Monitor mothers vs/ i&o; for increased vital signs
-NPO-ice chips(limited), peristalsis has slowed down
-IV fluids(change frequently)
-vaginal exams by MD and RN
-encourage breathing techniques
-pain management
-monitor mothers response
-change postition(what ever makes more comfortable and non-compromising)
-positive encouragement

56

Second Stage of Labor

-Mechanisms of Labor
-Begins with 10cm dilation and ends with birth of baby
-Bulging perineum
-Elevated Bp during contractions
-Episiotomy may be done
-Bladder distention(impedes descent)
-unable to dollow directions
-uncontrollable urge to push
-for head of baby to come out(multipara=30mins)(primi=3hrs)
-check perineum when mom feels pressure in area and she wants to go to the bathroom

57

Nursing Care-Second stage of Labor

-continued monitoring of mothers Vs and FHR
-Vs between contractions
-mother is pushing
-episotomy done if needed
-support back or assume appropriate positions
-check for bladder distention
-assist with breathing and pushing
-prepare resuscitation equipment for baby
-cord is clamped and cut when pulsating stops
-baby is shown to mom and support person

58

Third Stage of Labor

-Begins with birth of baby ends with placental expulsion
-5-60min after baby is born
-signs and symptoms of placenta detachment
-cord stops pulsating
-lengthening of cord
-gush of blood
Mechanisms
-Schultz-fetal side=shiny
-Duncan-maternal side=raw/lumpy

59

Nursing Care-Third stage of Labor

Mom
-assess placenta
-monitor mothers VS
-potential for hemorrhage(Diaphoresis,decreae Bp, increase HR/Pulse
-massage uterus
-obtain cord blood if needed for stem cells

Baby
-dry off and assess infant
-apgar score
-apply id bands to infant and parents
-assess and allow for parent/infant bonding

60

Apgar Score

-8-10 acceptable
-1min and 5min of life
-4-7=ok
-below 3 baby is in trouble

61

Fourth Stage of Labor

-recovery stage
-begins with delivery of placenta
-involution takes place-takes about 6weeks for everything to go back into place
-lasts 1- hrs
-frequent assessment of mother
-potential for hemorrhage

62

Nursing care-4th stage of Labor

monitor moms VS
-q15min then q30mins then q1hour
asses fundus
-firm-ripe plum
-if boggy-massage
-if ridged-cal MD
-just below umbilicus
-midline
-if to one side have mom empty bladder
I&O
-assess bladder
Monitor Lochia color and amount
-lochia is post partum bleeding
-pain in urination is normal
-lochia no oder, should progress forward
-300cc-500cc=normal blood loss during birth
-Lochia Rubra=red,small clots=should not bleed through pad less than 2hrs-2-3days
-Lochia Serosa=pinkish 4-7days
-Lochia Alba=whitish color-up to couple weeks
Pain Management
-after pain
-ice to peri area
Allow mom to rest
-allow for parent/infant bonding

63

Nursing care of neonate

immediate care
-suction
-clean secretions
-vernix=cheesy substance
-instillation of neomycin drops for opthalmia neonatorum
Provide warmth
-warm blanket
-heated bassinet
-radiant heat
-hat
General Observation
-body structures intact
-skin-milia(white spot)(clogged pores)
-acrocyanosis-blueish color of hands and feet
-fontanels-triangular
-caput succedaneum: pointed shape of head due to edema
-cephalo hematoma: accumulation of blood btw skull and periosteum

64

Labor

process of that begins with uterine contractions and ends one hour after delivery of the baby

65

Effacement

thinning and shortening of the cervix

66

Dilation

opening of the cervix

67

Cephalo-pelvic relationship

size of fetal head in relation to mom pelvis

68

Lie

relation of fetus long axis to moms long axis

69

Attitude

degree of flexion of fetus; relationship of fetal body parts to each other

70

Presentation

the part of the fetus that enters the pelvis first

71

Position

relationship of the fetus presenting part to the mothers 4 quadrants of the pelvis

72

Station

relationship of the presenting part to moms ischial spine

73

contraction

uterine activity that is part of the labor process

74

increment

beginning of contraction

75

acme

height of contraction

76

decrement

contraction starts to subside

77

intensity

mild moderate firm, strength of contraction

78

frequency

how often contraction occur, measured from the beginning of one to the beginning of the other

79

duration

how long a contraction lasts measured for increment to decrement

80

lightening

descent of fetus into the pelvis

81

Braxton hicks contraction

random mild abdominal contractions-false labor

82

mechanism of labor

rotation the fetus goes through while descending out of the body

83

apgar score

assessment tool of the neonate
done 1min and 5min after birth

84

crowning

appearance of fetal head in the vagina during contraction

85

loccia

bleeding that occurs after delivery

86

loccia rubra

bright red with small clots

87

loccia serosa

thin pinkinsh, brown discharge

88

Loccia Alba

white creamy discharge

89

after pain

contractions of the uterus after delivery may last 48-72hrs

90

involution

returning of the reproductive organs to the pre pregnant state