Labor Flashcards
Latent stage
- Contraction last 30 40 sec with increasing intensity
- 0-3cm dilation
- bloody show
- usually unable to walk/talk
- use diversion
First stage of labor
Dilating stage
Behind with the 1st true labor contraction and end with complete dilation of the cervix 10 cm
3 phases
Latent, active, transitional
Active stage
- contraction are stronger, 45-60 sec, Q3-5 minutes
- cervix dilates 4-7cm
- not able to walk, mother tends to withdraw from the surrounding environment but desire companionship and encouragement
Transient
- Sharp contraction, more intensified lasting 60-90sec, frequency is 2-3min
- dilation 8-10cm
- increase in bloody show
- mother unregenerate to push or having a BM
2nd stage of labor
Delivery/expulsive stage: from complete dilation to the birth of baby (where almost everything happens)
- crowning
- delivery of the baby
- clamping and cutting umbilical cord
- increase bloody show
- desire to bear down
- nausea, irritability, uncooperative, severe discomfort, pleas for relief
3rd stage of labor
Placental stage: from baby delivery to placental expulsion
4th stage of labor
Recovery and stabilization phase
- from placental delivery and uterus tends to relax
- goal is to prevent hemorrhage
What is engagement, descent, flexion?
When the widest part of the baby’s head passes the ischial spines as as the head is flexed onto the chest
Mechanism of labor
Engagement Internal rotation Extension External rotation Expulsion
What is LOA presentation?
Fetal occiput (back of the head) is facing towards the left side of the maternal pelvis and towards the front
LOA
(Left occiput anterior)
Full term fetal heart rate
120-160bpm baseline
Brady< 120
Tachy> 160
What FHR during contraction should do?
May increase or decrease by 30bpm and return to baseline immediately after
What to do if FHR does not vary with contraction?
- assist woman to change position
- notify physician/ certified unreserved midwife
What generalized edema indicate?
Preeclampsia or pregnancy induced hypertension
Especially edema is face and hands
What is fetal station?
The relationship between the presenting part of the baby with the mother pelvis
(Presenting part/pelvis)
What is fetal lie?
Relationship between the head to tail bone axis for both the fetus and the mother
(Lie/alignment)
What is fetal attitude
The relationship of the fetal body parts to one another
Posture
What is fetal presentation?
Portion of the baby that enters the pelvis first (cephalic, breech, shoulder)
Lab test
- urinalysis for protein
- antibody screen at 28weeks if client is Rh negative
- cervical culture for group B strep at 34-36 weeks gestation
- hemoglobin/Hct
When do you give rhogam?
- To Rh negative female @ 28-30 weeks during pregnancy
- after any possible mixing of fetal blood (ectopic pregnancy,miscarriage, MVA, amniocentesis, abortion….)
- within 72h of giving birth
- After the birth of a Rh positive newborn
- after a negative or normal Coombs test
How long the latent phase of the 1st stage of labor last?
Approximately 8hour for the primipara and 4-5hours for the multipara
How long is the active phase of the 1st phase of labor?
About 4h for primipara and 2h for multipara
What are nursing responsibilities before administration of epidural?
Take vs
Record FHR
Encourage to empty bladder or insert Foley catheter
How often should the nurse monitor FHR and BP after epidural?
Every 5 min for 30 minutes!!
- then if stable Q15 to 30 min
If hypotension, or fetal bradycardia occur, turn the woman to her left side
Serious side effect of epidural anesthesia
Headache
Shivering
Backaches
Nausea
Postpartum endocrine adaptation
- estrogen drop at birth, lowest in 1week
- Progesterone drop at birth, undetectable in 72h
- Oxytocin stimulate uterine contraction and milk letdown reflex
- Progestin stimulates milk production
When is loch is supposed to be pink to brown?
On days 3 to 7
Rubra (red) from day 1-3
Serosa (pink) 3-7
Alba (creamy white) on or around day 10
During teaching about breast feeding the nurse should tell the mom to….?
Baby should nurse 10-15 min on each side Q2- 3hours
Encourage 8 oz of fluid with each feeding and 500calories extra per day
Suggest warm compress or shower prior to breast feeding to assist the let down reflex
Baby should be fed Q2-3 hours during day and night
Start with the breast last fed on
Avoid using soap and water on nipple
What are postpartum warning signs for the mother to report?
- Temperature >100.4F (38C)
- Continued mood swing or depression
- Appetite loss
- Sleep disturbance
- Elimination problems (GI/GU)
- increased lochia clots or foul odor
- Perineal pain or swelling
- Calf tenderness
Newborn warning sign to report?
- temperature>100.4F
- Inconsolable crying
- Poor effort feeding
- Inability to arouse (exceedingly sleepy)
- No wet diaper in 8hours
- vomiting or diarrhea
- Yellowing of the skin
What is colostrum?
The first milk which is high in protein and fat soluble vitamins and has anti-infective properties.
What is Depo-provera?
An injection of progestin hormone (IM)
Each shot prevents pregnancy for three month
May delay conception for up to 2 years after discontinuation of the product
When do we Never administer Rhogam?
To a Rh positive mother
Someone with a positive Coombs test
A Rh negative woman wha has just given birth to an RH negative baby
To the father of the child
What is apgar score?
Rating of respiration, crying, reflexes, irritability, pulse,heart rate and skin color of the newborn
Score from 0 -10 given at 1 and 5 min from birth.
What does an apgar score of 6 means?
Mean this the baby has some mild depression (5-7= mild depression)
- The neonate may require some stimulation (gently but firmly slappy the sole of the frets or runnin the back/ spine.
- This kids may require oxygen
APGAR score
8-10= normal
5- 7= mild depression (need some stimulation, may need O2)
3- 4= moderate depression (baby will need O2 and may need insertion of feeding tune to decompress stomach)
0- 2= severe depression requiring immediate life support
Why do we instill erythromycin eye drop to new born within the few first hour of birth?
To prevent and protect the child against chlamidial conjunctivitis
Newborn vitals sign?
Temp: 97.9- 99.7 axial lark
Apical HR: 110-160bpm
BP: 50-75 mm hg
Resp: 30-60 resp per minute
Hyperbillirubinemia for newborn
15mg/dL or greater (term baby)
10mg/dL or greater (preterm)
Persistent elevated of bilirubin in the body place the infant at risk for neurotoxicity or BIND (bilirubin induced neurological dysfunction)
When do we screen the baby for PKU (Phenylketonuria)?
After 48 h of age and after adequate protein intake
The 4th stage of labor is the placental separation and expulsion
True or false?
False
The 3rd stage of labor is the placental separation and last about 5-30 min. The 4th stage of labor is maternal adaptation!!! Occurring 1 to 2 hour after birth.
When the fetus is active the FHR should increase by 15 bps
True or false?
True
When the fetus is active the HR will increase by 15 bpm above baseline
What is chloasma?
Discoloration of the skin during pregnancy
A gravida 3, para 3 woman should be rush to the delivery room once engagement has occurred
True or false?
False
Engagement just means that the head of the baby is no longer free floating, but has dropped into the pelvis. In a multipara, engagement normally occurs about 2 weeks before birth!
The safest time for the fetus is to give the mother analgesia when her cervix is dilated 8- 10cm
True or false?
False!
The safest time to give analgesia is when dilation is between 4-7 cm
What is the glabella reflex?
The baby will close his eyes when tapping on the glabella (flat bone between the eyebrows)
