Exam 1: labor lecture 2 Flashcards
Stages of labor Care of the laboring patient Pain management Fetal assessment/monitoring complications of pregnancy GBS Cord Prolapse Maternity Nursing
What are the stages of labor?
Stage 1: dilation
Stage 2: pushing
Stage 3: placenta delivery
Stage 4: recovery
What occurs in stage 1 of labor ?
- Dilation!
- This stage takes the longest
- Consist of phases (1st) late & (2nd) active.
- In the (1st) latent phase the pt is still excited and able to talk. She will become 2-3cm dilated in this phase.
- In the (2nd) active phase the pt is focused on contractions, in pain. She will become 10 cm dilated
Stage 1 of labor Admission assessments labs done
- H&H (for baseline)
- CBC (for infx)
- Type & screen for blood type and Rh status (if hemorrhage)
- Platelet count
- RPR (for sepsis)
- assess amniotic fluid
- Group B strep status
Stage 1 of labor caring for pt/nursing implications:
- admission assessment
- Labs
- Continuous assessments (Maternal & fetal)
- Positioning
- Support
What occurs in the 2nd stage of labor?
- Pushing! & Ends in delivery of baby!
Stage 2 of labor caring for pt/ nursing implications
- support: Encouragement, breathing
What occurs in the 3rd stage of labor?
Placenta delivery!
- Once baby is delivered, now time to delivery the placenta
- Important stage & time of delivery should be recorded
Stage 3 of labor caring for pt/ nursing interventions
- Pitocin!!
Watching for hemorrhage - Immediate newborn care
- education
What to watch for and nursing intervention during the 3rd stage of labor?
once the placenta is out NEED to watch for hemorrhage!
- Pt will receive Pitocin!!!!
- Hormone change instantly.
- Pregnant hormones: estrogen & progesterone
- PP hormones: Prolactin (breastfeeding) and Oxytocin (to make uterus contract=blood vessel constrict=no/stop bleeding)
What occurs in the 4th stage of labor?
Recovery! 1st 4 hrs
- Bonding and breastfeeding right away
- Fundus checks (want to be firm)
How to care for a patient in the 4th stage of labor?
- PP assessments
- observe for hemorrhage
- bonding and breastfeeding
- education
- voiding!!!
- firm fundus
- measuring amount of blood coming out
5 factors affecting labor (5 P’s)
- passenger
- Passageway
- Powers:
- position of mother
- psychologic response
Factor affecting labor-Passenger
-size of baby
-size of fetal head
-presentation- 97% vertex presentation
- Fetal attitude
-Fetal lie
- Fetal position & station
Factor affecting labor-Passenger
- what is fetal attitude?
relation of fetal body to each other
Factor affecting labor-Passenger
- what is lie?
Longitudinal or vertical
Factor affecting labor-Passenger
- what is presentation?
vertex
Factor affecting labor-Passageway
- includes what?
pelvis (more narrow=harder to go through)
soft tissues (related to cervical effacement & dilation)
Factor affecting labor-Powers
- includes what kind of forces?
(contractions that will make cervix thin out & dilate)
-primary force: involuntary contractions
- secondary force: voluntary pushing
Factor affecting labor-Psychologic Response dependent on what factors?
!!!!Support!!!
- Passed experiences
-pain tolerance & coping abilities
- culture
- emotional readiness
- self-confidence
- childbirth education
Status of membranes- What does TACO mean ?
status membranes status dependent on BOW (ROM)
T - time of rupture
A - amount of amniotic fluid
C - color of fluid want clear; meconium (1st bm) stained water will be yellow=fetal distress
O - odor
assessment tool to remember to assess when water breaks
Status of membranes- Important to always assess for?
Always assess for fetal heart tones- cord prolapse (emergency that occurs when the umbilical cord drops in front of the baby and passes through the cervix before the baby)
Tests done to confirm ruptured membranes
-Fern Test: Vaginal fluid swabbed & placed on a microscope slide. Fern pattern confirms amniotic fluid
- Amnisure test
Perineal trama- lacerations
Perineal lacerations usually occur when head is being delivered
- extent defined in terms of depth: 1st -4th degree
- Skin (1st) through rectal wall (4th)
Perineal trama- Episiotomy
Incision made in the perineum to enlarge the vaginal opening
Introduction of labor- cervical ripening agents/meds
Softens the cervix
- Prostaglandin
- Misoprostol (cytotec)
Augmentation/
Induction of labor-
hormone/med
-Oxytocin
- Pitocin (artifical)
Caring for/ nursing implications of laboring client
- clear fluids/food only
- hydration/IV
- Voiding/ catheterization
- Bowel elimination
-Ambulation/ positioning
-supportive care
What does BRAIN stand for?
B- benefits
R- risks
A- alternative
I- intuition
N- no, not now
What does BURP stand for?
B- breath
U- urinate
R- relax
P- position
BURP your patients!
Maternal assessment
- maternal vital signs
- review prenatal record if available
- GTPAL
- Assess for bleeding & rupture of membrane (ROM)
- Assess pain
- Reassess pain
Vaginal examination- done to assess?
-assess progression of labor (dilation, percentage of cervical effacement, fetal presentation, position, station, and fetal membrane status)
Vaginal examination- important to provide what to the client?
Privacy
Dignity
Education
What does ROM stand for?
Rupture of membrane
ROM priority nursing action?
Before TACO
- listen to the baby’s heart tones; see if there is a prolapsed cord, or any fetal distress
THEN TACO
What is Leopold Maneuver ?
done to look for fetal presentation/position
Labor pain is self-limiting
Meaning what?
Self- limiting meaning the pain will stop once you have your baby
Labor pain can be prepared for by?
Prepared for by
-breathing
-relaxation
-water birthing
-music therapy
-even kissing can help
Best position to rotate a baby from posterior to anterior position ?
Hands and knees position
What is the Gate Control Theory?
Reducing or blocking the capacity of nerve pathways to transmit pain
Interventions used the Gate control theory
- massage
-stroking - music
- focal points
- imagery
non-pharmacologic measures
- relaxation & breathing techniques *
position changes/motion - support person
- Effleurage (message on tummy)
- hydrotherapy
- Counter pressure (for back pain, massage)
-music
-imagery - attention focusing
Pharmacologic measures: Analgesia/Opioids meds
-Dilaudid (Hydromophone)
- Fentanyl (sublimaze)
- Stadol (Butorphanol)
- Nubain (Nalbuphine)
- Route: IV
(drugs in ()s will be used on exam)
Pharmacologic measures: Analgesia/Opioids indication
-Can still contractions but takes the edge off them
- gives patient a break for that 1st hour
-Fast and effective
when/how to administer opioids
- give through IV w/contraction (to allow more to go to mom than baby)
- administer slowly
**timing is important*
-given to early: could slow down process or get rid of labor
-given to late: baby can born w/med in them= baby not allowed to breath, move, or eat (give baby narcan)
-give at least a couple hrs before delivery
Opioids effects on mom
Will do the same to baby
- decrease maternal maternal HR & RR
- crosses placenta
- Normal finding in this case: absent or minimal FHR variability
-
Pharmacologic measures: Antiemetics
(drugs in ()s will be used on exam)
-Phenergan
(Promethazine)
-zofran (Ondansetron)
-Reglan (Metoclopramide)
Bicitra (Sodium vitrate/citric acid)
Pharmacologic measures: Antiemetics- ADEs & indications
(Promethazine)
- can also give relaxation feeling
- ADE:has sleepy& foggy effect
(Ondansetron)
-Most common
-Given during labor!!
-Given preOp
Metoclopramide)
-given preOp
-for full stomach; med will move the food down, so it doesnt come back up
(Sodium vitrate/citric acid)
-given preOp (preventative med)
- neutralizes the gastric acids of throw up
med given for episiotomy/laceration repair
Local - 1% Lidocaine
pudendal
local pain relief for second stage
Epidural administration and MOA
injection of a local anesthetic into the epidural space
-pain relief ; 0-4 pain rate throughout birth
-turn off after delivery
Epidural Nursing interventions after administration
right after administration
-BP taken every couple mins, then Q15mins, Q10mins, Q15mins until turned off
-& close eye on BP of the baby as well.
-monitor for bladder distension
Nursing interventions prior to administration Epidural
to prevent Hypotension: give 1000ml or 1 L bolus of LR
Epidural advantages
-Remains alert
-more comfortable + able to participate/move around
-can go from 10/10 pain to little to none
-can still empty bladder/bowels
Epidural disadvantages
Hypotension
-urinary retention (will be straight cath due to not knowing when have to pee)
-pruritus
Longer second stage
-feeling of fuzziness/HA
-It is a “drug”/opioid (effecting baby potential chance)
Maternal hypotension with epidural major s/sx
1st: 20%decreased of BPP from the pre-block baseline (if mom’s BP drops=decreased perfusion/oxygenated blood to baby=fetal distress)
2nd: fetal bradycardia
3rd: absent or minimal FHR variability
Maternal Hypotension with epidural-
Nursing interventions
1:lateral position
2:increase IV rate (to increase perfusion) and give 1000ml bolus IV prophylactic Lactated Ringer or even BP med
3: O2 @ 8-10 L/min via face mask
4: notify anesthesiologist + provider if 1-3 didnt work
-monitorBp and FHR at bedside
- IV vasopressor as ordered (ephedrine)
Complications of epidural and nursing interventions
-Hypotension leading to fetal bradycardia
(POISON)
-“total spinal”
-Spinal HA (when pt has HA the day after-educate to call provider)
-infx
-impotent block or “spotty” block (encourage position changes)
-Epidural hematoma
Spinal injection indication and MOA
-used for c/s (planned)
-provides anesthesia from the nipple down to the feet
-
Spinal injection Nuring interventions prior to administration
PRIOR give 2 Liters LR boluses
General anesthesia used for what kind of birth?
Necessary for emergency c/s
-keeping anesthesia time to a minimum to decrease side effects for/from mother to fetus
