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OB > Exam 1: labor lecture 2 > Flashcards

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

1
Q

What are the stages of labor?

A

Stage 1: dilation
Stage 2: pushing
Stage 3: placenta delivery
Stage 4: recovery

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2
Q

What occurs in stage 1 of labor ?

A
  • 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
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3
Q

Stage 1 of labor Admission assessments labs done

A
  • 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
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4
Q

Stage 1 of labor caring for pt/nursing implications:

A
  • admission assessment
  • Labs
  • Continuous assessments (Maternal & fetal)
  • Positioning
  • Support
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5
Q

What occurs in the 2nd stage of labor?

A
  • Pushing! & Ends in delivery of baby!
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6
Q

Stage 2 of labor caring for pt/ nursing implications

A
  • support: Encouragement, breathing
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7
Q

What occurs in the 3rd stage of labor?

A

Placenta delivery!
- Once baby is delivered, now time to delivery the placenta
- Important stage & time of delivery should be recorded

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8
Q

Stage 3 of labor caring for pt/ nursing interventions

A
  • Pitocin!!
    Watching for hemorrhage
  • Immediate newborn care
  • education
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9
Q

What to watch for and nursing intervention during the 3rd stage of labor?

A

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)

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10
Q

What occurs in the 4th stage of labor?

A

Recovery! 1st 4 hrs
- Bonding and breastfeeding right away
- Fundus checks (want to be firm)

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11
Q

How to care for a patient in the 4th stage of labor?

A
  • PP assessments
  • observe for hemorrhage
  • bonding and breastfeeding
  • education
  • voiding!!!
  • firm fundus
  • measuring amount of blood coming out
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12
Q

5 factors affecting labor (5 P’s)

A
  • passenger
  • Passageway
  • Powers:
  • position of mother
  • psychologic response
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13
Q

Factor affecting labor-Passenger

A

-size of baby
-size of fetal head
-presentation- 97% vertex presentation
- Fetal attitude
-Fetal lie
- Fetal position & station

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14
Q

Factor affecting labor-Passenger
- what is fetal attitude?

A

relation of fetal body to each other

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15
Q

Factor affecting labor-Passenger
- what is lie?

A

Longitudinal or vertical

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16
Q

Factor affecting labor-Passenger
- what is presentation?

A

vertex

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17
Q

Factor affecting labor-Passageway
- includes what?

A

pelvis (more narrow=harder to go through)
soft tissues (related to cervical effacement & dilation)

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18
Q

Factor affecting labor-Powers
- includes what kind of forces?

A

(contractions that will make cervix thin out & dilate)
-primary force: involuntary contractions
- secondary force: voluntary pushing

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19
Q

Factor affecting labor-Psychologic Response dependent on what factors?

A

!!!!Support!!!
- Passed experiences
-pain tolerance & coping abilities
- culture
- emotional readiness
- self-confidence
- childbirth education

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20
Q

Status of membranes- What does TACO mean ?

A

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

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21
Q

Status of membranes- Important to always assess for?

A

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)

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22
Q

Tests done to confirm ruptured membranes

A

-Fern Test: Vaginal fluid swabbed & placed on a microscope slide. Fern pattern confirms amniotic fluid

  • Amnisure test
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23
Q

Perineal trama- lacerations

A

Perineal lacerations usually occur when head is being delivered

  • extent defined in terms of depth: 1st -4th degree
  • Skin (1st) through rectal wall (4th)
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24
Q

Perineal trama- Episiotomy

A

Incision made in the perineum to enlarge the vaginal opening

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25
Q

Introduction of labor- cervical ripening agents/meds

A

Softens the cervix
- Prostaglandin
- Misoprostol (cytotec)

26
Q

Augmentation/
Induction of labor-
hormone/med

A

-Oxytocin
- Pitocin (artifical)

27
Q

Caring for/ nursing implications of laboring client

A
  • clear fluids/food only
  • hydration/IV
  • Voiding/ catheterization
  • Bowel elimination
    -Ambulation/ positioning
    -supportive care
28
Q

What does BRAIN stand for?

A

B- benefits
R- risks
A- alternative
I- intuition
N- no, not now

29
Q

What does BURP stand for?

A

B- breath
U- urinate
R- relax
P- position
BURP your patients!

30
Q

Maternal assessment

A
  • maternal vital signs
  • review prenatal record if available
  • GTPAL
  • Assess for bleeding & rupture of membrane (ROM)
  • Assess pain
  • Reassess pain
31
Q

Vaginal examination- done to assess?

A

-assess progression of labor (dilation, percentage of cervical effacement, fetal presentation, position, station, and fetal membrane status)

32
Q

Vaginal examination- important to provide what to the client?

A

Privacy
Dignity
Education

33
Q

What does ROM stand for?

A

Rupture of membrane

34
Q

ROM priority nursing action?

A

Before TACO
- listen to the baby’s heart tones; see if there is a prolapsed cord, or any fetal distress
THEN TACO

35
Q

What is Leopold Maneuver ?

A

done to look for fetal presentation/position

36
Q

Labor pain is self-limiting
Meaning what?

A

Self- limiting meaning the pain will stop once you have your baby

37
Q

Labor pain can be prepared for by?

A

Prepared for by
-breathing
-relaxation
-water birthing
-music therapy
-even kissing can help

38
Q

Best position to rotate a baby from posterior to anterior position ?

A

Hands and knees position

39
Q

What is the Gate Control Theory?

A

Reducing or blocking the capacity of nerve pathways to transmit pain

40
Q

Interventions used the Gate control theory

A
  • massage
    -stroking
  • music
  • focal points
  • imagery
41
Q

non-pharmacologic measures

A
  • relaxation & breathing techniques *
    position changes/motion
  • support person
  • Effleurage (message on tummy)
  • hydrotherapy
  • Counter pressure (for back pain, massage)
    -music
    -imagery
  • attention focusing
42
Q

Pharmacologic measures: Analgesia/Opioids meds

A

-Dilaudid (Hydromophone)
- Fentanyl (sublimaze)
- Stadol (Butorphanol)
- Nubain (Nalbuphine)
- Route: IV
(drugs in ()s will be used on exam)

43
Q

Pharmacologic measures: Analgesia/Opioids indication

A

-Can still contractions but takes the edge off them
- gives patient a break for that 1st hour
-Fast and effective

44
Q

when/how to administer opioids

A
  • 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
45
Q

Opioids effects on mom

A

Will do the same to baby
- decrease maternal maternal HR & RR
- crosses placenta
- Normal finding in this case: absent or minimal FHR variability
-

46
Q

Pharmacologic measures: Antiemetics

A

(drugs in ()s will be used on exam)
-Phenergan
(Promethazine)
-zofran (Ondansetron)
-Reglan (Metoclopramide)
Bicitra (Sodium vitrate/citric acid)

47
Q

Pharmacologic measures: Antiemetics- ADEs & indications

A

(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

48
Q

med given for episiotomy/laceration repair

A

Local - 1% Lidocaine

49
Q

pudendal

A

local pain relief for second stage

50
Q

Epidural administration and MOA

A

injection of a local anesthetic into the epidural space
-pain relief ; 0-4 pain rate throughout birth
-turn off after delivery

51
Q

Epidural Nursing interventions after administration

A

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

52
Q

Nursing interventions prior to administration Epidural

A

to prevent Hypotension: give 1000ml or 1 L bolus of LR

53
Q

Epidural advantages

A

-Remains alert
-more comfortable + able to participate/move around
-can go from 10/10 pain to little to none
-can still empty bladder/bowels

54
Q

Epidural disadvantages

A

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)

55
Q

Maternal hypotension with epidural major s/sx

A

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

56
Q

Maternal Hypotension with epidural-
Nursing interventions

A

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)

57
Q

Complications of epidural and nursing interventions

A

-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

58
Q

Spinal injection indication and MOA

A

-used for c/s (planned)
-provides anesthesia from the nipple down to the feet
-

59
Q

Spinal injection Nuring interventions prior to administration

A

PRIOR give 2 Liters LR boluses

60
Q

General anesthesia used for what kind of birth?

A

Necessary for emergency c/s
-keeping anesthesia time to a minimum to decrease side effects for/from mother to fetus

OB (8 decks)

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