Exam 2 Blueprint Flashcards
What are the major factors that affect the labor process.
🔸 Passanger.
- Size of fetal head
- Fetal presentation
- Fetal lie
- Fetal attitude
- Fetal position
🔸 Passageway
- Also known as the Birth canal.
- is composed of :-
* Boney pelvis
* Soft tissues
🔸 Powers
- Primary powers (Involuntary contractions)
- Secondary powers
What are the 5 p’s
🔸 Passenger
(Fetus & Placenta)
🔸 Passageway
(Birth canal)
🔸 Powers
(Contractions & maternal pushing efforts)
🔸 Psychologic Response
(Emotional response)
🔸 Position of Mother
What are the 4 Main Pelvic Types.
🔸 Gynoid
- Most favorable for delivery.
🔸 Arthropoid
- Possible for vaginal delivery.
🔸 Android
- Risk for a C-section
🔸 Platypelloid
List the Leopold Maneuvers.
🔸 Step 1.
- The patient should be in supine position.
- Palpate the uterine fundus (the top of the uterus) to distinguish the fetus’s position.
- Is the baby lying in a cephalic (head down) or breech (feet down) position?
🔸 Step 2.
- Starting at the top, feel along both sides of the uterus to identify the location of the fetal back.
- The baby’s back will feel smooth, while the pointier parts of the fetus like the knees and elbows.
🔸 Step 3.
- Palpate above the pubic bone and “pinch” the presenting part in an attempt to distinguish how engaged the fetus is in relation to the pelvis.
- If part of the fetus is pushed upward, that means it is not fully engaged in the pelvis; if there is difficulty moving the pinched part, that indicates that the fetus is engaged in the maternal pelvis.
🔸 Step 4.
- For a cephalic presentation, face the patient’s feet.
- Use your fingers to feel for the baby’s face.
Is the fetal head flexed (in a vertex position with chin and limbs tucked, i.e., normal) or extended (face up)?
Stages of labor.
🔸 1st Stage
- Onset of contractions - full dilations of the cervix (10 cm).
🔸 2nd Stage
- Full dilation (10 cm) to Birth.
🔸 3rd Stage (After Birth)
- Birth of the fetus - delivery of the placenta
(The placenta is delivered 5 - 15 minutes after birth).
🔸 4th Stage
- 2 hours after the delivery of the placenta.
1st Stage of Labor
- Onset of contractions - full dilations of the cervix (10 cm).
- 3 phases (Latent, Active, Transition Phase)
➤ Nursing Care.
- Determination of True and False labor.
- Prenatal Data.
- Interview & Admission (Sexual Abuse, Trauma)
- Psychosocial Factors (Hx of sexual abuse)
- Stress in labor (Provide comfort).
- Cultural Factors
- Labs & Diagnostic tests.
* COVID test
* Analysis of urine specimen (Hospital)
* Blood tests (Hospital)
* Group B strep results (Doctor’s office)
* Assessment of the Amniotic membranes & fluid
- Physical Examination
* Vital Signs
* Leopold maneuvers
* Vaginal exams
* Assessment of FHR and patterns
* Assessment of uterine contractions
* General system assessment
- Nursing interventions.
* General hygiene
* Nutrients & fluid intake (Oral & IV {LR})
* Oral intake (Clear fluids {Jello, Honey sticks})
* Elimination (Voiding {b4 epi}, Catheter {after epi}, Bowel elimination)
* Ambulation & positioning
2nd Stage of Labor
- Full dilation (10 cm) to Birth.
- 2 phases (Latent {Calm}, Descent {Active pushing})
➤ Nurse Care.
- Monitor the uterine contractions.
- Monitor the vital signs.
- Preparing for Birth
* Maternal position
* Bearing-down efforts
* FHR & patterns
* Support of father/partner
* Supplies, instruments & equipments
- Birth happens in the delivery room/birthing room
- Immediate assessment & care of the NEWBORN.
* Cord clamping (after 1 full min/60 secs).
* Patent Airways (Important) 🔸
* Preventing cold stress
* Brief assessment with APGAR scoring
* Identification
- Immediate assessment & care of the MOTHER.
* Perineal trauma related to childbirth.
- Perineal lacerations
- Vaginal & Urethral lacerations
- Cervical Injuries
- Episiotomy
3rd Stage of Labor
- After Birth
- From Birth to change of uterus shape
- Birth of the fetus - delivery of the placenta
- The placenta is delivered 5 - 15 minutes after birth.
➤ Nursing Care
- Firmly contracting fundus
- Change in the shape of the uterus
- Sudden gush of dark blood from introitus
- Apparent lengthening of umbilical cord
- Vagina; fullness
- Massage the fundus
- Administer Oxytocin/Pitocin to contract the uterus
4th Stage of Labor
- 2 hours after the delivery of the placenta.
- From Expulsion of placenta to 1st hour postpartum stabilization
➤ Nursing Care
- Expulsion of placenta to 1st hour postpartum stabilization
- Assessment
- Postanesthesia recovery (Monitor the respirations)
- Care of New Mother
- Care of the family
- Family to Newborn relationships
- Assess the vital signs (Every 15 mins)
Mechanism of Birth
- Vertex presentation
- Birth of the head
- Birth of the shoulders
- Birth of the rest of the body
Mechanism of Labor
- The 7 cardinal movements of mechanism of labor that occur in the vertex presentation include:-
➤ Think of “EDFIERE”
* Engagement (the head of the fetus is at O cm) * Descent (Fetus is coming down) * Flexion (Chin of the fetus is on its chest) * Internal Rotation * Extension (Fetus head is back) * Restitution & external rotation * Expulsion (Birth)
Signs preceding labor.
- Lightening or dropping (Crowning)
- Bloody show (Bloody secretion)
- Cervical ripening (Softening of the cervical)
- Backache
- Weight loss
- Surge of energy
- Possible rupture of membrane
- Strong Braxon Hicks contraction
Maternal adaptation
- During labor process the:-
🔸 ↑BP, RR, HR, Cardiac output (due to child birth pain).
🔸 ↑ WBC
🔸 ↑ Temperature
🔸 ↑ Urinary frequency
🔸 ↑ Estrogen (helps with uterine relaxation)
🔸 ↑ Oxytocin, & Prostaglandins (Stimulates uterine contractions)🔹 ↓Blood glucose (becoz they are NPO) 🔹 ↓Progesterone (helps the uterus to relax) 🔹 ↓Gastric motility (due to pain meds & labor) 🔹 Musculoskeletal changes (Back & Joint aches) 🔹 Neurological Changes (↑endorphins)
What are the Pharmacologic Pain Management methods.
🔸 Sedatives
- They are given to women with prolonged labor to prevent anxiety.
- Helps them sleep/rest.
- Barbituates (Seconal) - Crosses the placenta
- Phenothiazines (Phenergan)
- Benzodiazepines (Valium)
🔸 Analgesia & Anesthesia,
* Systemic Analgesia
➤ Opioid Agonist Analgesics
- Not recommented on 2nd stage of labor (causes respiration distress to the mother & fetus)
- Morphine (Crosses the placenta)
- Fentanyl (Given in multiple doses due to short half life)
- Remifentanil (PCA pump only, Short-acting)
➤ Opioid Agonist-Antagonist Analgesics
- Don’t give to opioid addicts mothers.
- Butorphanol (stadol)
- Nalbuphine (Nubain)
➤ Opioid Antagonists.
- Used as an Antidote of opioids effects on the fetus and mother.
- Naloxone Hydrochloride
(Narcan)
What are the Nursing responsibilities
appropriate in providing care for a woman receiving analgesia and anesthesia during labor.
1) Narcotic analgesia
2) Nitrous oxide for analgesia
➤ Pain Assessment
➤ Nursing care
➤ Monitor the BP
➤ Use non-pharmacological interventions
➤ Use pharmacological interventions
- Get an informed consent.
- Correct timing of the medication administration.
- Proper preparation of the procedures.
- Correct administration of the medication, such as:-
* IV
* IM
* Regional Anesthesia
- Monitor for adverse or allergic reactions
- Assess maternal vital signs and fetal heart rate and SpO2 protocol
Nerve block analgesia and anesthesia
Local perineal infiltration anesthesia
Spinal anesthesia
Epidural anesthesia or analgesia
🔸 Nerve block analgesia and anesthesia
- Used when doing an epistiomy or vaginal laceration repair.
- They use Lodacain to numb the site.
🔸 Local perineal infiltration anesthesia
- Used when doing an epistiomy or vaginal laceration repair.
- Epinephrine is added to the solution to prevent excessive bleeding
🔸 Spinal anesthesia
- Its given from the L3 , L4, L5 and subarachnoid space.
- It numbs from the nipples down to the toes.
- Monitor for marked hypotension, impaired placental perfusion & ineffective breathing patterns may occur.
🔸 Epidural anesthesia or analgesia
- Its given from L5.
- It numbs the hips to the toes
🔸 Nitrous oxide for analgesia
- Also known as laughing gas for labor.
- Its a safe and effective form of pain relief
What are non-pharmacologic pain management.
* Focus and relaxation
* Imagery
* Focal point
Non- Pharmacological pain managements are often:-
* Simple
* Safe
* Inexpensive
* Few adverse reactions
Examples of Non-pharmacological measures
- Water therapy
- Aromatherapy
- Music
- Touch & massage
- Application of Hot & Cold compress
- Childbirth preparation methods
- Relaxation & breathing techniques
- Focus & relaxation techniques
- Breathing techniques
