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OB > Exam 4: Ch 19 N.Care of family during labor and birth > Flashcards

Exam 4: Ch 19 N.Care of family during labor and birth Flashcards

1
Q

True labor: contractions

A
  • Occur regularly, become stronger, lasting longer, and occurring closer together
  • Become more intense with walking
  • Usually felt in lower back, radiating to lower portion of abdomen
  • Continue despite of comfort measures
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2
Q

True Labor: Cervix (by vaginal exam)

A
  • Shows progressive change (softening, effacement, and Dilation signaled by appearance of bloody show)
  • Moves to an increasing anterior position
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3
Q

True Labor: Fetus

A
  • Presenting part usually becomes engaged in the pelvis
  • This results in increased ease of breathing
  • The presenting part presses downward and compresses the bladder, resulting in urinary frequency
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4
Q

False Labor: Contractions

A
  • Occur irregularly or become regular only temporarily
  • Often stop with walking or position change
  • Can be felt in the back or abdomen above the naval
  • Often can be stopped through the use of comfort measures
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5
Q

False Labor: Fetus

A

-Presenting part is usually not engaged in the pelvis

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6
Q

Common positions during birth

A
  • Semirecumbant Position
  • Lateral Position
  • Upright Position
  • Hands-and-knees position
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7
Q

2nd stage of labor

A

full dilation and effacement : baby is born in this phase

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8
Q

Stage 1 of labor

A

begins with active contractions until the cervix is 10 cm. dilated and 100% effaced

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9
Q

longest stage of labor?

A

stage 1

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10
Q

Active labor

A

labor that has started and is continuing-progressing

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11
Q

1st stage: phases

A

Latent: 6-8 hours

Active: 3-8 hours

Transition: 20-40 min

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12
Q

1st stage: latent phase

A

Frequency: 5-30 minutes apart

Duration: lasts 30-45 seconds

Intensity: mild to moderate

Behavior: alert, excited, anxious, best time to teach

Cervix dilated 0-3 cm

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13
Q

1st stage: active phase

A

Frequency: 3-5 minutes apart

Duration: 45-70 seconds

Intensity: strong

Behavior: more demanding, hurting

Cervix: dilated 4-7 cm

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14
Q

1st stage: Transition phase

A

Frequency: 2-3 minutes apart

Duration: 45-90 seconds

Intensity: Strong

Behavior: irritable, n&v
Cervix: dilated 8-10 cm

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15
Q

cervical dilation for latent phase of 1st stage of labor ?

A

0-3cm

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16
Q

2nd stage of labor

A

begins with the complete dilation and effacement of the cervix and ends with the birth with the birth of the baby.

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17
Q

phases of stage 2

A
  • latent
  • active
  • transition
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18
Q

2nd stage: latent phase

A

10-30 seconds

  • Not really pushing except at the acme phase of contraction
  • Feels the worst is over, tired, sleepy, feels in control
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19
Q

2nd stage: active phase

A

duration varies

-increased urge to push

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20
Q

2nd stage: transition phase

A

5-15 minutes

-pushes, feels powerless, crowning, vagina stretches

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21
Q

What happens during the stage 2?

A

Lacerations-tears

episiotomy-cut with scissors the area between vagina and anus-perineum body to make an opening

  - midline 
 - mediolateral
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22
Q

midline episiotomy

A

from vaginal opening down to anal opening (can rip down into anal sphincter

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23
Q

mediolateral episiotomy

A

vaginal opening to either side of vaginal wall (could have vaginal wall laceration, but won’ tear into deep tissues)

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24
Q

Degrees of lacerations/episiotomies

A

➢ 1st degree involves- epidermis, Laceration that extends through the skin and structures superficial muscles
➢ 2nd degree- involves dermis, muscle and fascia (start having sutures), Laceration that extends through muscles of the perineal body
➢ 3rd degree- extends into the anal sphincter
➢ 4th degree -extends up the rectal mucosa

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25
Q

Stage 3

A
  • lasts from the birth of the baby until the placenta is expelled
  • the shortest stage
  • the placenta is usually expaled w/I 10-15 min after birth
26
Q

what is the priority in stage 3

A

bleeding

27
Q

stage 4

A

early postpartum period

°Fetus is now neonate

°Risk for fatigue r/t energy expenditure associated with childbirth

°1-2 hours after birth

28
Q

Stage 4 interventions

A

°BP, Pulse, Temp, RR, assessed every 15min for 1st hour

°Temp is assessed at beginning and after first hour

29
Q

______ increases the length of the stage 2 due to inability to bear down and push

A

epidural: limites her ability to attain an upright position.

30
Q

signs that suggest the onset of the second stage

A
  • urge to push or feeling need to have BM
  • Sudden appearance of sweat on upper lip
  • An episode of vomiting
  • Increased bloody show
  • shaking of extremities
  • increased restlessness: verbalizations “i can’t go on “
  • Involuntary bearing-down efforts
31
Q

Physical assessment of 2nd stage of labor

A
  • every 5-30 min: vitals
  • every 5-15 min, depending on risk status: fetal heart rate and pattern
  • every 10-15 min: vaginal show, sign of fetal descent, and changes in maternal appearance, mood, affect, energy level, and condition of partner/coach.
  • every contraction and bearing-down effort
32
Q

Interventions for 2nd stage: latent phase

A
  • help to resting position of comfort;encourage relaxation to conserve energy
  • Promote progress of fetal descent and onset of urge to bear down by encouraging position change, pelvic rock, ambulation, showering.
33
Q

Interventions for 2nd stage: active (pushing phase)

A
  • help change position and encourage spontaneous bearing-down efforts.
  • Help relax and conserve energy between contractions
  • Provide comfort and pain relief measures as needed.
  • Cleanse perineum promptly if fecal material is expelled
  • Coach to pant during contractions and to gently push between contractions when head is emerging
  • Provide emotional support, encouragement, and positive reinforcement of efforts
  • Keep woman informed regarding progress
  • Create a calm and quiet environment
  • Offer mirror to watch birth
34
Q

you may sit on toilet, stool, chair during active phase, although it may cause?

A

increased perineal edema and blood loss

35
Q

Why should you not force women legs to her abdomen when pushing?

A

increases the perineal stretching and the risk for perineal trauma as well as spinal and lower extremity neurological injuries.

36
Q

Valsalva maneuver

A
  • occurs when the woman closes her glottis, which increases intrathoracic and cardiovascular pressure.
  • this reduces cardiac output and decreases perfusion of the uterus and the placenta.
37
Q

most stressful phase

A

Stage 2 active pushing

38
Q

FHR

A 
If
-baseline rate begins to slow
-if absent or minimal variability occurs
-deceleration develops 
initiate intervention immediately
39
Q

When is the birthing table set up?

A

Nulliparous: Transition phase of first stage of labor

Multiparrous: active phase

40
Q

Crowning

A

occurs when the widest part of the head (biparietal diameter) distends the vulva just before birth

41
Q

Episiotomy

A

incision into the perineum to enlarge vaginal outlet

42
Q

3rd stage of labor

A

lasts from the birth of the baby until the placenta is expelled

43
Q

Signs that suggest Onset of 3rd stage of labor

A
  • firmly contracting fundus
  • change in uterus from a discoid to a globular ovoid shape as the placenta moves into the lower uterine segment
  • Sudden gush of dark blood from the introitus
  • Apparent lengthening of the umbilical cord as the placenta descends to the introits
  • The finding of vaginal fullness (the placenta) on vaginal or rectal examination or of fetal membranes at the introitus
44
Q

Physical Assessment of 3rd stage of labor

A
  • every 15 min: maternal blood pressure, pulse, and respirations
  • signs of placental separation and amount of bleeding
  • assist with Apgar at 1 min and 5 min
  • maternal and paternal response to completion of childbirth process and their reaction to the newborn
45
Q

3rd stage interventions

A
  • Assist to bear down
  • Admin oxytocin as ordered to prevent hemorrhage
  • pain relief
  • hygienic cleansing measures
  • keep parents informed of uterine progress and expulsion
  • introduce parents to their baby and facilitate bonding; delay eye prophylaxis, vit. k.
  • skin to skin; private time for parents to bond with baby
  • Encourage breast feeding if desired
46
Q

4th stage of labor

A

1-2 hours after birth; recovering from the physical process of birth

-maternal organs undergo their initial readjustment to the non pregnant state

47
Q

Assessment for stage 4

A

BP/Pulse= measure every 15 min for the first 2 hours

Temp: @ recovery period, then every 4 hours

48
Q

Active Phase : stage 1

A

Acute pain r/t uterine cx

-assess level of pain

49
Q

Active phase: Stage 1

A

Risk for infection r/t ROM placement of internal electrodes

  • SROM-ruptures on own
  • AROM- use amnihook to rupture
50
Q

Ferning

A

swab and will see a fern like under microscope and that will indicate amniotic fluid

51
Q

Interventions for fetus

A

observe FHR for non-reassuring signs of fetal hypoxia such as bradycardia, tachycardia, decreasing variability

  1. turn off pitocin
  2. reposition mom
  3. increase fluids
  4. oxygen 8-10 liters/min
52
Q

Transition phase

A

at risk for ineffective coping

53
Q

Stage 2

A

risk for acute pain r/t bearing down efforts and distention of the perineum

54
Q

Intervention for stage 2

A

iron the perineum-to prevent tearing or cutting

side-lying position for delivery is good

water birth-best; water is soothing and not as much pain is felt

55
Q

Midline epesiotomy

A

could still tear

56
Q

1st degree episiotomy/laceration

A

involves the epidermis

57
Q

2nd degree

A

involves the dermis, muscle and fascia

58
Q

3rd degree

A

extends into the anal sphincter

59
Q

4th degree

A

extends up the rectal mucosa

60
Q

3rd stage

A

Risk for deficient fluid volume r/t blood loss occurring after placenta separation/expulsion

61
Q

Intervention and meds for 3rd stage

A
  • open IV with Pitocin
  • massage fundus
  • put NB on moms breast to allow her natural oxytocin to be expelled

Meds : Pitocin, Methergine, Hemabate

62
Q

Stage 4

A

Risk for fatigue r/t expenditure associated with childbirth

now considered a neonate.

OB (6 decks)

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