[Exam 2] Chapter 14 – Nursing Management During Labor and Birth Flashcards
In a study, seven themes emerged about womens needs and expectations during birthing: Physiologic needs
Nutrition, room environment, hygiene, comfort, privacy
In a study, seven themes emerged about womens needs and expectations during birthing: Psychologic needs?
Empathy and advocacy, constant emotional support, and encouragement
In a study, seven themes emerged about womens needs and expectations during birthing: Information needs?
about labor process and hospital policies
In a study, seven themes emerged about womens needs and expectations during birthing: communication needs?
health care provider and familar attendant
In a study, seven themes emerged about womens needs and expectations during birthing: Esteem needs?
sense of value, confidence, involvement in decisions
In a study, seven themes emerged about womens needs and expectations during birthing: security needs?
calming fears
In a study, seven themes emerged about womens needs and expectations during birthing: medical needs?
pain relief and prevention of unnecessary interventions during labor and birth
United States Department of Health and Human Services addresses maternal health in what two objectives?
Reducing maternal deaths and reducing maternal illness and complications due to pregnancy
Maternal Assessment during Labor and Birth: Assessing maternal includes what?
Vital signs including temp, blood pressure, pulse, respiration and pain
Maternal Assessment during Labor and Birth: What to do if no vaginal bleeding on admission?
Vaginal exam is performed to assess cervical dilation
Maternal Assessment during Labor and Birth - Vaginal Exam: Recommendation for when to perform a digital vaginal exam?
At intervals of 4 hours for routine assessment
Maternal Assessment during Labor and Birth - Vaginal Exam: Purpose of performing a vaginal exam?
To assess the amount of cervical dilation, percentage of cervical effacement, and the fetal membrane status to gather information on position, station, and flexion.
Maternal Assessment during Labor and Birth - Vaginal Exam: How is woman positioned here?
Typically on her back during vaginal exam. Check for membrane status , water is used as a lubricant.
Maternal Assessment during Labor and Birth - Vaginal Exam: How is performed?
Index and middle finger inserted into vaginal introitus. Cervix palpated to assess dilation, effacement and position.
Maternal Assessment during Labor and Birth - Vaginal Exam: What happens if cervix is open to any degree?
Presenting fetal part, fetal part, and presence of molding can be assessed.
Maternal Assessment during Labor and Birth - Cervical Dilation and Effacement: 0% effacement is what?
Cervical canal 2 cm long
Maternal Assessment during Labor and Birth - Cervical Dilation and Effacement: Effacement 50% if how long?
cervical canel is 1 cm long
Maternal Assessment during Labor and Birth - Cervical Dilation and Effacement: Effacement 100% is how long?
cervical canal is obliterated
Maternal Assessment during Labor and Birth - Cervical Dilation and Effacement: Dilation at 0 cm shows what?
External cervical os is closed
Maternal Assessment during Labor and Birth - Cervical Dilation and Effacement: Dilation at 5 cm shows what?
External cervical os is halfway dilated
Maternal Assessment during Labor and Birth - Cervical Dilation and Effacement: Dilation at 10 cm shows what?
External os is fully dilated and ready for birth passage
Maternal Assessment during Labor and Birth - Fetal Descent and Presenting Part: How is this assessed?
Gloved index finger is used to palpate the fetal skull through the opened cervix or the butocks.
Maternal Assessment during Labor and Birth - Fetal Descent and Presenting Part: What if presenting part is palpated higher than maternal ischial spines?
Negative number assigned
Maternal Assessment during Labor and Birth - Fetal Descent and Presenting Part: What if presenting part is palpated below the maternal ischial spines?
Positive number is assigned.
Maternal Assessment during Labor and Birth - Fetal Descent and Rupture of Membranes: How will they feel if intact?
Will be felt as a soft bulge that is more prominent during a contraction
Maternal Assessment during Labor and Birth - Fetal Descent and Rupture of Membranes: How will they feel if ruptured?
Woman may report a sudden gash of fluid. May occur as slow trickle of fluid.
Maternal Assessment during Labor and Birth - Fetal Descent and Rupture of Membranes: Priority if membranes rupture?
Assess fetal heart rate (FHR) to identify deceleration, which might indicate cord compression.
Maternal Assessment during Labor and Birth - Fetal Descent and Rupture of Membranes: Signs of intrauterine infection include?
Maternal fever, fetal and maternal tachycardia, foul odor of vaginal discharge, and increased WBC count
Maternal Assessment during Labor and Birth - Fetal Descent and Rupture of Membranes: How to confirm if membranes ruptured?
Sampl efluid taken from vagina via vitrazine yellow dye swab to determine fluids pH. Turns it blue.
Maternal Assessment during Labor and Birth - Fetal Descent and Rupture of Membranes: If the nitrazine test doesn’t work, waht can be done?
Fern test. Fluid obtained, applied to microscopic slide, and allowed to dry. Slide examined for characteristic fern pattern
Maternal Assessment during Labor and Birth - Assessing Uterine Contractions: Uterine contractions with intensity of 30 mmHg or higher indicate what?
cervical dilation
Maternal Assessment during Labor and Birth - Assessing Uterine Contractions: Intensity during active labor and when resting?
Active = 50-80 mmHg
Resting = 5-10 mmHg
Maternal Assessment during Labor and Birth - Assessing Uterine Contractions: Different ways to palpate and describe fundus?
Like tip of the nose (mild), like the chin (moderate), or like the forehead (strong).
Maternal Assessment during Labor and Birth - Performing Leopold Maneuvers: What is this?
Method for determining the presentation, position, and lie of the fetus through four specific steps. Involves palpation and inspection of maternal abdomen
Maternal Assessment during Labor and Birth - Performing Leopold Maneuvers: What is Maneuver 1?
What fetal part (head or buttocks) is located in0 the fundus (top of uterus?
Maternal Assessment during Labor and Birth - Performing Leopold Maneuvers: What is Maneuver 2?
On which maternal side is the fetal back located?
Maternal Assessment during Labor and Birth - Performing Leopold Maneuvers: What is Maneuver 3?
What is the presenting part?
Maternal Assessment during Labor and Birth - Performing Leopold Maneuvers: What is MAneuver 4?
Is the fetal head flexed and engaged in pelvis?
Fetal Assessment During Labor and Birth - Analysis of Amniotic Fluid: How should this appear?
Should be clear
Fetal Assessment During Labor and Birth - Analysis of Amniotic Fluid: What does cloudly or foul-smelling amniotic fluid indicate?
Infection
Fetal Assessment During Labor and Birth - Analysis of Amniotic Fluid: What does green fluid indicate?
Fetus has passed meconium secondary to transient hypoxia.
Fetal Assessment During Labor and Birth - Analysis of FHR: How can this be done?
Using a fetoscope (modified stethoscope attached to headpiece) or Doppler (ultrasound) device
Fetal Assessment During Labor and Birth - Analysis of FHR and Intermittent FHR Monitoring: What does this involve?
Auscultation via a fetoscope or handheld doppler device that uses ultrasound waves that bound off fetal heart.
Fetal Assessment During Labor and Birth - Analysis of FHR and Intermittent FHR Monitoring: Best way to assess fetal-well being?
Start listening to the FHR at the end of the contraction so that late decelerations could be detected.
Fetal Assessment During Labor and Birth - Analysis of FHR and Intermittent FHR Monitoring: How long is this done for?
Assessed for full minute after a contraction. From then on, listen for 30 seconds and multiply value by 2.
Fetal Assessment During Labor and Birth - Analysis of FHR and Intermittent FHR Monitoring: What would cause assessmenets to happen more frequently?
ruptured membranes or the onset of bleeding.
Fetal Assessment During Labor and Birth - Analysis of FHR and Intermittent FHR Monitoring: Where is this most clearly heard on?
On the fetal back.
Fetal Assessment During Labor and Birth - Analysis of FHR and Intermittent FHR Monitoring: How often should FHR and contraction characteristics be assessed? in active labor and while pushing
Every 15-30 in active labor
Every 5-15 mins while pushing.
Fetal Assessment During Labor and Birth - Analysis of FHR and Guidelines for Assessing FHR: Guidlines on when to assess FHR?
Initial 10-20 min continuous on entry
Interrmitent ausculation every 30 mins during active labor and every 15 mins for high-risk woman.
Fetal Assessment During Labor and Birth - Analysis of FHR and Continuous Electronic Fetal Monitoring: What women is this indicated for?
Those receiving oxytocin inufsing, having epidural analgeia, and other problems related to compromise
Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous External Monitoring: How is this set up?
Two ultrasound transducers, each of which attahced to a belt, attached around a womens abdomen.
Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous External Monitoring: What is a tocotransducer?
Pressure-sensitive device that is applied against the uterus fundus. Detects change in uterine pressure and converts the pressure registered into an electronic signal. Placed over fundus.
Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous External Monitoring: Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous External Monitoring: What does the other ultrasound transducer do?
/Records the baseline FHR, long-term variability, accelerations, and decelerations. Positioned on abdomen in midline.
Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous External Monitoring: Signal disruptions can occur why?
Maternal obesity, fetal malpresentation, and fetal movements as well as by artifcat (describes irregular variations or absence of the FHR onfetal monitor record)
Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous Internal Monitoring: WHo is this indicated for?
Women or fetuses considered to be at high risk. Might include multiple gestation, descred fetal movement, maternal fever, or preeclampsia
Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous Internal Monitoring: How is this set up?
Placement of a spiral electrode into the fetal presenting part, usually the head, to assess FHR and a pressure transducer placed internally within uterus to record uterine contractions.
Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous Internal Monitoring: What can a fetal scalp electrode be used to do?
Monitor the fetal heartbeat without monitoring the maternal intrauterine pressure
Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous Internal Monitoring: Criteria for this to be used?
Ruptured membranes
Dilated 2 cm
Presenting fetal part low enough for placement
Skilled practioner available to insert
Fetal Assessment During Labor and Birth - Determining FHR Patterns: Assessment parameters of FHR include what?
Baseline FHR and variability, presence of accelerations, periodic or episodic decelerations, and changes or trends of FHR over time.
Fetal Assessment During Labor and Birth - Determining FHR Patterns: What is a Category I FHR pattern?
Strongly predictive of normal fetal acid-base status at the time of observation and needs no intervention
Fetal Assessment During Labor and Birth - Determining FHR Patterns: What is a Category II Fhr Pattern?
Not predictive of abnormal fetal acid-base status but does require evaluation and continued m onitoring
Fetal Assessment During Labor and Birth - Determining FHR Patterns: What is a Category III FHR Pattern?
Predictive of abnroaml fetal acid-bases status at the time of observation and requires prompt evaluation and interventions such as giving oxygen
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline FHR: What is this?
Refers to the average FHr that occurs during a 10-minute segmenet. Assessed when no contractions present
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline FHR: Normal baseline?
Between 110 and 160 bpm
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline FHR: Fetal Bradycardia occurs when?
When FHR is below 110 bpm and lass 10 minutes or longer. Can be a response to asphyxia
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline FHR: When does Fetal Tachycardia occur?
When FHR greater than 160 bpm that lasts 10 minutes or longer. Can represent an early compensatory response to asphyxia
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: What is this?
Defined as irregular fluctuations in the baseline FHR, which is measured as amplitude of the peak to trough in bpm
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Variability is described in what four categories?
Fluctuation range undetectable
Fluctuation ranges observed at < 5 bpm
Fluctuation range from 6-25 bpm
Fluctuation range > 25 bpm
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Absent or minimal variability typically caused by?
Fetal acidemia secondary ot uteroplacental insufficiency , or cord compression
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Methods to improve uteroplacental blood flow and perfusion through umbilical cord include?
lateral positioning of the mother, increasing IV fluid rate to improve maternal circulation, administer O2 from 8-10 L/min.
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Moderate viability indicates what?
That the autonomic and CNS of the fetus are well developed and well oxygenated. Considered a good sign of fetal well-being
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Marked variability occurs when?
there are 25 or more beats of fluctuation in the FHR
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Causes of marked variability?
Cord prolapse or compression, maternal hypotension, and uterine hyperstimulation
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Interventions for marked variability?
Determining the cause, l,ateral postioning, increasing IV fluid rate, and administering oxyge
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: FHR Variability is an important clinical indicator of?
Predictive fetal acid-base balance and cerebral tissue perfusion. Influced by fetal oxygenation status, CO , and drug effects
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: What happens to FHR as CNS is desensitized by hypoxia and acidosis?
FHR decreases until a smooth baseline pattern appears. Loss of variability may be associated with a poor outcome
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What are these?
Temporary, recurrent changes made in response to a stimulus such as a contraction. FHR can demonstrate patterns of accelerations or deceleration.
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What are fetal accelerations?
Transitiory aburpt increases in FHr abose the baseline that last <30 seconds from onset to peak
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What is a deceleration?
A transient fall in FHR caused by stimulation of the parasympathic nervous system . Described by their shape and classified as early, late, and variable only
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What are early decelerations?
Visually apparent, symmeetrical, and characterized by a gradual decrease in FHR in which the nadir (lowest point) occurs at the peak of the contraction
Rarely decrease more than 30-40 bpm below baseline
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: Usually the onset, nadir, and recovery of the deceleration occur at the same time as the
onset, peak, and recovery of contraction . Most often seen during the active stage of any normal labor during pushing, crowning, or vacuum extraction
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What are late decelerations?
Visually apparent, usually symmetrical, transitory decreases in FHR that occur after the peak of the contraction. Does not return to baseline until after contraction ended
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: Delayed timing of decelerations occurs when?
With the nadir of the uterine contraction
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: Late decelerations associated with what?
Uteroplacental insufficiency, which occurs when blood flow within the intervillious space is decreased to the extent that feetal hypoxia or myocardial depression exists
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: Recurrent or intermittent late decelerations are always what category?
II or III regardless of depth of develeration
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What do variable decelerations present as?
Viually apparent abrupt decreases in FHR below baseline and have an unpredictable shape on the FHR baseline, possibly demonstrating no consistent relationship to uterine contractions
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: Variable decelerations are associated with?
Cord compression
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: Prolonged decelerations are what?
Abrupt FHR declines of at least 15 bpm that last longer than 2 minutes but less than 10 minutes. Usually drop sto less than 90 bpm. Many factors are associated with this pattern including prolonged cord compression, abruptio placenta, and cord prolapse
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What is the sinusoidal pattern?
Described as having a visually apparent smoth, sinewave liek undulating pattern in the FHR baseline with cycle frequency of 3-5 bpm that persist for > 20 mins
Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What is the sinusoidal pattern associated with?
Derangement of CNS control of FHR and occurs when a severe degree of hypoxi secondary to fetal anemia and hypovolemia is present
Fetal Assessment During Labor and Birth - Umbilical Cord Blood Analysis: What does this identify?
Presence of intrapartum hypoxia and acidemia. Considered good indicator of fetal oxygenation and acid-base condiiton at birth.
Fetal Assessment During Labor and Birth - FetalScalp Stimulation: Abnormal buildup of carbon dioxide are reflected as what on FHR?
Abnormal FHR patterns as well as fetal inactivity
Fetal Assessment During Labor and Birth - FetalScalp Stimulation: What is done to promote fetal stiulation?
With vibroacoustic stimulator applied to womens abdomen and turned on for 3-5 seconds to produce sound and vibration. Will respond by moving in conjunction with the acceleration of 15 bpm above the baseline heart that lasts at least 15 seconds.
Promoting Comfort and Providing Pain Management During Labor: Physical causes of pain during labor include what?
Cervical stretching hypocia of uterine muscle, pressure on urethra, bladder, and rectum
Promoting Comfort and Providing Pain Management During Labor: In second stage, pain is caused by?
Stretching of vagina and perineum and compression of pelvic structures.
Nonpharmacologic Measures for Comfort during Labor: Most of these theories are based on the gate control theory of pain, which proposes what?
That local physical stimulation can interfere with pain stimuli by closing a hypothetical gate in the spinal cord, thus blocking pain signals from reaching the brain
Nonpharmacologic Measures for Comfort during Labor - Continuous Labor Support: How does this worok?
Offering sustained presence to laboring woman by providing emotional support, comfort measures, advocacy, information and advice.
Nonpharmacologic Measures for Comfort during Labor - Continuous Labor Support: What can support person assist the woman with?
To ambulate, reposition herself. and use breathing techniques.
Also acupressure, massage, music therapy, and therapeutic touch
Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: What is this?
Involves showering or soaking in a regular tub or whirlpool bath. Woman sits or stands in a shower chair in a warm shower and allows water to slide over her abdomen and back.
Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: What happens if they are in a tub or whirlpool?
Woman immerses herself in warm water for relaxation and relief of discomfort.
Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: Why is this beneficial?
Warmth and buoyancy help to release muscle tension and can impart a sense of well-being.
Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: What does warm water do to the the body?
Provides soothing stimulation of nerves in the skin, promoting vasodilation and reduction in catecholamines. Contractions less painful.
Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: Benefits of using this during labor?
Aids labor process, minimizes use of analgesic meds, offers fast acting pain and anxiety relief
Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: Recommendation for initiating hydrotherapy is what?
Woman to be in active labor (more than 5 cm dilateD) to prevent the slowing of labor contractions.
Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: Potential risks with this incldude what?
hyperthermia, hypothermia, changes in maternal heart rate, fetal tachycardia, and unplanned underwater birth.
Nonpharmacologic Measures for Comfort during Labor - Ambulation and Position Change: What evidence is there for walking during first stage of labor?
Reduce the length of labor and is not associated with increased intervention.
Nonpharmacologic Measures for Comfort during Labor - Ambulation and Position Change: How often should woman change positions?
Every 30 mins
Nonpharmacologic Measures for Comfort during Labor - Ambulation and Position Change: Why should supine positions be avoided?
May interfere with labor progress and can cause compression of vena cava and decrease blood returnt o heart
Nonpharmacologic Measures for Comfort during Labor - Acupuncture/Acupressure: What does acupuncture involve?
Stimulating key trigger points with needles. Purpose is to restore thus diminishing pain. Stimulating the trigger points causes release of endorphins, reducing the perception of pain.
Nonpharmacologic Measures for Comfort during Labor - Acupuncture/Acupressure: What does acupressure involve?
Application of a firm finger or massage used in acupuncture to reduce pain sensation.
Nonpharmacologic Measures for Comfort during Labor - Using Heat/Cold: Heat applied where
Womans back, lower abdomen, groin, or perineum.
Nonpharmacologic Measures for Comfort during Labor - Using Heat/Cold: Why is heat used?
To relieve chills or trembling, decrease joint stiffness, reduce muscle spasms, and increase CT extensibility
Nonpharmacologic Measures for Comfort during Labor - Using Heat/Cold: Where is cold therapy applied?
TO the womans back, chest, and or face.
Nonpharmacologic Measures for Comfort during Labor - Using Heat/Cold: Why does cold help?
RElieves muscle spasms and reduces inflammation and edema
Nonpharmacologic Measures for Comfort during Labor - Attention Focusing and Imagery: Why is this helpful?
Because the woman uses many sense of mind to focus on stimuli to calm themselves down
Nonpharmacologic Measures for Comfort during Labor - Effleurage and Massage: What is Effleurage?
A light, stroking, superficial touch of the abdomen, in rhythm with breathing during contractions
Nonpharmacologic Measures for Comfort during Labor - Effleurage and Massage: Why is Effleurage used?
AS a relaxation and distraction technique from discomfort.
Nonpharmacologic Measures for Comfort during Labor - Effleurage and Massage: WHy are messages effective?
By increasing production of endorphins in the body. Reduce transmission of signals between nerve cells
Nonpharmacologic Measures for Comfort during Labor - Breathing Techniques: Benefits of practicing this include what?
Automatic response to pain
Increases relaxation and can be used to deal with life’s everyday stresses
Provides a sense of well-being and a measure of control
Nonpharmacologic Measures for Comfort during Labor - Breathing Techniques: What is the first pattern of breathing?
Slow-paced breathing.Woman inhales slowly through her nose and exhales through pursed lips. Rate is 6-9 bpm
Nonpharmacologic Measures for Comfort during Labor - Breathing Techniques: What is the second pattern of breathing?
Woman inhales and exhales through her mouth at a rate of four breaths every 5 seconds
Nonpharmacologic Measures for Comfort during Labor - Breathing Techniques: What is the third pattern?
Breathing is puncutated every few breaths by a force exhalation through pursed lips
Pharmacologic Measures for Comfort during Labor: What is Neuraxial Analgesia/Anesthesia?
Administration of analgesic (opioids) or anesthetic (capable of producing a loss sensation in area of body), either continuously or intermittently, into epidural or intrathecal space to relieve pain
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia: What does this involve?
The use of one or more drugs administered orally, intramuscularly, or intravenously, and become distributed through body through circulatory sysem
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia: Most important thing to watch out for with these drugs?
Respiratory depresion
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia: What can happen if opioids given close to time of birth?
Can cause CNS depression in the newborn, needing naloxone to reverse the depressants effects of opioids . Will cross placenta.
Have birth within 1 hour or after 4 hours of adminisration
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia: Typically administered how?
Parenterally, though an existing IV line.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Opioids: What are these?
Morphine like medications that treat moderate to severe pain.. Administered IV.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Opioids: Associated with what?
Newborn respiratory depression, decreased alertness, inhibited sucking and a delay in effective feeding
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Opioids: How do they work?
Decrease transmission of pain impulses by binding to receptor site pathways that transmit pain signals to brain.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Opioids: What side effects can this have on woman?/
N/V, pruritis, delayed gastric emptying, drowsiness, and hypoventilation .
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Opioids: Why may opioid antagonists be given?
To reverse the side effects such as pruritis, urinary retention, N/V.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Antiemetics: Combined with opioiod to do what?
Decrease nausea and vomiting and lessen anxiety. They potentiate effectiveness of opioid.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Antiemetics: What drugs included here?
Promethazine (Phenergan - IV)
Hydroxyzine (Vistaril - PO or IM)
Prochlorperazine (Compazine - IV or IM with Morphine Sulfate)
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Benzodiazepines: What are they used?
For minor transquilizing and sedative effects.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Benzodiazepines: Why is Diazepam given?
IV to stop seizures resulting from eclampsia. Can calm woman who is out of control as well.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Benzodiazepines: Side effect with Lorazepam (Ativan)?
Can be used for its tranquilziing effect, but increased sedation occurs.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Benzodiazepines: What does Midazolam (Versed) do?
IV - produces good amnesia but no anelgesia.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Benzodiazepines: What opioids may be given?
Morphine
Merperidine (Demerol)
Butorphanol
Nalbuphine (Nubain)
Fentanyl
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Benzodiazepines: What antiemetics may be given?
Hydrozyzine (Vistaril)
Promethazine (Phenergan)
Prochlorperazine (COmpazine)
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Inhaled Analgesics: What to know about nitrous oxide for labor pain?
Half nitrous oxide gas is mixed with half oxygen. Is known as laughing gas
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Inhaled Analgesics: Potential side effects?
N/V, dizziness, dysphoria
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Regional Analgesia/Anesthesia: What does this provide to woman?
Provides pain relief without loss of consciousness.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Regional Analgesia/Anesthesia: What does Obstetric regional analgesia refer to?
A partial or complete lsos ofpain sensation below the T8 to T10 level of spinal cord
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Regional Analgesia/Anesthesia: Routes for this include what?
epidural block, CSE, local infiltration, pudendal block, or spinal analgesia.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Epidural Analgesia: What does this involve during labor and borth? How is it given?
Involves injection of lacal anesthetic agent (lidocaine or bupivacaine) and an opioid analgesic agent (morphine) into lumbar epidural space. Small catheter placed to provivde continuous access.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Epidural Analgesia: What does an epidural involve?
Injection of drug into the epidural space.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Epidural Analgesia: Who cannot use this?
Those who have previous history of spinal surgery or spinal abnormalities, coagulation defects, cardiac disease, or obesity
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Epidural Analgesia: Complications of this?
N/V, Hypotension, FEver, Pruritus, IV injection, maternal fever, or allergic reaction. Ensure that woman avoids supine position
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Combined Spinal-Epidural Analgesia: What does this involve?
Inserting the epidural needle into the epidural space and also inserting a small-gauge spinal needle through the epidural needle into the subarachnoid space.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Combined Spinal-Epidural Analgesia: How fast is this?
Relief within 3-5 minutes and can last up to 3 hours.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Combined Spinal-Epidural Analgesia: Why is CSE Analgesia so great?
Because the womans motor function remain active.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Combined Spinal-Epidural Analgesia: Complications of this?
Maternal hypotension, intravascular injection, accidental intrathecal blockade, and postdural puncture headache
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Patient Controlled Epidural- Analgesia: How does this work?
Use of an indwelling epidural catheter with infusion of medication and a programmed pump that allows woman to control dosing.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Local Infiltration: What does this involve?
Injection of a local anesthetic, such as lidocaine, into superficial perineal nerves to numb the perineal area. Done before perofrming an episiotomy or before suturing a laceration.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Pudendal Nerve Block: What is this?
Injection of a local anesthetic agent into the pudendal nerves near each ischial spine. Provides pain relief in the lower vagina.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Pudendal Nerve Block: When is this used?
For the second stage of labor, an episiotomy, or an perative vaginal birth with outlet forceps or vacuum extractor. Needs to be used 15 minutes before intended task.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Spinal (Intrathecal) Analgesia/Anesthestia: What is this?
Injection of an anesthetic “caine” agent, with or without opioids into teh subarachnoid space to provide pain relief during labor or cesarean birth.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Spinal (Intrathecal) Analgesia/Anesthestia: When is a intrathecal narcotic given?
Given during active phase (5cm or more of dilation). Maintains motor function and sensation.
Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Spinal (Intrathecal) Analgesia/Anesthestia: How long does the narcotics duration last?
May be only a few hours and not last through the entire labor
Pharmacologic Measures for Comfort during Labor - General Anesthesia: What is this reserved for?
Emergency C-Section where there is not enough time to provide spinal or epidural anesthesia.
Pharmacologic Measures for Comfort during Labor - General Anesthesia: What drug is typically given?
Thiopental or propofol is given IV to produce unconsciousness. Followed by muscle relaxant.
Pharmacologic Measures for Comfort during Labor - General Anesthesia: Primary complication with this?
FEtal depression, along with uterine relaxation and potential maternal vomiting and aspiraiton.
Pharmacologic Measures for Comfort during Labor - General Anesthesia: How do you reduce gastric acidiity?
Administer nonparticulate (clear) oral antacid or PPI
Nursing Management During First Stage of Labor: What will nursing care during this tage include?
Taking admission history, checking results of labs, amniocentesis, genetic studies, and ask woman about childbirth preparation
Nursing Management During First Stage of Labor: Key nursing interventions?
Identify estimated date of birth
Perform Leopold maneuvers to fetermine fetal position
Check amniotic fkuid
Nursing Management During First Stage of Labor: Guidelines for recording care include what?
All care rendered to prove standards met.
Nursing interventions before and after notifying provider
All flow sheets and forms, to validate care given
Facts, not personal opinions
Nursing Management During First Stage of Labor - Assessing Woman Upon Admission: Highest priorities once admitted include what?
Assessing FHR, assessing cervical dilation/effacement, and determining whether membranes ruptured
Nursing Management During First Stage of Labor - Assessing Woman Upon Admission: What information to gather during phone assessmenet?
Estimated DOB
Fetal Movement
Parity, gravida and previous birth experience
Characteristics of labor
Appearance of any vaginal bloody show.
Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Maternal Health HX and Cultural Assessment: What should maternal health history include?
Womans name/age and name of delivering health care provider.
Reason for admission, prenatal record ata, results of any lab tests, past pregnancy, and obstetric history.
Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Maternal Health HX and Cultural Assessment: It is critical to do what if woman has diabetes?
Monitor her glucose levels duringn labor, prepare for surgical birth if dystocia of labor occurs, and allert the newborn nursery of potential hypoglycemia.
Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Physical Exam: What assessments doees this include?
Pain level and coping behaviors demonstrated.
Uterine activity, including contraction frequency, duration
Fetal Status
Cervical Dilation
Status of membranes
Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies :What tests are usually included?
Urinalysis via clean-catch urine specimen and CBC.
Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies :What is GBS?
Gram-positive organism that colonizies in female tract. Women asymptomatic but newborn can catch. Mortality rate increased
Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies: When are women screened for GBS?
At 35-37 weeks gestation.
Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies: Maternal infections associated with GBS include what?
Acute chorioamnionitis, endometritis, and UTI.
Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies: NEonatal signs of GBS include what?
Pneumonia and sepsis.
Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies: What do GBS carriers receive ?
Intravenous antibiotic prophylaxis (penicillin) at onset of labor or ruptured membranes
Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies: What are women who are HIV positive given?
Zidovudine (2mg/kg IV over an hour until birth)
or
Nevirapine at oneset of labor.
Newborn given Zidovudine orally for 6 weeks
Nursing Management During First Stage of Labor - Continuing Assessment During First Stage of Labor: How often are VS assessed?
Every hour during latent phase.
Every 30 minutes during active and transition phases.
Nursing Management During First Stage of Labor - Continuing Assessment During First Stage of Labor: How often is temperature taken?
Every 4 hours throughout first stage of labor
Every 2 hours after membranes ruptured.
Nursing Management During First Stage of Labor - Continuing Assessment During First Stage of Labor: How often are uterine contractions monitored?
Every 30-60 mins during latent phase
Every 15-30 minutes during active phase
Every 15 mins during transition
Nursing Management During First Stage of Labor - Continuing Assessment During First Stage of Labor: How often should FHR be assessed?
Every 30-60 mins during latent
Active Phase, every 15-30 mins
Nursing Management During First Stage of Labor - Continuing Assessment During First Stage of Labor: Nursing interventions should include what on admission?
ASking about expecations about birth
Presenting information about fetal monitoring equipment.
Monitoring mother Vs to obtain baseline
REassure that labor progress will be monitored
Nursing Management During First Stage of Labor - Continuing Assessment During First Stage of Labor: Nursing interventions as women progresses through first stage of labor?
Encourage womans parter to participate
Provide clear fluid
Initiate comfort measures
Keep perineal area clean and dry
Monitor maternal vital signs frequently
Communicate requests from woman to appropriate personnel
Nursing Management During Second Stage of Labor: Current evidence for management of second stage supports the practices of?
Delayed pushing, spontaneous (nondirected) pushing, and maternal choice positions
Nursing Management During Second Stage of Labor: Nursing care here focuses on what?
Implement strats to prolong early passive phase of fetal descent, supporting involuntary bearing-down efforts, providing instruction and assistance, and using maternal positions that enhance descent
Nursing Management During Second Stage of Labor: Common practice is to coach woman to do what with every contraction?
Closed glottis pushing, starting at 10 cm dilation
Nursing Management During Second Stage of Labor: What is a first-degree laceration?
Extends through the skin
Nursing Management During Second Stage of Labor: What is a second-degree laceration?
Extends through the muscles of the perineal body
Nursing Management During Second Stage of Labor: what is a third-degree laceration?
Continues through the anal sphincter muscle
Nursing Management During Second Stage of Labor: What is a fourth-degree laceration?
Involves teh anterior rectal wall
Nursing Management During Second Stage of Labor: What is an episiotomy?
An incision made in the perineum to enlarge the vaginal outlet and theoretically to shorten the second stage of labor
Continuous Assessment During Second Stage of Labor: Assessments involve identifying the signs typical of second stage of labor including?
Increase ina pprehension or irritability
Spontaneous rupture of membranes
Appearance sweat on upper lip
Low grunting sounds
Increase in blood tinged show
Continuous Assessment During Second Stage of Labor: Associated signs with determining progress of labor includue what?
Bulging of perineum, labial separation, advancing and retreating of newborns head, and crowning
Continuous Assessment During Second Stage of Labor: When is it appropriate for woman to push?
If cervix is fully dilated to 10 cm.
Continuous Assessment During Second Stage of Labor and Nursing Interventions: What does this focus on?
Motivating the woman, assisting with positioning, and encouraging her to put all her efforts to pushing.
Continuous Assessment During Second Stage of Labor and Nursing Interventions: What is the Lithotomy position?
With feet up in stirrups. Most convenient position for caregivers,
Continuous Assessment During Second Stage of Labor and Nursing Interventions: What are some important nursing interventions here?
Providing continuous comfort measures
Telling them to push only when they feel urge, delay pushing for 90 mins after dilation. Short pushes of 6-7 seconds, and pushing several times with each contraction
Continuous Assessment During Second Stage of Labor and Nursing Interventions: How can you prepare for and assist with delivery?
Notify health care provider of estimated time frame for birth
Prepare delivery bed
Offer a mirror and adjust it so they can watch birth
Set up delivery instruments needed while maintaining sterility
REcord the time of birth
Continuous Assessment During Second Stage of Labor and Nursing Interventions - Birth: What to do once woman positioned for birth?
Cleanse the vulva and perineal areas
Continuous Assessment During Second Stage of Labor and Nursing Interventions - Birth: What does the health care provider do as soon as the head emerges?
Provider suctions the newborns mouth first and then the nares with bulb syringe to prevent aspiratio of mucus.
Continuous Assessment During Second Stage of Labor and Nursing Interventions - Immediate Care of Newborn: Assessment of newborn should immediately begin using apgar score. What is this?
Assesses five parameters
Heart Rate Respiratory Effort Muscle Tone REsponse to Irritation Stimulus Color
Continuous Assessment During Third Stage of Labor: What happens during the third stage of labor?
Strong uterine contractions continue at regular intervals bc of oxytocin. Uterine muscles shorten, leading to decrease in size of uterus which shears placenta away from attachment site.
Continuous Assessment During Third Stage of Labor: Nursing care here includes what?
Newborn assessment and observing for signs of placental separating, assist with delivery of placenta, and cording time of expulsion
Continuous Assessment During Third Stage of Labor: What does skin-to-skin contact immediately after birth do to the mother?
Further augment maternal oxytocin levels, streghten uterine contractions to prevent hemorrhage
Continuous Assessment During Third Stage of Labor: Assessments here include what?
Monitor placentral separation by looking for firmly contracting uterus and change inn uterine shape.
Examine placental and fetal membranes
Assess for any perineal traum
Continuous Assessment During Third Stage of Labor: Nursing interventions include what
Describe process of placental separation
Administer oxytocic agent if ordered
Cleaning and assisting client into comfortable position
Providing warmth by replacing warmed blankets over woman.
Continuous Assessment During fourth Stage of Labor: How often are VS taken here?
Every 15 mins 1 hour after birth
Every 30 for next hour if needed
Continuous Assessment During fourth Stage of Labor: Decrease in BP indicates what?
An uterine hemorrhage
Continuous Assessment During fourth Stage of Labor: Elevated pulse rate may be an early sign of what?
BLood loss
Continuous Assessment During fourth Stage of Labor: How often should you assess fundal height?
Every 15 mins during first hour following birth. Needs to remain firm to prevent excessive postpartum bleeding
Continuous Assessment During fourth Stage of Labor: How often should you assess vaginal discharge?
Every 15 minutes for the first hour and every 30 minutes for the next hour
Continuous Assessment During fourth Stage of Labor: Nursing Interventions here?
Providing support and information regarding episiotomy repair
Applying an ice pack
Assist with hygiene and perineal care
Asses for postpartum hemorrhage and urinary retention
