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Reproductive > labor & delivery > Flashcards

labor & delivery Flashcards

1
Q

What are the 3 phases of a contraction?

A

increment, peak (acme) and decrement

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2
Q

increment

A

contraction begins in fundus and spreads downward

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3
Q

Peak (acme)

A

contraction at greatest intensity

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4
Q

Decrement

A

decreasing intensity/relaxation

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5
Q

What are the terms used to describe the contraction cycle?

A

Frequency, duration, intensity, and interval

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6
Q

frequency

A
  • contractions are every __ minutes
  • Usually start far apart and get closer the farther you are along in labor
  • Beginning of one contraction to the beginning of the next contraction
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7
Q

duration

A
  • length of each contraction from beginning to end

- expressed in seconds

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8
Q

intensity

A
  • Strength of contraction
  • Contraction intensity as palpated by the nurse
  • Mild (tip of nose), moderate (chin), strong (forehead)
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9
Q

interval

A
  • amount of time between contractions

- fetal exchange of O2, nutrients and waste products occurs here

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10
Q

What do you do if fetus is in distress?

A

put mom on left side and give oxygen

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11
Q

Do contraction right after another put the fetus in trouble?

A

yes

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12
Q

What should you do if contractions are occurring with little or no intervals?

A
  • call Dr

- turn down pitocin

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13
Q

What part of the uterus actively contracts?

A

top 2/3

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14
Q

What does the bottom 1/3 of uterus do during contraction?

A
  • less active

- allowing for downward passage of fetus

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15
Q

What part of the uterus becomes thicker during labor?

A

upper uterus

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16
Q

What part of the uterus becomes thinner and is pulled upward?

A

lower uterus/cervix

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17
Q

What are the cervical changes that occur during labor?

A

dilation and effacement

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18
Q

dilation

A
  • opening of the cervix
  • expressed in cm
  • full dilation is 10cm
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19
Q

effacement

A
  • thinning and shortening cervix

- fully thinned cervix is 100% effaced

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20
Q

What happens if mom pushes before 100% effacement?

A

may tear cervix

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21
Q

What helps effacement?

A

Position changes, squat on bed, pull knees up

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22
Q

How is the cardiovascular system effected during the birth process?

A

Increase in BP and decrease in pulse

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23
Q

When do you asses vitals?

A

between contractions

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24
Q

How is the respiratory system effected during the birth process?

A

Increase in depth and rate of respirations

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25
Q

How is the GI system effected during the birth process?

A

Decreased gastric motility

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26
Q

How is the urinary system effected during the birth process?

A

Decreased sensation of full bladder

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27
Q

Should a nurse periodically ask mom if she wants to go to the bathroom?

A

yes

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28
Q

How does a full bladder effect labor?

A

inhibits fetal descent because it occupies space in the pelvis

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29
Q

How is the hematopoietic system effected during the birth process?

A
  • Clot breakdown decreases
  • Promotes coagulation at placental site
  • Increases the risk of maternal DVT, stroke & embolism
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30
Q

How is the fetal placental circulation effected during the birth process?

A
  • Circulation in placenta decreases
  • Blood supply to placenta stops with strong during contractions
  • Placental exchange takes place between contractions
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31
Q

How is the fetal Cardiovascular System effected during the birth process?

A

Rapid fetal heart rate (110-160 bpm)

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32
Q

What FHR should you be concerned with?

A

below 110 and above 160

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33
Q

How is the fetal Pulmonary System effected during the birth process?

A

Fetal lung fluid production decreases close to birth and absorption of fluid increases

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34
Q

What are the components of the birth process?

A

powers, passage, passenger and psyche

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35
Q

what are the four major components of the birth process commonly called?

A

the four “Ps”

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36
Q

Power

A

uterine contractions and mother’s pushing efforts

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37
Q

Who may have issues with pushing?

A

quads, paraplegic, neuromuscular, moms with heart disease

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38
Q

Passage

A

the passage for the birth of the fetus consists of the maternal pelvis and its soft tissue

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39
Q

Does the Dr evaluate passage during antepartum care?

A

yes

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40
Q

What happens if the Dr knows that the pelvis is not conducive to labor?

A

schedule a c-section

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41
Q

Passenger

A

fetus, membranes and placenta

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42
Q

Psyche

A
  • fear, anxiety, fatigue decrease ability to cope with pain

- relaxation helps the natural process of labor

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43
Q

What are the passage variations?

A

fetal lie, fetal attitude, fetal presentation & fetal position

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44
Q

passage variation - fetal lie

A
  • orientation of long axis of mom and long axis of fetus

- Longitudinal, transverse and oblique

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45
Q

passage variation - fetal lie - longitudinal

A
  • fetal head or buttocks enter pelvis first

- parallel

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46
Q

Are kids behind in kindergarten and 1st grade if they are delivered breech?

A

yes

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47
Q

passage variation - fetal lie - transverse

A
  • fetal body lying horizontally

- ok during pregnancy but not in the birth canal

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48
Q

passage variation - fetal lie - oblique

A

fetal body at an angle between longitudinal and transverse

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49
Q

passage variation - fetal attitude

A

flexion and extension

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50
Q

passage variation - fetal attitude - flexion

A
  • flexion is normal

- head flexed toward chest with arms and legs flexed over thorax, back in C-shape curve

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51
Q

passage variation - fetal attitude - extension

A
  • head extended

- chin gets caught in pelvic or hung up in pubic bone

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52
Q

passage variation - fetal presentation

A

cephalic, breech and shoulder

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53
Q

passage variation - fetal presentation - cephalic

A
  • head first

- vertex, military, brow, & face

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54
Q

passage variation - fetal presentation - cephalic - vertex

A
  • most common
  • head fully flexed
  • most favorable position because smallest diameter of fetal head is presenting
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55
Q

passage variation - fetal presentation - cephalic - military

A
  • head neither flexed or extended

- chin gets hung up

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56
Q

passage variation - fetal presentation - cephalic - brow

A

head partly extended

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57
Q

passage variation - fetal presentation - cephalic - face

A
  • head fully extended
  • baby born face up
  • baby should be born face down
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58
Q

passage variation - fetal presentation - breech

A
  • feet or buttocks first

- frank, full & footling

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59
Q

passage variation - fetal presentation - breech - frank

A

buttocks first, legs upward toward shoulders

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60
Q

passage variation - fetal presentation - breech - full

A
  • buttocks first

- head, knees and hips are flexed

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61
Q

passage variation - fetal presentation - breech - footling

A

one or both feet are first

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62
Q

passage variation - fetal presentation - shoulder

A
  • When there is a transverse lie, a shoulder is the presenting part
  • C-section is usually needed
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63
Q

passage variation - fetal position

A
  • Describes location of reference point to area in maternal pelvis
  • 3 letter acronym
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64
Q

passage variation - fetal position - right or left

A
  • fetal reference point is in the right (R) or left (L) area of the mother’s pelvis
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65
Q

passage variation - fetal position - Occiput, Mentum, or Sacrum

A
  • refers to fixed reference point
  • Occiput (O) - vertex
  • Mentum (M) - face
  • Sacrum (S) - breech
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66
Q

passage variation - fetal position - anterior, posterior or transverse

A
  • fetal reference point is in the anterior (A), posterior (P) or transverse (T)
  • transverse is used when it is neither anterior or posterior
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67
Q

LOA

A

the fetal occiput is in the left anterior quadrant of the maternal pelvis

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68
Q

RMP

A

the fetal mentum is in the right posterior quadrant of the maternal pelvis

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69
Q

LSA

A

the fetal sacrum is in the left anterior quadrant of the maternal pelvis

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70
Q

Warning Signs that Labor is Near

A
  • Braxton Hick’s
  • Lightening
  • Increase clear vaginal secretions
  • Bloody show
  • Energy Spurt
  • Small Weight loss
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71
Q

Warning Signs that Labor is Near - Braxton Hick’s

A
  • Can have them for a several weeks
  • Get uterus ready for labor
  • Don’t do anything for dilation or effacement
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72
Q

Warning Signs that Labor is Near - Lightening

A
  • Dropping of fetus into pelvis
  • Can breathe better
  • Pee all of the time
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73
Q

Warning Signs that Labor is Near - Bloody Show

A

mucous plug lets go

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74
Q

Warning Signs that Labor is Near - Energy spurt

A

Nesting, clean, get things fixed up, pack

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75
Q

Warning Signs that Labor is Near - Small weight loss

A
  • At 40 weeks she has lost 2 or 3 pounds
  • Associated with increasing progesterone
  • Progesterone has a mild diuretic effect
  • Tired and not all that hungry anymore
  • Energy spurt
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76
Q

true or false labor - contractions increasing frequency, duration, intensity of contractions

A

true labor

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77
Q

true or false labor - Contractions cause progressive changes in the cervix (effacement and dilation)

A

true labor

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78
Q

true or false labor - Walking usually increases contractions

A

true labor

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79
Q

true or false labor - Early labor feels like cramps

A

true labor

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80
Q

true or false labor - Pain starts in lower back sometimes and goes toward lower abdomen

A

true labor

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81
Q

true or false labor - Inconsistency in frequency, duration, and intensity of contractions

A

false labor

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82
Q

true or false labor - Walking usually does not increase contractions

A

false labor

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83
Q

true or false labor - Discomfort felt in abdomen and groin

A

false labor

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84
Q

true or false labor - No major changes in cervix

A

false labor

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85
Q

true or false labor - Frustrating or embarrassing to mother

A

false labor

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86
Q

true or false labor - Caused by dehydration, braxton hicks

A

false labor

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87
Q

cardinal movements of labor

A
  • descent
  • engagement
  • flexion
  • internal rotation
  • extension
  • external rotation
  • expulsion
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88
Q

cardinal movements of labor - descent

A

Descent of presenting part through pelvis

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89
Q

cardinal movements of labor - engagement

A

widest diameter of presenting part (usually head) reaches level of ischial spines of pelvis

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90
Q

cardinal movements of labor - flexion

A

Flexion of head so smallest diameter goes via pelvis

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91
Q

cardinal movements of labor - internal rotation

A

Internal Rotation allows largest fetal diameter to match largest pelvic diameter

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92
Q

cardinal movements of labor - extension

A

Extension of head as it passes under symphysis pubis bone

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93
Q

cardinal movements of labor - external rotation

A

External Rotation of head to allow shoulder to rotate in pelvis

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94
Q

cardinal movements of labor - expulsion

A

Expulsion of shoulders and rest of body

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95
Q

turtle pops

A
  • head pops out and then goes back in
  • is the cord around the neck
  • slip one or two of your fingers under it and try to unwrap the cord
  • in extreme measures cut the cord
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96
Q

station/engagement

A
  • descent of the presenting part in relation to the level of the ischial spines
  • as fetus descends, the station changes from higher negative numbers (-3, -2, -1) to higher positive numbers (+1, +2, +3)
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97
Q

station/engagement: -3

A

head moves freely or if you cant reach head, above ischial spine, not engaged

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98
Q

station/engagement: -2

A

feel head easily but can push it out

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99
Q

station/engagement: -1

A

harder to move head, doesn’t move very well back out

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100
Q

station/engagement: 0

A

engaged

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101
Q

station/engagement: +1

A

don’t see head

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102
Q

station/engagement: +2

A

bigger part of head

103
Q

station/engagement: +3

A

head crowning

104
Q

4 stages of labor

A
  • first stage (dilation and effacement)
  • second stage (expulsion)
  • third stage (placental)
  • fourth stage (recovery)
105
Q

3 phases of first stage of labor

A
  • latent
  • active
  • transition
106
Q

Stages of labor - 1st stage - latent

A

from beginning of labor, 0 and up to 3 cm dilation

107
Q

what is the environment like during the latent phase?

A
  • Parents are happy, excited, wants to see baby
  • Walking in hall, sitting on birthing ball
  • Not much for nurses to do here
108
Q

Stages of labor - 1st stage - active

A

dilation from 4-7 cm, effacement complete, fetal descent into pelvis, internal rotation begins

109
Q

what is the environment like during the active phase?

A
  • Effacement may only get to 90%
  • Check mom more often
  • Nurse needs to check mom more frequently, start to get supplies ready, help mom to work with contractions at 5 cm
110
Q

Stages of labor - 1st stage - transition

A

dilation from 8-10 cm, intense contractions, urge to push

111
Q

what is the environment like during the transition phase?

A
  • Can be really hard, uncomfortable
  • Women want to give up
  • Has urge to push, should be dr driven
112
Q

Second Stage of labor

A
  • expulsion
  • Begins with complete dilation (10 cm) and full effacement and end with birth of baby
  • Vulva distends and crowning of head occurs
  • Woman puts forth a lot of effort to push baby out
  • BABY BORN! - Rush of positive emotion
113
Q

Third Stage of Labor

A
  • placental
  • After baby is born, immediately uterus shrinks (involution) placenta separates from uterine wall
  • Placenta can be expelled with either the fetal shiny side first (most common) or the maternal rough side
  • Uterus must remain contracted afterwards to compress vessels at implantation site to prevent hemorrhage
114
Q

how long does involution take?

A

10 minutes but could be as long as an hour

115
Q

For a C-section what happens to get the uterus to shrink?

A

Pitocin injection will be given, placenta starts to separate, dr manually removes placenta

116
Q

what happens if upon placental examination you notice a piece is missing?

A

need to do D & C

117
Q

Placenta acreta

A
  • grown into endometrium but not in myometrium
  • physician peels placenta off the uterine wall
  • more likely to occur in red heads and previous C-section scar
118
Q

Placenta increta

A
  • rown into myometrium

- D&C, surgically remove placenta

119
Q

Placenta precreta

A
  • grown into perimetrium

- hysterectomy more than likely

120
Q

fourth stage of labor

A
  • recovery
  • 1-4 hours after birth
  • lochia flow starts (use peri pads and monitor drainage)
  • discomfort from birth trauma (apply ice packs to perineum)
  • start bonding, baby usually alert now (first 4 hours)
  • Start breastfeeding ASAP, if desired
  • May have postpartum chill
121
Q

fourth stage of labor - lochia

A
  • placenta detaches

- rubra, serosa & alba

122
Q

rubra

A

bright red, small clots might be present

123
Q

Serosa

A

turns over a day or two, lighter red or even a darker brown red

124
Q

can lochia switch back and forth between rubra & serosa?

A
  • yes
  • place of healing was disturbed
  • normal amount is ok
  • did too much activity
125
Q

What are the nurse’s responsibility during 4th stage of labor?

A
  • lochia - describe color, clots
  • Hemorrhage - more than 1 pad per hour
  • Ice packs on perineum for discomfort
  • Administer analgesic for pain
  • Facilitate bonding and breastfeeding
126
Q

What should a nurse do to minimize discomfort of birth?

A
  • apply ice packs to perineum

- administer analgesics

127
Q

when should bonding occur?

A
  • First 4 hours after birth
  • Baby moves from warm to a colder environment
  • If possible have mom see baby prior to being taken away
  • Take mom to nursery, touch baby
128
Q

postpartum chill

A
  • hypovolemia
  • weight of fetus
  • amniotic fluid
  • placenta
  • blood
  • Give warm blanket
129
Q

hypovolemia

A
  • lose a large amount of fluid
130
Q

RN/Admission Process

A
  • Welcome family (therapeutic communication)
  • Obtain consent form
  • Check database info
  • Assess mom and fetus
  • Notify Dr.
131
Q

fetal assessment

A
  • FHR
  • ROM
  • assess color and amount of amniotic fluid
132
Q

Leopold’s Maneuvers

A

Used to determine fetal position and presentation, aids in finding best place for assessing FHR on maternal abdomen

133
Q

Leopold’s Maneuvers - 1st step

A

palpate fundus to check for cephalic or breech presentation

134
Q

Leopold’s Maneuvers - 2nd step

A

check which side is fetal back and which side has arms and legs

135
Q

Leopold’s Maneuvers - 3rd step

A

palpate suprapubic area to confirm presentation between thumb and fingers

136
Q

Leopold’s Maneuvers - 4th step

A

turn to face patient’s feet. Place hands toward pelvic inlet to see if head is flexed (vertex) or extended (face presentation)

137
Q

Maternal Assessments

A
  • Vital signs
  • Assess contractions
  • Check dilation, fetal descent and effacement as well as
  • Intake and Output
  • Response to the labor
138
Q

Comfort Measures

A
  • Soothing Environment
  • Provide ice chips, popsicles, hard candy
  • Keep linens clean
  • Help with urinary elimination
  • Use of shower, tub, or whirlpool
  • Dysfunctional labor
  • Help with positioning
  • Provide encouragement and support birth partner
  • Analgesics as ordered and requested
139
Q

Responsibilities During Birth

A
  • Transfer patient to delivery room if utilized
  • Preparation of sterile table instruments
  • Prep the perineal area, drape, and position
  • Observe perineum
  • Delivery of baby if MD not available
140
Q

Responsibilities After Birth - Mother

A
  • Check for hemorrhage
  • Watch vital signs
  • Check fundus
  • Fluid loss
  • Bladder
  • Assess lochia and saturation of perineal pads
  • Relieving discomfort
141
Q

What is anticipated blood loss during labor?

A
  • 300mL

- More than 500 mL watch closer

142
Q

Responsibilities After Birth - Newborn

A
  • Cardiopulmonary
  • Thermoregulation
  • Determine Apgar scores at 1 minute and 5 minutes after birth
  • Apply ID bands to infant, mother, and father
143
Q

newborn - cardiopulmonary

A
  • Suction mouth and nose with bulb syringe
  • Baby picks up a lot of secretions as it moves through the birth canal
  • Usually enough to get them to breathe/cry
  • Have oxygen, ambu bag, and intubation equipment ready
144
Q

newborn - thermoregulation

A
  • dry infant
  • discard damp linens
  • apply cap to head - lose heat through top of head
  • place infant in warmer if needed
  • skin-to-skin contact to prevent heat loss is the best
145
Q

APGAR

A

Assess heart rate, resp. effort, muscle tone, reflex response, and color

146
Q

Monitoring of Labor

A
  • Auscultation of fetal heart rate
  • Palpation of uterine activity
  • Electronic fetal monitoring
  • See how the fetus tolerates labor
  • Assess fetal oxygenation
147
Q

Fetal oxygenations is influenced by…

A
  • Problems in the maternal blood flow
  • Intense uterine activity (irritable uterus)
  • Problems in placenta
  • Compression of the umbilical flow
  • Problems in fetus (anemia, hypotension, cardiac, and/or CNS abnormalities)
148
Q

Auscultation

A
  • Fetoscope
  • Palpate maternal pulse while listening for FHR
  • Doppler ultrasound (use transmission gel)
  • Best location for transducer is usually on fetus back
149
Q

Palpation

A

assess frequency, duration, intensity (mild, moderate, or strong), and uterine resting tone

150
Q

Fetal Heart Rate - Reassuring

A
  • Average rate of 110-160 beats per minute
  • Regular rhythm
  • Acceleration from baseline rate
  • No decrease in rate from baseline rate
151
Q

Fetal Heart Rate - Nonreassuring

A
  • FHR outside of normal limits
  • Irregular rhythm
  • Decrease in rate
  • Tachycardia or bradycardia for 10 minutes or more
152
Q

Do you notify Dr for fetal tachycardia or bradycardia?

A

yes

153
Q

Electronic Fetal Monitoring

A
  • More than nonstress test
  • Can be done continuously or intermittently
  • Gives more fetal information than auscultation, gives a printed record
  • External sensors are placed on woman’s abdomen to track uterine activity and FHR
154
Q

Internal Fetal Monitoring

A
  • Very accurate for monitoring
  • Invasive procedures
  • Increased risk for infection in mom and fetus
  • Requires ruptured membranes and 2 cm of cervical dilation
  • Fetal scalp electrode
  • Avoid electrode application to face, genitals, and fontanels.
155
Q

Fetal scalp electrode

A

detects electrical signals from fetal heart, electrode is attached to fetal scalp and rest of wire comes out of vagina and is attached to leg band

156
Q

Intrauterine Pressure Catheter

A
  • Measures uterine contractions and resting tone
  • Measured in mm Hg
  • Resting tone should be normal; soft uterus
  • Labor to aggressive if no/poor resting tone
  • Poor resting tone might be a risk for ruptured uterus
  • Some catheters also equipped with extra lumen for amniofusion to reduce cord compression, to dilute meconium in amniotic fluid and decrease risk of aspiration.
157
Q

FHR - variability

A
  • Assessed for at least 2 minutes within a 10 minute period
  • Absent: none can be detected
  • Minimal: 5 or fewer bpm
  • Moderate: 6-25 bpm considered reassuring
  • Marked: over 25 bpm; might mean trouble, watch more closely, might have cord around neck
  • nonreassuring
158
Q

FHR - Accelerations

A
  • Temporary increase
  • 15 bpm increase for 15 seconds - want to see this
  • Associated with fetal movement or contraction; reassuring
  • CNS is responsive
159
Q

FHR - Early Decelerations

A
  • Occurs only during contractions as the fetal head is compressed
  • Return to baseline by the end of the contraction
  • Low point of the FHR occurs at the peak of the contraction
  • Appear as “mirror images”: of the contraction on the paper strip
  • No fetal compromise, no intervention needed
  • Only acceptable with contraction
160
Q

FHR - Late Decelerations

A
  • Begin well after the contraction begins
  • FHR returns to baseline after the contraction ends
  • Not reassuring signs and reflects possible impaired placental exchange of oxygen. Could result in acidemia shift to anaerobic metabolism due to poor oxygenation
  • Requires intervention to improve placental blood flow an fetal oxygenation.
161
Q

uterine activity

A
  • Note the frequency, duration, intensity, and resting tone
  • Average resting tone 5-15 mm Hg
  • Active phase of labor: 75-80 mm Hg
  • Second stage (mother pushing) 100-150 mm Hg
162
Q

Placental exchange can be reduced if…

A
  • Contractions are too frequent
  • ontractions are too long
  • The resting interval between contractions is less than 30 seconds
  • Uterine resting pressure is more than 20 mm Hg
    will see FHR decelerations
163
Q

Reassuring Patterns FHR

A
  • Stable baseline FHR
  • Accelerations
  • Moderate variability
  • Variety of decelerations of less than 60 seconds with fast return to baseline
164
Q

Reassuring Pattern - FHR - Uterine activity:

A

frequency no more than every 2 minutes, duration no longer than 90-120 seconds, interval between contractions at least 30 seconds, resting tone under 20 mm Hg.

165
Q

Nonreassuring Patterns FHR

A

Associated with fetal hypoxia or acidosis, but does not necessarily mean that they have occurred

166
Q

nonreassuring patterns include…

A
  • Tachycardia/bradycardia
  • Late or prolonged decelerations
  • Hypertonic uterine activity
  • Decreased or absent variability
167
Q

Fetal scalp stimulation

A

sweep gloved fingers on scalp, then FHR should accelerate

168
Q

Vibroacoustic stimulation

A

sound and vibration stimulator placed on mother’s abdomen, then FHR should accelerate

169
Q

Fetal pulse oximetry

A

sensor placed alongside fetal cheek measures 02 saturation, normal in fetus is 30-65%

170
Q

Fetal scalp blood sampling

A

checks pH of blood, normal is 7.25-7.35. Under 7.2 reflects acidosis

171
Q

Umbilical cord blood gas and pH

A

sample checks pH and blood gases, done after birth

172
Q

Nursing Responses to Nonreassuring FHR Patterns

A
  • Notify Dr
  • Identify cause of pattern
  • Stop oxytocin infusion, if infusing
  • Reposition woman
  • Increase IV rate if ordered
  • Give O2 by mask at 8-10 liters
  • Continue fetal monitoring a
  • Prepare for immediate delivery
173
Q

Nursing Actions - FHR monitoring

A
  • Assess client’s knowledge, expectations of, and comfort
  • Include the labor pattern and ensure comfort of all people involved
  • Perform and record assessments according to facility policy.
  • Take corrective actions, notify MD, and document.
  • Listen to the woman
174
Q

Amniotomy

A
  • Artificial rupture of membranes (AROM)
  • Used to induce or stimulate labor
  • Permits internal electronic fetal monitoring
  • An Amnihook is used to perforate the amniotic sac
  • Not performed if fetal presentation is not cephalic (do not do with breech)
175
Q

amniotomy risks

A
  • Prolapsed umbilical cord
  • Cord compressed
  • Infection (chorioamnionitis)
  • Wear gloves
176
Q

Abruptio placenta

A
  • Placenta detaches from uterine wall prior to delivery which causes decrease in fetal oxygenation, decreased nutrition, and decreased waste disposal
  • Before delivery
  • Suffocates fetus
177
Q

Nursing Care for Amniotomy

A
  • Place pads under woman to absorb fluid and change pads as needed
  • Continue to assess FHR & VS afterwards
  • Chart color, amount, odor of fluid
178
Q

Induction of Labor

A

Used when ending a pregnancy is beneficial to woman or fetus and when labor/vaginal birth is considered safe

179
Q

indications for induction…

A
  • Nonstress test did not look good
  • Cervix is ripe and ready
  • Post-term pregnancy
  • Unfavorable environment for fetus
  • Mom is developing hypertension or preeclampsia
  • Fetal death
180
Q

Hydrophilic intracervical inserts

A
  • Dilapan or Lamicel
  • Mechanical method for ripening cervix
  • Absorb water and expand which helps dilate the cervix followed by oxytocin the next morning
181
Q

Prostaglandin gels, vaginal inserts

A
  • Misoprostol, IV oxytocin (Pitocin)
  • Medical methods
  • Stimulate contractions
182
Q

Bishop Scoring System

A

evaluation of the readiness of the cervix: checks dilation, effacement, fetal station, cervical softness, and cervical position

183
Q

Administering Oxytocin

A
  • Diluted in isotonic solution and given as a piggyback infusion, regulated by pump
  • Infusion started slowly, increased gradually and titrated as needed
  • Oxytocin has antidiuretic effects, mother can get water intoxication
184
Q

hypertonic uterine activity

A
  • contractions last longer than 90 seconds
  • contractions less than 2 minutes apart
  • relaxation less than 30 seconds
  • uterine tone at rest is above 20 mm Hg
  • late decelerations
185
Q

hyperstimulation of uterus

A
  • MD may order Terbutaline SQ
  • Decrease stimulation of uterus
  • Maternal heart rate speeds up/so the FHR may increase
  • Maternal gets shaky, irritable but goes away quickly
186
Q

Version

A
  • Baby is breech

- If there is a nice sized uterus and baby is healthy, given birth before

187
Q

Version - external

A
  • IV Terbutaline to relax uterus
  • Ultrasound guides the MD who pushes the breech part out of pelvis and turns fetus
  • Epidural or analgesic may be given to decrease maternal discomfort
188
Q

Version - internal

A
  • Surprise situation, unexpected
  • Usually done during twin births to change the presentation of the second twin after the birth of the first twin.
  • MD reaches into uterus with one hand and turns fetus into cephalic lie with other hand on maternal abdomen to allow delivery
189
Q

Forceps

A
  • Metal instrument with 2 curved blades (look like tongs), should be padded to protect fetal head, gently
  • Head crowns but does not push down further; mom is exhausted and not pushing well
190
Q

Forceps risk

A
  • bruising fetal head
  • create a hematoma
  • lacerations, burns (irritation to skin)
  • do not use for preterm because there is possibility of causing internal bleeding
191
Q

Vacuum Extractor

A
  • Uses suction on the fetal head
  • head crowns but does not push down further; mom is exhausted and not pushing well
  • CPD
192
Q

Cephalopelvic disproportion (CPD)

A

baby’s head is too big for pelvis

193
Q

Vacuum Extractor Risks

A
  • fetal cone head
  • hematoma
  • don’t want to use in a preterm baby (internal bleeding)
194
Q

Indications for Forceps/Vacuum

A
  • maternal exhaustion, inability to push, infections, cardiac and pulmonary problems
  • cord compression
  • contraindicated for severe compromise
  • CPD
195
Q

How much blood can a hematoma collect?

A
  • 1 to 2 L

- If you see just a trickle of blood on pad think vaginal hematoma

196
Q

Episiotomy

A
  • Surgical incision of the perineum to enlarge vaginal opening
  • Performed when presenting part has crowned
  • Used in forceps or vacuum extractor births, when there’s obvious risk to tissues for tearing, birth of “face up” fetus, vaginal breech births
197
Q

Episiotomy - median

A

off to the side

198
Q

Episiotomy - mediolateral

A

straight down towards rectum

199
Q

What should the nurse observe in a mom after an episiotomy?

A

hematoma and edema

200
Q

Cesarean Birth

A
  • Birth of a fetus through a surgical incision in the abdominal wall and uterus
  • Cephalopelvic disproportion
  • Dystocia
  • Active genital herpes
  • Previous cesarean with classic incision
201
Q

Dystocia

A

most likely shoulder dystocia or might be difficult labor and delivery

202
Q

Cesarean Incisions - skin and abdominal wall

A
  • Vertical

- Pfannenstiel (“bikini”)

203
Q

Cesarean Incisions - uterine

A
  • Low transverse
  • Low vertical
  • Classic
204
Q

Cesarean Post-op Care

A
  • Monitor vital signs
  • Assess LOC (level of consciousness)
  • General anesthesia - something critical
  • Spinal anesthesia - be awake, not an emergency
  • Return of motion and sensation
  • Check abdominal dressing and lochia
  • Urinary output
  • Uterine firmness and position
  • Pain level
  • Change position and TCDB (turn cough deep breathe)
205
Q

Vaginal Birth After Cesarean (VBAC)

A
  • Associated with risk for uterine rupture
  • Must be at least one year after previous C-section
  • Electronic fetal monitoring is recommended
  • Epidural anesthesia may be used
  • Induction and augmentation with oxytocin and prostaglandin gel may be used
  • Number one complication of vbac is emergency c-section
206
Q

Postpartum Adaptation

A
  • Puerperium
  • Begins after baby and placenta are born
  • Postpartum Period-first six weeks after birth of an infant
  • Body begins to return to non-pregnant state
  • Start of lactation
  • Return of menstrual cycle
  • Contraction of muscle fibers
  • Catabolism
  • Epithelium of the uterus regenerates
207
Q

Start of lactation

A

prolactin initiates milk production within 2-3 days of childbirth

208
Q

Production of colostrum

A

has immune part in it, natural immunity for babies

209
Q

Return of menstrual cycle - lactating

A

(varies) 12 weeks to 18 months after childbirth

210
Q

Return of menstrual cycle - nonlactating

A

(varies) 7-9 weeks after childbirth

211
Q

Contraction of muscle fibers

A
  • uterus decreases in size and contractions control bleeding
  • starts right away as soon as placenta is born
212
Q

Catabolism

A

converts living cells in the uterus into simpler compounds (reduces cell size), absorbed by bloodstream and then excreted as waste in urine

213
Q

Epithelium of the uterus regenerates

A
  • Lochia is the regeneration process
  • Outer part of epithelium expelled with placenta
  • One layer is shed in lochia and other layer will become new epithelium
  • Placental site heals by exfoliation (6-7 weeks)
214
Q

Descent of the Fundus

A
  • After delivery, fundus palpated between symphysis pubis and umbilicus
  • Drops below umbilicus after birth
  • In a few hours, it raises to level of umbilicus and will stay there for 24 hours
  • After 24 hours, fundus descends 1 cm or 1 fingerbreadth per day
215
Q

How long does it normally take before you are not able to feel the fundus?

A

10 - 14 days post partum

216
Q

Afterpains

A
  • Every time uterus contract
  • More babies more afterpains
  • Babies latch on to nurse
217
Q

Does the cervical os have a permanent slit in it after delivery?

A

yes

218
Q

How long does it take for vagina to shrink to prepregnancy size?

A

6 weeks

219
Q

Why may nursing mothers experience painful sexual intercourse?

A

vaginal dryness because of inadequate estrogen

220
Q

Premarin cream

A

made of estrogen, rub small amount on affected area

221
Q

How long does it take for an episiotomy to heal?

A

may take as long as 4-6 months

222
Q

How long does it take for the mother’s cardiac output to return to normal?

A

12 weeks post pregnancy

223
Q

How does the body rid itself of the extra fluid volume?

A

diuresis and diaphoresis

224
Q

diuresis

A

urinate more for a few weeks

225
Q

diaphoresis

A

warm for awhile after birth, sweat

226
Q

How long does it take WBC count to become normal?

A

4-7 days postpartum

227
Q

How long does it take for coagulation factors to return to normal?

A

3-4 weeks postpartum

228
Q

what does decline in placental hormones cause?

A

Normal to cry after birth, you have no clue as to why you are crying

229
Q

how long does it take for aldosterone levels to return to normal?

A

2 weeks

230
Q

what causes bleeding issues in postpartum?

A

hCG is high, possibly that she retained a placenta; hydatidiform mole may present and is typically cancerous

231
Q

Nursing Assessment After Childbirth

A

BUBBLEHE

232
Q

B - breast

A

What are they like, engorgement, milk coming in

233
Q

U - uterus

A

position, is it u/1 or u/u?, top of fundus midline, deviated to left or right, if deviated that means that bladder is full, uterus not midline tend to bleed

234
Q

B - bowel

A

Sounds, gas, constipation

235
Q

B - bladder

A
  • Up and urinate at normal time and amounts

- May put in Foley for a couple of days because message between bladder and brain is messed up

236
Q

Urecholine

A

drug for urinary retention

237
Q

L - lochia

A

Rubra, serosa, alba

238
Q

E - episiotomy

A
  • Check it for swelling, drainage, hematoma
  • Watch for hematoma and bruising
  • No episiotomy - use E to check the perineum
239
Q

H - homan’s sign

A
  • Check for clot in lower calf
  • One hand on patient’s knee, one hand on bottom of foot, pull foot towards their head
  • Sudden onset of pain - positive indication - possible clot in leg
  • Assessing for possible thrombophlebitis
  • No matter what you should be looking at leg for redness, tenderness, swelling
240
Q

E - emotional state

A
  • Bonding with baby
  • Postpartum blues natural process
  • Postpartum blues can exacerbate mental illness
  • Is she crying all of the time? Has a normal healthy baby. Not postpartum blues - too early
241
Q

Comfort Measures - postpartum

A
  • Ice packs to perineum
  • Perineal care with warm water
  • Anesthetic sprays
  • Sitz baths
  • Analgesics
242
Q

how long should you wait to have sex after a baby?

A

6 weeks

243
Q

Can you go on pill while nursing?

A

yes but may reduce milk supply if nursing

244
Q

Bonding

A
  • strong emotional tie or attraction to infant felt by the parents
  • enhanced if parents are able to touch infant during first 30-60 minutes after birth
245
Q

Attachment

A
  • process of creating a bond between infant and parent/other

- begins in pregnancy and lasts for many months after birth. Felt by both parents and infant

246
Q

Newborn Attachment Behaviors

A
  • Baby makes eye contact with prolonged gazing
  • Baby has heard mom and dad for a long time in utero
  • Moves eyes to track the parent’s face
  • Grasps fingers
  • Moves in response to patterns in paternal voice and is comforted by parent’s touch or voice
  • Root, latch, and suckle to breast
247
Q

Question why newborn’s don’t have attachment behaviors?

A
  • Degree of visual impairment - see only black, white and red, see shapes
  • Hearing difficulty - drop something metal on floor to test
  • Cognitive issue
  • Doesn’t gaze or interact, cries all the time - drug/alcohol addiction
248
Q

Maternal Role in Adaptation

A
  • Taking-In Phase
  • Taking-Hold Phase
  • Letting-Go Phase
249
Q

Taking-In Phase

A
  • Mother focused on her needs
  • Allows others to make decisions - spouse or nurse
  • Immediate postpartum phase
250
Q

Taking-Hold Phase

A
  • Mother becomes more independent (self-care)
  • Take shower by herself
  • Shifts attention to infant
  • Ready to bond
251
Q

Letting-Go Phase

A
  • Mother and father accept their roles and the infant as he/she is
  • Let go of negative thoughts and become more positive
  • Some struggle here - watch and document
252
Q

Postpartum Blues

A
  • Mild depression that affects >70% of U.S. women, cause is unknown (may be from letdown after birth, fatigue, anxiety, and discomfort)
  • Last no longer than 2 weeks
  • Does not affect mother’s ability to care for infant
253
Q

Postpartum Blues Symptoms

A
  • Not related to events

Fatigue, irritability, tearfulness, insomnia, anxiety, unstable moods

254
Q

Do postpartum depression or postpartum psychosis require treatment?

A

yes

Reproductive (2 decks)

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