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NURS 405 > Chapter 13: Nursing Care During Labor And Birth > Flashcards

Chapter 13: Nursing Care During Labor And Birth Flashcards

1
Q

What is the priorities for a focused assessment?

A
  • Determine condition of mother & fetus

- If birth is imminent

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2
Q

Focused assessment includes

A
  • FHR
  • Maternal VS
  • Impending Birht
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3
Q

Focused Assessment: FHR

A
  • Intermittent auscultation for termed fetus.
  • Normal rate and rhythm
  • Note presence of acceleration and absconded of decelerations.
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4
Q

Focused Assessment: Maternal VS

A

-Assessed to identify HTN or infection: BP and temperature

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5
Q

HTN or preeclampsia in pregnancy

A

140/90 or higher

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6
Q

Maternal temperature of 38 C (100.4 F) or higher suggests

A

Infection

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7
Q

Impending Birth sings include

A
  • Grunting sounds
  • Bearing down
  • Sitting on one buttock
  • “Baby is coming”
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8
Q

Comfort measures during labor and birth include **

A
  1. Lighting
  2. Temperature
  3. Cleanliness
  4. Mouth care
  5. Bladder
  6. Positioning
  7. Water
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9
Q

Comfort measures during labor & birth: Lighting

A

Soft, indirect lighting is soothing.

Bright overhead light is irritating.

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10
Q

Comfort measures during labor & birth: Temeprature

A
  • Mom is usually hot and perspiring. Cool, damp washcloths on her face and neck promote comfort.
  • Electrical fan
  • Socks if feet get cold
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11
Q

Comfort measures during labor & birth: Cleanliness

A

Bloody show and amniotic fluid leak from the vagina during labor.

  • Change sheets and gown as need, keep her dry and comfortable.
  • Change the underpad regularly to reduce microorganisms that may ascend into vagina. (Folded towel or bath blanket absorbs larger quantities of amniotic fluid than the pad alone)
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12
Q

Comfort measures during labor & birth: Mouth care

A
  • Ice chips, frozen juice bars, and hard candy on a stick reduce discomfort from dry mouth.
  • Brushing teeth and simply rinsing mouth.
  • Lip balm
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13
Q

Comfort measures during labor & birth: Bladder

A

Get her to empty her bladder and check her suprapubic area at least every 2 hours.

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14
Q

How can a full bladder affect labor and birth?

A
  • Intensifies pain during labor
  • Delay fetal descent
  • Cause pain that remains after epidural is started
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15
Q

Comfort measures during labor & birth: Positoning

A

-Movement and frequent position changes

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16
Q

Movement and frequent position changes in labor promotes:

A
  1. Decrease in pain, improve maternal-fetal circulation
  2. Improves the strength and effectiveness of contractions
  3. Decrease length of labor
  4. Facilitate fetal descent
  5. Decrease perineal trauma and episiotomies.
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17
Q

Six physiologic principles related to maternal positioning in labor

A
  1. ) promote spinal flexion
  2. ) promote an increase in the uteru-spinal drive angle
  3. ) facilitate stronger expulsive forces
  4. ) promote a good fit
  5. ) increase pelvic diameters
  6. ) facilitate occiput posterior rotation. “C” shape
18
Q

Back labor

A

Common when the back of the fetal head puts pressure on the woman’s sacral promontory. (Occiput posterior position)

19
Q

Positions that encourage the fetus to move away from the sacral promontory are:

A
  • Hands-and-knees position
  • Lean forward over a birthing ball (sturdy beach ball)

These two reduce back pain and enhance the internal rotation mechanism of labor.

20
Q

Women with epidural needs assisting with

A

Position changes q30-45 minutes

21
Q

Comfort measures during labor & birth: Water

A
  • Can slow labor if used in latent labor.

- Breast stimulation by a shower or whirlpool often provokes contractions by secretion of natural oxytocin.

22
Q

Water should be used in

A

Active labor or if persistent

23
Q

Nonpharmacologic ???***

A

….

24
Q

While the nurse cares for the mother, minimal information can be quickly gathered if birth is imminent:

A
  • Name of her physician or nurse-midwife if she had prenatal care
  • Names of mother and support person(s)
  • Number of pregnancies and prior births, including whether the birth was vaginal or cesarean
  • Status of membranes
  • Expected date of delivery
  • Problems during this or other pregnancies
  • Allergies to medications, foods, or other substances
  • Time and type of last oral intake
  • Maternal vital signs and FHR
25
Q

Women usually feel the urge to push when

A

· the cervix is fully dilated and effaced

· fetus descends to about +1 station or lower and internal rotation.

26
Q

Pushing against a cervix does not easily yield to pressure therefore

A

It can lead to cervical edema -> blocks labor progress or cervical laceration.

27
Q

What should be taught during the first stage?

A

Teach woman to exhale in short breaths if pushing is likely to injure their cervix or cause cervical edema.

28
Q

Second Stage: Laboring down

A

Technique of delaying pushing until reflux urge occurs.

29
Q

Laboring down allows for

A
  • Uterine contractions to cause most fetal internal rotation and descent after full dilation naturally.
  • Rest before actively pushing baby out.
30
Q

Pushing vigorously sooner before onset of the reflux urge can cause

A

Birth canal injury.

31
Q

If fetal descent has not occurred after 2 hours,

A

Open glottis pushing (w/o holding breath)

32
Q

Laboring down results in

A
  • Less maternal fatigue
  • Decreased: pushing time, risk of instrument-assisted and cesarean births
  • APGAR sores equivalent to those of women who pushed immediately on fully cervical dilation.
33
Q

Vertical maternal position enhances

A

Fetal descent

34
Q

Squatting

A
  • Ideal position for pushing because it enlarges the pelvic outlet slightly and adds the force of gravity to the mother’s efforts
  • Good if she has small pelvis or fetus to large
35
Q

What are other positions that have gravitational advantage?

A

o Pushing while sitting on birthing ball
o Pulling against squatting bar
o Tug of war game

36
Q

What should you teach a patient while she is pushing in a sitting or semi-sitting position?

A
  • Teach them to curve their body around her uterus like a “C” shape rather than arching their back.
  • Most effective, woman should pull on her knees, handholds, or a squat bar while pushing.
  • Also hold the “C” shape, in her upper body, if she is pushing on her side.
37
Q

What methods and breathing patterns should you teach your patient?

A

·Push w/ abdominal muscle while relaxing perineum area; begin by taking a breath and exhaling. Take another breath and exhale while pushing for 4-6 seconds at a time.
·Modest/woman that fear loosing control may inhibit their pushing efforts if you say “push like your taking a dump” instead tell them to push down and out under her symphysis, following the pelvic curve.
· Showing them a pic or diagram will help them to visualize the curve.

38
Q

Methods that reduce BF to placenta & is fatiguing include

A
  • Sustained pushing while holding a breath (valsualva maneuver or purple pushing)
  • Pushing more than 4x per contraction
39
Q

Encouragement during labor and delivery

A

▪Tell the woman when her labor is progressing; if she can see her efforts are effective, she has more courage to continue.
· Help her touch/ see the baby’s head with a mirror as crowing occurs.
· Praises the woman, reinforces her actions, which gives her a sense of control, respect and support.
· If one effort doesn’t work after 3-5 contraction, encourage them to try other techniques.

40
Q

Giving to self

A

▪ Do not overlook, even independent woman may become dependent during labor and need human contact.
▪ Although mom and support person may be prepared they often welcome suggestion and affirmation from the nurse. Gentle coaching and encouragement.

41
Q

Offering pharmacological measures

A

▪Be informative but neutral when explaining about available pain medication
▪She may feel disappointed and guilty because she took medication despite her planned unmediated birth
▪This should be done as early in the labor as possible while the woman is still in control and can think critically

42
Q

When offering pharmacological measures, include

A

· Include the option for the woman to change her mind and how that will be communicated
· Although the event may not be what she wanted, encouraging the woman to express her feeling helps her put it into perspective.

NURS 405 (17 decks)

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