Maternal Exam 3 Flashcards
Birth has effects on the whole family….
physiology of labor,risks in ven low risk pregnancies, affects on the mother and baby’s body systems
Physiological effects of birth process?
reproductive, caridiovascular, respiratory. gastrointestinal,urinary, hematopoietic
Reproductive system changes for mom?
cervical changes(size, lenght), contrations, uterus(responsible for the hardest work)
Labor contractions?
Uncontroled contractions that are involuntary and intermittent.
Labor contractions are measured by?
Frequentcy( how far part they are), duration (the contraction lenght from start to finsh), intensity( mild, modrate, strong) these can be felt by touching uterus and measureing the chin, nose, forhead approach
Cervical changes during birth?
2cm inlenght and becomes a turtleneck by effacment( thinning and shortening expressed in %) Dilation is the openess expressed in cm. 1 is finger tip and 10 is complete dialation.
What organ causes the contractions?
The uterus progresses though labor and lenghtens and increases intensity
The uterus is responsible for?
( Uteran muscles cause) The contractions that cause Effacment, dilatation and decent
Contractions pull the _______ over the presenting part, resulting in cervical dilatation.
Cervix ( turtleneck sweater)
Every time there is a contract it stops what?
The placental blood flow, thats why is we have to many to fast we need to stop them so baby can get O2.
What maternal VS will change during a contraction?
Increases in B/P and pulse, take VS often, only asses VS inbetween contraction not while one is happening.
EBL during delivery?
500ml
Hyperventilation is?
breathing to fast, too deep( tingleing in lips) not enough O2 and to much CO2, breath into bag.
During labor we only offer?
Clear liquids and ice chips due to very decreased GI motility.
A couple of days before the on set of labor, some GI changes that occur?
Less appetite, diarehha, vomiting, during delivery every thing will come out so dont eat.
During labor we catheterize because?
Mom has decreased bladder sensation, epidural may make them not feel it, full bladder could get a baby hung up
The maximum amount of blood loss during labor?
500mm, which is normal becaue the body increase blood volume by 1-2 L during the pregnancy
Clotting factors are higher during pregnancy and birth why?
Provides protection from hemorrhage but increases risk of DVT’s
During a contraction there is no?
Placental exchange of circulation( O2)
Fetal reserve?
High HgB and release O2 during a contraction and increases cardiac output
Lung fluid absoption rate?
In response to the stress of the labor, labor increases reabsortion of lung fluid, that is why some C-section babies have lung problems, because they have not had the fluid squeezed out of their lungs like a vaginal baby
5 P’s of labor?
1.Power, 2.Passageway, 3.Passenger,4. Position of mother, 5.Psychological
1.Primary source of power? and secondary source of power?
Uterine contractions are the primary source of power and secondary , you must have adequate strenght abdominal muscles and pelvic flooring
3 phases of a contraction?
increment( climbing up the hill), acme( highest piont), decrement ( swope down hill)
Uterine muscles are pushing?
Down and out at the same time
- The pssage way for the baby must?
normal saized and soft tissue and bony pelvis needs to be all correct
4 types of pelvises?
gynecoid(classic-good), andriod( male),anthropoid, and platypelloid
Frequency of contraction is measured how?
from the beging of one contraction to the beging of the next one
Pelvis bones opening measures?
10.5cm
smallest opening in pelvis?
true pelvis
False pelvis is used for?
structured support
- passanger on board must have some things in order beofr it come out?
Cranium bones offer some squshiness at the suture lines,positioning and head first
Fetal Lie?
Long axis of fetus ( measurement head to rump)
Presentation?
cephalic is most common( head first)
Breech?
knees and hips flexed( butt first)
Fetal position in relation to ?
Maternal pelvis can be felt ( LOA)
Brow presentation?
Frontal bones first ( bad), totally busted up face
Occiputal presentation?
Back of the head first ( good)
Vertex means?
Head down chin tucked( good job)
- Position of mother? It effects the comfort and progress of labor, all depends on the fetal monitoring,babies heart rate drop we need to change postitions
Left side laying, kneeling, hands and knees. squatting,(natural) standing, sitting upright
psychological adaptations in labor?
Partner is the most important role to support the mother
What causes labor to begin?
Estrogen starts contractions, prostoglandins from male sprem can induce labor( Sex) cortisol has a sharp increase from the baby
Signs of premonitory labor beging? Could happen as early as 37 wks and not delivery for a few wks still
lightening ( droping), braxton-hick contractions, persistent backache, 1-3 lb weight loss due to Gi upset from hormone shifts causing diarehha, N/V, nesting, cervical dialation, bloody show(plug), increase vaginal discharge
Signs of TRUE labor?
Pogressive cervical dialation, contractions that are regular, ROM,( spontaneous rupture of membranes)( water breaks), bloody show
Effaced 50% means dialation should?
begin
effaced 100% means dialation is at?
10cm
Station is the relationship of? and it determines?
The presenting part to the ischial spine
- negatives or ballotable flow above the spines(-1, -2), 0 is right at the spines and p[ositives are below the spine or already on the perineum( +4, +5)you can see the head already– this determine how long it will be befor the baby is born
Engagement is?
fetal head passes the inlet of pelvis only and confirms adequacy of inlet
6 cardinal movements of labor?
1.decent( engagment in inlet), 2.flexion( tuck the chin), 3. Internal rotation,4. extension(negotiates the pubic arch), 5. external rotation, 6. expulsion
OP ( occiput posterior) is going to be the ?
worst b/c of back labor
4 stages of labor? Stage 1…
onset of labor to full dilation, this is the longest stage and can take a couple of days– Latent labor(early labor) true labor >3cm dilated—active labor is 4-7cm dialation and transition is 8-10cm dilated and your doing hee blows
Stage 2 of labor?
pushing at 10cm and birth of baby
Stage 3 of labor?
Placental delivery( shortest stage), if 30min has gone by with out delivery of placenta, taken to OR to be removed
stage 4 of labor?
Recovery for 1-4 hrs
Schultze mechanism of delivering placenta?
Shiny Schultze, nice side up
Duncan mechanism of delivering placenta?
Dirty Duncan, maternal gross side up
Friedman’s labor curve is used to?
track the status of the moms labor. Plotted on a graph and chated everytime a vaginal eaxm is done. It is used to see if a woman cervical dilation is progressing at an expected rate
Pain is increased by?
Dialation of cervix( primary source), fear, aniexty, fatigue, fetal position
Non pharmacological pain managment?
relaxation, guided imagery, childbirth classes, Lamaze
Pharmacological pain managment?Must Check FHR befor and after administering any meds
- Systemic narcotice sedatives
- reginal anestesia( nerve blocks)( some times stops contractions and slows labor)
- general anestisai( not used often because it crossed placenta very quickly and effects baby
Systemic meds are?
Narcotics and Sedatives( may effect respiratory depression in neonate, have narcan available
- Stadol is our drug of choice given IV push
- Demerol is given with Vistarill to decrease anxiety
- Nubain can be given
- Phenergan is given for N/V
Local/Reginal Anesthesia?
Used for local pain, Epidural is the most popular but a major side effect is HYPOTENSION
- Caudal, pudendal and paracervial used as Lidocain for sutures afterward
- Duramorph is used frequently for pain relief coverage after a C-section for about 12hr coverage but a mojor sideeffect is RESPIRATORY DEPRESSION
- Spinal have an immediate onset but are short lived and can knick the spinal cord and cause server headache( must increase IV fluids and bed rest)
An epidural is place between?
dura mater and ligamentum flavum in the sacral canal
We do not give general anestesia to?
A mom in vaginal delivery
General anesthesia is used?
In emergency situations only because it crosses the placenta with in 2 mins and vigorous resuscitation may be needed at birth.
Never give a PT a bed pan unless?
They have been checked
Nursing issue with birth?
pain associated with birth, inexperience or negative experience of your own,unpredictablity, intimacy, leagal liability
When to go to the hospital is based on?
History of previous labor, transportation and distance, who to call, scheduled induction or C-section, SROM( spontaneous rupture of membrane)color of fluid and is the baby still moving
Leopolds maneuvers?
Sooth back , bumpy arms and legs and head should be presenting at pelvic inlet
FHR is heard best?
Over babies back
Two dip sticks are performed in a pregnant woman what are they for?
Glucose and protien– Protien in urine means preelamptic and glucose in urine means gestational Diabetes
ROA
Right occiput anterior
Transverse
mid line stuck
OP
Occiput posterior not good because of sacral prominace to get around back labor
Sacrum down
butt first LSA( left sacrum anterior
OA
Occiput anterior- good delivery
Stage one-latent (early)
-encourage rest
-take a warm shower
-walk around
-teach breathing
-Clear liquids only
Stage one ( phase 2 ) may need some pain meds
Stage one transition
Do not leave the pt alone, encourage relaxation
Stage 2- pushing, do not leave alone, assist pushing, check perineum, and praise
Stage 3
- birth of baby to delivery of placenta
- document time of delivery of baby and placenta
- monitore Maternal VS and blood loss
- administer oxytocin, or Methergine to stop the bleeding BUT Methergine can increase BP so check VS first
How do you know the placenta is seperating?
- Gush of blood
- Cord gets longer
- Uterus gets globular( balls up, not squishy and more)
Pitocin stop bleeding how?
It is a vasoconstrictor and constricts the open blood vessel so they dont keep profusing
Major responsibilty during delivery?
Document ALL intrapartal care, time of baby and placenta, 1 min and 5min apgar scores, immediate neonatal care, administered meds.
How much blood is usually loss with birth?
- Vaginal- 500ml
- C-section- 1000ml
What happens in immediate newborn care?
- Clamp and cut cord, count vessels
- clear airway and assess for distress
- VS
- apgar scoring at 1 min, 5 min and if its below 7 repeat every 5 mins for 20min
- eye prophylaxis
- vitamin K injection
Apgar scoring:
1)Heart Rate 2) Respiratory effort 3)muscle tone 4) reflex irritability 5) color
- 0= bad and 2= good
score of 0-2- severely compromised baby
score of 3-6- moderately compromised baby
score of 7-10-healthy newborn baby
Acrocyanosis
hand and feet are purple or bluish
Wharton’s jelly is?
The jello stuff surrounding the 2 arteries and 1 vein in the umbillical cord for squish protection
How do we identify new babies?
3 braclets( one for each ankle and one for mom), foot prints and a photo of baby
Fourth stage of labor is for?
Maternal bonding,breast feeding, observe for PP hemeraging, recovery time
Nursing care for fourth stage?
- VS, uterine tone, positon for uterus and lochia every 15 min for the hr( MUST be done)
- fundal massage to stimulate the contractions to expel clots( ALWAYS use 2 hands one to anchor the lower uterine segment, the other to gentaly massage)
What should be assessed in fourth stage?
- Fundus should be at or slightly below U midline
- If your fundus is shifting to the side you may have a full bladder pushing it or it is full of clots, that very bad
- assess the perineum for pain, edema,gaping, bruising, hematoma
What does lochia look like?
red in color with a few small clots, plum size clots are bad
What has happened if you have a continuous trickle?
Laceration of cervix- if your pt saturate more than 2 pads in an hr or is sitting in a pool of blood you need to reevaluate ( that is to much bleeding)
The first 1-2hrs PP are the most dangerous for hemerage and excessive bleeding
pulse and resp, are increase and BP is decreased, pale, cool ,clammy, N/V, light headed= hypovolemic shock( from to much blood loss)
What can you do if your pt is going into hypovolemic shock?
Call for help, lower the head of bed, check uterus, increase IV fluids
Comfort measures during fourth stage?
Sponge bath, change gown, ice on perineum, talk to pt about starting Kegel exercises ASAP
Grey and brown spots on the placenta mean?
No profussion was getting through to those spots, monitor the baby
amniotomy
Artificial rupture of membranes( most commonly invasive procedure in OB)
biggest risk of an amniotomy?
- Prolapsed cord, FHR is the priority to assess, for at least 1 full minute( you need to monitor the FHR before hand so you know if it has changed
- infection- check moms temp every 2 hrs after ROM
How do we know its amniotic fluid?
Nitrazine paper will be used and will turn blue if it is amniotic fluid due to the fluid being alkaline
-Document the color, odor, amount
A Bishop score is used?
To determine the readiness of you cervix for induction
We never do a vaginal delivery…
if the mother has active herpes( baby will die)
Induction fo labor?
Stimulate uterine contractions to onset labor with or with out ROM
-We do not induce a mom who has had a vertical c-section due to uterine contractions
Augmentation of labor
your contractions are not doing much so we are going to jump start your labor
Cervical ripening is a method of induction and augmenting by?
stripping membranes( causes prostoglandins to be release ,amniotomy,prostaglandin gel, Oxytocin,
versions are used to?
- extrenal- change the position of fetus from outside the body using tocolytics to relax the uterus
- internal- is usually used for twins when one is faceing down and the other not the doc will go in and change position so it can be pushed out
Forceps and vacuum are used?
To aid the womans birthing when she is just to tired to go on( forceps can cause nerve damage)
Episiotomy/ Laceration?
Lacerations actually heal better most of the time they will just let you rip.
Intermittent fetal monitoring?
Monitor is not on all the time, gives mom more freedom, only for low risk pregnancies, assess fetus more often as labor progresses
Monitor fetus BEFORE….
AROM, ambulation,medications,anestesia
Monitor fetus AFTER…
ROM, uterine contraction, medications, a vaginal exam, and ambulation
External fetal monitoring? ultra sound transducer..
high frequency sound waves reflect action of fetal heart
A tocotransducer is used for?
can show you the frequency and duration of the contraction ONLY, can not tell you the strength of the contraction
Internal fetal montioring?
fetal scalp electrode and can determine beat to beat variability and convert it into a pattern
IUPC( Internal uterine pressure catheter)….
only way to measure a contractions strength
Fetal monitoring decriptions?
Variable Cord compression=bad
Early deceleration Head compression=ok
Accelerations Ok=ok
Late Placenta old=bad
Three phases of a contraction?
increment( incline), acme( peak), decrement( down hill)
Frequency is?
the beginning of one contraction to the beginning of the next one
Duration is?
The beginning of the contraction until it ends
How do you monitor uterine activity?
The toco must be placed at the top of the funds
A healthy placenta offers?
A good exchange of O2 and CO2 via the CORD
What is nucchal cord?
Cord wrapped around babies neck
If your pt has oligohydraminos what will happen?
Mom will get an amino transfer to add fluid to placenta
What effects a fetal HR?
VS, position, drugs, labor phase, procedures, and DX
If moms blood pressure drops that means?
baby is not getting enough profession
Changes in fetal HR NOT from a contraction?
variables are due to cord compression, accelerations are due to movement and exercise
Baseline HR must be taken?
between contractions
Fetal tachy?
baseline rate is above 160 for more than 10 mins, and its due to, maternal fever, maternal dehydration, or hypoxemia
Fetal brady?
baseline rate is below 110 for more than 10 mins and its due to LATE fetal hypoxemia, maternal hypotension, meds~~ correct the mother hypotension, increase placental profusion and decrease uterine activity, change position of mom, give mom O2 , increase fluids to help with hypotension, Tycolitic to stop contractiins
Contractions can cause fetal heart rate to decrease in 3 ways?
myometrial vessels, umbilical cord and fetal head
Early deceleration?
head compression when uterine contraction, mirrors the contraction
Late deceleration?
returns to baseline AFTER the end of the contraction, placental insufficiency and means the exchange of O2 is bad baby has insufficient reserves( most often from anestisia or hyprstimulation from pitocin…..stop pitocin, turn mom to her L side, hydrate call doc.
Variable deceleration?
cord compression, change position of mom
