unit 3 Flashcards
fetal normal pH results
> 7.25
Reassuring
Associated with normal acid–base balance
fetal abnormal pH results
Between 7.20 and 7.25
Worrisome
May be associated with metabolic acidosis
<7.20
Critical
Represents metabolic acidosis
<7
Damaging
Frequently associated with fetal neurologic damage
fetal station
Station refers to the relationship of the presenting part of the fetus to the ischial spines of the pelvis.
-Zero station(0): presenting part is at the level of the ischial spines
-Minus station(-): presenting part is above the ischial spines
-Plus station (+): presenting part is below the ischial spines
fetal altitude
fetal position
The health care provider will determine fetal position by first establishing the presenting part (occiput, brow, etc.).The provider then determines if the part is facing the maternal right or left side and also which direction it is facing in relation to the maternal pelvis.
caput succedaneum
swelling to top of the head due to passing through the pelvis
Cephalohematoma
bleeding/hematoma noted to top of head/scalp due to trauma passing through pelvis
pelvic inlet
entrance to the true pelvis
pelvin outlet
exit point
ischial spines
the widest diameter of the presenting part is at the level of the ischial spines.
location, definition, what they mean
4 ps: passageway
-consists of bony pelvis, soft tissues of cervix and vagina(bony pelvis)
-pelvic shape: Gynecoid (most favorable for vaginal birth), Anthropoid, android and platypelloid
-pelvic dimensions: most import is obstetric conjugate; most desired shape to facilitate an easier delivery.
-soft tissues:Cervix must completely 100% effaced and dilated for the fetus to be born. Full dilation is equal to 10 cm; known as the second stage of delivery; Vagina
-cervical effacement and dilation: before labor, early effacement, complete effacement, full dilation
4 pelvic shapes and descriptions
-gynecoid pelvis, most favorable for vaginal birth. rounded shape allows fetus room to pass
-anthropoid pelvis, elongated in it dimensions. Can prevent vaginal delivery in some women
-android pelvis, heart shaped. Large babies become stuck and must be delivered c-section although smaller baby may be able to fit
-platypelloid pelvis, flat with a narrow anterior-posterior diameter and wide transverse diameter. Baby will be delievered c-section
(4) cervical effacement and dilations
A- before labor; cervix is not effaced or dilated
B- Early effacement, early dilation to 1cm
C- Complete effacement, mid-dilation to 5cm
D- full dilation to 10cm
4 ps: passenger
-fetal skull: most important in relation to labor and birth bc it is the largest and least compressible, molding is overlap of bones
-fetal lie: position of long axis of fetus in relation to long axis of pregnant woman(longitudinal,transverse,oblique)
-fetal presentation: foremost part of the fetus that enters the pelvic inlet
- 3 main presentations: head(cephalic
presentation majority of fetuses, feet or
buttocks (breech presentation),
shoulder(shoulder presentation is
uncommon)
-fetal attitude together determine the presenting part, relationship of fetal parts to one another.( Flexion, military, brow, face )]
-Fetal position: presenting part and location to the reference point,
-first letter/designation: refers to side of
maternal pelvis toward which presenting
part is face , R or L.
-second letter/designation: reference point
on presenting part, Occiput, Frontum or
brow, Mentum or chin, Sacrum, Scapula
-Third letter/designation: specifies
direction presenting part is facing,
Anterior(A) front of pelvis, Posterior(P)
back of pelvis, Transverse(T) side of pelvis
-ROA or LOA most favorable fetal positions
for vaginal birth
-fetal station: relationship of presenting part to ischial spines
4 ps: primary powers
The primary power of labor comes from involuntary uterine contractions, serves to efface and dilate the cervix
Maternal pushing efforts supply secondary powers during the second stage of labor
contraction pattern: frequency, duration and intensity
resting interval
must be periods of relaxation between contraction: allow reoxygenation to fetus, momentary relief for woman
4 ps: secondary powers
Maternal psyche is an important influence on the labor process
Current pregnancy experience
Previous birth experiences
Expectations for current birth experience
Preparation for birth
Presence and support of birth companion
Woman’s culture influence
Nursing interventions can help break the cycle of fear, tension, and pain that can interfere with labor
table 8.2 true labors
Cervical changes: progressive dilation and effacement
Membranes: may bulge or rupture spontaneously
Bloody Show: present
Contraction Pattern: Regular (may be irregular at first) pattern develops in which contractions become increasingly intense and more frequent
Pain Characteristics:Often starts in the small of the back and radiates to the lower abdomen; may begin with a cramping sensation
Effects of walking:Contractions continue and become stronger
table 8.2 false labors
Cervical Changes:no change
Membranes:remain intact
Bloody Show:Absent; may have pinkish mucus or may expel mucus plug
Contraction Pattern: Pattern tends to be irregular, although the contractions may seem to have a regular pattern for a time
Pain Characteristics:May be described as a tightening sensation; usually the discomfort is confined to the abdomen
Effects of walking:May decrease the frequency or eliminate the contractions altogether
mucus plug
Sometimes the mucus plug is expelled a week or two before labor begins. When the mucus plug passes, the woman will notice a one-time clear or pink-tinged discharge that is the consistency of jelly.
bloody show
presence of bloody show (mucous vaginal discharge that is pink or brown tinged which occurs as the blood vessels in the cervix start to rupture as effacement and dilation are beginning).
normal fetal pH & conditions associated with them
Abnormal fetal pH & conditions are associated with them
diet & fluid education for moms in active labor
stages of labor table 8.3; what is happening at each stage of labor and the typical reactions of the laboring women
pg 160 in our book
chapter 9
uterine rupture
nursing process pg 178 & care plan of the laboring women pg 179
gate control theory of pane & leverage with touch and massage
pharmacological intervention for pain- uses, assessment of the patient, side effects and outcomes of
Epidural anesthesia use- assessment of the patient, potential side affects of the epidural and outcomes
Post Catherine
Patient education regards to analgesia and sedation
Identify what stage it is appropriate to start analgesia
table 170; patterned breathing techniques for labor; slow paced breathing
The woman takes slow, deliberate breaths while she focuses on maintaining a relaxed stance. She may use effleurage, music, or any technique that encourages relaxation while using slow-paced breathing. The rate is approximately 6–10 breaths per minute
table 170; patterned breathing techniques for labor; Modified-paced breathing
The woman begins taking slow, deep breaths at the beginning of the contraction. She then increases the rate while decreasing the depth of respirations as she reaches the contraction peak, after which she slows the rate and increases the depth
table 170; patterned breathing techniques for labor; patterned-paced breathing or the pant-blow technique
This technique is similar to modified-paced breathing with the addition of a rhythmic pattern. The woman takes four light breaths and then blows out through her lips, as if she is blowing out a candle. The woman repeats this pattern through the peak of the contraction
table 171
table 173 9.3
know when it is appropriate to receive pain medication and when it is not (patient education)
positions of comfort during labors pg 171,172
Any position of comfort is acceptable, as long as the fetal heart rate stays within the normal range. If the woman wants to be on her back, be certain to place a pillow or a wedge under one hip to prevent supine hypotension. The woman may find a birthing ball to be helpful. The ball allows her to rock and move to a position of comfort. Women who ambulate and reposition themselves as needed during labor tend to report higher satisfaction levels with the birthing process.
factors that influence labor pain pg 168
threshold, pain threshold is the level of pain necessary of for an individual to perceive pain
pain tolerance refers to the ability of an individual to withstand pain once its recognized
nonpharmacological interventions to control pain to use during labor
Encourage the use of relaxation techniques. Reinforce the use of patterned breathing. Encourage the use of effleurage for as long as it is helpful. Encourage the use of counterpressure when effleurage is no longer helpful. The use of touch, such as effleurage and pressure, can interrupt the sensation of pain. Offer complementary therapies to increase comfort, such as a birthing ball or hydrotherapy, as appropriate. Allow alternative pain treatments that are culturally relevant to the client, if not contraindicated during labor.
Nonpharmacologic interventions to relieve labor pain include continuous labor support, comfort measures, various relaxation techniques, intradermal water injections, and acupressure and acupuncture.
affect of anxiety on the labor process
chapter 10
positions to help facilitate the birth process pg204-205
lochnia findings
box 10-7; signs of an increasingly distressed fetus, as fetus becomes hypoxic, here are signs and symptoms
Absent accelerations
Gradual increase in FHR baseline
Loss of baseline variability
Late deceleration pattern develops
Decelerations gradually increase in length and take longer to recover to baseline
Persistent bradycardia
Death
box 10-8 pg 196
box 10-9: food and fluid intake during labor
In the United States for the past several decades, the normal practice has been to withhold food and fluids from the laboring woman. The rationale for this practice was to prevent the woman from aspirating in the event that anesthesia was needed for a cesarean delivery. However, the woman needs fluids during labor to prevent dehydration and ketosis. Practices vary at hospitals across the country. The general consensus is for the woman to avoid solid food but allow clear liquids. Many health care providers prefer to give IV fluids to every woman in active labor and allow only ice chips, whereas others allow clear liquids. The nurse should follow the birth attendant’s recommendations and facility policy regarding food and fluid intake during labor
box 10-10; danger signs during labor; if you see any of these signs.. run
Elevated maternal blood pressure (BP) (≥140/90mm Hg)
Low or suddenly decreased maternal BP (≤90/50mm Hg)
Elevated maternal temperature (>100.4°F)
Amniotic fluid that is green, cloudy, or foul-smelling
Nonreassuring FHR patterns
Prolonged uterine contractions (>90 seconds duration)
Failure of the uterus to relax between contractions
Heavy or bright red bleeding
Maternal reports of unrelenting pain, RUQ pain, or visual changes
Maternal reports of difficulty breathing or shortness of breath
stages of labor; identify the stages, assessment finding & intervention to facilitate the birth and nursing interventions and what to expect to find at each stage of labor
membrane rupture- what is a normal assessment finding
evalute fetal heart rate patterns
electronic fetal monitoring
fetal distress
assisted delivery
nursing role/duties during the birthing and labor process
chapter 11
the assisted delivery
cesarean birth
cervical widening
mechanical methods used
pharmacological methods used
rupture of the membrane
oxytocin induction and nursing care plan pg 219-220
vaginal birth after cesarean delivery and client teaching
shoulder dystocia
fetal distress with assisted delivery
c section delivery: preoperative, intraoperative, postoperative; what is the LVNs goal during each phase and when is nursing care transferred to another caregiver
provide clients support pg230
why is there an increase rate of labor inductions
inform consents
clorioimmuneoncitis
signs of labor induction readiness
mechanical induction labor methods: membrane stripping
box 11.3
