module 4 Flashcards
1
Q
framin labor pain
A
-educate on the purpose of the pain: cervical change
-educate on how to deal with pain: deep breathing,
-tell that it is intermittent
-
2
Q
what does one need give birth?
A
- privacy
- the feeling of safety
- unobserved
- no distractions
- need for saftey is primal, embedded in the midbrain limbic system. you cant talk yourself into feeling safe
3
Q
positive feedback loops
A
- body’s design for safety, ease, and pleasure
- this loop is easiest to disrupt in early labor
- hormones promote mother-baby bonding and breastfeeding
- feedback loop is driven by sensation
4
Q
early labor
A
- the first stage of labor usually comes with visceral pain
- the cervix will dilate from closed to 6 cms. effacement begins
- the contraction pattern is every 5-20 minutes for 30-40 seconds
- the average length is 6-12 hours but can be more than 24 hours
- if in the hospital, there is typically documentation every 30 mins
5
Q
moms in early labor
A
- should conserve their energy as much as possible
- emotion, denial.
- distraction is important for this stage of labor: showers with warm water, light snacks, and drinks, light activities
- time contractions
6
Q
assessment during the first stage
A
- prenatal data
- interview
- admission data
- stress assessment
- cultural factors
- physical exam
7
Q
physical assessment at first stage of labor
A
- general systems assessment
- vital signs
- Leopold maneuvers
- assessment of fetal heart rate and pattern
- assessment of uterine contractions
- vaginal exam (depending on where you are)
8
Q
fetal assessment
A
fetal position
assessment of fetal HR
9
Q
how to determine fetal position?
A
- Leopold maneuver: identify what part of the fetus is at the fundus, next look for the smooth convex on the fetal back and arms and legs, next determine the fetal part that is presenting over the inlet of the true pelvis and finally determine if the head is engaged or not
- vaginal exam
- ultrasound exam
10
Q
assessment of the fetal heart rate
A
- objective: assess the adequacy of fetal oxygenation during labor.
- auscultation (intermittent).
- electric fetal monitoring: internal (fetal spiral electrode) external(ultrasound transducer)
11
Q
laboratory and diagnostic tests first stage of labor
A
- analysis of urine specimen: urinary analysis
- blood tests: routine CBC
- syphilis screening, HbsAg screening, GBS, HIV, and possibly drug screening
- if there’s a ROM, assess the amniotic membranes and fluid for infection
12
Q
assessment of uterine contractions
A
frequency
intensity: nose, chin, forehead
duration
resing tone
13
Q
active labor
A
the second part of the first stage of labor
- dilation from 6 cms to 8 cms
- the cervix is fully effaced meaning it is thinned and open.
- contraction pattern is every 2-5 minutes with a duration of 45-60 seconds
- during this stage, documentation is done every 15 minutes
14
Q
presentation of the baby’s head during active labor
A
the baby’s head is facing the mother’s side. in this position, the widest part of the baby’s head is in the wides part of the mother’s pelvis
15
Q
moms in active labor
A
- hydration is important
- changing position and movement help cope
- relax as much as possible
- breathing
- partner support is important both emotional and physical with pressure or massage
16
Q
assess for a rupture of membranes
A
you want the mom to report color, odor, amount, and timing
- is the fluid coming out of the vagina, if yes test with nitrazine paper and if it turns blue there is likely a rupture
- ferning test: fern-like patterns present mean there is likely amniotic fluid
17
Q
first stage of labor nursing interventions
A
- hygiene
- hydration either orally or via IV(125 cc per hour)
- elimination: voiding q2h, straight cath (want to avoid), Bowel Elim, ambulation and positioning
18
Q
transition stage of labor
A
- the cervix completes the process of dilation
- the baby begins to rotate toward the mother’s backbone with the chin ticked to the chest
- this is the best position for birth because the head must align with the widest part of the mother’s pelvic outlet
- contractions are every 2-3 minutes and last for 60-90 seconds
19
Q
what is considered the second stage of labor
A
Pushing
- 10 cm, fully effaced and feeling pressure
- there is a strong urge to bear down and a burning sensation of the perineum from stretching
- contractions are less frequent lasting 60-90 seconds every 3-5 minutes
- usually lasts 1-3 hours but can be longer especially with an epidural
- each push is about 6-8 seconds
- ends with the birth of the baby
20
Q
there are two phases of the second stage of labor what are they
A
- latent phase: relatively calm with passive descent of the baby through the birth canal
- descent: active pushing and urges to bear down
21
Q
vertex position progression
A
When you give birth, your baby usually comes out headfirst, also called the vertex position. first is anteroposterior slit, then oval opening, the circular shape, then corwning
22
Q
ritgen maneuver
A
control of the head during labor. slow extraction to prevent tears
23
Q
perineal trauma related to childbirth
A
perineal laceration
vaginal and urethral laceration
cervical injury
episiotomy: mediolateral if median
24
Q
third stage of labor
A
delivery of the placenta
want it to easily come off of the uterus like tearing the aluminum foil
-firmly contracting fundus
-change in the shape of the uterus
-a sudden gush of dark blood from introitus (opening)
-apparent lengthening of the umbilical cord
-vaginal fullness
25
fourth stage of labor
- assessment
- post anesthesia recovery
- care of the new mother
- care of the family
- newborn relationships
26
maternal assessment during fourth stage of labor
- blood pressure every 15 minutes for the first 2 hours
- pulse: assess rate and regularity. Assess every 15 for the first 2h
- temperature: assess at the beginning of the recovery period. then every 4 h after for the first 8h then once every 8 h
- fundus check: should be at the umbilicus at the midline
- lochiaL amount, color, consistency, odor
- perineum: episiotomy and lasceration (REEDA)
27
visceral pain
from cervical changes, distension of lower uterine segment, and uterine ishemia. located over the lower portion of the abdomen
28
somatic pain
pain described as intense, sharp, burning, and localized. due to stretching and distension of perineal tissues and pelvic floor to allow passage of the fetus from distinction and traction on the peritoneum and uterocervical supports during contractions and lacerations o soft tissue
29
referred pain
originates in the uterus, radiates to the abdominal wall, lumbosacral area of the black, iliac crests, gluteal area, and down the things
30
pain during the stages of labor
first stage: visceral
second stage: somatic pain
Third stage: similar to the first stage
31
perception of pain
threshold remarkably similar in all regardless of gender, social, thing, or cultural differences
- differences play a definite role in a person's perception of and behavioral response to pain
- pain tolerance refers to the level of pain a woman is willing to endure
32
emotional expressions of suffering often seen
- increased anxiety
- writhing, crying, groaning, gesturing, excessive muscular excitability
- a cultural expression of pain varies
33
non pharmacologic pain interventions
- childbirth preparation
- relaxation and breathing
- counter pressure
- touch and massage
- continuous support
- application of heat and cold
- ambulation
- acupressure and acupuncture
- TENS
- warm water
- aromatherapy and imaging
34
how can nurses provide labor support
- convey respect
- create a clam environment
- discuss clients values and preferences
- provide encouragement
- advocate for client
35
upright positions
use gravity to rotate the baby into the anterior position and head descend and increases pressure on cervix
- walking, slow dancing
- sitting: kees lower than hips
36
forward leaning positons
use gravity to help the baby turn and align in the pelvis
sitting
standing
rocking on hand and knees
37
asymmetrical positions
offer good traction and support person must be with you to maintain balance
- stair claiming
- kneeling lunges
- standing lunges
38
benefits of non pharmacological pain management
-provide a sense of control over childbirth safe, inexpensive
39
pharmacologic pain management
- sedative
| - analgesia and anesthesia
40
systemic analgesia
-typically parenterally through an IV line
-can be inhaled: nitrous oxide
-drugs: Opioids: butorphanol, nalbuphine, meperidine, fentanyl
antiemetics and ataractics: hydroxyzine, promethazine
benzodiazepines: diazepam, midazolam
41
regional analgesia and anesthesia
- epidural block: continuous infusion or intermittent injection usually stated when dilations above 5 cm
- combined spinal-epidural block (CSE): patient-controlled epidural
- spinal during a cesarean birth
42
when are pudendal nerve blocks used?
required when a vacuum or forceps are used for delivery. can also be used for a second stage laceration, episiotomy, or operative vaginal birth
43
when is local infiltration used
usually for episiotomy or lasceration repair
44
positioning for epidural and spinal
at the bedside wither dangling feet of laying on the side
45
epidural risks
- drop in BP, immobility, slowing of labor, increased need for other interventions, increased use of forceps and vacuums and increase in tears
- can cause a decrease in metal blood oxygen supple, decrease in HR, can cross the placenta, drowsy at birth with trouble breastfeeding
46
general anesthesia
emergency cesarean birth or woman with contraindication of regional
- can be iv or inhalation
- usually iv then intubated and unconsciousness maintained
47
spinal special implication
can be inserted into the spinal fluid space and cause a leach causing a spinal headache. this is relieved with a blood patch to fill the hole.
