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OB Nursing > Process of Labor > Flashcards

Process of Labor Flashcards

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1
Q

Theories of Onset Labor - Maternal Factors

A

Stretching of uterine muscles
Estrogen/Progesterone changes
Oxytocin (“Love” hormone)
Release of prostaglandins

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2
Q

Theories of Onset Labor - Fetal Factors

A
  • Fetal cortisol changes
    • Shunts blood away from the uterus causing the uterus to contract and become irritable
    • Increases RR & HR
  • Placenta ages
  • Prostaglandins increase causing contractions
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3
Q

Signs of Impending Labor

A 
Lightening
Increased Vaginal D/C
Increased Energy
GI Symptoms (Diarrhea)
Cervical Change
ROM
Lower Back Pain
Weight loss
Uterine Contractions
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4
Q

True Labor

A
  • Contractions bring about changes in cervical effacement and dilation
  • Regular contractions increase in frequency and intensity
  • Continues despite comfort measures
  • Cervix: moves to anterior position; bloody show
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5
Q

False Labor

A
  • Irregular contractions with little or no cervical changes
  • Decrease in frequency, duration, and intensity with walking or position changes
  • Hydration or sedation slows/stops contractions
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6
Q

Stages of Labor

A

First stage – 3 parts: Latent, Active, Transition Phase
Second stage – delivery of baby
Third stage – delivery of placenta
Fourth stage – recovery

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7
Q

Latent Phase

A 
Primip = 9 – 19 hours
Multip = 6 – 14 hours
Cervix: 
•effacing
•dilating from 0 cm to 4 cm
Contractions:
•Frequency: 5 – 15 minutes 
•Duration: 10 – 30 seconds
•Intensity: mild/bearable
Bloody show occurs with cervical change
Membrane usually intact, but can rupture
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8
Q

Latent Phase Characteristics

A

Cramps, backache, talkative and eager

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9
Q

Latent Phase - Nursing Interventions

A

Assessment:
o VS q1-2 hrs
o Assess cervical changes by SVE
o Assess FHR and UC q30 minutes
o Ascertain presence of blood show and ROM
Encourage activity
o Helps in fetal placement and cervical change
Encourage controlled breathing
Distraction activities
Position changes (off patient’s back) and ambulation

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10
Q

Active Phase

A 
Primip: 5 hours, 
Multip: 2 – 3 hours 
Cervix: 
• Effacing, 
• Dilating from 4 cm to 7 cm 
Contractions:
• Frequency: 3–5 min
• Duration: 30–45 sec
• Intensity: mod/strong
• More D/C or blood show
ROM or still intact
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11
Q

Active Phase Characteristics

A
  • rapid dilation and effacement
  • some fetal descent
  • feelings of hopelessness
  • anxiety and restlessness increase as contractions grow stronger
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12
Q

Active Phase Interventions

A 
Assessment:
o VS q1-2 hrs
o Assess cervical changes by SVE PRN
o Assess FHR and UC q15-30 minutes
o Ascertain presence of blood show and ROM
Encourage controlled breathing
Distraction activities (back rub)
Position changes (off patient’s back) and ambulation
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13
Q

Transition Phase

A 
Primip: average 4 hours
Multip: average 1 hour
Cervix: 
• Complete effacement
• Dilation from 7 cm to 10 cm 
Contractions:
• Frequency: 1–2 min
• Duration: 40–60min
• Intensity: strong
• Heavy blood show
ROM
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14
Q

Transition Phase Characteristics

A
  • tired
  • restlessness
  • irritable
  • feeling out of control “cannot continue”
  • N/V
  • urge to push
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15
Q

Transition phase Nursing Interventions

A 
Assessment:
o VS q1 hrs
o Assess cervical changes and fetal position by SVE
o Assess FHR and UC q15 minutes
o Ascertain presence of blood show and ROM
o Check bladder distention 
Encourage controlled breathing
Reassurance
Position changes (off patient’s back)
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16
Q

Second Stage of Labor

A 
Begins with cervical dilation 10 cm and ends with delivery of the baby
Primip: 1 – 2 hours
Multip: > 1 hour
Cervix: fully dilated and effaced
Contractions:
• Frequency: 1–2 min
• Duration: 50–60 min
• Intensity: less painful, expulsive
• Heavy blood show
 ROM
Station: Primip: +2 to +4; Multip: +2 to +4
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17
Q

Second Stage of Labor Characteristics

A

intra-abdominal pressure (bearing down)
urge to push
perineum bulges and flattens
perineal burning and stretching

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18
Q

Second Stage of Labor Interventions

A

Assessment:
o VS q1 hrs
o Assess position, station and progress by SVE
o Assess FHR after every contraction
o Assess pt’s readiness and urge to push
Encourage controlled breathing and rest between contractions
Reassurance
Support legs, chest, arms, and back
Position changes (off patient’s back): upright

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19
Q

Third Stage of Labor

A

Begins with the delivery of neonate and ends with delivery of placenta
Duration 1 – 20 minutes
Less painful
Characteristic: relieved

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20
Q

Third Stage of Labor Nursing Interventions

A 
Maternal VS q15 minutes
Assess for bleeding and complete placental detachment 
Encourage relaxation
Fluid intake
Assess condition of newborn at birth
Apgar scoring 1 minute and 5 minutes
Maintain fetal body heat (skin-to-skin)
Baby I.D
Reassurance, praise
Explain after delivery procedures
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21
Q

Fourth Stage of Labor

A

First 2 – 4 hours after birth

Characteristics: post-partum chills, hunger, thirst, drowsy, moderate to heavy lochia, painless contraction

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22
Q

Fourth Stage of Labor Nursing Interventions

A

VS q15 minutes for the first hour then every 1 hour (for the next 2 – 4) then every 4 hours
Assessment of fundus and lochia q 15 min X 1 hour then q30 minutes
Repositioning for comfort
Diet and fluid as tolerated
Assessment of Fetus:
• VS q15 min X 1 hour then q30 min
• Keep on skin to skin contact for at a least one hour after birth
• Initiate breast feeding
• Give routine meds
• Maintain thermoregulation
• Initial head to toe assessment

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23
Q

Five “P”s of Labor

A 
Power
Passenger
Passageway
Position
Pyschology
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24
Q

Power

A
  • Primary – maternal pushing during the second stage of labor
  • Secondary – contractions occur in the second stage of labor
  • Blood supply to the cervix 800 – 1000mL/min
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25
Q

Passenger

A 
Fetal descent through the birth canal is determined by:
	Size of fetal head
	Fetal lie
	Fetal attitude 
	Fetal position
	Fetal presentation
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26
Q

Size of Fetal Head

A

If too big (macrosomia) then a vaginal birth will not happen

Molding of the fetal head will happen during a vaginal birth

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27
Q

Fetal lie

A
  • Where the baby’s spine in reference to mother’s spine

* Want baby to be longitudinal with head toward pelvis

28
Q

Fetal Attitude

A

Relationship of fetal parts to one another (rounded appearance)
• Head is in complete flexion in a vertex presentation
• Chin is touching chest
• Fetus back becomes convex
• Arms crossed over thorax
• Legs flexed at the knees

29
Q

Fetal position

A
  • Relation of the denominator or reference point to the maternal pelvis
  • Want the occipital bones to be the presenting bones in the pelvis b/c they have the molding capability
  • Occipital bones be facing anterior (front) for an easy transition of the fetus through the birth canal (OA)
30
Q

ROA

A

right occiput anterior

occipital bones facing the right side of the mother’s pelvis and facing anteriorly

31
Q

Any position that is not R/L OA:

A 
Will delay or impede fetal descent
o Causing mother to:
 Use more primary power
 Have severe back pain
o Second stage of labor is prolonged
o Changing positions sometimes helps 
 Position mother on all fours
 Use of a peanut
 High Fowlers position
32
Q

Fetal Presentation

A

• Cephalic presentation

o Vertex position (normal): fetus head first and facing backwards

33
Q

Breech Presentation

A

Breech –> head entrapment complication –> fetal death
o Head entrapment happens when pressure is released from the uterus once majority of the baby is delivered causing the cervix to close before the fetal head has been delivered and closes around the neck
Frank breech
Complete breech
Footling breech
Shoulder Dystocia

34
Q

Passageway

A

 Station

 Effacement

35
Q

Station

A

 Where the baby is at in the mother’s pelvis
 Feel for cervix, diameter of cervix, and fetus head
Measured from -5 to +5
 0 station: baby’s head is at the ischial spine
o Creating pressure on the cervix
 +5 station: baby is completely delivered

36
Q

Nursing Interventions for baby at -1 or -2 and dilation in the active stage:

A

o Ambulation!!!
o Birthing ball
 Opens pelvis by increasing anterior-posterior diameter
o Peanut
 Placed b/w legs for patients in bed to help open legs to further progress fetal descent

37
Q

Closed Cervix

A

2 cm thick

4 cm length

38
Q

Effacement

A
  • Thinning of the cervix
  • Measures: 0, 25, 50, 75, 100% (completely thinned out)
  • Primip: usually thins out first then dilates
  • Multip: occurs simultaneously
39
Q

Pyschology

A 
Influenced by:
culture
social support
childbirth preparation
expectations
40
Q

Position

A

Maternal position during labor and birth

41
Q

Positioning in 1st Stage of Labor:

A
  • Upright: walking, sitting, kneeling, or squatting
  • Lateral position: Decreases compression of the maternal descending aorta and ascending vena cava
  • Upright position: Aiding the descent of the fetus and more effective contractions
42
Q

Positions in the 2nd Stage of Labor

A
  • Common is lithotomy position

* Upright position: Increase pelvic outlet and better fetal alignment with the pelvic inlet

43
Q

Why do frequent position changes?

A

reduction of fatigue, and increase in comfort, improved circulation to the mother and fetus

44
Q

Cardinal Movements of Labor

A

Process that is important for the fetus to move into the fetal descent

  • engagement
  • descent
  • flexion
  • internal rotation
  • extension
  • external rotation
  • expulsion
45
Q

Engagement

A

Fetal head passes through the pelvic inlet

46
Q

Descent

A

Movement of the fetus through the birth canal during the 1st and 2nd stages of labor

47
Q

Flexion

A

Fetus chin moves toward the chest, occurs when the descending head meets resistance from maternal tissues

48
Q

Internal rotation

A

Rotation of the fetal head aligns the long axis of its head to the long axis of the maternal pelvis
2nd stage of labor

49
Q

Extension

A

Resistance of the pelvic floor causes the presenting part to pivot beneath the pubic symphysis and the head to be delivered
2nd stage of labor

50
Q

External rotation

A

Sagittal suture moves to transverse diameter and the shoulders align in the anteroposterior diameter
Maintains alignment with the fetal trunk as the trunk navigates through the pelvis

51
Q

Expulsion

A

Shoulders and remainder of the body are delivered.

52
Q

Pain Management During Labor

A

Can be managed Pharmacologically or Non-pharmacologically

53
Q

Pain is caused by:

A 
 Uterine Muscle Hypoxia
 Lower Uterine and Cervical Stretching
 Pressure on the pelvis
 Traction on the pelvic structures
 Perineum pressure (baby is in 2nd stage)
 Influenced by Culture
54
Q

Analgesics

A

opioids
narcotics
barbiturates
anti-histamines

55
Q

Regional Anesthetics

A

Epidural Block

Intrathecal Space

56
Q

Epidural Block

A 
Administer at least dilation of 4 cm
- Know Plt count before administration 
- Needs to be over 100,000 
- Below 100,000  risk for bleeding
Local anesthetic + opioid
500 – 1000 mL glucose fluid prior to administration
Affects mothers BP or uterine blood flow leads to fetal distress
- N/V, pruritus, respiratory depression
57
Q

Pre-anesthesia Nursing Care

A
  • Patient Hx: allergies
  • Assess FHR
    Call physician, CRNA, anesthesiologist
    • Obtain consent form
  • Check SVE cervical dilation
  • Check lab values (Plt count)
  • IV fluid bolus with NS or LR
  • Ensure emergency equipment is available
  • Do a time-out procedure
  • Bed is laid flat
  • Patient is sitting straight on the edge of bed, hunched forward
    • Hug a pillow and hunch their head
    • Do not want the patient to be moving
58
Q

Post-anesthesia Nursing Care:

A
  • Lay the patient down on the bed on side to avoid compression of major vessels
  • Monitor maternal VS and FHR q5 minutes initially and after every re-bolus then q15 minutes
    • FHR alterations
    • Hypotension (Systolic BP <90)
  • Assess pain and level of sensation and motor loss q1 hour
  • Assess for any adverse reactions
    • Pruritus, N/V, HA
  • Foley Catheter
59
Q

Hypotension from epidural

A

• Alert CRNA or anesthesiologist (who ever did the epidural placement)
• Fluid bolus (500 – 1000 mL) to raise BP
• If any medications are given to raise mom’s BP normally causes decrease blood flow to the uterus
o Ephedrine
 Does not compromise blood flow to the uterus
 Nurses and CRNAs can administer

60
Q

Demerol

A

Opioid
 Rarely used b/c does not help in labor pain
 Side effects N/V, CNS depression and Neonatal Respiratory Depression

61
Q

Morphine

A 
Opioid
 Less side effects (CNS depression and Neonatal Respiratory Depression)
 Given IM or IV (quicker)
 Administered during latent labor
 Only lasts a couple of hours
62
Q

Butorphanol (Stadol) & Nalbuphine (Nubain)

A

 Opioid agonist-antagonists
 No respiratory depression in mother or neonate
 Contraindicated for women with prior drug abuse

63
Q

Sublimaze (Fentanyl)

A

 Short-acting opioid antagonist
 Crosses the placenta rapidly
 Side effects: FHR alterations, Hypotension, CNS and respiratory depression

64
Q

Non-Pharmacological Interventions

A 
o Rhythmic breathing
o Paced breathing
o Labor Breathing Techniques
o Hydrotherapy
o Ambulation 
o Sitting on a birthing ball 
o Relaxation through:
 Massage
 Music (any type of music)
 Imagery
 Biofeedback
 Aroma therapy
65
Q

Estimated blood loss in during a vaginal delivery

A

500 cc

66
Q

Estimated blood loss in during a C-section

A

1000 cc

OB Nursing (4 decks)

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