Labor and Delivery(HD) Flashcards
(90 cards)
1
Q
Labor
A
- 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
Q
Stage 1 of Labor
A
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
Q
Stage 2 of Labor
A
-dilated cervix to birth of baby
4
Q
Stage 3 of Labor
A
-birth of baby to delivery of placenta
5
Q
Stage 4 of Labor
A
-1-4 hrs after delivery of placenta
6
Q
how long stage of labor 1-4
A
-16-36hrs
7
Q
Factors Effecting Labor(Passageway)
A
- the structure the fetus passes through(size) of pelvis
- size of pelvis, cervix, vagina, baby
8
Q
Factors Effecting Labor(Passenger)
A
-size and position of fetus
9
Q
Factors Effecting Labor(Power)
A
-intensity of contractions
10
Q
Factors Effecting Labor(placenta)
A
-can separate to early where placenta is attached
11
Q
Factors Effecting Labor(Psyche)
A
-moms emotional status
12
Q
Factors Effecting Labor(Position)
A
-maternal position and gravity
13
Q
Passageway
A
- True vs False pelvis- linea terminals
- True pelvis: pelvic inlet, cavity, outlet
- size and shape of pelvis has effect on delivery of baby
14
Q
Soft tissue(passageway)
A
-vagina cervix
15
Q
Effacement(passageway)
A
- dilation of internal os
- shorteining/flattening
- measured in percentage
16
Q
Dilation(Passageway)
A
- cervix thins out
- 0-10cm
- how open it is
17
Q
vagina(passageway)
A
-rugae is going to stretch as baby is coming through
18
Q
Fetal Skull(passenger)
A
- molding
- cephalo pelvic relationship(CPD)
- size of head/size of pelvis is disproportion
19
Q
Fetal lie(passenger)
A
- 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
Q
Fetal Presentation(passenger)
A
- 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
Q
Fetal Attitude
A
- relationship of fetal parts to its self/ one another
- flexion-head down, arms and legs up, smallest part of head entering first
22
Q
Fetal Position
A
- 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
Q
Fetal station/engagement
A
- 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
Q
Powers(contractions)
A
-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
