Unit 19 Labor & Delivery Flashcards
(56 cards)
During an admission of a gravida PT what basic things would you assess?
Fetal HR
Mother VS
Contraction status
What do the different amniotic colors mean? Red, Green/Yellow, White and clear.
Red could indicate bleeding
Green/Yellow usually from bile/ meconium staining
White/clear is normal
How and what is assessed for in uterine activity?
Assessed by palpations or electronic monitoring
Assessing for frequency, duration, intensity
In what phase of the first stage of labor would you introduce medications if needed? What happens if Rx is given in transition phase?
The active phase
If given in transition phase, baby will be lethargic, cyanotic, etc.
Describe the contraction frequency and duration during the phases in the first stage of labor and the cervix dilation.
Latent phase: Contractions are 10-30 minutes apart lasting 30 seconds then 5-7 minutes apart lasting 30-40 seconds 1-3cm cervix
Active phase: 2-5 minutes apart lasting 40-60 seconds
4-7 cm cervix
Transition phase: 1 1/2- 2 minutes apart lasting 60-90 seconds 8-10 cm cervix
When does the abdomen become hard in labor?
When woman has contraction
How is frequency timed during labor?
Timed from the beginning of a contraction to the beginning of the next one with no monitor,
With a monitor it’s from one peak to the next.
What will too few rest periods between contractions create?
Fetal hypoxia, which will cause learning disabilities
How is duration timed?
Beginning of a contraction to the end of the same contraction
What is the other word for peak of a contraction?
Acme
What does effacement mean?
To become shorter and thinner [the cervix]
What does each fingertip equal in centimeters and what does the cervix dilate up too?
Each finger is about 2 cm.
Cervix dilates up to 10cm.
What are some medications to soften the cervix when it is just too rigid during labor, their action, and side effects?
- dinoprostone (Cervidil) [Prostaglandin class of meds]
- misoprostol (Cytotec)
- (Laminaria)
they are hydrophilic, bringing water to the area which helps dilate/soften the cervix and stimulate contractions.
Side effects: Maternal nausea, vomiting, diarrhea (usually when stomach is full)
What are signs of true labor?
- Effacing followed by dilating
- Progressive dilation (usually the mother is 10-20% effaced prior to labor pattern
- Contraction that occur regularly, become stronger, last longer, and occur more closely together
- More intense with walking
- Contractions usually felt in lower back radiating to lower portion of abdomen
- Contractions that continue despite comfort measures
Describe the mother behavioral patterns/signs and symptoms during the 3 phases of the first stage of labor.
Latent phase: little descent, irregular contractions, talking and happy, using breathing and focusing techniques.
Active phase: serious, intense, tired, more demanding, using breathing techniques
Transition phase: Effacement complete, fearful, nausea, vomiting, rectal discomfort, shakes from fluid volume shift (not cold), paced breathing desire to have bowel movement
What does the desire to have bowel movement during labor or before labor indicate?
Fetal pressure on bowels and head descent
How would a woman’s bladder be emptied during labor and what is difficult unless bladder is empty?
Foley catheter to relieve full bladder, baby will have difficulty coming with full bladder
Describe the second, third, and fourth stages of labor.
Second stage: Complete effacement/dilation to delivery, the “pushing stage”. Head on vaginal wall. If woman is nullparas (never given birth yet) could take up to 3 hours.
Third stage: Birth to delivery up placenta
Fourth stage: Immediate recovery (offer ice chips, flat ginger-ale instead of water)
What could slow, lazy contraction be from?
Possibly an epidural that was given
Where are the following places in the cervix…anterior, posterior, midposition.
Anterior refers to by the opening of the vagina
Posterior refers to the far back of the vagina
Mid-position is midway
What is an artificial rupture of the membrane (AROM) also known as and what instrument can be used?
amniotomy
amnihook
What tests can be performed to evaluate for amniotic fluid leak/rupture?
Nitrazine strip against cervix, will turn blue/positive when exposed to amniotic fluid
Fern test done by resident- cervix is swabbed side to side and if green like a fern it’s positive/reactive
After amniotic fluid is ruptured what is the first thing assessed?
Fetal HR! (almost always assessed first)
What is the appropriate amount of amniotic fluid at 20 weeks gestation? 36-38 weeks gestation?
20 weeks = 400ml
36-38 = 1000ml
