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Women and Families > L and D > Flashcards

L and D Flashcards

1
Q

5 Ps of labor

A
  • passageway
  • passenger
  • power of labor (physiologic)
  • position of mother
  • psychosocial consideration
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2
Q

the passenger

A
  • fetal presentation (vertex, breech, shoulder)

- station (ischial spines are 0 station)

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3
Q

power of labor

A
  • progesterone: relaxant: keeps uterus relaxed
    estrogen: excites uterine response
  • oxytocin and prostaglandin: increase muscle contraction: to induce labor
  • uterine contractions: frequency, duration, intensity
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4
Q

indocin

A

antiprostagladin: stops contraction in preterm labor

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5
Q

tachysystole

A

-more than 5 contractions in 10 minutes

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6
Q

what do contractions causes

A

cervical change

  • dilatation: opening up of cervix
  • effacement: thinning out of cervix
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7
Q

signs associated with cervical change

A
  • loss of mucous plug
  • rupture of membranes
  • blod show
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8
Q

premonitory signs of labor

A

-lightening
-Braxton hicks
-bloody show
-rupture of membranes
-sudden burst of energy (nesting)
-weight loss
-backache
-n/v/d
occur 1-2 weeks before

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9
Q

stages of labor: first stage

A

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
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10
Q

assessment of first stage of labor

A
  • prenatal record
  • interview
  • physical exam
  • psychological adaptation
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11
Q

labor stauts assessment

A
  • uterine contractions
  • cervical dilatation
  • cervical effacement
  • fetal descent/station
  • membranes
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12
Q

first stage of labor nursing interventions

A
  • 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
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13
Q

frequency of VS during first stage

A
  • low risk: 30 minutes

- high: 15 minutes

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14
Q

frequency of VS during second stage

A

low: 15minutes

- high: 5 minutes

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15
Q

External fetal monitoring

A

continuous monitoring of fetal heart rate and uterine activity

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16
Q

evaluation of fetal monitoring: what do you want to know

A
  • determine baseline
  • determine Basile variability
  • determine whether there are periodic changes
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17
Q

FHR

find baseline? tachycardia? bradycardia?

A

baseline: mean FHR during 10 minutes, observed for 2 minutes: normal 110-160
tachycardia: over 160
Bradycardia: less than 110

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18
Q

baseline variability

A
  • 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
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19
Q

what are periodic changes

A
  • changes that occur with uterine contractions
  • accelerations
  • decelerations: early/late/ variable
20
Q

accelerations

what? types? association?

A
  • 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
21
Q

early decelerations

A
  • 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
22
Q

late decelerations

A
  • 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
23
Q

late deceleration interventions

A
  • immediate intervention for recurrent lates
  • stop IV Pitocin
  • position change (left lateral)
  • increase IV fluids
  • oxygen via face mask
  • notify physician
24
Q

variable deceleration

A
  • 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
25
Q

variable deceleation interventions

A
  • 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
26
Q

factors affecting response to pain

A
  • preparation for childbirth
  • individuals response to painful stimuli
  • cultural norms
  • fatigue and sleep deprivation
  • previous experience with pain
  • anxiety
  • support
27
Q

types of pain management

A
  • regional anesthesia: epidural/spinal
  • local anesthesia
  • systemic analgesia
28
Q

regional anesthesia

A
  • temperary and reversible loss of sensation
  • prevent initiation and transmission of nerve impulses
  • type: epidural or spinal
29
Q

epidural advanatages

A
  • 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
30
Q

epidural disadvantages

A
  • 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
31
Q

spinal block advantages

A
  • immediate onset of anesthesia
  • relative ease of administration
  • smaller drug volume
  • little placental transfer
32
Q

spinal block disadvantages

A
  • high incidence of hypotension
  • greater potential for fetal hypoxia
  • uterine tone is maintained: make intrauterine manipulation difficult
  • short acting
  • possible total spinal
33
Q

what to teach about analgesia

A
  • type of med
  • route
  • expected effects
  • implications for the baby
  • safety measure required (no walking?)
  • complications
34
Q

systemic analgesia

A
  • goal to provide maximum pain relief with minimal risk

- alteration in material state affects fetus

35
Q

administrating systemic analgesic

A
  • woman is uncomfortable
  • well established labor pattern
  • contractions occurring regularly
  • significant duration of contractions
  • moderate strong intensity
36
Q

sedatives

A

use: early latent phase
purpose: relaxation and sleep
like ambien

37
Q

h1 receptor antagonist

A

use: early latent phase
purpose: sedative, antiemetic
- phenergan, Benadryl

38
Q

narcotics

A
  • use: active phase
  • purpose: pain management
  • Nubain, fentanyl
  • narcotic antagonist: narcan
39
Q

second stage of labor

A
  • begins with complete dilatation 10 cm

- end with birth of baby

40
Q

second stage interventions

A
  • 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
41
Q

third stage of labor

A
  • from birth of infant to delivery of placenta
  • placental separation
  • palpate fundus
  • sign : cord will lengthen and gush blood
42
Q

third stage interventions

A

encourage breathing and abdominal relaxation during delivery of placenta

  • possible administration of Pitocin
  • provide newborn care
  • assist with delivery of placenta
43
Q

fourth stage of labor

A
  • 4 hours after birth
  • physiological readjustment
  • thirsty and hungry
  • shaking
  • bladder is ofren hypotonic
  • uterus should remain contracted
44
Q

care of newborn after birth

A
  • maintain respirations
  • provide and maintain warmth
  • APGAR score
  • phsycial assessment
  • newborn identification
  • facilitate attachment
45
Q

fourth stage of labor interventions

A
  • palpate fundus every 15 minutes for 1 hour
  • assess vaginal bleeding
  • encourage bonding and breastfeeding
  • assess perineum
  • perineal care

Women and Families (7 decks)

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