Study Guide / Tutoring Notes Flashcards
Dilation/Effacement/Station
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Dilation: opening of the cervix in centimeters
Effacement: thinning of the cervix
* measured in %
Station: position of the baby’s head in relation to the mother’s ischial spine
* measured in -/+
Positioning during Labor
Different maternal positions can help progress labor & reduce pain
- sitting
- standing
- side-lying
- squatting
Primary vs. Secondary Powers
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Primary Powers: involuntary uterine contractions
Secondary Powers: voluntary maternal efforts like pushing
What is the difference in primary & secondary powers?
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Primary Powers involve involuntary contractions while secondary powers are voluntary maternal efforts like pushing
Primary Powers
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Involuntary uterine contractions
Secondary Powers
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Voluntary maternal efforts like pushing
Epidural Analgesia
A common pain relief option during labor, involving administration of medication into the epidural space
VEAL CHOP
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Mnemonic to remember the cause of fetal heart rate changes
- Variable decels = Cord compression
- Early decels = Head compression
- Accelerations = Ok
- Late decels = Placental insufficiency
What are the causes of the following changes in fetal heart rate?
- Variable Decelerations
- Early Decelerations
- Accelerations
- Late Decelerations
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1.) Variable decelerations = Cord compression
2.) Early decelerations = Head compression
3.) Accelerations = Ok
4.) Late decelerations = Placental insufficiency
Early Decelerations
- What do they look like?
- What is the cause?
- What does it mean?
- Nursing Intervention
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A gradual decrease in FHR that mirrors uterine contractions (FHR begins to drop at the start of a contraction & returns to baseline by the end of the contraction.
- CAUSE: Head Compression
- Meaning: early decelerations are benign & generally do not indicate fetal distress
- Nursing Intervention: no intervention required because this is a normal response to labor
Late Decelerations
* What do they look like?
* What is the cause?
* What does it mean?
* Nursing Intervention
A gradual decrease in FHR that begins after the contraction starts, with nadir (lowest point) of the deceleration occuring after the peak of the contraction. The FHR returns to baseline after the contraction has ended
Cause: Placental Insufficiency meaning the placenta is not delivering enough oxygen to the fetus during contractions.
* Can be due to various factors, such as maternal hypotension, preeclampsia, uterine hyperstimulation (excessive contractions) or placental problems (abruption, aging placenta, etc.)
Meaning: Late decelerations are concerning because they suggest fetal hypoxia. Repeated late decelerations indicate that the fetus may not be tolerating labor well.
Nursing Interventions:
* 1.) Stop pitocin if the contractions are too frequent
* 2.)Change maternal position (L lateral side-lying poistion) to improve blood flow to the uterus
* Administer oxygen to the mother (via face mask)
* Increase IV fluids to improve maternal circulation
* Notify HCP if late decelerations persist
Variable Decelerations
- What do they look like?
- What is the cause?
- What does it mean?
- Nursing Interventions
Abrupt drops in FHR that occur any time in relation to contractions. The shape of the decelerations is variable & may have a “V”, “U”, or “W” pattern on the monitor. They tend to be deeper & more sudden than early or late decelerations
Cause: Cord Compression
* The cord may be wrapped around the baby’s neck ro body, compressed between the baby & the uterine wall, or prolapsed (coming out before the baby)
What it means: Whiel variable decelerations are common, they can indicate intermittent disruption fo blood flow & oxygen to the fetus. If they are infrequent & recover quickly they may not be a concern. However, frequent or prolonged variable decelerations suggest more serious fetal distress
Nursing Interventions
* Change maternal position to relieve cord compression (side-lying, hands-and-knees, etc.)
* Administer oxygen to the mother
* Amnioinfusion (instillation of saline into the uterus) may be considered to relieve pressure on the cord.
* Notify HCP if decelerations persist or worsen
What do Early Decelerations look like?
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A gradual decrease in FHR that mirrors uterine contractions (the FHR begins to drop at the start of a contraction & returns to baeline by the end of the contraction)
CAUSE
Early decel = Head compression
What is a late deceleration?
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A gradual decrease in fetal heart rate that begins AFTER the contraction starts with the nadir (lowest point) of the deceleration occuring AFTER the PEAK of the contraction. The FHR returns to baselline after the contraction has ended
CAUSE
Late decel = Placental insufficiency
* not enough oxygen is being delivered to the fetus during contractions
What are the interventions for late decelerations?
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LIONS PIT
- 1.) STOP PITOCIN
- ** Left lateral side-lying position** (to improve blood flow to the uterus)
- IV fluids (increase / open IV fluids to improve maternal circulation)
- Oxygen administration via mask
- Notify the HCP if late decelerations persist
What are Variable Decelerations?
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Abrupt drops in fetal heart rate that occur at any time in relation to contractions. The shape of the deceleration is variable & may have a “V”, “U”, or “W” pattern on the monitor. Tend to be depper & more sudden than early or late decelerations.
CAUSE
- Variable decels = Cord compression
External Fetal Monitoring (EFM)
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Non-invasive, easy to use, & suitable for most patients, but are less precise in measuring contraction intensity or fetal heart rate variability
TYPES:
- Fetal heart rate = ultrasound transducer
- Contractions = Toco transducer
What is the name of the external fetal monitoring device used to monitor fetal heart rate?
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Ultrasound Transducer
What is the name of the external fetal monitoring device used to monitor contractions?
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Toco transducer
What are Internal Fetal Monitors?
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Invasive, but more accurate & used when precise data is required or EFM is inadequate
TYPES:
- Fetal heart rate = fetal scalp electrode
- Contractions = Intrauterine pressure catheter (IUPC)
What is the name of the internal fetal monitoring device used to monitor fetal heart rate?
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Fetal Scalp Electrodes
What is the name of the internal fetal monitoring device used to monitor contractions?
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Intrauterine pressure catheter (IUPC)
What is the difference in true and false labor?
True Labor leads to cervical changes!!!!
- False labor consists of braxton hicks contractiosn with no cervical dilation
Rupture of membranes
When the amniotic sac breaks, labor usually follows
- be mindful of timing & color of fluid
Nurse support during labor
- Emotional support
- Pain management
- Helping with labor progression
Maternal Hypotension
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Common after epidural & can affect fetal heart rate
- Nurses often use position changes & IV Fluid Bolus to manage it.
Afterpains
Cramping pain after delivery due to uterine contractiosn as the uterus returns to its pre-pregnancy size.
Lochia Stages
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Postpartum Vaginal Discharge
Classifications:
* Lochia rubra: days 1-3; bright red
* Lochia serosa: days 4-10; pinkish-brown
* Lochia alba: days 10+; yellowish-white
What are the 3 classifications of lochia? Describe each classification.
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Lochia Rubra
* days 1-3
* bright red blood w/ small clots
Lochia Serosa
* days 4 - 10
* pinkish-brownish
Lochia Alba
* after day 10
* Yellowish-white
Really = Rubra
Sore = Serosa
After = Alba
Engorgement
Breast swelling due to increased blood flow & milk production
For Breastfeeding Mothers:
* hand expression
* pumping
For Non-Breastfeeding Mothers
* cold therapy
* tight bra
* cabbage leaves
Puerperium
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The postpartum period when the mother’s body returns to its pre-pregnancy state
Maternal Lab Values to Monitor in the postpartum period
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Hemoglobin, hematocrit, & white blood cells
Normal Postpartum Hematocrit Levels
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30 - 60%
- a drop in hematocrit is common after delivery due to blood loss, but if it drops below 30%, it may indicate excessive blood loss (postpartum hemorrhage) or anemia
- elevated hematocrit may indicate dehydration
Normal Postpartum Hemoglobin levels
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10 - 14 g/dL
- a hemoglobin level below 10 g/dL may indicate postpartum anemia, particularly if associated with significant blood loss during delivery
Normal Postpartum WBC Range
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12,000 - 25,000 cells/mcL
- a persistently elevated WBC count (< 25,000 a few days beyond postpartum) may indicate an infection such as endometriosis, wound infectoin, or mastitis
- a drop in WBC count may suggest recovery from the physiological stress of labor
What are the normal postpartum ranges for the following labs?
- Hematocrit
- Hemoglobin
- WBCs
KNOW THIS!!!!!
Hematocrit: 30 - 60%
* < 30% = excessive blood loss or anemia
* > 60% = dehydration
Hemoglobin: 10 - 14 g/dL
* < 10 g/dL = postpartum anemia
WBCs: 12,000 - 25,000 cells / mcL
* > 25,000 = infection (endometriosis, wound infection, or mastitis)
Involution
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Postpartum shrinking of the uterus back to its pre-pregnancy size
Subinvolution
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delayed or incomplete return of the uterus to its pre-pregnancy size
What is the difference in involution & subinvolution?
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Involution is the postpartum shrinking of the uterus back to its pre-pregnancy size.
- Subinvolution is delayed or incomplete shrinking of the uterus to its normal pre-pregnancy size
What is the estimated blood loss in a vaginal & cesarean section delivery?
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Vaginal = 500 mL
C-Section = 1,000 mL
Rh Status
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Rh-Negative (-) mothers with Rh-positive (+) babies require Rh immunoglobulin to prevent Rh sensitization
Respiratory Changes in the Newborn Transition to Extrauterine Life
First Breath
* When the baby is born, the cold air, light, & physical stimulation cause the baby to take their first breath. This breath si strong enough to expand the lungs which were previously filled with fluid
Surfactant:
* a substance produced in the fetal lungs late in pregnancy, reduces surface tension in the alveoli, allowing the lungs to stay open for effective gas exchange.
Fluid Clearance
* In utero, the lungs are filled with amniotic fluid. During labor & delivery, much of this fluid is squeezed out of the lungs as the baby passes through the birth canal
* After birth, the rest of the fluid is absorbed into the blood stream & lymphatic system, allowing air to fill the lungs & facilitating proper breathing
Establishment of Air Breathing
* The first breath inflates the lungs & changes the pressures in the thoracic cavity, making it easier for the newborn to continue breathing. This also allows oxygen to be absorbed into the bloodstream
Heat Loss in Newborns
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Newborns are at risk of heat loss through evaporation, conduction, convection, & radiation.
- Use skin-to-skin care to regulate body temperature
APGAR Score
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A quick assessment of the newborn at 1 & 5 minutes of life
- based on Appearance, Pulse, Grimace, Activity, & Respiration
- 7-10 = normal / good / no distress
- 4-6 = moderate distress
- 0-3 = severe distress
Appearance (skin color)
* 0: blue or pale all over
* 1: pink body with blue extremities (acrocyanosis)
* 2: completely pink
Pulse (heart rate)
* 0: no heart rate
* 1: heart rate < 100 bpm
* 2: heart rate > 100 bpm
Grimace (reflex irritability)
* 0: no response to stimulation (suction, mild pinch, etc.)
* 1: grimace or weak response to stimulation
* 2: strong response like crying, pulling away, or coughing
Activity (muscle tone)
* 0: limp or floppy
* 1: some flexion of the arms & legs
* 2: active motion & well-flexed muscles
Respiration (breathing effort)
* 0: no breathing
* 1: weak, irregular, or slow breathing
* 2: strong, clear cry
Feeding Cues
Early signs of hunger
- rooting
- hand-to-mouth movements
- sucking motions
Breastfeeding Effectiveness
Indicators include good latch, audible swallowing, & appropriate output
Colostrum
Nutrient-rich, antibody-laden first milk produced
Skin-to-Skin
Promotes bonding, breastfeeding success, & thermal regulation
Fetal circulation vs. neonatal circulation
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Closure of the Foramen Ovale:
* Foramen ovale is the hole between the R & L atria that allows blood to bypass the lungs
Closure of the Ductus Arteriosus:
* Ductus arteriosus is a vessel that connects the pulmonary artery to the aorta, allowing blood to bypass the lungs
* After birth, as the oxygen levels rise in the baby’s blood, the ductus arteriosus constricts & eventually closes (usually within the first few hours of life)
* Closure ensures that blood flows to the lungs to get oxygen
Closure of the Ductus Venosus:
* Ductus venosus shunts blood from the umbilical vein directly to the inferior vena cava, bypassing the liver
* After the umbilical cord is clamped, blood no longer flows through the umbilical vein & the ductus venosus closes, therefore redirecting blood flow through the liver for filtration
Closure of the Foramen Ovale
Foramen ovale is the hole between the L & R atria, which allows blood to bypass the fetal lungs (since the placenta oxygenates the blood).
- At birth, as the lungs inflate & the pressure in the L side of the heart increases, the foramen ovale closes.
- Closure of the foramen ovale directs blood to flow from the R atrium to the R ventricle to the lungs for oxygenation
Closure of the Ductus Arteriosus
The ductus arteriosus is a vessel that connects the pulmonary artery to the aorta, allowing blood to bypass the lungs during fetal circulation
- After birth, as oxygen levels rise in the baby’s blood, the ductus arteriosus constricts & eventually closes (usually within the first few hours of life).
- Closure of the ductus arteriosus ensures that blood flows through the lungs for oxygenation.
Closure of the Ductus Venosus
Ductus venosus shunts blood from the umbilical vein directly to the inferior vena cava, bypassing the liver.
- After the umbilical cord is clamped, blood no longer flows through the umbilical vein & the ductus venosus closes.
- Closure of the ductus venosus redirects blood flow through the liver for filtration (of waste products)
Jaundice
Yellowing of skin due to high bilirubin levels
- early feeding can help reduce the risk
CCHD Screening
Critical Congenital Heart Disease screening helps detect serious heart defects in newborns.
Newborn Weight Loss Calculation
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Normal for newborns to lose weight in first few days; 5-7% is typical
- anything over 10% weight loss needs evaluation
