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SEM 1 > W4: Labor & Delivery > Flashcards

W4: Labor & Delivery Flashcards

1
Q

when does labour begin?

A

between 37 - 42 weeks

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2
Q

What happens before labor begins?

A

increase braxton hick’s
cervicla ripening
increase excitability in uterine musculature
mechanical stretching of the uterus increases contractility
ferguson reflex: increase oxytocin receptors & level of oxytocin

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3
Q

Signs of Onser of labour

A

lightening/dropping
increase in vaginal d/c- bloody show
stronger braxton hick’s contraction
weight loss of 0.5-1.5kg

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4
Q

signs preceding labor

A

surge of energy (nesting)
flulike symptoms
cervical ripening
possible rupture of membrane

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5
Q

true labor signs

A

contractions: increase in intensity + duration, discomfort in back –> abdomen, closer together, don’t go away w/ walking
cervix: begins to efface & dilate
show: may/may nor dilate

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6
Q

false labor signs

A

contractions: do not increase in intensity, duration, frequency, discomfort in abdomen, may disappear with walking
cervix: none
show: none

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7
Q

5 Ps of Labor

A

Power (contractions)
Passageway (birth canal)
Passenger (fetus and placenta)
Position of mother
Psychological Response

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8
Q

Powe

A

primary powers: contraciton, effacement, dilation, ferguson reflex
secondary powers: bearing down efforts

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9
Q

Passenger: 3 Fetal Presentations

A

cephalic/vertex- head presenting part
breech: buttocks presenting prt
shoulder/transverse- shoulder as presenting part

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10
Q

Components of the Passenger

A

fetal presentation
fetal head size
fetal lie
fetal attitude
fetal position (station, engagement)

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11
Q

Ideal Fetal presentation

A

ROA- right occiput anterior (back of head)

LOA is okay as well

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12
Q

Fetal Lie

A

reltionship of long axis of fetus to long avis of mother

longitudinal - parallel
transverse- perpendicular
oblique - at an angle

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13
Q

Fetal Atittude

A

relationship of fetal head to its spine

complete flexion- chin of fetus flexed, touching sternum
moderate flexion- military (chin not touching chest, alert)
deflection, extenion- back arches & head extended

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14
Q

Fetal Station

A

relationship of presenting part to an imaginary line drawn between maternal ischial spines

(above) - 5 –> + 5 (below)

O = head at level of spine

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15
Q

Passageway

A

types of pelves:
- gynecoid
- android
-anthropoid
- platypelloid

soft tissue of cervix
pelvic floor
vagina
introitus

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16
Q

Positon

A

position affects woman’s adaptation to labor
changes in posiiton = relief of fatifue, more comfort, improves circulation
woman should find position most comfortable to her
gravity promotes descent of fetus

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17
Q

descibe all 4 stages of labor

A

1: onset of contractions to full dilation of cervix (latent & active)
2: full dilation of cervix - birth, pushing
3: birth of the fetus until delivery of the placenta
4: 2 hrs post delivery of placenta

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18
Q

describe the latent phase of the first stage of labor

A

onset of regular contractions, effacement, descent

3-4 cm dilation

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19
Q

describe the active stage of first stage of labor

A

rapid dilation of cervix, descent

4-10 cm dilation

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20
Q

Assessment of Uterine Contraction

A

by: palpation, external + internal monitoring
intensity:
- mild: indented with general pressure (nose)
- moderare firm pressure (chin)
- strong: no indentation (forehead)
frequency: # of contraction in 10min period over 10 mins
dulation: time between onsent and end of contraction
restinf tone: tension in uterine muscle btw contractions (relaxation?)

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21
Q

NC; 1st Stage

A

relaxation, distractions
breathing techniques
praise
inform
oral care (n/v)
inform partner that pt might act abnormally

22
Q

2nd Stage

A

full dilation –> infant born
nulliparous pt: 3 hours w/o anesthesia, 4 hrs w/ anesthesia
multiparous: 2 hrs w/o anesthesia, 3 hrs w/ anesthesia

23
Q

2nd Stage: Passive Phase

A

delayed pushing, laboring down, passive descent
0-2+

24
Q

2nd Stage: Active Phase

A

active pushing, urge to bear down
ferguson reflex
4-5 contractions q10m, for 90s
fetal head +2-+4
rate fo descent increases
fetal head is crowning

25
Q

crowning

A

widest part of the head distends the vulva

26
Q

Changes in feta skull during birth

A

parital bones overlap
occipital bone go under pareital
= cone shape head

27
Q

Cardinal Movements of the mechanisms of labor

A

engagement: head into pelvic inlet

descent: fetal head is forced downwards on the crvix

flexion: fetusflexes head so that the vertex is leading (chin-chest)

internal rotation: of fetal head (usually to OA)

extension: delivery of head (occiput, face, chin)

restitution & external rotation: realigns head w/ back & shoulders

28
Q

NC: Passive Phase of 2nd Stage

A

comfort
prmote fetal descent (ambulation, position change, pelvic rock)

29
Q

NC: Active Phase of 2nd Stage

A

change position & encourage bearing down
relac, conserve energy btw contractions
pain-relief + comfort
cleanse perineum (fecal matter)
coach pt to pant
push between contractions (gently)
keep informed
offer mirror to watch / feel top of head as they push

30
Q

Assesment & Care of Newborn

A

APGAR score
immediate skin-skin (infant bonding, breastfeeding duration, cardiorespiratory stability, bodytemp)
delayed cord clamping (1-3 min after birth/ after it stops pulsating)

31
Q

Why is delaeyd crod clamping recommended

A

improces hematologcla status
transfer of blood

32
Q

Instructing partner to cut cord

A

approx 2.5 cm above the clamp

33
Q

3rd Stage of Labor

A

placental seperation + expulsion (contracting fundus, change in uterus shape, gush of blood, lengthning of cord, vaginal fullness)

occurs 15 mins after the birth of the baby

34
Q

when is placenta considered retained

A

if it has not come out by 30 mins

35
Q

Expectant Mgt 3rd Stage

A

watching for signs for placental seperation
no oxytocic meds given
facilitated bt gravity or nipple stimulation

36
Q

Active Management: 3rd Stage

A

oxytocic meds
decreases rate of PP hemorrhage d/t uterine atony
gentle cord traction following contractions

37
Q

Examination of Placenta

A

ensure no portion remains in the uterine cavity
contains 15-20 lobes
vessels: 2 arteries, 1 vein
membrane should have no holes

38
Q

4th Stage of Labor

A

begins with expulsion of placenta and lasts until pt is stable within the first 2 hours (time for parent-infant bonding)

39
Q

vital signs frequency @ 4th stage

A

q15mins fro 1st hour

stable: q2hrs

40
Q

Uterine Assesment after birth

A

firm w/ uterus located midline
- if not firm, massage to contract
observe perniuem for size & amt of + size of clots
expel clots while keeping hands placed over uterus (downwards pressure)
tell pt to take deep breaths throughout

41
Q

Bladder Assessment after birth

A

distension (firmness of fundus)
- rounded bulge, dull to percussion, fluctuated like water balloon
distended bladder: boggy uterus, above umbilicus, deviated to R side
asess pt to void + measure amt (catheter if needed)
reassess after voiding/catheter to make sure bladder is not palpable, fundus is midline & firm

42
Q

Pain threhold vs tolerance

A

threshold is the same in everyone
tolerance differs

43
Q

Factors influencing pain response

A

physiological
culture
anxiety + fear
previous experience
gate control theory
environment
trauma
childbirth prep

44
Q

expressions of pain

A

anxiety
writhing
crying
groaning
gesturing
excessive muscular excitability

45
Q

Non-Pharmacological Pain Mgt

A

relaxation
imagery + visualization
music
touch + massage
breathing techniques
effleurage & counterpressure
hydrotherapy (water bath)

TENS
heat/cold
hypnosis
biofeedback
aromatherapy
sterile water block
maternal position & movement

46
Q

Epidural Induced Hypotension

A

f:
fetal bradycardia
absent/minimal FHR
impaired placental perfusion
ineffective breathing pattern

47
Q

Interventions for Epidural Induced Hypotension

A

turn pt to lateral positon, place pillow under one hip (displace weight on aorta)
maintain IV fluid
O2 (8-10)- hypovolemia, hypoxia
IV vasopressor

48
Q

baseline FHR

A

110-160BPM

49
Q

Fetal tahcycardia

A

160+ bpm for longer than 10 mins

50
Q

fetal bradycardia

A

baseline less than 110 bpm for 10 mins

51
Q

VEAL CHOP acronym

A

V: variable deceleration = C: cord compression –> reposition pt

E: early deceleration = H: head compression –> fetus descent

A: accelerations = O: OK!

L: late deceleration = P: problem –> fetal resus, Oxygenation

SEM 1 (11 decks)

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