Labor and Delivery Flashcards by Crystal Sanders

T/F Labor: Contractions are irregular

False labor

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T/F Labor: Contractions keep coming no matter what you do

True labor

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T/F Labor: Contractions steadily get stronger

True labor

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T/F Labor: Contractions get stronger with ambulation

True labor

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T/F Labor: Contractions do not get closer together with time

False labor

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T/F Labor: Pain is usually felt only in the front

False labor

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T/F Labor: Contractions come at regular intervals and get closer together

True labor

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T/F Labor: Contractions are often weak and tend to stay that way

False labor

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T/F Labor: Contractions, if strong, are followed by weaker ones

False labor

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T/F Labor: Contractions last 30-90 seconds

True labor

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T/F Labor: Pain usually starts in the back and moves to the front

True labor

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T/F Labor: Contractions before 24 weeks might be accompanied by vaginal spotting

True labor

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T/F Labor: Braxton Hicks contractions do not dilate the cervix

False labor

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1st stage of labor

Cervix reaches full dilation

Longest phase

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Latent phase of 1st stage of labor

Contractions become more frequent and stronger
10-12 hours for woman with children
20 hours for primagravida

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Active phase of 1st stage of labor

From 3-4 cm to 8-9 cm

5 hours in 1st time mothers

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2nd stage of labor

Mother actively pushes baby out
Delivery of the baby

1st time mothers - 2-3 hours
2nd babies + - often less than 1 hour

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3rd stage of labor

Begins immediately after the birth of the baby

Ends with delivery of the placenta

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4 “P” Components of Labor

Passageway
Passenger
Power
Psyche

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Assessment of Documentation of Membranes

Intact 
Ruptured 
ROM 
SROM 
AROM 
PROM 
Gush or trickle

Greenish color indicates meconium is in danger

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Primary nursing responsibilities of the membrane

Document time, color, and odor o fluid as a baseline

Continue to observe

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Once the membrane ruptures, the danger is:

Infection

Note color and odor of amniotic fluid

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How should amniotic fluid look?

Clear with occasional white particles

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The lecitihin/sphinhomyelin radio is used to:

determine fetal lung maturity

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Surfactant is a mixture of:

Lipids Proteins Lecithin - makes surfactant mixture more effective Sphingomyelin

What is an episiotomy?

Perineal incision to enlarge the vaginal outlet

Molding of fontanels:

Head is molded during delivery | WIll return to normal in a few days

Presentation of the descending fetus:

fetal part that enters the pelvis first

Position the descending fetus:

position of baby's occiput relative to mom's pelvis

Lie of the descending fetus:

position of baby's body relative to mom's spine

Attitude if the descending fetus:

flexion

Leopold's Maneuvers:

Helps determine position and lie of the baby

1st Leopold's Maneuver

What is in the *fundus*?

2nd Leopold's Maneuver

Where is the fetal *back*?

3rd Leopold's Maneuver?

What is in the *pelvis*?

4th Leopold's Maneuver?

What is *presenting*?

Normal HR of fetus?

120-160

4 things to assess of fetal heart tones

HR Variability (beat-to-beat, long term) Accelerations Decelerations

Accelerations in fetal heart tones are:

expected

Late decelerations in fetal heart tones are:

bad

Variability in a fetus' hear tones is a good indication of:

fetal wellness

Variable deceleration:

transient series of decelerations that vary in intensity, duration, and relation to uterine contraction

Late deceleration:

in fetal HR monitoring, a transient decrease in HR occurring at or after the peak of uterine contraction may indicate *fetal hypoxia* or possible *utero-placental insufficiency*

Oxytocin (Pitocin) stimulates and produces what?

Stimulates uterine smooth muscle | Produces uterine contractions

Oxytocin (Pitocin) induces and controls what?

Induces labor | Controls post partum bleeding

(2) maternal and (1) infant oxytocin complication:

``` Maternal -coma -seizures Infant -intracranial hemorrhage ```

If the mother has a prolapsed cord, what do you do?

Place her in knee-chest position

Determine contractions by what 3 things?

Intensity Duration Frequency

Optimal Contractions (4)

Involuntary Shortening of uterine fibers Endogenous oxytocin Every 3-5 minutes x 60 seconds

When using narcotics, monitor for signs of maternal and fetal:

distress *closely*

Schedule II drugs for labor:

Morphine | Fentanyl

Mixed agents (narcotic agents) for pain management for labor:

Stadol | Nubain

What to monitor with epidural blocks:

Hypotension | Urinary retention

Epidural block is placed where?

Under dura and arachnoid membranes

What does an epidural block?

Transmission of pain impulses

Who does the epidural block?

Anesthesiologist

Spinal patch is used for:

C-Section

How should the mother lie after a spinal patch?

Flat | Prevents HA

Mother loses all feeling below where after spinal patch?

Below the block

Spinal patch acts quickly and requires more/less medicine than an epidural?

less

2 adverse effects of spinal patch:

Hypotension (more severe than epidural block) | Urinary retention

Nursing care for patient undergoing adverse effect of spinal patch:

Analgesics Oral and IV fluids to relieve HA Bed rest

Epidural is injected into:

the epidural space

Can an epidural be used with a C-section?

Yes

How dilated must the cervix be for an epidural?

4 cm

3 reasons you cannot give an epidural?

Abnormal clotting Infection present Hypovolemic

Nursing care for post-op epidural:

Hypotension (extreme drop) Urinary retention Catheterize if full bladder Monitor VS according to hospital policy

Pudendal block works by:

Injecting pudendal nerves with a local anesthetic just before vaginal birth

Who administers a pudendal block?

Nurse-midwife or MD

Adverse effects of pudendal blocks:

Vaginal hematoma Abscesses Allergic reaction

Nursing care for pudendal blocks:

Check for allergies | Consider pain and hematoma

When is the pudendal block administered?

Just before vaginal birth

Risk of general anesthesia for C-Section?

``` Aspiration (mother) Respiratory depression (baby) ```

APGAR

``` Heart rate Respiratory effort Muscle tone Reflex irritability Color Done at 1 minute and 5 minutes after birth (Note time of birth) ```

Narcotic drug of choice for pain relief during labor when cervix is <4 cm dilated?

Meperidine