Intrapartum Assessment & Interventions (Ch.8) Flashcards
What is the intrapartum period?
Begins with the onset of regular uterine contractions and lasts until the expulsion of the placenta
How does estrogen stimulate labor?
Estrogen increases stimulating uterine response
How does progesterone effect labor?
Progesterone is withdrawn allowing estrogen to stimulate contractions
Braxton Hicks
-Irregular uterine contractions that don’t effect the cervix
“False labor”
Describe Braxton Hicks contractions?
- Usually not painful
- Don’t have regular intervals
- Don’t get closer together
- Don’t feel stronger over time
What helps Braxton Hicks contractions?
Changing activities or position
What are signs of impending labor?
- Braxton Hicks
- Loss of mucous plug or have a change in discharge
- Low backache
- “Bloody show” - Brownish or blood-tinged cervical mucus discharge
What are the 5 P’s that effect the outcome of labor and delivery?
- Powers (Contractions)
- Passage (the pelvis and birth canal)
- Passenger (fetus)
- Psyche (response of women)
- Position (maternal postures & physical positions to facilitate labor)
How does uterine contractions effect the cervix?
Dilation (opening) and effacement (thinning) in the first stage of labor
How are uterine contractions measured?
- Frequency (minutes)
- Duration (seconds)
- Intensity
What is the most common type of pelvis?
Gynecoid
What does “station” mean when talking about passage of labor?
Fetal station refers to where the presenting part is in your pelvis
What is the largest portion of the fetus to come through the birth canal?
Fetal head
What should the posture or attitude of the fetus be during labor?
Head flexed so the chin is against chest
What is the least favorable type of pelvis?
Android (heart) shaped
What does it mean when the fetus lie is transverse?
Baby is perpendicular to the mother
Cannot be delivered vaginally
Associated with shoulder being the presenting part
What is the difference between true labor and false labor?
True: Changes in cervical effacement & dilation
False: Irregular contractions with little or no cervical change
When does the rupture of membranes occur?
During labor
-Women should deliver within 24 hrs to reduce risk of infection to herself & her fetus
What does the AmniSure test do?
Noninvasive way to see if ROM has occurred
What should normal amniotic fluid look like?
Clear or cloudy with a normal odor
If the amniotic fluid is meconium-stained, what could that indicate?
Fetal compromise in uterus
When should you tell a first-time pregnancy with no risk factors to go to the hospital?
When contractions are 5 minutes apart, last 60 seconds, and are regular for at least 1 hour
What is the first stage of labor?
Begins with onset of labor and ends with complete cervical dilation
What is the second stage of labor?
Begins with complete dilation of cervix and ends with delivery of the baby
What is the third stage of labor?
Begins after delivery of the baby and ends with delivery of the placenta
What is the fourth stage of labor?
Begins after delivery of the placenta and is completed 4 hours later
Immediate postpartum period
What are you assessing first stage of labor?
- Maternal VS
- The women’s response to labor & pain
- FHR & UCs
- Cervical changes
- Fetal position and descent in the pelvis
What are the three phases of first stage of labor?
Latent, Active, Transition
What happens during the active phase of first stage of labor?
- Discomfort increases (go to the hospital if they haven’t already)
- Medical intervention: Rupture membranes if not perviously ruptured, if indicated
What does the nurse monitor during the active phase of first stage of labor?
- Monitor FHR and contractions every 15-30 minutes
- Monitor maternal VS every 2 hrs; every 1 hrs if ROM
- Assess pain (location & degree)
Characteristics of transition phase of first stage of labor
- Often feel and act out of control
- Trembling
- More vocal with primal noises and facial expressions
- Intense contractions every 1-2 minutes lasting 60-90 seconds
Medication interventions during transition phase of first stage of labor
- Perform amniotomy if not previously done
- Assess fetal position and cervix
- Prepare for delivery
What do you assess during second stage of labor?
- Monitor fetal response to pushing
2. Check FHR every 5-15 minutes or after each contraction
If the third stage of labor lasts more than 30 minutes what interventions are implemented?
IV/IM oxytocin may be used to manage the retained placenta
What are the two things that happen during the fourth stage of labor?
- Assess the funds for firmness
2. Repair the episiotomy or laceration
What does the nurse monitor/interventions during the 4th stage of labor?
- Fundal massage
- Assess loch for color, amount, and clots
- Assess maternal VS every 15 minutes
- Apply ice packs to perineum
- Assist women to the bathroom & measure void
- Assess for return of full motor-sensory function if epidural or spinal anesthesia is used
- Explore any request to keep placenta
Can you push oxytocin?
No
What Apgar score indicated severe distress?
0-3
What is the Apgar used for?
Rapid objective status of the newborn and the response of resuscitation immediately after birth
When is an Apgar done?
1 minute and 5 minutes after birth
What does the Apgar look at? (good sign)
Respiratory effort (good cry) Heart rate(above 100) Muscle tone (Active motion) Reflex activity (Vigorous cry) Color (Completely pink)
What do you do to resuscitate a neonate?
- Place under heat source
- “sniffing” position to open airway
- Clearing airway with bulb syringe
- Drying the baby
- stimulate breathing
What three medications can you administer to newborns?
- Erythromycin ointment
- Vitamin K given IM
- Hepatitis B virus vaccine
Why would you give a baby Erythromycin ointment?
Administered to the eyes to prevent gonococcal and Chlamydia infections
Why would you give a IM injection of Vitamin K to a baby?
Prevent hemorrhagic disease caused by Vitamin K deficiency
Symptoms of Respiratory Alkalosis for mother
- Tingling of the fingers
- Lightheadness
- Dizziness
Treat: Breathe into a bag or cupped hands
What can cause Respiratory Alkalosis in mother?
Labor pains increasing > women to breathe in more rapid and shallow > hyperventilation
Effleurage (Non-pharmacological management of labor pain)
Cutaneous stimulation by lightly stroking the abd in rhythm with breathing during contractions
Thermal Stimulation (Non-pharmacological management of labor pain)
Application of warmth or cold to reduce anxiety and promote well-being
What is the purpose of Sterile Water Injections?
SQ injection of 0.5 mL gives 60-90 minutes of lower back pain relief
When would you give a local anesthetic?
- Second stage of labor, immediately before delivery
2. Anesthetizes local tissue for episiotomy and repair
What do you need to check before giving Epidural Block?
- Obtain consent
- Check lab values esp. bleeding/clot abnormalities
- IV fluid bolus w/ NS or LR
- Ensure emergency equipment
What is the most common complication from giving Epidural Block?
Hypotension
Postprocedure for an Epidural Block
Monitor mom VS and FHR every 5 min initially then every 15 min
Urinary retention can be common
Assess pain and level of sensation & motor loss
Position women on as needed (on side to prevent inferior vena cava syndrome)
Assess for itching, N/V, and headache, and administer PRN meds
What is the nurses role for an epidural anesthesia?
Nurse monitor but do not manage the care of women receiving epidural anesthesia
Responsibilities: Monitor Mother VS, mobility, LOC, and perception of pain, as well as fetal status
What are you looking for if Intravascular Injection has occurred after Epidural Block?
HTN, Dizziness, Tinnitus, Metallic taste in the mouth, LOC
Treated by anesthesia care provider
