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NRSG 206: OB > [Exam 2] Chapter 14 – Nursing Management During Labor and Birth > Flashcards

[Exam 2] Chapter 14 – Nursing Management During Labor and Birth Flashcards

1
Q

In a study, seven themes emerged about womens needs and expectations during birthing: Physiologic needs

A

Nutrition, room environment, hygiene, comfort, privacy

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2
Q

In a study, seven themes emerged about womens needs and expectations during birthing: Psychologic needs?

A

Empathy and advocacy, constant emotional support, and encouragement

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3
Q

In a study, seven themes emerged about womens needs and expectations during birthing: Information needs?

A

about labor process and hospital policies

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4
Q

In a study, seven themes emerged about womens needs and expectations during birthing: communication needs?

A

health care provider and familar attendant

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5
Q

In a study, seven themes emerged about womens needs and expectations during birthing: Esteem needs?

A

sense of value, confidence, involvement in decisions

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6
Q

In a study, seven themes emerged about womens needs and expectations during birthing: security needs?

A

calming fears

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7
Q

In a study, seven themes emerged about womens needs and expectations during birthing: medical needs?

A

pain relief and prevention of unnecessary interventions during labor and birth

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8
Q

United States Department of Health and Human Services addresses maternal health in what two objectives?

A

Reducing maternal deaths and reducing maternal illness and complications due to pregnancy

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9
Q

Maternal Assessment during Labor and Birth: Assessing maternal includes what?

A

Vital signs including temp, blood pressure, pulse, respiration and pain

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10
Q

Maternal Assessment during Labor and Birth: What to do if no vaginal bleeding on admission?

A

Vaginal exam is performed to assess cervical dilation

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11
Q

Maternal Assessment during Labor and Birth - Vaginal Exam: Recommendation for when to perform a digital vaginal exam?

A

At intervals of 4 hours for routine assessment

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12
Q

Maternal Assessment during Labor and Birth - Vaginal Exam: Purpose of performing a vaginal exam?

A

To assess the amount of cervical dilation, percentage of cervical effacement, and the fetal membrane status to gather information on position, station, and flexion.

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13
Q

Maternal Assessment during Labor and Birth - Vaginal Exam: How is woman positioned here?

A

Typically on her back during vaginal exam. Check for membrane status , water is used as a lubricant.

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14
Q

Maternal Assessment during Labor and Birth - Vaginal Exam: How is performed?

A

Index and middle finger inserted into vaginal introitus. Cervix palpated to assess dilation, effacement and position.

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15
Q

Maternal Assessment during Labor and Birth - Vaginal Exam: What happens if cervix is open to any degree?

A

Presenting fetal part, fetal part, and presence of molding can be assessed.

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16
Q

Maternal Assessment during Labor and Birth - Cervical Dilation and Effacement: 0% effacement is what?

A

Cervical canal 2 cm long

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17
Q

Maternal Assessment during Labor and Birth - Cervical Dilation and Effacement: Effacement 50% if how long?

A

cervical canel is 1 cm long

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18
Q

Maternal Assessment during Labor and Birth - Cervical Dilation and Effacement: Effacement 100% is how long?

A

cervical canal is obliterated

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19
Q

Maternal Assessment during Labor and Birth - Cervical Dilation and Effacement: Dilation at 0 cm shows what?

A

External cervical os is closed

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20
Q

Maternal Assessment during Labor and Birth - Cervical Dilation and Effacement: Dilation at 5 cm shows what?

A

External cervical os is halfway dilated

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21
Q

Maternal Assessment during Labor and Birth - Cervical Dilation and Effacement: Dilation at 10 cm shows what?

A

External os is fully dilated and ready for birth passage

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22
Q

Maternal Assessment during Labor and Birth - Fetal Descent and Presenting Part: How is this assessed?

A

Gloved index finger is used to palpate the fetal skull through the opened cervix or the butocks.

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23
Q

Maternal Assessment during Labor and Birth - Fetal Descent and Presenting Part: What if presenting part is palpated higher than maternal ischial spines?

A

Negative number assigned

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24
Q

Maternal Assessment during Labor and Birth - Fetal Descent and Presenting Part: What if presenting part is palpated below the maternal ischial spines?

A

Positive number is assigned.

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25
Q

Maternal Assessment during Labor and Birth - Fetal Descent and Rupture of Membranes: How will they feel if intact?

A

Will be felt as a soft bulge that is more prominent during a contraction

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26
Q

Maternal Assessment during Labor and Birth - Fetal Descent and Rupture of Membranes: How will they feel if ruptured?

A

Woman may report a sudden gash of fluid. May occur as slow trickle of fluid.

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27
Q

Maternal Assessment during Labor and Birth - Fetal Descent and Rupture of Membranes: Priority if membranes rupture?

A

Assess fetal heart rate (FHR) to identify deceleration, which might indicate cord compression.

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28
Q

Maternal Assessment during Labor and Birth - Fetal Descent and Rupture of Membranes: Signs of intrauterine infection include?

A

Maternal fever, fetal and maternal tachycardia, foul odor of vaginal discharge, and increased WBC count

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29
Q

Maternal Assessment during Labor and Birth - Fetal Descent and Rupture of Membranes: How to confirm if membranes ruptured?

A

Sampl efluid taken from vagina via vitrazine yellow dye swab to determine fluids pH. Turns it blue.

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30
Q

Maternal Assessment during Labor and Birth - Fetal Descent and Rupture of Membranes: If the nitrazine test doesn’t work, waht can be done?

A

Fern test. Fluid obtained, applied to microscopic slide, and allowed to dry. Slide examined for characteristic fern pattern

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31
Q

Maternal Assessment during Labor and Birth - Assessing Uterine Contractions: Uterine contractions with intensity of 30 mmHg or higher indicate what?

A

cervical dilation

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32
Q

Maternal Assessment during Labor and Birth - Assessing Uterine Contractions: Intensity during active labor and when resting?

A

Active = 50-80 mmHg

Resting = 5-10 mmHg

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33
Q

Maternal Assessment during Labor and Birth - Assessing Uterine Contractions: Different ways to palpate and describe fundus?

A

Like tip of the nose (mild), like the chin (moderate), or like the forehead (strong).

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34
Q

Maternal Assessment during Labor and Birth - Performing Leopold Maneuvers: What is this?

A

Method for determining the presentation, position, and lie of the fetus through four specific steps. Involves palpation and inspection of maternal abdomen

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35
Q

Maternal Assessment during Labor and Birth - Performing Leopold Maneuvers: What is Maneuver 1?

A

What fetal part (head or buttocks) is located in0 the fundus (top of uterus?

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36
Q

Maternal Assessment during Labor and Birth - Performing Leopold Maneuvers: What is Maneuver 2?

A

On which maternal side is the fetal back located?

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37
Q

Maternal Assessment during Labor and Birth - Performing Leopold Maneuvers: What is Maneuver 3?

A

What is the presenting part?

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38
Q

Maternal Assessment during Labor and Birth - Performing Leopold Maneuvers: What is MAneuver 4?

A

Is the fetal head flexed and engaged in pelvis?

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39
Q

Fetal Assessment During Labor and Birth - Analysis of Amniotic Fluid: How should this appear?

A

Should be clear

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40
Q

Fetal Assessment During Labor and Birth - Analysis of Amniotic Fluid: What does cloudly or foul-smelling amniotic fluid indicate?

A

Infection

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41
Q

Fetal Assessment During Labor and Birth - Analysis of Amniotic Fluid: What does green fluid indicate?

A

Fetus has passed meconium secondary to transient hypoxia.

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42
Q

Fetal Assessment During Labor and Birth - Analysis of FHR: How can this be done?

A

Using a fetoscope (modified stethoscope attached to headpiece) or Doppler (ultrasound) device

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43
Q

Fetal Assessment During Labor and Birth - Analysis of FHR and Intermittent FHR Monitoring: What does this involve?

A

Auscultation via a fetoscope or handheld doppler device that uses ultrasound waves that bound off fetal heart.

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44
Q

Fetal Assessment During Labor and Birth - Analysis of FHR and Intermittent FHR Monitoring: Best way to assess fetal-well being?

A

Start listening to the FHR at the end of the contraction so that late decelerations could be detected.

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45
Q

Fetal Assessment During Labor and Birth - Analysis of FHR and Intermittent FHR Monitoring: How long is this done for?

A

Assessed for full minute after a contraction. From then on, listen for 30 seconds and multiply value by 2.

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46
Q

Fetal Assessment During Labor and Birth - Analysis of FHR and Intermittent FHR Monitoring: What would cause assessmenets to happen more frequently?

A

ruptured membranes or the onset of bleeding.

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47
Q

Fetal Assessment During Labor and Birth - Analysis of FHR and Intermittent FHR Monitoring: Where is this most clearly heard on?

A

On the fetal back.

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48
Q

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

A

Every 15-30 in active labor

Every 5-15 mins while pushing.

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49
Q

Fetal Assessment During Labor and Birth - Analysis of FHR and Guidelines for Assessing FHR: Guidlines on when to assess FHR?

A

Initial 10-20 min continuous on entry

Interrmitent ausculation every 30 mins during active labor and every 15 mins for high-risk woman.

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50
Q

Fetal Assessment During Labor and Birth - Analysis of FHR and Continuous Electronic Fetal Monitoring: What women is this indicated for?

A

Those receiving oxytocin inufsing, having epidural analgeia, and other problems related to compromise

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51
Q

Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous External Monitoring: How is this set up?

A

Two ultrasound transducers, each of which attahced to a belt, attached around a womens abdomen.

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52
Q

Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous External Monitoring: What is a tocotransducer?

A

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.

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53
Q

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?

A

/Records the baseline FHR, long-term variability, accelerations, and decelerations. Positioned on abdomen in midline.

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54
Q

Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous External Monitoring: Signal disruptions can occur why?

A

Maternal obesity, fetal malpresentation, and fetal movements as well as by artifcat (describes irregular variations or absence of the FHR onfetal monitor record)

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55
Q

Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous Internal Monitoring: WHo is this indicated for?

A

Women or fetuses considered to be at high risk. Might include multiple gestation, descred fetal movement, maternal fever, or preeclampsia

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56
Q

Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous Internal Monitoring: How is this set up?

A

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.

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57
Q

Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous Internal Monitoring: What can a fetal scalp electrode be used to do?

A

Monitor the fetal heartbeat without monitoring the maternal intrauterine pressure

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58
Q

Analysis of FHR and Continuous Electronic Fetal Monitoring - Continuous Internal Monitoring: Criteria for this to be used?

A

Ruptured membranes

Dilated 2 cm

Presenting fetal part low enough for placement

Skilled practioner available to insert

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59
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns: Assessment parameters of FHR include what?

A

Baseline FHR and variability, presence of accelerations, periodic or episodic decelerations, and changes or trends of FHR over time.

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60
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns: What is a Category I FHR pattern?

A

Strongly predictive of normal fetal acid-base status at the time of observation and needs no intervention

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61
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns: What is a Category II Fhr Pattern?

A

Not predictive of abnormal fetal acid-base status but does require evaluation and continued m onitoring

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62
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns: What is a Category III FHR Pattern?

A

Predictive of abnroaml fetal acid-bases status at the time of observation and requires prompt evaluation and interventions such as giving oxygen

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63
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline FHR: What is this?

A

Refers to the average FHr that occurs during a 10-minute segmenet. Assessed when no contractions present

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64
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline FHR: Normal baseline?

A

Between 110 and 160 bpm

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65
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline FHR: Fetal Bradycardia occurs when?

A

When FHR is below 110 bpm and lass 10 minutes or longer. Can be a response to asphyxia

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66
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline FHR: When does Fetal Tachycardia occur?

A

When FHR greater than 160 bpm that lasts 10 minutes or longer. Can represent an early compensatory response to asphyxia

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67
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: What is this?

A

Defined as irregular fluctuations in the baseline FHR, which is measured as amplitude of the peak to trough in bpm

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68
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Variability is described in what four categories?

A

Fluctuation range undetectable

Fluctuation ranges observed at < 5 bpm

Fluctuation range from 6-25 bpm

Fluctuation range > 25 bpm

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69
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Absent or minimal variability typically caused by?

A

Fetal acidemia secondary ot uteroplacental insufficiency , or cord compression

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70
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Methods to improve uteroplacental blood flow and perfusion through umbilical cord include?

A

lateral positioning of the mother, increasing IV fluid rate to improve maternal circulation, administer O2 from 8-10 L/min.

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71
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Moderate viability indicates what?

A

That the autonomic and CNS of the fetus are well developed and well oxygenated. Considered a good sign of fetal well-being

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72
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Marked variability occurs when?

A

there are 25 or more beats of fluctuation in the FHR

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73
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Causes of marked variability?

A

Cord prolapse or compression, maternal hypotension, and uterine hyperstimulation

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74
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: Interventions for marked variability?

A

Determining the cause, l,ateral postioning, increasing IV fluid rate, and administering oxyge

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75
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: FHR Variability is an important clinical indicator of?

A

Predictive fetal acid-base balance and cerebral tissue perfusion. Influced by fetal oxygenation status, CO , and drug effects

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76
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Baseline Variability: What happens to FHR as CNS is desensitized by hypoxia and acidosis?

A

FHR decreases until a smooth baseline pattern appears. Loss of variability may be associated with a poor outcome

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77
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What are these?

A

Temporary, recurrent changes made in response to a stimulus such as a contraction. FHR can demonstrate patterns of accelerations or deceleration.

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78
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What are fetal accelerations?

A

Transitiory aburpt increases in FHr abose the baseline that last <30 seconds from onset to peak

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79
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What is a deceleration?

A

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

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80
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What are early decelerations?

A

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

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81
Q

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

A

onset, peak, and recovery of contraction . Most often seen during the active stage of any normal labor during pushing, crowning, or vacuum extraction

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82
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What are late decelerations?

A

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

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83
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: Delayed timing of decelerations occurs when?

A

With the nadir of the uterine contraction

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84
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: Late decelerations associated with what?

A

Uteroplacental insufficiency, which occurs when blood flow within the intervillious space is decreased to the extent that feetal hypoxia or myocardial depression exists

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85
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: Recurrent or intermittent late decelerations are always what category?

A

II or III regardless of depth of develeration

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86
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What do variable decelerations present as?

A

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

87
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: Variable decelerations are associated with?

A

Cord compression

88
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: Prolonged decelerations are what?

A

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

89
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What is the sinusoidal pattern?

A

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

90
Q

Fetal Assessment During Labor and Birth - Determining FHR Patterns and Periodic Baseline Changes: What is the sinusoidal pattern associated with?

A

Derangement of CNS control of FHR and occurs when a severe degree of hypoxi secondary to fetal anemia and hypovolemia is present

91
Q

Fetal Assessment During Labor and Birth - Umbilical Cord Blood Analysis: What does this identify?

A

Presence of intrapartum hypoxia and acidemia. Considered good indicator of fetal oxygenation and acid-base condiiton at birth.

92
Q

Fetal Assessment During Labor and Birth - FetalScalp Stimulation: Abnormal buildup of carbon dioxide are reflected as what on FHR?

A

Abnormal FHR patterns as well as fetal inactivity

93
Q

Fetal Assessment During Labor and Birth - FetalScalp Stimulation: What is done to promote fetal stiulation?

A

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.

94
Q

Promoting Comfort and Providing Pain Management During Labor: Physical causes of pain during labor include what?

A

Cervical stretching hypocia of uterine muscle, pressure on urethra, bladder, and rectum

95
Q

Promoting Comfort and Providing Pain Management During Labor: In second stage, pain is caused by?

A

Stretching of vagina and perineum and compression of pelvic structures.

96
Q

Nonpharmacologic Measures for Comfort during Labor: Most of these theories are based on the gate control theory of pain, which proposes what?

A

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

97
Q

Nonpharmacologic Measures for Comfort during Labor - Continuous Labor Support: How does this worok?

A

Offering sustained presence to laboring woman by providing emotional support, comfort measures, advocacy, information and advice.

98
Q

Nonpharmacologic Measures for Comfort during Labor - Continuous Labor Support: What can support person assist the woman with?

A

To ambulate, reposition herself. and use breathing techniques.

Also acupressure, massage, music therapy, and therapeutic touch

99
Q

Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: What is this?

A

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.

100
Q

Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: What happens if they are in a tub or whirlpool?

A

Woman immerses herself in warm water for relaxation and relief of discomfort.

101
Q

Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: Why is this beneficial?

A

Warmth and buoyancy help to release muscle tension and can impart a sense of well-being.

102
Q

Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: What does warm water do to the the body?

A

Provides soothing stimulation of nerves in the skin, promoting vasodilation and reduction in catecholamines. Contractions less painful.

103
Q

Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: Benefits of using this during labor?

A

Aids labor process, minimizes use of analgesic meds, offers fast acting pain and anxiety relief

104
Q

Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: Recommendation for initiating hydrotherapy is what?

A

Woman to be in active labor (more than 5 cm dilateD) to prevent the slowing of labor contractions.

105
Q

Nonpharmacologic Measures for Comfort during Labor - Hydrotherapy: Potential risks with this incldude what?

A

hyperthermia, hypothermia, changes in maternal heart rate, fetal tachycardia, and unplanned underwater birth.

106
Q

Nonpharmacologic Measures for Comfort during Labor - Ambulation and Position Change: What evidence is there for walking during first stage of labor?

A

Reduce the length of labor and is not associated with increased intervention.

107
Q

Nonpharmacologic Measures for Comfort during Labor - Ambulation and Position Change: How often should woman change positions?

A

Every 30 mins

108
Q

Nonpharmacologic Measures for Comfort during Labor - Ambulation and Position Change: Why should supine positions be avoided?

A

May interfere with labor progress and can cause compression of vena cava and decrease blood returnt o heart

109
Q

Nonpharmacologic Measures for Comfort during Labor - Acupuncture/Acupressure: What does acupuncture involve?

A

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.

110
Q

Nonpharmacologic Measures for Comfort during Labor - Acupuncture/Acupressure: What does acupressure involve?

A

Application of a firm finger or massage used in acupuncture to reduce pain sensation.

111
Q

Nonpharmacologic Measures for Comfort during Labor - Using Heat/Cold: Heat applied where

A

Womans back, lower abdomen, groin, or perineum.

112
Q

Nonpharmacologic Measures for Comfort during Labor - Using Heat/Cold: Why is heat used?

A

To relieve chills or trembling, decrease joint stiffness, reduce muscle spasms, and increase CT extensibility

113
Q

Nonpharmacologic Measures for Comfort during Labor - Using Heat/Cold: Where is cold therapy applied?

A

TO the womans back, chest, and or face.

114
Q

Nonpharmacologic Measures for Comfort during Labor - Using Heat/Cold: Why does cold help?

A

RElieves muscle spasms and reduces inflammation and edema

115
Q

Nonpharmacologic Measures for Comfort during Labor - Attention Focusing and Imagery: Why is this helpful?

A

Because the woman uses many sense of mind to focus on stimuli to calm themselves down

116
Q

Nonpharmacologic Measures for Comfort during Labor - Effleurage and Massage: What is Effleurage?

A

A light, stroking, superficial touch of the abdomen, in rhythm with breathing during contractions

117
Q

Nonpharmacologic Measures for Comfort during Labor - Effleurage and Massage: Why is Effleurage used?

A

AS a relaxation and distraction technique from discomfort.

118
Q

Nonpharmacologic Measures for Comfort during Labor - Effleurage and Massage: WHy are messages effective?

A

By increasing production of endorphins in the body. Reduce transmission of signals between nerve cells

119
Q

Nonpharmacologic Measures for Comfort during Labor - Breathing Techniques: Benefits of practicing this include what?

A

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

120
Q

Nonpharmacologic Measures for Comfort during Labor - Breathing Techniques: What is the first pattern of breathing?

A

Slow-paced breathing.Woman inhales slowly through her nose and exhales through pursed lips. Rate is 6-9 bpm

121
Q

Nonpharmacologic Measures for Comfort during Labor - Breathing Techniques: What is the second pattern of breathing?

A

Woman inhales and exhales through her mouth at a rate of four breaths every 5 seconds

122
Q

Nonpharmacologic Measures for Comfort during Labor - Breathing Techniques: What is the third pattern?

A

Breathing is puncutated every few breaths by a force exhalation through pursed lips

123
Q

Pharmacologic Measures for Comfort during Labor: What is Neuraxial Analgesia/Anesthesia?

A

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

124
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia: What does this involve?

A

The use of one or more drugs administered orally, intramuscularly, or intravenously, and become distributed through body through circulatory sysem

125
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia: Most important thing to watch out for with these drugs?

A

Respiratory depresion

126
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia: What can happen if opioids given close to time of birth?

A

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

127
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia: Typically administered how?

A

Parenterally, though an existing IV line.

128
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Opioids: What are these?

A

Morphine like medications that treat moderate to severe pain.. Administered IV.

129
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Opioids: Associated with what?

A

Newborn respiratory depression, decreased alertness, inhibited sucking and a delay in effective feeding

130
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Opioids: How do they work?

A

Decrease transmission of pain impulses by binding to receptor site pathways that transmit pain signals to brain.

131
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Opioids: What side effects can this have on woman?/

A

N/V, pruritis, delayed gastric emptying, drowsiness, and hypoventilation .

132
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Opioids: Why may opioid antagonists be given?

A

To reverse the side effects such as pruritis, urinary retention, N/V.

133
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Antiemetics: Combined with opioiod to do what?

A

Decrease nausea and vomiting and lessen anxiety. They potentiate effectiveness of opioid.

134
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Antiemetics: What drugs included here?

A

Promethazine (Phenergan - IV)

Hydroxyzine (Vistaril - PO or IM)

Prochlorperazine (Compazine - IV or IM with Morphine Sulfate)

135
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Benzodiazepines: What are they used?

A

For minor transquilizing and sedative effects.

136
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Benzodiazepines: Why is Diazepam given?

A

IV to stop seizures resulting from eclampsia. Can calm woman who is out of control as well.

137
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Benzodiazepines: Side effect with Lorazepam (Ativan)?

A

Can be used for its tranquilziing effect, but increased sedation occurs.

138
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Benzodiazepines: What does Midazolam (Versed) do?

A

IV - produces good amnesia but no anelgesia.

139
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Benzodiazepines: What opioids may be given?

A

Morphine

Merperidine (Demerol)

Butorphanol

Nalbuphine (Nubain)

Fentanyl

140
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Benzodiazepines: What antiemetics may be given?

A

Hydrozyzine (Vistaril)

Promethazine (Phenergan)

Prochlorperazine (COmpazine)

141
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Inhaled Analgesics: What to know about nitrous oxide for labor pain?

A

Half nitrous oxide gas is mixed with half oxygen. Is known as laughing gas

142
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Inhaled Analgesics: Potential side effects?

A

N/V, dizziness, dysphoria

143
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Regional Analgesia/Anesthesia: What does this provide to woman?

A

Provides pain relief without loss of consciousness.

144
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Regional Analgesia/Anesthesia: What does Obstetric regional analgesia refer to?

A

A partial or complete lsos ofpain sensation below the T8 to T10 level of spinal cord

145
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Regional Analgesia/Anesthesia: Routes for this include what?

A

epidural block, CSE, local infiltration, pudendal block, or spinal analgesia.

146
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Epidural Analgesia: What does this involve during labor and borth? How is it given?

A

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.

147
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Epidural Analgesia: What does an epidural involve?

A

Injection of drug into the epidural space.

148
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Epidural Analgesia: Who cannot use this?

A

Those who have previous history of spinal surgery or spinal abnormalities, coagulation defects, cardiac disease, or obesity

149
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Epidural Analgesia: Complications of this?

A

N/V, Hypotension, FEver, Pruritus, IV injection, maternal fever, or allergic reaction. Ensure that woman avoids supine position

150
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Combined Spinal-Epidural Analgesia: What does this involve?

A

Inserting the epidural needle into the epidural space and also inserting a small-gauge spinal needle through the epidural needle into the subarachnoid space.

151
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Combined Spinal-Epidural Analgesia: How fast is this?

A

Relief within 3-5 minutes and can last up to 3 hours.

152
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Combined Spinal-Epidural Analgesia: Why is CSE Analgesia so great?

A

Because the womans motor function remain active.

153
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Combined Spinal-Epidural Analgesia: Complications of this?

A

Maternal hypotension, intravascular injection, accidental intrathecal blockade, and postdural puncture headache

154
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Patient Controlled Epidural- Analgesia: How does this work?

A

Use of an indwelling epidural catheter with infusion of medication and a programmed pump that allows woman to control dosing.

155
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Local Infiltration: What does this involve?

A

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.

156
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Pudendal Nerve Block: What is this?

A

Injection of a local anesthetic agent into the pudendal nerves near each ischial spine. Provides pain relief in the lower vagina.

157
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Pudendal Nerve Block: When is this used?

A

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.

158
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Spinal (Intrathecal) Analgesia/Anesthestia: What is this?

A

Injection of an anesthetic “caine” agent, with or without opioids into teh subarachnoid space to provide pain relief during labor or cesarean birth.

159
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Spinal (Intrathecal) Analgesia/Anesthestia: When is a intrathecal narcotic given?

A

Given during active phase (5cm or more of dilation). Maintains motor function and sensation.

160
Q

Pharmacologic Measures for Comfort during Labor - Systemic Analgesia and Spinal (Intrathecal) Analgesia/Anesthestia: How long does the narcotics duration last?

A

May be only a few hours and not last through the entire labor

161
Q

Pharmacologic Measures for Comfort during Labor - General Anesthesia: What is this reserved for?

A

Emergency C-Section where there is not enough time to provide spinal or epidural anesthesia.

162
Q

Pharmacologic Measures for Comfort during Labor - General Anesthesia: What drug is typically given?

A

Thiopental or propofol is given IV to produce unconsciousness. Followed by muscle relaxant.

163
Q

Pharmacologic Measures for Comfort during Labor - General Anesthesia: Primary complication with this?

A

FEtal depression, along with uterine relaxation and potential maternal vomiting and aspiraiton.

164
Q

Pharmacologic Measures for Comfort during Labor - General Anesthesia: How do you reduce gastric acidiity?

A

Administer nonparticulate (clear) oral antacid or PPI

165
Q

Nursing Management During First Stage of Labor: What will nursing care during this tage include?

A

Taking admission history, checking results of labs, amniocentesis, genetic studies, and ask woman about childbirth preparation

166
Q

Nursing Management During First Stage of Labor: Key nursing interventions?

A

Identify estimated date of birth

Perform Leopold maneuvers to fetermine fetal position

Check amniotic fkuid

167
Q

Nursing Management During First Stage of Labor: Guidelines for recording care include what?

A

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

168
Q

Nursing Management During First Stage of Labor - Assessing Woman Upon Admission: Highest priorities once admitted include what?

A

Assessing FHR, assessing cervical dilation/effacement, and determining whether membranes ruptured

169
Q

Nursing Management During First Stage of Labor - Assessing Woman Upon Admission: What information to gather during phone assessmenet?

A

Estimated DOB

Fetal Movement

Parity, gravida and previous birth experience

Characteristics of labor

Appearance of any vaginal bloody show.

170
Q

Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Maternal Health HX and Cultural Assessment: What should maternal health history include?

A

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.

171
Q

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?

A

Monitor her glucose levels duringn labor, prepare for surgical birth if dystocia of labor occurs, and allert the newborn nursery of potential hypoglycemia.

172
Q

Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Physical Exam: What assessments doees this include?

A

Pain level and coping behaviors demonstrated.

Uterine activity, including contraction frequency, duration

Fetal Status

Cervical Dilation

Status of membranes

173
Q

Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies :What tests are usually included?

A

Urinalysis via clean-catch urine specimen and CBC.

174
Q

Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies :What is GBS?

A

Gram-positive organism that colonizies in female tract. Women asymptomatic but newborn can catch. Mortality rate increased

175
Q

Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies: When are women screened for GBS?

A

At 35-37 weeks gestation.

176
Q

Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies: Maternal infections associated with GBS include what?

A

Acute chorioamnionitis, endometritis, and UTI.

177
Q

Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies: NEonatal signs of GBS include what?

A

Pneumonia and sepsis.

178
Q

Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies: What do GBS carriers receive ?

A

Intravenous antibiotic prophylaxis (penicillin) at onset of labor or ruptured membranes

179
Q

Nursing Management During First Stage of Labor - Assessing Woman Upon Admission and Lab Studies: What are women who are HIV positive given?

A

Zidovudine (2mg/kg IV over an hour until birth)

or

Nevirapine at oneset of labor.

Newborn given Zidovudine orally for 6 weeks

180
Q

Nursing Management During First Stage of Labor - Continuing Assessment During First Stage of Labor: How often are VS assessed?

A

Every hour during latent phase.

Every 30 minutes during active and transition phases.

181
Q

Nursing Management During First Stage of Labor - Continuing Assessment During First Stage of Labor: How often is temperature taken?

A

Every 4 hours throughout first stage of labor

Every 2 hours after membranes ruptured.

182
Q

Nursing Management During First Stage of Labor - Continuing Assessment During First Stage of Labor: How often are uterine contractions monitored?

A

Every 30-60 mins during latent phase

Every 15-30 minutes during active phase

Every 15 mins during transition

183
Q

Nursing Management During First Stage of Labor - Continuing Assessment During First Stage of Labor: How often should FHR be assessed?

A

Every 30-60 mins during latent

Active Phase, every 15-30 mins

184
Q

Nursing Management During First Stage of Labor - Continuing Assessment During First Stage of Labor: Nursing interventions should include what on admission?

A

ASking about expecations about birth

Presenting information about fetal monitoring equipment.

Monitoring mother Vs to obtain baseline

REassure that labor progress will be monitored

185
Q

Nursing Management During First Stage of Labor - Continuing Assessment During First Stage of Labor: Nursing interventions as women progresses through first stage of labor?

A

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

186
Q

Nursing Management During Second Stage of Labor: Current evidence for management of second stage supports the practices of?

A

Delayed pushing, spontaneous (nondirected) pushing, and maternal choice positions

187
Q

Nursing Management During Second Stage of Labor: Nursing care here focuses on what?

A

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

188
Q

Nursing Management During Second Stage of Labor: Common practice is to coach woman to do what with every contraction?

A

Closed glottis pushing, starting at 10 cm dilation

189
Q

Nursing Management During Second Stage of Labor: What is a first-degree laceration?

A

Extends through the skin

190
Q

Nursing Management During Second Stage of Labor: What is a second-degree laceration?

A

Extends through the muscles of the perineal body

191
Q

Nursing Management During Second Stage of Labor: what is a third-degree laceration?

A

Continues through the anal sphincter muscle

192
Q

Nursing Management During Second Stage of Labor: What is a fourth-degree laceration?

A

Involves teh anterior rectal wall

193
Q

Nursing Management During Second Stage of Labor: What is an episiotomy?

A

An incision made in the perineum to enlarge the vaginal outlet and theoretically to shorten the second stage of labor

194
Q

Continuous Assessment During Second Stage of Labor: Assessments involve identifying the signs typical of second stage of labor including?

A

Increase ina pprehension or irritability

Spontaneous rupture of membranes

Appearance sweat on upper lip

Low grunting sounds

Increase in blood tinged show

195
Q

Continuous Assessment During Second Stage of Labor: Associated signs with determining progress of labor includue what?

A

Bulging of perineum, labial separation, advancing and retreating of newborns head, and crowning

196
Q

Continuous Assessment During Second Stage of Labor: When is it appropriate for woman to push?

A

If cervix is fully dilated to 10 cm.

197
Q

Continuous Assessment During Second Stage of Labor and Nursing Interventions: What does this focus on?

A

Motivating the woman, assisting with positioning, and encouraging her to put all her efforts to pushing.

198
Q

Continuous Assessment During Second Stage of Labor and Nursing Interventions: What is the Lithotomy position?

A

With feet up in stirrups. Most convenient position for caregivers,

199
Q

Continuous Assessment During Second Stage of Labor and Nursing Interventions: What are some important nursing interventions here?

A

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

200
Q

Continuous Assessment During Second Stage of Labor and Nursing Interventions: How can you prepare for and assist with delivery?

A

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

201
Q

Continuous Assessment During Second Stage of Labor and Nursing Interventions - Birth: What to do once woman positioned for birth?

A

Cleanse the vulva and perineal areas

202
Q

Continuous Assessment During Second Stage of Labor and Nursing Interventions - Birth: What does the health care provider do as soon as the head emerges?

A

Provider suctions the newborns mouth first and then the nares with bulb syringe to prevent aspiratio of mucus.

203
Q

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?

A

Assesses five parameters

Heart Rate
Respiratory Effort
Muscle Tone
REsponse to Irritation Stimulus
Color
204
Q

Continuous Assessment During Third Stage of Labor: What happens during the third stage of labor?

A

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.

205
Q

Continuous Assessment During Third Stage of Labor: Nursing care here includes what?

A

Newborn assessment and observing for signs of placental separating, assist with delivery of placenta, and cording time of expulsion

206
Q

Continuous Assessment During Third Stage of Labor: What does skin-to-skin contact immediately after birth do to the mother?

A

Further augment maternal oxytocin levels, streghten uterine contractions to prevent hemorrhage

207
Q

Continuous Assessment During Third Stage of Labor: Assessments here include what?

A

Monitor placentral separation by looking for firmly contracting uterus and change inn uterine shape.

Examine placental and fetal membranes

Assess for any perineal traum

208
Q

Continuous Assessment During Third Stage of Labor: Nursing interventions include what

A

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.

209
Q

Continuous Assessment During fourth Stage of Labor: How often are VS taken here?

A

Every 15 mins 1 hour after birth

Every 30 for next hour if needed

210
Q

Continuous Assessment During fourth Stage of Labor: Decrease in BP indicates what?

A

An uterine hemorrhage

211
Q

Continuous Assessment During fourth Stage of Labor: Elevated pulse rate may be an early sign of what?

A

BLood loss

212
Q

Continuous Assessment During fourth Stage of Labor: How often should you assess fundal height?

A

Every 15 mins during first hour following birth. Needs to remain firm to prevent excessive postpartum bleeding

213
Q

Continuous Assessment During fourth Stage of Labor: How often should you assess vaginal discharge?

A

Every 15 minutes for the first hour and every 30 minutes for the next hour

214
Q

Continuous Assessment During fourth Stage of Labor: Nursing Interventions here?

A

Providing support and information regarding episiotomy repair

Applying an ice pack

Assist with hygiene and perineal care

Asses for postpartum hemorrhage and urinary retention

NRSG 206: OB (42 decks)

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