Unit VIII - Intrapartum Flashcards
Maternal Childcare Book - Chapter 7
What is lightening?
It is the descent of the fetus into the pelvis. This descent relieves pressure on the diaphragm, allowing the mother to breathe more easily
Note: May not occur in multipara clients.
Maternal Childcare Book - Chapter 7
What is effacement?
The shortening and thinning of the cervix
Maternal Childcare Book - Chapter 7
The opening of the cervical opening or os is referred to as
Dilatation
Maternal Childcare Book - Chapter 7
Explain “Bloody Show”.
It is the release of the mucous plug from the cervix. The plug may contain small amounts of blood.
Maternal Childcare Book - Chapter 7
What is the spontaneous rupture of membranes (SROM)? When does it usually occur?
It is a tearing or perforation of the amniotic sac releasing amniotic fluid. It usually occurs after labor begins
Maternal Childcare Book - Chapter 7
What is the danger of a ballotable (able to be pushed away from the cervix) after a SROM?
There is a danger that the umbilical cord may be washed out of the cervix with the amniotic fluid. The infant’s head may compress the umbilical cord against the pelvis.
Maternal Childcare Book - Chapter 7
What is a prolapse umbilical cord?
It is when the fetus compresses the umbilical cord against the pelvis, obstructing the blood flow through the umbilical cord.
Maternal Childcare Book - Chapter 7
Explain Premature Rupture of Membranes (PROM).
Occurs when the membranes rupture before the 38th week of gestation. This condition can indicate the onset of premature labor. It requires immediate medical attention.
Maternal Childcare Book - Chapter 7
What are the signs of impending labor?
- Lightening
- Cervical changes (effacement, dilatation)
- Rupture membranes (SROM, PROM)
- Sudden increase in energy
Maternal Childcare Book - Chapter 7
What are the 5 P’s affecting labor?
1) Passage
2) Passenger
3) Powers
4) Position
5) Psyche
Maternal Childcare Book - Chapter 7
What is the first P (Passage) (as related to variables that affect labor)
Consists of the maternal structures through which the fetus must travel.
Maternal Childcare Book - Chapter 7
What does station refer to?
The relationship between the fetus and the maternal ischial spines. when the fetus reaches 0 station, the head is considered to be fully engaged.
Negative station is towards the umbilicus. Positive station, the fetus is engaged.
Maternal Childcare Book - Chapter 7
What is the second P (Passenger) (as related to variables affecting labor)?
Refers to the fetus.
Maternal Childcare Book - Chapter 7
What are the two things that affect how easily the fetus is delivered?
1) The relationship of the fetal parts to the maternal uterus
2) The size of the fetus
Intrapartum Powerpoint
What does Vertex Presentation refer to?
Refers to head presentation.
Remember: “Presentation” refers to the fetal part that enters the pelvis.
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What does frequency and duration of contractions refer to?
How do you measure them
Frequency refers to how often the contractions are. They are measured from the beginning of one contraction to the beginning of the next
Duration refers to how long the contractions last. They are measured from the beginning to the end of one contraction.
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Explain Leopold’s Maneuver.
It is performed during a physical assessment to determine fetal position.
If the examiner can move the baby’s head, then the baby is engaged into the pelvix.
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What is the goal of fetal heart monitoring?
to detect problems and deviations early so effective intervention can be applied.
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What is the normal baseline for the FHR?
120-160 BPM
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What is fetal tachycardia?
FHR >160 BPM
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What is fetal bradycardia?
FHR <120 BPM
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What are the leading causes of fetal tachycardia?
- Maternal fever
- Some meds
- Amnionitis
- Early fetal hypoxia
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How can a nurse manage fetal tachycardia?
- Identify and correct underlying cause (ex.: take temp)
- Change maternal position
- Admin O2 10-12L/min
- IV hydration
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What are the leading causes of fetal bradycardia?
- Late fetal hypoxia
- Maternal hypertension
- Prolonged umbilical cord compression
- Meds: Beta Blockers, Narcotics (Stadol, Demerol)
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How can a nurse manage fetal bradycardia?
- Identify & correct underlying cause (ex. assess maternal B/P)
- Change maternal position
- Administer O2 10-12L/min
- IV hydration
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Explain early decelerations.
It begins early in contraction and ends before contraction is over. (mirrors the contractions)
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What causes early decelerations?
Caused by fetus head compression in late labor.
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How can a nurse treat early decelerations?
This is normal. Usually no treatment needed.
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Describe the phases of the 1st stage of labor.
- Latent phase (cervix dilates 0-4 cm)
- Active phase (cervix dilates 4-8 cm)
- Transition phase (cervix dilates 8-10 cm)
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Describe the 2nd stage of labor
It is the full dilation of cervix (10 cm) - to birth. Mother will feel the urge to push
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Describe the 3rd stage of labor
It is the birth of the placenta
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Describe the 4th stage of labor
The 1st hour after delivery of the placenta
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What is the nursing care during the latent phase of the 1st stage of labor?
- Provide emotional support
- Teach breathing techniques
- Position changes
- Empty bladder q2h
- Provide light meals with fluids
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What is the nursing care during the active phase of the 1st stage of labor?
- Provide simple explanations
- Provide non-pharmacological relief
- Assess VS, FHR, contractions
- Administer pain meds as needed.
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What is the nursing care during the transition phase of the 1st stage of labor?
- Provide very short explanations
- Provide Positive reinforcement, support
- Position changes.
- Provide calm environment
- Administer pain relief measures
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What are the regional blocks. WHat is the most common used?
- Paracervical block
- Pudental block
- Epidural block (most commonly used)
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What is administered to newborns and mothers in the event of respiratory depressions after an opioid is administered?
Narcan
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What are the weeks that consists of the 1st trimester of pregnancy?
0-12 weeks
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What are the weeks that consists of the 2nd trimester of pregnancy?
13-24 weeks
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What are the weeks that consists of the 3rd trimester of pregnancy?
25-40 weeks
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How much weight should a pregnant woman gain during the course of her pregnancy?
25-35 lbs.
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How much calories should a pregnant woman increase in her daily diet?
300 kcals/day
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When is the rubella titer administered to a pregnant woman?
Postpartum, if immune.
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When are antibiotics administered to a pregnant woman who tests positive for Group B Strep?
It is administered during labor.
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What does an elevated Alpha-fetoprotein test indicate?
- Neural tube defects
* Multiple gestation
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What does a positive (blue) Nitrazine Test indicate?
Positive (Blue) indicates membranes have ruptured
*Negative (Yellow), membranes have not ruptured.
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What does a minus station indicate?
It indicates the baby’s head is above the ischial spines and is not engaged.
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What does attitude refer to?
It indicates the degree of flexion of the neck extension of the fetus
Remember:
Attitude = twisting the neck (ghetto style)
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How would a nurse manage late decelerations?
- Identify and treat cause (ex: hypotension)
- Change maternal position
- Increase IV to bolus rate
- D/C Oxytocin
- Notify care provider
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What are the signs and symptoms of labor?
- Consistent contractions with regular pattern.
- Spontaneous ruptured membranes.
- Blood show (mucus plug)
- Backache
- Rectal pressure (closer delivery)
- S/S usually occur together.
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What is a reaction to Demerol?
Nausea & Vomiting.
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How should the nurse treat nausea and vomiting after administration of Demerol?
Administer Vistrail or Phenergan
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What should the nurse assess prior to administration of opioids?
- Cervix dilation
- Pain level
- Vital Signs
- Level of sedation
- Respirations
- Nausea and vomiting.
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When should the nurse hold opioids?
- When respirations are <10/min
* In the 2nd stage of labor
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What is an abruptio placenta?
It is when the placenta separates from the uterine wall prior to birth
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What are the signs and symptoms of an abruptio placenta?
- Vaginal bleeding
* Changes in FHR
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What is the treatment in the occurrence of an abruptio placenta?
Immediate delivery (C-section)
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What happens if an abruptio placenta is left untreated?
Leads to fetal and maternal death.
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What are the nursing interventions in the event of abruptio placenta?
- Administer IV, blood transfusion, and oxygen
- Provide maternal position changes
- Monitor FHR
- Monitor bleeding
- Prepare for C/S
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What are the nursing intervention in the event of a preterm labor/birth (before 37 weeks gestation)?
- IV hydration
- Brethine (to decrease contractions)
- Beta Methasone (for lung maturity)
- Promote bed rest
- Monitor FHR and uterine activity
- Provide emotional support to parents/family
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What is the cause of hemorrhage before delivery?
Abuptio placenta or previa
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What is the cause of hemorrhage after delivery?
- Retained placenta
- Uterine activity due to fatigue or distended bladder.
- Lacerations
