lp5- presntations and videos Flashcards
prep
culture
emotions
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
Common fears r/t childbirth-
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
What attributes to a positive birth experience-
what are the parts of it
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
What causes labor to start?
when is fetus matured
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-
Early signs of labor
lightening
Lightening- “Dropped”-lower baby, pressure in groin/bladder, bladder urgency and incontince, easier to breath, waddling gait, lower edema, leg cramps pelvic pressure
Braxton hicks
ripening
bloody show
early signs of labor
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
Nesting and 1 more
early signs of labor
Nesting-sudden burst of energy for 24-48 hrs beforehand
Rupture of membranes
prostaglandin surge
signs of early labor
Wt loss
Diarrhea
Nausea
indigestion
Rupture of membranes
Nitrazine paper-test
sometimes
what +/-
test if membrane that has ruptured amniotic fluid or not
sometimes it could be urine
urine will be negative, amniotic fluid is positive
Prolapsed cord
can do what
how do you help situation
rupture of membrane
-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
false labor
true
common
moms need what
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
Components of Labor
4 p’s
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
fetal skull molding
-ability of babys head to mold and flex to be able to squeeze out vagina during birth
fetal skull
fontanelles sutures
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.
fetal attitude flexion
how flexed is fetus so that smallest part of head exits first
fetal lie
what 2 ways
fetal presentation
Longitudinal -north to south-preferred
Transverse-side to side
presenting part
normal
Malpresentations(B/T)
fetal presentation
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
engagement measurements
head is what
Engagement-head down.
Head is engaged into cervix.
Once it hits 0 station(around area of isheac spine) it is engaged into birthing process
station measurements
how measure
full ____ baby upwards
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
fetal positons measuemrents
anterior
posterior
transverse
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)
Leopold’s maneuver
can palpate fetal back, butt, extremities
Vaginal exam
what feeling for
if not engaged
when is 0
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
FHR
methods
normal
Methods-dopler, ultra sound, fetal scope
Normal rate-110-160
3-Fetal assessment -Common location of FHR
ROA and LOA are normal and most common positions,
so heart rate in lower abdomen
breach position FHR
if heard upper
breach means what
which means hr is heard where
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
cardinal movements of labor
descent/flexion
internal roation
extension
external rotation
expulsion
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
Powers of labor-
buildup of contractions in its longest phase-beginning of one to end of same contraction
primary powers of labor
frequency
duration
intensity
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
powers of labor secondary
what are they
are they
length
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
Contractions phases
increments
acme
decrement
Increment-upward intensity phase
Acme-peak intensity
Decrement-downward intensity
contractions descriptions
frequenct
duraion
intensity
Frequency-start of contraction until next one starts
Duration-start to end of one contraction
Intensity-how intense it gets
Cervical Changes
true
effacement
dilation
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
Cervix effacement
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
1st stage - how long/much
true onset
all three 3 stages
1st stage – true onset of labor until 10 cm dilation-
true onset is cervical change
latent
active
transition
Latent
how dialted
contractions
keep
start
-0-3 cm dilated,
mild contractions, 20-40 seconds,
keep mom active at this point
start birth plan
active
dialtef
contractions
more
spontaneous
4-7 cm,
contractions last 40 -60 seconds every 3-5 minutes-
more pain and anxiety,
spontaneous rupture of membranes-closer to delivery
Transition-
how dialated
contractions
membranes
how will mother feel
is this pt ready for birth
use what to check cervix/why
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
what happens if mom pushes before 10 cm
vaginal area will swell and won’t fully dialate
labor will not fully progress and most likely c section
promoting comfort in labor
bp
to
pa
wa
re
br
b/b
Birth plan,
touch,
pain,
walking, relaxation,
breathing,
bladder/bowel – keep empty to assist with fetal descent
2nd stage of labor
how dilated
crowning
stretching
check on
provide
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
3rd stage of labor-what is it
SS
DD
takes how long
do not want what
do not do what
– 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
4th stage of labor
-what is
moms
time
increase in
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
Contraction Assessment
palpation
electronic
–external
–internal
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
FHR Assessment
variability:-need what
absent
minimal
moderate
marked
fetal Brady
fetal tacky
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
accerlations
what are
how long
usually
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
declarations
need
temporary
___term
need to be closely monitored
temporary drops in the fetal heart rate
short term
early deceleration
what causes
nursing assessment
head is compressed
monitor-not too signifiant
late deceleration
what causes
what helps
uterine placental problems
change moms positions and prepare for c section and oxygen 10-15 liters
variable decelerations
what looks like
why happens
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
What factors affect pain response?
Childbirth preparation
Culture
Fatigue/sleep
Previous experience
Anxiety level
Unfamiliar surroundings
Separation from family
Attention-spotlight
Distraction
nonpharmalogical pain relief
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
Analgesics – IM or IV-: Stadol, Nubain, Demerol
fetal/mother
opiate antagonist
advantages
disadvantages
NR-assess fetal/mother respiratory rate and heart rate
Opiate antagonist: Narcan
Advantages:reduces anxiety- makes it easier to dilate
Disadvantages: resp depress,
Anesthesia-Regional-
what is
what kinds
s/e
put in after
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
Anesthesia-Local
what does
what is in it
when is it
last
numbness in vagina
lidocaine
any stage of labor
last resort
Anesthesia-general
last
only under
if mom
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
Assisted Delivery
forceps
vacuum
check
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
Episiotomy-what is it
midline
mediolateral
intentional incision to allow ease of birth without tearing, not routinely done
midline-cut straight
medilateral -cut sideways
Potential labor complications
Maternal concerns
Decreased HR
Bleeding
Meconium-poop from baby
Resp distress
Potential labor complications
Fetal concerns
Decreased FHR
Meconium-poop
Resp distress
If mother wants epidural
give
biggest risk
what stage
no what //d/t
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
c section
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
boggy uterus
what feels like
what means
what do you want
soft and squishy uterus
means bleeding is happening
want a hard uterus
Involution of the uterus
what is it
right after where
where __ hrs after
how much decreases
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
what can influence involution height
when will funds settle back into cervix
full bladder
around 9-10 days
Assessment of fundal height postpartum
when measure
should be
if not
postpartum women
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
Healing postpartum
Lochia Types+days
rubra
serosa
alba
abnormal-possible
no
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
Cervical changes
-slowly closes and hardens, end of 7 days size of pencil eraser
Vaginal changes
6 weeks
walls
what helps
sexual intercourse
-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
Perineal changes
what for first week
what helps
expect menstrualcycle when
-edema for first week
sprays help forceps damage
expect menstrual cycle in 6-10 weeks if not breastfeeding, if breastfeeding 3-4 months
Return of ovulation and menstruation
non breastfeeding
if breastfeeding
-takes non breastfeeding 6-10 weeks
if breastfeeding 3-4 months or longer
Urinary tract-
lot=
keep
use
urinate
lot of urine output =good thing,
-keep bladder empty,
use kegels
urinate using straight cath if cant urainate
GI system-
vaginal
C-section
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
Circulatory
dieresis
a lot of
shift where
increase what
dieresis of 2-5 days after
a lot of urine output
shift of fluid into circulatory and excreted in kidneys
drink lots of water
Striae
-permanent but will begin to fade and lighten to silver color, can be on legs arm back
Diastasis recti abdominis-
abdominal muscles don’t gerneally go back if they are separated
Lactation
inc calories-
feed on
first milk
hormones
breast feel
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
lactation
rotate
pump when
if issues
how know if milk production is enough
dont take
, 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
lactation
increase
wash
devices
increased fluid by 6-8 glasses a day-8 oz
wash breast with clear water/ mild soap
nursing pads/supportive bra
Inverted nipples
-devices can help
nipple shields can make possible by attaching to breast
Nipple soreness-
some is expected
completely normal
Engorgement
what is
what helps milk flow
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
what helps engorgment pain
warm
warm
supportive
oral
support
warm showers
warm compress
supportive bra
oral analgesics
abdominal support with pillow
Cracked nipples
what is
what helps
-moisture cream that is safe for baby
lanolin cream protects sore nipples
Inadequate let-down-
what is
what helps
techniques that lactation constant can help with
double pumping-try to drain breasts as much as possible
Plugged ducts
A plugged milk duct feels like a tender, sore lump or knot in the breast
Mastitis
s/s
treatments
can still
if reddened breast, painful, flu symptoms, high temps- mastitis
treat with antibiotics
can still breastfeed unless pus
Suppression of lactation
accumulation
hormones do what
what helps
accumulation of milk inhibits further milk production
however hormones will still produce milk
suppress with well fitting bra and cabbage leaves help absorb milk
suppression of lactation in class
can cause
engorgment
relief of symptoms (oa/ bra/ 0/ compress)
dont
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
Postpartum assessment vs
how often first hr
how often next 3 hr
then how often
temp
pulse
blood pressure
resp
- 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
when to clamp a catheter
and why
after 1000 ml
because hypotension
postpartum assessment blod values
hemoglobin
anemia
wbc
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
weight loss
birth
dieresis
lochia
what else helps
when back to normal
12 lbs at birth,
dieresis is 5 lbs,
2-3 lbs lochia,
good diet and gentle exercise
baseline wight is epected at 6 weeks
after pains-what is
use
dont use
contractions during breastfeeding-happens with latching of baby
use tylonel or ibuprofen–
no aspirin or heat
rhogam
when give
what does
28 weeks preg or 72 hrs postpartum
. If mom is rh negative and baby is positive then helps with further pregnancy
Psychologic adaptations in postpartum
Taking-in
when is it
what is it
allow
what helps
-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
Taking-hold, postpartum stage
women makes own decisions, decide to take care of self
simultaneously with taking in
Letting go postpartum stages
-accepts new role of baby
lets go of fantasies
Postpartum blue
common
look for
assure
after 2 weeks
what reduces chance
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
What factors influence parent-infant attachment
finaces
wanted baby,
partner
reality of birth
siblings
fatigue
family interventions
Attachment behaviors
Progression of touch-
attachment
, fingertips
, skin on skin touching,
, engaged in baby,
En face position
a position in which the mother and infant are face to face
good for bonding
Father/partner
Engrossment
beginning of bonding
observing for extended periods of time
want mom to take care of herself as well
Cultural influences in postpartum care
be respectful and ask about culture factors
Perineal discomfort-
manifestation
cleaning
wiping
dab
inc
natural=no
prevent
-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,
Perineal discomfort-
pain meds
ice/heat
baths
ages
peri
back rub
use ibuprofen and Tylenol,
ice packs for 24 hrs, then dry heat
Sitz baths
Topical agents
Perineal care-up
backrubs
hemmorhoids
treatment–
increast
re
sprays
caution
manifestations
pain, itching,bm bleeding, swelling
increase water and fiber
rest
aesthetic sprays
caution w/ laxitives
afterpains
After delivery you will feel your uterus contract and relax as it shrinks back to its normal size
Postpartum discharge instructions
work
rest
excercise
hygiene
coitus
contraception
follow up
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
Interventions to promote maternal/family well-being in the postpartal period
work on baby schedule
eat when baby eat
sleep when baby sleep
Nursing management after a cesarean birth
risks
average stay
harder to what
get mom-reduces
look for
incetive
needs
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
c section teaching plan
help
increase
find
restrict
resume
early
provide
adequate
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
signs of infection in c section
temo
incision
urination
bleeding
temp over 100.4
redness/drainage at incision site
burning/frequent urination
bleeding heavier then menstrual period
biggest risk for mom postpartum
dont use what
hemorrhaging
no aspiring because increased risk of hemorrhaging
