quiz 3 (week 7 & 8) Flashcards
Cultural/Macrosystem Factors/Expectations
Cultural Attitudes
(Gender Role Expectations)
(Values Influencing the Medical System)
(Media Portrayals of Pregnancy & Birth)
Family/Microsystem Factors
Caregiver
Family Support & Involvement
Partner Relationship and Partner as Parent
Community Support & Connection
Connection with Baby
Parenting
Breastfeeding
Baby’s Characteristics
Individual Factors:
Attitudes and Expectations
Agency & Empowerment
Personal Wellbeing
Spirituality and Meaning
Labour & Delivery Experience
Preparation
Medical Concerns
Pain management
Staying Busy/Active
Community Factors
Workplace Polices
Workplace experiences
Labour Environment
Healthcare Access & Nature of Care
(Practices in Maternal and Infant Care)
Preparation
Information
(Educational and Social Services for Perinatal Women)
Medical Interventions
Paternity Leave Policies
perinatal mental heatlh influlences
Depression
Anxiety and stress
Trauma (present, or past)
Loss (grief and bereavement)
Body Image
Identity and relationship issues
depression
DSM Criteria
Depressed mood or irritable most of the day
Decreased interest or pleasure Significant weight change(5%)or change in appetite
Change in sleep: Insomnia or hypersomnia
Change in activity: Psychomotor agitation or retardation
Fatigue or loss of energy
Guilt/worthlessness
Concentration
Suicidality
Dystocia - Abnormal or difficult labour
Vast number of maternal and fetal factors
Problems with powers: hypertonic uterine dysfunction, hypotonic uterine dysfunction, precipitous labour
Problems with the passageway: abnormal pelvis, obstructions in maternal birth canal
Problems with psyche: psychological distress-Emotions such as fear, anxiety, helplessness, being alone, and weariness can lead to psychological stress, indirectly causing dystocia
Problems with passenger: occiput posterior position, breech presentation, multifetal pregnancy, macrosomia and CPD, structural abnormalities
shoulder dystocia
Nursing Assessment
History of risk factors
Vital signs - temp
Uterine contractions
Fetal heart rate
Fetal position
Nursing Management
Ensure bladder is empty
Promoting labor progress Mc Robert’s Manoeuvre and suprapubic pressure
Providing physical and emotional comfort
Communication and empowerment
umbilical cord prolapse
Pathophysiology: partial or total
occlusion of cord with rapid fetal
deterioration
Nursing Assessment
Continuous assessment of client and fetus
Nursing Management
Prevention-Aware of risk factors
Prompt recognition via FHR, vaginal exam
Measures to relieve compression of the cord
Expedite delivery (C Section)
uterine rupture
uterus tears or breaks open
Nursing Assessment
Risk factors, onset marked by sudden fetal bradycardia, fetal parts felt really well, excruciating pain, signs of shock
Nursing Management
Preparation for urgent cesarean birth
Continuous maternal and fetal monitoring
amniotic fluid embolism
Obstetric emergency
Sudden onset of hypotension, hypoxia,
coagulopathy due to breakage in barrier between maternal circulation and amniotic fluid
Nursing Assessment:
difficulty in breathing, hypotension, cyanosis, seizures, tachycardia, coagulation failure, DIC, pulmonary edema, uterine atony with subsequent hemorrhage, cardiac arrest
Nursing Management:
supportive measures to maintain oxygenation
hemodynamic function and to correct coagulopathy;
critical care monitoring
forceps or vacuum assisted birth
Application of traction to fetal head with risk of tissue trauma to mother and newborn.
Indications:
Failure of presenting part to fully rotate and descend
Non reassuring FHR pattern
Presumed fetal jeopardy, limited sensation or inability to push effectively
Prolonged second stage of labour
Maternal fatigue
Maternal heart disease
Acute pulmonary edema
cesarean birth
Classic or low transverse incision- Pfannenstiel
Major surgical procedure and accompanying risks
Nursing Assessment: history and physical examination for maternal and fetal indications
Vaginal Birth After Cesarean (VBAC)
Controversy related to risk of uterine rupture and hemorrhage
Contraindications e.g. CPD, ↓2years since last section
**Special areas of focus: **
Consent
Continuous fetal heart surveillance
Readiness for emergency
Nurses as advocates for clients
managing a non reassuring FHR pattern
Make sure patient has a wedge (not on back)
Change patient’s position
Adjust FHR transducer/check maternal pulse
Start Oxygen
Reassure the client and family
If oxytocin is in progress, turn it off and speed up the IV to reduce the effects of the oxytocin
Call for help
onset of labour factors involved
Labor begins when the forces favoring the continuation of pregnancy are overcome by the forces that want it to end
Hormone Changes
↑ fetal adrenal gland activity - production of glucocorticoids so ↓ progesterone and uterus easily stimulated
↓progesterone and ↑ estrogen
Release of ↑prostaglandins
Mechanical factors
Stretching, pressure, irritation of the uterus and cervix – leads to release of ↑ oxytocin and it is more sensitive to Oxytocin
signs preceding labour
Lightening
Urinary frequency
↑ Braxton-Hicks
Weight loss ~3 lbs
Surge of energy “nesting”
Backache
↑ vaginal discharge
Bloody show
Rupture of Membranes
Contractions
true labour vs pre/early labour
TRUE
Contractions – ↑ frequency, duration, & intensity
May ↑ with activity
Discomfort- lower back sweeps around , across thighs
Cervix – Effacement and dilation
May have bloody show
PRE-Labor or Early Labor
Contractions: Inconsistent – do not ↑
No Δ with Activity ↓ when resting
Discomfort is in lower abdomen
Cervix – no change
Not usual to have bloody show
Critical Factors Affecting Labour and Birth (“5 Ps”)
Passageway (birth canal: bony pelvis & soft tissues)
Passenger (fetus and placenta)
Powers (contractions)
Position (maternal)
Psychological maternal response to labour
Five Additional Factors Affecting the Labour Process
Philosophy (low-tech, high-touch)
Partners (support caregivers)
Patience (natural timing)
Patient preparation (childbirth knowledge base)
Pain control (comfort measures)
landmarks on baby
Occipital bone (0): Vertex presentation
Chin (mentum [M]): Face presentation
Buttocks (sacrum [S]): Breech
powers primary vs seconadry
Primary - Nature of the contractions
Secondary – amniotic fluid and maternal bearing down efforts
cardinal movements of labour
Engagement
Descent with Flexion
Internal rotation
Extension-sweeps perineum
Restitution and External rotation
Shoulders rotate
Expulsion of body
first stage of labour
First stage (8-12 hrs) longest of 3 stages Start of true labor till complete cervical dilatation-10 cm
Latent phase up to 3 cm
Active phase 3- 8cm
Transition phase 8-10cm
second stage of labour
cervix 10 cm dilated to birth of baby
third stage of labour
birth of infant to placental expulsion
fourth stage of labour
1-4 hours following delivery
Pharmacological Agents of Pain Relief.
Sedatives/anti-emetics-
Morphine & Gravol - IM
Local Anesthesia- Lidocaine
Pudendal Block- Lidocaine
Regional anesthesia
Neuraxial analgesia/anesthesia techniques: continuous, intermittent –(Epidural, Spinal)
Nursing Management of a client -Epidural
This is a sterile procedure (cap and mask)
Client must have an iv, a doctor’s order
Epidural information sheet - shared with client and client consent must be obtained
Position the client (C) and ask her to remain still
Provide the anesthesiologist with correct medication (bupivacaine and fentanyl) and set up epidural pump
Obtain baseline vitals and position client with a wedge
Perform hourly sensory, motor, respiration and blood pressure checks
Insert a foley catheter
Restrict intake to clear fluids only
narcotics in labour
If woman has had narcotics within 4 hours of birth
Keep antidote ready for baby
Naloxone Hydrochloride (Narcan)
.1mg per Kg body weight
i.e. – .3mg IM
Oxytocin for Induction or Augmentation of labour
Normal reassuring fetal heart tracing is a requirement
Continuous fetal and uterine monitoring
Dose increased every 30 mins in a safe manner
Start with 1 milli unit and a max of 20 milli units per minute unless the obstetrician permits a higher dose
5-6 strong contractions per 10 minutes with a good resting tone is desirable
Signs of Placental Separation
The uterus rises upward
The umbilical cord lengthens
A sudden trickle of blood is released from the vaginal opening
The uterus changes its shape to globular
