typical: week 2 Flashcards
(45 cards)
1
Q
cervix and soft tissues
A
Cervix
effaces: thins and shortens
- 0-100%
- occurs during the first stage of labor
- occurs first in primips
dilates: opens widening the outlet
- 0 cm to 10 cms
- full dilation marks the end of the first stage of labor
- occurs first in multips
2
Q
definition of labor
A
the onset of regular contractions causing cervical changes
3
Q
5 P’s affecting labor
A
Passenger: baby Passageway: pelvis Powers: uterus contraction Postion of mother: gravity, movement Psychologic response: fear, anxiety
4
Q
distinguish false vs. true labor
A
False: - irregular contractions (abdomen) - stops with change in position - no change in effacement or dilation - no "descent" True - contractions increase in regularity and intensity - lower back, radiates - no difference in position change - results in cervical dilation and effacement and descent
5
Q
stages of labor
A
First
- onset of labor to full dilation (3-16+ hours later)
Second
- full dilation to birth of infant (10min-3hrs)
Third
- birth of infant to expulsion of placenta (up to 20 minutes)
Fourth
- expulsion of placenta to approx 1-4 hours. highest risk for hemorrhage. massage uterus.
6
Q
first stage of labor: phases
A
- latent/early: 0-3cm
- active: 4-7cm
- transition: 8-10cm
7
Q
nursing role and general care during labor
A
- fetal assessment
- labor process
- maternal and fetal tolerance of labor (level of anxiety)
- pain management
- I/O: IV fluids, epidural
- v/s
- communication with MD/CNM
- have mom empty bladder
- promote position changes: movement promotes rotation.
- provide hygiene
- provide support & encouragement
- assist with breathing techniques
8
Q
maternal physiologic adaptations during labor
A
- increased demand for o2: risk for hyperventilation, alkalosis
- increased cardiac output: increased pulse, BP. risk of supine hypotension r/t position.
- decreased GI motility: n/v. good sign of progress.
9
Q
supine hypotension
A
- pressure from weight of uterus/baby on vena cava if supine
- decreases blood return to heart
- decreases blood pressure
- may affect fetal heart rate: decreased blood flow to uterus= decreased flood flow to placenta= dec. flow to baby
10
Q
latent phase: early labor
A
- generally the longest period
- 7-8 hours average for primips
- 5-6 hours for multips
- effacement completed in primips
- contractions established as rhythmic and coordinated
- dilation progresses to 2-3 cm
11
Q
latent phase: woman and nurse actions
A
woman: - independence anticipation, excitement, happiness, relief, apprehension - grimace with contractions: uncomfortable - alert, talkative, sociable nurse: - diversion/support/relaxation - encourage ambulation if appropriate - Pt & SO education
12
Q
active pase
A
- rate of cervical dilation begins to increase
- stage lasts 2-4 hours
- cervical progress 3-7cm
- moderate to moderate-strong, longer, more frequent contractions (q 5-3; 40-60secs;mod)
- average rate of dilation: 1.2cm/hr in primip, 1.5cm/hr in multips.
- 3,2,1 rule: cx q3m: come in to hospital. lasting 1 minute, going on for more than 2 hours.
13
Q
active phase: woman and nurse actions
A
woman: - anxiety increases - fears loss of control and anger at the loss of control - may exhibit decreased ability to cope - helplessness and increased dependence - becomes serious and concentrates on labor nurse - comfort, support position - breathing reinforcement - touch - pain assessment - pain management options
14
Q
transition phase
A
- cervix becomes part of the lower uterine segment
- uterine contractions start to put pressure on perineal structure
- q 1.5-3 min; 60-90 secs; strong
- generally the most difficult time for women: 1 hour for primip, 10-15 min for multip
15
Q
characteristics of transition phase
A
- amnesia between contractions
- nausea, vomiting, belching
- leg tremors and involuntary shaking
- increased perspiration
- increase in bloody show
- irritability
- c/o rectal pressure
- anxiety increases
- restless and/or anger
- does not want to be alone
- inner directed, withdrawn, tired
- generalized discomfort
- fear of perineal tearing
16
Q
urge to push
A
- may experience urge without completed dilation
- stay with mom
- change breathing to panting or blowing
- may have mild pushing w/multips
17
Q
nursing care: transition
A
- assessments
- support and encouragement
- breathing reinforcement
- minimal handling
- encourage rest
- provide information
- provide privacy
18
Q
second stage of labor
A
- from full dilation to delivery of baby
- accomplished by involuntary and voluntary pushing efforts (bearing down) with uterine contractions
- open glottis pushing: sounds
- delayed pushing: fully dilated, not pushing
- descent of the presenting part through the pelvis: station
19
Q
support during second stage
A
- assist with pushing techniques
- provide encouragement
- reposition frequently
- assess bladder distention
- prepare for birth: blankets, birth table
- ongoing fetal assessment
20
Q
episiotomy
A
not a routine procedure incision in the perineum to enlarge outlet midline - most common - easily repaired - least painful - can extend to anal sphincter mediolateral - operative birth and possible posterior extension - may have 3rd degree laceration with epis - more difficult repair - greater blood loss - more painful ?
21
Q
perineal lacerations
A
first degree
- through skin and superficial structures
second
- extends through muscles of perineal body
third
- continues through anal sphincter muscles
fourth
- involves anterior rectal wall
22
Q
third stage of labor
A
birth to placenta - up to 20 minutes assess placenta for intactness - shiny shultze fetal side - dark duncan maternal side
23
Q
nursing care during 3rd stage
A
assist with perineal repair - surgical field/count assess - uterine tone (fundus firm) - vaginal bleeding - v/s - response to anesthesia administration of medications - oxytocin/pitocin - IV or IM
24
Q
fourth stage of labor
A
- recovery period
- approx 4 hours after placenta
- immediate hemodynamic stability of mother
- bonding
25
nursing care during 4th stage
- v/s
- physical assessment: uterus, bleeding, perineum, bladder
- teaching needs assessment
- newborn assessment
- promotion of bonding: breastfeeding if applicable
26
nonpharm management of discomfort
- often simple, safe, inexpensive
- provide sense of control over childbirth and measures best for woman
- methods require practice for best results
- try variety of methods and seek alternatives, including pharm, if measure no effective
27
non pharm management: childbirth preparation
- Dick-Read
- Lamaze
- Bradley
- HypnoBirthing
- Birthing from within
- Childbirth and Postpartum Professional Association
28
non pharm management: relaxing and breathing techniques
- relaxation
- imagery and visualization
- music
- touch and massage
- conscious breathing
- energy work
- effleurage and counterpressure
- hydrotherapy
- acupuncture
29
Pharm management of discomfort
sedatives
analgesia and anesthesia
- anesthesia
- systemic analgesia: opioid agonist analgesics, agonist-antagonist analgesics, antagonists
30
Medications: labor
- Fentanyl
- Sufentanyl
- assess for respiratory depression in mother and newborn (duration of 30 minutes-1.5 hours)
- Stadol
- Nubain: less respiratory depression, lasts longer
31
Narcan
- 0.4mg IV q2-3 min
| - Infant: 0.1mg/kg IV or IM q2-3minutes up to 3 doses
32
epidural anesthesia
- primary concern is hypotension
- important to ensure adequate hydration PRE admin: systemic vasodilation
- frequent assessment of BP post administration
- maternal positioning: q5m first 30 minutes evaluate
- reversal of hypotension with ephedrine and fluid bolus
- risks to fetus
33
nurse's role with regional anesthesia
- assess IV access
- ensure adequate hydration prior to delivery of anesthesia (min 500mL bolus pre epi)
- assess fetal well being
- assist with positioning of patient for procedure
- monitor vital signs (BP q5m, then q15)
- assess progress of labor
- assess bladder distention (foley if needed)
- encourage/direct patient to push when indicated
- request reduction in medication if pushing efforts are ineffective
34
spinal anesthesia
- used primarily for c-section
- rapid onset (1-3min)
- full anesthesia
- similar risks/contraindications to epidural
- risk of headache (needle too far- dural puncture. pressure change)
35
general anesthesia
- used rarely for vaginal births
- infrequently for elective c-sec
- may be necessary if indications necessitate a rapid birth
36
basis for monitoring fetus: fetal response
- labor is a period of physiologic stress for fetus
- frequent monitoring of fetal status is part of nursing care during labor
- fetal oxygen supply must be maintained during labor to prevent fetal compromise
37
basis for monitoring fetus: fetal oxygen supply can decrease...
reduction of blood flow through maternal vessels as a result of:
- maternal HTN: chronic or pregnancy-induced
- hypotension caused by supine maternal position, hemorrhage, epidural analgesia, or anesthesia
- hypovolemia caused by hemorrhage
reduction of O2 content in maternal blood as result of hemorrhage or severe anemia
- alterations in fetal circulation with compression of umbilical cord
- reduction in blood flow to intervillous space in placenta
38
basis for monitoring fetus: reassuring patterns
- fetal well-being during labor measured by response of FHR to uterine contractions
- reassuring FHR patterns are: 110-160 bpm, no periodic changes and a moderate baseline variability
- - accelerations of FHR with fetal movement
39
basis for monitoring fetus: non-reassuring patterns
- baseline 160 bpm
- decrease or increase in baseline
- periodic decreases in FHR in association with decreased blood flow
- sustained decrease in variability
40
EFM
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external monitoring
- FHR: ultrasound transducer
- UCs: tocotransducer
internal monitoring (invasive)
- spiral electrode (not used as much- risks outweigh benefits)
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41
Influences of FHR
placental bloodflow
- cotyledons: subuntis intervillus space
- exchange of o2, nutrients
- removal of waste
- storage of extra o2 for "reserve"
maternal blood flow influences placental blood flow
- decreases in maternal blood flow influence FHR
intrinsic mechanisms
- CNS development: SNS & PSNS development. SNS develops first
- fetal blood flow: shunting and preferential blood flow to vital organs (can't have firing w/o o2 to brain)
42
FHR: variability
- most important prognostic indicator of fetal oxygenation
- reflects interaction between SNS and PSNS
- o2 required
- described: absent, mild < 5 bpm, moderate 6-25m> 3 cycles, marked (>25bpm)
- changes can be from hypoxemia, acidosis, medications (narcotics), sleep states
Baseline:
- tachy: > 160 for 10 minutes or longer
- brady: <110 for 10 minutes or longer
43
FHR patterns: changes
- periodic changes occur w/ UC's
- episodic (nonperiodic) non associated with UCs
- accelerations
decelerations:
- early: response to fetal head compressions.
- late: uteroplacental insufficiency
- variable: caused by cord compression
- prolonged: FHR below baseline of 15bpm and lasting more than 2m
44
FHR interventions
- intervention should address the probable cause
- most decelerations can be alleviated by changes in the mother's position
- additional interventions:
- - increased IV fluid rate
- - administration of supp o2 (shouldn't be the first thing you do)
- - modified pushing
- - amnioinfusion
45
FHR: nurse's role
- identification of FHR patterns
- interventions
- documentation
- timely communication
- follow up
