Test 2 Flashcards
Episiotomy / Laceration
Posterolateral-more painful, longer to heal, less chance of tearing to rectum.
Median-less painful, risk of tearing to rectum
Amniotomy
artificial rupture of membranes-document time, color of fluid, odor, amount; monitor FHR (cord prolapse)
pH of amniotic fluid = alkaline - (pH paper yellow to blue) **- **ferning is definitive
IOL
(induction of labor)
- assess BP and pulse frequently
- record I&O
- H/A, blurred vision, behavior change, increased BP, respirations
- assess for uterine atony post-partum, jaundice of NB
Operative/Assisted Birth
-forceps, vacuum extractor
–increased risk of injury for both mother and NB
- Mom: lacerations, hematomas of vagina
- Baby: ecchymosis, facial/scalp lacerations/abrasions, cephalohematomas, intracranial or subgaleal bleed
C-Section
- catheter
- type & cross
- baby out STAT bf anesthesia affects it
- pre-op meds: anti-emetics, bicitra (antacid), atropine (post-op N/V), antibiotics
- Low, transverse-heals better, less likely to rip, can have VBAC
- Low, vertical-can be extended upward to make larger incision if needed, more likely to rupture during subsequent birth
- Classical (verticla, up higher)-most likely of incisions to rupture during subsequent births, elimnates VBAC.
Post-C-Section
- assess: fundus, lochia, dressing, urine output, consciousness, gag reflex, pain, airway
- SCD’s for DVT (more clotting factors, immobile)
- promote bonding with infant
Leopold’s Maneuvers
- empty bladder
1. palpate fundus (moving the baby’s bottom moves it’s entire trunk, conversely, if the head is at the fundus-moving it will not move trunk)
2. palpate sides-determine posiiton of back
3. palpate suprapubic area-attempt to grasp presenting part (possible only if it is not engaged)
4. determine whether head is flexed (vertex, normal) or extended (face)
Passenger Presentation
- Right or Left
- presenting part (Occiput or Sacrum)
- Anterior or Posterior (refering to mother)
ROA or LOA is easer
RSA or LSA is breech (no fetal scalp electrode possible)
if ROP or LOP, mother complains of back pain, labor takes longer.
First Stage of Labor
Latent: reg contractions 3 cm (woman is usually sociable)
Active: 4-7 cm
Transitional-8-10 cm
Second Stage of Labor
Pushing!!!
10 cm until delivery
2 hours
perineal cleansing
document: time of ROM, baby, placenta, Apgar, Oxytocin, repairs, bleeding, pain, bonding, newborn resuscitation.
Third Stage of Labor
birth until placenta is delivered
administer oxytocin
care of infant: Apgar at 1 & 5 minutes, sucition as needed, thermoregulation, identification
watch for signs of placental separation (lengthening of cord, gush of blood, change in uterine shape)
document time and method of placental delivery (spontaneous, assisted, shiny/dirty)
Fourth Stage of Labor
1-4 hours post-delivery
VS of mother, fundus, lochia, bladder, perineum, pain (return of sensation)
promote bonding
promote comfort
Station
-5 (highest) to +5 (lowest)
references postion above or below ischial spine
Involution of Uterus
- return to pre-pregnancy state
- just after delivery, fundus should be at level of umbilicus
- normal size is fist
- risk of infection-no sex, baths; watch for fever, foul odor, increased bleeding
- excessive bleeding-massage fundus
- normal blood loss (vaginal) is 500 mL; ceseraian is 1000 mL
- cervical os will be slit and will never return to pre-preg
Lochia
- Rubra
- Serosa (second week)
- Alba (3 weeks)