Ob quiz 2 labor and birth, care of woman w/complications during labor and delivery Flashcards
The 4 P’s of the birth process
- Powers
- Passage
- Passenger
- Psyche
The 2 powers of labor are?
- uterine contractions
- maternal pushing
cervical effacement is expressed as ?
percentage of its original length
the amount of cervical dilation is expressed in ?
Centimeters
The nurse should promptly report contraction duration longer than?
- 90 seconds or intervals shorter than 60 seconds and frequency closer than 2 minutes.
Why should the nurse report long lasting, short interval timed contractions?
- placenta doesnt get enough oxygen carrying blood, when the uterus is tightly contracted. (fetal oxygen supply)
2 reasons why the sutures and fontanelles of fetal head are important in the birthing process?
- allows for shaping, accomodation to size and shape of maternal pelvis.
- Provides landmarks to determine how the fetus is oriented within the mothers pelvis.
RSA
Right sacrum anterior- breech
LMT
Left mentum transverse- face presentation
ROA
Right occiput anterior-most common
LOP
Left occiout posterior- back labor
key difference between real and false labor
change in cervical effacemant/dilation
3 phases of 1st stage of labor
- Latent- 1-4 cm 4-6 hours
- Active- 4-7 cm and effacement 2-6 hours
- Transition- 7-10 cm complete effacement 2-6 hours
Typical maternal behaviours during 1st stage of labor
- Latent- cooperative, alert, talkative, welcomes diversions, frequent urination, thirst.
- Active- apprehensive, anxious, introverted, less social, focused on breathing, prespires, flushing, wants pain relief.
- Transition- irritable, rejects support person, introverted, wants to give up, restless, leg tremors, fears losing control, want pain relief.
Typical maternal behaviours durng 2nd stage of labor
- Bulging perineum
- passage of stool
- spontaneoud pushing or urge
- states baby is coming
- exausted
Third stage bmaternal behaviours
- Elation
- Relief
- tremors
- increased energy
- curious about baby
- desires to nurse baby
- minimal pain with placental expulsion
Fourth thage maternal behaviours
- time for parents and new baby to get aquainted
- mother nurses baby
Nornal fetal heart rate
- 110-120
- 150-160
Characteristics of abnormal amniotic fluid
- cloudy yellow fluid-infection
- strong odor-infection
- meconium-possible meconium aspiration for baby
Assessments reportable to MD by nurse
- temp: 110.4>
- blood pressure: 140/90 > or <90 for systolic
- FHR: outside of 110-120/150-160
Baseline Fetal HR of 125 during labor is?
Normal for term fetus
When assessing duration of contraction by palpation, it is time by?
bef=ginning of one contraction, to the end of the same contraction
during normal labor, contraction usually become?
more frequent and longer duration
when the fetus is cephalic in presentation, the amniotic fluid is expected to be?
clear
The thinning of the cervix during labor is called?
Effacement
Fetal descent during labor is measured in relation to the mothers?
Ischial spines
When the placenta is delivered with the fetal side presenting, its called?
Schultze
A nurse should learn to evaluate the progress of labor by methods other than vaginal examination, primarily because vaginal examination increases?
risk of infection
whicj=h maternal position should be avoided during labor?
supine
VBAC should be observed during labor, particularily for signs of ?
uterine rupture
the priority observation during the fourth stage of labpor is ?
vaginal bleeding
amniotic fluid usually turns a PH swab or paper?
dark blue
Effleurage
Stroking of the abdomen, thighs, or other body parts
Endorphins
internal substance similar to morphine
Focal point
Intense concentration on an object
pain threshold
Least amount of stimulation that a person perceives as painful.
Pain tolerance
maximum amount of pain one is willing to bear
Physical factors that cause pain during labor
- Dilation and stretching of cervix
- reduced uterine blood supply during contraction
- Pressure of fetus on pelvic structures
- Stretching of vagina and perineum
How do physical factors influence womans pain during labor
- Cervical readiness- prelabor changes can help cervix efface and dilate more readily.
- Pelvic size and shape- how readily fetus descends, may favor normal fetal positiion or remain in unfavorable position.
- Labor intensity- Short, intense may cause more pain.
- Maternal fatigue- decreased pain tolerance and ability to use coping skills.
- Fetal presentation and position- unfavorable adds pressure on sensitive areas and may prolong labor.
umbilical cord protruding from the vagina, what should you do?
- displace fetus upward by maternal position in knee chest or trendelenburg.
- placing mother on side with hips elevated on pillows
Severe back pain during labor?
baby is facing the back
Degrees of lacerations
- 1st degree- involves the superficial vaginal mucosa or prineal skin
- 2nd degree- involves the vaginal mucosa, perineal skin, and deeper tissues of perineum.
- 3rd degree- same as seconf degree, plus involves the anal sphincter.
- 4th degree- extends through the anal sphincter and into the rectal mucosa.
Fetal bradycardia
- FHR is less than 110 bpm for 10 minutesor longer
- Cause- fetal hypoxia, maternal hypoglycemia, materb=nal hypotension, or prolonged umbilical cord compression.
fetal tachycardia
- FHR above 160 that last 2-10 minutes or longer.
- cause- maternal fever or dehydration
decreased or absent variability
- little fluctuations in rate
Late Decelerations
- decrease in FHRbegins after contraction starts and persists after contraction is over.
Vaariable decelerations
- FHR falls abruptly to less than 60 bpm, lasting 60 seconds or more, and the return to baseline is prolonged.
Abnormal uterine activity
- more than 5 uterine contractions in q 10 minute period; duration more than 60 seconds relaxation between contractions.
nitrizine test
- test performed if its unclear if membranes rupture
- nitrizine paper is a ph paper. alkaline amniotic fluid turn darg green-blue or dark blue
Nursing care during birth
- prep the delivery intruments and infant equipment
- doing the perineal scrub preparation
- administering drugs to the mother or infant
- providing initial care to the infat such as suctioning, drying the skin, placing infant on warmer
- assessing infants apgar scores
- examining the placenta to be sure its intact and records if it was expelled schultze or duncan
- any abnormalities of the placent, cord or insertion site need to be reported asap
- assessing infant for obvious abnormalities
- making a note if infant has a stool or urinates
- Identifying mother and infant with like numbered id bracelets
- promoting infant bonding by holding, breastfeeding and exploring baby
nursing care during labor
- Monitor the fetus- FHR patterns and amniotic fluid
- inspection of amniotic fluid- the membranes amy rupture spontaneously or by amniotomy- insect for foul odor, yellow color or meconium.
- Monotoring the woman- vital signs- temp q 4 hrs, BP, RR, HR q hour
- Contractions- by palpation or contimuous EFM- normal contractions are fewer than 5 in a 10 minute period for 30 minutes
- Progress of labor- vaginal examination periodically to determine how labor is progressing.
- I & O- time and approximate amount of urine is recorded, may not sense full bladder, must be assessed q 2 hrs for bladder fullness and bulge above symphisis pubis
- response to labor- breathing and relaxation techniques and supports adaptive responses
evaporation heat loss of the newborn
- keep thermoregulation of newborn by immediately drying baby to prevent heat loss through evaporation of amniotic fluid from skin.
newborn hypothermia
- cause hypoglycemia because bodu uses more glucose to generate heat
- causes cold stress because body increases metabolic rate to produce heat causing incresed respirations and oxygen demand, baby cant supply the o2 needs causing hypoxia
contradiction to an epidural block
- abnormal blood clotting
- an infection on injection site or systemic infection
- hypovolemia
how soon after delivery can mother get MMR vaccine?
Immediately after birth
preterm 35 wk labor, reportable findings
everything
quickening
fetal movement felt by mother
fibronectin
protein secretion from fetal mebranes that leaks in ti vaginal secretions, if uterine activity, infection or dilation of 2 cm or more occurs
preterm infant risks
- exposure to diethylstilbestrol DES
- underweight
- chronic illness such as diabetes or hypertension
- dehydration
- preeclampsia
- previous preterm labor or birth
- previous pregnancy losses
- uterine/cervical abnormalities or sx
- uterine distention
- abdominal sx during pregnancy
- infection
- anemia
- preterm premature rupture of membranes
- inadequate prenatal care
- poor nutrition
- age younge than 18 or older than 40
- poor education
- poverty
- smoking
- substance abuse
- chronic stress
- multifetal presentation
internal fetal scalp monitor
- membranes must be ruptures and dilation of 1-2 cm for insertion of device.
- small disposobal spiral electrode is inserted
organism is a leading cause of perinatal infections that result in a high neonatal mortality rate, and can be found in the women’s rectum, vagina, cervix, throat, or skin
group B strep
