Exam 4: Ch 19 N.Care of family during labor and birth Flashcards
True labor: contractions
- 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
True Labor: Cervix (by vaginal exam)
- Shows progressive change (softening, effacement, and Dilation signaled by appearance of bloody show)
- Moves to an increasing anterior position
True Labor: Fetus
- 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
False Labor: Contractions
- 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
False Labor: Fetus
-Presenting part is usually not engaged in the pelvis
Common positions during birth
- Semirecumbant Position
- Lateral Position
- Upright Position
- Hands-and-knees position
2nd stage of labor
full dilation and effacement : baby is born in this phase
Stage 1 of labor
begins with active contractions until the cervix is 10 cm. dilated and 100% effaced
longest stage of labor?
stage 1
Active labor
labor that has started and is continuing-progressing
1st stage: phases
Latent: 6-8 hours
Active: 3-8 hours
Transition: 20-40 min
1st stage: latent phase
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
1st stage: active phase
Frequency: 3-5 minutes apart
Duration: 45-70 seconds
Intensity: strong
Behavior: more demanding, hurting
Cervix: dilated 4-7 cm
1st stage: Transition phase
Frequency: 2-3 minutes apart
Duration: 45-90 seconds
Intensity: Strong
Behavior: irritable, n&v
Cervix: dilated 8-10 cm
cervical dilation for latent phase of 1st stage of labor ?
0-3cm
2nd stage of labor
begins with the complete dilation and effacement of the cervix and ends with the birth with the birth of the baby.
phases of stage 2
- latent
- active
- transition
2nd stage: latent phase
10-30 seconds
- Not really pushing except at the acme phase of contraction
- Feels the worst is over, tired, sleepy, feels in control
2nd stage: active phase
duration varies
-increased urge to push
2nd stage: transition phase
5-15 minutes
-pushes, feels powerless, crowning, vagina stretches
What happens during the stage 2?
Lacerations-tears
episiotomy-cut with scissors the area between vagina and anus-perineum body to make an opening
- midline - mediolateral
midline episiotomy
from vaginal opening down to anal opening (can rip down into anal sphincter
mediolateral episiotomy
vaginal opening to either side of vaginal wall (could have vaginal wall laceration, but won’ tear into deep tissues)
Degrees of lacerations/episiotomies
➢ 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
Stage 3
- 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
what is the priority in stage 3
bleeding
stage 4
early postpartum period
°Fetus is now neonate
°Risk for fatigue r/t energy expenditure associated with childbirth
°1-2 hours after birth
Stage 4 interventions
°BP, Pulse, Temp, RR, assessed every 15min for 1st hour
°Temp is assessed at beginning and after first hour
______ increases the length of the stage 2 due to inability to bear down and push
epidural: limites her ability to attain an upright position.
signs that suggest the onset of the second stage
- 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
Physical assessment of 2nd stage of labor
- 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
Interventions for 2nd stage: latent phase
- 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.
Interventions for 2nd stage: active (pushing phase)
- 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
you may sit on toilet, stool, chair during active phase, although it may cause?
increased perineal edema and blood loss
Why should you not force women legs to her abdomen when pushing?
increases the perineal stretching and the risk for perineal trauma as well as spinal and lower extremity neurological injuries.
Valsalva maneuver
- 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.
most stressful phase
Stage 2 active pushing
FHR
If -baseline rate begins to slow -if absent or minimal variability occurs -deceleration develops initiate intervention immediately
When is the birthing table set up?
Nulliparous: Transition phase of first stage of labor
Multiparrous: active phase
Crowning
occurs when the widest part of the head (biparietal diameter) distends the vulva just before birth
Episiotomy
incision into the perineum to enlarge vaginal outlet
3rd stage of labor
lasts from the birth of the baby until the placenta is expelled
Signs that suggest Onset of 3rd stage of labor
- 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
Physical Assessment of 3rd stage of labor
- 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
3rd stage interventions
- 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
4th stage of labor
1-2 hours after birth; recovering from the physical process of birth
-maternal organs undergo their initial readjustment to the non pregnant state
Assessment for stage 4
BP/Pulse= measure every 15 min for the first 2 hours
Temp: @ recovery period, then every 4 hours
Active Phase : stage 1
Acute pain r/t uterine cx
-assess level of pain
Active phase: Stage 1
Risk for infection r/t ROM placement of internal electrodes
- SROM-ruptures on own
- AROM- use amnihook to rupture
Ferning
swab and will see a fern like under microscope and that will indicate amniotic fluid
Interventions for fetus
observe FHR for non-reassuring signs of fetal hypoxia such as bradycardia, tachycardia, decreasing variability
- turn off pitocin
- reposition mom
- increase fluids
- oxygen 8-10 liters/min
Transition phase
at risk for ineffective coping
Stage 2
risk for acute pain r/t bearing down efforts and distention of the perineum
Intervention for stage 2
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
Midline epesiotomy
could still tear
1st degree episiotomy/laceration
involves the epidermis
2nd degree
involves the dermis, muscle and fascia
3rd degree
extends into the anal sphincter
4th degree
extends up the rectal mucosa
3rd stage
Risk for deficient fluid volume r/t blood loss occurring after placenta separation/expulsion
Intervention and meds for 3rd stage
- open IV with Pitocin
- massage fundus
- put NB on moms breast to allow her natural oxytocin to be expelled
Meds : Pitocin, Methergine, Hemabate
Stage 4
Risk for fatigue r/t expenditure associated with childbirth
now considered a neonate.
