unit 2 Flashcards
how many stages of labor?
4
what is the 1st stage of labor?
onset of labor to 10cm dilated
what are the phases in the 1st stage of labor?
latent phase
active phase
transition phase
what is the latent phase of the 1st stage of labor?
dilation from 0-3cm
little descent
more frequent contractions
not too much pain
how does mom feel during the latent phase of stage 1 labor?
mom is excited
what is the active phase of the 1st stage of labor?
dilation from 4-7cm
increase pain
epidural is given
how does mom feel during the active phase of stage 1 labor?
apprehensive
what is the transition phase of the 1st stage of labor?
dilation from 8-10cm
effacement complete
full dilation
how does mom feel during the transition phase of stage 1 labor?
tired
doubt themselves
anxious
what must be done before mom can start pushing?
empty bladder
must be fully dilated
what is the 2nd stage of labor?
birthing the baby
active pushing
what are the 2 stages in the 2nd stage of labor?
latent phase
transitioning stage
what happens in the later phase of the 2nd stage?
descent of baby through birth Canal
mom is actively pushing/bearing down
what happens in the transition phase of the 2nd stage?
presenting part of baby on perineum
bearing down most effective
cardinal movements
interventions for 2nd stage of labor?
vitals every 5-15min
empty bladder
reposition as needed
monitor fetal descent
patterned breathing
tearing
interventions for 1st stage of labor?
monitor FHR
monitor contractions
what does multipara mean?
multiple pregnancies
how long can stage 2 be for a multipara mom?
0-30minutes
what does primipara mean?
first pregnancy
how long can stage 2 be for a primipara mom?
0-3 hours
what is the 3rd stage of labor?
delivery of placenta
placental care
repair tearing/laceration
what to ensure with the delivery of placenta?
cord is clamped and cut
uterus rises, volume shrink
gush of blood expels uterine contents
what is the 4th stage of labor?
postpartum
1-4hr after delivery
recovery period
important things to monitor for in the 4th stage?
monitor bleeding
mom has 6hr to pee
interactions between mom and baby
what are important interactions between mom and baby?
skin to skin
bonding
breastfeeding
What are symptoms leading up to labor?
incr urinary frequency
membrane rupture
nesting
Braxton hicks
incr vaginal discharge: bloody show
softening of cervix
What is false labor?
irregular contractions
goes away with resting or walking
no cervical changes
higher up (above umbilicus)
what is true labor?
regular contractions
not go away
worsen with walking
cervical changes (uterus distension, hormone release (oxytocin), cervical pressure)
lower (below umbilicus)
what are the 5 P’s of labor?
passageway, passenger, positon, power, psyche
what is the passageway?
the birth canal
(body pelvis, soft tissue, cervix, pelvic floor muscles, vagina introits)
what is passenger?
fetus & placenta
(size of baby, fetal presentation, fetal lie (spine to moms spine), attitude, position)
what is position?
position of mother during birth
(upright, all fours, lateral)
what are the stages of powers?
primary
secondary
what is the primary stage of power?
beginning labor
(contraction, dilation, effacement, Ferguson reflex)
what is the secondary stage of power?
expulsion of baby after dilation
(bearing/pushing down)
what can affect moms labor?
positions
(incr comfort, easier labor, placental perfusion)
what is psyche?
emotional response
(social support, past experience, knowledge)
if the fetal heart tones are present above the umbilicus, it indicates what?
breech
if the fetal heart tones are present below the umbilicus, it indicates what?
vertex
what are fetal positions based on?
mom
3 part abbreviation
(L)eft or (R)right of mom
(O)cciput, (S)capula, (M)entum first
(A)nterior (facing ground) (P)osterior (facing ceiling)
what is station?
relation of fetus to moms pelvis
types of station?
-3, -2, -1 = above pelvis (bear down)
0 = engaged
+1, +2, +3 = below pelvis (forceps, vacuum)
importance facts about intimate partner violence?
be nonjudgemental
screen before, during, after pregnancy
leading cause of death in pregnancy/PP
what do FHR strips record?
peak to trough, 1 cycle of baby HR
what are the different variabilites?
absent
minimal
moderate
marked
sinusoidal
what is absent variability?
flat like line
no variability=bad
what is minimal variability?
baby might be sleeping
stimulate baby
little variability=sad
what is moderate variability?
normal
what is marked variability?
contractions occurring
mom just ate
jagged lines=stressed
What is sinusoidal variability?
smooth wave like pattern
20min=bad
fetal distress (anemia, infection, meds)
IV fluids, positon change, O2, HCP
what are decelerations?
how to FHR corresponds to the moms contractions
what are the different types of decelerations?
early
late
variable
prolonged
what are early decelerations?
FHR mirror moms contractions
normal
compression of baby’s head
intervention for compression of baby’s head?
none
what are late decelerations?
FHR occurs after moms contractions
baby is in distress
uteroplacental insufficiency
intervention for uteroplacnetal insufficiency?
GIVE FLUIDS
elevate legs
position changes
oxygen
what are variable decelerations?
FHR occurs whenever, regardless of contractions
V, W, U shaped-uncoordinated, not smooth
cord compression
intervention for cord compression?
POSITION CHANGE
oxygen
what are prolonged decelerations?
FHR decreased
typically from tachysystole from mom
no perfusion
intervention for no perfusion?
call HCP
stat c-section
what is the difference between prolonged and variable decelerations
prolonged, between 2 & 10 minutes
variable, under 2 minutes
What is bradycardia?
FHR under 110
cause of bradycardia?
infection
HEART CONDITION
medications
maternal hypoglycemia
interventions for bradycardia?
call HCP
oxygen
find/fix underlying cause
what is tachycardia?
FHR over 160
not related to contractions
cause of tachycardia?
INFECTION
HTN
hypoxia
maternal fever
anemia
meds
interventions for tachycardia?
d/c Pitocin
fluids
VS
call HCP
what is tachysystole?
no many contractions close together
-contractions under 1min apart
-5 contractions in 10min
-contractions lasting over 2 min
what is an elective induction?
for convince of woman
what is indicated induction?
medical reason
obstetric
fetal problems
what are the two types of inductions?
mechanical
chemical
example of mechanical induction?
stripping (sweeping)
foley build induction
example of chemical induction?
oxytocin (Pitocin)
prostaglandin
what must occur before mechanical induction can occur?
patient has to be partially dilated
what is stripping?
finger inserted into cervix
separates amniotic sac from wall
-stimulate effacement/dilation
-cramps/spotting
what is foley bulb induction?
foley Cath inserted into cervix
inflated
pressure on cervix–> dilation
-sterile
-safe
what is oxytocin?
pitocin
antidiuretic
stimulates uterine contractions
what should the nurse monitor when a patient is on Pitocin?
FHR
tachysystole
uterine rupture
water intoxication
what to do if tachysystole occurs with Pitocin?
d/c Pitocin
side-lying position
oxygen 10-15L/min
(tubuterline–> not resolved)
what is prostaglandin?
E1-cytotec
E2-cervidil
what is cytotec for?
induction of labor
hemorrhage
what is cervadil for?
hemorrhage
shock
what is gate control theory?
activating another sense, to mute/distract from the sense of pain
What are the different types of analgesics used to control pain?
non-opioid
opioid agonist analgesics
opioid agonist
what are non-opioids used for pain?
zofran (antiemetic, antianxity, sedative)
Benzodiazepines (feel out of control)
Barbituates (rarely used)
Nitrous Oxide (laughing gas, N/V 1&2 stage)
what are opioid agonist analgesics?
Dilaudid
CAUSE WITHDRAWL, NO FOR MOMS WITH ADDICTION
drowsy, urinary retention
respiratory sedation in baby
what are opioid agonist?
Naloxone (narcan)
not for opioid dependent mom
what are the different types of anesthetics?
regional
general
pudendal
local
what are regional anesthetics?
spinal
lumbar epidural
spinal epidural
when are regional anesthetics given?
1st or 2nd stage of labor
side effects of regional anesthetics?
loss of sensation to push
slow/prolong labor
drop in BP
intervention for BP drop?
IV bolus of fluid
epinephrine
what is a spinal?
shot
deeper than epidural
numb breast to feet
5-10min
side effects of spinal?
cerebralspinal fluid leakage
auditory/vision problems
intervention for cerebrospinal fluid leakage?
blood patch
drink fluids
rest
what is an epidural?
continuous Cath or numbing medication
side effects of anesthesia?
hypotension
respiratory depression
urinary retention
fever
incr risk of forceps delivery
assistance with ambulation
what is general anesthesia used for?
emergent c-section
major risk (maternal blood loss, aspiration, cardiac/respiratory distress)
what is pudendal block?
local anesthetic for repair
lower vagina, vulva, perineum
no relief from contractions
pudendal block for 2nd stage?
extraction
pudendal block for 2nd-3rd stage?
pain relief
pudendal block for 3rd stage?
repair
pudendal block side effects?
infection
urinary retention
hematoma
what is local perineal infiltration anesthesia?
numbs perineum only
prior to birth(episiotomy)
laceration repair
side effect of local perineal infiltration?
infection
hematoma
brusing
discoloration
vacuum/forceps delivery cannot be done until…
mom has ruptured
what is vacuum delivery?
use of pressure to birth head
move baby during contractions
no longer than 15 min at a time
what are the prerequisites for a vacuum delivery?
ruptured membranes
baby vertex
what are the side effects of vacuum delivery?
scalp wound
bleeding
cephalhematoma
what is forceps delivery?
assist birth of large baby for small pelvis
shortens 2nd stage is dystocia
during contractions
side effects of forceps delivery?
lacerations to moms wall
baby bruising, skull fracture
brachial injury
brain bleed
facial paralysis
what is precipitous labor?
labor under 3 hours
happens once, it’ll happen again
support peritoneum
call for help
side effects of precipitous labor?
baby bruising
mom can tear
hemorrhage
hypoxia
uterine rupture
what is shoulder dystocia?
baby is stuck by the shoulder in the pelvis
turtle sign
McRoberts maneuver
what is turtle sign?
baby comes out and then goes back in because its caught on pelvis
what is McRoberts maneuver?
moms knees to chest to open pelvis
shoulder dystocia side effects?
fetal hypoxia, cerebral palsy, stroke, abnormal reflexes, birth injury
maternal episiotomy, lacerations, endometriosis
what is a grade 3 laceration?
sphincter torn
what is a grade 4 laceration?
rectum torn
what is a big no for lacerations?
no enema or suppository–> lead to hemorrhage
what is episiotomy care?
surgery
peri bottle
sitz bath
colace
blotting
REEDA
what is REEDA?
Redness
Erythema
Edema
Drainage
Approximation
…of a laceration/tear
what is post term?
gestation over 42 weeks
what are post term complications?
large infant
dysfunctional labor
shoulder dystocia
meconium
post maturity syndrome
what is a prolapsed cord?
cord moves next to or past presenting part
what does a prolapsed cord indicate?
variable decelerations
what are the different types of prolapsed cords?
occult
what is an occult cord?
cord can be seen or felt
what is a prolapsed cord?
cord can be felt
what is a complete cord?
cord can be seen
what are different types of contraceptions?
IUD
implantable progestin
oral contraception
condom
abstinence
what is IUD?
hormone 3-5 years
copper 10 years
side effects of IUD?
grow into uterus
hard to take out
perforate uterus
what is implantable progestin?
depo
small rods under skin
3years
what is oral contraceptives?
DVT & HTN
no clotting/smoking hx
take at same time each day
(spot and have issues if not)
different condoms?
vaginal
penile
what is the contraceptive that has 100% protection?
abstinence
breast care?
engorgement
-massage, pumping, warm water
nipple soreness
-no soap and water
-put colostrum on it
-anti-inflammatory
tired
-breastfeed
supply & demand for milk?
10-15min on both sides
milk production/supression
what is mastitis?
infection of breast
flu like symptoms
not emptying breast, clogged duct, cracked nipple, breast trauma
treatment of mastitis?
antibiotics
cold compress
NSAIDs
fluid intake
breast feed
proper latch
hygiene
Lochia days 1-4
rubra
heavy bleeding
small clots
Lochia days 5-9
serosa
more watery than bloddy
Lochia days 10-14
alba
little to no blood
Lochia s/s to look for?
spotting can go up to 6wk
pad saturated 1 hr= watch close
pad saturated 15min=emergency
What is a VTE?
blood clots
DVT
PE
post partum depression?
6mo
sadness
fatigue
sleep problems
detached from baby
post partum psychosis?
disorientation
harm to self/baby
hallucination
hematoma?
pain, not relieved by meds
collection of blood in connective tissue
life threatening
hemorrhage?
vag blod loss>500ml
c blood loss> 1000ml
early (within 24hr)
late (24hr-6wk)
drugs to manage hemorrhage?
Pitocin
hemabate
methergine
cytotec
what is Pitocin?
hyponatremia
antidiuretic
what is hematite?
no HTN
common
fever
diarrhea
take with zofran
what is methergine?
common
no HTN
N/V
take with zofran
what is cytotec?
sometimes used
can take with HTN
what are some postpartum complications?
uterine atony
inversion of uterus
sub involution
retained placenta
what is uterine atony?
leading cause of hemorrhage
uncontrolled bleeding, low BP
massage uterus, meds, IV infusion, hysterectomy
what is inversion of uterus?
life threatening
incomplete (can’t be seen, in cervix)
complete (in vagina)
prolapsed (out of vagina)
what is sub involution?
delay in uterus to return to normal size
prolonged bleeding
larger uterus
meds, D&C, antibiotics
what is retained placenta?
placenta not removed 30 min from delivery
hemorrhage
