6.1a First Stage of Labor Flashcards
1
Q
First Stage of Labor
A
- Begins with onset of contractions and ends with complete dilation and effacement
Latent - Regular, painful uterine contractions causing cervical change - 0-6 cm dilation Active - Greatest rate of cervical dilation - Begins at 6 cm - Ends at 10 cm
2
Q
Assessment
A
- Begins at first contact with patient
- Minimize anxiety by explaining terms commonly used in labor
Relevant Data to Document
- Prenatal record
- Initial interview
- Physical exam to establish baseline (vitals)
- Lab and diagnostic results
- Psychosocial and Cultural factors
- Evaluation of labor status
3
Q
True Labor
A
Contractions
- Occur regularly and become stronger, last longer, occur closer together
- Become more intense when walking
- Felt in lower back radiating to lower abdomen
- Continue despite comfort measures
4
Q
False Labor
A
- Irregular and only regular temporarily
- Often stop when walking or changing position
- Felt in back “or” abdomen above umbilicus
- Can be stopped with use of comfort measures
5
Q
Prenatal Data
A
- Identifies needs and risks
- Usually done during 3rd trimester
- If there are no records, nurse will need to obtain baseline information
- Ask questions between contractions if patient is in discomfort
- Partner/Support person can be a secondary source of information
6
Q
Emergency Medical Treatment and Active Labor Act (EMTALA)
A
- Patients who are having contractions or may be in labor are considered unstable.
- They must be assessed, stabilized, and treated at the hospital where they are present regardless of insurance or ability to pay.
The Nurses Role
- Providing services to patients when they experience pregnancy problem
(labor, decreased fetal movement, rupture of membranes)
- Document all information
(Assessment, interventions implemented, client response to care)
7
Q
Prenatal Factors to Tailor Care
A
- Age
- Height and Weight
- General Health Status
- Current Medical Conditions
- Allergies
- Respiratory Status
- Previous Surgical Procedures
8
Q
Prenatal Records
A
- Should always occur upon admittance to the facility
HISTORY - Gravidity (Number of Pregnancies)
- Parity (Number given birth above 20 weeks whether alive or not)
- Problems (bleeding, hypertension, gestational diabetes, infection, EDB)
- Patterns of weight gain
- VS, fundal height, Baseline FHR, Lab/Test results
9
Q
Common Diagnostic and Fetal Assessments
A
- Amniocentesis (testing sample of amniotic fluid)
- Non-stress test (NST) - Assess fetal heart rate and oxygen supply (overall baby health)
- Biophysical Profile (BPP) - Measures fetal heart rate in response to movement. Combines nonstress test with ultrasound
- Ultrasound Examination
10
Q
Assessment
A
If patient had previous births the below must be noted
- Characteristics of previous labor
- Types of pain relief used
- Type of birth (c-section, vacuum assisted, forceps assisted, vaginal)
- Condition of newborn
- Patients perception of previous labor and birth
11
Q
Interview
A
- Determine primary reason for coming to hospital
- Auscultate and assess respiratory status (asthma which may affect general anesthesia)
- Allergies including latex and tape
- Routinely used medications in OB
- Time and type of most recent solid/liquid intake
- Birth plan
- Type of pain management
- Choice of infant feeding method
- Name of pediatric provider
- Preparations made for childbirth
- Support person or family member who will be available
- Cultural needs
- Alcohol/Tobacco use
- Plans for preserving memories such as photos and videotaping
12
Q
Triage
A
- Determine status of amniotic membrane
13
Q
Sterile Speculum Examination and Nitrazine (pH)
A
- Cotton tip swab to test pH of fluid.
- Amniotic fluid is alkaline
- Urine/purulent material is acidic
14
Q
Fern Test
A
- Determines if membranes have ruptured by getting a sample of cervical mucus smears
- When estrogen is elevated smears form a fern like pattern
15
Q
Bloody Show
A
- Pink and sticky discharge
- Sign of labor
Brownish/bloody discharge may be caused by vaginal examination or coitus
16
Q
MATERNAL TRIAGE CLASSIFICATIONS
A
17
Q
STAT/Priority 1
A
- > 130 or <40 HR, SPO2 <93%, BP 150+/110+, <60HR, No FHR, FHR <110
- Cardiac compromise
- Severe respiratory distress
- Seizing/Hemorrhaging
- Placental Abruption/Uterine Rupture
- Mental status change/Cannot follow verbal commands
- Prolapsed cord
- Active bearing down
- Fetal parts visible on perineum
18
Q
Urgent/Priority 2
A
HR >120 or <50, Temperature >101.0, RR >26 or <12, SPO2 <95, BP 140+/90+ symptomatic, FHR 160+ for 60+ seconds - Severe pain greater or equal to 7 - High risk medical condition - Difficulty breathing - Altered Mental Status - Suicidal/Homicidal - <34 week SROM leaking or spotting - Active vaginal bleeding (not spotting or show) - Decreased fetal movement - Recent Trauma - SROM Leakage including (HIV, Breech, Multiple gestation, Placental Previa)
19
Q
Prompt/Priority 3
A
- Temp >100.4, BP 140+/90+ asymptomatic
- Signs of active labor >34 weeks
- Early signs of labor
- Woman is not coping
20
Q
Non-Urgent/Priority 4
A
- Common discomfort
- Vaginal discharge
- Constipation
- Ligament pain
- Nausea
- Anxiety
21
Q
Scheduled/Priority 5
A
- Prescription refills
- Missed outpatient services
22
Q
Postural Management (Position)
A
- Non-cephalic positions are risky (breech, transverse)
- Should be corrected before engagement but close enough to term where position will be maintained
23
Q
External Cephalic Version (ECV)
A
- Ultrasound guided hands on procedure to manipulate fetus into cephalic lie
- Done at 36-37 weeks of gestation
- If preformed at 34-36 weeks, it can significantly increase chances of baby being born in cephalic presentation.
- Beta stimulants are used to relax the uterus
- Most successful is multiparous women with adequate amniotic fluid
- Small risks for ECV
- All women with breech position should be offered this
- Positioning women with pelvis elevated is not shown to work
24
Q
Early Phase of Labor
A
- 0-5cm dilation
- Nulliparous and Multiparous progress at similar rates
- Mild to moderate contractions
- 2-30 minutes apart
- 30-40 seconds duration
- No descension
- Brown discharge of mucus plug (scant)
- Patient is excited, able to walk
