Week 04 Flashcards
Introduction to Labor and Postpartum
labor initiation theories
- estrogen and progesterone ratio
- prostaglandins
- positive feedback loop
- aging placenta
labor assessment
- interview
- review of prenatal record
- consent forms
- cultural influences
- physical exam
- Leopold’s maneuvers
- cervical exam
- membrane’s status
- contraction assessment
5 P’s of labor
- passenger
- passageway
- powers
- position (passenger and passageway)
- psychological influences
passenger
- fetal lie: position compared to the maternal spine
- attitude: the position of the fetal head
passageway
- birth passage
- affected by pelvis size, pelvis shape, ability to efface and dilate
powers
- uterine contractions: duration, frequency, intensity
- maternal pushing efforts: involuntary, patients who do not have the urge to push may be less effective
position (passenger and passageway)
- the presenting parts relationship to the maternal pelvis
- fatal station
- presenting part
- engagement
- presentation
psychological influences
stress, tension, anxiety
molding
- sutures allow for the bones of the skull to overlap
- the skull may be more cone shaped at birth, but will return to normal in the first few days of life
what causes the skull to be cone shaped at birth
molding
mentum
fetal chin (face presentation)
occiput
the area of the fetal skull that is occupied by the occipital bone, beneath the posterior fontanelle
sacrum
breech position (butt presentation)
acromion
acromion process (shoulder presentation)
fetal tachycardia
- greater than 160 BPM
- caused by: fetal anemia, hypoxia, fever, maternal dehydration, medications, infection, substance abuse
fetal bradycardia
- less than 110 BPM
- caused by: medications, maternal hypotension, hypoglycemia, cord prolapse, fetal heart block, contraction patterns, abruption, rupture or chronic head compression
prolonged deceleration
greater than 15 beats lasting 2-10 minutes
tachysystole
greater that 5 contractions in 10 minutes
presentation
which direction the fetal spine/ baby is facing
signs of labor
- energy spurt
- lightening: subjective
- engagement: objective
- increase in vaginal secretions
- loss of mucus plug
- bloody show
- ruptured membranes
- cervical changes
rupture of membrane assessments
ROM, nitrazine test for pH, fern test, amnisure
ROM assessment
- SROM
- AROM
nitrazine test for pH
- amniotic fluid is alkaline
- amniotic fluid pH of 6.5-7.5
- vaginal pH of 3.8-4.2
- blue= positive; yellow= negative
fern test
- sterile vaginal swab
- if positive the sample will look like a fern under the microscope
amnisure
works like a pregnancy test
true labor signs
- cervical contractions
- contractions are consistent and get stronger
- increase in pressure
false labor signs
- no cervical change
- irregular contractions that are not equal in strength
- can get relief
baseline FHR
110-160 BPM
elective induction of labor
after 39 weeks
medical induction of labor
- maternal conditions
- maternal infections
- fetal demise
- fetal conditions
- post-term
pharmacological cervical ripening
- dinoprostone (cervidil)
- oxytocin (Pitocin)
- misoprostol (cytotec)
dinoprostone (cervidil) dosing
every 12 hours
oxytocin (Pitocin) dosing
low dose over night
misoprostol (cytotec) dosing
every 4 hours
non-pharmacological cervical ripening
- foley bulb
- striping of membrane
oxytocin induction
- increase dose every 30 – 60 minutes until contractions are every 2 – 3 minutes
- continuous maternal/ fetal assessments every 15 – 30 minutes
- assess tolerance, progress, and pattern of labor
- record intake and output
cardinal movement of labor
- engagement: the baby in the pelvis
- descent: the fetal head enters the maternal inlet
- flexion: the fetal chin flexes downward
- internal rotation: the fetal head rotates so the skull fits under the pubic bone
- extension: moves under the pubis
- restitution: rotates back for realignment
- external rotation: continues to rotate so the shoulder can deliver
- expulsion: delivery
4 stages of labor
Stage 1
3 phases: Latent phase (0-3 cm), Active phase (4-7 cm), Transition (7-10 cm)
Beginning of contractions until full dilation occurs, Behavioral changes
Stage 2
10 cm until delivery
interventions
- Assist with bearing down efforts
- Positioning
- Rest between contractions
- Avoid pushing before complete dilation and effacement
- Foley/BM
Injuries
- Fist degree: involves the perineal skin and vaginal mucous membrane
- Second degree: involves the skin, mucous membrane, and fascia of the perianal body
- Third degree: involves the skin, mucosa membrane, and muscle of the perineal body and extends to the rectal sphincter
- Fourth degree: extend into the rectal mucosa and exposes the lumen of the rectum
Stage 3
Birth of infant until the birth of the placenta
Birth to expulsion of placenta
- Uterus becomes spherical in shape
- The umbilical cord descends further into the vagina
- Gush of blood
Oxytocin administrated if needed after placental expulsion
Cultural considerations
Stage 4
Birth of the placenta until 2 hours postpartum
Monitor BP, pulse every 15 minutes
- Should remain firm and contraction
- Lochia is bright red and may contain clots
- VS return to pre-labor values
l&d nuring interventions
- general hygiene, nutrition and fluid intake (oral and IV), elimination, ambulation/positioning, labor support (evidence-based practice), advocacy, protecting women’s privacy, managing pain and discomfort, caring for the support persons
cesarian section indications
- hypertensive disorders, active herpes, HIV, DM, malpresentation, placental abnormalities, prolapsed cord, multifetal pregnancy, dysfunctional labor
- advocate, assessment, Reeda, post-op complications
external cephalic version (ECV)
- turning the fetus from breech or transverse lie to vertex
- success rate 60%-70%
- done between 36-38 weeks
- internal version
non pharmacological pain management
- music/ relaxation, guided imagery, massage, hydrotherapy, hypnotherapy, yoga, heat/ cold, TENS, intradermal water block, acupressure
nursing priorities for epidural
- maternal blood pressure
- administer fluid bolus before administering
- void after 30 minutes
nursing priorities for narcotics
- cervical dilation
- will cross the placenta and effect the baby
G.I. system
- usually, NPO or clear liquids during labor
- decreased GI motility and absorption, can lead to N/V
- fluid requirements
cardiovascular system
- large increase in cardiac output
- CV workload increases with pain and anxiety
- blood pressure increases during contractions
respiratory system
- oxygen demand and consumption increase
- hyperventilation may occur
musculoskeletal system
- diaphoresis, fatigue, proteinuria (1+), and possibly increased temperature
- backache and joint aches
- leg cramps
postpartum period
- period between birth and the organs return to pre-pregnancy state
- 6 weeks
- physical adaptation
- adjustment to maternal role
- new family dynamics
elemination
change peri-pad every time void to decrease infection risk
temperature
normal up to 100.4 for 1st 24 hours
pulse
can lower HR (50-70 BPM)
respirations
normal 12-20 BPM
BUBBLE-HE
breasts, uterus, bladder, bowel, lochia, Episiotomy (perineum, Homan sign, emotion
breast complications
engorgement, mastitis
palpating fundus of uterus
- consistency and lactation: explain the procedure, bladder should be empty
- supine position
- clean gloves
- lower perineal pad
- place the side of the non-dominant hand above the pubis symphysis to stabilize the uterus
- begin at the umbilicus pushing inward and down to locate the fundus
- location is documented in relation to the umbilicus
- if the fundus is boggy the RN messages until it becomes firm
- note Lochia flow during palpation Consistency: firm, boggy
- lochia: scant, light, moderate, heavy
- location
- +/- and a number
- -1, -3
- referring to the number of cm away from the umbilicus
- is above, - is below
- midline, left or right
- a uterus that is displaced to the right or left is generally caused by a full bladder
- if the uterus is firm and the patient is still bleeding, then the RN cannot stop the bleeding with massage and the MD needs to be notified
bladder
- drop in Estrogen After Birth Causes Diuresis
- should Spontaneously Void Within 6-8 Hours
- urine Output up to 3000mL/day for Days 2-5
- a Full Bladder Will Interfere with Uterine Invocation
bowel
- assess Bowel Sounds, Especially in C-Section Patients
- pain Medication May Cause Constipation
- moms are Fearful of First BM
lochia rubra
bright red like a period, small clots
lochia serosa
brownish pink discharge, more stringy clumps, more like end of period
lochia alba
while/ yellow discharge, no blood or clots, spotty
episiotomy
- REEDA: redness, edema, ecchymosis, discharge, approximation
- ask mom to lay on her side with top leg bent at the knee (sim side-lying)
C- section assessment
- VS every 4 hours for 48-72 hours
- incision assessment: dressing, staples, S/S of infection, dehiscence, evisceration
- bowel sounds may be hypoactive
- breath sounds
- urine output
