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4500 Gender & reproductive health > Class 5 labour and birth part 1 > Flashcards

Class 5 labour and birth part 1 Flashcards

1
Q

What are the 2 most important questions when someone comes into triage?

A
  1. do you have bleeding?
  2. is there fetal movement ?
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2
Q

What assessments do we do when someone comes into triage?

A

Height
Weight

Vitals

Leopolds

Vag exam if indicated (dilation)

Fetal heart rate (IA or EFM)

ROM: obvious or needs more tests?

HDP, GDM

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3
Q

When do we want someone to come to triage?

A
  1. Pain management
  2. bleeding
  3. contractions stronger and closer together q5 min for 1 hr.
  4. Membrane rupture ROM
  5. decreased fetal movement
  6. feeling unwell - like something isn’t right
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4
Q

What do we give every person after delivery to ensure there’s no postpartum hemorrhage?

A

oxytocin/syntocinon

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5
Q

What encompases stage 1?

A

start of true labour
to
complete dilation (10 cm) and effacement

Longest stage
includes latent/early phase & active phase.

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6
Q

What encompasses stage 2?

A

complete effacement & dilation
to
birth of baby

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7
Q

What emcompasses stage 3?

A

birth of newborn
to
placenta delivery

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8
Q

What encompases stage 4?

A

first 2 hours post placenta delivery

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9
Q

how much should someone dilate each hour?

A

1 cm per hour

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10
Q

what % of effacement is first stage, early/latent phase?

A

75% effaced

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11
Q

What % of effacement is first stage, active phase?

A

100% fully effaced

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12
Q

What are contractions like for someone in first stage, early/latent phase?

A

5-30 min apart

last 30-45 seconds

Irregular

Mild-moderate

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13
Q

What are contractions like for somone in first stage, active phase?

A

2-5 min apart

40-90 sec

regular

moderate-strong

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14
Q

What are the 5 P’s that can affect labour and birth?

A
  1. passageway
  2. Passenger (fetus)
  3. Powers
  4. Position (birther)
  5. Psychological
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15
Q

What are powers?

A

Primary powers: involuntary uterine contractions

Secondary Powers: bearing down efforts : pushing

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15
Q

What does passenger (fetus) mean?

A

presentation
position
station
lie
attitude

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15
Q

what does passageway mean?

A

birth canal

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16
Q

What fetal position is not ideal?

A

ROP
LOP
(sunnyside up - pressure on mom spine)

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17
Q

How often should the birther change positions?

A

q 20 min

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18
Q

What are the mechanisms of labour?

A

how the fetus adjusts during 1st and 2nd stage of labour

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19
Q

At what point do we determine we have dystocia?

A

> 4 hours with less than 0.5 cm per hour of cervical dilation during active labour

OR

> 1 hour pushing with no descent

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20
Q

What are the causes of dystocia?

A

hypotonic- poo poo contractions

ineffective pushing

passageway isn’t great

birther position isn’t helping

unhelpful psychological response

Issues with fetus position etc. size, cephalopelvic disproportion (head is too big)

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21
Q

What is ECV?

A

external cephalic version
- rotating the baby into cephalic position

22
Q

What are nursing interventions for Dystocia?

A
  1. EFM for 20 min read
  2. Ultrasound for positioning
  3. risk assessment
  4. position changes
  5. assess the cause and timing (which stage/phase)
23
Q

How long do we wait to intervene after water ROM has broken?

A

12 hours we give oxytocin

24
Q

What 2 things do we NOT want in the ruptured membranes?

A

meconium (flecks)
odour = infection

25
Q

What do we administer if ROM goes over 12 hours?

A

antibiotics

26
Q

What are the 4 things assessed during vaginal exam?

A
  1. dilation
  2. effacement
  3. presenting part
  4. status of membranes
27
Q

What is chorioamniotnitis?

A

an infection of the amniotic cavity

28
Q

What are the risks of chorioamnionitis?

A
  • labour dystocia
  • C-section
  • pelvic wound abscess

Newborn risks:
PN, bacteremia
sepsis

29
Q

What are 3 things we do to manage chorioamnionitis?

A
  1. Induce labour
  2. broad-spect IV abx
  3. birth the fetus
30
Q

What can advance to chorioamnionitis?

A

GBS
group B streptococcus

31
Q

how do we treat GBS?

A
  1. IV abx prophylaxis
  2. Pen G 5 million units IV- loading
  3. Pen G 2.5 million units IV - maintenance
  4. q 4 hours until birth
32
Q

What is the nursing assessment for first stage of labour?

A
  1. Vitals
  2. FHR - IA or EFM
  3. Uterine activity
  4. Membranes and vaginal show
  5. Vag exam
  6. Oral intake & urinate q2
33
Q

How often do we check Vitals in first stage , latent phase and active phase?

A

q 30-q60

temp- q4 if no ROM
q1-2 if ROM

34
Q

How often do we check FHR and uterine activity during latent phase compared to active phase?

A

latent- q30-60
active- q15-30 (usually 15)

35
Q

How often do we do vag exam and check oral intake during first stage latent phase or active phase?

A

PRN

36
Q

what stage/phase is the person fully dilated with no urge to push?

A

seconde stage
Passive phase

37
Q

What stage/phase is there pushing and crowning?

A

Second stage/active phase

38
Q

How often do contractions come in second stage, active phase?

A

(q2 min) 4-5 contractions in 10 min
last 90 sec

39
Q

what stage do people tend to experience N &V?

A

Second stage, passive phase

40
Q

How often do we assess vitals (BP, HR, RR) during second stage?

A

Q5-30 min

41
Q

how often do we check FHR & pattern during second stage?

A

Q5 min during pushing

42
Q

how often do we check vaginal show, fetal decent and changes in status of birther (mood, energy, emotions) during second stage?

A

ongoing

43
Q

What is really important for the nurse to do at the time of birth?

A

Write down the time of birth!

44
Q

Why is episiotomy performed?

A

prevent tearing to the anus
midiolateral cut

45
Q

When are forceps indicated?

A
  1. to shorten 2nd stage if dystocia is happening
  2. Fetal:
    - abnormal FHR tracing
    - abnormal presentation
    - arrest of rotation
    - extract the head in breech
46
Q

When is forceps contraindicated?

A
  1. cervix isn’t quite dilated
  2. water hasn’t broken
  3. fetal head isn’t engaged
47
Q

what do we document when forceps are used?

A
  1. when they are placed
  2. number of pulling & timing
48
Q

which do we prefer, vacuum or forceps?

A

vacuum

49
Q

what do we document with vacuum use?

A
  1. when it is placed
  2. number of times it pops off
  3. how many pulls
  4. max amount of suction used
50
Q

When is third stage of labour?

A

baby birth
to
placenta

15 min-1 hr

51
Q

how do we know the placenta is ready to be delivered?

A

-cramping
-umbilical cord gets longer
-sudden gush of blood
-you can see it
-feel pressure again

52
Q

what are nursing interventions in stage 3?

A

vitals (BP, HR, RR) q 15 min

document placenta delivary time

cord blood collection (check for Rh status of baby)
blood gases & if mom is Rh- then WinRoh

pain management

check fundus
check for PPH

make sure placenta is whole

53
Q

What is the fourth stage of labour?

A

recovery

q15 min vitas for first 1 hour
30 min vitals for next hour

temp x1

check perineum, fundus, etc

pain management

hygiene

4500 Gender & reproductive health (6 decks)

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