Chapter 16: Labor & Delivery Flashcards
1
Q
Power
5 P’s of labor
secondary and primary
A
- primary: involuntary uterine contractions and Ferguson reflex –> cervical dilation
- secondary: voluntary action of pushing –> increase intraabdominal pressure
2
Q
passageway
5 p’s of labor
A
anatomy of bony pelvis and soft tissue of pelvic floor muscles, introitus (opening to vagina), and vaginal canal
3
Q
passenger
5 p’s of labor
A
fetus
- fetal head (fontanels, sutures)
- fetal presentation (breech, cephalic, shoulder)
- fetal attitude (position of body parts in relation to each other)
- fetal lie (longitudinal or transverse)
- fetal position (presenting part relation to maternal pelvis)
4
Q
psyche
5 p’s of labor
A
- maternal affect
- feelings abt herself, pregnancy, surroundings
- psychological health
- ex) anxiety, stress, fear
5
Q
position
5 p’s of labor
A
- gravity assists in labor and delivery
- upright and ambulating –> better contractions
- sharply flexed angle of pelvis –> easier fetal passage
- lithotomy position –> better perfusion
- engourage positions where mom is comfy like upright or lateral
6
Q
fetal head
A
moulding = infant head molds (sutures and fontanels move) to fit birth canal easier
7
Q
fetal presentation
A
part of fetus that enters pelvis first, or the presenting part
8
Q
cephalic presentation
A
enter pelvis head first
9
Q
vertex presentation
A
- most common and ideal
- chin is on chest
- head down, facing spine
- occiput enters first
10
Q
breech presentation
A
butt or feet descending first into pelvis
11
Q
shoulder presentation
A
- shoulder entering true pelvis first
- needs correction if vaginal delivery
12
Q
sinciput presentation
A
- fetal chin off chest
- neck straight
- aka military attitude
- face and forehead present first
13
Q
fetal attitude
A
- position of fetal body parts in relationship to each other
- ex) chin on chest, arms flexed against chest, legs flexed at knees, neck rounded
- if neck is straight, fetus may not be able to pass through true pelvis
14
Q
fetal lie
A
- longitudinal (vertical)
- transverse (horizontal)
15
Q
fetal position
A
- relationship of presenting part to maternal pelvis
- best = vertex, OA (occiput, anterior)
- bad = sacrum (breech), mentum (face/brow), Sc (transverse lie)
16
Q
fetal position 1st letter
direction
A
- L/R
- left or right
17
Q
fetal position 2nd letter
presenting part
A
- O: occiput (back of head) GOOD
- M: mentum (brow or face) NOT GOOD
- Sc: scapula (transverse lie)
- S: sacrum (breech)
18
Q
fetal position 3rd letter
position relative to maternal pubic symphysis
A
- P: posterior
- A: anterior
- T: transverse
19
Q
ROA, LOA, ROP, LOP
A
- right occiput anterior
- left occiput anterior
- right occiput posterior
- left occiput posterior
20
Q
signs of impending labor (8)
A
- bloody show
- contractions more frequent, consistent
- 4-1-1 rule: new contraction every 4 min, lasts 1 min for 1 hr
- lightening: descent of fetal head to pelvis
- nesting
- cervical changes
- GI symptoms
- weight loss
21
Q
amniotic fluid norm and abnormal findings
A
- normal: clear, meconium in late babies but check FHR to make sure not fetal hypoxia
- abnormal: cloudy, foul odor = infection
22
Q
how to describe and chart contractions?
A
- intensity: mild, moderate, strong
- duration: seconds, beginning to end
- frequency: seconds, beginning to beginning
- uterine tone at rest b/t contractions: hard or soft?
23
Q
cervical dilation
A
- gradual opening of cervix
- happens during 1st stage of labor
24
Q
cervical effacement
A
- gradual thinning of cervix
- happens during labor and late in preg
25
fetal station
* how far fetal presenting part descends into the uterine canal
* 0 station = presenting part at lvl of ischial spines aka fetus engaged
* goes from +1 to +5 station
* +5 station = crowning
* negative numbers = presenting part still above station 0
26
first stage of labor
* cervical dilation and effacement
* menstrual cramp-like contractions
* low backache
* has 3 phases
27
stage 1 phase 1 of labor
* latent
* cervix dilates 0-3 cm
28
stage 1 phase 2 of labor
* active phase
* cervix dilates 3-7 cm
29
stage 1 phase 3 of labor
* transition phase
* cervix dilates 8-9.9 cm
* many women irritable and don't want to be touched
30
stage 2 of labor
* cervix fully dilates to 10 cm
* ferguson reflex
* birth of baby
31
stage 3 of labor
* birth of baby
* birth of placenta
32
stage 4 of labor
* birth of placenta
* recovery
* 4 hrs postop or when mom is stable
33
nursing assessments for 1st stage of labor (8)
* interview
* vitals, FHR, contractions
* duration, frequency, intensity, onset of contractions
* any pain or other discomfort?
* last food or drink
* sterile speculum exam for membrane rupture or bleeding
* sterile vaginal exam for dilation, effacement, fetal station/presentation/position
* leopold maneuver
34
nursing interventions for 1st stage of labor (5)
* IV and labs
* encourage voiding
* encourage participation in activities + ambulation
* educate to not lie flat on back
* soothing voice, offer affirmations
35
nursing interventions and assessments for 2nd stage of labor (4)
* check FHR every 15 min
* vitals hourly
* comfort measures (ice chips, positioning, etc.)
* support, encouragement for open glottis pushing (pushing without holding breath), coaching to push
36
nursing assessments and interventions for 3rd stage of labor (5)
* initiate skin-skin contact and breastfeeding
* put baby under warmer
* vitals every 15 minutes
* coach mother to breathe with contractions
* encourage father bonding with baby
37
nursing assessments and interventions for 4th stage of labor (7)
* examine maternal portion of placenta, look for retained
* administer uterotonics and analgesics
* assess fundal tone, position, location (norm = lvl of umbilicus right after birth)
* rubia lochia = norm, 500 mL blood loss
* ice packs
* perineum
* bladder function
38
external fetal monitoring
* want to put on fetus' back
* placed outside of belly
39
internal fetal monitoring
* IUPC
* invasive, so only done if membranes ruptured or cervix is dilated (acute situations bc more accurate)
* want to put on fetus' head
40
intermittent fetal monitoring
* only used if low risk pt
41
continuous fetal monitoring
* usually the norm now
* higher risk pts or pts further along in contractions
42
pain in 1st stage of labor
* like wrapping lower torso with belt
* more acute in lower-mid abd + lower back
* referred pain that radiates
* pain subsides b/t contractions
* like running up and down mountain
43
pain in 2nd, 3rd, 4th stage of labor
* perineum
* feeling of stretching, pulling, tearing
* visceral (in organs) similar to 1st stage but not as acute
* bearing down may decr intensity
44
pharm pain mgmt
| 6
* opioids: meperidine (demerol), sublimaze (fentanyl)
* mixed opioid agonists/antagonists: nalbuphine (Nubain), butorphanol (Stadol)
* antiemetics: promethazine (phenergan), hydroxyzine (vistaril)
* epidurals, spinals, combined spinal-epidural
* nitrous oxide (laughing gas)
* pudenal block
*careful with use because can cause neonate resp depression and maternal somnolence + hypotension*
45
nonpharm pain mgmt
| 6
* breathing techniques
* hypnosis
* biofeedback
* aromatherapy
* music therapy
* cutaneous stim (effleurage, counter pressure, intradermal water block, acupuncture, massage, hydrotherapy)
