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lp5- presntations and videos Flashcards

1
Q

prep

culture

emotions

A

Childbirth prep and classes–childbirth education classes help emotionally and physical prepare for birth

Culture-different for each culture-be respectful and integrate practices

lots of uncertainty, some overjoyed/ cant wait or some can be nervous/can be frightened, all depends

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2
Q

Common fears r/t childbirth-

A

losing child,

easily frustrated,

expected performance,

raising children,

how supportive is their partner

, things never being the same in vaginal area

changing lifestyle

pain, image

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3
Q

What attributes to a positive birth experience-

what are the parts of it

A

more education=better experience.-childbirth education classes help emotionally and physical prepare for birth

Birth plan supportive people, whose in room, where giving birth, if at home or hospital to provider special needs like meds and postpartum

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4
Q

What causes labor to start?

when is fetus matured

A

no for sure answer, generally Increased oxytocin/ Prostaglandin to induce contractions with decreased progesterone

uterine muscle stretches

fetus is pressing on cervix

Corticotropin releasing hormone (CRH)

Placenta may reach age

potentially semen

-Fetus matured at 37-42 weeks-

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5
Q

Early signs of labor

lightening

A

Lightening- “Dropped”-lower baby, pressure in groin/bladder, bladder urgency and incontince, easier to breath, waddling gait, lower edema, leg cramps pelvic pressure

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6
Q

Braxton hicks

ripening

bloody show

early signs of labor

A

Braxton hicks-practice contractions-painful to some but not all-does not mean in labor

Ripening-softening of cervix

Bloody show-loss of mucus plug like 24-48 hrs before labor- if too much then go get emergency care

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7
Q

Nesting and 1 more

early signs of labor

A

Nesting-sudden burst of energy for 24-48 hrs beforehand

Rupture of membranes

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8
Q

prostaglandin surge
signs of early labor

A

Wt loss

Diarrhea

Nausea

indigestion

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9
Q

Rupture of membranes

Nitrazine paper-test

sometimes

what +/-

A

test if membrane that has ruptured amniotic fluid or not

sometimes it could be urine

urine will be negative, amniotic fluid is positive

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10
Q

Prolapsed cord

can do what

how do you help situation

rupture of membrane

A

-umbilical cord falls out before baby head is engaged

can cut circulation off to baby-very dangerous

-put steril glove on and push babys head up into vaginal area into cervix so baby is not compressing cord

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11
Q

false labor

true
common
moms need what

A

true labor needs cervical changes

false labor is common-urine can come out instead of membranes

moms need lots of reassurance, they can be very anxious and nervous

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12
Q

Components of Labor

4 p’s

A

Passage – woman’s pelvis-maternal pelvis shape

Passenger - fetus

Powers – uterine contractions/factors-how powerful to push out baby

Psyche – woman’s psych. State or mind, coping, how dealing with hormones and pain

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13
Q

fetal skull molding

A

-ability of babys head to mold and flex to be able to squeeze out vagina during birth

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14
Q

fetal skull

fontanelles sutures

A

facilitate the movement and molding of the cranium through the birth canal during labor.

They also allow for rapid postnatal growth and development of the brain.

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15
Q

fetal attitude flexion

A

how flexed is fetus so that smallest part of head exits first

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16
Q

fetal lie

what 2 ways

fetal presentation

A

Longitudinal -north to south-preferred

Transverse-side to side

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17
Q

presenting part

normal
Malpresentations(B/T)

fetal presentation

A

Cephalic-head down

Malpresentation –breach and transverse lie

//B-may need c section because feet,bottom out first

/T- risky,gambling, baby coming out sideways, doctor may need to pull baby so it doesn’t breach

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18
Q

engagement measurements

head is what

A

Engagement-head down.

Head is engaged into cervix.

Once it hits 0 station(around area of isheac spine) it is engaged into birthing process

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19
Q

station measurements
how measure

full ____ baby upwards

A

Station-0=head is engaged

-anything above that is negative cm.

once out in below of cervix, then it is positive numbers

baby head progress–
-3
-2
-1
0
1
2
3

full bladder can push baby upwards

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20
Q

fetal positons measuemrents

anterior
posterior
transverse

A

dependent on where baby is sitting-ideally loa

. if baby is ROA-then heartrate is in right lower abdomen

if baby is LOA-then heartrate is in left lower abdomen.

Anterior is lower abdomen,(LOA,ROA)

posterior is upper abdomen,(LOP,ROP)

transverse is outer part (LOT,ROT)

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21
Q

Leopold’s maneuver

A

can palpate fetal back, butt, extremities

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22
Q

Vaginal exam

what feeling for
if not engaged
when is 0

A

During a vaginal exam, your doctor will feel for your baby’s head, cervical effacement,sofetening,dialtion and where baby is

If the head is high and not yet engaged in the birth canal, it may float away from their fingers. At this stage, the fetal station is -5.

When your baby’s head is level with the ischial spines, the fetal station is zero

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23
Q

FHR

methods
normal

A

Methods-dopler, ultra sound, fetal scope

Normal rate-110-160

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24
Q

3-Fetal assessment -Common location of FHR

A

ROA and LOA are normal and most common positions,

so heart rate in lower abdomen

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25
Q

breach position FHR

if heard upper
breach means what
which means hr is heard where

A

if FHR is heard in upper abdomen it could mean breach position

Breach means baby is flipped upward woth feet, butt going first,

so it would be in upper part of abdomen, not lower

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26
Q

cardinal movements of labor

descent/flexion

internal roation

extension

external rotation

expulsion

A

Descent, flexion,- baby’s head hitting the soft tissues of the pelvis, align head w/ chin toward chest as they get into pelvic cavity

internal rotation-when in pelvic floor, head will rotate

, extension-ead passes through the pelvis at the base of the neck-face and neck appear outside of body

, external rotation-head moved from face down to side

, and explusion-shoulder out

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27
Q

Powers of labor-

A

buildup of contractions in its longest phase-beginning of one to end of same contraction

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28
Q

primary powers of labor

frequency
duration
intensity

A

Primary-how much and how often

Frequency of contractions-start of one to start of other

Duration of contractions-60 seconds

Intensity of contractions- some pain, tightening pushes baby out

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29
Q

powers of labor secondary

what are they
are they
length

A

Effectiveness of pushing-

are contractions strong enough and are they frequent enough to actually push out-don’t want too much time

Length of labor- may take longer if newer, can push 2-3 hrs sometomes

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30
Q

Contractions phases

increments
acme
decrement

A

Increment-upward intensity phase

Acme-peak intensity

Decrement-downward intensity

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31
Q

contractions descriptions

frequenct
duraion
intensity

A

Frequency-start of contraction until next one starts

Duration-start to end of one contraction

Intensity-how intense it gets

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32
Q

Cervical Changes

true

effacement

dilation

A

cervix has to change for it to be true labor

Effacement- shortening of cervical canal, cervix is paper thin, then it is 100% effaced.

Dilatation/dilation- opening that increases to 10 cm. do not want mom pushing before full dilation

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33
Q

Cervix effacement

A

Cervix starts off as long and thick, then cervix will shortnen to give baby less travel tme out of cervix

Cervix will keep thinning out to allow easier push, amniotic fluid will break, membranes will rupture

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34
Q

1st stage - how long/much
true onset

all three 3 stages

A

1st stage – true onset of labor until 10 cm dilation-

true onset is cervical change

latent
active
transition

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35
Q

Latent

how dialted
contractions
keep
start

A

-0-3 cm dilated,

mild contractions, 20-40 seconds,

keep mom active at this point

start birth plan

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36
Q

active

dialtef
contractions
more
spontaneous

A

4-7 cm,

contractions last 40 -60 seconds every 3-5 minutes-

more pain and anxiety,

spontaneous rupture of membranes-closer to delivery

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37
Q

Transition-

how dialated
contractions
membranes
how will mother feel
is this pt ready for birth
use what to check cervix/why

A

8-10 cm,

2-3 minutes part, 60-70 second contractions,

if rupture of membrane hasn’t happen it wont fully dilate. -doctor will rupture membrane for them

Intense and uncomfortable, reaction of vomit, pain, anxiety, irritable, pressure, wants to push, shaking, hyperventilating,

definitely ready ,

use sterile gloves to check cervix, wait until 10 cm to push– if lots of burning or urge to push, and lots of pressure need to check

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38
Q

what happens if mom pushes before 10 cm

A

vaginal area will swell and won’t fully dialate

labor will not fully progress and most likely c section

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39
Q

promoting comfort in labor

bp
to
pa
wa
re
br
b/b

A

Birth plan,

touch,

pain,

walking, relaxation,

breathing,

bladder/bowel – keep empty to assist with fetal descent

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40
Q

2nd stage of labor

how dilated
crowning
stretching
check on
provide

A

10 cm dilation until birth of baby

Crowning-severe pain, burning in vaginal canal-head is right there

Stretching of perineum and anus-massage of areas to prevent mom from tearing so baby doesn’t go out too fast and keep mom comfortable

check on cervial and assess patient

provide comfort and push

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41
Q

3rd stage of labor-what is it

SS
DD
takes how long
do not want what
do not do what

A

– placenta separation and expulsion

“Shiny Schultze”-blue side that faces baby

“Dirty Duncan”-side on uterine wall-where attached-

from 5-30 minutes-

do not want any placenta in mother-want all of it out of body, not much pain, cord is attached but already clipped off of baby

do not pull on placenta

Comfort

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42
Q

4th stage of labor

-what is

moms

time

increase in

A

first 4 hours after placenta delivery

Mom’s recovery and physiologic readjustment

Time wanting to spend with baby,

increase in urine function dt fluid loss, usually can take 2 weeks

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43
Q

Contraction Assessment

palpation
electronic
–external
–internal

A

Palpation-touch and feel them happenin

Electronic monitoring
External –toko belts on abdomen
Internal-right into baby scalp inside vagina, is most accurate way but used less often

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44
Q

FHR Assessment

variability:-need what

absent
minimal
moderate
marked

fetal Brady
fetal tacky

A

Variability-difference between highest and lowest hr

need a 2 minute strip

Absent-no range detected

Minimal- 5 beats or less

Moderate-6-25 beats

Marked-greater then 25 bpm

Fetal brady- less then 110 for 10 minites

Fetal tachy-more then 160 for 10 minutes

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45
Q

accerlations

what are
how long
usually

A

Accelerations are short-term rises in the heart rate of at least 15 beats per minute,

lasting at least 15 seconds

usually 2 minutes or less

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46
Q

declarations

need
temporary
___term

A

need to be closely monitored

temporary drops in the fetal heart rate

short term

47
Q

early deceleration

what causes
nursing assessment

A

head is compressed

monitor-not too signifiant

48
Q

late deceleration

what causes
what helps

A

uterine placental problems

change moms positions and prepare for c section and oxygen 10-15 liters

49
Q

variable decelerations

what looks like
why happens

A

irregular, often jagged dips in the fetal heart rate that look more dramatic than late deceleration

Variable decelerations happen when the baby’s umbilical cord is temporarily compressed

50
Q

What factors affect pain response?

A

Childbirth preparation

Culture

Fatigue/sleep

Previous experience

Anxiety level

Unfamiliar surroundings

Separation from family

Attention-spotlight

Distraction

51
Q

nonpharmalogical pain relief

A

Relaxation
Focusing and imagery
Doula/coach
Spirituality
Breathing techniques
Herbal preparations
Aromatherapy/Essential oils
Heat or cold
Bathing/hydrotherapy
Touch/massage
Yoga/meditation
Reflexology
Hypnosis
Biofeedback
Nerve stimulation
Acupuncture and acupressure

52
Q

Analgesics – IM or IV-: Stadol, Nubain, Demerol

fetal/mother

opiate antagonist

advantages
disadvantages

A

NR-assess fetal/mother respiratory rate and heart rate

Opiate antagonist: Narcan

Advantages:reduces anxiety- makes it easier to dilate

Disadvantages: resp depress,

53
Q

Anesthesia-Regional-
what is
what kinds

s/e

put in after

A

complete loss of sensation from nipple line down-not much pain

Epidural-lower back
Spinal-spine
Combined epidural-spinal

hypotension,numbess, headache

put in catheter

54
Q

Anesthesia-Local

what does

what is in it

when is it

last

A

numbness in vagina

lidocaine

any stage of labor

last resort

55
Q

Anesthesia-general

last
only under
if mom

A

Last resort if needed to knock mom out.

Only under severe cirmucnatnces-total emergency

. If mom needs emergency surgery to pass baby due to issue with mom or fetal health

56
Q

Assisted Delivery

forceps
vacuum
check

A

Forceps-tongs - go around baby, pull out-issues with malplacemnt-brain injuries

Vacuum-suction cup on baby head

. If vaccum and forceps check mom for tears and baby for bruises

57
Q

Episiotomy-what is it

midline
mediolateral

A

intentional incision to allow ease of birth without tearing, not routinely done

midline-cut straight

medilateral -cut sideways

58
Q

Potential labor complications

Maternal concerns

A

Decreased HR

Bleeding

Meconium-poop from baby

Resp distress

59
Q

Potential labor complications

Fetal concerns

A

Decreased FHR

Meconium-poop

Resp distress

60
Q

If mother wants epidural

give
biggest risk
what stage
no what //d/t

A

give lactated ringers before,
needs bolus

hypotention is biggest risk for that,

in stage 1

no narcotics at this point because of resp depression for baby and mom

61
Q

c section

A

Dystocia-difficulty labor

Hypotonic labor-stop in dialation

Fetal malposition-not in right spot

Macrosomia-big baby

Multiple gestation

Intrauterine fetal death

Abruptio placentae-gushes of blood

Placenta previa

Prolapsed cord-cord out before baby

Hydramnios-not enough fluid

Active herpes

Amniotic fluid embolism

Cephalopelvic disproportion (CPD

62
Q

boggy uterus

what feels like
what means
what do you want

A

soft and squishy uterus

means bleeding is happening

want a hard uterus

63
Q

Involution of the uterus

what is it
right after where
where __ hrs after
how much decreases

A

Measurment of fundus right after delivery

-Right after delivery of placenta, top of fundus is midline, halfway between symphysis pubis and umbilicus

-6-12 hr after birth, fundus is at level of umbilicus

Height of fundus then decreases by_1cm per day postpartum

64
Q

what can influence involution height

when will funds settle back into cervix

A

full bladder

around 9-10 days

65
Q

Assessment of fundal height postpartum

when measure

should be

if not

postpartum women

A

Each shift will assess-immediately after will be every 15 minutes w/ vs, then every hr, then every 4 for 24, then 8

should be firm, not smush or soft-want to be measuring good

, if not properly placed then look at possible bladder distention,

2 weeks after delivery women are at risk for urinary retention

66
Q

Healing postpartum

Lochia Types+days

rubra
serosa
alba
abnormal-possible
no

A

Lochia rubra-redneded pieces-1-3 days

Lochia serosa-pink -7-14 days

Lochia alba-white/gray-10-14 days-up tp 6 weeks

Abnormal –never be absence or never should have foul oder-possible infection

for 6 weeks-no sex

67
Q

Cervical changes

A

-slowly closes and hardens, end of 7 days size of pencil eraser

68
Q

Vaginal changes

6 weeks
walls
what helps
sexual intercourse

A

-6 weeks to resume normal state-truly never normal

walls will remain thin until estrogen stimulation from ovaries but can be delayed months d/t breastfeeding

kegel excercises can help-

sexual intercouse bleeding d/t estrogen

69
Q

Perineal changes

what for first week
what helps
expect menstrualcycle when

A

-edema for first week

sprays help forceps damage

expect menstrual cycle in 6-10 weeks if not breastfeeding, if breastfeeding 3-4 months

70
Q

Return of ovulation and menstruation

non breastfeeding
if breastfeeding

A

-takes non breastfeeding 6-10 weeks

if breastfeeding 3-4 months or longer

71
Q

Urinary tract-

lot=
keep
use
urinate

A

lot of urine output =good thing,

-keep bladder empty,

use kegels

urinate using straight cath if cant urainate

72
Q

GI system-

vaginal
C-section

A

if vagnal birth complain of hunger/thirst, -eat at any time

c section- delay any food or drink until gastric movement/ positive bowel sounds, go full liquid diet-increase fiber to inc out

73
Q

Circulatory

dieresis
a lot of
shift where
increase what

A

dieresis of 2-5 days after

a lot of urine output

shift of fluid into circulatory and excreted in kidneys

drink lots of water

74
Q

Striae

A

-permanent but will begin to fade and lighten to silver color, can be on legs arm back

75
Q

Diastasis recti abdominis-

A

abdominal muscles don’t gerneally go back if they are separated

76
Q

Lactation

inc calories-
feed on
first milk
hormones
breast feel

A

inc calories by 500 from pre pregnancy,

feed on demand every 2-3 hrs

first milk is called colostrum-great antibodys ,

prolactin stimulated milk production and oxytocin lets breast down so milk is there from mammery glands for baby to eat.

Breast can feel hard and full

77
Q

lactation

rotate
pump when
if issues
how know if milk production is enough
dont take

A

, rotate sights,

pump during night to maintain milk production

, if having issues go to privider

, true way to know if milk production for baby is if baby is gaining weight,

don’t take in anything bad like alchohol or drugs

78
Q

lactation
increase
wash
devices

A

increased fluid by 6-8 glasses a day-8 oz

wash breast with clear water/ mild soap

nursing pads/supportive bra

79
Q

Inverted nipples

A

-devices can help

nipple shields can make possible by attaching to breast

80
Q

Nipple soreness-

A

some is expected

completely normal

81
Q

Engorgement

what is
what helps milk flow

A

happens when milk isn’t fully removed from your breast

Gently massage your breasts to help milk flow during breastfeeding or pumping-ice can help

82
Q

what helps engorgment pain

warm

warm

supportive

oral

support

A

warm showers

warm compress

supportive bra

oral analgesics

abdominal support with pillow

83
Q

Cracked nipples

what is
what helps

A

-moisture cream that is safe for baby

lanolin cream protects sore nipples

84
Q

Inadequate let-down-

what is
what helps

A

techniques that lactation constant can help with

double pumping-try to drain breasts as much as possible

85
Q

Plugged ducts

A

A plugged milk duct feels like a tender, sore lump or knot in the breast

86
Q

Mastitis
s/s
treatments
can still

A

if reddened breast, painful, flu symptoms, high temps- mastitis

treat with antibiotics

can still breastfeed unless pus

87
Q

Suppression of lactation

accumulation
hormones do what
what helps

A

accumulation of milk inhibits further milk production

however hormones will still produce milk

suppress with well fitting bra and cabbage leaves help absorb milk

88
Q

suppression of lactation in class

can cause
engorgment

relief of symptoms (oa/ bra/ 0/ compress)

dont

A

can cause strong pain

engrossment subsides by 3rd day

relief of symptoms
oral analgesics
snug fitting bra
0 nipple stimulation
cold compress

dont restrict fluid or pump breast milk

89
Q

Postpartum assessment vs

how often first hr
how often next 3 hr
then how often

temp
pulse
blood pressure
resp

A
  • every 15 minutes for 1 hr,

every hr for 3 hr

, then every 4 hour,

temperature, some may go up dt dehyrateion, febrile at 100.4-s/s infection

pulse may decrease to 60-70,

hypertension from eclampsia //hypotension can be from blood loss,

resp don’t change

90
Q

when to clamp a catheter

and why

A

after 1000 ml

because hypotension

91
Q

postpartum assessment blod values

hemoglobin
anemia
wbc

A

hemoglobin and hematocrit will return after 2 weeks

, shift in anaemia 12-24 hrs

wbc will spike immdalty after birth, will spike up to prevent infection

92
Q

weight loss

birth
dieresis
lochia
what else helps
when back to normal

A

12 lbs at birth,

dieresis is 5 lbs,

2-3 lbs lochia,

good diet and gentle exercise

baseline wight is epected at 6 weeks

93
Q

after pains-what is

use
dont use

A

contractions during breastfeeding-happens with latching of baby

use tylonel or ibuprofen–

no aspirin or heat

94
Q

rhogam

when give
what does

A

28 weeks preg or 72 hrs postpartum

. If mom is rh negative and baby is positive then helps with further pregnancy

95
Q

Psychologic adaptations in postpartum

Taking-in

when is it
what is it
allow
what helps

A

-1-3 days,

reflection on pregnancy-what happened how did birth go

allow to talk about feelings,

fatigued and crying after pregnancy, helps w pain

96
Q

Taking-hold, postpartum stage

A

women makes own decisions, decide to take care of self

simultaneously with taking in

97
Q

Letting go postpartum stages

A

-accepts new role of baby

lets go of fantasies

98
Q

Postpartum blue

common
look for
assure
after 2 weeks
what reduces chance

A

common for disappointment

look for bonding and attachment

assure that its normal due to drop of estrogen and progesterone

, after 2 weeks if mom is still down then depression mom may need more help

breastfeeding and bonding reduces chance

99
Q

What factors influence parent-infant attachment

A

finaces

wanted baby,

partner

reality of birth

siblings

fatigue

family interventions

100
Q

Attachment behaviors

A

Progression of touch-

attachment

, fingertips

, skin on skin touching,

, engaged in baby,

101
Q

En face position

A

a position in which the mother and infant are face to face

good for bonding

102
Q

Father/partner

Engrossment

A

beginning of bonding

observing for extended periods of time

want mom to take care of herself as well

103
Q

Cultural influences in postpartum care

A

be respectful and ask about culture factors

104
Q

Perineal discomfort-
manifestation

cleaning
wiping
dab
inc
natural=no
prevent

A

-swelling/pain in repairs

,cleaning area out ,
wiping front to back, dabbing and patting

inc water and fiber, natural laxatives, no straining,

prevent any tears or retears,

105
Q

Perineal discomfort-

pain meds
ice/heat
baths
ages
peri
back rub

A

use ibuprofen and Tylenol,

ice packs for 24 hrs, then dry heat

Sitz baths

Topical agents

Perineal care-up

backrubs

106
Q

hemmorhoids

treatment–
increast
re
sprays
caution

manifestations

A

pain, itching,bm bleeding, swelling

increase water and fiber

rest

aesthetic sprays

caution w/ laxitives

107
Q

afterpains

A

After delivery you will feel your uterus contract and relax as it shrinks back to its normal size

108
Q

Postpartum discharge instructions

work
rest
excercise
hygiene
coitus
contraception
follow up

A

Work-6 weeks at least

Rest-sleep as much as possible

Exercise-hold until doctor

Hygiene-cleaning peri

Coitus-held off for 6 week

Contraception-careful and discuss provider

Follow –up-made at 6 weeks

109
Q

Interventions to promote maternal/family well-being in the postpartal period

A

work on baby schedule

eat when baby eat

sleep when baby sleep

110
Q

Nursing management after a cesarean birth

risks
average stay
harder to what
get mom-reduces
look for
incetive
needs

A

risk of infections/hemorraging

2-4 days average stay in hospital,

harder to breastfeed

get mom up walking - after anesthesia wears off- reduces risk of blood clots

look for pain /redness

incetive spirometry- preventes pnemnoues,

needs rest periods

111
Q

c section teaching plan

help
increase
find
restrict
resume
early
provide
adequate

A

help bond succescfully

increase fluids

find support system and find rescources

restrict exercise and activity

resume coitus when comfortable

early ambulation to avoid complications

provide rest time

adequate pain management

112
Q

signs of infection in c section

temo
incision
urination
bleeding

A

temp over 100.4

redness/drainage at incision site

burning/frequent urination

bleeding heavier then menstrual period

113
Q

biggest risk for mom postpartum

dont use what

A

hemorrhaging

no aspiring because increased risk of hemorrhaging

d- health alteration lp7 (7 decks)

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