Dressler Module 3 Flashcards
What are some alternative pain controls
Positioning, Relaxation Techniques, Control breathing with EFFLEURAGE (light massage on abdomen), Positive imagery, Distractions, Acupressure, Massage, Cultural Implications
What does Analgesic Pain Control provide
Provides emotional & physiological benefits but can interfere with respiratory system of newborn. NOT GIVEN IF BIRTH IS WITHIN ONE HOUR
What are opiates
Decreases perception of pain (Narcan, Demerol)
These are used in latent phase and allows mom to rest to conserve energy
Sedative
What do tranquilizers do
relaxes mom and baby (NOT RECOMMENDED)
When can narcotics be given
Active phase
Used during emergencies when quick intervention is necessary (For c-section)
Anesthesia (Drug like novacane or lidocaine placed in vaginal wall)
Pudendal Block
Local in the perineum
Good for EPISIOTOMY
This drug blocks pain sensation from waist down, patient must have an IV to receive. used for POST-OP pain control.
Epidural
Major side effect of an Epidural
Hypotension
This is an injection into 3,4,5 spinal column, Patient must lie flat.
Spinal anesthesia
Norms during Continuous Fetal Monitoring
FHR decreases during contraction Temporary lack of oxygen HR should return to 120 between contractions Monitoring gives ongoing fetal status Fetal Heart Rate should be 120-180
Subjects of Internal Fetal Monitoring
Saline filled catheter in place Ruptured membranes Accurate assessment Monitors FHR Intensity of contractions Risk of infection Permanent record
Early FHR Deceleration
Deceleration starts & ends with each contraction
Variable FHR Decelerations
Deceleration begins & end abruptly, not consistent
Umbilical cord compression
Late FHR Deceleration
Delay in decrease, does not go back to baseline
Uteroplacental insufficiency
Lack of BLOOD FLOW TO PLACENTA
During labor Blood pressure and Heart Rate
Increase during 1st and 2nd stage, returns to pre-labor during 3rd and 4th stage
During labor respirations
Increase and become prone to blood gas disturbances
Some changes to kidney during Labor
They become stressed
Trace of protein as a result of muscle breakdown during labor
Potential for decreased urinary flow due to position
During labor Myometrium
Works very hard
Because baby is pushing on bladder this can occur
Urinary retention can occur
During labor Peristalsis and absorption
slows down and patient is NPO except ice chips
During labor Muscle activity _____ sweating and fluid _____ and patient is at risk for
Increase
Increase
Dehydration
Signs and Symptoms of Impending Labor
Lightening Braxton Hicks Contractions Cervical changes (mucous plug comes out) Increased energy (Nesting syndrome) Weight loss (Polyuria)
When moms mucous plug comes out mom is at risk for
infection
During true labor Contractions ______ in frequency, duration, and intensity.
increases
During ____ labor there is no increase in frequency, duration, and intensity
False
Sequence of Mechanism of Labor / Cardinal Movements
Engagement Descent Flexion Internal rotation Extension External rotation Expulsion
The soft spot on the babys head is called the
Fentanyl
Squiggly lines on babys head are called
Sutures
What are the 3 phases in stage 1 of Labor
Latent –> Active –> Transition
Phase where early labor, feels like bad menstrual cramps (4cm dilated)
Latent phase
Phase where mom starts to feel labor, need for pain medication, goes through TRANSITION, mood swings (4cm-7cm)
Active phase
Phase where cant give no more pain medication (7cm - 10cm)
Transition
Stage where dilated cervix to birth of the baby (baby comes out)
Stage 2
Stage where birth of baby to delivery of placenta (Placenta needs to be pushed out
Stage 3
Stage where 1-4 hours after delivery
Stage 4
The 5 p’s of labor are
Passageway Passenger Power Position Psyche
The structure the fetus passes through
Passageway
Size and position of fetus
Passenger
Another word for contractions
Power
Maternal position and gravity
Position
Moms emotional status
Psyche
When 10cm dilated the _____ falls out
Mucous plug
_____ help pull cervix open
Contractions
Flattening of cervix that we measure and want to be 100% this
Effacement
Top of pelvis is also called
Inlet
Bottom of pelvis is called
Outlet
Comparison of babys head to opening
Cephalo Pelvic Relationship
Fetal heads will ____ to moms opening
adjust
Position of fetus long axis in relationship to moms long axis
Fetal Lie
What are the three Fetal Lies
Longitudinal, Transverse, Oblique
Foremost part of the fetus entering the pelvic inlet
Presentation
Cephalic presentation
Head first
Vertex presentation
IDEAL tip top of head
Military presentation
flat part of head toward tapur
Brow presentation
Forehead / Eyebrows
Face presentation
Can see face
Breech presentation
Painful for mom Feet / Buttocks / Shoulder
What do we do when fetus is in Breech Buttocks
push baby back in and try again
Relationship of fetal parts to one another
Fetal attitude
Ideal Fetal attitude
Flexion - head down arms and legs up smallest part of head entering first
Relationship of the presenting parts to moms pelvic 4 quadrants
Position
Relationship of presenting part to ischial spine
Station
At station 0 the ischial spine is
Engaged
Station is measured in
centimeters negative to positive
Where can the nurse put her hand on to feel contractions
Fundus
Contractions should not last longer than ____
90 seconds (Fetal heart rate would be too low for too long
Upper portion of the uterus that detaches from wall with CONTRACTIONS
Placenta
The Traditional / Lithotomy position the mom is
Supine Knees are up
When fetal pulse is low we can place mom on her
Left side
When moms cord drops out before fetus ____ must occur and patient should be in ____ position
C-section
Knee Chest
Stage that starts with onset of contractions and ends at 10cm dilation
First stage
Which phase follows? 0-3cm, Effacement, Contractions q20-q5 and last 15-40 seconds
Latent phase
4-7cm, Amniotic rupture, ok to give pain meds, Contractions q2-q5 min last 40-60 seconds
Active phase
8-10cm, fully effaced, difficult for mom, contractions q2min, lasting 60-90 seconds
Transition phase
When membranes are ruptured and contractions are less than 5 min apart what should mom do
come to hospital
What can LPNs do and what cant they
LPNs can do vaginal exams however anything that involves going inside the vagina is disobeyed LPNs can check perineum to assess bulging/crowning
During first stage of labor what nursing implications are most important
Monitor FHR
Intake and Output
IV fluids for electrolyte imbalance
When changing moms position what position is best
Whichever mom is most comfortable
When moms feels bowel movements what should we do
Check perineum because bowel movements can be mistaken for the baby coming
Ends with birth of baby (10cm dilated) and where EPISIOTOMY may be done
Second stage
Surgical incision
Episiotomy
Nursing care for Second stage of labor
Check VS between contractions
Suction baby
Push shoulder up to help increase gravity
Encourage mom the INHALE DURING CONTRACTION.
Begins with Birth of the baby Ends with Placental Expulsion
3rd stage
Smooth and dry side of placenta attached to baby
Shultz
Red Gushy side attached to mom
Duncan
During 3rd stage of labor mom has a potential for
hemorrhage
Nursing Care for 3rd stage of labor
Skin pale cold and clammy IS NORMAL Massage uterus Uterus should look like 20 week stage Check for necessity of PITOCIN Obtain CORD BLOOD IF NEEDED
During 3rd stage of labor what should we do for baby
Dry off and assess VS
Apgar scoring
Apply ID bands IMMEDIATELY
Higher the APGAR score the higher the babys
Adaptability to the world (rub their feet if low)
Begins with delivery of placenta, and where involution takes place
4th stage
Where organs start to return to pre-pregnancy stage
Involution
Nursing care for 4th stage of labor
Monitor moms vital signs
Assess fundus
What is the ideal palpation for fundus
Firm(Like a ripe plum)
If Fundus is Boggy
Massage
If Fundus is Rigid
Call MD
What is the average loss of blood during 4th stage of labor
400-500ml
Stages of Lochia after birth
Rubra(Bright red) –> Serosa(Pinkish) –> Alba(Whitish)
Women should be able to wear OB pad for more than
2hours
If mother is experiencing pain after 4th stage of labor it important to tell her
Uterus is going back into place
Nursing care of Neonate(Newborn)
Suction
Clean secretions
Vernix (Wrap baby)
Instillation of neomycin drops for ophthalmia
Wrapping baby and swabbing everything else away is called
Vernix
Given for eye infections that may cause blindness
Neonatorum
Observations we can make for newborn
Skin milia (Acne)
Acrocyanosis
Caput succedaneum
Cephalohematoma
Pointed shape of head due to edema
Caput succedaneum
Accumulation of blood between skull and periosteum
Cephalohematoma
Labor
Process that begins with uterine contractions and ends one hour after delivery of the baby
Effacement
Thinning and shortening of the cervix
Dilation
Opening of the cervix
Cephalo
Pelvic relationship Size of fetal head in relation to moms pelvis
Lie
Relation of fetus long axis to moms long axis
Attitude
Degree of flexion of Fetus, Relationship of fetal body parts to each other
Presentation
The part of the fetus that enters the pelvis first
Position
Relation of the fetus presenting part to the Mothers 4 quadrants of the pelvis
Station
The relationship log the presenting part to moms ischial spine
Contraction
Uterine activity that is a part of the labor process
Increment
The beginning of a contraction
Acme
The height of a contraction
Decrement
The contraction starts to subside
Intensity
The strength of contraction Mild moderate firm
Frequency
His often a contraction occurs Measured from the beginning if one to the beginning of the other
Duration
How long a contraction lasts measured from increment to decrement
Lightening
The descent of the fetus into the pelvis
Braxton hicks contractions
Random mild abdominal contractions “false labor”
Mechanism of labor
The rotation the fetus goes through while descending out of the body
Apgar score
Assessment took of the neonateDone 1 and 5 minutes after birth
Crowning
The appearance of the the fetal head in the vagina during contraction
Lochia
The bleeding that occurs after delivery
Lochia rubra
Bright red with small clots
Lochia Serosa
ThinPinkish Brown discharge
Lochia Alba
White creamy discharge
After pains
Contractions of the uterus after delivery may last 48-72 hours
Involution
The retuning of the reproductive organs to the prepregnant state
