Nursing Care during Labor Flashcards
1
Q
T/F
Exact cause of labor onset is not clearly understood
A
True.
We know that during late pregnancy the myometrium is triggered to begin labor somehow.
2
Q
How can infections affect onset of labor?
A
If a woman has an infection, they are more likely to have preterm labor.
3
Q
Explain the Progesterone Withdrawal Theory for onset of labor
A
Progesterone quiets the uterus & so around labor we have less of progesterone for the uterus & so labor starts
4
Q
What is the Prostaglandin hypothesis for onset of labor
A
Prostaglandins can ripen or soften the cervix. Such as Prostaglandin E which responds to Oxytocin in order for labor to initiate.
5
Q
How can the fetal role affect onset of labor
A
Baby’s with part of brain missing or anencephaly will go past 41 weeks.
The hypothalamus, pituitary, and adrenal cortex may play a role here.
6
Q
What does it mean to be a Premonitory sign of labor?
A
Early sign of labor.
7
Q
Your patient who is a primipara or first PG mom had lightening (dropping) occur recently but your other multipara mom has not. What type of labor sign is this? And why are there lightenings so different?
A
The lightening is an early sign of labor or premonitory.
First time PG mothers experience lightening earlier on around 38 weeks.
Multipara mothers have lightening closer to term since they’ve been PG before.
8
Q
Patient complains of her urinary frequency returning. You tell her this is a sign of what?
A
Urinary frequency can be related to lightening putting pressure on bladder & therefore could be a premonitory sign of labor.
9
Q
Patient asks if she’ll have contractions in early on in labor. What do you say?
A
PG women will have Braxton hicks contractions as a premonitory sign of labor but she won’t be able to feel them until it is closer to labor. They are actually good.
10
Q
You check your patients cervix and notice it is ripening. What does this mean?
A
Ripening is a premonitory sign of labor and it just means the cervix has softened.
11
Q
Your patient has Leukorrhea present and then you tell them that eventually they will experience something known as a “bloody show”. What is Leukorrhea? And how does that progress to blood?
A
Both are premonitory signs of labor.
Leukorrhea is a when there’s extra mucus discharge in PG to help flush out bacteria.
When closer to labor, the mucus will become blood tinges due to ruptured capillaries being stretched and thus rupture. As labor progresses, the bloody show will become heavier.
12
Q
What is SROM? What type of labor sign is it?
A
Spontaneous rupture of membrane which is a premonitory or early sign of labor.
13
Q
Your patient reports having lots of energy & wanting to get their home ready for the baby. What do you tell them?
A
Tell them their burst of energy is a premonitory sign of labor & that they need to save that energy for when she goes into labor by resting. Needs an energy reserve.
14
Q
Your PG patient reports losing 3 pounds. What do you do?
A
Due to hormone loss, they release tissue fluid as a premonitory sign of labor.
15
Q
PG patient reports back ache along with diarrhea & n/v. What could this mean?
A
All of them are premonitory signs of labor. Back ache occurs to fetus dropping. The GI symptoms may even make them think they have the flu due to uterus stimulating the bowel.
16
Q
True or false labor:
contractions are irregular with no obvious pattern of shortening of intervals in between them
A
false labor
17
Q
True or false labor:
contractions stay around the same intensity
A
false labor since they dont change in intensity
18
Q
True or false labor:
while having contractions, the discomfort is in the abdomen
A
false labor since the area that hurts is the abdomen
19
Q
True or false labor:
while having contractions you are still able to walk fine without increased pain
A
false labor since walking doesn’t change intensity
20
Q
True or false labor:
no dilation present or effacement
A
false labor. both would be present
21
Q
True or false labor:
resting and taking a warm bath helps with contraction intensity
A
false labor since the bath helps them.
22
Q
True or false labor:
contractions are coming at regular intervals but there is a pattern where relaxation periods get shorter therefore contractions are longer
A
true labor
23
Q
True or false labor:
pain starts in back and makes its way to the abdomen too
A
true labor since it is in the back too
24
Q
True or false labor:
walking makes the contractions hurt more
A
true labor since walking makes it more intense
25
True or false labor:
cervix is dilated and effacement is present
true labor
26
True or false labor:
rest & bubble bath didn't make contractions decrease
true labor
27
What happens upon admission to hospital?
First part/check in
Second part/if she's really in labor
Will need to get history by looking at prenatal record. But will also need to get current history.
We will do a quick physical assessment but also run through a psych history and cultural assessment.
Of course they'll need to check if she's actually in labor by doing her labor status exam with the monitor and do cervical exam.
They'll check her membrane & then check the fetus status.
Afterwards, they discuss the birth plan.
Early labor may be sent home if they're there too early. No reason to lay in bed at the hospital.
28
Evaluating the BOW status:
What subjective data will she tell you?
Objective data
- Nitrazine
- Ferning
- Pooling
- ROM plus
- AFI
May say she felt a gush of fluid or that she feels wet.
Nitrazine golden ph test that will turn blue if amniotic fluid is detected (which means rupture).
Ferning can give you an idea of fertile mucus now present which only happens in PG if a rupture
Speculum used to check for pooling means rupture
Rom plus lab test for rupture
AFI is amniotic fluid index being low means a rupture (use a sonogram).
29
Fetal Status:
What do you check for when you look at the FHR monitor?
How to check for presentation & position?
What should you remember about fetal activity?
What types of ruptures are there?
What about the ruptured liquid? What if it is green? What if its red?
Check their baseline FHR, variability, accelerations, and decelerations.
Do Leopold Maneuver with hands
Remember they sleep in 20 min cycles.
SROM & AROM
Check for cloudy or clear liquid. If it is green, then it is meconium & means distress.
If the liquid is grossly bloody that can mean internal bleeding.
30
What are the 9 P's for?
Progressing of Labor
31
Passenger
Passageway
Passenger is fetus and placenta
Passageway is birth canal
32
Powers
Position
Powers are contractions
Position is of the mother in labor - do better on their side, upright, walking, tilted compared to on back
33
Psychologic response
Place of birth
Can be different in everyone. Some people have been taking classes.. some have not.
Some want to be in hospital, birth center, at home 1%.
Hospitals do try to feel like home though.
34
Provider
Procedures utilized during birth
....
Procedures like blocks, meds, whirlpool
35
Gynecoid pelvis
Optimal pelvis for birth that is shaped like a heart
36
Android pelvis
Male pelvis
| Not ideal for vaginal delivery of normal sized fetus. May need a c-section.
37
Anthropoid pelvis
Narrow & not ideal for vaginal delivery. May need c section.
38
Platypeloid pelvis
Long transverse with a mid pelvis reduced.
39
How must baby's present for vaginal births
Biparietal diameter
Head down & we will sonogram the mother to make sure this is the case once she's arrived on the floor. Head is often widest.
Biparietal diameter is largest part of head which is from ear to ear.
40
Fetal attitude? What should it be?
Relationship of fetal parts to others and should be a complete flexion
41
What are suture lines?
Types of Fontanels?
spaces between the bones
Anterior fontanel is a diamond shape. Last to close. Around 18 months or by walking age.
Posterior is triangular shaped. Closes around 2 months.
Fontanels are important so bones can overlap & compress in labor to mold and adapt to birth canal. Will be a cone-head if in labor a long time.
^ goes away around a day or so. Let dad know lol.
42
What portion of head should present upon delivery?
Vertex or back of head.
43
What if a baby has a big biparietal reading?
C- section
| avg is 9.25
44
What is complete flexion attitude?
What if a baby isn't in the complete flexion position but in face presentation?
What if neck is distended?
Head, arms, legs flexed inwards and together. Oval shape to fit in uterus. We want this!
Face presentation of a term baby will need a c section if they can't be repositioned.
If neck is distended there is an alteration in attitude. Will need to reposition or c section... i think.
45
Fetal lie
Longitudinal lie?
Relation of fetus spinal column to mom's spine.
Longitudinal lie is when the baby's spine is aligned w moms. Can either be head down or up (cephalic 99% or breech 3%).
If breech, automatic c section.
You want a cephalic longitudinal lie.
46
Transversal Lie
Baby is sideways in moms uterus. It will create a wider stomach for mom - shaped like a cross with her spine.
Will need to be turned or c section.
47
Oblique Lie
Diagonal baby compared to mom's spine. 45 degree angle. The face will face toward her hip bone.
48
Station
zero?
Below?
above?
We do this to measure lightening. So what if the baby hasn't accomplished lightening yet?
Descent of baby down birth canal w presenting part being the head - so where is the head in relation to the pelvis or where is it stationed.
We use ischial spine as the zero station (and we want these landmarks to be flat).
below is positive numbers.
above will be negative numbers
If lightening hasn't happened its belottlement.. or whatever the word is. Means to be moveable.
49
What if someone is dilated but the station remains above or in a negative number?
Baby head could be too big or the station is too slim for baby to pass. May need c section.
50
What is fetal presentation again
What is normal?
Abnromal?
The part of the fetus that is presenting in the pelvic inlet/opening.
Occiput or vertex
Brow, face, shoulder, breech
51
What to keep in mind when determining fetal position?
It is the MOM's pelvis that is the reference point. Do not think of you when you are trying to figure this out. Opposite of your R and L.
52
Landmarks of fetal positioning
Occiput (O)
Mentum or chin (M)
Sacrum (S)
Acromion process or scapula (A)
53
How many letters do you use to label fetal positioning?
3 letters:
Left or Right (the back)
Landmarks
Anterior or posterior
54
ROP example of fetal positioning means what
Location of presenting part in moms uterus is on the right
Occiput so proper landmark
Posterior means the baby's back is same way as mom's back (this baby is not the facing the optimal direction)
55
Posterior vs anterior fetal positioning
If baby's back is opposite of mom's back it is anterior (we want this one). <>
If baby's back is the same way as mom's back it is posterior
56
Which fetal positioning will be ok to deliver vaginally?
ROA or LOA usually. (LOP or ROP i think too)
57
Do BP changes occur during contractions or at rest? And when should you evaluate BP?
Contractions increase BP but that means if you want an accurate reading of mom's BP, do it when she's at rest.
58
How does labor affect breathing of the respiratory rate? What can they develop?
What about their temp?
They may hyperventilate and develop respiratory alkalosis.
Temp will have a slight increase. Nothing more than 99. If she does go above febrile point then that is a concern for sepsis.
59
Do we allow women to eat near or during labor?
What condition can arise now?
No - they need to keep an empty stomach due to the possibility that they'll need to be on anesthesia in case of emergency and so they don't puke either.
Due to no eating upon something as tiring as labor, you can develop metabolic acidosis.
60
T/F
Labor is not strenuous enough to make someone sweat. If they do sweat, this is a sign of acid base balance issue.
False.
| Sweating is completely normal.
61
Why is protein urea common in labor?
How can we avoid trauma to the bladder? Why is this bad? How can you check?
Proteinuria is common during labor due to metabolic acidosis.
Bladder trauma - women should be catheterized every 2-3 hours due to their block not letting them void on their own. If it is too full then the fetal passageway can be obstructed & so baby can't come out.
Check symphysis pubis swelling too.
Natural births obviously won't use blocks. But they will need to void too.
62
Why are PG women in a polyuria state during labor?
Because we are giving them IVs. SO all the more reason to void.
63
What happens to gastric motility in labor?
What types of food can you have for a home labor?
It slows in labor. So exactly why you don't wanna eat before labor. You will probably vomit & you can aspirate.
Clear liquids at home.
64
What will wbc count look like in labor? Which? Why?
WBC count will be high. Especially neutrophils & it is normal to prevent sepsis.
65
In labor, if one woman does it naturally and one want s a block, should you judge?
No! Pain is individualized. You aren't meant to be a trooper.
66
Primary force of labor
Secondary force of labor
Primary is involuntary beginning of labor
Occurs in second stage of labor where you actively push.
67
Frequency of contractions & how is it timed
Timed from beginning of one contraction to the beginning of the next contraction timed in minutes
68
Duration of contractions & how is it timed
Timed from start of a contraction to the end expressed in seconds
69
Intensity of contractions
Measurements used?
What about when it is used with an internal monitor? external monitor?
Described how strong the contraction is at its peak
mild = cheeks
moderate = chin
strong = forehead
When used with an internal monitor intensity is measured in MMhg.
But remember, if you use an external monitoring device the intensity reading won't be to be captured. You will have to palpate for this.
70
Resting Tonus for uterine contractions
How long do we want?
Oxytocin usage?
Counting how long the uterus relaxes during contractions. We want it to be at least 30 seconds or more bc that is when the baby breathes. Without it, hypoxia can occur.
Now, if oxytocin induces a longer contraction they'll stop it.
71
Cervical Effacement
How is it expressed?
Means thinning of the cervix due to the lower segment of the cervix being stretched up to thicken the upper portion.
It is expressed in percentage with 100% being all the way thin.
72
Dilation is what and determined by who
How does this happen? When does it stop?
What is it aided by?
Opening of cervix - anyone can determine this. Cervix pulls open.
Will first be closed and have mucus plug. You lose the plug and begin to dilate. Once you're at 10 cm then you're done.
Can be aided by the bag of water but the head is a much better dilating wedge so we may arom or rupture the sac to promote progress.
73
Stage 1 of labor
How many phases does stage 1 have?
Onset of true labor that occurs until you are dilated. This takes a long time. Not complete until 10 cm
3 phases.
1) 0-4 cm or latent phase so kinda easy but slow.
2) 5-7 cm so active phase. labor is picking up and active
3) 8-10 cm. transition phase but short
74
Stage 2 of labor
From the point you are fully dilated at 10 cm and then give birth.
You'll have to push in stage 2
Some women can only push so much and some can push for hours. Contractions come in waves so you push at intervals.
75
Stage 3 of labor
A very short stage where you go from delivering the baby to delivering the placenta.
76
Stage 4 of labor
How long?
What is greatest concern in this stage?
After you deliver the placenta you have to recover.
Period of homeostasis that is around 2-4 hrs
Stage 4 recovery has a risk of Hemorrhage due to there still being contents in the uterus.
77
Who takes longer to go through stages of labor? Primi or multi?
multipara will go faster
78
Doula
Payed attendant in labor to provide encouragement and support
Mainly experience based but they aren't there to give care. They're there for the mom especially if no one is there to do that.
A support person can be very helpful for labor.
79
Benefits of support in labor?
Decreased use of meds
Decreased need for operative birth (vacuum, forceps, c section)
Increased incidence of spontaneous vaginal birth
Increased satisfaction
80
T/F
PG mothers aren't worried about modesty
Fasle.
Always try to keep modesty in mind.
81
Should you assume a male is ok to be in the room during labor?
No - need to ask for cultural reasons
82
Should you assume someone is going to follow their cultural norms
no - dont assume that either.
83
What do people in latent phase act like?
Should someone be up and moving during the latent phase?
What rule helps them know when to go to the hospital?
They can cope with discomfort and they feel excited usually but may feel some anxiety.
They talk a lot during this phase.
It is ok to walk in latent phase and it is actually encouraged.
511 RULE. Contractions every 5 minutes that last one minute that go on for a hole hour.
84
What rule helps them know when to go to the hospital in the latent phase?
511 rule. Contractions for 5 minutes for 1 hour and lasting 1 minute
85
What care should give in the latent phase?
Home?
Guide them on what to anticipate, provide emotional support, encourage them to walk.
If at home, clear liquids. In hospital they will be NPO
86
How do moms act in active phase of labor?
How can we help them cope
Their anxiety will probably increase and they will express their fears. They will begin to turn into themselves & wanna focus on work of labor.
Help them cope by telling them to breath, imagery , etc
87
Active phase interventions:
Document?
Cervical exams?
voiding?
assess vitals?
FHR
ROM
Document contractions ever 15-30 min
Cervix exams but only if need be bc of risk for bacteria
if patient can't void anymore, do catheter
assess vitals every hour
FHR auscultated every 30 min
ROM may or may not occur here
88
Transition phase
Most difficult phase for women but it is the shortest
withdrawal into themself & can become irritable.
But she doesn't wanna be alone.
Don't touch her face
She prob will say she doesn't wanna be here in the situation
n/v, belching, leg trembling
89
Transiton phase interventions:
how long should we tell her this will be?
ROM?
breathing
pushing
Tell her it is the shortest phase
May have to do arom if not ruptured yet.
help them w breathing techniques
don't let them push until 10 cm so tell her to pant like a dog. if she pushes, her cervix can swell.
90
Second stage of labor
what is passive descent?
Ferguson reflex?
This is where mom can now push since she is dilated and it ends when the baby is born
PUSHING or bearing down efforts BDE's
Passive descent is when the urge to push isn't felt but you will feel the need to push once ferguson reflex is stimulated if not blocked
91
How long can you push?
Up to 3 hrs and can happen if it is your first time
If she needs help can do vacuum, forcepts , etc
92
Mechanisms of labor
main point is that the head will have to shift and one shoulder will come out first
93
Second stage emotional response
Relieved but apprehension .
94
Nursing interventions for second stage
Keep everything as sterile as possible and take vitals every 5 min
Provide support
Help her know when to push and do tug of war to help direction of pushing
95
Cord blood banking
A pretty rare thing to do but using a kit, you collect stem cells and there's no risk of pain or anything.
Can be used for family hx or cancer treatment
It is very expensive though. You have to pay for kit and storage fee in nitrogen
96
Third stage of of labor involves?
blood gases?
What will they check for?
When the baby is deliver and the placenta is delivered as well but only lasts like 30 min
- Just peels away and leaves behind placental site and the uterus needs to be clamped
blood gases are taken from cord blood
check for rh- and rh+ differences between mom and baby
97
What do they give to mom after placenta is delivered?
How many nurses are there?
can mom and baby do skin to skin contact?
Large Oxytocin bolus. It causes uterus to constrict.
2 nurses ; but if it is a high risk then nicu will come in with a incubator
Can do skin to skin contract if everything checks out
98
Shiny shults
fetal side of placenta delivers up
99
dirty duncan
bloody maternal side delivers up
100
Recovery stage of labor
Can mom eat?
Shaking and trembling?
Hypotonic
What should uterus feel like
hemorrhage
ID
Fourth and final stage that lasts 2-4 hrs after delivery where homeostasis does its thing.
Mom can eat if everything checks out
Some women shake and tremble after delivery and that is ok. Just give them warm blankets and fluids
Make sure to void due to hypotonic bladder and see if they empty. if there's residual urine, then there's uti risk.
uterus should be firm and in center. check every 15 minutes
hemorrhage concern for every patient and delivery route
Do full assessment to make sure
ID the baby the moment the baby and mom are separated
101
Interventions for recovery stage of labor
Assess
Use
Remove
Asses for Lochia or vaginal bleeding
do vitals for both mom and baby
Assess fundus check- midline and firm
Use ice peaks near perineal area but do so intermittently to avoid thermal burns. Use 20 min and leave off for hour.
Cather will be removed before post partum & they must be self sufficient there
102
How should blood pressure look after birth
what about pulse
bladder?
perineum?
emotional status of mom?
returns to prelabor level
pulse should be slightly lower than what it was during labor
shouldn't be able to palpate the bladder
perineum should be smooth , pink, without bleeding
Mom can be emotional but she should be happy
103
Precipitous or emergent delivery
first
position and delivery
clamp
mechanisms of delivery
handling
oxytocin
fundus
document
When there's an emergency birth happening you need to have someone go get help and emergency pack
Put mom in lowest position possible or lying down
delivery needs to be steady and slow bc you don't have utensils to fix her if emergency
Only clamp the fetal cord if it is done w sterile utensil
just know that you need to lower the anterior shoulder and elevate the baby to deliver the posterior one
baby will be slippery
putting baby to skin or near breast can stimulate oxytocin and therefore help stop bleeding
check fundus for midline and firmness
document as best as you can
104
EMTALA
ensures?
true labor?
Emergency medical treatment and active labor act
Ensures any woman going into labor receives
treatment regardless of insurance or cost
do all assessments & documentation just like anyone else
Only a medical professional can declare she is not in true labor but until then, we treat it as so.
hospitals must abide by this.
