Class 2 Study Guide

Question 1

Cardiovascular effects from labor contractions

Answer 1

Contractions cause momentary rise in BP and decrease in HR due to temp. increase of blood volume due to decreased placental flow.

Question 2

3 characteristics of uterine contractions:

Coordinated
involuntary
Intermittent

Answer 2

Coordinated: contractions have regular pattern of increased frequency, duration, and intensity. Begin at fundus downward.

Involuntary: contractions are involuntary, activities may stimulate and anxiety can diminish

Intermittent: allows relaxation of muscle and resumption of blood glow to and from the placenta

Question 3

The Contraction Cycle:
increment
Peak aka acme
Decrement
Frequency
Duration
Interval
Intensit

Answer 3

Increment: when contraction begins
Peak: most intense part of contraction
Decrement: period of decreasing intensity
Frequency: period from beginning of one contraction to the next
Duration: length of each contraction
Intensity: strength of contraction (tip of nose, chin, forehead)
Interval: period between end of one contraction to the beginning of the next.

Question 4

The four P’s of labor process

Answer 4

Powers: contraction, pushing efforts
Passage: pelvis, vaginal canal
Passenger: fetus, placenta, membranes
Psyche: mind set, can be anxious, positive or negative

Question 5

First Stage of Labor

Answer 5

Stage of dilation and cervical effacement
3 phases: Latent (3-5 dilation, woman social, talking, excited), Active (4-6 dilation, labor picks up, may be irritable), Transition (7-complete, major internal focus)

Question 6

Second Stage of Labor

Answer 6

Expulsion
begins with 10 cm dilation and 100% effacement and ends with birth of fetus
involuntary and voluntary pushing effort

Question 7

Third Stage of Labor

Answer 7

expulsion of placenta
Signs of placental detachment: spherical shape of uterus, uterus rises in abdomen, cord descends further in vagina, blood gush from behind placental attachment site

Can be expelled in 2 ways:
Shultz: shiny fetal side first
Duncan: rough side first

Question 8

Fourth Stage of Labor

Answer 8

Stage of physical recovery (first 1-4 hours post birth)
good time to initiate breastfeeding and bonding
uterus firmly contracts vessels at placental site
Discomfort
Drainage -Lochia Rubra

Question 9

How do you assess fetal oxygenation and what are some interventions

Answer 9

Assessment: FHR, contractions, amniotic fluid, maternal V/S

Interventions: maternal reposition to promote optimal placental function
Observe for conditions associated with fetal compromise- assess fetus more frequently and notify birth attendant if fetal compromise is present.

Question 10

How do you assess maternal discomfort and what are some interventions

Answer 10

normal head to toe assessment, pain, fatigue, emotion, oxygenation

Interventions: lighting-soft and indirect to help soothe
Temperature: cool, damp washcloths, electric fan for breeze on laboring mother
Cleanliness- change sheets and gown to keep woman dry, change underpads often to prevent bacterial growth
Mouth care: ice chips
Empty bladder
sitting and standing help contractions be more productive
shower/tub is relaxing, but use in late stage may prolong labor

Question 11

VEAL CHOP

Answer 11

VEAL CHOP  
V: Variable C: Cord Compression
 E: Early H: Head Compression 
A: Accelerations O: Okay
 L: Late P: Placental Insufficiency  

Just remember: Earlys are okay and no intervention taken, natural for head to be compression DURING contractions. The compression will mirror the contraction.

Lates, bad Variables, not good. They resemble letter U, V, W on the strip

Accellerations need to be 15 x 15 for a full term preg…15 bpm higher for 15 seconds in duration

Question 12

Four categories of variability

Answer 12

Absent: undetectable
Minimal: undetectable up to 5 bpm
Moderate: 6-25 bpm
Marked: >25

Question 13

Accelerations

Answer 13

increase in FHR that peaks 15bpm above baseline that last at least 15 seconds.

Reassuring sign and reflects fetal active CNS

Question 14

3 types of Decelerations

Answer 14

Early: caused by fetal head compression that causes increase ICP which decreases HR. Occurs during contraction and not associated with compromise

Late: caused by impaired exchange of 02 and waste in placenta. Can be caused by uteroplancetal insufficiency, maternal hypotension, HTN, or DM. Not reassuring.

Variable: caused be conditions that reduce flow though umbilical cord. Fall and rise abruptly with relief of cord compression

Question 15

Breathing techniques for first stage of labor (5)

Answer 15

Cleansing breath: each contraction begins and ends with deep inspiration and expiration

Slow-paced breathing: slow, deep breathing

Modified-paced breathing: when slow paced is no longer effective, chest breathing at fast rate but still focused on releasing tension.

Pattern-paced breathing: pant blow, hee hoo breathing. Rhythmic.

Controlling urge to push: blowing prevents breath holding during strenuous pushing

Question 16

Breathing techniques for second stage of labor

Answer 16

avoid holding breath while pushing because it decreases oxygen in blood through placenta.