Midterm - Mod 4 Flashcards

1
Q

Four interrelated components called the four “Ps” make up the process of labour and birth. What are the four P’s?

A

Powers, Passage, Passenger, Psyche

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2
Q

(4 p’s) What is the powers of labour? What are the two powers?

A

forces that cause the cervix to open and that propel the fetus downward through the birth canal.
- Two powers: uterine contractions (primary power) and the mother’s pushing efforts

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3
Q

what are the effects of contractions on the cervix?

What are the three phases of contractions and what happens?

A

Efface (thin) and Dilate (open)
•Increment: period of increasing strength
•Peak: period of greatest strength
•Decrement: period of decreasing strength

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4
Q

Intensity is the Approx. strength of contraction and described as mild, moderate, and firm contractions. Describe each

A
  • Mild – fundus is easily indented with the fingertips; fundus of the uterus feels similar to tip of nose
  • Moderate – fundus can be indented with the fingertips but with more difficulty; the fundus of the uterus feels similar to chin
  • Firm – fundus can not be readily indented with fingertips; fundus feels similar to foreheard
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5
Q

How are contractions measured and what are the numbers we want for frequency, increment peak decrement, and relax period?

A

Contractions are measured from start of one contraction to the end of that contraction, and then relaxing period.

  • No more frequent than 2 min
  • Increment peak decrement: no longer than 90 secs
  • 60 sec rest break between contractions
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6
Q

the Passage of labour consists of?

The pelvis is divided into what two major parts?

A

Consists of the mother’s boney pelvis and soft tissues.
•True pelvis (lower part): Directly involved in childbirth is further divided
o Inlet, Midpelvis, Outlet
•False (upper, flaring part)

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7
Q

What are the 4 passengers?

A

Fetus, placenta, amniotic membranes and amniotic fluid

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8
Q

How is “Lie” described

A

how the fetus is oriented to the mothers spine

- Most common orientation is the longitudinal lie, in which the fetus is parallel to the mother’s spine

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9
Q

What is the normal fetal attitude?

A

normally the head is flexed forward and the arms and the legs are flexed; if extension occurs labour may be prolonged

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10
Q

Presentation refers to the fetal part that enters the pelvis first. Cephalic presentation is most common, there are variations that can occur - Vertex, military, brow, face, breech. Describe each

A

Vertex- fetal head is fully flexed
Military- fetal head is neither flexed nor extended
Brow- fetal head is partly extended
Face- fetal head is fully extended
Breech legs and buttocks are entering pelvis first

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11
Q

Position refers to

A

how a resting point on the fetal presenting part is oriented within the mother’s pelvis

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12
Q

Psyche in labor refers to

A

Impact of the woman’s entire being on the birthing process

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13
Q

What are the signs of impending labour

A
  • Braxton Hicks contractions
  • Increased vaginal discharge
  • Bloody show
  • Rupture of the membranes
  • Energy spurt
  • Weight loss
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14
Q

Reassuring FHR patterns are: Baseline FHR in a normal range of____.
Are accelartions of FHR normal or abnormal?

A

110 to 160 beats/min, with no periodic changes and a moderate baseline variability
- Accelerations of FHR with fetal movement are normal patterns

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15
Q

Nonreassuring FHR patterns

A
  • Baseline FHR <110 or >160 beats/min
    • Decreased or absent variability; little fluctuation in rate
    • Late decelerations
    • Variable decelerations
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16
Q

False or true labor: Contractions irregular

A

False labor

17
Q

Signs of true labor

A
  • Contractions gradually develop a regular pattern
  • Contractions become stronger and more effective with walking
  • Discomfort in lower back or abdomen
  • Bloody show often present
  • Progressive effacement and dilation of cervix
18
Q

What is the first stage of labour and its 3 phases

A

dilation and effacement (can last 4 to 6 hours)
•Latent phase: up to 3 cm of dilation (not very painful, happy. Contractions are far apart)
•Active (labor) phase: 4 to 7 cm of dilation (pain, not happy)
•Transition phase: 8 to 10 cm of dilation (lots of pain, not happy)
(dilate/contract cervix. Longest stage)

19
Q

what occurs in the second stage of labour

A

expulsion of fetus (30 minutes to 2 hours)

- ends with birth of infant

20
Q

what occurs in the third stage of labor? Nurses responsibilities?

A

expulsion of placenta (5 to 30 minutes) – sometimes theres a massage to help expulsion
- cord is cut
 Nurses responsibility to assess the placenta and monitor woman’s vital signs

21
Q

what is the fourth stage of labor and what is the nursing care?

A

Recover stage - 1-4 hrs after birth of placenta
Nursing care:
- Identifying and preventing hemorrhage
• Evaluating and intervening for pain
• Observing bladder function and urine output
• Evaluating recovery from anesthesia
• Providing initial care to the newborn infant
• Promoting bonding and attachment between the infant and family

22
Q

What are Nonpharmacologic Pain Relief Measures during labor?

A
  • Relaxation techniques
  • Skin stimulation: Effleurage
  • Sacral pressure
  • Thermal stimulation
  • Positioning
  • Diversion and distraction
  • Breathing
23
Q

Difference Between Analgesic and Anesthetic?

Monitor mother for signs off…

A

• Analgesic blocks pain
• Anesthetic blocks both pain and motor responses
- Monitor mother for signs of hypotension and respiratory depression

24
Q

Indications for Labor Induction

A
  • Gestational hypertension
  • Ruptured membranes without spontaneous onset of labor
  • Infection within the uterus
  • Medical problems in the woman that worsen during pregnancy
  • Fetal problems such as slowed growth, prolonged pregnancy, or incompatibility between fetal and maternal blood types
  • Placental insufficiency
  • Fetal death
25
Q

Pharmacologic Methods to Stimulate Contractions

A
  • Cervical ripening – physical softening of the cervix that leads to effacement and dilation
  • Oxytocin stimulates contractions
  • Prostaglandin E2, Prostaglandin E1 : soften cervix
26
Q

what are the benefits of using forceps during labour?

when is it used?

A

• Provides traction and rotation of the fetal head when the mother’s pushing efforts are insufficient to accomplish a safe delivery
o Used at end of second stage of labor in vaginal delivery

27
Q

Vacuum labour uses suction applied to the fetal head so the physician can assist the mother’s expulsive efforts. When should it be used?

A

Used only with occiput presentation and at end of second stage of labor

28
Q

Preparation for Cesarean Birth

A
  • Clinical lab studies to identify anemia and blood-clotting abnormalities
  • CBC, coagulation studies, blood typing
  • Baseline vital signs, including fetal heart rate
  • Position woman for comfort
  • IV line
  • Foley catheter inserted
29
Q

Emergencies During Childbirth: what is a Prolapsed umbilical cord

A

o Complete: The cord is visible at the vaginal opening.
o Palpated: The cord cannot be seen but can be felt as a pulsating structure when a vaginal examination is done.
o Occult: The prolapse is hidden and cannot be seen or felt; it is suspected based on abnormal fetal heart rates.

30
Q

Emergencies During Childbirth: what is a Placenta accreta

A

An abnormal attachment of the placenta to the uterine wall

31
Q

Emergencies During Childbirth: uterine rupture, describe complete, incomplete, dehiscence

A

Complete- whole from uterine wall into the abdominal cavity
Incomplete- uterus tears into a nearby structure such as a ligament
Dehiscence- an old uterine scare separates