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SEM 1 > W4: Labor & Delivery > Flashcards

W4: Labor & Delivery Flashcards

(51 cards)

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1
Q

when does labour begin?

A

between 37 - 42 weeks

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2
Q

What happens before labor begins?

A

increase braxton hick’s
cervicla ripening
increase excitability in uterine musculature
mechanical stretching of the uterus increases contractility
ferguson reflex: increase oxytocin receptors & level of oxytocin

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3
Q

Signs of Onser of labour

A

lightening/dropping
increase in vaginal d/c- bloody show
stronger braxton hick’s contraction
weight loss of 0.5-1.5kg

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4
Q

signs preceding labor

A

surge of energy (nesting)
flulike symptoms
cervical ripening
possible rupture of membrane

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5
Q

true labor signs

A

contractions: increase in intensity + duration, discomfort in back –> abdomen, closer together, don’t go away w/ walking
cervix: begins to efface & dilate
show: may/may nor dilate

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6
Q

false labor signs

A

contractions: do not increase in intensity, duration, frequency, discomfort in abdomen, may disappear with walking
cervix: none
show: none

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7
Q

5 Ps of Labor

A

Power (contractions)
Passageway (birth canal)
Passenger (fetus and placenta)
Position of mother
Psychological Response

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8
Q

Powe

A

primary powers: contraciton, effacement, dilation, ferguson reflex
secondary powers: bearing down efforts

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9
Q

Passenger: 3 Fetal Presentations

A

cephalic/vertex- head presenting part
breech: buttocks presenting prt
shoulder/transverse- shoulder as presenting part

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10
Q

Components of the Passenger

A

fetal presentation
fetal head size
fetal lie
fetal attitude
fetal position (station, engagement)

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11
Q

Ideal Fetal presentation

A

ROA- right occiput anterior (back of head)

LOA is okay as well

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12
Q

Fetal Lie

A

reltionship of long axis of fetus to long avis of mother

longitudinal - parallel
transverse- perpendicular
oblique - at an angle

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13
Q

Fetal Atittude

A

relationship of fetal head to its spine

complete flexion- chin of fetus flexed, touching sternum
moderate flexion- military (chin not touching chest, alert)
deflection, extenion- back arches & head extended

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14
Q

Fetal Station

A

relationship of presenting part to an imaginary line drawn between maternal ischial spines

(above) - 5 –> + 5 (below)

O = head at level of spine

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15
Q

Passageway

A

types of pelves:
- gynecoid
- android
-anthropoid
- platypelloid

soft tissue of cervix
pelvic floor
vagina
introitus

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16
Q

Positon

A

position affects woman’s adaptation to labor
changes in posiiton = relief of fatifue, more comfort, improves circulation
woman should find position most comfortable to her
gravity promotes descent of fetus

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17
Q

descibe all 4 stages of labor

A

1: onset of contractions to full dilation of cervix (latent & active)
2: full dilation of cervix - birth, pushing
3: birth of the fetus until delivery of the placenta
4: 2 hrs post delivery of placenta

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18
Q

describe the latent phase of the first stage of labor

A

onset of regular contractions, effacement, descent

3-4 cm dilation

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19
Q

describe the active stage of first stage of labor

A

rapid dilation of cervix, descent

4-10 cm dilation

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20
Q

Assessment of Uterine Contraction

A

by: palpation, external + internal monitoring
intensity:
- mild: indented with general pressure (nose)
- moderare firm pressure (chin)
- strong: no indentation (forehead)
frequency: # of contraction in 10min period over 10 mins
dulation: time between onsent and end of contraction
restinf tone: tension in uterine muscle btw contractions (relaxation?)

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21
Q

NC; 1st Stage

Study These Flashcards
A

relaxation, distractions
breathing techniques
praise
inform
oral care (n/v)
inform partner that pt might act abnormally

22
Q

2nd Stage

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A

full dilation –> infant born
nulliparous pt: 3 hours w/o anesthesia, 4 hrs w/ anesthesia
multiparous: 2 hrs w/o anesthesia, 3 hrs w/ anesthesia

23
Q

2nd Stage: Passive Phase

Study These Flashcards
A

delayed pushing, laboring down, passive descent
0-2+

24
Q

2nd Stage: Active Phase

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A

active pushing, urge to bear down
ferguson reflex
4-5 contractions q10m, for 90s
fetal head +2-+4
rate fo descent increases
fetal head is crowning

25
crowning
widest part of the head distends the vulva
26
Changes in feta skull during birth
parital bones overlap occipital bone go under pareital = cone shape head
27
Cardinal Movements of the mechanisms of labor
engagement: head into pelvic inlet descent: fetal head is forced downwards on the crvix flexion: fetusflexes head so that the vertex is leading (chin-chest) internal rotation: of fetal head (usually to OA) extension: delivery of head (occiput, face, chin) restitution & external rotation: realigns head w/ back & shoulders
28
NC: Passive Phase of 2nd Stage
comfort prmote fetal descent (ambulation, position change, pelvic rock)
29
NC: Active Phase of 2nd Stage
change position & encourage bearing down relac, conserve energy btw contractions pain-relief + comfort cleanse perineum (fecal matter) coach pt to pant push between contractions (gently) keep informed offer mirror to watch / feel top of head as they push
30
Assesment & Care of Newborn
APGAR score immediate skin-skin (infant bonding, breastfeeding duration, cardiorespiratory stability, bodytemp) delayed cord clamping (1-3 min after birth/ after it stops pulsating)
31
Why is delaeyd crod clamping recommended
improces hematologcla status transfer of blood
32
Instructing partner to cut cord
approx 2.5 cm above the clamp
33
3rd Stage of Labor
placental seperation + expulsion (contracting fundus, change in uterus shape, gush of blood, lengthning of cord, vaginal fullness) occurs 15 mins after the birth of the baby
34
when is placenta considered retained
if it has not come out by 30 mins
35
Expectant Mgt 3rd Stage
watching for signs for placental seperation no oxytocic meds given facilitated bt gravity or nipple stimulation
36
Active Management: 3rd Stage
oxytocic meds decreases rate of PP hemorrhage d/t uterine atony gentle cord traction following contractions
37
Examination of Placenta
ensure no portion remains in the uterine cavity contains 15-20 lobes vessels: 2 arteries, 1 vein membrane should have no holes
38
4th Stage of Labor
begins with expulsion of placenta and lasts until pt is stable within the first 2 hours (time for parent-infant bonding)
39
vital signs frequency @ 4th stage
q15mins fro 1st hour stable: q2hrs
40
Uterine Assesment after birth
firm w/ uterus located midline - if not firm, massage to contract observe perniuem for size & amt of + size of clots expel clots while keeping hands placed over uterus (downwards pressure) tell pt to take deep breaths throughout
41
Bladder Assessment after birth
distension (firmness of fundus) - rounded bulge, dull to percussion, fluctuated like water balloon distended bladder: boggy uterus, above umbilicus, deviated to R side asess pt to void + measure amt (catheter if needed) reassess after voiding/catheter to make sure bladder is not palpable, fundus is midline & firm
42
Pain threhold vs tolerance
threshold is the same in everyone tolerance differs
43
Factors influencing pain response
physiological culture anxiety + fear previous experience gate control theory environment trauma childbirth prep
44
expressions of pain
anxiety writhing crying groaning gesturing excessive muscular excitability
45
Non-Pharmacological Pain Mgt
relaxation imagery + visualization music touch + massage breathing techniques effleurage & counterpressure hydrotherapy (water bath) TENS heat/cold hypnosis biofeedback aromatherapy sterile water block maternal position & movement
46
Epidural Induced Hypotension
f: fetal bradycardia absent/minimal FHR impaired placental perfusion ineffective breathing pattern
47
Interventions for Epidural Induced Hypotension
turn pt to lateral positon, place pillow under one hip (displace weight on aorta) maintain IV fluid O2 (8-10)- hypovolemia, hypoxia IV vasopressor
48
baseline FHR
110-160BPM
49
Fetal tahcycardia
160+ bpm for longer than 10 mins
50
fetal bradycardia
baseline less than 110 bpm for 10 mins
51
VEAL CHOP acronym
V: variable deceleration = C: cord compression --> reposition pt E: early deceleration = H: head compression --> fetus descent A: accelerations = O: OK! L: late deceleration = P: problem --> fetal resus, Oxygenation

SEM 1 (11 decks)

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