Module 2 Labor, Birth, and Post Partum Flashcards
Any medication that suppresses contractions makes your blood pressure go up or down?
Go down
What are the 5 factors that affect the labor process?
Passenger, Powers, Passageway, Position, and Psychological Status
Who is the passenger?
The fetus and the placenta
Define power.
Uterine contractions cause effacement during the first stage of labor and dilation of the cervix that occurs once labor has started and the fetus is descending.
What is the passageway?
The birth canal
Define position. (5 factors that affect the labor process)
The client should change positions during labor to increase comfort, relieve fatigue, and promote circulation.
Involuntary urge to _____ and voluntary ______ ______ in the second stage of labor helps in the evacuation of the fetus.
Push, Bear Down
What is effacement?
The shortening and thinning of the cervix.
What is the introitus?
The vaginal opening
The size of the fetal ____, fetal ______, fetal ___, fetal ________, and fetal _______ affect the ability of the fetus to navigate the birth canal.
Head, Presentation, Lie, Attitude, and Position
When the membranes rupture, what do you think is the priority nursing action?
Assess the fetal heart rate.
Any alteration to the five P’s will _____ labor.
Slow
Pneumonic for TRUE Labor:
T: Timing of contractions- can be irregular then become regular increasing in frequency.
R: Radiating contraction pain that begins in the lower back and radiates to the abdomen.
U: Unable to relieve w/ activity. Walking can increase contraction intensity.
E: Effacement: True labor leads to dilation of the cervix and effacement (the shortening and thinning of the cervix.
Pneumonic for TRUE Labor:
T: Timing of contractions- can be irregular then become regular increasing in frequency.
R: Radiating contraction pain that begins in the lower back and radiates to the abdomen.
U: Unable to relieve w/ activity. Walking can increase contraction intensity.
E: Effacement: True labor leads to dilation of the cervix and effacement (the shortening and thinning of the cervix.
Pneumonic for FALSE Labor:
F: Fails to cause changes- No significant change in dilation or effacement.
A: Activity diminishes contractions
K: Keep feeling contractions above the belly button. (or felt in lower back, but does NOT radiate)
E: Erratic timing of contractions- The contractions are painless, irregular, and intermittent.
Pneumonic for FALSE Labor:
F: Fails to cause changes- No significant change in dilation or effacement.
A: Activity diminishes contractions
K: Keep feeling contractions above the belly button. (or felt in lower back, but does NOT radiate)
E: Erratic timing of contractions- The contractions are painless, irregular, and intermittent.
Name the characteristics of TRUE Labor.
True labor leads to cervical dilation and effacement,
Contractions can begin irregularly, but become regular in frequency, Contractions are stronger, last longer, and are more frequent, Contractions are felt in the lower back, then radiating to the abdomen, Walking can INCREASE contraction intensity, Contractions continue despite efforts to provide comfort, The cervix has a progressive change in dilation and effacement and moves to an anterior position, BLOODY SHOW, Fetus; the presenting part engages in pelvis.
Name the characteristics of FALSE Labor.
Contractions are painless, irregular frequency, and intermittent, Contractions decrease in frequency, duration, and intensity with walking or position changes, The contractions are felt in the lower back OR abdomen ABOVE the umbilicus. (Does NOT radiate), The contractions often stop with sleep or comfort measures (oral hydration, EMPTYING THE BLADDER), There is no significant change in cervix dilation or effacement, Often remains in the posterior position, NO SIGNIFIGANT BLOODY SHOW, Fetus: the presenting part is not engaged in the pelvis.
In vaginal exams, what are we assessing?
Cervical dilation, Descent of the fetus through the birth canal, Fetal position, Presenting part, and lie, Membranes that are intact or ruptured
What assessment data should be gathered upon admission?
Maternal and fetal well-being during labor, the progress of labor, psychosocial and cultural factors that affect labor, vitals, etc.
What are Leopold maneuvers?
Leopold maneuvers consist of feeling the uterus through the abdominal wall to determine the number of fetuses, presenting part, fetal lie, and fetal attitude, the degree of the presenting part into the pelvis, location of the fetus’s back to assess for fetal heart tones.
How should a client be positioned when performing Leopold maneuvers?
Supine position with a pillow under the head, and have both knees slightly flexed.
What should you ask the client to do before beginning Leopold maneuvers?
Empty their bladder
What should you do to prevent supine hypotensive syndrome when performing Leopold maneuvers?
Place a small, rolled towel under the client’s right or left hip to displace the uterus off the major blood vessels.
For VERTEX presentation, where should fetal heart tones be assessed?
Below the clients belly button (umbilicus) in either the right- or left- lower quadrant of the abdomen.
For BREECH presentation, where should fetal heart tones be assessed?
Above the clients belly button in either the right- or left- upper quadrant of the abdomen.
Describe lightening regarding physiological changes preceding labor.
The process of the fetus settling or lowering into the true pelvis about 14 days before labor; the feeling that the fetus has “dropped”; it makes for easier breathing, but it does put more pressure on the bladder causing urinary frequency and it is more pronounced in clients who are primigravida.
Describe uterine contractions regarding physiological changes preceding labor.
They begin with irregular uterine contractions (Braxton Hicks) that eventually get stronger and more regular.
Describe vaginal discharge or bloody show regarding physiological changes preceding labor.
Brownish or blood-tinged mucus plug resulting from the onset of cervical dilation and effacement. Expulsion (getting something out of the body) of the cervical mucus plug may occur.
Describe energy burst regarding physiological changes preceding labor.
Sometimes called “nesting” response. (the urge to clean and organize)
Describe the GI changes regarding physiological changes preceding labor.
They are less common but inclue, nausea, vomiting, or indigestion.
For a vaginal exam preceding labor, what do we wear especially if the water is broken?
Sterile Gloves
What lab test would confirm the premature rupture of membranes?
Positive nitrazine paper test
When is the assessment of amniotic fluid done?
Once the membranes rupture
What should the amniotic fluid look like?
Watery, clear, and have a slight yellow tinge.
Odor should NOT be foul.
What should be the volume of amniotic fluid?
700 to 1,000 mL
Describe cervical ripening.
The cervix becomes soft (opens) and partially effaced, and can begin to dilate.
Labor usually occurs within __ hours of the rupture of membranes.
24
Prolonged rupture of membranes GREATER than 24 hours before delivery of fetus can lead to a(n) ________.
Infection
How do we assess uterine labor contraction characteristics?
palpation (placing a hand over the fundus), or by external or internal fetal monitoring.
Established from the beginning of one contraction to the end of beginning of the next.
Frequency of contractions
The time between the beginning of a contraction to the end of that same contraction.
Duration
The strength of the contraction at its peak, described as mild, moderate, or strong.
Intensity
Describe how a MILD contraction would feel upon palpation.
Slightly tense, like pressing finger tip of nose
Describe how a MODERATE contraction would feel upon palpation.
Firm, like pressing finger to chin.
Describe how a STRONG contraction would feel upon palpation.
Rigid, like pressing finger to forehead.
Tone of the uterine muscle between contractions.
Resting tone of uterine contractions.
If the baby CAN NOT fit through the pelvis, what happens?
A c-section will be performed.
What is the circumference of the pelvic inlet? (to know if baby can fit through)
385mm
The circumference of the babies head should be ____ to ____ to be able to fit through the mothers 385 mm pelvic inlet.
320-370 mm
If a client tells you they have experienced a gush or leakage of clear fluid from the vagina, what has happened?
Rupture of membranes
Abrupt FHR variable or prolonged deceleration and a visible or palpable cord at the vaginal opening indicate what complication of rupture of membranes?
Prolapsed umbilical cord
What cephalic (head) presentation is IDEAL for birth?
Vertex
Is there anything you can do to fix a cephalic presentation that is NOT ideal?
No
What are the four different cephalic presentations?
Vertex, military, brow, and face
Describe breech presentation.
The fetus’s bottom is first and NOT the head. It has a higher risk for complications, and most HCP want a c-section.
What are the two best fetal positions?
ROA and LOA.
Describe station.
How far the baby is coming down.
How we measure the opening of the cervix. (0-10 cm)
Dilation
What happens in the latent phase of labor?
The client will have irregular/ mild/ moderate contractions. And it is VERY EARLY labor.
How many cm dilated is the mother during the latent phase of labor?
0-3 cm.
What is the frequency of contractions during the latent phase of labor?
5 to 30 min
What is the duration of contractions during the latent phase of labor?
30 to 45 seconds
What happens during the active phase of labor?
Contractions are more regular, and are moderate to strong.
What are the frequency of contractions during the active phase of labor?
3 to 5 min.
What are the duration of contractions during the active phase of labor?
40 to 70 seconds
How many cm dilated is the patient during the active phase of labor?
4 to 7 cm
What happens during the transition phase of labor?
Contractions are strong to very strong.
What is the frequency of contractions during the transition stage of labor?
2 to 3 mins
What is the duration of contractions during the transition stage of labor?
45 to 90 seconds
How many cm dilated is the patient during the transition phase of labor?
8 to 10 cm
Describe what happens during the second stage of labor.
Full dilation, Progreses to intense contractions every 1 to 2 min. The client is pushing. Crowning.
Describe what happens during the third stage of labor.
The delivery of the neonate TO the delivery of the placenta.
Describe what happens during the fourth stage of labor.
The delivery of the placenta until 2 hours after delivery.
What are some nursing actions done during the latent, active, and transition phases of labor?
Vaginal exam to monitor the progress of cervix of fetal descent, encourage frequent voiding, prepare for delivery, monitor the FHR
What are some nursing actions done during the second stage of labor?
Monitoring the patient and the fetus, assiting with pushing and resting
What are some nursing actions done during the third stage of labor?
Administering an analgesics as needed, promoting bonding, assessing vital signs every 15 mins
Waht are some nursing actions done during the fourth stage of labor?
Maternal stabilization of vital signs every 15 min, assessing the fundus and lochia every 15 min, encourage voiding, promote rest
During an epidural and spinal block what should you as the nurse remember to do?
Monitor the mothers blood pressure for possible hypotension and the baby.
What is the normal range for a fetal heart rate?
110-160
What are the different types of fetal heart rate monitors?
Continuous electronic fetal monitoring, Continuous internal fetal monitoring
What are the different types of uterus monitors?
Tocodynamometer, and intrauterine pressure catheter
What does a tocodynamometer do?
Measures the frequency of contractions
What does a intrauterine pressure catheter do?
Measures the frequency and strength of contractions.
Describe fetal heart rate variability.
It is the prescence of instantaneous varriation in HR from beat to beat; it is an indicator of fetal well being.
If the FHR has MARKED variability how many BPM?
Greater than 25
If the FHR has MODERATE variability how many BPM?
Variation from 6 to 25 BPM- GOOD this is what we want
Describe absent & minimal variability.
It could be okay or bad, the baby may be asleep.
When do early decelerations occur?
With the onset of uterine contractions.
When do late decelerations occur?
Follows the onset of uterine contractions
When do prolonged decelerations occur?
It stays down
What should you look at if decelerations are early or late?
FHR and uterine contractions
When do variable decelerations occur?
Irregardless of onset of uterine contractions
Decelerations Pneumonic: VEAL CHOP V- Variable ----- C- Cord Compression E-Early----- ------ H- Head Compression A-Acceleration--O - Okay or oxygen L-Late-------------P- Placental Insufficency
Decelerations Pneumonic: VEAL CHOP V- Variable ----- C- Cord Compression E-Early----- ------ H- Head Compression A-Acceleration--O - Okay or oxygen L-Late-------------P- Placental Insufficency
What is the primary concern with minimal or absent variability?
If it lasts over an hour, could be problem.
What are the nursing actions for minimal or absent variability?
Continue to monitor, position changes
Are there any primary concerns or nursing actions with moderate variability and early decelerations?
No
What are some nursing interventions for variable decelerations?
Change positions, give oxygen , if consistent call doctor
What is the primary concern with late decelerations?
The baby is not getting enough blood/o2 supply. (placental insufficiency)
Where do you place a FHR monitor?
on the baby’s shoulder
What are some nursing interventions for late decelerations?
Change positions- side lying, apply a non-rebreather O2 at 10 L/min, turn off pitocin, Increase IV fluids, call HCP, prep for c-section
More than __ uterine contractions in ___ mins or __ uterine contractions lasting more than ___ seconds in duration is tachysystole and requires intervention.
5 UC, 10 mins or 2 UC, 120 seconds
FHR less than 110/min for 10 min or more.
Fetal bradycardia
FHR greater than 160/min for 10 min or more.
Fetal tachycardia
What are some nursing interventions for fetal bradycardia?
Change positions- side lying, apply a non-rebreather O2 at 10 L/min, turn off pitocin, Increase IV fluids, call HCP, administer a tocolytic
What are some nursing interventions for fetal tachycardia?
Administer antipyretics for maternal fever if present, apply a non-rebreather O2 at 10 L/min, Administer fluids
If you visualize or palpate the umbilical cord protruding from the introitus, the FHR monitor shows variable or prolonged deceleration, and there is excessive fetal activity followed by cessation of fetal movement, and the client states they feel something coming through the vagina, what might this indicate?
Prolapsed umbilical cord
Is a prolapsed umbilical cord an emergency?
Yes - call for help and prepare for c-section
What are some nursing actions related to a prolapsed umbilical cord?
Call for help and prepare for c-section, apply pressure to presenting part to remove pressure from the cord, reposition to knee-chest, trendelenburg, or side-lying.
What should you do after you perform leopolds maneuvers? Why?
Auscultate the FHR and to assess the fetal tolerance to the procedure
Greenish, blackish, yellow amniotic fluid.
Meconium- stained amniotic fluid
What should you do if your client has meconium stained amniotic fluid?
Notify the nursery for the neonatal resusitation team to be present at birth, monitor the FHR, suction below the vocal cords using an endotracheal tube before spontaneous breath occur if respirations are depressed, muscle tone decreased, and HR less than 100/min, suction mouth and nose using bulb syringe if respiratory efforts are strong, muscle tone good, and HR greater than 100/min.
A difficult or abnormal labor related to the 5 P’s of labor. Atypical uterine contraction patterns prevent the normal process of labor and its progression. Contractions can be hypo or hypertonic.
Dystocia (dysfunctional labor)
The client is ineffective in pushing with no voluntary urge to bear down, there is a lack of progress in dilation, effacement, or fetal descent during labor.
Dystocia (dysfunctional labor)
What are some nursing actions you can perform for a client who is in Dystocia?
Encourage regular voiding, change positions (comfortable positions) (on both hands and knees), encourage ambulation, coach on pushing, promote relaxation, apply counterpressure to sacral area for discomfort, prepare for a possible forceps-assisted, vacuum-assisted, or c-section birth, continue monitoring FHR
Labor that lasts 3 hr or less from the onset of contractions to the time of delivery.
Precipitous labor
The client has a low back ache, abdominal pressure or cramping, increased or bloody vaginal discharge, quickly changing cerival dilation and effacement, diarrhea, fetal presentation, station, and position, and the membranes are ruptured. (but membranes can also be in tact) What do these findings indicate?
Precipitous labor
What are some nursing actions related to precipitous labor?
Side-lying position changes, do NOT leave unattended, control the urge to push, do not attempt to stop delivery, control rapid delivery by applying pressure to the perinal area and fetal head, gently pressing upward toward vagina, assess for complications of precipitous labor
Involves the wall of the uterus, peritoneal cavity, and/or broad ligament. Internal bleeding is present. Rare but life-threatening. EMERGENCY.
Complete uterine rupture
Dehiscence of uterus at the site of a prior scar (c-section, surgical intervention). Internal bleeding might not be present. Rare but life-threatening. EMERGENCY.
Incomplete uterine rupture
The client reports a sensation of “ripping”, “tearing”, or sharp pain. Also reports abdominal pain, uterine tenderness. The FHR is nonreassuring with indications of distress, there is a change in uterine shape and fetal parts are palpable, cessation of contractions and there is a loss of fetal station, and the client shows manifestations of hypovolemic shock.
Uterine rupture
What are some nursing actions you perform if your client has a uterine rupture?
Administer IV fluids, administer oxygen, administer blood products as prescribed, prepare the client for an immediate c-section
Occurs when there is a rupture in the amniotic sac or maternal uterine veins accompanied by high intrauterine pressure that causes infiltration of the amniotic fluid into the maternal circulation. It can occur during, labor, birth, or 30 min. following birth.
Anaphylactoid syndrome of pregnancy (amniotic fluid embolism)
The client reports sudden chest pain and SOB, there are indications of respiratory distress, coagulation failure, and circulatory collapse.
Anaphylactoid syndrome of pregnancy (amniotic fluid embolism)
What are some nursing actions you perform if your patient has anaphylactoid syndrome of pregnancy (amniotic fluid embolism)?
Administer oxygen via mask 8-10 L/min, reform CPR if necessary, Admin IV fluids, position client on side, admin blood products, insert urinary catheter and measure output, monitor maternal and fetal status, prepare the client for emergency c-section if the fetus is not yet delivered.
What ar some non-pharmacological methods of controlling pain during labor?
aromatherapy, breathing techniques, imagery, music, use of focal points, subdued lighting, back rubs and massage, walking, rocking, effleurage, sacral counterpressure, application of heat/cold, transcutaneous electric nerve stimulation, hydrotherapy, acupressure, frequent maternal position changes, child birth education, childbirth prep methods, Doulas, hypnosis, biofeedback
What are some pharmacological methods of controlling pain during labor?
Opioid analgesics, (ondansteron and metoclopramide- non analgesic but used w/ analgesics to control nausea and anxiety), epidural and spinal regional analgesia
The delivery of the fetus through a transabdominal incision of the uterus to preserve the life or health of the client and fetus when there is evidence of complications.
Cescarean birth
During a cescarean birth, during the procedure, what are some nursing actions you should implement?
Monitor the FHR, continue to monitor vital signs, IV fluids, and urinary output
Before a cescarean birth, what are some nursing actions you should implement?
Obtain informed consent, assess and record FHR and vitals, assist w/ultrasounds, position client supin w/wedge under one hip, insert a urinary catheter, Apply SCD’s,
After a cescarean birth, what are some nursing actions you should implement?
Monitor for infection and bleeding of insertion site, assess the fundus for firmness and tenderness, assess the lochia amount and characteristics, monitor I & O, monitor vitals, provide pain relief, encourage turning, coughing, and deep breathing, encourage splinting of incision w pillows, encourage ambulation
What are the three greatest risks during the postpartum period?
hemorrhage, shock, infection
Focused Assessment Pneumonic: B: Breasts U: Uterus B: Bowel B: Bladder L: Lochia E: Episiotomy
Focused Assessment Pneumonic: B: Breasts U: Uterus B: Bowel B: Bladder L: Lochia E: Episiotomy
A patient is 1 hour out of delivery, where should the fundus be?
At the level of the umbilicus
Every 24 hr, the fundus should descend approximately __ to __ cm.
1 to 2
After about 2 weeks, the fundus should lie within the ____ _____ and should not be _________.
true pelvis, palpable
Encourage early breast feeding for a client who is lactating. This will stimulate the production of ______ and prevent ________.
Oxytocin, hemorrhage
Physical changes of the uterus include _______ of the uterus. _______ occurs with contractions of the uterine smooth muscle, whereby the uterus returns to its prepregnant state.
Involution, Involution
The fundus should be _____ and not _____.
firm, boggy
If the fundus is boggy, what should you as the nurse do?
Massage it
If the uterus does not firm after massaging, what should you do?
Keep massaging and notify the HCP.
Is postpartum blues expected or unexpected?
expected but it doesnt happen in everyone
_______ and ______ occur within the first 2 to 5 days after delivery, and rid the body of the excess fluid accumulated during the last part of pregnancy.
Diaphoresis and Diuresis
Hematocrit levels ____ moderately for 3 to 4 days then begin to ______ and reach nonpregant levels by 8 weeks postpartum.
drop, increase
During the first 4 to 7 days after birth, WBC values between _______ and _______ mm3 are common.
20,000 and 25,000 mm3
Coagulation factors and fibrinogen levels _____ during pregnancy and remain _______ in the immediate postpartum period. Hypercoagability predisposed the postpartum client to thrombus formation and thromboembolism.
increase and remain elevated
Is there a change in blood pressure during the postpartum period?
No, maybe a slight increase but normally remains unchanged.
Possible _____ _____ within the first 48 hours postpartum can occur immediately after standing up.
Orthostatic hypotension
You should encourage frequent voiding in a postpartum client to prevent what two things?
uterine displacement and uterine atony
Lochia characteristics:
Dark red color, bloody consistency, fleshy odor, can contain small clots, lasts 1 to 3 days after delivery.
Rubra
Lochia characteristics:
Pinkish, brown color, and serosanguineous consistency. Can contain small clots and leukocytes, lasts for approximately day 4 to day 10 after delivery.
Serosa
Lochia characteristics:
Yellowish white creamy color, fleshy odor. Can consist of mucus and leukocytes. Lasts from day 10 up to 8 weeks postpartum.
Alba
Lochia typically ____ from the vaginal opening but ____ more steadily during uterine contractions.
trickles, flows
How often should you check for lochia for the first hour after delivery?
Every 15 min
If a c-section was performed, the amount of bleeding will be ______.
decreased
Excessive spurting of bright red vlood from the vagina, numerous large clots and excessive blood loss (saturated pads in 15 min or less), foul odor, persistent heavy lochia rubra in the early postpartum period beyond day 3, continued flow of lochia serosa or alba beyond the normal length of time especially if it is accompanied by fever, pain, or abdominal tenderness.
UNEXPECTED FINDINGS POSTPARTUM IN LOCHIA
The cervix is soft directly after birth and can be edematous, bruised, and have small lacerations, within 2 to 3 days postpartum, it shortens, regains its form and becomes firm, lacerations to the cervix can decrease the amount of cervical mucus.
EXPECTED FINDINGS OF THE CERVIX POSTPARTUM
The vagina gradually returns to its prepregnancy size with the reappearance of rugae and a thickening of the vaginal mucousa, muscle tone is never restored completely, breastfeeding increases the incidence of vaginal dryness and atrophy.
EXPECTED FINDINGS OF THE VAGINA POSTPARTUM
The soft tissues of the perineum can be erythematous and edematous, especially in areas of an episiotomy or lacerations, hematomas or hemorrhoids can be present, pelvic floor muscles can be overstretched and weak.
EXPECTED FINDINGS OF THE PERINEUM POSTPARTUM
A bright red trickle of blood from the episiotomy site in early postpartum is a ________ finding.
normal
Colostrum transitions to mature milk by about 72 to 96 hours after birth, engorgment of the breast
EXPECTED FINDINGS OF THE BREAST POSTPARTUM
Erythema, breast tenderness, cracked nipples, are expected or unexpected findings of the breast postpartum?
unexpected - infection (mastitis)
What is colostrum?
early milk
Elevation of pulse, stroke volume, and cardiac output for the first hour postpartum occurs and then gradually _____ to a prepregnant baseline by 6 to 8 weeks. (expected finding postpartum)
decreases
Due to elevations in stroke volume during the first 2 days after delivery, the heart rate can be as low as _____. This is called puerperal _________ and this is a common finding.
40/min, bradycardia
Should tachycardia in the postpartum period be evaluated?
yes
Is an elevation in temperature the first 24 hours after labor an expected or unexpected finding?
expected
Increased appetite following delivery, constipation, hemorrhoids, flatus (after c-section birth)
EXPECTED GI FINDINGS POSTPARTUM
______ and _______ are contraindicated for clients who have third- or fourth- degree perineal lacerations.
Enemas and suppositories
Postpartal diuresis w/ increased urinary output begins within __ hr of delivery
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