objective 4 Flashcards
a normal physiological process that involves the health of the mother and a fetus
It involes the welfare of two patients and the use of skills from medical-surgical and pediatric nursing, psychosocial and communication skills, and specific skills involved in obstetrical care
child birth
what are the factors affecting L&D?
Preparation
Professional help
Place
Procedures
People
what are the 5 Ps?
powers
passage
passenger
maternal position
psyche
what are the powers?
uterine contractions
maternal pushing
what are the 3 phases of contractions?
increment
peak
decrement
beginning of one contraction until beginning of next
frequency
how long the contractions last (40-50secs)
duration
approximate stregnth of the contraction
mild,moderate, and strong or firm
intensity
When the cervix is 10cm dilated, female adds voluntary pushing to involuntary contractions which bring the babe down and out
2nd stage involves boht powers
maternal pushing
false pelvis
true pelvis
bony pelvis
upper flaring part
fale pelvis
lower part
true pelvis
Yield more readily to the forces of contractions and pushing efforts in women who have had a previous vaginal birth
soft tissue
he fetus along with the placnta and amniotic membranes
passenger
Composed of several bones separated by strong connective tissues called sutures
head
where sutures meet
fontanelles
diamond-shaped area formed by the intersection of four sutures (closes 12-18 months)
anterior fontanelle
tiny triangular depression formed by the intersection of 3 sutures (closes by end of 2 months)
posterior fontanelle
Describes how fetus is oriented to mothers spine
lie
what are the types of lie?
longitudinal
transverse
oblique
Degree of flexion and extension
attitude
head flexed forward and arms and legs flexed
flexion
prolongs descent…longer labor
extension
Refers to the fetal part that enters the pelvis first
Cephalic (head)
Shoulder
Breech
presentation
has a significant impact on the progress of labor
maternal position
A woman’s mental state can affect the course of labour
Promote a positive childbearing experience, including as many of the family’s birth expectations as possible
The woman’s cultural and individual values influence how she will cope with childbirth
psyche
what are the signs of impending labor?
Braxton hicks contractions
Lightening
Cervical changes
Vaginal discharge ‘bloody show’
Energy spurt
Weight loss & flu like symptoms
Rupture of membranes
Contractions irregular, do not increase in frequency, duration and intensity
Walking relieves discomfort/contractions
Discomfort in abdomen and groin
Bloody show usally not present
No change in effacement or dilation of cervix
false labor
Regular contractions, frequent, longer and more intense
Contractions become stronger and more effective with walking
Discomfort in lower back and lower abdomen
Bloody show is often present
Progressive effacement and dilation of the cervix occr
true labor
how do know when to do to the hospital?
Ruptured membranes
Bleeding other than bloody show
Contractions
1st pregnancy: 14-5, regular for 1 hour, lasts approx. 60 secs
2nd pregnancy: q5-7 min, regular for 1 hour
Decreased fetal movement
Cervix dilation 0-3cm
Contractions: q5-30 mins, 30-45 sec long; mild to moderate
Mom is happy, laughing, excited
latent (early) phase
Cervix dilation: 4-10cm
Contractions: 12-5 min apart, 40-90secs, long moderate to strong
Mom is anxious, less social, rejects support, legs tremor, irritable
active phase (approx 2-8hrs)
Full dilation (10cm) to birth (last 30 mins to 2 hrs or more)
Contractions: strong, every 2-3 mins, lasting 60-90secs
Contractions function to push baby out of mothers body
Bulging perineum, uncontrollable urge to push
stage 2: delivery of the fetus (10cm to birth)
Duration: 5-30mins
Contractions: intermittent, mild to moderate
Umbilical cord is cut
Observe for signs of placental separation
stage 3: deliver of placenta
1-2 hours after birth
Uterus remains midline, firmly contracted at or below umbilicus level
Lochia rubra saturates perineal pad (no more than 1pad/hour)
Cramping may occur
Observe for clots larger than toonies
Women may have shaking chills
stage 4: recovery
what are the nursing responsibilities during birth?
Prepare the deliver instruments and infant equipment
Perineal scrub
Admin meds
Provide initial care to infant
Assess apgar score
Assess infant for obvious abnormalities
Examine the placenta
Identify mother and infant
Promote parent-infant bonding
what are the phases of care of the newborn?
Phase 1 (birth-1hr)
Usually in delivery room
Phase 2 (1-3hrs)
In nursery or postpartum unit
Phase 3 (2-12hrs)
Usually in PP unit if rooming-in with the mother
“Station” describes level of presenting part in pelvis
Estimated in cm
Level of ischial spine: zero station
Above ischial spine: minus stations
Belove ischial spine: plus stations
decent
Reaches ischial spines or pelvic inlet (station 0 or lower)
engagement
Contractions increase fetal head flexion until chin is on chest
flexion
When the fetus enters the pelvis the occiput is oriented to the occiput is oriented to the mothers Rt or LT side
Head turns until occiput is directly under symphysis pubis
internal rotation
Head changes from flexion to extension
Head swings anteriorly as it extends with each maternal push
extension
When head born, shoulders are not in line with head
Head and shoulder turn to realign
external rotation
Anterior shoulder delivers, posterior should, quickly followed by the rest of the body
expulsion
what are the nursing response to FHR patterns?
Position changes
Decrease oxytocin
VS
Use altered pusing and breathing techniques in the second stage of labor
Increase IV fluids
Admin oxygen 6L/min
what are the nonpharmacological nursing interventions?
Skin stimulation
Positioning-encourage frequent position changes
distraction/diversion-music, imagery, TV
Thermal stimulation
Heat
Cold
Breathing techniques-remind them of prenatal classes
block pain without loss of consciousness
analgesics
enhance effectiveness of; or counteract side effects of analgesics
adjuncts
blocks pain and motor responses
anesthetics
what are examples of analgesics?
Morphine sulphase: best given in early labor
Demerol: not recommended unless person has allergy to morphine
Fentanyl: rapid onset, short duration
Nubain: avoid use in women with known addictions
what are examples of adjuncts?
Narcan: reverses respiratory depression
Gravol: antiemetic
Nitronox: inhaled anesthetic, decreases awareness of pain
The pudendal block is often used for episiotomies, vacuum- assisted, and/or low forceps deliveries
There is usually a delay between the injection and the onset of action
The injection is made on both sides of the perineal area prior to delivery
The medication bathes the nerves
pudendal block
Often a combo of local anesthetics w/ a small dose of opioids- this yields a quicker onset of action and a longer-lasting pain relief; with minimal loss of movement
The women can sometimes ambulate and assume any position
Med constantly infuses through a catheter via an infusion pump
CAUTION: hypotension and urinary retention
epidural (epidural space)
Much smaller amount of drug is needed to achieve the anesthesia when compared with the epidural
Also anesthesia occurs quickly and is much more profound; in addition to lasting longer than the epidural method
Loss of movement and sensation below the level of the ‘block’
One-shot block as opposed to continuous infusion via a catheter
Used for C-sections
CAUTION: hypotension and urinary retention
spinal (subarachnoid)
best given in early labor
morphine
not recommended unless person has allergy to morphine
demerol
rapid onset, short duration
fentanyl
avoid use in women with known addictions
nubain
reverses respiratory depression
narcan
inhaled anesthetic, decreased awareness of pain
nitronox
Exhausted from pushing
Ineffective pushing
If mothers condition warrants it
forceps
Soft suction cup attached to suction
Cup placed over baby occiput
Suction applied with contraction
Scalp edema
vacuum extraction
Removal of infant through incision in abdominal and uterine wall
C-section
