Sim Lab Flashcards
What constitutes the First Stage of Labor?
Initial Assessment
- contact (usually phone): health history, prenatal record, birth plan
- inquire about fetal movement, EDB, bloody show, membrane status, characteristics of contractions, other s/s of labor, GP, previous childbirth experiences
- determine: True vs False LAbor
- do they have support
what is EDB?
estimated date of birth
what is gravida? parity?
gravida - how many times pregnant
parity - number of greater than 20 weeks (so miscarriages still a part of this)
How do you determine between true and false labor?
- examination of cervix
True: will change cervix
False: won’t change cervix
How do you perform an initial, physical assessment for someone in labor?
General Assessment
- head 2 toe and vitals (pain)
- Leopold’s maneuver
- vaginal examination for baseline
- amniotic membrane status: know when water broke b/c want to have labor at least 24 hours after it breaks
- uterine contraction
- FHR and pattern
What is Leopold’s maneuver?
- palpation to try and figure out how the baby is positioned in the belly, look up how to do
butt: more point
head: round ball
***most babies are head first
what is the top of the uterus called?
the fundus
Describe the vaginal examination for baseline during labor
2 fingers with lube through vaginal opening
- need to assess THICKNESS of cervix and how far DILATED it is (2 most important thing)
- also assess how far down the fetus has descended
What is the range of dilation when doing a vaginal examination during labor?
0-10 cm
How to rate fetal descent?
-3,-2,-1,0,+1,+2,+3 where positive numbers are further down means the labor will be shorter rather than longer
how do you check if it’s fluid from amniotic sac and not urine when water breaks?
nitrozine test, vaginal fluid pH is acidic where amniotic fluid is alkaline, use pH strip and see if it turns blue
(sometimes use amnisure, special q tip insert in vagina leave in for a minute and when you take it out put it in a solution and lab tests it)
What do you need to assess with uterine contractions?
- frequency: measure start of one contraction to start of next contraction
- intensity: how strong contraction is
- duration
- resting tone
What is the FHR and what do you need to to know about it?
fetal heart rate - either reassuring or non-reassuring: look at contractions and how baby's reacting to them, good = reassuring normal HR (measured over 10 min): 110-160 - determine variability (Minimal, moderate, marked): marked variability could mean baby's being pressed, mom has moved etc; there will also be periodic baseline changes (bad is minimal variability with late deceleration baseline changes)
Do you have to get the woman’s consent to test for HIV?
yes
what is a really important genital swab to do on a pregnant woman about to give birth?
for strep B
What are the non-pharm methods for pain management
1) Continuous Labor Support: someone in room for them
(biggest one)
2) Hydrotherapy: relaxation/buoyancy, vasodilation
3) Ambulation and position changes (definitely NOT flat on back)
4) Acupuncture
5) Attention Focusing and Imagery (eye contact’s important)
6) Therapeutic Touch/Massage
7) Breathing Techniques
What is Nursing Management during Second Stage of Labor
Delivery
- cleanse perineal area/vulva b/c from here on out always leaking fluid
- birth assist includes suctioning of newborn, holding legs, umbilical cord clamping
- immediate care of newborn
What entails immediate care of the newborn?
1) Drying/Stimulation
2) Apgar score
3) Identification
4) Hugs band: alarm band
5) measure baby/brith statistics
What is the third stage of labor
Placenta discarded
- assess for trauma, episiotomy, lacerations
- usually separates within 10 minutes
Interventions
- instruct to push
- admin oxytocin PRN
- apply ice to perineum if vaginal delivery
What’s the Fourth Stage of Labor?
- first 4 hours after delivery
- vital signs, fundus, perineal area, comfort level, lochia, bladder status
What is lochia?
description of fluid coming from uterus
What is bladder status indicative of after labor?
recovery status of mother
Why should a mother not lay on her side? (or is it her back?)
- supine vena cava syndrome
if have to tilt, better to be on left side
For whihc babies are phototherapy lights used for?
- babies with elevated bilirubin
If you have a baby that’s high or low birthweight, what’s an important second assessment to do?
blood glucose test
What’s the respiration rate for the newborn?
30-60 breaths/min
what is it called when baby’s trunk and face are pink but extremities are blue?
acrocyanosis
How do you perform a PKU?
heel stick, do it on the outer edges
