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2- health alteration lp7 > lp5- presntations and videos > Flashcards

lp5- presntations and videos Flashcards

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1
Q

prep

culture

emotions

A

Childbirth prep and classes–childbirth education classes help emotionally and physical prepare for birth

Culture-different for each culture-be respectful and integrate practices

lots of uncertainty, some overjoyed/ cant wait or some can be nervous/can be frightened, all depends

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2
Q

Common fears r/t childbirth-

A

losing child,

easily frustrated,

expected performance,

raising children,

how supportive is their partner

, things never being the same in vaginal area

changing lifestyle

pain, image

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3
Q

What attributes to a positive birth experience-

what are the parts of it

A

more education=better experience.-childbirth education classes help emotionally and physical prepare for birth

Birth plan supportive people, whose in room, where giving birth, if at home or hospital to provider special needs like meds and postpartum

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4
Q

What causes labor to start?

when is fetus matured

A

no for sure answer, generally Increased oxytocin/ Prostaglandin to induce contractions with decreased progesterone

uterine muscle stretches

fetus is pressing on cervix

Corticotropin releasing hormone (CRH)

Placenta may reach age

potentially semen

-Fetus matured at 37-42 weeks-

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5
Q

Early signs of labor

lightening

A

Lightening- “Dropped”-lower baby, pressure in groin/bladder, bladder urgency and incontince, easier to breath, waddling gait, lower edema, leg cramps pelvic pressure

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6
Q

Braxton hicks

ripening

bloody show

early signs of labor

A

Braxton hicks-practice contractions-painful to some but not all-does not mean in labor

Ripening-softening of cervix

Bloody show-loss of mucus plug like 24-48 hrs before labor- if too much then go get emergency care

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7
Q

Nesting and 1 more

early signs of labor

A

Nesting-sudden burst of energy for 24-48 hrs beforehand

Rupture of membranes

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8
Q

prostaglandin surge
signs of early labor

A

Wt loss

Diarrhea

Nausea

indigestion

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9
Q

Rupture of membranes

Nitrazine paper-test

sometimes

what +/-

A

test if membrane that has ruptured amniotic fluid or not

sometimes it could be urine

urine will be negative, amniotic fluid is positive

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10
Q

Prolapsed cord

can do what

how do you help situation

rupture of membrane

A

-umbilical cord falls out before baby head is engaged

can cut circulation off to baby-very dangerous

-put steril glove on and push babys head up into vaginal area into cervix so baby is not compressing cord

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11
Q

false labor

true
common
moms need what

A

true labor needs cervical changes

false labor is common-urine can come out instead of membranes

moms need lots of reassurance, they can be very anxious and nervous

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12
Q

Components of Labor

4 p’s

A

Passage – woman’s pelvis-maternal pelvis shape

Passenger - fetus

Powers – uterine contractions/factors-how powerful to push out baby

Psyche – woman’s psych. State or mind, coping, how dealing with hormones and pain

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13
Q

fetal skull molding

A

-ability of babys head to mold and flex to be able to squeeze out vagina during birth

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14
Q

fetal skull

fontanelles sutures

A

facilitate the movement and molding of the cranium through the birth canal during labor.

They also allow for rapid postnatal growth and development of the brain.

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15
Q

fetal attitude flexion

A

how flexed is fetus so that smallest part of head exits first

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16
Q

fetal lie

what 2 ways

fetal presentation

A

Longitudinal -north to south-preferred

Transverse-side to side

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17
Q

presenting part

normal
Malpresentations(B/T)

fetal presentation

A

Cephalic-head down

Malpresentation –breach and transverse lie

//B-may need c section because feet,bottom out first

/T- risky,gambling, baby coming out sideways, doctor may need to pull baby so it doesn’t breach

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18
Q

engagement measurements

head is what

A

Engagement-head down.

Head is engaged into cervix.

Once it hits 0 station(around area of isheac spine) it is engaged into birthing process

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19
Q

station measurements
how measure

full ____ baby upwards

A

Station-0=head is engaged

-anything above that is negative cm.

once out in below of cervix, then it is positive numbers

baby head progress–
-3
-2
-1
0
1
2
3

full bladder can push baby upwards

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20
Q

fetal positons measuemrents

anterior
posterior
transverse

A

dependent on where baby is sitting-ideally loa

. if baby is ROA-then heartrate is in right lower abdomen

if baby is LOA-then heartrate is in left lower abdomen.

Anterior is lower abdomen,(LOA,ROA)

posterior is upper abdomen,(LOP,ROP)

transverse is outer part (LOT,ROT)

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21
Q

Leopold’s maneuver

A

can palpate fetal back, butt, extremities

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22
Q

Vaginal exam

what feeling for
if not engaged
when is 0

A

During a vaginal exam, your doctor will feel for your baby’s head, cervical effacement,sofetening,dialtion and where baby is

If the head is high and not yet engaged in the birth canal, it may float away from their fingers. At this stage, the fetal station is -5.

When your baby’s head is level with the ischial spines, the fetal station is zero

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23
Q

FHR

methods
normal

A

Methods-dopler, ultra sound, fetal scope

Normal rate-110-160

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24
Q

3-Fetal assessment -Common location of FHR

A

ROA and LOA are normal and most common positions,

so heart rate in lower abdomen

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25
breach position FHR if heard upper breach means what which means hr is heard where
if FHR is heard in upper abdomen it could mean breach position Breach means baby is flipped upward woth feet, butt going first, so it would be in upper part of abdomen, not lower
26
cardinal movements of labor descent/flexion internal roation extension external rotation expulsion
Descent, flexion,- baby’s head hitting the soft tissues of the pelvis, align head w/ chin toward chest as they get into pelvic cavity internal rotation-when in pelvic floor, head will rotate , extension-ead passes through the pelvis at the base of the neck-face and neck appear outside of body , external rotation-head moved from face down to side , and explusion-shoulder out
27
Powers of labor-
buildup of contractions in its longest phase-beginning of one to end of same contraction
28
primary powers of labor frequency duration intensity
Primary-how much and how often Frequency of contractions-start of one to start of other Duration of contractions-60 seconds Intensity of contractions- some pain, tightening pushes baby out
29
powers of labor secondary what are they are they length
Effectiveness of pushing- are contractions strong enough and are they frequent enough to actually push out-don’t want too much time Length of labor- may take longer if newer, can push 2-3 hrs sometomes
30
Contractions phases increments acme decrement
Increment-upward intensity phase Acme-peak intensity Decrement-downward intensity
31
contractions descriptions frequenct duraion intensity
Frequency-start of contraction until next one starts Duration-start to end of one contraction Intensity-how intense it gets
32
Cervical Changes true effacement dilation
cervix has to change for it to be true labor Effacement- shortening of cervical canal, cervix is paper thin, then it is 100% effaced. Dilatation/dilation- opening that increases to 10 cm. do not want mom pushing before full dilation
33
Cervix effacement
Cervix starts off as long and thick, then cervix will shortnen to give baby less travel tme out of cervix Cervix will keep thinning out to allow easier push, amniotic fluid will break, membranes will rupture
34
1st stage - how long/much true onset all three 3 stages
1st stage – true onset of labor until 10 cm dilation- true onset is cervical change latent active transition
35
Latent how dialted contractions keep start
-0-3 cm dilated, mild contractions, 20-40 seconds, keep mom active at this point start birth plan
36
active dialtef contractions more spontaneous
4-7 cm, contractions last 40 -60 seconds every 3-5 minutes- more pain and anxiety, spontaneous rupture of membranes-closer to delivery
37
Transition- how dialated contractions membranes how will mother feel is this pt ready for birth use what to check cervix/why
8-10 cm, 2-3 minutes part, 60-70 second contractions, if rupture of membrane hasn’t happen it wont fully dilate. -doctor will rupture membrane for them Intense and uncomfortable, reaction of vomit, pain, anxiety, irritable, pressure, wants to push, shaking, hyperventilating, definitely ready , use sterile gloves to check cervix, wait until 10 cm to push-- if lots of burning or urge to push, and lots of pressure need to check
38
what happens if mom pushes before 10 cm
vaginal area will swell and won't fully dialate labor will not fully progress and most likely c section
39
promoting comfort in labor bp to pa wa re br b/b
Birth plan, touch, pain, walking, relaxation, breathing, bladder/bowel – keep empty to assist with fetal descent
40
2nd stage of labor how dilated crowning stretching check on provide
10 cm dilation until birth of baby Crowning-severe pain, burning in vaginal canal-head is right there Stretching of perineum and anus-massage of areas to prevent mom from tearing so baby doesn’t go out too fast and keep mom comfortable check on cervial and assess patient provide comfort and push
41
3rd stage of labor-what is it SS DD takes how long do not want what do not do what
– placenta separation and expulsion “Shiny Schultze”-blue side that faces baby “Dirty Duncan”-side on uterine wall-where attached- from 5-30 minutes- do not want any placenta in mother-want all of it out of body, not much pain, cord is attached but already clipped off of baby do not pull on placenta Comfort
42
4th stage of labor -what is moms time increase in
first 4 hours after placenta delivery Mom’s recovery and physiologic readjustment Time wanting to spend with baby, increase in urine function dt fluid loss, usually can take 2 weeks
43
Contraction Assessment palpation electronic --external --internal
Palpation-touch and feel them happenin Electronic monitoring External –toko belts on abdomen Internal-right into baby scalp inside vagina, is most accurate way but used less often
44
FHR Assessment variability:-need what absent minimal moderate marked fetal Brady fetal tacky
Variability-difference between highest and lowest hr need a 2 minute strip Absent-no range detected Minimal- 5 beats or less Moderate-6-25 beats Marked-greater then 25 bpm Fetal brady- less then 110 for 10 minites Fetal tachy-more then 160 for 10 minutes
45
accerlations what are how long usually
Accelerations are short-term rises in the heart rate of at least 15 beats per minute, lasting at least 15 seconds usually 2 minutes or less
46
declarations need temporary ___term
need to be closely monitored temporary drops in the fetal heart rate short term
47
early deceleration what causes nursing assessment
head is compressed monitor-not too signifiant
48
late deceleration what causes what helps
uterine placental problems change moms positions and prepare for c section and oxygen 10-15 liters
49
variable decelerations what looks like why happens
irregular, often jagged dips in the fetal heart rate that look more dramatic than late deceleration Variable decelerations happen when the baby's umbilical cord is temporarily compressed
50
What factors affect pain response?
Childbirth preparation Culture Fatigue/sleep Previous experience Anxiety level Unfamiliar surroundings Separation from family Attention-spotlight Distraction
51
nonpharmalogical pain relief
Relaxation Focusing and imagery Doula/coach Spirituality Breathing techniques Herbal preparations Aromatherapy/Essential oils Heat or cold Bathing/hydrotherapy Touch/massage Yoga/meditation Reflexology Hypnosis Biofeedback Nerve stimulation Acupuncture and acupressure
52
Analgesics – IM or IV-: Stadol, Nubain, Demerol fetal/mother opiate antagonist advantages disadvantages
NR-assess fetal/mother respiratory rate and heart rate Opiate antagonist: Narcan Advantages:reduces anxiety- makes it easier to dilate Disadvantages: resp depress,
53
Anesthesia-Regional- what is what kinds s/e put in after
complete loss of sensation from nipple line down-not much pain Epidural-lower back Spinal-spine Combined epidural-spinal hypotension,numbess, headache put in catheter
54
Anesthesia-Local what does what is in it when is it last
numbness in vagina lidocaine any stage of labor last resort
55
Anesthesia-general last only under if mom
Last resort if needed to knock mom out. Only under severe cirmucnatnces-total emergency . If mom needs emergency surgery to pass baby due to issue with mom or fetal health
56
Assisted Delivery forceps vacuum check
Forceps-tongs - go around baby, pull out-issues with malplacemnt-brain injuries Vacuum-suction cup on baby head . If vaccum and forceps check mom for tears and baby for bruises
57
Episiotomy-what is it midline mediolateral
intentional incision to allow ease of birth without tearing, not routinely done midline-cut straight medilateral -cut sideways
58
Potential labor complications Maternal concerns
Decreased HR Bleeding Meconium-poop from baby Resp distress
59
Potential labor complications Fetal concerns
Decreased FHR Meconium-poop Resp distress
60
If mother wants epidural give biggest risk what stage no what //d/t
give lactated ringers before, needs bolus hypotention is biggest risk for that, in stage 1 no narcotics at this point because of resp depression for baby and mom
61
c section
Dystocia-difficulty labor Hypotonic labor-stop in dialation Fetal malposition-not in right spot Macrosomia-big baby Multiple gestation Intrauterine fetal death Abruptio placentae-gushes of blood Placenta previa Prolapsed cord-cord out before baby Hydramnios-not enough fluid Active herpes Amniotic fluid embolism Cephalopelvic disproportion (CPD
62
boggy uterus what feels like what means what do you want
soft and squishy uterus means bleeding is happening want a hard uterus
63
Involution of the uterus what is it right after where where __ hrs after how much decreases
Measurment of fundus right after delivery -Right after delivery of placenta, top of fundus is midline, halfway between symphysis pubis and umbilicus -6-12 hr after birth, fundus is at level of umbilicus Height of fundus then decreases by_1cm per day postpartum
64
what can influence involution height when will funds settle back into cervix
full bladder around 9-10 days
65
Assessment of fundal height postpartum when measure should be if not postpartum women
Each shift will assess-immediately after will be every 15 minutes w/ vs, then every hr, then every 4 for 24, then 8 should be firm, not smush or soft-want to be measuring good , if not properly placed then look at possible bladder distention, 2 weeks after delivery women are at risk for urinary retention
66
Healing postpartum Lochia Types+days rubra serosa alba abnormal-possible no
Lochia rubra-redneded pieces-1-3 days Lochia serosa-pink -7-14 days Lochia alba-white/gray-10-14 days-up tp 6 weeks Abnormal –never be absence or never should have foul oder-possible infection for 6 weeks-no sex
67
Cervical changes
\-slowly closes and hardens, end of 7 days size of pencil eraser
68
Vaginal changes 6 weeks walls what helps sexual intercourse
-6 weeks to resume normal state-truly never normal walls will remain thin until estrogen stimulation from ovaries but can be delayed months d/t breastfeeding kegel excercises can help- sexual intercouse bleeding d/t estrogen
69
Perineal changes what for first week what helps expect menstrualcycle when
-edema for first week sprays help forceps damage expect menstrual cycle in 6-10 weeks if not breastfeeding, if breastfeeding 3-4 months
70
Return of ovulation and menstruation non breastfeeding if breastfeeding
-takes non breastfeeding 6-10 weeks if breastfeeding 3-4 months or longer
71
Urinary tract- lot= keep use urinate
lot of urine output =good thing, -keep bladder empty, use kegels urinate using straight cath if cant urainate
72
GI system- vaginal C-section
if vagnal birth complain of hunger/thirst, -eat at any time c section- delay any food or drink until gastric movement/ positive bowel sounds, go full liquid diet-increase fiber to inc out
73
Circulatory dieresis a lot of shift where increase what
dieresis of 2-5 days after a lot of urine output shift of fluid into circulatory and excreted in kidneys drink lots of water
74
Striae
-permanent but will begin to fade and lighten to silver color, can be on legs arm back
75
Diastasis recti abdominis-
abdominal muscles don’t gerneally go back if they are separated
76
Lactation inc calories- feed on first milk hormones breast feel
inc calories by 500 from pre pregnancy, feed on demand every 2-3 hrs first milk is called colostrum-great antibodys , prolactin stimulated milk production and oxytocin lets breast down so milk is there from mammery glands for baby to eat. Breast can feel hard and full
77
lactation rotate pump when if issues how know if milk production is enough dont take
, rotate sights, pump during night to maintain milk production , if having issues go to privider , true way to know if milk production for baby is if baby is gaining weight, don’t take in anything bad like alchohol or drugs
78
lactation increase wash devices
increased fluid by 6-8 glasses a day-8 oz wash breast with clear water/ mild soap nursing pads/supportive bra
79
Inverted nipples
-devices can help nipple shields can make possible by attaching to breast
80
Nipple soreness-
some is expected completely normal
81
Engorgement what is what helps milk flow
happens when milk isn't fully removed from your breast Gently massage your breasts to help milk flow during breastfeeding or pumping-ice can help
82
what helps engorgment pain warm warm supportive oral support
warm showers warm compress supportive bra oral analgesics abdominal support with pillow
83
Cracked nipples what is what helps
-moisture cream that is safe for baby lanolin cream protects sore nipples
84
Inadequate let-down- what is what helps
techniques that lactation constant can help with double pumping-try to drain breasts as much as possible
85
Plugged ducts
A plugged milk duct feels like a tender, sore lump or knot in the breast
86
Mastitis s/s treatments can still
if reddened breast, painful, flu symptoms, high temps- mastitis treat with antibiotics can still breastfeed unless pus
87
Suppression of lactation accumulation hormones do what what helps
accumulation of milk inhibits further milk production however hormones will still produce milk suppress with well fitting bra and cabbage leaves help absorb milk
88
suppression of lactation in class can cause engorgment relief of symptoms (oa/ bra/ 0/ compress) dont
can cause strong pain engrossment subsides by 3rd day relief of symptoms oral analgesics snug fitting bra 0 nipple stimulation cold compress dont restrict fluid or pump breast milk
89
Postpartum assessment vs how often first hr how often next 3 hr then how often temp pulse blood pressure resp
- every 15 minutes for 1 hr, every hr for 3 hr , then every 4 hour, temperature, some may go up dt dehyrateion, febrile at 100.4-s/s infection pulse may decrease to 60-70, hypertension from eclampsia //hypotension can be from blood loss, resp don’t change
90
when to clamp a catheter and why
after 1000 ml because hypotension
91
postpartum assessment blod values hemoglobin anemia wbc
hemoglobin and hematocrit will return after 2 weeks , shift in anaemia 12-24 hrs wbc will spike immdalty after birth, will spike up to prevent infection
92
weight loss birth dieresis lochia what else helps when back to normal
12 lbs at birth, dieresis is 5 lbs, 2-3 lbs lochia, good diet and gentle exercise baseline wight is epected at 6 weeks
93
after pains-what is use dont use
contractions during breastfeeding-happens with latching of baby use tylonel or ibuprofen-- no aspirin or heat
94
rhogam when give what does
28 weeks preg or 72 hrs postpartum . If mom is rh negative and baby is positive then helps with further pregnancy
95
Psychologic adaptations in postpartum Taking-in when is it what is it allow what helps
-1-3 days, reflection on pregnancy-what happened how did birth go allow to talk about feelings, fatigued and crying after pregnancy, helps w pain
96
Taking-hold, postpartum stage
women makes own decisions, decide to take care of self simultaneously with taking in
97
Letting go postpartum stages
-accepts new role of baby lets go of fantasies
98
Postpartum blue common look for assure after 2 weeks what reduces chance
common for disappointment look for bonding and attachment assure that its normal due to drop of estrogen and progesterone , after 2 weeks if mom is still down then depression mom may need more help breastfeeding and bonding reduces chance
99
What factors influence parent-infant attachment
finaces wanted baby, partner reality of birth siblings fatigue family interventions
100
Attachment behaviors
Progression of touch- attachment , fingertips , skin on skin touching, , engaged in baby,
101
En face position
a position in which the mother and infant are face to face good for bonding
102
Father/partner Engrossment
beginning of bonding observing for extended periods of time want mom to take care of herself as well
103
Cultural influences in postpartum care
be respectful and ask about culture factors
104
Perineal discomfort- manifestation cleaning wiping dab inc natural=no prevent
-swelling/pain in repairs ,cleaning area out , wiping front to back, dabbing and patting inc water and fiber, natural laxatives, no straining, prevent any tears or retears,
105
Perineal discomfort- pain meds ice/heat baths ages peri back rub
use ibuprofen and Tylenol, ice packs for 24 hrs, then dry heat Sitz baths Topical agents Perineal care-up backrubs
106
hemmorhoids treatment-- increast re sprays caution manifestations
pain, itching,bm bleeding, swelling increase water and fiber rest aesthetic sprays caution w/ laxitives
107
afterpains
After delivery you will feel your uterus contract and relax as it shrinks back to its normal size
108
Postpartum discharge instructions work rest excercise hygiene coitus contraception follow up
Work-6 weeks at least Rest-sleep as much as possible Exercise-hold until doctor Hygiene-cleaning peri Coitus-held off for 6 week Contraception-careful and discuss provider Follow –up-made at 6 weeks
109
Interventions to promote maternal/family well-being in the postpartal period
work on baby schedule eat when baby eat sleep when baby sleep
110
Nursing management after a cesarean birth risks average stay harder to what get mom-reduces look for incetive needs
risk of infections/hemorraging 2-4 days average stay in hospital, harder to breastfeed get mom up walking - after anesthesia wears off- reduces risk of blood clots look for pain /redness incetive spirometry- preventes pnemnoues, needs rest periods
111
c section teaching plan help increase find restrict resume early provide adequate
help bond succescfully increase fluids find support system and find rescources restrict exercise and activity resume coitus when comfortable early ambulation to avoid complications provide rest time adequate pain management
112
signs of infection in c section temo incision urination bleeding
temp over 100.4 redness/drainage at incision site burning/frequent urination bleeding heavier then menstrual period
113
biggest risk for mom postpartum dont use what
hemorrhaging no aspiring because increased risk of hemorrhaging

2- health alteration lp7 (7 decks)

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