Vital Signs, Tears, and Varney's 4th Stage Flashcards
What are the normal vital signs for mom?
Temperature: 96-99.0F
BP: 90/50 - 140/90 during labor, prenatally should not be more than 130/90
Pulse: 60-80; during labor: 60-100bpm
Respirations: 12-20
Temp may be elevated up to 101.0 with an epidural
What are the normal vital signs for baby?
Temperature: 97-100.00F
Pulse: 120-160, can go down as low as 100 when resting
Respirations: 30-60
What are the vital sign warning signs during labor?
- Baby’s heartbeat is less then 100 or great than 180 and does not change with oxygen, fetal scalp massage, or fluids.
- BP goes past 140/90 and mom has protein in urine (preeclampsia)
- BP drops 15 points or more in the bottom number (Bleeding/placenta separation)–sign of shock
What are the vital signs of dehydration?
Low grade fever (up to 100.4)
Fast deep breathing (more than 20 reap/min
Fast weak pulse (more than 100 bpm)
Baby’s heartbeat is elevated during labor (greater than 160bpm)
What are the vital signs of shock?
Fast but weak, threat pulse (Greater than 100bpm) Lower blood pressure (less than 90/50 or BP drops 15 points or more in the diastolic number) Increased Respirations (more than 20)
What are the vital signs of infection?
Increase in pulse (+15 bpm over normal baseline pulse)
Increased temp in adult (greater than 100.4)
In Newborns–will see a lowered temp (less than 97)
What are the increased risk for tears?
- Chronic yeast infections
- Red heads (delicate skin)
- Thongs/Tight pants/Non-cotton undies
- Pantyhose (too hot)
- Fear or birth or fear of tearing
- Being in an uncomfortable environment
- Long Labors (lack of oxygen to perineum)
- Large baby
- Post dates (molding doesn’t happen)
- Nuchal hand
- Lithotomy Position
- Over-aggressive coaching during pushing
What are helpful ways to prevent tearing?
- Grapefruit sitting
- Prenatal Perineal massage
- “Tell stories” during labor/vaginal exams to ease the woman’s tension
- Warm compresses and Olive oil to the perineum while the mother is pushing.
- Having a woman reach down and touch her baby when beginning to crown.
- Ease the baby out at crowning. Have the mother slow pushing and pant, blow, or cough the baby out.
What are good Remedies for the Perineum?
- Arnica oil (helps tissue stretch
- Before looking at a tear put lidocaine topically so she will not feel it.
- Don’t put ice packs right after birth–use frozen OB pads
- Sea Salt Sitz Baths
- Super glue first degree tears
What are causes of 3rd and 4th degree tears?
Increase in epidurals, pushing through the crowning sensation, giving birth in the lithotomy position, squealing or high pitch screaming, squatting for too long.
What is the midwife responsible for in the first hour post partum?
- Evaluation of uterine contractility and bleeding.
- Inspection and evaluation of cervix, vagina, and perineum
- inspection and evaluation of the placenta, membranes, and umbilical cord
- Assessment and repair of lacerations or episiotomy
- Evaluation of vital signs and other physiological changes that indicate recovery
What other important activity takes place during the first hour after birth?
The formation of family relationships
What does a uterus found above the umbilicus indicate?
If centrally located, he presence of blood and clots int he uterus that need to be expressed. If displaced, it means the bladder needs to be empty.
How should the uterus feel?
Firm to the touch
What does the midwife need to notice about the placenta?
Identify the different types and cord insertions; be aware of whether the placenta and membranes are complete, and if any abnormalities are present.
What is the first thing the midwife should do after the placenta is delivered?
Massage the fundus
What hormones work together during the fourth stage?
Oxytocin, Endorphins, Prolactin, Adrenalin
Oxytocin
Hormone of well being, love-hormone, present in breastfeeding.
Endorphins
Help with pain relief during and after labor; facilitate prolactin release
Prolactin
mothering and lactation hormone
Adrenaline
Baby should have high amounts stimulating them to breathe, it should decrease in the mother; stimulates breathing and wide eyed appearance.
How often are vital signs taken in the first hour after birth?
Every 15 minutes
What is the purpose of taking vital signs during the first hour of labor?
Monitoring for shock and preeclampsia
What should be done in the fourth stage in regard to caring for the mother?
- Vital Signs
- Fundal Massage
- Check Bleeding
- Ensure Bonding
- Clean Mom
- Check for perineal trauma
- Have the mother urinate
- Get the mother to eat and drink
What should be done for the newborn postpartum?
- Monitor vitals
- Keep room warm
- Facilitate skin to skin
- Help with breastfeeding
- Newborn Exam
Skid mark
as deep as a paper cut, do not need to be sutured
1st degree
Does not go into muscle; can be superglued or sutured if gaping
2nd degree
torn into perineal muscles, but the anal sphincter is intact
3rd degree
Tear enters into the interior anal sphincter, takes a long time to heal and has much more pain in perineal area
4th degree
tear enters into the exterior anal sphincter
What are some reasons for a 3rd and 4th degree tear?
large baby, forceps or vacuum
Mediolateral Episiotomy
Less chance of third or fourth degree tears; more painful and takes longer to heal
Midline Episiotomy
increases your risk of developing a third or fourth degree tear; quicker healing and less painful than Mediolateral
Perineal Hematoma
bleeding into perineal tissues, Arnica oil and ice can help
Granular tissue
Comes from a laceration trying to heal; can be described as too many cells trying to heal at once.
