objective 4 Flashcards by Kaitlyn Dominie

a normal physiological process that involves the health of the mother and a fetus
It involes the welfare of two patients and the use of skills from medical-surgical and pediatric nursing, psychosocial and communication skills, and specific skills involved in obstetrical care

child birth

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what are the factors affecting L&D?

Preparation
Professional help
Place
Procedures
People

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what are the 5 Ps?

powers
passage
passenger
maternal position
psyche

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what are the powers?

uterine contractions
maternal pushing

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what are the 3 phases of contractions?

increment
peak
decrement

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beginning of one contraction until beginning of next

frequency

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how long the contractions last (40-50secs)

duration

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approximate stregnth of the contraction
mild,moderate, and strong or firm

intensity

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When the cervix is 10cm dilated, female adds voluntary pushing to involuntary contractions which bring the babe down and out
2nd stage involves boht powers

maternal pushing

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false pelvis
true pelvis

bony pelvis

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upper flaring part

fale pelvis

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lower part

true pelvis

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Yield more readily to the forces of contractions and pushing efforts in women who have had a previous vaginal birth

soft tissue

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he fetus along with the placnta and amniotic membranes

passenger

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Composed of several bones separated by strong connective tissues called sutures

head

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where sutures meet

fontanelles

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diamond-shaped area formed by the intersection of four sutures (closes 12-18 months)

anterior fontanelle

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tiny triangular depression formed by the intersection of 3 sutures (closes by end of 2 months)

posterior fontanelle

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Describes how fetus is oriented to mothers spine

lie

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what are the types of lie?

longitudinal
transverse
oblique

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Degree of flexion and extension

attitude

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head flexed forward and arms and legs flexed

flexion

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prolongs descent…longer labor

extension

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Refers to the fetal part that enters the pelvis first
Cephalic (head)
Shoulder
Breech

presentation

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has a significant impact on the progress of labor

maternal position

A woman's mental state can affect the course of labour Promote a positive childbearing experience, including as many of the family's birth expectations as possible The woman's cultural and individual values influence how she will cope with childbirth

psyche

what are the signs of impending labor?

Braxton hicks contractions Lightening Cervical changes Vaginal discharge ‘bloody show’ Energy spurt Weight loss & flu like symptoms Rupture of membranes

Contractions irregular, do not increase in frequency, duration and intensity Walking relieves discomfort/contractions Discomfort in abdomen and groin Bloody show usally not present No change in effacement or dilation of cervix

false labor

Regular contractions, frequent, longer and more intense Contractions become stronger and more effective with walking Discomfort in lower back and lower abdomen Bloody show is often present Progressive effacement and dilation of the cervix occr

true labor

how do know when to do to the hospital?

Ruptured membranes Bleeding other than bloody show Contractions 1st pregnancy: 14-5, regular for 1 hour, lasts approx. 60 secs 2nd pregnancy: q5-7 min, regular for 1 hour Decreased fetal movement

Cervix dilation 0-3cm Contractions: q5-30 mins, 30-45 sec long; mild to moderate Mom is happy, laughing, excited

latent (early) phase

Cervix dilation: 4-10cm Contractions: 12-5 min apart, 40-90secs, long moderate to strong Mom is anxious, less social, rejects support, legs tremor, irritable

active phase (approx 2-8hrs)

Full dilation (10cm) to birth (last 30 mins to 2 hrs or more) Contractions: strong, every 2-3 mins, lasting 60-90secs Contractions function to push baby out of mothers body Bulging perineum, uncontrollable urge to push

stage 2: delivery of the fetus (10cm to birth)

Duration: 5-30mins Contractions: intermittent, mild to moderate Umbilical cord is cut Observe for signs of placental separation

stage 3: deliver of placenta

1-2 hours after birth Uterus remains midline, firmly contracted at or below umbilicus level Lochia rubra saturates perineal pad (no more than 1pad/hour) Cramping may occur Observe for clots larger than toonies Women may have shaking chills

stage 4: recovery

what are the nursing responsibilities during birth?

Prepare the deliver instruments and infant equipment Perineal scrub Admin meds Provide initial care to infant Assess apgar score Assess infant for obvious abnormalities Examine the placenta Identify mother and infant Promote parent-infant bonding

what are the phases of care of the newborn?

Phase 1 (birth-1hr) Usually in delivery room Phase 2 (1-3hrs) In nursery or postpartum unit Phase 3 (2-12hrs) Usually in PP unit if rooming-in with the mother

“Station” describes level of presenting part in pelvis Estimated in cm Level of ischial spine: zero station Above ischial spine: minus stations Belove ischial spine: plus stations

decent

Reaches ischial spines or pelvic inlet (station 0 or lower)

engagement

Contractions increase fetal head flexion until chin is on chest

flexion

When the fetus enters the pelvis the occiput is oriented to the occiput is oriented to the mothers Rt or LT side Head turns until occiput is directly under symphysis pubis

internal rotation

Head changes from flexion to extension Head swings anteriorly as it extends with each maternal push

extension

When head born, shoulders are not in line with head Head and shoulder turn to realign

external rotation

Anterior shoulder delivers, posterior should, quickly followed by the rest of the body

expulsion

what are the nursing response to FHR patterns?

Position changes Decrease oxytocin VS Use altered pusing and breathing techniques in the second stage of labor Increase IV fluids Admin oxygen 6L/min

what are the nonpharmacological nursing interventions?

Skin stimulation Positioning-encourage frequent position changes distraction/diversion-music, imagery, TV Thermal stimulation Heat Cold Breathing techniques-remind them of prenatal classes

block pain without loss of consciousness

analgesics

enhance effectiveness of; or counteract side effects of analgesics

adjuncts

blocks pain and motor responses

anesthetics

what are examples of analgesics?

Morphine sulphase: best given in early labor Demerol: not recommended unless person has allergy to morphine Fentanyl: rapid onset, short duration Nubain: avoid use in women with known addictions

what are examples of adjuncts?

Narcan: reverses respiratory depression Gravol: antiemetic Nitronox: inhaled anesthetic, decreases awareness of pain

The pudendal block is often used for episiotomies, vacuum- assisted, and/or low forceps deliveries There is usually a delay between the injection and the onset of action The injection is made on both sides of the perineal area prior to delivery The medication bathes the nerves

pudendal block

Often a combo of local anesthetics w/ a small dose of opioids- this yields a quicker onset of action and a longer-lasting pain relief; with minimal loss of movement The women can sometimes ambulate and assume any position Med constantly infuses through a catheter via an infusion pump CAUTION: hypotension and urinary retention

epidural (epidural space)

Much smaller amount of drug is needed to achieve the anesthesia when compared with the epidural Also anesthesia occurs quickly and is much more profound; in addition to lasting longer than the epidural method Loss of movement and sensation below the level of the ‘block’ One-shot block as opposed to continuous infusion via a catheter Used for C-sections CAUTION: hypotension and urinary retention

spinal (subarachnoid)

best given in early labor

morphine

not recommended unless person has allergy to morphine

demerol

rapid onset, short duration

fentanyl

avoid use in women with known addictions

nubain

reverses respiratory depression

narcan

inhaled anesthetic, decreased awareness of pain

nitronox

Exhausted from pushing Ineffective pushing If mothers condition warrants it

forceps

Soft suction cup attached to suction Cup placed over baby occiput Suction applied with contraction Scalp edema

vacuum extraction

Removal of infant through incision in abdominal and uterine wall

C-section