Module 2 INTRAPARTUM - LECTURE 6 Flashcards

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1
Q

Nursing process?

A

Assessment: This is the first step in the nursing process. Nurses gather data about the patient’s health status, including their physical, emotional, social, and spiritual aspects. This information is collected through interviews, observations, physical examinations, and reviewing medical records.

Diagnosis/Analysis: Based on the data collected during the assessment, nurses analyze the information to identify the patient’s health problems and needs. Nursing diagnoses are different from medical diagnoses and focus on the patient’s response to their health issues.

Planning: After identifying the nursing diagnoses, nurses develop a plan of care. This plan outlines specific goals and interventions that are tailored to address the patient’s unique needs. It also involves setting priorities and establishing a timeline for care.

Implementation: In this step, nurses put the plan into action. They carry out the interventions and treatments outlined in the care plan, with a focus on promoting the patient’s health, preventing complications, and meeting their individual needs.

Evaluation: Continuous assessment and evaluation are crucial in nursing. Nurses assess the patient’s progress and determine whether the interventions are achieving the desired outcomes. If the outcomes are not met, the nurse may need to revise the care plan and make necessary adjustments.

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2
Q

Initial Assessment of Patient

A

Admit patient to triage: When a pregnant patient arrives at the healthcare facility in labor, they should be admitted to the triage area for initial assessment and evaluation.

POC (Point of Care): Urine dip: This involves conducting a point-of-care urine dipstick test to check for various parameters like protein, glucose, ketones, and signs of urinary tract infection. Abnormalities may indicate potential complications.

Initiate fetal monitoring: Fetal monitoring is crucial to assess the baby’s heart rate and monitor for signs of distress. This can be done externally using a fetal Doppler or internally with a fetal scalp electrode, depending on the clinical situation.

Obtain VS (Vital Signs): Measure the patient’s vital signs, including blood pressure, pulse rate, respiratory rate, and temperature. Monitoring vital signs helps in assessing the mother’s overall health and identifying any abnormalities.

Characteristics of Labor: Assess the characteristics of labor, including the frequency, duration, and intensity of contractions. This information helps determine the stage of labor and progression.

Assess for VB (Vaginal Bleeding): Check for any signs of vaginal bleeding, as it can be an alarming symptom during labor and may indicate complications.

Assess FM (Fetal Movement): Subjective: Ask the mother about fetal movement. Decreased or absent fetal movement can be a sign of fetal distress.

Check for Ruptured Membranes/Dilation: Examine the patient to determine if the amniotic membranes have ruptured (water has broken). Assess cervical dilation and effacement to gauge the progress of labor.

Prenatal Record: Review the patient’s prenatal record to gather information about the pregnancy history, any known medical conditions, previous pregnancies, and prenatal care history.

Physical Exam: Including high-risk s/sx (Signs and Symptoms): Perform a comprehensive physical examination, paying attention to any signs or symptoms that may indicate high-risk conditions or complications, such as pre-eclampsia, gestational diabetes, or infections.

Report to provider: Communicate the findings and assessment results to the healthcare provider (physician or midwife) responsible for the patient’s care. The provider can then make informed decisions regarding further management and interventions.

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3
Q

Admit or Send Home?

A

Is the patient in active labor?

Assess the characteristics of contractions, including their frequency, duration, and intensity.
Evaluate cervical dilation and effacement.
Active labor typically involves regular contractions, cervical dilation of at least 4 cm, and progressive effacement.
ROM (Rupture of Membranes)? GBS status (Group B Streptococcus (GBS) ?

Determine if the patient’s amniotic membranes have ruptured (water has broken).
Assess the patient’s Group B Streptococcus (GBS) status to determine if they require prophylactic antibiotics during labor.
Coping well?

Evaluate the patient’s ability to cope with pain and discomfort. This may include their pain management preferences and overall emotional well-being.
Labor History (Labor Hx)?

Consider the patient’s previous labor history, especially if there were complications or unique circumstances in prior pregnancies and deliveries.
High-risk diagnoses (High risk dx)?

Identify any high-risk conditions or complications that the patient may have, such as pre-eclampsia, gestational diabetes, or a history of preterm labor.
Fetal concerns?

Assess the well-being of the baby, which may include fetal heart rate monitoring.
Evaluate any concerns or signs of fetal distress.
Based on these considerations, you can make a decision regarding admission or discharge:

Earlier Admission: If the patient is in active labor, their water has broken (ROM), they are GBS positive, coping poorly, have a history of high-risk complications, or there are fetal concerns, earlier admission may be necessary. This could involve interventions such as pain management, administration of antibiotics for GBS, or close fetal monitoring.

Delayed Admission: If the patient is not yet in active labor, their membranes are intact, they are GBS negative, coping well, have a history of straightforward pregnancies, and there are no immediate fetal concerns, delayed admission may be considered. This approach allows for a more natural progression of labor without unnecessary interventions.

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4
Q

Diagnosing Rupture of Membranes
What’s the difference?

A

PROM (Preterm Rupture of Membranes): PROM occurs when the amniotic sac (membranes) ruptures before 37 weeks of gestation. This is a concern because it can lead to preterm birth, which carries risks for the baby. Diagnosing PROM involves a clinical assessment, which may include:

Confirming the presence of amniotic fluid leakage through a physical examination (e.g., sterile speculum exam, nitrazine paper or ferning test).
Ultrasound evaluation to assess the amniotic fluid volume and the status of the membranes.
PPROM (Preterm Premature Rupture of Membranes): PPROM is a specific subset of PROM that occurs before 37 weeks of gestation and before the onset of labor. PPROM is a concerning condition as it may lead to infection, premature birth, and other complications. Diagnosing PPROM involves the same methods as PROM.

SROM (Spontaneous Rupture of Membranes): SROM refers to the spontaneous rupture of membranes, typically during the course of labor when contractions have started. It can also occur in late pregnancy. In SROM, the amniotic sac breaks naturally without any external intervention. The diagnosis is often straightforward because there is usually a clear gush of amniotic fluid and other clinical signs.

AROM (Artificial Rupture of Membranes): AROM is the deliberate rupture of the amniotic sac by a healthcare provider using a sterile instrument, such as an amnihook, during labor. This procedure is often done to augment labor or facilitate internal monitoring of the baby’s status. AROM is different from SROM because it is intentionally initiated by a healthcare provider.

In summary, the key differences between these terms lie in the timing and circumstances of the membrane rupture:

PROM and PPROM both involve the rupture of membranes before 37 weeks of gestation, with PPROM specifically referring to preterm rupture before the onset of labor.
SROM refers to the spontaneous rupture of membranes during labor or late pregnancy, and it occurs naturally.
AROM is the artificial or medically induced rupture of membranes by a healthcare provider during labor or for specific medical reasons.

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5
Q

Diagnosing Rupture of Membranes

A

Nitrazine Test: The nitrazine test involves using nitrazine paper or strips to assess the pH level of vaginal secretions. Amniotic fluid has a pH level of around 7 to 7.5, which is more alkaline compared to the vaginal secretions. Therefore, if the nitrazine test strip turns blue (indicating alkalinity), it may suggest the presence of amniotic fluid. However, other factors, such as infections or semen, can also affect pH levels, so this test is often used in conjunction with other assessments.

Pooling: Pooling refers to the collection of amniotic fluid in the vaginal fornix. During a speculum exam, if a healthcare provider observes a visible pool of amniotic fluid in the vaginal canal, it is a strong indicator of ROM. Pooling is a visual sign of amniotic fluid leakage.

Fern Test (Ferning Test): The ferning test involves examining a sample of vaginal fluid under a microscope. When amniotic fluid dries on a glass slide, it forms a fern-like pattern due to the crystallization of proteins and salt present in the fluid. This unique ferning pattern is characteristic of amniotic fluid and can be observed under the microscope. It is a specific and reliable indicator of ROM.

Speculum Exam: A speculum exam is a physical examination performed by a healthcare provider using a speculum to visualize the cervix and vaginal canal. During this exam, the provider can assess for signs of amniotic fluid leakage, such as pooling and the presence of ferning.

Cervical Fluid Microscopic Examination: In some cases, cervical fluid collected with a swab may be viewed under a microscope to look for ferning patterns, which can further support the diagnosis of ROM.

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6
Q

vagina vs vaginal vault ?

A

Vagina: The vagina is the muscular, tubular structure that connects the external genitalia (vulva) to the cervix of the uterus. It serves several functions, including as the birth canal during childbirth and as a passageway for menstrual flow to exit the body. The vaginal walls are lined with mucous membranes and are capable of stretching to accommodate various activities, such as sexual intercourse.

Vaginal Vault: The vaginal vault is a specific anatomical term that refers to the upper portion or end of the vagina. After a hysterectomy, which is the surgical removal of the uterus, the lower part of the uterus is typically removed, leaving the upper part, which is sometimes referred to as the vaginal vault. In other words, the vaginal vault is the top part of the vagina where it connects to the cervix when the uterus is still intact.

The distinction between these terms is important in the context of gynecological procedures and surgery, especially when discussing the removal of the uterus. After a hysterectomy, the vaginal vault may be closed or sutured, depending on the type of surgery performed. It’s also relevant in discussions related to the anatomy of the female reproductive system and gynecological examinations.

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7
Q

Nitrazine Testing for ROM

A

The nitrazine test, also known as the nitrazine paper test, is a diagnostic tool used to determine whether the amniotic membranes (the sac surrounding the baby in the womb) have ruptured during pregnancy. The test relies on measuring the pH level of vaginal fluids to distinguish between amniotic fluid (which is alkaline) and other vaginal secretions (which are typically acidic). The color changes on the nitrazine paper correspond to different pH levels, as you’ve described:

For acidic pH (indicating that the membranes are likely not ruptured):

Yellow = pH 5.0
Olive-yellow = pH 5.5
Olive-green = pH 6.0
For alkaline pH (indicating that the membranes may have ruptured):

Blue-green = pH 6.5
Blue-gray = pH 7.0
Deep blue = pH 7.5
The principle behind this test is that amniotic fluid, when it comes into contact with the nitrazine paper, causes the paper to turn a color in the alkaline range (blue-green to deep blue), while vaginal secretions remain in the acidic pH range (yellow to olive-green).

A positive result (alkaline pH) suggests that the membranes may have ruptured, while a negative result (acidic pH) indicates that the membranes are likely intact. It’s important to note that while the nitrazine test can be a useful initial indicator of ruptured membranes, it may not always provide a definitive diagnosis. In cases where there is uncertainty or the clinical presentation is unclear, additional assessments, such as a ferning test or clinical examination, may be used to confirm the diagnosis of ruptured membranes.

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8
Q

What else has a ph of 7.4-7.5?

A

A pH range of 7.4 to 7.5 is slightly alkaline, and several biological fluids in the human body fall within this range. Here are some examples of bodily fluids and substances with a pH in this range:

Blood: Arterial blood in a healthy human typically has a pH of around 7.4, making it slightly alkaline. Maintaining this pH level is crucial for the normal functioning of enzymes and metabolic processes in the body.

Cerebrospinal Fluid (CSF): The pH of cerebrospinal fluid, which surrounds the brain and spinal cord, is generally around 7.4. This stable pH helps protect and maintain the health of the nervous system.

Intracellular Fluid: The pH inside most cells in the body is maintained close to 7.4. This is important for cellular processes and maintaining cellular health.

Interstitial Fluid: The fluid that surrounds cells in tissues, known as interstitial fluid, also typically has a pH around 7.4. This pH is important for the exchange of nutrients, gases, and waste products between cells and the bloodstream.

Saliva: Saliva in a healthy individual typically has a slightly alkaline pH, ranging from about 7.4 to 7.6. Saliva pH can vary slightly depending on factors like diet and hydration.

Urine: The pH of urine can vary depending on several factors, including diet and health. In a healthy individual, urine pH tends to be slightly acidic (around 6 to 6.5) but can become more alkaline (closer to 7.4) under certain conditions or with specific diets.

Semen: Semen, the fluid ejaculated during sexual activity, is typically alkaline, with a pH ranging from 7.2 to 8.0. This alkaline pH helps to neutralize the acidity of the vaginal environment, providing a more hospitable environment for sperm.

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9
Q

Sterile Vaginal Exam (SVE)

A

A Sterile Vaginal Exam (SVE), also known as a Sterile Speculum Exam, is a medical procedure performed by healthcare professionals to examine the vagina and cervix. It is called “sterile” because it involves the use of sterile instruments and techniques to minimize the risk of infection during the examination.

Here is an overview of the steps involved in a Sterile Vaginal Exam:

Preparation: The healthcare provider, often an obstetrician, gynecologist, or nurse, prepares for the exam by washing their hands thoroughly and wearing sterile gloves and a sterile gown. They also assemble the necessary sterile equipment, including a speculum and a light source.

Patient Preparation: The patient is typically asked to lie on their back on an examination table with their feet in stirrups, allowing for proper access and visibility. The patient may be covered with a drape for privacy.

External Examination: The healthcare provider may begin with an external examination, inspecting the vulva (external genitalia) for any abnormalities, signs of infection, or visible lesions.

Speculum Insertion: A sterile speculum, which is a metal or plastic instrument shaped like a duckbill, is inserted gently into the vagina. The speculum is gradually opened to allow a clear view of the cervix.

Cervical Examination: With the cervix visible through the speculum, the healthcare provider can assess various aspects of the cervix, including its position, size, color, and the presence of any discharge or abnormalities. They may also perform procedures like a Pap smear or collect samples for various tests if indicated.

Palpation (Optional): In some cases, the healthcare provider may use their gloved fingers to gently palpate (feel) the cervix and surrounding structures to assess for tenderness, masses, or other abnormalities.

Speculum Removal: Once the examination is complete, the speculum is carefully removed from the vagina.

Patient Education and Discussion: The healthcare provider may discuss their findings with the patient, answer any questions, and provide recommendations for further evaluation or treatment if necessary.

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10
Q

sve

A

During a Sterile Vaginal Exam (SVE), healthcare providers may assess three important aspects related to labor and childbirth: dilation, effacement, and station. These measurements help determine the progress of labor and the positioning of the baby in the birth canal.

Dilation: Dilation refers to the opening of the cervix. It is measured in centimeters (cm) and is an essential indicator of labor progress. The cervix starts out closed (0 cm) and needs to dilate to 10 cm or fully open for the baby to pass through the birth canal. Dilation typically occurs gradually during the active phase of labor, with each centimeter of dilation representing progress toward childbirth.

Effacement: Effacement, also known as cervical effacement or effacement of the cervix, describes the thinning and shortening of the cervix. Effacement is expressed as a percentage. For example, if the cervix is 50% effaced, it means that it is halfway thinned and shortened compared to its original length. Effacement typically occurs along with dilation as the cervix prepares for labor. A fully effaced cervix is often necessary for the baby’s head to descend and engage in the pelvis.

Station: Station refers to the position of the baby’s head (or presenting part) in relation to the mother’s pelvis. It is usually measured in relation to the ischial spines of the maternal pelvis. The ischial spines are bony landmarks in the pelvis, and their level is designated as “zero station.” A baby’s station can be described as negative (above the ischial spines) or positive (below the ischial spines). For example, a baby at -2 station means the baby’s head is 2 cm above the ischial spines, while a baby at +2 station means the head is 2 cm below the ischial spines. As labor progresses, the baby typically descends deeper into the pelvis (moves to a more positive station).

These measurements are crucial for healthcare providers to assess the progress of labor, determine the stage of labor, and make decisions regarding the management of labor and potential interventions. Monitoring dilation, effacement, and station helps ensure the safe and effective progression of labor and the well-being of both the mother and the baby.

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11
Q

Assessment ofVaginal bleeding

A

Assessing vaginal bleeding during pregnancy is a crucial aspect of prenatal care, labor, and delivery. Here are some key points to consider when assessing vaginal bleeding:

Bloody Show: The “bloody show” is a term used to describe the passage of a small amount of blood-tinged mucus from the vagina, often seen as a pink or brownish discharge. It can be a normal part of late pregnancy or early labor as the cervix begins to dilate and efface. It’s generally not a cause for concern unless accompanied by other concerning symptoms.

Scant Bleeding Normal After SVE: After a Sterile Vaginal Exam (SVE), it’s not uncommon for the patient to have a small amount of vaginal bleeding or spotting. This is usually due to the manipulation of the cervix during the examination and is generally considered normal.

Reporting Vaginal Bleeding to Healthcare Provider: Any vaginal bleeding during pregnancy should be reported to the healthcare provider (MD/CNM) promptly. While some bleeding can be normal (such as bloody show), it’s essential to rule out potentially serious causes.

Closely Monitoring Moderate to Heavy Bleeding: Any moderate to heavy vaginal bleeding during pregnancy is concerning and should be closely monitored. Healthcare providers may use pad counts or weights to quantify the amount of bleeding. Heavy bleeding can indicate a potential problem and requires immediate medical attention.

Sources of Abnormal Bleeding: Several serious conditions can cause abnormal vaginal bleeding during pregnancy, including:

Placenta Previa: This condition occurs when the placenta partially or completely covers the cervix. It can cause painless vaginal bleeding, often in the later stages of pregnancy. Placenta previa is a medical emergency and requires immediate attention.
Placental Abruption: Placental abruption is the premature separation of the placenta from the uterine wall. It can cause painful vaginal bleeding and can be life-threatening for both the mother and the baby. Immediate medical intervention is necessary.

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12
Q

Assessment of uterine activity

A

Subjective Assessment (Patient’s Report):
During labor, healthcare providers often start by asking the patient questions to obtain subjective information about uterine contractions. These questions can include:

“Can you describe the sensation or pain you’re feeling during contractions?”
“How frequent are your contractions?”
“How long do your contractions typically last?”
“Have you noticed any changes in the intensity of your contractions?”
“Are there any other sensations, such as back pain, associated with your contractions?”
The patient’s responses provide valuable information about their perception of uterine activity and can help healthcare providers gauge the progress of labor.

Objective Assessment:
Objective assessment involves clinical observations and measurements performed by healthcare providers. It includes:

Palpation: Healthcare providers use their hands to palpate the patient’s abdomen to assess the strength and frequency of uterine contractions. They may describe contractions as “mild,” “moderate,” or “strong.” This assessment can help determine the progress of labor and whether contractions are effective in cervical dilation and effacement.

Observation: Healthcare providers visually observe the patient for signs of uterine contractions. This can include noting the abdominal wall tightening and relaxation associated with contractions.

Tocometer: A tocometer is an external monitoring device that measures uterine contractions. It consists of sensors placed on the patient’s abdomen to detect changes in uterine activity. The tocometer provides continuous data on the frequency and duration of contractions.

IUPC (Intrauterine Pressure Catheter): In some cases, particularly when more precise monitoring is needed, an IUPC may be used. This is a thin catheter that is inserted through the cervix and placed inside the uterine cavity to directly measure the pressure generated by uterine contractions. It provides real-time data on the strength and frequency of contractions and is commonly used in situations like labor inductions or high-risk pregnancies.

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13
Q

uterine contractions during labor, specifically focusing on the assessment of contractions.

A

Contractions: Contractions refer to the rhythmic tightening and relaxing of the uterine muscles during labor, which help in the progress of labor and the eventual delivery of the baby.

Assessment of Contractions:

Increment: Building (longest phase): The increment phase of a contraction is when the uterine muscles start to tighten and build in intensity. It is the longest part of a contraction.

Acme: Peak: The acme phase is the peak or climax of a contraction. It’s when the uterine muscles are at their strongest and most intense.

Decrement: Ending: The decrement phase is the gradual relaxation and ending of the contraction. This is when the uterine muscles start to release their tension.

Describe contractions:

Frequency: Frequency refers to how often contractions occur, typically measured from the beginning of one contraction to the beginning of the next.
Duration: Duration is the length of time a contraction lasts, typically measured from the beginning of a contraction to its end.
Intensity: Intensity refers to the strength or palpation of contractions. Contractions can be categorized as mild, moderate, or strong based on how intense they feel when touched or palpated externally or internally using a uterine catheter.
Resting tone: Resting tone refers to the baseline tension in the uterine muscles between contractions. It’s the level of uterine muscle activity when no contractions are occurring. Monitoring resting tone is important to ensure that the uterus is relaxing adequately between contractions, allowing for proper blood flow to the baby and preventing excessive fatigue of the uterine muscles.

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14
Q

Location of fetal heart

A

RSA - Right Sacroanterior: This refers to a fetal position where the baby’s back is on the right side of the mother’s abdomen, and the baby is facing toward the front (anterior) with the sacrum (the lower part of the spine) positioned toward the mother’s anterior pelvis.

ROP - Right Occipitoposterior: This describes a fetal position where the baby’s occiput (the back of the head) is on the right side of the mother’s pelvis, and the baby is facing toward the back (posterior).

RMA - Right Mentoanterior: This refers to a fetal position where the baby’s chin (mentum) is on the right side of the mother’s pelvis, and the baby is facing toward the front (anterior).

ROA - Right Occipitoanterior: In this position, the baby’s occiput (the back of the head) is on the right side of the mother’s pelvis, and the baby is facing toward the front (anterior).

LSA - Left Sacroanterior: This position indicates that the baby’s back is on the left side of the mother’s abdomen, and the baby is facing toward the front (anterior) with the sacrum (the lower part of the spine) positioned toward the mother’s anterior pelvis.

LOP - Left Occipitoposterior: This describes a fetal position where the baby’s occiput (the back of the head) is on the left side of the mother’s pelvis, and the baby is facing toward the back (posterior).

LMA - Left Mentoanterior: In this position, the baby’s chin (mentum) is on the left side of the mother’s pelvis, and the baby is facing toward the front (anterior).

LOA - Left Occipitoanterior: This position indicates that the baby’s occiput (the back of the head) is on the left side of the mother’s pelvis, and the baby is facing toward the front (anterior).

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15
Q

Case Study:
Patient presents ambulatory to triage at 03:00 a.m. Reports this is her first baby and states she has never been pregnant before when questioned by RN. State, “the baby was due yesterday”. States Uterine Contractions (Ucs) started 4 hours ago and have increased in frequency/intensity. Reports UCs now q5, w/ intermittent, low abd pain 7/10 on pain scale. Pt stops conversation to focus on breathing during UCs. Reports small amount of mucous d/c per vagina streaked w/ blood x one hour ago, and sensation of “wetting pants” on car ride to hospital. Reports fm wnl.

A

Case study: Nursing Interventions:

Obtain weight/height:

Obtain the patient’s weight and height to assess baseline health parameters and calculate the patient’s body mass index (BMI). This information is useful for monitoring overall health during pregnancy.
Obtain urine specimen & perform POC (Point of Care):

Collect a urine specimen to perform a point-of-care test, such as a dipstick urinalysis. This can help assess for proteinuria (a possible sign of preeclampsia) and urinary tract infections, which can be common during pregnancy.
Assess VS (Vital Signs):

Monitor the patient’s vital signs, including blood pressure, pulse, respiratory rate, and temperature. Frequent monitoring is essential to detect any signs of maternal distress.
Assess labor signs/symptoms & fetal wellbeing:

Continuously monitor the patient’s uterine contractions (UCs) to assess their frequency, duration, and intensity.
Perform fetal heart rate monitoring to assess fetal wellbeing. Ensure that the fetal heart rate (fm) remains within the normal range (wnl).
Review hx (History):

Review the patient’s medical history and obstetric history, including any past medical conditions, surgeries, allergies, and prenatal care. This information can help in providing appropriate care.
Assess symptoms related to specific diagnosis:

Assess the patient’s specific symptoms, such as the reported uterine contractions, abdominal pain, mucous discharge streaked with blood, and the sensation of “wetting pants.” Document the findings accurately to monitor changes over time.
Report to provider:

Communicate all relevant findings and assessments to the healthcare provider or obstetrician. This includes the patient’s vital signs, fetal heart rate, cervical dilation if checked, and any concerning symptoms or complications. Prompt reporting ensures timely decision-making regarding the course of care, such as the need for admission, induction, or other interventions.

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16
Q

CASE STUDY:
ADDITIONAL DATA

A

Urine: The urine analysis results continue to show that all values are negative, and the specific gravity (SG) is 1.010, which is within the normal range. There are no signs of urinary tract infection or proteinuria.

VS (Vital Signs):

Blood Pressure (BP): 102/66 mmHg - Blood pressure remains within the normal range.
Respiratory Rate (RR): 18 breaths per minute - Normal respiratory rate.
Heart Rate (HR): 78 beats per minute - Normal heart rate.
Temperature (T): 37.0°C - Normal body temperature.
Oxygen Saturation (O2 sat): 98% - Normal oxygen saturation.
Height/Weight: The patient’s BMI of 23 is indicative of a healthy weight for her height.

Fetal Heart Rate (FHR): The fetal heart rate remains at 145 bpm, categorized as Category I, with accelerations (accels) x 2. This indicates a normal and reassuring fetal heart rate pattern.

Uterine Activity: Uterine contractions (UCs) occur approximately every 4-5 minutes, lasting 70 seconds each, with moderate palpation. These contractions continue to suggest active labor and progressive cervical dilation.

SVE (Sterile Vaginal Examination): Sterile vaginal examination has been deferred, meaning that a cervical check has not been performed at this time.

Leopold’s Maneuvers: Leopold’s maneuvers confirm a vertex (cephalic) presentation, with the baby’s occiput on the right (ROA). This confirms the position of the baby’s head, which is an important aspect of labor assessment.

Based on the provided data, the patient remains in active labor with reassuring signs of fetal well-being. Her vital signs, urine analysis, and fetal heart rate are all within normal limits. The Leopold’s maneuvers have confirmed the fetal presentation, which is cephalic.

Continued monitoring of contractions, fetal heart rate, and maternal comfort is essential. Communication with the healthcare provider should be maintained to determine the appropriate timing for a cervical examination and to discuss any potential interventions as labor progresses. Pain management options should also be considered and discussed with the patient to ensure her comfort during labor.

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17
Q

Report to Provider

A

S: Situation

Age: [Patient’s Age]
G_P_: [Patient’s Gravida and Para]
Gestational Age: [Patient’s Gestational Age]
Presenting Symptom: [Brief description of the patient’s complaint]
B: Background

Patient’s medical history: [Brief summary of the patient’s relevant medical history]
Obstetric history: [Brief summary of the patient’s obstetric history]
Current pregnancy status: [Brief summary of the current pregnancy status, if applicable]
A: Assessment Findings

Vital Signs: [Include vital signs such as blood pressure, heart rate, temperature, and respiratory rate, if available]
Physical Examination: [Describe any relevant physical findings, such as uterine contractions, fetal heart rate, cervical dilation, etc., as applicable]
Laboratory and Diagnostic Results: [Include any pertinent lab or diagnostic results, such as ultrasound findings, blood test results, etc., if available]
Obstetric Assessment: [Summarize the assessment related to the patient’s obstetric condition, including the condition of the fetus if applicable]
Pain Level: [Rate the patient’s pain level on a scale from 0-10, if applicable]
R: Recommendation

Plan: [Describe the proposed plan of care, including any interventions, treatments, or consultations needed]
Follow-up: [Indicate the recommended follow-up actions or monitoring]
Provider Orders: [Include any specific orders or medications prescribed]
Family/Patient Education: [Note any education provided to the patient or family]
Disposition: [Indicate the recommended disposition of the patient, such as admission, discharge, or transfer]

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18
Q

Signs of Possible
Intrapartum Complications

A

Increased Intrauterine Pressure (IUP): Elevated uterine pressure can indicate potential issues. Monitor closely for any significant rise in IUP.

Contractions Lasting > 90 Seconds: Contractions lasting longer than 90 seconds can lead to decreased fetal oxygenation and potential complications. Timely intervention may be necessary.

Tachysystole: (fast squeezing) Tachysystole, defined as more than 5 uterine contractions in 10 minutes, averaged over 30 minutes, can reduce fetal oxygen supply. Close monitoring and intervention may be required.

Abnormal Fetal Heart Tracing (Category II or III): Abnormal fetal heart rate tracings, categorized as II or III, indicate fetal distress. Immediate assessment and potential interventions are crucial to safeguard fetal well-being.

Amniotic Fluid Abnormalities: Meconium-stained, cloudy, or foul-smelling amniotic fluid can be indicative of fetal distress or infection. It requires careful monitoring and evaluation.

Labor Dystocia (Failure to Progress/FTP): Prolonged labor with failure to progress can lead to maternal and fetal complications. Consider interventions, such as augmentation or cesarean section, if appropriate.

Maternal Temperature > 38°C: Maternal fever during labor may suggest infection. It requires prompt evaluation, possible administration of antibiotics, and monitoring of fetal well-being.

Foul-Smelling Discharge: A foul-smelling discharge can be a sign of infection in the postpartum period. Immediate assessment and treatment are necessary.

Continuous Bright Red Bleeding: Continuous bright red bleeding during labor may indicate placental abruption or other significant bleeding issues. Rapid assessment and intervention are essential.

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19
Q

Common intrapartum NURSING DIAGNOSES

A

Impaired Communication: This diagnosis might apply when a pregnant person has difficulty expressing their needs, concerns, or understanding instructions due to factors like language barriers, pain, or anxiety.

Anxiety and Fear: Anxiety and fear can be common emotions during labor and delivery. Nurses assess and address these emotions to provide emotional support and reduce stress.

Risk for Injury: This diagnosis indicates that there is a risk that the pregnant person or the fetus may sustain an injury during labor and delivery. It may be due to factors such as difficult labor or the position of the fetus.

Pain: Pain management is a critical aspect of intrapartum care. Nurses assess the level of pain and implement pain relief strategies, which can include medications, relaxation techniques, or positioning.

Fluid Volume Deficit: This diagnosis is used when there is a risk or evidence of decreased fluid volume in the body. Maintaining adequate hydration is essential during labor and delivery.

Impaired Physical Mobility: During labor, a pregnant person’s mobility may be restricted due to monitoring equipment or epidural anesthesia. This diagnosis is relevant when mobility is limited, and interventions are needed to improve mobility and prevent complications.

Altered Pattern Urinary Elimination: Changes in urinary elimination patterns can occur during labor. Nurses monitor urinary output and address any issues, such as urinary retention or incontinence.

Risk of Infection: Infection is a concern during labor and delivery. Nurses assess for signs of infection and take measures to prevent its occurrence.

Impaired Gas Exchange, Fetal: This diagnosis is related to concerns about the exchange of oxygen and carbon dioxide between the mother and the fetus. It is closely monitored to ensure the well-being of the baby.

Ineffective Family Coping: Labor and delivery can be a stressful time for the family, and this diagnosis is used when family members are struggling to cope with the situation. Nurses provide support and education to help them manage their stress and emotions.

Knowledge Deficit: Some pregnant individuals may lack knowledge about the labor and delivery process or may have misconceptions. Nurses provide education and information to address any knowledge gaps and promote informed decision-making.

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20
Q

Common intrapartumNURSING interventions

A

Assessments/Monitoring: Continuous assessment and monitoring of the pregnant person’s vital signs, fetal heart rate, contractions, and cervical dilation are crucial. This information helps the healthcare team make informed decisions about the progress of labor and any necessary interventions.

Fluid Intake: Oral/IV: Maintaining proper hydration is important during labor. Nurses may encourage the pregnant person to drink clear fluids or provide intravenous (IV) fluids when necessary to prevent dehydration and ensure an adequate blood volume.

Bladder/Bowel Evacuations: Nurses assist with regular bladder and bowel evacuations to ensure the bladder is empty and there is less pressure on the uterus during contractions, which can help progress labor.

Pain Management: Providing pain relief options, such as medications (e.g., epidurals, analgesics), comfort measures (e.g., massage, breathing techniques), and positioning, is a critical nursing intervention to help the pregnant person manage pain and discomfort during labor.

Ambulation & Position Changes: Encouraging the pregnant person to change positions, walk, or use birthing balls can help facilitate labor progress and provide comfort. Different positions can also help relieve pressure and pain.

Nutritional Needs: Assessing and addressing the nutritional needs of the pregnant person, such as offering light snacks and clear fluids, helps maintain energy levels during labor, especially for those with long labors.

Emotional Support: Emotional support is essential throughout labor. Nurses provide reassurance, comfort, and encouragement, addressing the emotional needs of the pregnant person and their support system.

Integrating Care Team: Coordinating care with other healthcare providers, including obstetricians, midwives, and doulas, ensures a collaborative approach to intrapartum care. Involving family and friends as a source of support, per the pregnant person’s preferences, can also enhance the birthing experience.

Education and Informed Decision-Making: Nurses provide information and education about the labor process, interventions, and options to empower the pregnant person to make informed decisions about their care.

Fetal Monitoring: Continuous or intermittent fetal monitoring helps assess the well-being of the baby during labor. Nurses interpret and respond to fetal heart rate patterns and other indicators of fetal health.

Infection Control: Ensuring a sterile environment and practicing proper infection control measures helps reduce the risk of infection during labor and delivery.

Supporting Natural Labor Progression: Nurses encourage and support the natural progression of labor, avoiding unnecessary interventions when possible while keeping the healthcare team informed of any deviations from the normal course of labor.

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21
Q

Part 2 Nursing care in the first stage of labor

A
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22
Q

Components of Nursing care: stage 1

A
  1. Early Phase of Labor:

Monitoring the Labor Patient:
Vital Signs (VS): Regularly assess blood pressure, heart rate, respiratory rate, and temperature to monitor the patient’s overall condition.
Screenings and Assessments: Perform initial assessments, including cervical dilation, effacement, station, and fetal heart rate monitoring.
Fetal Assessment: Continuously monitor the fetal heart rate to ensure the baby’s well-being.
Pain Management/Labor Support: Assess the patient’s pain level and provide comfort measures such as relaxation techniques, breathing exercises, and positioning. Offer pain relief options as appropriate.
Communication with Team: Collaborate with the healthcare team, including obstetricians, midwives, and other support staff, to ensure coordinated care.
Consider Maslow’s Hierarchy: Address the patient’s physiological and safety needs by monitoring vital signs and providing pain relief.
2. Active Phase of Labor:

Monitoring the Labor Patient:
Continue monitoring vital signs, cervical dilation, effacement, and station. Assess for progression of labor.
Fetal Assessment: Maintain continuous fetal heart rate monitoring, paying close attention to any changes or signs of distress.
Pain Management/Labor Support: Continue to provide pain relief measures and support as labor intensifies.
Communication with Team: Update the healthcare team on the progress of labor and any changes in the patient’s condition.
Consider Maslow’s Hierarchy: Address the patient’s physiological and safety needs, ensuring their comfort and safety during active labor.
3. Transition Phase of Labor:

Monitoring the Labor Patient:
Frequent monitoring of vital signs, cervical dilation, effacement, and station is crucial during this intense phase.
Fetal Assessment: Maintain continuous fetal heart rate monitoring, as the baby’s well-being remains a top priority.
Pain Management/Labor Support: Provide strong pain relief measures and emotional support, as this phase is often the most challenging for the patient.
Communication with Team: Communicate effectively with the healthcare team to ensure a smooth transition phase and respond to any emergent situations promptly.
Consider Maslow’s Hierarchy: Address the patient’s physiological and emotional needs during this phase, focusing on pain relief and emotional support.

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23
Q

Nursing care in the first stage of labor:Pain management

A

Part of a Normal Process: Pain during the first stage of labor is a normal physiological response to uterine contractions as the cervix dilates and effaces. It’s important for healthcare providers to reassure the laboring person that this pain is a normal part of the birthing process and can be managed effectively.

Intensity Increases as Labor Progresses: Pain during the first stage of labor typically starts as mild discomfort and gradually intensifies as contractions become stronger and more frequent. Nursing care involves assessing and addressing the changing intensity of pain.

Occurs in a Predictable Pattern with Regular Respite (in a Normal Labor): Contractions in a normal labor follow a predictable pattern. They begin, peak in intensity, and then subside, providing periods of rest between contractions. Nurses assist the laboring person in recognizing this pattern and utilizing the rest periods for relaxation and recovery.

Ends with the Birth of the Baby: Pain during the first stage of labor ends when the cervix is fully dilated, and it’s time to push and give birth to the baby. Nursing care during this phase includes preparing the laboring person for the transition to the second stage of labor.

Nursing interventions for pain management during the first stage of labor can include:

Providing emotional support: Offering encouragement, reassurance, and a calming presence.
Teaching relaxation techniques: Guiding the laboring person in deep breathing, visualization, and progressive muscle relaxation exercises to help manage pain.
Position changes: Encouraging changes in position (e.g., walking, rocking, squatting) to optimize comfort and progress labor.
Medications: Administering pain relief medications as ordered, which may include epidurals, analgesics, or other pharmacological interventions.
Hydrotherapy: Offering the option of a warm shower or bath, which can help alleviate pain and provide relaxation.
Monitoring and reassessment: Continuously assessing pain levels and adjusting pain management strategies as needed.
Advocating for the patient: Ensuring that the patient’s preferences and comfort are prioritized in the birthing plan.
Providing information and consent: Explaining pain relief options, their risks and benefits, and obtaining informed consent for interventions.

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24
Q

Sources of Pain: Stage 1

A

Uterine Anoxia: Uterine anoxia refers to a temporary decrease in the oxygen supply to the uterine muscles during contractions. As the uterus contracts and tightens during labor, it can temporarily reduce blood flow to the uterine muscles. This decreased oxygen supply can result in pain and discomfort, often described as cramping or aching sensations. These contractions are responsible for cervical dilation and effacement, which are essential for the progress of labor.

Stretching of the Cervix: The cervix is the lower part of the uterus that needs to dilate (open) and efface (thin out) to allow the baby to pass through the birth canal. As the cervix gradually stretches and opens, it can cause pain and discomfort. This stretching sensation is often described as intense pressure or aching in the lower abdomen and pelvis.

Stretching of the Uterine Ligaments: The uterus is held in place by various ligaments that support its position in the pelvis. As the uterus contracts and the baby descends during labor, these ligaments are stretched and may cause pain. The stretching of uterine ligaments can lead to sensations of pulling or sharp discomfort in the lower abdomen and pelvic area.

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25
Q

Sources of Pain: Stage 2

A

Distention of the Vagina and Perineum: As the baby’s head begins to descend through the birth canal, the vagina and perineum (the area of skin and muscle between the vaginal opening and the anus) stretch and distend to accommodate the baby’s head. This stretching and distention can cause significant pain and discomfort. The sensation is often described as a burning or stinging sensation.

Pressure of the Baby on Tissues and Organs: The baby’s head and body exert pressure on various tissues and organs as they move through the birth canal. This pressure can be felt in several areas, including:

Bladder: Pressure on the bladder can result in a strong urge to urinate or discomfort.
Rectum: Pressure on the rectum can cause the sensation of needing to have a bowel movement.
Pelvic Floor Muscles: The stretching and pressure on the pelvic floor muscles can lead to sensations of fullness, pressure, and discomfort.
Perineal Tears or Episiotomy: In some cases, the perineum may tear naturally as the baby’s head emerges, or healthcare providers may perform an episiotomy (a surgical cut to widen the vaginal opening). These procedures can cause additional pain and discomfort.

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26
Q

Sources of Pain: Stage 3

A

Uterine Cramping: After the baby is born, the uterus continues to contract to help expel the placenta. These uterine contractions can be painful, and they are often described as cramping or aching sensations. These contractions are necessary to reduce bleeding and facilitate the separation and expulsion of the placenta.

Lacerations: Occasionally, during childbirth, a birthing person may experience lacerations or tears in the vaginal or perineal tissues. These tears can range in severity from minor abrasions to more extensive lacerations. The presence of lacerations can cause pain and discomfort, especially when sutures are needed to repair them.

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27
Q

Factors that Influence Pain

A

Fear and Anxiety: High levels of fear and anxiety can increase the perception of pain. Fear and anxiety can lead to muscle tension and the release of stress hormones, which may intensify the perception of pain.

Fatigue: Labor can be physically demanding, and fatigue can make pain feel more challenging to cope with. Prolonged labor or a lack of rest can contribute to fatigue.

Individual Pain Tolerance: Every person has a unique pain tolerance threshold. Some individuals may have a higher tolerance for pain, while others may have a lower tolerance.

Support: The presence of supportive individuals, such as a partner, family member, or doula, can have a significant impact on a laboring person’s ability to cope with pain. Emotional and physical support can reduce stress and pain perception.

Cultural Expression of Pain: Cultural norms and expectations regarding pain and childbirth can influence how pain is expressed and managed during labor.

Psychosocial Factors: A person’s mental and emotional state can affect their perception of pain. Factors such as mood, stress levels, and coping mechanisms play a role.

Preparation: Education and preparation for childbirth, including childbirth classes, can help individuals understand what to expect during labor and develop effective pain management strategies.

Previous Experience (Self and Others): Personal experiences with past pregnancies and childbirth, as well as hearing others’ birth stories, can shape expectations and perceptions of pain during labor.

Information/Lack of Information: Having access to information about labor and pain relief options can empower individuals to make informed decisions about pain management. Conversely, a lack of information may lead to uncertainty and anxiety.

Length of Labor: The duration of labor can vary widely from person to person. Longer labors can be more physically and emotionally challenging, potentially increasing the perception of pain.

Medical Interventions: The use of medical interventions, such as epidurals or pain-relieving medications, can significantly influence the experience of pain during labor. These interventions can provide effective pain relief.

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28
Q

Assessing Pain

A

Pain Scale: This scale is typically used to assess the intensity and quality of pain that a laboring person is experiencing. The Pain Scale helps healthcare providers and nurses understand the level of discomfort and pain the individual is going through. It often involves a numerical rating, with 0 indicating no pain and higher numbers indicating increasing levels of pain. For example, a 0-10 pain scale is commonly used, with 0 being no pain and 10 being the worst pain imaginable. The laboring person is asked to self-report their pain level at specific intervals or when they feel a change in pain intensity. This scale helps guide pain management interventions, such as pain relief medications or relaxation techniques.

Coping Scale: The Coping Scale assesses how well the laboring person is managing and coping with the pain. It focuses on the individual’s ability to use various pain management strategies effectively. Healthcare providers may ask the laboring person questions related to their coping mechanisms, such as breathing techniques, relaxation, positioning, or the use of support from a partner or doula. The Coping Scale helps healthcare providers and nurses tailor their support and interventions to enhance the laboring person’s coping strategies. It also provides valuable insights into the effectiveness of pain management techniques and allows adjustments to be made if necessary.

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29
Q

COPING ASSESSMENT On a scale of 1-10, how well are you coping with your contractions/labor?
Coping vs not coping

A

Coping Well (10 to 6):

In this section, it appears to be describing a person who is coping well with their situation.
The text mentions various coping strategies or tools such as using tools and techniques, changing positions, accepting assistance, and requesting specific strategies.
The word “Mother” may indicate that the person is receiving support from their mother or a maternal figure.
There’s a focus on being positive and having support (“Supported” and “Positive”).
“H.EL.P.” may stand for a support system or network of help, and the person is an advocate and attentive to it.
The person is described as being confident, calm, and involved in their situation.
Coping (5 to 4):

This section describes someone who is still coping but is facing some challenges.
The person is willing to accept help and listens to suggestions.
They take encouragement from others, indicating they are open to support.
There’s a mention of cancer, which might be the cause of their stress or challenge.
The person might be feeling nervous and worried but is not in the worst state of coping.
Not Coping Well (3 to 0):

This section describes someone who is not coping well and is experiencing significant distress.
The person is nervous, worried, fatigued, self-conscious, discouraged, and hesitant.
They might be unwilling or unable to accept help or direction.
The emotions escalate from nervousness to panic.
“Alan” is mentioned, but it’s not clear who or what role Alan plays in this context.
The statement at the end suggests that medication is considered as one tool among many for relieving distress during a challenging period.
Overall, this text appears to outline different levels of coping and emotional states, with a focus on the strategies and support systems that can help individuals navigate difficult situations, particularly in the context of dealing with a challenging health issue like cancer.

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30
Q

Options for managing intrapartum pain

A

Non-Pharmacologic Pain Management:

Breathing Techniques: Controlled breathing patterns, such as slow and deep breathing, can help manage pain and provide a sense of control during contractions.

Position Changes: Encouraging the laboring person to change positions (e.g., walking, swaying, kneeling) can alleviate discomfort and promote optimal fetal positioning.

Massage and Counterpressure: Gentle massage and applying counterpressure to specific areas can relieve tension and provide comfort.

Hydrotherapy: Soaking in a warm bath or using a shower can ease muscle tension and provide relaxation.

Acupressure and Reflexology: Applying pressure to specific points on the body may help reduce pain and promote relaxation.

Visualization and Guided Imagery: Guided mental imagery techniques can distract from pain and reduce anxiety.

Hypnotherapy: Hypnosis techniques can be used to promote relaxation and pain relief.

Pharmacologic Pain Management:

Epidural Analgesia: Epidurals are a common choice for pain relief during labor. They involve the administration of anesthesia into the epidural space, providing significant pain relief while allowing the person to remain awake and alert.

Intravenous (IV) Medications: Medications like opioids can be administered through an IV to provide short-term pain relief. They may cause drowsiness but can be an option for those who prefer not to have an epidural.

Nitrous Oxide (Laughing Gas): Nitrous oxide is inhaled through a mask during contractions to provide pain relief and relaxation.

Pudendal Block: A local anesthetic injection into the pudendal nerve can be used for pain relief during the second stage of labor.

Spinal Block: Similar to an epidural, a spinal block provides pain relief by injecting anesthesia directly into the spinal fluid.

Combined Spinal-Epidural (CSE): This combines the benefits of a spinal block for immediate pain relief with an epidural for continuous relief.

Centering Patient in Decision-Making:

It’s essential to involve the laboring person in the decision-making process. This includes discussing the available options, explaining the risks and benefits of each, and considering the individual’s preferences, pain tolerance, and medical history. The healthcare team should respect the patient’s choices and adapt the pain management plan accordingly throughout labor and childbirth. Effective communication and informed decision-making help ensure a positive birthing experience.

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30
Q

COPING ASSESSMENT

A

States they are coping well: Open communication about their feelings and coping abilities is a positive sign.

Rhythmic activity during contractions: Engaging in rhythmic movements like rocking or swaying can help distract from pain and create a sense of control.

Focused inward: Being able to concentrate on their own thoughts and sensations may suggest that the patient is managing the contractions effectively.

Rhythmic breathing: Controlled, rhythmic breathing techniques, such as deep breathing or patterned breathing, can help manage pain and discomfort.

Able to relax between contractions: The ability to relax between contractions is crucial for conserving energy and reducing overall stress during labor.

Vocalization: Vocalizing through moaning, chanting, or counting can be a way to release tension and cope with the pain.

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30
Q

COPING ASSESSMENT
not coping

A

States she is NOT coping: Openly expressing that they are not coping well is a clear sign that they are struggling with the pain and discomfort.

Crying, tearfulness, tremulous voice: Emotional distress, including crying and a shaky voice, may indicate that the pain is overwhelming.

Inability to focus or concentrate: Difficulty concentrating or staying focused could suggest that the pain is making it hard to think clearly or stay in control.

Panicked activity during contractions: Engaging in frantic or panicked movements during contractions may indicate a lack of effective coping strategies.

Jitteriness, thrashing in bed: Restlessness and excessive movement may signal discomfort and anxiety.

Tense, sweaty: Physical signs such as tension and sweating can also be indicators of distress.

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30
Q

Non-Pharmacological Management & labor support

A

Supporting Patient’s Labor Goals:

Birth Plan: Start by discussing the patient’s birth plan. A birth plan outlines their preferences for labor and childbirth, including pain management, delivery positions, and any specific requests. It’s essential to respect and support the patient’s choices outlined in their birth plan.
Assessment:

Assess Patient’s Needs: Begin by assessing the patient’s physical and emotional needs. This includes understanding their pain tolerance, any medical conditions, and their emotional state.

Discuss Pain Management Preferences: Have a conversation about the patient’s preferences for pain management. This could involve reviewing their birth plan and discussing their options, both pharmacological and non-pharmacological.

Implementation:

Non-Pharmacological Techniques: Depending on the patient’s preferences, implement non-pharmacological pain management techniques, such as breathing exercises, position changes, massage, or relaxation techniques.

Continuous Support: Provide continuous emotional and physical support throughout labor. Offer encouragement, reassurance, and a comforting presence.

Respect Privacy and Dignity: Ensure that the patient’s privacy and dignity are respected at all times. Create a supportive and respectful environment.

Evaluate:

Continuous Assessment: Continuously assess the effectiveness of the non-pharmacological techniques being used. Ask the patient for feedback on their level of comfort and pain relief.

Adapt and Modify: Be flexible in adapting and modifying the techniques as needed. What works at one stage of labor may not be as effective later on.

Multiple Methods Available:

Offer Variety: Recognize that different patients may respond differently to non-pharmacological methods. Be prepared to offer a variety of techniques and support as needed.

Involve the Birth Partner: If the patient has a chosen birth partner, involve them in providing support and assisting with non-pharmacological techniques. The birth partner can play a significant role in helping the patient achieve their labor goals.

Consult with a Doula: Some patients may choose to have a doula, a trained labor support professional, as part of their birth team. Doulas are experienced in providing non-pharmacological support and can work closely with the healthcare team.

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30
Q

Non-Pharmacological Management Cont’d

A

Hydrotherapy:
Hydrotherapy involves using water for pain relief and relaxation. Options include:

Warm Baths: Soaking in a warm bath can ease muscle tension and provide comfort during contractions.

Shower: A warm shower can also help relax and soothe the laboring person.

Hydrotherapy can be particularly effective for relaxation and pain relief during early labor.

Aromatherapy:
Aromatherapy uses essential oils and scents to promote relaxation and reduce stress. Options include:

Diffusers: Essential oil diffusers can disperse calming scents into the room, creating a soothing environment.

Topical Application: Diluted essential oils can be applied to the skin or a cloth for inhalation.

Different scents, such as lavender or chamomile, can have various calming effects. Always ensure the laboring person isn’t sensitive or allergic to specific oils.

Guided Relaxation/Breathing:
Guided relaxation and breathing exercises help the laboring person stay calm and focused. Techniques include:

Deep Breathing: Controlled, rhythmic breathing helps manage pain and promotes relaxation.

Visualization: Guided mental imagery can distract from pain and reduce anxiety.

Meditation: Mindfulness meditation techniques can help maintain mental focus and reduce tension.

These methods are often taught in childbirth education classes and can be highly effective for pain management.

Massage/Effleurage:
Massage and effleurage are techniques involving gentle, rhythmic strokes and kneading to ease tension and provide comfort. Options include:

Back Massage: Massaging the lower back can help alleviate back pain during contractions.

Effleurage: Gentle stroking of the abdomen or back can provide comfort and relaxation.

Labor partners or trained doulas can provide massage support.

Position Changes/Ambulation:
Changing positions and staying mobile can help ease labor pain and promote optimal fetal positioning. Options include:

Walking: Taking short walks during early labor can help relieve discomfort and promote progress.

Swaying/Rocking: Gentle swaying or rocking movements can be comforting during contractions.

Kneeling/Hands and Knees: These positions can relieve back pain and encourage the baby to move into a favorable position.

Squatting: Squatting bars or using a birthing stool can assist with gravity and the descent of the baby.

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30
Q

Prepared Childbirth Methods

A

Lamaze:

Focus: Lamaze emphasizes natural childbirth and encourages women to trust their bodies during labor and birth.
Breathing Techniques: Lamaze is known for its emphasis on specific breathing techniques that help manage pain and promote relaxation.
Movement and Positioning: Lamaze encourages movement and changing positions during labor to alleviate discomfort and facilitate labor progress.
Educational Classes: Lamaze classes provide information on the stages of labor, medical interventions, and informed decision-making.
Bradley Method:

Focus: The Bradley Method, also known as “Husband-Coached Childbirth,” centers around the idea that childbirth is a natural process, and education and relaxation are key components.
Husband/Partner Involvement: The Bradley Method places significant emphasis on the birth partner (often the husband) being actively involved in providing physical and emotional support.
Nutrition and Exercise: It includes a focus on proper nutrition and exercises during pregnancy to prepare for childbirth.
Relaxation Techniques: The method teaches deep relaxation to reduce pain and stress during labor.
BundleBirth:

Focus: BundleBirth is a more modern childbirth education program that incorporates evidence-based information and techniques for childbirth.
Customizable: It offers a customizable approach to childbirth education, allowing parents to choose from a variety of modules that suit their specific needs and preferences.
Online Learning: BundleBirth often utilizes online learning platforms, making it accessible to a wide audience.
Interactive: It includes interactive elements, such as videos, quizzes, and practical exercises to engage participants.

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31
Q

Non-Pharmacological Management Cont’d

A

Sacral Pressure (Counter Pressure):

Focus: Sacral pressure, also known as counter pressure, targets the lower back, particularly the sacrum, which is the triangular bone at the base of the spine. It is especially useful for relieving back pain during labor.

Technique: To apply sacral pressure, a birth partner or support person typically uses their hands, elbows, or a massage tool to exert firm and steady pressure on the lower back, usually during contractions.

Benefits: Sacral pressure helps alleviate the discomfort associated with back labor, which can be caused by the baby’s position or the pressure of the baby’s head on the sacrum. It can provide significant relief and relaxation.

Positioning: The laboring person often leans forward against a surface like a bed, wall, or a birthing ball while the support person applies pressure. The amount of pressure should be adjusted based on the laboring person’s comfort and feedback.

Hip Squeeze:

Focus: The hip squeeze technique targets the hip joints and lower back to alleviate pain and pressure during contractions. It can be particularly helpful if the laboring person is experiencing pelvic discomfort or sciatica.

Technique: To perform a hip squeeze, a birth partner or support person stands behind the laboring person. They place their hands or palms firmly on the sides of the hips, just above the hip bones. Then, they gently squeeze or compress the hips together during contractions.

Benefits: The hip squeeze technique can reduce tension and pressure in the pelvic region, making contractions more manageable and less painful.

Positioning: The laboring person can stand or sit, depending on their comfort. The support person should apply steady and even pressure, adjusting as needed to provide relief.

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32
Q

Non-Pharmacological Management Cont’d Doulas

A

Doulas:

Professional, Trained Birth Attendant: Doulas are trained professionals who provide continuous emotional, physical, and informational support to laboring individuals and their birth partners. They are not medical practitioners but are knowledgeable about the birthing process.

Reduced Complications: Research has shown that having a doula present during labor can lead to positive outcomes. Studies suggest that individuals supported by doulas are about half as likely to experience complications during labor and birth compared to those without doula support.

Reduced Rates of Intervention: Doulas can help reduce the likelihood of medical interventions such as cesarean sections, epidurals, and the use of forceps or vacuum extractors. They provide support and techniques that can help manage pain and facilitate labor progress.

Greater Client Satisfaction: Laboring individuals who have the support of a doula often report higher levels of satisfaction with their birth experience. Doulas offer continuous reassurance, encouragement, and a comforting presence, which can enhance the overall birthing experience.

Emotional, Physical Support, and Information: Doulas offer a range of support, including:

Emotional Support: They provide comfort, reassurance, and a calming presence throughout labor.
Physical Support: Doulas offer massage, counter pressure, and assist with position changes to alleviate pain and discomfort.
Informational Support: They explain medical procedures, offer evidence-based information, and help individuals make informed decisions during labor and childbirth.

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33
Q

Non-Pharmacological Management. Birth Ball: Regular or Peanut

A

Regular Birth Ball:

Shape: Regular birth balls are spherical in shape, similar to standard exercise balls. They are available in various sizes, typically based on the user’s height.

Benefits:

Balance and Stability: Regular birth balls provide stability and can be used for sitting, rocking, swaying, and changing positions during labor.
Comfort: Sitting on a regular birth ball can help relieve pressure on the lower back and pelvis, making contractions more manageable.
Versatility: They are versatile and can be used for exercises, relaxation, and positioning during labor.
Considerations:

Size Matters: Choosing the right size birth ball is important to ensure comfort and stability during use.
May Require Inflation: Regular birth balls need to be properly inflated, which can be done with a pump.
Peanut-Shaped Birth Ball:

Shape: Peanut-shaped birth balls are elongated with a narrow middle section and two round ends. They resemble a peanut, hence the name.

Benefits:

Stability and Support: The unique shape of peanut balls provides extra stability and support, making them particularly useful for sitting and rocking during labor.
Pelvic Alignment: Peanut balls are designed to help maintain proper pelvic alignment, which can reduce discomfort and aid in labor progress.
Ease of Use: Their shape allows for more secure positioning between the legs, making them a preferred choice for some during labor.
Considerations:

Size: Peanut balls come in different sizes to accommodate varying body types. Selecting the right size is essential for comfort and effectiveness.
Specialized Use: Peanut balls are primarily used for specific positions, such as sitting or straddling, during labor.

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34
Q

Check slide 46

A
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35
Q

Pharmacological Management. types of agents. Systemic Analgesics

A

Systemic Analgesics:

These are medications that are administered systemically, usually through an intravenous (IV) line or intramuscular (IM) injection.
Common systemic analgesics used during labor include opioids like morphine or fentanyl.
They provide general pain relief and can help take the edge off the pain, but they may not completely eliminate it. They can cause drowsiness in both the laboring individual and the baby.
Inhaled Analgesics:

Nitrous oxide, often referred to as “laughing gas,” is an inhaled analgesic used during labor.
It is self-administered by the laboring individual through a mask, providing quick-acting pain relief and relaxation.
Nitrous oxide does not eliminate pain entirely but can make it more manageable while allowing the laboring person to remain alert and in control.
Local Anesthesia:

Local anesthesia involves the administration of anesthetic agents directly to a specific area of the body.
It may be used for procedures like perineal repair or episiotomies after childbirth to provide pain relief in the localized area.
Regional Analgesia/Anesthesia:

Regional analgesia and anesthesia methods are often used to provide targeted pain relief during labor and childbirth.
Epidural Analgesia: An epidural involves the injection of anesthetic medication into the epidural space of the spine. It provides pain relief from the waist down and is commonly used for labor pain management.
Spinal Block: Similar to an epidural, a spinal block provides quick pain relief but is typically used for shorter procedures, such as a cesarean section.
Combined Spinal-Epidural (CSE): This method combines the benefits of both spinal and epidural anesthesia, offering rapid pain relief and the option for continuous pain management.
General Anesthesia:

General anesthesia is rarely used during childbirth and is typically reserved for emergency situations or specific medical reasons.
It involves the administration of medications that induce unconsciousness and loss of sensation throughout the body, rendering the individual completely unaware during childbirth.
General anesthesia is usually used for emergency cesarean sections or other urgent situations when regional anesthesia methods are not feasible or safe.

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36
Q

Pharmacological Management

substance that binds to and activates opioid receptors in the brain and other parts of the body. Opioid receptors are specific proteins found on the surface of nerve cells that play a central role in regulating pain perception

A

First Stage (Labor):

Systemic Analgesia:

Administration of medications, such as opioids, via intravenous (IV) or intramuscular (IM) injection for general pain relief during the first stage of labor.
Opioid Agonist Analgesics:

Medications like morphine or fentanyl can be administered for pain relief.
Opioid Agonist-Antagonist Analgesics:

Medications like nalbuphine may be used for pain relief during the first stage of labor.
Epidural (Block) Analgesia:

Epidural anesthesia involves the injection of anesthetic medication into the epidural space of the spine, providing pain relief from the waist down.
Combined Spinal-Epidural (CSE) Analgesia:

CSE analgesia combines the benefits of spinal and epidural anesthesia and provides rapid pain relief.
Nitrous Oxide:

Inhaled analgesia, often referred to as “laughing gas,” can be used for pain management during the first stage of labor.
Second Stage (Delivery):

Nerve Block Analgesia and Anesthesia:

Local anesthetic blocks may be administered to specific nerve regions to provide pain relief during the second stage of labor and delivery.
Local Infiltration Anesthesia:

Local anesthesia can be used to numb specific areas for procedures like perineal repair.
Pudendal Block:

A local anesthetic block is administered to the pudendal nerve to provide pain relief during the second stage of labor.
Spinal (Block) Anesthesia:

Spinal anesthesia may be used to provide pain relief and numbness for the second stage of labor and vaginal birth.
Epidural (Block) Analgesia:

Epidural anesthesia may continue to provide pain relief during the second stage of labor and delivery.
CSE Analgesia:

Combined spinal-epidural analgesia can be used for pain management during the second stage of labor.
Nitrous Oxide:

Inhaled analgesia can be continued during the second stage for pain relief.
Vaginal Birth:

For a vaginal birth, the same options as mentioned for the second stage may be used, including local infiltration anesthesia, pudendal block, spinal anesthesia, epidural anesthesia, CSE analgesia, and nitrous oxide.
Cesarean Birth:

For a cesarean birth, spinal or epidural anesthesia is commonly used. In some emergency situations, general anesthesia may be administered, rendering the individual unconscious for the surgery.

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37
Q

Pharmacological Management

A

Morphine:

Indication: Used for pain relief in early labor.
Dosage: 12-15 mg intramuscular (IM) injection.
Administered with: Hydroxyzine.
Therapeutic Effect: Provides pain relief for approximately 4-6 hours.
Fentanyl:

Indication: Used during active labor and/or for severe pain.
Dosage: Administered intravenously (IV) as 50-100 mcg (micrograms) via an IV push (IVP).
Therapeutic Effect: Provides relatively rapid pain relief within 30-60 minutes.
Adjunctive Medications:

Hydroxyzine:
Dosage: 50-100 mg IM injection.
Administered with: Morphine.
Role: Acts as an adjunct to potentiate the effect of opioids. It also has antihistamine and antiemetic properties, helping to reduce nausea and vomiting.
Promethazine:
Role: It is an antiemetic and antihistamine medication commonly used in combination with opioids to prevent or reduce nausea and vomiting that can be associated with opioid use.

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38
Q

Pharmacological ManagementNursing Care : considerations

A

Assess Labor Progress:

Continuous monitoring of labor progress, including cervical dilation, effacement, fetal descent, and station, is essential to determine the effectiveness of pharmacological pain management.
Assess Pain and Coping:

Regularly assess the laboring individual’s pain level and their coping mechanisms. Encourage open communication to adjust pain management strategies as needed.
Assess Patient’s Labor Goals and Expected Outcomes:

Review the patient’s birth plan and preferences for pain management. Ensure that the chosen pharmacological methods align with their goals and expectations.
Assess Fetal Heart Rate (FHR):

Continuous monitoring of the fetal heart rate is critical when using pharmacological pain management. Changes in FHR may indicate the need for intervention or adjustments to medication.
Parenteral Route:

Administer medications via the parenteral route (e.g., intravenous or intramuscular) with careful attention to proper technique, dosage, and timing.
Efficacy:

Regularly evaluate the effectiveness of the pharmacological pain management method chosen. Assess whether pain relief is adequate, monitor for side effects, and ensure the laboring individual’s comfort.
Document:

Thoroughly document the administration of medications, including the type, dosage, time of administration, and the individual’s response. Accurate documentation is crucial for tracking the laboring individual’s progress and ensuring proper care.
Narcan (Naloxone):

Have naloxone (Narcan) readily available when administering opioid medications like morphine or fentanyl. Naloxone is an opioid receptor antagonist that can reverse opioid overdose. Be prepared to administer it in case of respiratory depression or overdose.
Patient Education:

Provide information to the laboring individual about the potential side effects and risks associated with pharmacological pain management options. Ensure they are aware of the benefits and possible drawbacks.
Pain Assessment Scales:

Use standardized pain assessment scales (e.g., visual analog scale or numeric rating scale) to quantify pain levels and monitor changes.
Continuous Monitoring:
Maintain close monitoring of the laboring individual’s vital signs, including blood pressure, heart rate, and oxygen saturation, especially if they are receiving medications that may affect these parameters.
Communication and Consent:
Continuously communicate with the laboring individual and their birth partner to obtain informed consent, discuss any concerns or changes in the pain management plan, and ensure they are comfortable and informed throughout the process.

39
Q

Pharmacological Management. NITROUS OXIDE:(N20)

A

Nitrous oxide (N2O), commonly known as “laughing gas,” is a pharmacological option for pain management during labor and is administered through inhalation. Here are key points to understand about nitrous oxide for labor pain management:

Inhalation Method:

Nitrous oxide is inhaled by the laboring individual using a mask or a mouthpiece. It is typically self-administered, allowing the person in labor to control when and how much they inhale.
Timing of Administration:

Nitrous oxide is usually administered just before and during contractions to provide pain relief during the most intense moments of labor.
Common Side Effects:

Nitrous oxide may have side effects, including nausea and vomiting (N/V), dizziness, and dysphoria (a feeling of unease or discomfort). These side effects are generally mild and can vary from person to person.
No Effect on Fetal Heart Rate (FHR):

Nitrous oxide does not typically cause changes in the fetal heart rate (FHR), making it a safe option for pain management without affecting the baby’s heart rate.
Mechanism of Action:

Nitrous oxide primarily acts on the central nervous system (CNS) by interacting with opioid receptors. It provides a sense of relaxation and reduces the perception of pain.
Rapid Elimination:

One advantage of nitrous oxide is its rapid elimination from the body. As soon as the laboring individual stops inhaling the gas, its effects wear off quickly.
Patient-Controlled:

A significant benefit of nitrous oxide is that it is patient-controlled. The laboring person can choose when to use it and how much to inhale, providing a sense of autonomy and control over their pain relief.
Minimal Risk of Overdose:

Nitrous oxide has a low risk of overdose because it is self-administered. The laboring individual can easily stop inhaling if they feel they have had enough.
Contraindications:

While nitrous oxide is generally safe, it may not be suitable for individuals with certain medical conditions or those unable to use the mask or mouthpiece effectively. Healthcare providers assess each case individually to determine if nitrous oxide is an appropriate option.
Temporary Effects:

The effects of nitrous oxide are temporary and last only while it is being inhaled. Once the laboring individual stops inhaling, they quickly return to their baseline state.

40
Q

Pharmacological Management. Precautions with N20

A

Current Vitamin B12 Deficiency:

Nitrous oxide can interfere with the body’s ability to use vitamin B12, potentially leading to vitamin B12 deficiency. Healthcare providers should be cautious when using nitrous oxide in individuals with a known vitamin B12 deficiency. Monitoring and supplementation may be necessary.
Abnormal Fetal Heart Rate (FHR) Tracing:

If there are concerns about the fetal heart rate pattern, such as decelerations or other abnormalities, nitrous oxide administration should be carefully evaluated. Alternative pain management methods may be considered.
Hemodynamic Instability and/or Impaired Oxygenation:

Nitrous oxide should be used cautiously in individuals with hemodynamic instability (e.g., low blood pressure) or impaired oxygenation (e.g., respiratory distress). It may be contraindicated in such cases.
Respiratory Depression:

Nitrous oxide can cause respiratory depression, particularly when used in high concentrations or for extended periods. Healthcare providers should closely observe for any signs of respiratory depression, including slow or shallow breathing.
COVID-19 or Other Respiratory Illness:

In cases of individuals with COVID-19 or other respiratory illnesses, the use of nitrous oxide should be evaluated carefully. These conditions can impact respiratory function, and the use of nitrous oxide may need to be adjusted or avoided.

41
Q

Pharmacological Management. Precautions with N20 Continues

A

Acute Drug or Alcohol Intoxication or Impaired Consciousness:

Nitrous oxide should not be administered to individuals who are currently experiencing acute drug or alcohol intoxication or have impaired consciousness. These conditions can interfere with the individual’s ability to self-administer and safely use nitrous oxide.
Inability to Hold Face Mask:

The proper use of nitrous oxide requires the laboring individual to hold a face mask or mouthpiece for inhalation. If the individual is unable to hold the mask securely or maintain a proper seal, the effectiveness of nitrous oxide administration may be compromised. In such cases, alternative pain management methods should be considered.
Medical Conditions Such as Pneumothorax or Increased Intracranial Pressure:

Nitrous oxide may not be suitable for individuals with certain medical conditions. For example, individuals with a pneumothorax (collapsed lung) or increased intracranial pressure may not be able to tolerate the changes in gas pressure associated with nitrous oxide inhalation. Healthcare providers should carefully evaluate the medical condition and overall health of the individual before considering the use of nitrous oxide.

42
Q

Anesthesia

A

Local Anesthesia:

Indication: Local anesthesia is used to numb a specific area of the body. In the context of labor and childbirth, it may be administered for procedures like perineal repair or episiotomies.
Administration: Local anesthetic medication is injected directly into the area that requires numbness.
Effect: It provides temporary and localized pain relief, allowing for minor medical procedures without discomfort.
Regional Anesthesia:

Regional anesthesia involves numbing a larger region of the body, typically from the waist down, to provide pain relief during labor and childbirth. It is administered via injection into specific areas of the spine. The three main types of regional anesthesia used in labor and childbirth are:

Spinal Anesthesia:

Indication: Spinal anesthesia is often used for cesarean sections or during the second stage of labor.
Administration: A single injection of anesthetic medication is made into the spinal fluid in the lower back.
Effect: It results in rapid and profound pain relief from the waist down, typically lasting for a few hours.
Epidural Anesthesia:

Indication: Epidural anesthesia is commonly used for pain relief during labor and vaginal childbirth.
Administration: An epidural catheter is inserted into the epidural space of the spine, allowing for continuous administration of anesthetic medication.
Effect: It provides pain relief from the waist down while allowing the laboring individual to remain alert and active.
Combined Spinal-Epidural (CSE):

Indication: CSE anesthesia combines the benefits of spinal and epidural anesthesia. It is used for both pain relief during labor and for medical procedures like cesarean sections.
Administration: A spinal injection provides rapid pain relief, and an epidural catheter is placed for continuous pain management.
Effect: CSE offers the advantages of both spinal and epidural anesthesia, allowing for rapid relief and prolonged pain management.
General Anesthesia:

Indication: General anesthesia is rarely used during childbirth and is typically reserved for emergency situations or specific medical reasons when regional anesthesia methods are not feasible or safe.
Administration: General anesthesia is administered intravenously or via inhalation, leading to unconsciousness and loss of sensation throughout the body.
Effect: It renders the individual completely unaware and unconscious during the procedure.
The choice of anesthesia method depends on various factors, including the type of birth (vaginal or cesarean), the individual’s medical history, and their preferences.

43
Q

EPIDURAL ANESTHESIA AND/OR ANALGESIA BLOCK

A

Regional Medication Administration:

Epidural anesthesia and analgesia are regional anesthesia techniques. This means that medication is administered in a specific region of the body, typically the epidural space of the spine.
Blocking Painful Afferent Nerve Fibers:

The primary purpose of epidural anesthesia and analgesia is to block the transmission of pain signals from sensory nerve fibers to the cerebral cortex in the brain. By doing so, it effectively numbs or reduces pain sensations in the lower part of the body, allowing for pain relief during labor or surgical procedures.
Medication Injection into Epidural Space:

The medication used in epidural anesthesia and analgesia is injected into the epidural space, which is the outermost part of the spinal canal, surrounding the spinal cord and its protective membranes.
Onset of Action:

The onset of action for epidural anesthesia and analgesia typically ranges from 20 to 30 minutes after the medication has been administered. The individual undergoing the procedure will gradually experience a decrease in pain sensations within the region served by the epidural.
Epidural anesthesia is commonly used during childbirth to provide pain relief during labor and delivery. It allows the laboring individual to remain alert and actively participate in the birthing process while experiencing reduced pain. Epidural analgesia can also be used for postoperative pain management after certain surgical procedures.

44
Q

SPINAL ANESTHESIA

A

Indications:

Spinal anesthesia is typically employed when there is an imminent need for anesthesia or analgesia, especially in cases of imminent vaginal delivery or cesarean section (C-section).
It may not be suitable for prolonged labor due to the rapid onset and limited duration of action.
Rapid Onset:

One of the notable advantages of spinal anesthesia is its rapid onset of action. It can achieve a full anesthetic effect within 5 to 10 minutes after administration, making it well-suited for cases requiring quick pain relief or anesthesia.
Administration:

During spinal anesthesia, a small, precise amount of local anesthetic medication (often combined with an opioid for analgesia) is injected directly into the cerebrospinal fluid within the subarachnoid space of the spine. This blocks pain signals and results in numbness in the lower part of the body.
Limited Duration:

Spinal anesthesia has a limited duration of action, typically providing anesthesia or analgesia for a specific period of time. The duration can vary but is usually sufficient for surgical procedures or the immediate postpartum period.
Risk of Post-Dural Headache (PDPH):

One of the potential side effects or complications of spinal anesthesia is the risk of post-dural headache (PDPH). This type of headache occurs when there is a leakage of cerebrospinal fluid through the puncture site in the dura mater (the outermost protective layer of the spinal cord). PDPH is characterized by a severe headache that typically worsens when the individual sits or stands and improves when lying down. It can be managed with conservative measures or, in some cases, with an epidural blood patch.
Risk of Reduced Blood Pressure (Hypotension):

Spinal anesthesia can lead to a sudden drop in blood pressure (hypotension) due to sympathetic nerve blockade. This is a common side effect and can be managed with intravenous fluids and medications if necessary. Preventative measures, such as administering intravenous fluids before the procedure, are often taken to minimize the risk of hypotension.

45
Q

COMBINED SPINAL-EPIDURAL (CSE)

A

Combined Administration:

CSE anesthesia involves the simultaneous administration of both spinal and epidural anesthesia during the same procedure. This allows healthcare providers to take advantage of the rapid onset of spinal anesthesia and the continuous pain relief provided by epidural anesthesia.
Rapid and Continuous Anesthesia/Analgesia:

CSE anesthesia is valued for its ability to provide a rapid and profound level of anesthesia or analgesia. The spinal component provides quick relief, while the epidural component offers ongoing pain management.
Versatility:

CSE anesthesia can be used in a variety of medical settings, including during labor and childbirth (for both vaginal delivery and cesarean section) and for other surgical procedures where rapid pain relief and/or anesthesia are required.
Labor or Cesarean Section (C-Section):

CSE anesthesia is commonly employed during labor and childbirth. It allows the laboring individual to benefit from rapid pain relief provided by the spinal component while maintaining the option for continuous pain management throughout labor, making it suitable for both vaginal deliveries and C-sections.
Procedure:

During a CSE procedure, an epidural catheter is typically placed first, allowing for the continuous infusion of epidural anesthesia/analgesia. Following this, a single injection of spinal anesthesia is administered into the subarachnoid space of the spine, achieving rapid and profound anesthesia.
Adjustable Pain Relief:

The advantage of CSE anesthesia is that healthcare providers can adjust the balance between spinal and epidural anesthesia to suit the individual’s specific pain relief needs. For example, during labor, the epidural component can provide continuous pain relief, while the spinal component offers rapid relief during contractions.

46
Q

ADVANTAGES OF EPIDURAL/CSE

A

Effective Pain Relief:

Epidural and CSE anesthesia are highly effective at providing pain relief. They can significantly reduce or eliminate pain sensations in the lower part of the body, allowing the individual to have a more comfortable experience during labor or surgery.
No Altered Level of Consciousness (LOC):

One of the notable advantages of epidural and CSE anesthesia is that they do not alter the individual’s level of consciousness. The person remains awake, alert, and able to communicate throughout the procedure, which is particularly important during childbirth when the individual may want to actively participate in the process.
Continuous Pain Relief:

Epidural and CSE anesthesia provide continuous pain relief. Epidural catheters can be used to infuse a continuous supply of medication, ensuring consistent pain management over an extended period. This is especially valuable during labor, where pain can be ongoing.
Option to Be Awake for Birth (C-Section):

In cases where epidural or CSE anesthesia is used for a cesarean section (C-section), the individual can remain awake and alert during the surgical procedure. This allows them to be present and conscious for the birth of their baby, promoting a more emotionally connected experience.
Customizable Pain Management:

Epidural and CSE anesthesia offer flexibility in pain management. Healthcare providers can adjust the dosage and timing of medication to tailor pain relief to the individual’s specific needs and comfort levels.
Reduced Stress and Anxiety:

Effective pain relief with epidural or CSE anesthesia can help reduce stress and anxiety associated with labor or surgery. This can lead to a more relaxed and positive birthing or surgical experience.
Improved Maternal Well-being:

Epidural and CSE anesthesia can improve maternal well-being by allowing the laboring individual to rest and conserve energy during labor, leading to a more positive and less exhausting childbirth experience.
Option for Prolonged Pain Management:

Epidural catheters can be left in place for an extended period, which can be particularly beneficial for individuals with prolonged labor or for postoperative pain management.
Control Over Pain Levels:

Epidural and CSE anesthesia allow for individual control over pain levels. The individual can request adjustments to the medication infusion rate to maintain a comfortable level of pain relief.

47
Q

DISADVANTAGES OF EPIDURAL ANESTHESIA

A

Decreased Blood Pressure (Hypotension):

Epidural anesthesia can lead to a drop in blood pressure (hypotension) due to the sympathetic nerve blockade associated with the medication. This drop in blood pressure may affect placental perfusion, potentially reducing blood flow to the placenta, which can be a concern for the baby’s well-being.
Urinary Retention:

Epidural anesthesia can interfere with the normal sensation of the bladder, leading to urinary retention. The individual may have difficulty urinating and may require catheterization to empty the bladder.
Limited Mobility:

Once an epidural is in place, it can restrict mobility. The individual may be confined to bed, which can limit their ability to move around during labor. Restricted mobility can impact the progress of labor and may necessitate changes in position to facilitate labor progress.
Prolongation of the Second Stage of Labor:

Epidural anesthesia has been associated with a longer second stage of labor (the pushing stage). This can be due to reduced sensation and muscle strength in the pelvic area, making it more challenging for the individual to effectively push during contractions.
Increased Risk of Instrumental Delivery:

Epidural anesthesia has been linked to an increased likelihood of instrumental deliveries, such as forceps or vacuum-assisted deliveries. These interventions may be necessary if the individual’s ability to push effectively is compromised.
Potential Side Effects:

Epidural anesthesia can result in side effects, including itching, shivering, and nausea. Rarely, individuals may experience more severe side effects, such as respiratory difficulties or allergic reactions to the medication.
Limited Pain Relief Control:

While epidural anesthesia provides excellent pain relief, the individual may have limited control over the level of pain relief. Adjustments to the medication infusion rate are typically made by healthcare providers.
Increased Risk of Epidural-Related Complications:

There is a small risk of epidural-related complications, such as epidural hematoma (accumulation of blood near the spinal cord), infection, or nerve damage. These complications are rare but can have serious consequences.

48
Q

Contraindications toregional anesthesia

A

Clotting Disorders, Including Thrombocytopenia:

Regional anesthesia involves the insertion of a needle or catheter into the epidural or subarachnoid space, which carries a risk of bleeding. Individuals with clotting disorders, such as hemophilia or thrombocytopenia (low platelet count), may have an increased risk of bleeding complications and are generally not candidates for regional anesthesia.
Medication Allergy:

Allergies to the medications used in regional anesthesia, such as local anesthetics or opioids, can be a contraindication. Individuals with known allergies to these medications should not receive regional anesthesia, as it can lead to allergic reactions.
Anatomical Problems:

Anatomical issues that affect the spine can complicate the placement of needles or catheters for regional anesthesia. These may include severe scoliosis (abnormal curvature of the spine), prior spinal fusion surgeries, or other spinal anomalies that make the procedure technically challenging or risky.
Inability to Place:

In some cases, the inability to safely and effectively place the needle or catheter in the desired location can be a contraindication. This may be due to anatomical factors, patient positioning, or other technical considerations.
Infection at the Site:

An active infection at or near the site where the regional anesthesia would be administered is a contraindication. Introducing a needle or catheter into an infected area can lead to the spread of infection or other complications.
Severe Hypovolemia (Low Blood Volume):

Severe hypovolemia, often seen in cases of profound dehydration or significant blood loss, can be a contraindication to regional anesthesia. Reduced blood volume can make it difficult to maintain blood pressure, which is important during regional anesthesia.
Uncooperative Patient:

Regional anesthesia procedures require cooperation from the patient, including remaining still during the placement of the needle or catheter. An uncooperative or agitated patient may not be suitable for regional anesthesia.

49
Q

NURSING CARE: pre-EPIDURAL PLACEMENT

A

Educate the Patient:

Start by providing the patient with comprehensive education about the procedure, including the benefits, potential risks, and what to expect during and after the epidural placement. Address any questions or concerns the patient may have.
Confirm Completion of Consents:

Ensure that all necessary consent forms have been completed and signed by the patient. This step is essential to verify that the patient fully understands the procedure and has given informed consent.
Pre-Hydrate with IV Bolus:

Administer an IV bolus of fluids before the epidural procedure. Pre-hydration helps prevent hypotension (low blood pressure), a common side effect of epidural anesthesia. Adequate hydration is crucial for maintaining blood pressure during the procedure.
Obtain Medication and Equipment:

Verify that all required medications and equipment are readily available and properly prepared for the procedure. This includes the local anesthetic, epidural needle and catheter, sterile drapes, and other supplies.
Position the Patient and Place BP Cuff/Pulse Oximeter:

Help the patient assume the appropriate position for the epidural placement, which is typically a seated or lateral position with the back arched and the spine exposed. Position the patient comfortably, and place a blood pressure cuff and pulse oximeter for continuous monitoring of vital signs.
Time Out:

Conduct a “time out” or final verification step to confirm that you are performing the correct procedure on the correct patient at the correct site. This safety check involves the entire healthcare team and helps prevent errors.
Continue Labor Support and Maintain Fetal Monitoring:

Throughout the preparation for epidural placement, continue to provide emotional and physical support to the patient. Ensure that fetal monitoring is ongoing to assess the well-being of the baby during the procedure.
Assess Patient Readiness and Comfort:

Before proceeding with the epidural placement, assess the patient’s readiness and comfort level. Address any additional questions or concerns the patient may have, and ensure they feel informed and prepared.
Monitor for Adverse Reactions:

During and after epidural placement, closely monitor the patient for any adverse reactions or complications, such as hypotension, allergic reactions, or infection. Promptly address any issues that arise.
Document:

Thoroughly document the pre-epidural care, including patient education, consent, vital signs, and any specific details related to the procedure. Accurate and comprehensive documentation is essential for patient care and legal purposes.

50
Q

NURSING CARE: EPIDURAL PLACEMENT

A

Safety:
Safety should be the top priority during epidural placement. Ensure that the procedure is performed in a sterile environment to reduce the risk of infection. Additionally, follow safety protocols, such as hand hygiene and proper aseptic technique, to minimize complications.

Independent Double Checks:
Implement a double-check system, where two healthcare providers independently verify the patient’s identity, procedure, and site before initiating the epidural placement. This additional layer of verification helps prevent errors.

Pharmacy Prepared Medications:
Ensure that all medications used for the epidural, including local anesthetics and opioids, are prepared by the pharmacy or a designated healthcare professional with expertise in medication preparation. This helps ensure accurate dosing and reduces the risk of medication errors.

Clearly Label Solutions and Lines:
Properly label all solutions, syringes, and lines used during the procedure. Clear labeling helps prevent mix-ups and ensures that the correct medications and fluids are administered.

Patient Monitoring:
Continuously monitor the patient’s vital signs, including blood pressure, heart rate, and oxygen saturation, throughout the epidural placement procedure. Be vigilant for any signs of adverse reactions, such as hypotension or allergic reactions, and respond promptly if they occur.

Documentation:
Thoroughly document the entire epidural placement procedure, including the medications administered, the technique used, the location of the epidural placement, and the patient’s response. Detailed and accurate documentation is essential for patient care, legal purposes, and continuity of care.

Assist the Anesthesia Provider:
Collaborate closely with the anesthesia provider during the epidural placement. Assist with patient positioning, provide support to the patient, and follow the provider’s instructions precisely.

Patient Education and Comfort:
Continue to educate and reassure the patient throughout the procedure. Explain each step, provide emotional support, and address any questions or concerns the patient may have. Ensure the patient is comfortable during the placement.

Immediate Post-Placement Monitoring:
After the epidural placement, closely monitor the patient for any immediate complications, such as hypotension or allergic reactions. Be prepared to initiate appropriate interventions if needed.

Pain Assessment:
Assess the effectiveness of the epidural anesthesia in providing pain relief. Communicate with the patient to determine their level of comfort and adjust the epidural as necessary to achieve the desired pain relief.

Ongoing Care:
Continue to monitor the patient’s vital signs and overall condition in the post-placement period. Provide ongoing care and support to ensure the patient’s well-being.

51
Q

NURSING CARE: EPIDURAL PLACEMENT

A

Timing of the Procedure:

Epidural placement should be conducted before any invasive procedure or surgery for pain management or anesthesia. It is typically initiated when pain relief is required, especially during labor or before certain surgeries.
Resolution of Concerns:

Ensure that any patient concerns or questions related to the procedure are addressed and resolved before proceeding with epidural placement. It’s essential to create an environment where the patient feels informed and comfortable.
Initiation by Healthcare Team Member:

A member of the healthcare team with the necessary training and expertise, often an anesthesia provider or anesthesiologist, initiates the epidural placement procedure. They are responsible for performing the procedure safely and effectively.
Participation of All Team Members:

All members of the healthcare team present during the procedure should actively participate and collaborate to ensure that every step is carried out accurately and safely.
Verification Steps:

Before the epidural placement procedure begins, a series of verification steps are crucial to prevent errors:
Verify the Correct Patient: Confirm the patient’s identity using at least two unique identifiers (e.g., name and date of birth) and match them with the patient’s medical record or wristband.
Verify the Correct Procedure: Ensure that the procedure being performed is the intended epidural placement.
Verify the Correct Site: Confirm that the epidural placement is targeted at the correct anatomical site, which may involve checking the patient’s medical records or images to identify the appropriate spinal level.
Sterile Technique:

Maintain a sterile environment during the procedure to reduce the risk of infection. This includes proper hand hygiene, wearing sterile gloves and gowns, and using sterile drapes and equipment.
Continuous Monitoring:

Continuously monitor the patient’s vital signs, including blood pressure, heart rate, and oxygen saturation, during the procedure. Promptly address any changes or concerns in the patient’s condition.
Comfort and Communication:

Throughout the procedure, prioritize patient comfort and communication. Explain each step of the procedure, offer reassurance, and address any questions or anxiety the patient may have.
Post-Procedure Care:

After the epidural placement is completed, continue to monitor the patient closely for any immediate complications or side effects. Assess the effectiveness of pain relief and adjust the epidural as needed to achieve the desired level of pain management.
Documentation:

Thoroughly document the entire procedure, including the patient’s consent, the medications administered, the technique used, the location of the epidural placement, and the patient’s response. Accurate documentation is essential for patient care and legal purposes.

52
Q

NURSING CARE:EPIDURAL PLACEMENT

A

Preparation:

Before positioning the patient, ensure that all necessary equipment and supplies for the epidural placement procedure are readily available, and that the healthcare team is prepared.
Informed Consent:

Confirm that the patient has provided informed consent for the epidural placement procedure and that any questions or concerns have been addressed.
Patient Education:

Explain the positioning process to the patient to reduce anxiety and enhance cooperation. Inform them about the expected sensations and sensations they may experience during the procedure.
Gather Assistants:

Depending on the healthcare facility’s protocols and the complexity of the procedure, you may need assistance from one or more healthcare team members to help position the patient safely.
Positioning for Epidural Placement:

The patient is typically positioned in one of the following ways:
a. Seated Position (Flexed Forward):

This position is commonly used for epidural placement during labor and certain medical procedures.
Instruct the patient to sit at the edge of the bed or examination table with their feet on a footstool or a low chair, creating a sitting position.
Ask the patient to arch their back forward, rounding their shoulders, and bending their neck slightly forward. This flexion of the spine opens up the intervertebral spaces for access to the epidural space.
Ensure the patient’s back is exposed and cleaned in a sterile fashion for the procedure.
b. Lateral Decubitus Position (Side-Lying):

This position is sometimes used when the patient cannot tolerate the seated position due to pain or other factors.
Instruct the patient to lie on their side, with one side of their body facing upward and their knees drawn up toward their chest.
The healthcare provider will position the patient’s back in a curved posture to access the epidural space between the vertebrae.
Pillow or Support:

Provide a pillow or cushion for the patient to support their head and maintain comfort during the procedure.
Maintain Sterility:

Ensure that the sterile field is maintained during the positioning process. Sterile drapes are often used to cover the patient’s back and maintain aseptic conditions.
Assist with Positioning:

As needed, assist the patient in assuming the correct position, especially if they have mobility limitations or discomfort.
Continuous Monitoring:

Once the patient is positioned, continue to monitor their vital signs, such as blood pressure and oxygen saturation, throughout the procedure.
Comfort and Communication:

Maintain open communication with the patient, addressing any concerns or discomfort they may have. Reassure them and offer support throughout the procedure.

53
Q

NURSING CARE: POST EPIDURAL PLACEMENT

A

Assess Vital Signs (VS):

Continuously monitor the patient’s vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation. Frequent assessments help detect any changes in the patient’s condition, such as hypotension or respiratory distress.
Monitor Fetal Heart Rate (FHR) and Uterine Contractions (UCs):

If the epidural was placed during labor and childbirth, closely monitor the fetal heart rate and uterine contractions. Assessing these parameters is essential to ensure the well-being of both the mother and the baby.
Assess Pain Level:

Regularly assess the patient’s pain level using a pain scale or the patient’s self-report. Adjust the epidural infusion rate or provide additional pain management interventions as needed to maintain adequate pain relief while ensuring the patient’s comfort.
Place Foley Catheter:

Epidurals can impair the patient’s ability to sense bladder fullness and may lead to urinary retention. Insert a Foley catheter to empty the bladder and prevent discomfort or complications related to urinary retention.
Order a Clear Diet:

Depending on the healthcare facility’s policies and the patient’s condition, healthcare providers may order a clear liquid diet for the patient after epidural placement. Ensure the patient’s dietary needs and restrictions are followed.
Change Patient Position:

Change the patient’s position regularly to prevent complications associated with immobility, such as pressure ulcers and discomfort. Position changes every 30-60 minutes are recommended.
Alternating between a lateral position and tilting slightly from side to side can help maintain blood flow, alleviate pressure on bony prominences, and enhance patient comfort.

54
Q

NURSING CARE: POST EPIDURAL ANESTHESIA

A

Lateral Position:

Placing the patient in a lateral (side-lying) position means they are lying on their side with their uppermost leg flexed at the hip and knee and their lowermost leg kept relatively straight.
The lateral position is often used during epidural placement and may be maintained for a brief period afterward to allow the anesthesia to spread evenly and take effect.
It can help prevent the spread of anesthesia to unwanted areas and facilitate the flow of medication to the desired spinal levels.
Tilted Position (Left or Right Side):

Tilted positions involve elevating the patient’s upper body or hips slightly higher than their lower body by placing a wedge or cushion under one side of their body.
Tilted positions are commonly used during labor after epidural placement. Tilting to the left or right side can help improve maternal and fetal blood flow, optimize uterine contractions, and reduce the risk of supine hypotensive syndrome (low blood pressure when lying flat on the back) in pregnant patients.
Tilted positions can also enhance comfort and reduce the risk of pressure ulcers, especially for patients who may be immobile for an extended period.

55
Q

General Anesthesia

A

Indications:

General anesthesia is commonly used for surgical procedures, including cesarean sections (C-sections). It is not typically used for labor and vaginal childbirth but may be necessary for certain medical reasons or in emergency situations.
Non-Routine Use:

General anesthesia is not considered a routine choice for childbirth. It is typically reserved for cases where regional anesthesia (e.g., epidural or spinal) is not feasible, contraindicated, or has failed.
Reasons for General Anesthesia in Childbirth:

Some situations where general anesthesia for a C-section may be considered include emergencies, urgent deliveries, or specific medical conditions that make regional anesthesia unsafe or impractical.
Administration:

General anesthesia involves the administration of a combination of medications, including intravenous (IV) drugs and inhaled anesthetic agents. These medications are carefully titrated to induce and maintain a state of unconsciousness and pain relief during the procedure.
Medication Combination:

The specific combination of medications used for general anesthesia can vary based on the patient’s medical history, the nature of the surgery, and the preferences of the anesthesia provider. Common medications used in general anesthesia may include fentanyl (an opioid), midazolam (Versed), propofol, ketamine, and others.
Monitoring and Recovery:

During the administration of general anesthesia, the patient is closely monitored by the anesthesia team to ensure their safety and well-being. Vital signs, oxygen levels, and other parameters are continuously assessed.
After the surgical or medical procedure is completed, the patient is transferred to the Post-Anesthesia Care Unit (PACU), where they continue to be monitored as they awaken from anesthesia. Pain management and other post-operative care are initiated in the PACU.
Recovery Time:

The duration of recovery from general anesthesia can vary depending on the patient, the surgical procedure, and the specific medications used. Patients typically remain in the PACU until they are stable and awake. The anesthesia team assesses the patient’s readiness for discharge from the PACU.
Potential Side Effects and Risks:

General anesthesia, like any medical intervention, carries certain risks and potential side effects. These can include nausea, vomiting, respiratory issues, and rare but serious complications. Patients are thoroughly assessed before receiving general anesthesia to minimize these risks.

56
Q

Part 3: Nursing care during stages 2-4

A
57
Q

LaborStages 2-4

A

2nd Stage of Labor (Stage 2):

This stage begins when the cervix is fully dilated (approximately 10 centimeters) and continues until the baby is delivered. It is often referred to as the “pushing stage.”
During this stage, the mother actively participates by pushing to help the baby move through the birth canal and into the world.
Contractions continue, but their frequency and intensity may change. The mother is guided on when and how to push effectively by healthcare providers, such as nurses, midwives, or obstetricians.
The baby’s descent and rotation occur as they navigate through the pelvis, eventually leading to the baby’s head emerging (crowning) and the rest of the body following.
The baby is born during this stage, and it marks the culmination of labor’s first two stages.
3rd Stage of Labor (Stage 3):

The third stage of labor begins immediately after the baby’s birth and continues until the placenta is delivered.
During this stage, contractions usually continue, but they are generally milder than during active labor and pushing.
The placenta, which provided oxygen and nutrients to the baby during pregnancy, detaches from the uterine wall and is expelled from the uterus.
Healthcare providers carefully inspect the placenta to ensure it is complete and intact to minimize the risk of complications.
4th Stage of Labor (Stage 4):

The fourth stage of labor encompasses the period from the delivery of the placenta until up to 4 hours afterward. It is sometimes referred to as the “recovery stage.”
This stage is a crucial time for both the mother and the baby. The mother’s body begins to stabilize after the intense experience of childbirth.
Healthcare providers continue to monitor the mother’s vital signs, such as blood pressure and heart rate, and assess for any signs of postpartum hemorrhage or complications.
Skin-to-skin contact between the mother and her newborn is often encouraged during this stage to promote bonding and breastfeeding initiation.
The baby is examined to assess their overall health, Apgar scores are assigned, and any necessary immediate care or interventions are provided.
Monitoring and support are crucial during this stage to ensure that both the mother and baby transition safely and comfortably into the postpartum period.

58
Q

2nd Stage:Nursing assessments

A

Vital Signs (VS):

Monitoring vital signs is essential during this stage. Blood pressure, pulse, and respiratory rate are typically assessed “per protocol,” which means following the facility’s established guidelines. The frequency of monitoring may vary based on the patient’s condition, but it is often recommended to check vital signs every 5 to 15 minutes, as per Ricci.
Fetal Heart Rate (FHR):

Continuous monitoring of the fetal heart rate is crucial to assess the baby’s well-being during pushing. The frequency of FHR assessments may be adjusted based on the risk level and the specific circumstances. High-risk situations may require more frequent monitoring, typically every 5 to 15 minutes.
Uterine Contractions (UCs):

Documenting the frequency, duration, and intensity of uterine contractions is essential to assess the progress of labor. This information helps healthcare providers determine the effectiveness of pushing efforts and the baby’s descent. UCs are typically documented every 5 to 15 minutes.
Coping and Pain Management:

Assessing the mother’s coping mechanisms and pain level is vital during the pushing stage. Encourage open communication with the mother to understand her pain experience and provide support as needed. Offer pain relief options, such as relaxation techniques, position changes, or epidural adjustments, if appropriate.
Fetal Descent:

Monitor and document the descent of the baby’s head through the birth canal. This assessment helps healthcare providers gauge the progress of labor. Observing the station (position of the baby’s head in relation to the mother’s pelvis) can provide important information about the baby’s descent.

59
Q

2nd Stage:Nursing interventions

A

Prepare Room for Delivery:

Ensure that the delivery room is properly set up for childbirth, including having all necessary equipment and supplies readily available. This may include sterile instruments, delivery trays, newborn resuscitation equipment, and lighting adjustments.
Communicate with Providers:

Maintain effective communication with healthcare providers, such as obstetricians, midwives, and neonatologists, as needed. Keep them informed about the progress of labor, any concerns, and the readiness for delivery.
Support the Patient with Pushing Efforts:

Provide encouragement, guidance, and emotional support to the mother during each pushing effort. Assist her in using effective pushing techniques and help her understand when and how to push effectively.
Continue Comfort Measures:

Implement and maintain comfort measures that were effective during the earlier stages of labor. This may include massage, position changes, warm compresses, and relaxation techniques.
Discontinue Foley Catheter (Foley D/C):

If a Foley catheter was inserted to empty the bladder during labor, remove it once the mother is in the pushing stage. This allows the mother to push without obstruction and reduces the risk of catheter-related complications.
Ensure Adequate Hydration:

Offer sips of clear fluids or ice chips to keep the mother hydrated between contractions. Adequate hydration is important for her energy and comfort during the pushing stage.
Respond to Abnormal Assessment Findings:

Continuously monitor the mother and baby’s vital signs, uterine contractions, and fetal heart rate. If any abnormalities or concerning findings arise, promptly notify the healthcare provider and initiate appropriate interventions.
Assist with Delivery:

Collaborate with the healthcare provider during the actual delivery of the baby. Assist with positioning the mother, preparing for delivery, and providing support during the baby’s descent and birth. Be ready to provide immediate care to the newborn.

60
Q

Positions for Pushing

A

check slide 77

61
Q

Instrument Table for Vaginal Birth

A

Sterile Gloves: To ensure aseptic conditions during delivery.

Sterile Gowns and Drapes: To maintain a sterile environment.

Sterile Surgical Towels or Sheets: Used for cleaning and drying.

Forceps: Obstetrical forceps may be used to assist in the delivery of the baby’s head.

Vacuum Extractor: A vacuum device used to assist in the delivery of the baby’s head.

Scissors: Used for cutting the umbilical cord.

Clamps: Used for clamping the umbilical cord before cutting.

Suction Device: To clear the baby’s airway and mouth if needed after delivery.

Bulb Syringe: Used for suctioning mucus from the baby’s nose and mouth.

Episiotomy Scissors: If an episiotomy is performed, these specialized scissors are used to make the incision.

Suture Material: Used for stitching any tears or episiotomy.

Needle Holder and Scissors for Suturing: Instruments for stitching.

Sterile Vaginal Exam Equipment: Includes a sterile speculum, swabs, and lubricant for vaginal exams.

Amniotic Hook: Used to rupture the amniotic sac if it hasn’t broken naturally.

Perineal Warm Compresses: Warm compresses can be soothing during the pushing stage and can help prevent tearing.

Medications and Local Anesthetics: Such as lidocaine, if required for pain relief or suturing.

Baby Blankets and Towels: For immediately wrapping and drying the newborn.

Cord Blood Collection Kit: If cord blood is to be collected for banking.

Fetal Monitoring Equipment: For continuous or intermittent fetal monitoring.

Basin and Sterile Containers: For collecting and disposing of placental and other tissues.

Infection Control Supplies: Hand sanitizer, sterile drapes, and other items to maintain a sterile field.

Emergency Equipment: In case of unexpected complications, such as a neonatal resuscitation unit.

62
Q

ACoG “Bonding is when you develop feelings of unconditional love for your newborn”

A

The American College of Obstetricians and Gynecologists (ACOG) recognizes the significance of bonding between a parent and their newborn. While the wording you provided is not an exact quote from ACOG’s guidelines, the concept aligns with the idea that bonding involves the development of strong emotional connections and feelings of love between parents (or caregivers) and their newborns.

63
Q

3rd stageassessments

A

Vital Signs (VS):

Monitor the mother’s vital signs, including blood pressure, pulse, and respiratory rate, approximately every 15 minutes during the 3rd stage of labor. This regular monitoring helps identify any signs of postpartum hemorrhage or other complications.
Apgar Scores:

Apgar scores are used to assess the newborn’s overall condition and well-being at 1 minute and 5 minutes after birth. The Apgar assessment evaluates five key parameters: appearance, pulse, grimace response, activity, and respiration. It provides valuable information about the baby’s immediate health and helps guide any necessary interventions.
Observation for Placental Separation:

Continuously observe and monitor for signs of placental separation. Placental separation occurs when the placenta detaches from the uterine wall. Signs of separation may include a change in the length of the umbilical cord, a gush of blood, and a change in the shape and position of the uterus.
Assess Fundus and Lochia:

After the placenta is delivered, assess the mother’s uterine fundus (the top of the uterus) and the lochia (postpartum vaginal discharge). Fundal assessment helps determine if the uterus is contracting properly to prevent postpartum hemorrhage. Lochia assessment helps identify any excessive bleeding or abnormal discharge.

Fundal assessment involves gently palpating the uterus to check for firmness, position, and location. The uterus should be firm and located near the level of the umbilicus (belly button) immediately after delivery.

Lochia assessment involves observing the amount, color, and consistency of vaginal discharge. Lochia typically progresses from bright red to pink or brown over the postpartum period.

64
Q

APGAR SCORE

A

Heart Rate:

0: Absent heart rate
1: Heart rate below 100 beats per minute
2: Heart rate above 100 beats per minute
Respiration (Breathing):

0: Absent respiration
1: Slow or weak cry, gasping
2: Good, strong cry
Muscle Tone (Flexion):

0: Flaccid (limp) muscle tone
1: Some flexion of extremities
2: Well-flexed, active movements
Reflex Irritability (Response to Stimulation):

0: No response to stimulation (e.g., tapping on the sole of the foot)
1: Grimace or minimal response to stimulation
2: Vigorous response, crying or pulling away from stimulation
Color (Skin Color):

0: Blue or pale color all over (cyanosis)
1: Core (body) is pink, but extremities (hands and feet) are blue or pale
2: Completely pink all over

65
Q

3rd stage:nursing interventions

A

Respond to Abnormal Assessment Findings:

Continuously monitor the mother for any abnormal assessment findings, including excessive bleeding (postpartum hemorrhage), signs of infection, or other complications. Promptly report any concerns to the healthcare provider for appropriate intervention.
Administer Uterotonics PRN/As Ordered:

Uterotonics are medications that help the uterus contract and prevent postpartum hemorrhage. They may be administered as needed or as ordered by the healthcare provider. Common uterotonics include oxytocin (Pitocin), misoprostol (Cytotec), and methylergonovine (Methergine).
Active Management of the 3rd Stage:

Active management of the 3rd stage involves a proactive approach to facilitate the prompt delivery of the placenta and reduce the risk of postpartum hemorrhage. It typically includes controlled cord traction, uterine massage, and the administration of uterotonics.
Assist with Birth-Related Fluids (BRF) & Monitor Newborn (NB):

After the placenta is delivered, assist with collecting and documenting birth-related fluids (amniotic fluid, blood) and any cord blood samples for testing. Additionally, ensure that the newborn is promptly assessed for vital signs, Apgar scores, and overall well-being.
Post-Delivery Care:

Assist with any necessary repairs or suturing if the mother has experienced perineal tears or lacerations during childbirth. Provide pain medications as prescribed and offer ice to the perineum as needed for comfort and to reduce swelling.

66
Q

Breastfeeding support

A
67
Q

4th stage: nursing assessment

A

Fundal Check and Lochia Assessment:

Monitor the mother’s uterine fundus (the top of the uterus) and assess the lochia (vaginal discharge) to ensure the normal progression of the postpartum period.
Assess the fundus and lochia every 15 minutes for the first 2 hours after delivery (Q15 x 4) to ensure the uterus is contracting well and to identify any signs of excessive bleeding or abnormal discharge.
After the initial 2-hour period, assess the fundus and lochia every 30 minutes for the next 2 hours (Q30 x 2) or as indicated by the facility’s protocols.
Vital Signs and Pain Assessment:

Continue monitoring the mother’s vital signs, including blood pressure, pulse, and respiratory rate, at regular intervals to detect any signs of postpartum complications.
Assess the mother’s pain level and provide pain relief as needed. This may include administering pain medications or providing non-pharmacological pain management options.
Newborn (NB) Admission Exam:

Perform a thorough admission assessment of the newborn to evaluate their overall health and well-being. This assessment includes measuring vital signs, assessing skin color and tone, evaluating the baby’s reflexes, and conducting a head-to-toe examination.
Document the findings of the newborn assessment and communicate any concerns or abnormalities to the healthcare provider

68
Q

4th stage:nursing interventions

A

Pain Interventions PRN (as needed): Assess the patient’s pain level regularly using a pain scale and administer pain medications as prescribed by the physician. Ensure the patient is comfortable and pain-free as much as possible.

Hydrate/Provide Nutrition: Monitor the patient’s fluid intake and output to maintain proper hydration. Administer intravenous fluids as needed. Begin with clear liquids and advance the diet as tolerated to ensure the patient receives adequate nutrition.

Facilitate Voiding ASAP: Encourage the patient to void (urinate) as soon as possible after surgery, as this helps prevent urinary retention. Provide privacy and support if needed. If the patient is unable to void, notify the healthcare provider.

Promote Rest: Promote a comfortable and restful environment for the patient. Ensure the patient is positioned comfortably in bed, provide pillows for support, and adjust the bed as needed to prevent pressure ulcers and promote circulation.

Assist with First Ambulation (Walking) / Assess for Readiness to Ambulate Post-Anesthesia: Depending on the type of surgery and the patient’s condition, assist the patient in their first attempt to walk post-anesthesia. Ensure the patient is stable, not dizzy or lightheaded, and can bear weight safely. Assess their readiness to ambulate and document their response.

Education: Provide the patient and their family with post-operative instructions. This may include information about wound care, pain management, medication administration, activity restrictions, and any potential complications to watch for. Ensure they understand and can follow these instructions.

69
Q

4th stage:nursing interventionsNewborn (NB)

A

Assist with Newborn Feeding: Support and educate parents on newborn feeding techniques. Ensure that newborns are breastfeeding or bottle-feeding effectively, latching correctly, and taking in an adequate amount of milk. Address any breastfeeding challenges or concerns and provide guidance on feeding schedules.

Administer Newborn Medications: If the newborn requires any medications, such as vitamin K or eye ointment for infection prevention, administer them according to the physician’s orders. Ensure accurate dosage and safe administration.

Infant Security: Maintain a strict protocol for infant security. This includes using identification bands on both the newborn and the mother, verifying identities, and ensuring that the newborn is always in the care of authorized personnel. Preventing infant abduction and ensuring the safety of the newborn is paramount.

Education: Provide parents with essential education on newborn care. Topics may include newborn hygiene, diapering, cord care, safe sleep practices, signs of newborn distress, and recognizing normal newborn behaviors. Answer any questions the parents may have and offer resources for additional support, such as breastfeeding classes or postpartum support groups.

70
Q

Nursing Diagnoses:Stages 2-4

A

Stage 2: Labor and Birth

Risk for Injury to Patient and Fetus/NB: During labor and birth, this diagnosis is relevant due to the potential for maternal and fetal complications. The nurse must monitor for signs of distress in both the mother and the fetus/newborn, addressing any concerns promptly.
Stage 3: Post-Delivery/Newborn Care

Knowledge Deficit: This nursing diagnosis is essential in stage 3, especially for first-time parents. The nurse should provide education on newborn care, breastfeeding, postpartum recovery, and any specific instructions related to the mother’s or newborn’s health.

Pain: Postpartum pain management is critical. This diagnosis may apply to the mother who may experience pain due to uterine contractions, episiotomy or perineal discomfort, and the newborn who may undergo routine procedures like heel sticks for blood tests.

Ineffective Coping and Anxiety: The postpartum period can be emotionally challenging for parents. These diagnoses address emotional and psychological well-being. Nursing interventions may include emotional support, counseling, and referral to support groups.

Stage 4: Postnatal/Newborn Care

Risk for Infection: In this stage, infection prevention is crucial for both the mother and the newborn. Nurses should assess for signs of infection, promote proper hygiene, and ensure a clean environment.

Risk for Fluid Volume Deficit/Excessive Blood Loss: This diagnosis is relevant for the mother, as postpartum hemorrhage is a potential concern. Monitoring vital signs, assessing for excessive bleeding, and maintaining adequate hydration are essential.

71
Q

PART 4: FETAL MONITORING

A
72
Q

Fetal assessment

A

Subjective:

Pt Report, “Kick Counts”: This refers to the mother’s subjective assessment of fetal movement. Mothers are often encouraged to monitor and record the frequency and strength of fetal movements, commonly known as “kick counts.” A decrease in fetal movement can be a sign of fetal distress and should be reported to healthcare providers.
Objective:

Continuous Fetal Monitoring (EFM - Electronic Fetal Monitoring): EFM is a standard method of objective fetal assessment during labor. It involves the use of electronic devices to continuously monitor the fetal heart rate and uterine contractions. The two main components of EFM are:

Fetal Heart Rate (FHR) Monitoring: This measures the baby’s heart rate, which can provide valuable information about the fetus’s well-being.
Uterine Contractions Monitoring: This tracks the frequency and intensity of contractions in the mother’s uterus, which can help assess the progress of labor.
FSE (Fetal Scalp Electrode): In some cases, when a more accurate and continuous monitoring of the fetal heart rate is needed, a fetal scalp electrode may be used. It’s a small electrode attached directly to the baby’s scalp during labor to monitor the FHR more precisely.

Intermittent Auscultation: This is another method of assessing the fetal heart rate, but it is not continuous like EFM. With intermittent auscultation, the healthcare provider uses a handheld Doppler device or a fetoscope to periodically listen to the baby’s heart rate at specific intervals during labor. This method is often used when continuous EFM is not feasible or when the mother prefers a less invasive approach.

73
Q

Assessment frequency

A

Stage 1 (Cervical Dilation and Effacement):
Stage 1
Low risk: early labor Q 1 hour, active labor Q30 min
High risk: early labor Q 30 min, active labor Q15 min

Stage 2 (Crowning and Delivery):
Stage 2
Low risk: Q 15 min
High risk: Q 5 min

74
Q

Intermittent auscultation

A

Assess Maternal Pulse: Before auscultating the fetal heart rate, it’s important to assess the maternal pulse. This helps ensure that the healthcare provider is not confusing the mother’s pulse with the fetal heart rate when using the Doppler or fetoscope.

Associated with Lower Rate of Cesarean Sections and Unnecessary Interventions: Intermittent auscultation is often associated with a lower rate of cesarean sections (c-sections) and unnecessary interventions in low-risk pregnancies. It allows for a more natural approach to labor without continuous electronic fetal monitoring (EFM).

Equal Perinatal Outcomes in Low-Risk Patients: Research has shown that intermittent auscultation can provide perinatal outcomes that are as safe as continuous electronic fetal monitoring for low-risk patients. This means that in uncomplicated pregnancies, both methods yield similar results in terms of fetal well-being.

Auscultate 3-5 Minutes Through Uterine Contractions: During IA, the healthcare provider should listen to the fetal heart rate for about 3-5 minutes while a uterine contraction is occurring. This helps assess how the baby’s heart rate responds to contractions, which is an important indicator of fetal well-being.

Assessment Frequency: The frequency of intermittent auscultation in low-risk patients is typically less frequent than continuous electronic fetal monitoring. However, the specific frequency may vary based on clinical protocols and individual patient needs. It is generally recommended to auscultate every 15-30 minutes during active labor in low-risk patients.

75
Q

Fetal Monitor Tracing Interpretation

A

NICHD (National Institute of Child Health and Human Development): NICHD provides standardized terminology and guidelines for fetal heart rate monitoring. These guidelines help healthcare providers uniformly interpret and communicate findings related to fetal monitoring.

Visual Interpretation: Healthcare providers visually assess the FHR and UC patterns on the fetal monitor tracing. This involves observing the graphical representation of the FHR and uterine contractions over time.

Identify FHR Baseline: The baseline fetal heart rate is the average rate observed over a 10-minute segment of the tracing, excluding periods of significant variability, accelerations, or decelerations. It’s important to establish a stable baseline as it serves as a reference point for evaluating changes in FHR.

Identify Variability: FHR variability refers to the irregular fluctuations in the fetal heart rate above and below the baseline. Normal variability is a sign of fetal well-being, while decreased variability can indicate fetal distress.

Identify Accels/Decels (Accelerations/Decelerations): Accels are increases in the fetal heart rate, often in response to fetal movement or contractions, and are considered reassuring. Decels are decreases in the fetal heart rate, which can be further classified into early, late, or variable decelerations, each with different clinical implications.

Determine UC Pattern: Healthcare providers assess the uterine contractions’ frequency, duration, and intensity. Contractions are evaluated to ensure they are regular and of adequate strength, as excessive or prolonged contractions can reduce fetal oxygen supply.

Intervene PRN (As Needed): Based on the interpretation of the fetal monitor tracing, healthcare providers may need to intervene to optimize fetal well-being. Interventions may include repositioning the mother, administering oxygen, discontinuing uterine-stimulating medications, or preparing for cesarean section if necessary.

76
Q

Identify Baseline

A

Normal Baseline FHR: The normal baseline FHR for a fetus is in the range of 110 to 160 beats per minute (bpm). This range indicates that the fetus is generally in good condition and well-oxygenated.

Bradycardia: Bradycardia is defined as a baseline FHR less than 110 bpm. Bradycardia in the fetus can be a sign of fetal distress or a lack of oxygen. It may require prompt evaluation and intervention.

Tachycardia: Tachycardia is defined as a baseline FHR greater than 160 bpm. Tachycardia can be a sign of various conditions, such as maternal fever, fetal anemia, or fetal distress. The cause of tachycardia should be determined and addressed accordingly.

77
Q

Variability

A

Variability: FHR variability represents the irregular changes in the baseline FHR that occur due to the interplay between the sympathetic and parasympathetic branches of the fetal autonomic nervous system.

Normal Variability: Normal FHR variability is a positive sign indicating that the fetal central nervous system (CNS) is functioning within normal limits and that there is an absence of fetal acidemia (acidosis). Normal variability typically falls within the range of 6 to 25 beats per minute (bpm) and is considered reassuring.

Absent Variability: Absent variability means that there are undetectable fluctuations in the baseline FHR. It is a concerning sign and may indicate fetal compromise or a problem with the fetal autonomic nervous system’s regulation.

Minimal Variability: Minimal variability is defined as fluctuations in the baseline FHR of less than 5 bpm. While not as concerning as absent variability, it is still considered non-reassuring and may warrant further evaluation.

Moderate Variability: Moderate variability is the desired and reassuring range of FHR variability. It typically falls between 6 and 25 bpm. Moderate variability suggests a healthy interaction between the sympathetic and parasympathetic nervous systems and indicates fetal well-being.

Marked Variability: Marked variability refers to fluctuations in the baseline FHR that exceed 25 bpm. While it is generally not associated with adverse outcomes, marked variability can sometimes be seen in situations like fetal movement or mild cord compression. It is usually a sign of fetal responsiveness.

78
Q

Fetal heart rate patterns (Accelerations) Bueno

Accelerations:

Abrupt Increase: Accelerations are rapid increases in the FHR from the baseline. These are reassuring signs and are often an indication of fetal well-being.
Criteria for Accelerations: To be considered an acceleration, there should be an abrupt increase of at least 15 beats per minute (bpm) lasting for at least 15 seconds.
Baseline Change After 10 Minutes: If accelerations persist for more than 10 minutes, they may establish a new baseline heart rate.

A

Fetal heart rate patterns (Decelerations)

2 negativo y la early esta bien
Early Decelerations:

Associated with Uterine Contractions (UCs): Early decelerations are FHR decreases that are associated with uterine contractions. They typically mirror the timing of contractions.
Gradual Decrease: The deceleration in FHR is gradual, starting at the onset of the contraction and returning to baseline by the end of the contraction.
Onset to Nadir > 30 Seconds: Early decelerations usually take more than 30 seconds from the onset to reach their lowest point.
Generally Reassuring: Early decelerations are generally considered reassuring and are often a result of fetal head compression during contractions.
Variable Decelerations:

Abrupt Drop from Baseline: Variable decelerations are characterized by an abrupt drop in the FHR from the baseline. They have a rapid onset to nadir.
May Occur Without UCs: Variable decelerations may occur with or without uterine contractions.
“V” Shaped: They often have a distinct “V” shape on the FHR tracing.
Criteria for Variable Decelerations: To be considered variable, the deceleration should have at least a 15 bpm drop and last for at least 15 seconds.

79
Q

Fetal heart rate patterns continues

A

Accelerations:

Abrupt increase in the FHR.
Criteria for term (32 weeks or more): 15 bpm increase lasting for 15 seconds or more.
Criteria for preterm (less than 32 weeks): 10 bpm increase lasting for 10 seconds or more.
If present for more than 10 minutes, it may establish a new baseline.
Early Decelerations:

Associated with uterine contractions (UCs).
Gradual decrease in the FHR that mirrors the UC pattern.
Onset to nadir (lowest point) takes more than 30 seconds.
Generally considered reassuring as they result from fetal head compression during contractions.
Variable Decelerations:

Abrupt drop from the baseline FHR.
Rapid onset to nadir, typically lasting less than 30 seconds.
May occur with or without UCs.
Often have a distinct “V” shape.
Criteria: At least a 15 bpm drop lasting for at least 15 seconds.
Late Decelerations:

Associated with uterine contractions (UCs).
Gradual decrease in the FHR, with the nadir occurring after the peak of the contraction.
Onset to nadir takes more than 30 seconds.
Return to baseline occurs after the UC has ended.
Concerning sign, indicating potential fetal hypoxia or distress.
Prolonged Accelerations/Decelerations:

Prolonged accelerations or decelerations are those that last for more than 2 minutes but less than 10 minutes.
These patterns may require close monitoring and evaluation, as they can indicate changes in fetal well-being.

80
Q

Fetal heart rate patternssignificance

A

Accelerations:

Significance: Accelerations are generally considered reassuring signs.
Meaning: They indicate that the fetus is receiving adequate oxygen and is responsive to stimuli.
Clinical Implication: The presence of accelerations suggests that the acid-base status of the fetus is within normal limits.
Early Decelerations:

Significance: Early decelerations are typically associated with head compression and vagus nerve stimulation.
Meaning: These decelerations occur in response to the pressure exerted on the fetal head during uterine contractions.
Clinical Implication: Early decelerations are usually reassuring and do not indicate fetal distress.
Variable Decelerations:

Significance: Variable decelerations are often associated with cord compression.
Meaning: These decelerations result from compression of the umbilical cord, which may temporarily reduce oxygen flow to the fetus.
Clinical Implication: Variable decelerations can be concerning, especially if they are frequent or severe. Close monitoring and intervention may be necessary to relieve cord compression and ensure fetal well-being.
Late Decelerations:

Significance: Late decelerations are associated with uteroplacental insufficiency and a potential interruption in the “oxygen pathway.”
Meaning: Late decelerations occur when the fetus receives inadequate oxygen due to reduced blood flow or oxygen exchange in the placenta.
Clinical Implication: Late decelerations are concerning and may indicate fetal hypoxia or distress. Prompt intervention and evaluation are essential to address the underlying cause and prevent fetal compromise.

81
Q

FHRCategories

A

Category I (CAT I):

FHR within the normal range.
Accelerations may or may not be present.
Decelerations are absent.
Predictive of normal acid/base balance.
Generally reassuring, indicating that the fetus is likely in good condition.
Category II (CAT II):

Tracings that do not fit within Category I or Category III.
These tracings are not predictive of normal acid/base balance.
They have indeterminate significance, meaning that they do not definitively indicate fetal well-being or distress.
Continuous monitoring and further evaluation are often needed to assess the fetal condition.
Category III (CAT III):

Includes at least one of the following:
Absent variability with recurrent late decelerations: Late decelerations are concerning as they may indicate uteroplacental insufficiency.
Absent variability with recurrent variable decelerations: Recurrent variable decelerations are often associated with cord compression.
Absent variability with bradycardia: Bradycardia (FHR < 110 bpm) can be a sign of fetal distress.
Sinusoidal Pattern: A sinusoidal pattern is a severe and concerning FHR pattern characterized by a smooth, undulating waveform.
Category III tracings indicate fetal distress or potential compromise.
Immediate intervention and evaluation are necessary to address the underlying cause and ensure the safety of the fetus.

82
Q

Contraction interpretation

A

Frequency: Contraction frequency refers to how often contractions occur. It is measured by timing the interval from the beginning of one contraction to the beginning of the next contraction. For example, if contractions occur every 4 minutes, the frequency is 4 minutes.

Duration: Contraction duration is the length of time the contraction lasts, typically measured in seconds. It is the time from the beginning of a contraction to the end of the same contraction.

Intensity: Contraction intensity measures how strong or forceful the contractions are. It is often described subjectively by the mother as mild, moderate, or strong.

Resting Tone: Resting tone refers to the level of uterine activity between contractions. A resting tone that is too high can indicate uterine hyperactivity, which may be problematic.

Tachysystole: Tachysystole is a condition characterized by excessive uterine contractions. It is defined as having more than 5 contractions in 10 minutes, averaged over a 30-minute period. Tachysystole can be concerning as it may reduce fetal oxygenation and increase the risk of fetal distress.

Intervention for Tachysystole: If tachysystole is detected, healthcare providers may intervene by adjusting the mother’s position, administering intravenous fluids, discontinuing uterine-stimulating medications (if applicable), or providing oxygen to the mother. The goal is to reduce uterine activity and improve fetal oxygenation.

83
Q

Nursing interventions for abnormal FHR

A

Intrauterine Resuscitation:

Measures to improve fetal oxygenation, such as optimizing maternal oxygenation and perfusion, which can include increasing maternal oxygen supply via a face mask.
Change Patient’s Position:

Repositioning the mother, such as turning her onto her side, can help alleviate pressure on the vena cava and improve blood flow to the fetus.
Intravenous (IV) Fluid Bolus:

Administering IV fluids, such as lactated Ringer’s solution (LR) or normal saline (NS), can help improve maternal hydration and blood volume, potentially enhancing fetal perfusion.
Treat Hypotension:

Addressing maternal hypotension, which can reduce uteroplacental perfusion and lead to abnormal FHR patterns, through measures like administering IV fluids or medications as prescribed.
Turning Off Pitocin (Oxytocin):

Discontinuing or reducing the administration of synthetic oxytocin (Pitocin) if it is being used to induce or augment labor. Pitocin can cause or exacerbate abnormal FHR patterns in some cases.
Tocolytic Administration:

Administering tocolytic medications, such as terbutaline, to reduce uterine activity and allow for improved fetal oxygenation. Terbutaline is a smooth muscle relaxant that can help slow down contractions.
Rapid Delivery (As Needed):

Preparing for a rapid delivery if the fetal distress is severe or does not improve with other interventions. This may involve expediting the delivery through techniques such as vacuum extraction or forceps delivery or proceeding with a cesarean section.

84
Q

Must check slide 107, 120 Must

A
85
Q

Must check quizzes starting 121

A
86
Q

Fetal heart rate categories, also known as FHR categories, are used by healthcare providers to assess the well-being of a fetus during labor. The categories are based on patterns observed in the fetal heart rate tracing, which is typically monitored using electronic fetal monitoring (EFM). There are three main categories:

Category I (Normal):
Baseline fetal heart rate: 110-160 beats per minute (BPM).
Moderate variability: Fluctuations in the heart rate that indicate a healthy, responsive nervous system.
Absence of late decelerations: The absence of a consistent pattern of the heart rate slowing down after contractions.
Absence of variable decelerations: The absence of abrupt and temporary decreases in the heart rate that can occur with changes in fetal position or cord compression.
Accelerations may be present: Short-term increases in the heart rate in response to fetal movement or contractions.
Category I is considered reassuring and indicative of a healthy fetal status.

Category II (Indeterminate):

This category includes heart rate tracings that do not fit the criteria for Category I or Category III.
It may include heart rates outside the 110-160 BPM range, minimal variability, or intermittent late or variable decelerations.
Category II tracings are not definitively reassuring or non-reassuring and often require further evaluation or intervention.
Category III (Non-Reassuring):

Baseline fetal heart rate: < 110 BPM or > 160 BPM.
Absent variability: Little to no fluctuation in the heart rate, which may indicate a problem with the fetal nervous system.
Late decelerations: Consistent slowing of the heart rate after contractions, which can suggest compromised oxygen supply to the fetus.
Variable decelerations with bradycardia: Abrupt and significant decreases in the heart rate often associated with cord compression.
Category III tracings are concerning and may require immediate medical attention, such as changes in maternal position, oxygen administration, or even emergency delivery if the situation does not improve.

A
87
Q

Leopold’s maneuvers are a set of four systematic and standardized steps that healthcare providers use to assess the position, presentation, and engagement of the fetus within the mother’s womb during pregnancy. These maneuvers are typically performed by a healthcare professional, such as an obstetrician, midwife, or nurse. The primary purposes of Leopold’s maneuvers are:

Determine Fetal Position and Presentation: Leopold’s maneuvers help the healthcare provider determine the position and presentation of the fetus. This information is essential for assessing the progress of labor and planning for delivery. There are three main fetal presentations:

Cephalic Presentation: The baby’s head is the presenting part, which is the ideal position for a vaginal delivery.
Breech Presentation: The baby’s buttocks or feet are the presenting part, which may require a different approach to delivery.
Transverse or Oblique Presentation: The baby is positioned sideways, which is not favorable for vaginal delivery.
Determine Fetal Engagement: Engagement refers to how deeply the fetal head or presenting part has descended into the mother’s pelvis. Engagement is an important indicator of readiness for labor and delivery. Leopold’s maneuvers can help determine whether the fetus is engaged, partially engaged, or not engaged.

Assess Fetal Lie: Fetal lie refers to the orientation of the fetus within the uterus, whether it is lying longitudinally (lengthwise) or transversely (sideways). Knowing the fetal lie is crucial for planning and monitoring the progress of labor.

Here are the four steps involved in Leopold’s maneuvers:

Step 1: The healthcare provider palpates the upper abdomen to determine the location of the fetal head or buttocks. This helps identify which part is presenting.

Step 2: The provider uses both hands to feel the sides of the abdomen to assess the fetal back and position. This step helps determine the fetal spine’s location.

Step 3: The provider uses one hand to grasp the lower part of the abdomen above the pubic bone to determine the fetal head’s descent into the pelvis and engagement.

Step 4: Finally, the provider palpates the lower abdomen just above the pubic bone to assess the presenting part’s position and confirm the engagement of the fetal head.

Leopold’s maneuvers are a non-invasive and valuable tool for assessing the progress of pregnancy and labor. They help healthcare providers make informed decisions about the best approach to labor and delivery, monitor fetal well-being, and plan for any potential complications or interventions.

A
88
Q

Etymology Dystocia:
The term “dystocia” has its origins in Greek etymology. It is derived from two Greek words:

“Dys” (δύς) - In Greek, “dys” means “difficult” or “abnormal.”

“Tokia” (τοκεία) - “Tokia” in Greek pertains to childbirth or labor.

So, when you combine these two Greek words, “dystocia” essentially means “difficult or abnormal childbirth or labor.”

A

.

89
Q

why does Nitrous Oxide make you laugh ?

A

Nitrous oxide (N2O), often referred to as “laughing gas,” can induce laughter and a sense of euphoria when inhaled in small doses. The exact mechanisms behind why nitrous oxide has this effect on some people are not entirely understood, but it is believed to involve several factors:

Central Nervous System (CNS) Depression: Nitrous oxide acts as a central nervous system depressant, which means it slows down brain activity. In small doses, this can lead to a feeling of relaxation and disinhibition, making people more likely to laugh or experience a sense of well-being.

Release of Endorphins: Nitrous oxide may stimulate the release of endorphins, which are natural chemicals produced by the body that act as painkillers and mood elevators. Endorphins can produce feelings of happiness and euphoria.

Altered Perception: Nitrous oxide can distort a person’s sensory perception, leading to a sense of detachment from reality. This altered perception can contribute to the feeling of amusement or silliness.

Social Environment: The context in which nitrous oxide is used can influence its effects. People often use nitrous oxide in social settings or at events where laughter and celebration are common, which can contribute to the association between nitrous oxide and laughter.

It’s important to note that nitrous oxide, when used recreationally or without proper medical supervision, can be dangerous and even lead to serious health risks, including oxygen deprivation. Therefore, its use should always be controlled and supervised by qualified medical professionals. In medical settings, nitrous oxide is used for anesthesia and pain relief, where its effects are carefully monitored and controlled.

User
what are the main neurotransmitters and thier functions
ChatGPT
Neurotransmitters are chemical messengers that play a crucial role in communication between nerve cells (neurons) in the brain and throughout the nervous system. There are many different neurotransmitters in the human body, each with its own specific functions. Here are some of the main neurotransmitters and their functions:

Acetylcholine (ACh):

Function: Involved in muscle movement, learning, memory, and the regulation of the autonomic nervous system.
Location: Found at neuromuscular junctions and in various parts of the brain.
Dopamine:

Function: Plays a role in reward and pleasure, motor control, mood, attention, and learning.
Location: Concentrated in areas like the substantia nigra and ventral tegmental area of the brain.
Serotonin:

Function: Regulates mood, emotion, sleep, and appetite. It is also involved in blood clotting and digestion.
Location: Primarily found in the brainstem and various parts of the brain.
Norepinephrine (Noradrenaline):

Function: Involved in alertness, arousal, and the “fight or flight” response.
Location: Found throughout the brain and in the autonomic nervous system.
GABA (Gamma-Aminobutyric Acid):

Function: Acts as an inhibitory neurotransmitter, helping to reduce neuronal excitability. It plays a role in relaxation and anxiety reduction.
Location: Distributed widely in the brain.
Glutamate:

Function: Acts as an excitatory neurotransmitter, promoting neural activity and information transmission. It is critical for learning and memory.
Location: Abundant in various regions of the brain.
Endorphins:

Function: Serve as natural painkillers and mood elevators. They are produced in response to stress and pain and contribute to feelings of pleasure and well-being.
Location: Released throughout the body, including the brain and spinal cord.
Histamine:

Function: Regulates wakefulness, appetite, and cognitive functions.
Location: Found in the hypothalamus.
Oxytocin:

Function: Often called the “love hormone” or “bonding hormone,” oxytocin plays a role in social bonding, maternal behavior, and uterine contractions during childbirth.
Location: Produced in the hypothalamus and released by the pituitary gland.
These are just a few of the many neurotransmitters in the human body, and they interact in complex ways to regulate various physiological and psychological functions. Imbalances in neurotransmitters can contribute to a wide range of neurological and psychiatric disorders. Medications and therapies are often used to address these imbalances and manage associated conditions.

User
can you give me a real life example of each one of them
ChatGPT
Certainly! Here are real-life examples of the main neurotransmitters and their functions:

Acetylcholine (ACh):

Real-Life Example: When you reach out to grab an object, acetylcholine is released at the neuromuscular junction, allowing your muscles to contract and control your movement.
Dopamine:

Real-Life Example: The feeling of pleasure and reward you experience when you receive praise, win a game, or enjoy a delicious meal is mediated in part by the release of dopamine in your brain’s reward pathways.
Serotonin:

Real-Life Example: When you feel happy and content after spending time with loved ones or during a sunny day, it’s likely due in part to the release of serotonin, contributing to your positive mood.
Norepinephrine (Noradrenaline):

Real-Life Example: In a stressful situation, your body releases norepinephrine to increase alertness and heart rate, preparing you for the “fight or flight” response.
GABA (Gamma-Aminobutyric Acid):

Real-Life Example: The calming and relaxation effects of having a glass of wine or practicing mindfulness meditation can be attributed, in part, to the increase in GABA activity in the brain.
Glutamate:

Real-Life Example: When you’re learning a new skill or solving a problem, glutamate is involved in the transmission of information between neurons, facilitating memory and cognitive processes.
Endorphins:

Real-Life Example: Runner’s high, experienced after vigorous exercise, is often attributed to the release of endorphins, which reduce pain and induce feelings of euphoria.
Histamine:

Real-Life Example: Histamine is involved in alertness and wakefulness. Antihistamine medications, like those used to treat allergies, can induce drowsiness because they block histamine receptors.
Oxytocin:

Real-Life Example: Oxytocin is released during physical contact, such as hugging or cuddling, and during childbirth to promote uterine contractions and bonding between mother and child.

90
Q

All 3 make up the first stage of labor out of the 4 .

A

‘Early Phase of Labor: This is the initial stage of labor during which the cervix begins to efface (thin out) and dilate (open up). Contractions become regular but are usually mild and may be spaced apart. This phase can last for several hours, and it’s when a woman typically starts to feel some discomfort or pain.

Active Phase of Labor: In this phase, the cervix continues to dilate more rapidly, and contractions become stronger, longer, and closer together. This is when labor becomes more intense, and the woman often needs more support and pain management techniques. The active phase typically continues until the cervix is about 7-10 centimeters dilated.

Transition Phase of Labor: The transition phase is the most intense and challenging part of labor. Contractions are extremely strong, lasting around 45-90 seconds with only 30 seconds to 2 minutes between them. The cervix fully dilates to 10 centimeters during this phase. Women may experience intense pain, nausea, and a sense of pressure as the baby descends into the birth canal. It’s a relatively short but intense phase that precedes the pushing stage of labor.

91
Q

Administration Site:

Spinal: Spinal anesthesia involves injecting medication (local anesthetic and sometimes a small amount of opioid) directly into the cerebrospinal fluid in the subarachnoid space of the spinal cord. This is usually done in the lower back.
Epidural: Epidural anesthesia involves injecting medication (local anesthetic or a combination of local anesthetic and opioid) into the epidural space, which is the space just outside the dura mater of the spinal cord.
Combined Spinal-Epidural (CSE): CSE combines elements of both spinal and epidural anesthesia. It typically involves first performing a spinal injection followed by placing an epidural catheter. This allows for a quick onset of anesthesia (from the spinal injection) and the ability to extend or maintain the anesthesia through the epidural catheter.
Onset and Duration:

Spinal: Spinal anesthesia usually provides a rapid onset of complete anesthesia below the level of injection. However, its duration is relatively short, making it suitable for shorter surgical procedures.
Epidural: Epidural anesthesia has a slower onset compared to spinal anesthesia but can provide prolonged pain relief, making it suitable for longer surgical procedures or for postoperative pain management.
Combined Spinal-Epidural (CSE): CSE combines the rapid onset of spinal anesthesia with the extended duration of epidural anesthesia, offering a flexible option for different types of surgeries.
Level of Anesthesia:

Spinal: Spinal anesthesia typically results in a more profound and extensive block of sensation and motor function since it directly affects the spinal cord.
Epidural: Epidural anesthesia can be adjusted more easily to provide different levels of anesthesia, making it versatile for various surgical needs. It can be used for both partial and complete pain relief.
Combined Spinal-Epidural (CSE): CSE allows for both the rapid onset of spinal anesthesia and the ability to tailor the level and duration of anesthesia through the epidural catheter.
Needle Placement:

Spinal: The needle used for a spinal block is usually smaller and is inserted directly into the subarachnoid space.
Epidural: The epidural needle is larger and is inserted into the epidural space, which is a more superficial layer compared to the subarachnoid space.
Combined Spinal-Epidural (CSE): CSE involves the use of both a spinal needle and an epidural needle.
Complications and Risks:

Spinal: Spinal anesthesia carries a risk of hypotension (low blood pressure) and post-dural puncture headache (commonly referred to as a “spinal headache”).
Epidural: Epidural anesthesia may have a lower risk of post-dural puncture headache but carries a higher risk of unintentional dural puncture during placement.
Combined Spinal-Epidural (CSE): CSE combines the risks associated with both spinal and epidural techniques.
Clinical Applications:

Spinal: Commonly used for procedures involving the lower abdomen, pelvis, and lower extremities.
Epidural: Used for a wide range of surgeries, including labor and delivery, abdominal surgeries, and orthopedic procedures.
Combined Spinal-Epidural (CSE): Often used in obstetrics (e.g., labor epidurals) and other surgical procedures where rapid onset and extended duration of anesthesia are required.

A
92
Q

1- First Stage of Labor: Se divide a su vez en 3

A) Early Labor: This is the initial phase of labor when contractions begin but are usually mild and irregular. The cervix begins to efface (thin) and dilate (open), typically from 0 to around 3-4 centimeters.

B) Active Labor: During this stage, contractions become more regular, frequent, and intense. The cervix continues to dilate, usually from 4 to about 7-8 centimeters. This is the stage when most women head to the hospital or birthing center.

C) Transition to Second Stage: This is the most intense phase of the first stage of labor. Contractions are very strong, close together, and can last up to a minute or more. The cervix completes its dilation, reaching around 10 centimeters. This transition phase can be physically and emotionally challenging for the laboring person.

2- Second Stage of Labor:
During the second stage, the baby moves through the birth canal. Contractions continue, but now the focus shifts to pushing and delivering the baby. This stage ends with the birth of the baby.

3- Third Stage of Labor:
After the baby is born, the third stage of labor begins. During this stage, the placenta (afterbirth) is delivered. This usually happens within a few minutes to up to 30 minutes after the baby’s birth. Healthcare providers will monitor and assist with this process.

4- Fourth Stage of Labor:
The fourth stage is often referred to as the “recovery” stage. It’s the period following the birth of the baby and placenta when the mother’s body begins to stabilize. Vital signs such as blood pressure and heart rate are monitored closely. This stage typically lasts for a few hours after childbirth, during which healthcare providers ensure that the mother and baby are stable and provide any necessary postpartum care.

A

can you use bullet points to explain it ?

Certainly, here’s an explanation of the stages of labor using bullet points:

First Stage of Labor:

Early Labor
Contractions begin (mild and irregular).
Cervix effaces (thins) and dilates (opens) from 0 to around 3-4 centimeters.
Active Labor
Contractions become regular, frequent, and intense.
Cervix dilates from 4 to about 7-8 centimeters.
Transition to Second Stage
Intense contractions.
Cervix completes dilation (around 10 centimeters).
Second Stage of Labor:

Baby moves through the birth canal.
Focus on pushing and delivering the baby.
Ends with the birth of the baby.
Third Stage of Labor:

After the baby is born.
Delivery of the placenta (afterbirth).
Typically occurs within a few minutes to 30 minutes after the baby’s birth.
Fourth Stage of Labor:

Often called the “recovery” stage.
Period following the baby’s birth and placental delivery.
Monitoring the mother’s vital signs.
Ensuring both mother and baby are stable.
Lasts a few hours post-birth.

93
Q

So the location is the same. What varies is the amount of the drug and the effects. One alleviates the pain and the other one completely numbs us

A

Yes, you are correct. Both epidural analgesia and epidural anesthesia involve the administration of medication into the epidural space of the spine, so the location is the same. The key differences lie in the amount and type of medication used, as well as the intended effects:

Epidural Analgesia: This procedure involves the administration of a combination of local anesthetics and opioids in a way that provides pain relief while allowing the patient to maintain some sensation and muscle control. It alleviates pain but doesn’t result in complete numbness or loss of movement.

Epidural Anesthesia: In contrast, epidural anesthesia uses a higher dose of local anesthetics to achieve a more profound and complete block of sensation and muscle control. This results in the patient experiencing a lack of sensation and mobility in the lower part of the body, effectively numbing it and making it suitable for surgery or procedures where the patient should not feel pain.

So, you are correct in noting that the location is the same, but the key differences lie in the dosage and the effects of the medication used, with one aimed at pain relief and the other at creating a state of numbness for more extensive medical procedures.

94
Q

epidural can be to cause an analgesic effect (some numbness) or complete numbness during a longer period of time. Where as spinal anesthesia also known as spinal block causes fast numbness but lasts less time. Then CSE is used to get the benefits of both ?

You’re absolutely correct, and you’ve described the distinctions between epidural, spinal anesthesia (spinal block), and combined spinal-epidural (CSE) anesthesia accurately.

  1. Epidural Anesthesia (Analgesia): Epidural anesthesia can indeed be used to provide a range of effects, from pain relief (analgesia) with some numbness to more profound numbness, depending on the type and amount of medication administered. It’s often used for pain relief during labor and can also be used for surgical procedures. Epidurals can be maintained for an extended period to manage pain during labor or postoperative recovery.
  2. Spinal Anesthesia (Spinal Block): Spinal anesthesia is known for its rapid onset and profound numbness. It’s typically used for shorter surgical procedures or when the goal is complete, immediate anesthesia. However, spinal anesthesia has a limited duration of effect and may not provide long-term pain relief.
  3. Combined Spinal-Epidural (CSE) Anesthesia: CSE anesthesia combines elements of both epidural and spinal anesthesia to provide the benefits of rapid onset and profound initial numbness (from the spinal component) and the option to extend the numbness or provide ongoing pain relief (from the epidural component). This makes it a versatile choice for certain procedures, particularly when the duration of anesthesia or pain relief needs to be tailored to the patient’s needs. CSE is often used in childbirth and for some surgical procedures.

In summary, each type of anesthesia has its own advantages and is chosen based on the specific medical situation, procedure duration, and the level of anesthesia or pain relief required. Epidurals offer a more extended duration with flexibility, spinal anesthesia provides rapid and profound numbness but for a shorter period, and CSE combines aspects of both to provide a balance between rapid onset and potential extended effect. The choice depends on the medical circumstances and the goals of the procedure.

A

cases where we would each one of them during labor?

The choice between epidural, spinal anesthesia (spinal block), and combined spinal-epidural (CSE) anesthesia during labor depends on various factors, including the patient’s preferences, the specific medical situation, and the healthcare provider’s recommendations. Here are some scenarios where each type of anesthesia may be used during labor:

  1. Epidural Analgesia:

Pain Management During Labor: Epidural analgesia is commonly used to manage pain during labor. It allows the laboring person to have pain relief while remaining conscious and able to participate actively in the birthing process. It’s often chosen when the goal is to alleviate pain while maintaining some mobility.
2. Spinal Anesthesia (Spinal Block):

Scheduled Cesarean Section: Spinal anesthesia is often preferred for scheduled cesarean sections because of its rapid onset and profound numbness. It ensures the mother remains comfortable and pain-free during the surgery.
Operative Vaginal Delivery: In cases where an operative vaginal delivery (e.g., forceps or vacuum extraction) is necessary, spinal anesthesia can be used to provide quick and effective anesthesia for the procedure.
3. Combined Spinal-Epidural (CSE) Anesthesia:

Labor with the Option for Rapid Pain Relief: CSE anesthesia combines the benefits of both spinal and epidural techniques. It can be used when a laboring person desires rapid pain relief (spinal component) during the active phase of labor and the option to extend pain relief with an epidural for the remainder of labor.
Uncertain Duration of Labor: CSE may be chosen when the expected duration of labor is uncertain, and the healthcare provider wants to provide effective pain relief without committing to a specific duration.

94
Q

Accelerations:

What Happens: The baby’s heart rate suddenly goes up by at least 15 beats per minute for at least 15 seconds.
What It Means: This is a good sign, showing that the baby is doing well and is healthy. If it lasts for more than 10 minutes, it might set a new normal heart rate for the baby.
Early Decelerations:

What Happens: The baby’s heart rate goes down when the mother has contractions (when the womb squeezes).
What It Means: This is usually okay. It happens because the baby’s head gets squeezed a bit during contractions, but the heart rate goes back to normal quickly.
Variable Decelerations:

What Happens: The baby’s heart rate drops suddenly by at least 15 beats per minute and comes back up, often making a “V” shape on the monitor.
What It Means: These can happen with or without contractions. They need close watching because they can be a sign of a problem, and the baby might need extra attention.
Late Decelerations:

What Happens: The baby’s heart rate goes down during contractions, and the lowest point happens after the peak of the contraction. It goes back to normal after the contraction ends.
What It Means: This is a concerning sign. It could mean the baby isn’t getting enough oxygen, so doctors and nurses need to act quickly to make sure the baby gets the oxygen they need.

A
95
Q

Of course! Let’s simplify the Fetal Heart Rate (FHR) categories:

Category I (Good): This is the best category. It means the baby’s heart rate is normal, with a steady beat between 110 and 160 beats per minute. The heart rate shows some up-and-down movement (variability), and there are no worrisome drops in heart rate during contractions.

Category II (Not Clear): This category is a bit uncertain. It includes different situations:

Category II (A): The heart rate has minimal variability (less up-and-down movement), but there are no concerning drops.
Category II (B): The heart rate shows normal variability, but there may be occasional drops in heart rate.
Category II (C): The heart rate is too slow, below 110 bpm.
Category III (Bad): This is the concerning category. It means there are problems with the baby’s heart rate. It includes:

Very little or no up-and-down movement in the heart rate.
Repeated drops in heart rate after contractions.
The heart rate is too slow (below 110 bpm).

A
96
Q

Interventions:

Fetal bradycardia or tachycardia

A
LION:
* L: position woman on left side
* I: IV fluids or blood administration
* O: give 8 - 10 liters of oxygen by face mask
* N: notify HCP

A
97
Q

What are the 3 parts of the first stage of labor?

LAT:
1. Latent stage
2. Active stage
3. Transition stage

The first stage of labor is typically divided into three distinct phases or stages, not parts. These stages represent the progression of labor as the cervix dilates and the baby descends through the birth canal. The three stages of the first stage of labor are:

Latent Stage:

This is the early phase of labor.
Contractions during this stage are usually mild to moderate in intensity and may be irregular.
Cervical dilation begins during this stage but is often slow, and it may not be very noticeable.
This stage can last for several hours, and it is often a time when the woman is encouraged to stay at home and try to relax.
Active Stage:

This stage follows the latent stage.
Contractions become more regular, stronger, and closer together.
Cervical dilation progresses more rapidly during this stage.
The active stage is further divided into two phases: the “active phase” and the “transition phase.”
Transition Stage:

The transition phase is the final part of the active stage.
Contractions are strong and occur very close together.
Cervical dilation is nearing completion (usually around 8 to 10 centimeters).
Many women experience intense discomfort, pressure, and sometimes a feeling of urgency during this phase.
It is a relatively short phase, typically lasting from minutes to an hour or two.

A
98
Q

Yes, you are correct. VEAL CHOP is an acronym used in obstetrics to help healthcare professionals and students remember the correlation between fetal heart rate patterns (accelerations and decelerations) and their potential causes during labor and delivery. Here’s what VEAL CHOP stands for:

V - Variable decelerations: These are abrupt, sharp decreases in the fetal heart rate that are often associated with cord compression. When you see variable decelerations, you should think “Variable” and “Cord Compression.”

E - Early decelerations: These are gradual decreases and increases in the fetal heart rate that mirror the contractions. Early decelerations are typically caused by head compression during contractions. So, when you see early decelerations, you should think “Early” and “Head Compression.”

A - Accelerations: These are increases in the fetal heart rate and are generally a reassuring sign. When you see accelerations, you should think “Accelerations” and “Okay” or “Reassuring.”

L - Late decelerations: These are gradual decreases in the fetal heart rate that occur after the peak of the contraction. Late decelerations can indicate uteroplacental insufficiency or poor oxygenation. So, when you see late decelerations, you should think “Late” and “Placental Insufficiency.”

C - Cord compression is a potential cause of variable decelerations.

H - Head compression is a potential cause of early decelerations.

O - Oxygenation is a consideration for late decelerations, which can be due to poor oxygen exchange between the mother and fetus.

P - Placental insufficiency is another potential cause of late decelerations, indicating inadequate blood flow through the placenta.

Remembering VEAL CHOP can be helpful in clinical practice and during childbirth education to quickly assess and respond to fetal heart rate patterns and their possible causes, ensuring the well-being of both the mother and the fetus during labor and delivery.

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99
Q

The second stage of labor is indeed a physically intense and demanding phase. During this stage, the cervix is fully dilated, and the woman is actively pushing to deliver the baby. Contractions in the second stage tend to be strong and frequent, which can make it challenging for the woman to focus on anything other than the intense sensations and the process of giving birth.

Many women describe the second stage of labor as a time when their entire attention is directed towards the physical experience of labor, and they may have difficulty thinking about anything else. The urge to push and the sensations of the baby moving through the birth canal can be overwhelming.

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100
Q

Fetal lie describes the position of the long axis of the fetus in relation to the long axis of the pregnant woman.

ChatGPT
Yes, you are correct. Fetal lie refers to the orientation or position of the long axis of the fetus within the pregnant woman’s womb, specifically in relation to the long axis of the pregnant woman’s body. This orientation can be described in one of three ways:

Longitudinal Lie: In this position, the long axis of the fetus is parallel to the long axis of the mother. This is the most common fetal lie and is considered the ideal position for a vaginal delivery.

Transverse Lie: In this position, the fetus is lying horizontally across the mother’s uterus, perpendicular to her long axis. Transverse lie is not conducive to a vaginal birth and may require medical intervention, such as a cesarean section.

Oblique Lie: In an oblique lie, the fetus is at an angle between the longitudinal and transverse positions. This position may also necessitate medical management or a cesarean section.

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101
Q

Prolonged Decelerations:

Associated Causes: Prolonged decelerations can be caused by factors like prolonged cord compression, placental abruption (abruptio placentae), cord prolapse, maternal position (especially a supine position), maternal seizures, regional anesthesia, or uterine rupture.
Significance: Prolonged decelerations are concerning and may indicate significant fetal distress. They often require prompt medical intervention to address the underlying cause and ensure the well-being of the fetus.
Variable Decelerations:

Associated Causes: Variable decelerations can occur due to umbilical cord compression. They are the most common type of deceleration.
Significance: Variable decelerations are usually transient and correctable. They may not always indicate fetal distress, but their management depends on the degree and duration of the decelerations.
Early Decelerations:

Associated Causes: Early decelerations are thought to result from fetal head compression during contractions.
Significance: Early decelerations are generally considered benign and not indicative of fetal distress. They do not typically require intervention, as they are a normal response to the pressure on the fetal head during uterine contractions.
Fetal Accelerations:

Associated Causes: Fetal accelerations are transitory increases in FHR and are a sign of fetal well-being.
Significance: Fetal accelerations are reassuring and provide evidence that the fetus is coping well with the stress of labor. They are a positive sign and are typically associated with a healthy fetus.

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