Intrapartal Nursing Flashcards
Duration
Beginning of contraction (muscle begins to tense), to the end of same contraction (muscle is completely relaxed)
Frequency
Beginning of one contraction to the beginning of the next
Uterine resting tone
Between uterine contractions when optimum uterine relaxation is achieved
Acme or peak
Intensity is evaluated subjectively by estimating firmness (nose, chin, four head= mild, moderate, and strong)
Early or Latent phase of labor
0 to 3 cm, relaxed, excited, anxious
Active phase of labor
4 to 7 cm, more intense, begins to tire
Transitional phase of labor
8 to 10 cm, feel tired, unable to cope, needs frequent coaching to maintain breeding patterns
Electronic monitoring with external toco
Can determine frequency and direction, cannot determine intensity, may be used BEFORE and AFTER ROM rupture of membranes, placed over fetal part of fundus on outside of abdomen
Internal uterine pressure catheter (IUPC)
Inserted into uterine cavity of cervical os, place in area of fetal small parts, can only be used AFTER ROM ruptured membranes, measures resting tone of uterus between contractions, measure actual pressure during contractions – intensity
Advantage – critical in woman attempting vaginal birth to avoid tachysystole and uterine rupture
Leopold maneuver position
Bladder empty
Lie on back with abdomen uncovered, shoulders race lightly on pillow, knees drawn up a little
Completed between contractions
Determines lie – longitudinal or transverse
Fetal scalp electrode – FSE – internal monitoring
Most precise method of monitoring EKG of FHR, attached to fetus during vaginal exam
Cervix must be 2 cm dilated, pedal car presenting, are ROM
Avoid in preterm infants because increased risk of ventricular hemorrhage
Baseline fetal heart rate
Must be at least two minutes of identical baseline segments and any 10 minute window
Acceleration deceleration or periods of mart fetal heart rate variability are excluded
Fetal tachycardia
BL FH are greater than 160 bpm for at least a 10 minute.
Variable deceleration
Decrease in fetal heart rate – defined as onset of the deceleration to beginning of fetal heart rate made her a 30 seconds or less
Decrease in fetal heart rate 15 beats a minute, lasting 15 seconds or more, in less than two minutes duration
Prolonged deceleration
Decrease in fetal heart rate of 15 beats a minute or more that last more than two minutes and less than 10 minutes
Critical factors in labor
x5
Birth passage Fetus Relationship between birth passage of fetus Physiological forces of labor Psychosocial considerations
Fetal attitude
Posture the fetus assumes as it conforms to the shape of the uterine cavity
-* normal is general flexion: baby ducks head down, presenting the clown
Fetal lie
Relationship of access, spinal column, a fetus to access of mother spinal column
Longitudinal lie
Cephalocaudal access of the feudal spine is parallel to one months time
Transverse lie
Cephalocaudal access of the fetal spine is at a right angle to the woman spine
- cause shoulder presentation
- Csection
Fetal presentation
Determined by fetal lie, body part a fetus that enters maternal pelvis first, “presenting part” felt through cervix on vag exam
Cephalic (head first), breech (buttocks or feet first), or shoulder (malpresentation)
Vertex presentation
Most common
fetal head completely flexed
Smallest diameter presents
*Occiput is landmark
Sinciput presentation
Fetal head partially flexed
Top of head is presenting part
Occiptofrontal diameter presents
*Occiput is landmark
Brow presentation
Head partially extended
Occipitomental diameter/ LARGEST anterioposterior diameter presented
* Chin is landmark
Face presentation
Head is hyper extended
Submentobregmatic diameter
*Chin is landmark
Complete breech
Head and knees flexed,thighs on abdomen
Cavs on posterior aspect of thighs
Buttocks and feet present
* sacrum is landmark
Frank breech
Hips flexed, knees extended
Buttocks presents
* sacrum is landmark
Footling breach
Hips and knees extended
Feet present
Single footling, double footling
* sacrum is landmark
Effacement
Drawing up of internal os and cervical canal into uterine sidewalls
Shoulder presentation
Shoulder is presenting part
Fetus is in transverse lie
*Acromion process of scapula is landmark
Cephalon presentation
Engagement
Biparietal diameter is largest dimension of fetal skull to pass through pelvic inlet
Breech presentation engagement
Tetrochanteric diameter (transverse diameter between right and left trochanter) is largest to pass through pelvic inlet
Engagement
When largest diameter of presenting part reaches or passes through pelvic inlet
Station
Relationship of presenting part to an imaginary line drawn between Ischial spines of maternal pelvis
Higher is negative
Lower is positive
Lightning
Fetus begins to settle in pelvic inlet
“the baby dropped”
Bloody show
mucous plug expel due to softening and effacement of cervix, blood loss from expose cervical capillaries
Ripening
Softening of cervix
Spontaneous rupture of membranes
SROM
Risk of prolapsed cord if fetus not engaged, bacteria can enter
Premature rupture of membranes
PROM
Any spontaneous rupture of membranes before onset of labor
Preterm premature rupture of membranes
PPROM
Leakage or rupture of amniotic fluid before 37 weeks
True labor
Dilation and effacement
Back pain that radiates around to abdomen
Pain not relieved by ambulating
Contractions regular and increasing in frequency, duration, intensity
First stage
Active phase
Onset of regular contractions, mild intensity
Cervix dilate and effaces but a little fetal dissent
Able to cope, smiling, talkative
Should not exceed 20 hours
First stage
Active phase
Intensification of contractions
Fetal dissent is progressive
anxiety tends to increase, fear loss of control, decreased ability to cope
* Metabolic acidosis compensated by respiratory alkalosis
Cervix dilate from about 4 to 7 cm
First stage
Transitional phase
Contractions become more frequent and strong Increased rectal pressure, urge to Bear down
Significant anxiety, crying and yelling, hyperventilation and restlessness, “lose her mind”
Cervical dilation slows from 8 to 10 cm and rate of fetal dissent increases
Generalized discomfort, sensitivity to touch
Needs partner support or nurses
Hiccuping, belching, nausea or vomiting, perspiration on upper lip
Positional changes a fetus
Flexion
As fetal head to sense, result of resistance, fetal chin flexes downward onto chest
Positional changes a fetus
Internal rotation
Fetal HEAD must rotate to fit diameter of pelvic cavity, occiput rotates from LEFT to RIGHT (side to front) and sagittal suture aligns in anterioposterior pelvic diameter
Positional changes a fetus
Restitution
Shoulders of infant enter pelvis obliquely, neck becomes twisted. Once head emerges, neck untwist turning head to one side and aligns (restitution) with position of back in birth canal
Positional changes a fetus
External rotation
Shoulders rotate to the anterior posterior position and pelvis head is turned farther to the side
Positional changes a fetus
Expulsion
After external rotation, anterior shoulder is born before posterior shoulder, body follows quickly
Third stage
Placental separation signs
- globe shaped uterus
- Rise a fundus in abdomen
- Sudden gush or trickle of blood
- further protrusion of umbilical cord out of vagina
Third stage
Placental delivery
Retained placenta – more than 30 minutes elapsed
- Shultze Mechanism: expelled with fetal shiny side presenting,” shiny shultze”
- Duncan Mechanism: expelled with maternal surface delivering first, surface is rough, “dirty Duncan”
Fourth stage
One to four hours after birth
Physiologic readjustment of mothers body begins
VS: drop in blood pressure, increased polls, moderate tachycardia
May experience shaking chill
Hemodynamic changes
Acid/base is more balanced
Secobarbital
Second choice
Oral
Treat false labor and produce sedation affect
Long half-life, remain in maternal and fetal blood for up to 40 hours
Zolpidem (Ambien)
First choice Barbituate
Oral
False labor and produce sedation effect
Half-life of 4.5 hours
For sleep to encourage rest
Diazepam (Valium)
Midazolam (Versed)
Benzodiazepine
Treat anxiety, anticonvulsant action
Fetal side effects: increase in variability of FHR, hypotonicity, hyperactivity, impaired temperature regulation, impaired metabolic response to cold stress
Not recommended before baby is born
Associated with low Apgar scores when administered five minutes or less before birth
Promethazine (Phenergan)
Sedative, antiemetic
Crosses placenta barrier and result in decreased FHR variability
Hydroxyzine (Vistaril)
IM
Given in early labor to decrease anxiety and nausea
Diphenhydramine ( Benadryl)
Treat allergic rhinitis and hives
Sedative and antiemetic
Half-life last up to 6 to 8 hours
Butorphanol (Stadol)
Narcotic
Precipitate withdraw and drug dependent individuals
(Know patients drug history)
Given in labor
Fentanyl (Sublimaze)
Narcotic
Moderate analgesia and mild sedation
Rapid onset, short half-life
*Limited placental transfer
Nubain
Narcotic
May precipitate drug withdrawal of woman is physically dependent on narcotics
* crosses placental to fetus, respiratory depression
Meperidine (demerol)
Narcotic
Used to relieve shaking
Crosses placenta within 90 seconds
Maternal side affects: urinary retention, respiratory depression, sedation, conversions, dizziness, N/V
Fetal side effects: decreased/absent respiratory movement, decreased fetal movement, decrease in variability, low Apgar scale, low O2 sat, alteration in fetal ECG
Local anesthetics Esters -Novacaine -Nesacaine -Pontocaine
Rapidly metabolized
Toxic maternal levels not as likely, placenta transferred to fetus is present prevented
Local anesthetic Amides -Bupivicaine (Marcaine)* -Ropivacaine* -Levobupivicaine*
Powerful and long-acting
Cross placenta, affect fetus for prolonged period
Lumbar epidural block
Epidural space is between dura mater and ligamentum flavum
Disadvantage:* most common complication is maternal hypotension
Onset of analgesia may not occur for up to 30 minutes
Avoid perforating Dura mater
Close observation of mother and fetus required
Decreased FHR variability, late the cells if maternal hypotension occur
Lumbar epidural block
Relative contraindication
Platelet count less than 100,000 Sepsis Hypertension Uncooperative patient Severe anatomic abnormalities of the spine
Lumbar epidural block
Technique
IV infusion begun, preload of 500 to 2000 ml of IVF given over 15 to 30 minutes (prevents) hypotension
Positioned on the right or left side, or sitting on edge of bed with back
Woman is attained by nurse for first 20 minutes
Blood pressure monitor every 1 to 2 minutes for first 10 minutes, then every 5 to 15 minutes until block wears off
Hypotension: left lateral displacement of uterus, Trendelenburg, epinephrine
Spinal block
Local Anesthetic injected into spinal fluid and subarachnoid space
Does not cross fetal circulation
Contraindication: CNS disease
Position: placed on back with pillow under head positions alter the level of those within 3 to 5 minutes
Pudenal Block
Perineal anesthesia for second stage of labor, birth, episiotomy
Injected below pudendal plexus
Relief of pain from perineal distention, does not relieve contraction pain
disadvantage: decreased urged to bear down, burning
complications: perforation of rectum, trauma to sciatic nerve, potential broad ligament hematoma
Ketamine
IV Gen. Anasthesia
Last 20 to 60 minutes
Hyper salivation can occur, hallucinations
Contraindication: preeclampsia or chronic hypertension
Inhaled anesthesia agent
Nitrous oxide
Crosses placenta immediately, less neonatal depression
Inhaled anesthesia
Isofurane, Sevofurane, Halothane, Desflurane,Enflurane
Maybe use for woman with aortic stenosis
Used if spinal or epidural anesthesia ineffective
