Chapter 15 - Nursing Care Of A Family During Labor And Birth Flashcards
What are the 7 theories explaining ONSET OF LABOR?
- ) Uterine muscle stretches - results in release of prostaglandin
- ) Fetus presses on cervix - stimulates release of oxytocin
- ) Oxytocin stimulation works with prostaglandins to initiate contractions.
- ) Changes in ratio of estrogen to progesterone - progesterone withdrawal.
- ) Placenta reaches set age - triggers contraction.
- ) Rising cortisol levels reduce progesterone formation - increases prostaglandin formation.
- ) Fetal membrane begins to produce prostaglandins - stimulates contractions.
What does the component PASSENGER of labor include?
Structure and diameter of fetal skull
Molding
Fetal presentation and position (attitude, fetal lie, engagement and station)
What are the 4 types of fetal attitude?
Vertex (full flexion)
Sinciput (moderate flexion [military attitude])
Brow (partial flexion)
Face (poor flexion, complete extension)
Know about fetal station.
Relationship of the presenting part of the fetus to the level of the ischial spines.
Floating: -4, -3, -2, -1
Engaged: 0
At outlet: +1, +2, +3, +4
{+3 and +4 is crowning}
What is fetal presentation and what are the types?
Denotes the body part that will first contact the cervix or be born first, and is determined by the combination of fetal lie and the degree of fetal flexion (attitude).
Cephalic- head first, most common (95%)
Breech- butt of feet first (3%) [complete, frank, footling]
Shoulder- transverse lie (less than 1%)
What are the types of breech positions?
Complete - Indian style
Frank - feet extended upward, butt first
Footling - feet first
Know the abbreviations for fetal position.
The relationship of the presenting part to a specific quadrant and side of the woman’s pelvis.
Quadrants: A.) right anterior B.) left anterior C.) right posterior D.) left posterior
Fetal landmarks: O = occiput M = mentum Sa = sacrum A = acromion process
Landmark points:
A = anteriorly
P = posteriorly
T = transversely
What are the six cardinal movements of labor?
- ) Descent
- ) Flexion
- ) Internal Rotation
- ) Extension
- ) External Rotation
- ) Expulsion
Powers of Labor: What are the stages of Uterine Contractions?
Origin
Phases:
> Increment (the intensity of the contraction increases)
> Acme (when the contraction is at its strongest)
> Decrement (when the intensity decreases)
- As labor progresses, the relaxation intervals decrease from 10 minutes in early labor to 2-3 minutes.
- Duration of contractions increase from 20-30 seconds to 60-70 seconds at the end of the first stage.
(Powers of Labor: Cervical Changes)
What is effacement?
The shortening and thinning of the cervical canal.
- Primiparas (first child) effacement is accomplished before dilation begins.
- Multiparas (multiple children) dilation may occur before effacement is complete.
(Powers of Labor: Cervical Changes)
What is dilation?
Enlargement or widening of the cervical canal.
Uterine contractions gradually increase the diameter of the cervical canal lumen by pulling the cervix up over the presenting part of the fetus. The fluid-filled membranes push ahead the fetus and serve as an opening wedge.
As dilation begins, there is an increase of vaginal secretions because minute capillaries in the cervix rupture and the last of the mucous plug that has sealed the cervix is released.
True contractions vs. false contractions
True contractions:
> begin irregular but become regular and predictable
> first felt in lower back and sweep around to the abdomen in a wave.
> continue no matter what the level of activity is
> increase in duration, frequency and intensity
> active cervical dilation
False contractions: > begin and remain irregular > felt in the abdomen and groin area > disappears with ambulation or sleep > don't increase in duration, frequency or intensity > doesn't not achieve cervical dilation
What do preliminary signs of labor include?
Lightening
Increase in level of activity
Braxton Hicks contractions
Ripening of cervix
1st Stage of Labor: what are the three phases?
Takes about 12 hours to complete.
> > Latent Phase: begins at the onset of regularly uterine contractions and ends when rapid cervical dilation begins. Contractions are mild and short, lasting 20-40 seconds. Cervical effacement occurs, and cervical dilates from 0-3cm. *stage lasts about 6hrs for nulliparas and 4.5hours for multiparas.
> > Active Phase: cervical dilation occurs more rapidly, increasing from 4-7cm (1cm/hour for nulliparas and 2cm/hour for multiparas). Contractions grow stronger, lasting 40-60 seconds and occur every 3-5 minutes (lasts 3 hours for nullipara, 2 hours for multiparas). Increased vaginal secretions (show) and possibly rupture of membranes.
> > Transition Phase: contractions reach their peak of intensity, occur ing every 2-3 minutes, lasting 60-70 second and cervical dilation to 8-10cm. Membranes will for sure rupture if they haven’t already.
*nausea, vomiting, LOC, anxiety or irritability may occur due to intense discomfort. Administer epidural now if specified.
What happens in the 2nd Stage of Labor?
Full dilation and cervical effacement to crowning, and birth of infant.
What happens in the 3rd Stage of Labor?
Placental separation and placental expulsion.
What are the 5 maternal danger signs of labor?
Falling BP: first sign of intrauterine hemorrhage, hypovolemic shock, apprehension, increased pulse and pallor.
Contractions: less frequent, less intense and sorter duration may indicate uterine exhaustion (inertia).
Pulse: heart rate above 100bpm may indicate hemorrhage.
Abnormal lower abdominal contour: having a full bladder during labor by injure the bladder itself by the pressure of the fetal head or the pressure of the full bladder may not allow the fetal head to descend.
Increased apprehension: sign of O2 deprivation or internal hemorrhage
What are 4 fetal danger signs of labor and what do they indicate?
Heart Rate: 160+bpm or less than 110bpm = fetal distress
Meconium staining: loss control of rectal sphincter, stimulates vagal reflex, increases bowel motility = hypoxia
Hyperactivity = hypoxia
Low 02 sat = hypoxia and acidosis
During the maternal exam during the first stage of labor, what does “history” include?
Current pregnancy history (gravida and parity status, description of pregnancy, plans for labor and plans for child care)
Past pregnancy history (prior pregnancies, abortions and miscarriages - including numbers, dates, types of birth, any complications/outcomes including health, sex and birth weights of previous children)
Past health history (previous surgeries, heart disease, diabetes, anemia, TB, kidney disease, hypertension, STIs, high risk or prescription/nonprescription drug abuse or HIV exposure)
Family medical history (potentially inherited conditions: cognitive challenge, heart disease, diabetes, kidney disease, allergies, seizures, hearing loss or malignant hyperthermia)
During the maternal exam during the first stage of labor, what does “physical examination” include?
Pelvic exam
General health
Presentation and position of the fetus
Stage of cervical dilation
During the maternal exam during the first stage of labor, what are you looking for in a “vaginal exam”?
Extent of cervical softening, effacement and dilation, and to confirm fetal presentation, position and degree of descent.
What all is assessed during the maternal exam in the first stage of labor?
History Physical exam Leopold maneuvers Rupture of membranes Vaginal exam Pelvic adequacy Lab analysis Uterine contractions (length, intensity, frequency)
What laboratory tests are done in the first stage of labor?
Blood: hemoglobin, hematocrit, serum for syphilis, hep B antibodies, blood typing and HIV test (if consented)
Urine: protein and glucose then complete UA
What is included in the fetal exam during the first stage of labor?
External and internal electronic monitoring > telemetry > FHR and uterine contractions > FHR patterns > baseline FHR > variability > periodic changes
Scalp stimulation
Fetal blood sampling
Acoustic stimulation
What is included in Nursing Care in the 1st Stage of Labor?
Respect contraction time Change positions Voiding and bladder care Support Pain management Amniotomy (artificial rupture of membranes)
What is included in Nursing Care during the 2nd Stage of Labor?
Preparing for birth Positioning for birth Pushing Perineal cleaning Episiotomy Birth Cutting and clamping cord
What is included in the Nursing Care of the 3rd and 4th Stages of Labor?
Oxytocin Placental delivery Perineal repair Assessment Immediate postpartum
