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NUR 102 OB Assessment #1 > Giving Birth > Flashcards

Giving Birth Flashcards

1
Q

Maternal Response to Labor

* Coordinated, involuntary, intermittent contractions

* Cervical changes: effacement & dilation

* Increased BP & decreased pulse

* Decreased gastric motility

* Decreased bladder sensation

* Hematopoietic changes

A

Coordinated, involuntary, intermittent contractions

  • Coordinated as begin @ uterine fundus & spread down towards cervix

> Lower 3rd of uterus stays relaxed to help in cervical dilation

  • Involuntary as labor can’t be stopped by conscious effort
  • Intermittent to allow relaxation of muscle & resumption of maternal blood flow to & from placenta & fetus
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2
Q

?

Is the thinning & shortening of the cervix

A

Effacement

Non-laboring cervix begins @ about 2cm long; called 0% effaced

100% effaced ⇒ paper thin

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3
Q

?

Is opening of the cervix

From uterus pulling upward

A

Dilation

Cervix must dilate to 10cm to allow for passage of average size term fetus

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4
Q

Increased BP & decreased pulse

140/90 is abnormal & concerning

With each contraction, blood flow to placenta decreases

A

Decreased gastric motility

Causes dry mouth & thirst

Decreased bladder sensation

If unmedicated, empty bladder every 2 hours

For an epidural (block), intermittent catheterization every 2 hours or an indwelling catheter

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5
Q

Hematopoietic changes

  • EBL - estimated blood loss
  • QBL - quantitative blood loss [exact]
  • With vaginal blood loss, up to 500mL is normal
A
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6
Q

Contractions

2 - 2-1/2 minutes apart (frequency)

60-90 seconds long (duration)

* Intensity can’t be measured on a fetal monitor without using a specialized invasive device

* Palpated at uterine fundus (in order to measure); mild, moderate or strong

A

Increment = as contraction begins

Decrement = decrease intensity as uterus relaxes

Interval (uterine relaxation) = uterine resting tone

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7
Q

Fetal Response to Labor

* Decreased placental exchange during contractions

* Cardiovascular system responds quickly to labor events

* Labor speeds the absorption of fetal lung fluid, & compression from vaginal delivery helps expel remaining fluid

  • HTN & DM cause narrowing of arteries
  • Affects fetal gas exchange
A
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8
Q

The Four “P’s” of Labor

Powers

Passage

Passenger

Psyche

A
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9
Q

Powers

  • Uterine contractions (primary force)
  • Maternal pushing

> Push fetal head against cervix to help efface & dilate it

> Don’t push in-between contractions

A
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10
Q

Passage

  • Maternal pelvis (false pelvis, true pelvis)
  • Soft tissues

?

is a condition in which the fetal head will not fit through the pelvis

___ will soften cartilage, connecting the bones

A

cephalopelvic disproportion (CPD)

Relaxin

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11
Q
A
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12
Q
A
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13
Q

Passenger

* Fetus

* Membranes

* Placenta

  • Cephalic presentation
  • Adapt to size & shape of pelvis
  • Skull bones are not yet fused; connected by sutures

___ - spaces where sutures meet

> Anterior & posterior (gives an idea to infant’s position in utero)

A

Fontanels

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14
Q

1) Longitudinal lie

Could be a cephalic or breech presentation

Is what’s desired for a vaginal birth

2) Transverse lie

Rare; contraindicates a vaginal birth

Shoulder-first presentation

A

3) Oblique sideways

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15
Q

Breech Presentations

* Frank

* Full

* Single footling

  • Risk of umbilical cord compression when head is last thing born
A
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16
Q
  1. Determine landmark

Occiput - a presenting part

Mentum - fetal chin

Sacrum

Scapula (not favorable)

  1. Where to feel fixed reference point? To right, left, or directly on horizontal line
  2. Anterior, posterior, or transverse plane?
A
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17
Q

Psyche

  • Ease fear & anxiety into confidence & empowerment
  • Provide education; be an advocate
  • Respect cultural, religious, & individual preferences
  • Creating a birth plan
A

Now remember, at this point we are looking at what normal labor and childbirth look like…

18
Q

How does labor begin?

Process begins gradually over the last few weeks of pregnancy

___ decreases, while ___ increases

Prostaglandins are released from the fetal membranes (helps to soften cervix)

Natural secretion of ___ (from pituitary)

Fetal ___ and ___ are secreted

Cervical stretching also causes secretion of maternal ___

A

progesterone; estrogen

oxytocin

oxytocin, cortisol

oxytocin

19
Q

___ Labor

Braxton-Hicks contractions

Lightening

Bloody show

A

Premonitory

20
Q

?

Is a discharge of the mucous plug that occurs as the cervix softens

Means that the cervix is softening, effacing, or dilating

___ - a spurt of energy during a tired period; slight weight loss

A

Bloody show

Nesting

21
Q

?

A dropping sensation as fetus descends toward pelvic inlet

Stomach looks lower; lung capacity increases

2-3 weeks

A

Lightening

22
Q

?

Are contractions that shouldn’t be painful

False labor; not doing anything to the cervix

Are irregular, mild; stop & decrease spontaneously

A warm shower will help settle these down

A

Braxton-Hicks contractions

23
Q

True Labor vs False Labor

___ labor means no cervical change is occurring

* Assess the cervix

A

False

24
Q

Stages and Phases of Labor

1st / 2nd / 3rd / 4th

A
25
Q

?

A term used to describe a woman who has not given birth before

A

nulliparous

26
Q

First Stage

* Begins w/the onset of true labor contractions, & ends w/complete cervical effacement & dilation

* Shortest / longest stage of labor (?)

* 3 phases: Latent / Active / Transition

A

Longest

27
Q

?

Faster

Intense contractions

7-8 until 10cm

Tremors, nausea, vomiting, irritability

A

Transition

28
Q

?

3-5cm of dilation

Some discomfort

A

Latent

29
Q

?

Cervix dilates more rapidly

Nulliparous - 1cm every 1-2 hours

Much faster for multiparous women; 4-6cm dilation

A

Active

30
Q

Second Stage

* Complete dilation & effacement until the birth of the baby

* Fetal descent places pressure on the rectum & pelvic floor, leading to an involuntary pushing response

* Often gives sensation of “I need to poop,” or “I need to push”

* Pain is often relieved w/the ability to push w/contractions

* Stretching & burning occurs w/crowning of the fetal head

A

Cardinal Movements of Labor

“Every Day Farmers Incubate Eggs Eggs Eggs”

Engagement / Descent / Flexion / Internal rotation

Extension / External rotation / Expulsion

31
Q

Third Stage

* Begins w/the birth of the baby, ends w/the expulsion of the placenta

* Some pain here; not as much as childbirth

A

Fourth Stage

* Stage of physical recovery

* Delivery of the placenta - through the first 1-4 hours post-birth

* Monitor uterine contractions, vaginal drainage, perineal trauma (tears, episiotomy, hemorrhoids), & “afterpains” (contractions after delivery that should feel like menstrual cramps)

* Promote familial bonding

32
Q

How does labor differ between a nulliparous woman and a multiparous woman?

* Delivers quicker

* Body & labor progress quickly

* A history of rapid labor can lead to another labor

A

The Role of the Nurse in Labor and Delivery

33
Q

Determine the Setting to Care for the Patient

  • Hospital, birth center, or home birth

> Hospital setting for high-risk cases; pharmacological approach needed

  • Who to contact for problems or questions
A

Establish a Therapeutic Relationship

  • Level of knowledge & preparation
  • Determining expectations surrounding birth
  • Convey confidence in the woman’s choices & abilities
  • Assign a primary nurse (helps to ensure continuity of care)
  • Respect personal, religious, & cultural values
34
Q

Admission Assessment

  • Review prenatal care records (if present)
  • Interview the woman regarding pregnancy, labor, & conditions that may affect her care
  • Review current labor pattern; evaluate contractions
  • Review client background (rx’s, food, environment, allergies, infections)
A
  • Assess birth preferences (birth plan, culture/personal preferences)
  • Evaluate fetal status (via intermittent auscultation or electronic monitoring for HR; assess fetal membranes [intact or ruptured?])
  • Evaluate labor status (strength of contraction by palpation)
  • Physical examination

> Perform vaginal examination to determine cervical dilation & effacement

> Leopold’s maneuvers to estimate size & position in utero

> Evaluate pain; vital signs; heart/lung sounds; palpate breasts; assess GI system; midstream urine collection (look for protein, UTI’s); assess DTR’s

35
Q

Leopold’s Maneuvers

1st / 2nd / 3rd / 4th

A
36
Q

Ongoing Assessments

* Fetal Assessments

> Fetal HR
> Amniotic fluid

* Maternal Assessments

> Vital signs
> Contractions
> Labor progress
> I&O (look for urinary retention)
> Response to labor

A

Rupture?

> spontaneous or artificial

Clear fluid

> cloudy, yellow, foul = infection

> Meconium - stained fluid

  • Light yellow to pea soup green

8 cervical exams total throughout labor

37
Q

How much amniotic fluid?

___ >1000mL

___ 500-1000mL

___ 100-500mL

___ small

A

Large

Moderate

Small

Scant

38
Q

Labor Support

Focus is on oxygenation, maternal discomfort, & maternal injury

  • Look for S/S of fetal compromise
  • Soft, indirect lighting
  • Comfortable temperature
  • Showers if able; oral care; hydrotherapy
  • Empty bladder every 2 hours; focus on positioning
A
39
Q

Nursing Care During Birth

Preparation of a sterile delivery table

Perineal cleansing preparation

Preparation for initial care & assessment of the newborn

Administration of rx’s as needed

Important to be certified in neonatal resuscitation for those present

A

Nursing Care After Birth

* Immediate care & assessment of the neonate

  • Maintaining cardiopulmonary function
  • Supporting thermoregulation
  • Provide proper newborn identification

* Immediate care & assessment of the mother

  • Monitor for S/S of postpartum hemorrhage

> Fundus, bladder, lochia

  • Vital signs
  • Pain management
40
Q

Promote Early Attachment

First hour after birth “The Golden Hour”

Infant can remain w/the parents for assessments

Initiate breastfeeding, if desired; in 1st hour = positive effects

Siblings can be introduced to the new family member

Observe & document signs of early attachment

Be cognizant of cultural variations

A

NUR 102 OB Assessment #1 (11 decks)

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