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OB > Chapter 16: Labor & Delivery > Flashcards

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
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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

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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)
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4
Q

psyche

5 p’s of labor

A
  • maternal affect
  • feelings abt herself, pregnancy, surroundings
  • psychological health
  • ex) anxiety, stress, fear
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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
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6
Q

fetal head

A

moulding = infant head molds (sutures and fontanels move) to fit birth canal easier

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7
Q

fetal presentation

A

part of fetus that enters pelvis first, or the presenting part

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8
Q

cephalic presentation

A

enter pelvis head first

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9
Q

vertex presentation

A
  • most common and ideal
  • chin is on chest
  • head down, facing spine
  • occiput enters first
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10
Q

breech presentation

A

butt or feet descending first into pelvis

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11
Q

shoulder presentation

A
  • shoulder entering true pelvis first
  • needs correction if vaginal delivery
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12
Q

sinciput presentation

A
  • fetal chin off chest
  • neck straight
  • aka military attitude
  • face and forehead present first
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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
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14
Q

fetal lie

A
  • longitudinal (vertical)
  • transverse (horizontal)
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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)
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16
Q

fetal position 1st letter

direction

A
  • L/R
  • left or right
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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)
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18
Q

fetal position 3rd letter

position relative to maternal pubic symphysis

A
  • P: posterior
  • A: anterior
  • T: transverse
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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
Q

fetal station

A
  • 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
Q

first stage of labor

A
  • cervical dilation and effacement
  • menstrual cramp-like contractions
  • low backache
  • has 3 phases
27
Q

stage 1 phase 1 of labor

A
  • latent
  • cervix dilates 0-3 cm
28
Q

stage 1 phase 2 of labor

A
  • active phase
  • cervix dilates 3-7 cm
29
Q

stage 1 phase 3 of labor

A
  • transition phase
  • cervix dilates 8-9.9 cm
  • many women irritable and don’t want to be touched
30
Q

stage 2 of labor

A
  • cervix fully dilates to 10 cm
  • ferguson reflex
  • birth of baby
31
Q

stage 3 of labor

A
  • birth of baby
  • birth of placenta
32
Q

stage 4 of labor

A
  • birth of placenta
  • recovery
  • 4 hrs postop or when mom is stable
33
Q

nursing assessments for 1st stage of labor (8)

A
  • 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
Q

nursing interventions for 1st stage of labor (5)

A
  • IV and labs
  • encourage voiding
  • encourage participation in activities + ambulation
  • educate to not lie flat on back
  • soothing voice, offer affirmations
35
Q

nursing interventions and assessments for 2nd stage of labor (4)

A
  • 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
Q

nursing assessments and interventions for 3rd stage of labor (5)

A
  • 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
Q

nursing assessments and interventions for 4th stage of labor (7)

A
  • 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
Q

external fetal monitoring

A
  • want to put on fetus’ back
  • placed outside of belly
39
Q

internal fetal monitoring

A
  • IUPC
  • invasive, so only done if membranes ruptured or cervix is dilated (acute situations bc more accurate)
  • want to put on fetus’ head
40
Q

intermittent fetal monitoring

A
  • only used if low risk pt
41
Q

continuous fetal monitoring

A
  • usually the norm now
  • higher risk pts or pts further along in contractions
42
Q

pain in 1st stage of labor

A
  • 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
Q

pain in 2nd, 3rd, 4th stage of labor

A
  • perineum
  • feeling of stretching, pulling, tearing
  • visceral (in organs) similar to 1st stage but not as acute
  • bearing down may decr intensity
44
Q

pharm pain mgmt

6

A
  • 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
Q

nonpharm pain mgmt

6

A
  • breathing techniques
  • hypnosis
  • biofeedback
  • aromatherapy
  • music therapy
  • cutaneous stim (effleurage, counter pressure, intradermal water block, acupuncture, massage, hydrotherapy)

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