Birth Flashcards
What are some other signs of impending labor? 今にも起こりそうな
Burst of energy (nesting)
Lighting(Baby drops into the pelvis 骨盤)
Weight loss
GI upset
Leg cramps
Water broke
Pelvic pressure
What are we looking for on the NST?
A normal baseline and 2 accelerations of 15 beats, lasting 15 seconds in a 20 min period.
a) baseline?
b) variability?
c) Accelerations?
The baby is currently well perfused because:
There is a normal baseline - 145
Moderate variability with 6 to 25 beats of variation
Accelerations are present; No decelerations
Latent phase
a) dilation cm?
b) duration?
c) frequency?
a) 0cm-3cm
b) 30-45secs
c) 5-30mins
Active phase?
a) dilation cm?
b) duration?
c) frequency?
a) 4-7cm
b) 40-70secs
c) 3-5 mins
Transition
a) dilation cm?
b) duration?
c) frequency?
a) 8-10cm (full)
b) 45-90secs
c) 2-3mins
Second stage is?
Full dilation to birth
Third stage is?
Birth to deliver placenta
Fourth stage is?
Deliver of placenta to hemostasis
2 hours post-delivery of the placenta
What does the acronym VEAL CHOP pertain to?
Assessment of changes in the Fetal Heart Rate
The complications to assess for in ALL women during labor are? 3
Bleeding
Infection
Decreased Fetal Perfusion
How can we measure the strength of her contractions?
Palpation
What is the only definite way to tell if a patient is in true labor?
Cervix is changing
頸部
Can we send mom who has false labor home?
No, we need to check the fetal heart rate and perform an NST.
Non-pharmacologic Pain Management
Cutaneous
example?
Massage
Heat or Cold packs
Rocking or Walking
Sacral counterpressure
(heal of hand to massage mom’s sacrum)
Acupressure
Non-pharmacologic Pain Management
Relaxation
example?
Non-touching aromatherapy
Music
Breathing
Imagery
a) Kelly’s baby is “-2” so that means
b) If Kelly’s baby was “+2” what would that mean?
a) Kelly’s baby is 2 cm above the ischial spines
b) The baby is 2 cm below the ischial spines
Tammy is afraid to get an epidural and wants to know if you can just give her something through her IV.
What can you tell her about systemic forms of pharmacologic pain relief?
IV Medications cross the placenta and may cause respiratory distress in the baby after delivery requiring Naloxone (Narcan). Therefore, we won’t administer any if you are close to delivery.
What form of pain relief is the epidural?
Is it systemic of regional?
Regional - which doesn’t enter the blood stream and doesn’t cross the placenta.
Which of the five process of labor may be affected at this stage? after epidural
Position - the patient will still need to move during labor so the nurse will have to help her change
position every couple of hours
Passenger - The epidural causes hypotension which can affect fetal perfusion
The provider decides to breaks Kelly’s water.
After the membranes are ruptured what is the first thing you do?
Assess the Fetal Heart rate
What is this?
Leopold’s Maneuvers
-determine the position of the fetus
Kelly is very anxious to see if she can start pushing and wants to know why you are not checking her cervix as frequently. (after water brake)
What can you tell her?
I want to limit your exams, so I don’t introduce an infection now that your water is broken.
Kelly states that she feels like she need to have a bowel movement.
Should you check her cervix now?
Yes!
C/C/+2
This means that Kelly is in what stage of labor?
Second Stage
a) Later stage of labor,
what pharmacological pain relief is
available? (for the lower vaginal and
perineal area)
b) Any risk?
a) The pudendal block
b) no risk from hypotension
it does not enter the blood stream and therefore does not affect the baby, like the IV medications
Unfortunately, it can’t be re-dosed like the epidural or IV medication
What is this position called?
The occiput anterior position.
This is the best position for the fetal head to exit the pelvis.
What is this position?
That is the occiput posterior position.
This is much harder to deliver. The second stage will likely take longer.
The provider delivers the rest of the body, suctions the mouth and nose, then dries the baby and places the baby on Kelly’s abdomen.
What stage of labor is Kelly in now?
The third stage of labor
The placenta slides out of the vagina.
What stage of labor is Kelly in now?
The fourth stage
Now that the placenta has separated, Kelly is a risk for??
Hemorrhage
What interventions should be implemented by fourth stage?
Oxytocics medication Pitocin(contract the uterus)
Assess fundus every 15 mins /(ensure that it is firm, and her lochia isn’t too heavy)
If her fundus is not firm, fundal massage is needed
What are some benefits of skin-to-skin?
Bonding
Breastfeeding
Thermoregulation for baby
Glucose control for baby
Breastfeeding
(leads to increased uterine tone and decreases bleeding for Kelly)
What are the 5 P?
Passenger
Passageway
Powers
Position of mother
Psychologic response
What are the passenger factor?
Size of fetal head
Fetal presentation
Fetal position
Fetal lie
Fetal attitude
Position
Why do they need to frequent changes in position?
Relieve fatigue
Increase comfort
Improve circulation
Normal Psychologic Response
Latent Labor
Excited
Some apprehension
Pain controlled fairly well
able to follow directions
Normal Psychologic Response
Active Labor
More serious
Attention is inward
Some difficulty following directions
Normal Psychologic Response
Transition
Fearful
Irritable
doubt about ability to continue
Fetal adaptation, 3 changes occur in
Fetal heart rate
Fetal circulation
Fetal respiration
What are the innervation when late and variable decelerations?
LIOON
Left lying
IV fluid
Oxygen
Stop oxytocin
Notify provider
The nurse locates the fetal heart tones in the patient’s RUQ. The
nurse should suspect that the fetus is in which of the following
positions?
- A – Cephalic
- B – Transverse
- C – Posterior
- D – Breech
D
A nurse is caring for a client who was just admitted at 39 weeks of
gestation and in active labor. Which of the following actions should
the nurse include in the patient’s plan on care?
- A – Keep four side rails up while the client is in bed.
- B – Monitor the fetal heart rate (FHR) every hour.
- C – Check the cervix prior to analgesic administration.
- D – Insert an indwelling urinary catheter.
C
What is the Braxton Hicks Contraction?
Irregular in frequency, less intense and usually go away if you change positions
What is the sing for preceding labor?
Weight loss
Lightening
Braxton Hicks contractions
Nesting
What can we make for general comfort while moms have pain?
Patient is dry
Bladder empty
Room appropriate temp
Question answer
Nursing care first stage?
Perform Leopold maneuvers
Perform a vaginal examination
Assessments related possible rupture of membrane
Suspected– FHR
Nursing care in active phase?
Monitor FHR
Encourage frequent position change
Encourage voiding
Encourage relaxation
Provide pharmacological pain relief
Nursing care during Transition phase?
Monitor FHR
Encourage voiding
Encourage breathing control
Encourage bearing down once cervix fully dilated
What Is Crowning?
When you can see the top of your baby’s head through the opening of your vagina
Transition phase and mom need to have bowel movement.
What nurse should do?
Prepare for an impending deliver 差し迫った
urge bowel movement indicate fetal descent 下降
What is the sing for placenta separation?
Lengthening of the umblical cord
Appearance of dark blood from the vagina
Fundus firm upon palpation
The patient has vaginal bleeding for 2weeks.
What should nurse do?
Defer vaginal exam 延期する
Why do we encourage to mom to void every 2hours during labor?
A distended bladder reduces pelvic space needed for birth
a) Effacement?
b) Dilation?
a) Thinning/stretching of the cervix 90-100%)
b) How wide opening cervix (0-10cm)
a) Epidural cause what?
b) Intervention?
a) Maternal hypotension
b) Administer IV fluids
Position change
