Mod 2& 3 Flashcards
What are premonitory signs of labor? (6)
Cervical changes lightening increased energy level Bloody show Braxton Hicks contractions spontaneous rupture of membranes
What changes does the cervix go through before labor?
Softens, effacement, dilation
Define effacement.
Progressive thinning and shortening of the cervix measured from 0 to 100%, 100% is fully effaced.
Define dilation.
Opening of the cervix during labor measured from 0 to 10 cm, 10 cm is fully dilated.
Define lightning as it relates to premonitory signs of labor.
Fetal head entering maternal pelvis
What are the two forms of lightening.
Primipara, and, multipara
When does primipara generally occur?
Up to two weeks prior to delivery.
When does mulitpara generally occur?
It may not occur until labor begins (baby drops further into pelvis)
When does an increase energy level occur as a premonitory sign of labor?
24 to 48 hours before onset of labor. It is thought to be due to increased epinephrine.
What is the bloody show?
Mucous plug is expelled causing the discharge of a small amount of blood and mucus.
What are Braxton Hicks contractions?
Contractions the woman has experienced during pregnancy become more frequent and stronger however they do not dilate the cervix and they are painless.
Define spontaneous rupture of membranes SROM.
When the membranes or bag of waters DOW rupture resulting in a setting gush or steady flow of amniotic fluid.
What is dangerous about spontaneous rupture of membranes?
The barrier to infection is gone, there’s a risk of ascending infection. Possible cord prolapse if the head is not engaged.
What is the first thing you do after spontaneous rupture of membranes?
Check fetal heart tones ASAP if in the hospital, if at home advise the mother to come to the hospital.
Define SROM.
Spontaneous rupture of membranes
Define PROM.
Premature rupture of membranes. Rupture before the onset of labor.
Define SPROM.
Spontaneous premature rupture of membranes.
Define AROM.
Artificial rupture of membranes
What is a Ferning smear?
When fluid is smeared on a slide and examined under a microscope to determine if it is amniotic fluid.
What are three ways to determine if the amniotic sac is ruptured?
Pooling of fluid in the vaginal vault, nitrazine paper (it will turn blue), ferning smear to determine amniotic fluid.
What are four things to assess for if the membrane is ruptured?
Color, odor, amount of fluid, time of rupture.
Why do you check for fetal heart times after rupture of the amniotic sac?
To monitor for cord prolapse
What are the defining characteristics of contractions in true labor?
They are regular with increasing frequency, duration, and intensity.
What are the characteristics of discomfort in true labor?
Discomfort generally radiates from the back around the abdomen.
Two or false contractions decrease with rest in true labor?
False
In true labor what are the characteristics of the Cervix?
The cervix will progressively efface and dilate.
What are the characteristics of contractions in false labor?
They are irregular usually with no change in frequency, duration, or intensity
What are the characteristics of discomfort in false labor?
Discomfort is usually only abdominal
True or false, and false labor cervical changes do not occur?
True
What are the four instances in which the mother should go to the hospital?
- When contractions are five minutes apart, lasting 45 to 60 seconds, and they’re strong enough that she cannot talk during the contractions.
- When there is spontaneous rupture of membranes
- When there is decreased fetal movement
- If there is vaginal bleeding
What are the five P’s affecting labor process?
Passageway, passenger, position or partnership, powers, psychosocial
What are the four types of passageways, or pelvis shapes?
Gynecoid (typical female)
android (typical male)
anthropoid (narrow)
platypelloid (wide).
What is the pelvic inlet?
Is the view from above, allows entrance to true pelvis. It is wider sideways
What is the pelvic outlet?
View from below, wider front to back.
What are the five fetal factors?
Fetal head Fetal attitude Fetal lie Fetal presentation Fetal position
Define molding
The elongated shape of the fetal skul as a result of overlapping of the cranial bones.
Define fetal attitude.
Posturing, flexion or extension, of the joints in relation to the fetal parts.
What is a good fetal attitude?
Flexion of joints.
What is a bad fetal attitude?
Extension of joints
Define fetal lie
The relationship of the spinal column of the fetus to the spinal column of the mother, either longitudinal or transverse.
What is the fetal position?
Describes the relationship of a given points of the presenting part of the fetus to the designated point of the maternal pelvis.
What are the four landmarks of fetal presenting parts?
Occipital bone (O) – vertex presentation presentation
Chin (Mentum or M) - Face presentation
Buttocks (Sacrum or S) - Breach presentation
Scapula (acrominum process or A) - Shoulder Presentation
When charting fetal position what does the first letter indicate?
weather the presenting part of the child is tilted towards the left or the right of the maternal pelvis.
When charting the fetal position what does the second letter stand for?
The presenting part of the fetus O for occipit S for sacral M for mentum A for acromion process
When charting fetal position what does the third letter stand for?
It defines a location of the presenting part in relation to the anterior A, posterior P, if it is in the side of the pelvis it is designated as transverse.
Define fetal station.
Refers to the relationship of the presenting part of the maternal pelvis to the ischial spines of the pelvis. It is measured in centimeters and is referred to as a minus or a plus
Define zero station.
It is designated to when the presenting part is at the level of ischial spines.
Define fetal engagement
When the largest diameter of the fetal presenting part, usually the head, enters the smallest part of the maternal pelvis. Fetus is engaged in the pelvis when the presenting part reaches zero station. Determined by a pelvic exam or vaginal exam
Define floating or Ballotable
A fetal head that has not descended and has not become fixed in the maternal bony pelvis. Upon examination the head is able to move up-and-down. When the fetal head is engaged it cannot be moved?
True or false on the fetal head is engaged it cannot be moved?
True
What is the purpose of the maternal assessment during labor and birth through vaginal exam?
To assess the amount of cervical dilation, the percent of effacement and the status of the membranes, and the status of the fetal head (presentation and position)
How is effacement recorded?
%
How is station recorded?
Ballotable and -2 to +3
Should you ever perform a vaginal exam on a pregnant woman complaining of vaginal bleeding?
No do a speculum exam or an ultrasound instead
What is the primary force of labor?
Uterine muscle contractions
What is the secondary force of labor?
Pushing during the second stage of labor
What are the three things that are measured with uterine contractions?
Frequency, duration, intensity
Define frequency as it relates to uterine contractions.
The timeframe in minutes from the beginning of one contraction to the beginning of the second
Define duration as it relates to uterine contractions.
Timeframe in seconds from the beginning of one contraction to its completion.
What is the normal resting tone between contractions?
10-12mm Hg of pressure
What is the normal interuterine pressure during early labor?
25-40 mm Hg
What is the normal interuterine pressure during active labor?
50-70 mm Hg
What is the normal interuterine pressure during transition?
80 - 100 mm Hg
What is the normal interuterine pressure during pushing?
Greater than 100 mm Hg
Define stage one of labor.
Beginning of labor to complete dilation, there are three phases latent, active, and transition
What is the second stage of labor?
Complete dilation to delivery of the baby
What is the third stage of labor?
Birth of the baby and delivery of the placenta
What is the fourth stage of labor?
Recovery or the first four hours after delivery
What is the primary task of the first stage of labor?
Dilate the cervix
What is the primary task of the second stage of labor?
To get the baby out of the body
What is the primary task of the third stage of labor?
To get the placenta out of the body
What is the primary task of the fourth stage of labor?
To stop the bleeding
What Defines the latent stage of the first stage of labor
Regular contractions up until 4 cm of dilation
What defines the active phase of the first stage of labor?
4 cm dilation to 7 cm dilation.
What defines the transition phase of the first phase of labor?
7 cm dilation to 10 cm dilation (full)
What are the four signs of placental separation?
Globular shaped uterus
A rise in the fundus within the abdomen
A sudden gush or trickle of blood
Further protrusion or lengthening of the umbilical cord out of the vagina
True or false when you’re caring for an individual labor you’re caring for two people?
True
What are the maternal assessment you will perform as she progresses through labor?
Labor progress, contractions and pain management
What are the fetal assessments you will perform as a mother progresses through labor?
Monitor fetal heart rate, presentation position and fetal activity
What is an important nursing intervention during the first stage of labor?
Ensuring in the patient’s bladder is empty
What are the three pharmacological pain management options for a woman in labor?
Systematic analgesics, oral IM or IV
Regional analgesic’s
General anesthesia, only used for emergency situations
What are three nonpharmacologic pain management options for the laboring woman?
Hydrotherapy, ambulation, birthing ball, acupuncture/acupressure, application of hot/cold, attention focusing and imagery, therapeutic touch, breathing techniques
What are three typical signs that a woman is entering the second stage of labor?
Increased anxiety and irritability, SROM, sudden onset of sweat on upper lip, increased blood tinged bloody show, rectal and peroneal pressure, beginning of involuntary bearing down efforts
What are the five things to do after a newborn is delivered?
Establish airway, Apgar score, clamp umbilical cord, provide warmth and stimulation, place ID bands
What are the nursing interventions for the third stage of labor?
Wait and watch for signs of placental separation, prepare/administer Pitocin, provide newborn care
What are three nursing interventions for the fourth stage of labor?
Vital signs, massage fundus, assess vaginal bleeding, empty bladder, Peri care and ice on perineum, warm blanket, encourage bonding and breast-feeding, food
