L and D Flashcards
5 Ps of labor
- passageway
- passenger
- power of labor (physiologic)
- position of mother
- psychosocial consideration
the passenger
- fetal presentation (vertex, breech, shoulder)
- station (ischial spines are 0 station)
power of labor
- progesterone: relaxant: keeps uterus relaxed
estrogen: excites uterine response - oxytocin and prostaglandin: increase muscle contraction: to induce labor
- uterine contractions: frequency, duration, intensity
indocin
antiprostagladin: stops contraction in preterm labor
tachysystole
-more than 5 contractions in 10 minutes
what do contractions causes
cervical change
- dilatation: opening up of cervix
- effacement: thinning out of cervix
signs associated with cervical change
- loss of mucous plug
- rupture of membranes
- blod show
premonitory signs of labor
-lightening
-Braxton hicks
-bloody show
-rupture of membranes
-sudden burst of energy (nesting)
-weight loss
-backache
-n/v/d
occur 1-2 weeks before
stages of labor: first stage
early/latent: 0-3 cm, mild contractions with increasing frequency, duration, and intensity
- active: 4-7cm, more frequent and intense contraction: progressive fetal descent
- transition: 8-10cm, progressive fetal descent, contraction more frequent and intense
assessment of first stage of labor
- prenatal record
- interview
- physical exam
- psychological adaptation
labor stauts assessment
- uterine contractions
- cervical dilatation
- cervical effacement
- fetal descent/station
- membranes
first stage of labor nursing interventions
- palpate contraction q 15-30 mins
- vaginal exams to assess when you need to know
- encourage client to void
- start IV fluid infusion if unable to tolerate fluids
- auscultate fetal heart rate every 15-30 mins
- assess color and odor of amniotic fluid and FHR the it ruptures
- comfort measures
frequency of VS during first stage
- low risk: 30 minutes
- high: 15 minutes
frequency of VS during second stage
low: 15minutes
- high: 5 minutes
External fetal monitoring
continuous monitoring of fetal heart rate and uterine activity
evaluation of fetal monitoring: what do you want to know
- determine baseline
- determine Basile variability
- determine whether there are periodic changes
FHR
find baseline? tachycardia? bradycardia?
baseline: mean FHR during 10 minutes, observed for 2 minutes: normal 110-160
tachycardia: over 160
Bradycardia: less than 110
baseline variability
- reliable indictor: fetal cardiac and neurological function
- absent; amplitude no detected
- minimal: amplitude range detectable less than or equal to 5bpm
- moderate: amplitude range 6-25bpm
marked: amplitude ove 25 bpm
what are periodic changes
- changes that occur with uterine contractions
- accelerations
- decelerations: early/late/ variable
accelerations
what? types? association?
- visually apparent increase in baseline FHR of 15bpm, onset to Peaks less than 30 sec and last more than 15 sec
- types: episodic (not associated with contractions), periodic (associated with contractions
- generally associated with stimulation of ANS
early decelerations
- usually symmetric with gradual increase
- Nadir occurs when the contraction peaks (onset to Nadir more than 30 sec)
- result of vagal nerve stimulation
- normally reassuring
late decelerations
- usually symmetric, gradual decrease
- associated with uterine activity
- nadir occurring after peaks of contraction (onset to nadir is more than 30 s)
- result of uteroplacental insufficiency (might fetal acidosis
late deceleration interventions
- immediate intervention for recurrent lates
- stop IV Pitocin
- position change (left lateral)
- increase IV fluids
- oxygen via face mask
- notify physician
variable deceleration
- abrupt decrease in FHR
- may or may not be associated with uterine contractions (onset to nadir less than 30 sec, decrease more than 15 bpm and last 15s or more
- varies with successive contraction
- not usually concerning Unless: less than 70bpm, lasts more than 60s, and slow return to baseline
variable deceleation interventions
- isolated/occasional/moderate
- change material position
- stop oxytocin
- perform vaginal exam
- monitor FHR
- oxygen by face mask
- report finding, document
- provide explanation to woman and partner
factors affecting response to pain
- preparation for childbirth
- individuals response to painful stimuli
- cultural norms
- fatigue and sleep deprivation
- previous experience with pain
- anxiety
- support
types of pain management
- regional anesthesia: epidural/spinal
- local anesthesia
- systemic analgesia
regional anesthesia
- temperary and reversible loss of sensation
- prevent initiation and transmission of nerve impulses
- type: epidural or spinal
epidural advanatages
- produces good anesthiseia
- woman is fully awake during labor and birth
- continous technique allow different blocking for each stage of labor
- dose of anesthetic agent can be adjusted
epidural disadvantages
- maternal hypotension: increase IV fluids
- cardiorespiratory arrest
- vertigo
- onset of analgesia mayn’t occur for up to 30 minutes
- difficulty pushing
- loss of bladder sensation may cause urine retention
- causes itch: give Benadryl
spinal block advantages
- immediate onset of anesthesia
- relative ease of administration
- smaller drug volume
- little placental transfer
spinal block disadvantages
- high incidence of hypotension
- greater potential for fetal hypoxia
- uterine tone is maintained: make intrauterine manipulation difficult
- short acting
- possible total spinal
what to teach about analgesia
- type of med
- route
- expected effects
- implications for the baby
- safety measure required (no walking?)
- complications
systemic analgesia
- goal to provide maximum pain relief with minimal risk
- alteration in material state affects fetus
administrating systemic analgesic
- woman is uncomfortable
- well established labor pattern
- contractions occurring regularly
- significant duration of contractions
- moderate strong intensity
sedatives
use: early latent phase
purpose: relaxation and sleep
like ambien
h1 receptor antagonist
use: early latent phase
purpose: sedative, antiemetic
- phenergan, Benadryl
narcotics
- use: active phase
- purpose: pain management
- Nubain, fentanyl
- narcotic antagonist: narcan
second stage of labor
- begins with complete dilatation 10 cm
- end with birth of baby
second stage interventions
- sterile vaginal exams to asses fetal descent
- assess maternal VS q5
- provide support and give information about labor process
- assist with pushing
- assist the physician with birth
third stage of labor
- from birth of infant to delivery of placenta
- placental separation
- palpate fundus
- sign : cord will lengthen and gush blood
third stage interventions
encourage breathing and abdominal relaxation during delivery of placenta
- possible administration of Pitocin
- provide newborn care
- assist with delivery of placenta
fourth stage of labor
- 4 hours after birth
- physiological readjustment
- thirsty and hungry
- shaking
- bladder is ofren hypotonic
- uterus should remain contracted
care of newborn after birth
- maintain respirations
- provide and maintain warmth
- APGAR score
- phsycial assessment
- newborn identification
- facilitate attachment
fourth stage of labor interventions
- palpate fundus every 15 minutes for 1 hour
- assess vaginal bleeding
- encourage bonding and breastfeeding
- assess perineum
- perineal care
