Week 04 Flashcards
Introduction to Labor and Postpartum (63 cards)
1
Q
labor initiation theories
A
- estrogen and progesterone ratio
- prostaglandins
- positive feedback loop
- aging placenta
2
Q
labor assessment
A
- interview
- review of prenatal record
- consent forms
- cultural influences
- physical exam
- Leopold’s maneuvers
- cervical exam
- membrane’s status
- contraction assessment
3
Q
5 P’s of labor
A
- passenger
- passageway
- powers
- position (passenger and passageway)
- psychological influences
4
Q
passenger
A
- fetal lie: position compared to the maternal spine
- attitude: the position of the fetal head
5
Q
passageway
A
- birth passage
- affected by pelvis size, pelvis shape, ability to efface and dilate
6
Q
powers
A
- uterine contractions: duration, frequency, intensity
- maternal pushing efforts: involuntary, patients who do not have the urge to push may be less effective
7
Q
position (passenger and passageway)
A
- the presenting parts relationship to the maternal pelvis
- fatal station
- presenting part
- engagement
- presentation
8
Q
psychological influences
A
stress, tension, anxiety
9
Q
molding
A
- 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
10
Q
what causes the skull to be cone shaped at birth
A
molding
11
Q
mentum
A
fetal chin (face presentation)
12
Q
occiput
A
the area of the fetal skull that is occupied by the occipital bone, beneath the posterior fontanelle
13
Q
sacrum
A
breech position (butt presentation)
14
Q
acromion
A
acromion process (shoulder presentation)
15
Q
fetal tachycardia
A
- greater than 160 BPM
- caused by: fetal anemia, hypoxia, fever, maternal dehydration, medications, infection, substance abuse
16
Q
fetal bradycardia
A
- less than 110 BPM
- caused by: medications, maternal hypotension, hypoglycemia, cord prolapse, fetal heart block, contraction patterns, abruption, rupture or chronic head compression
17
Q
prolonged deceleration
A
greater than 15 beats lasting 2-10 minutes
18
Q
tachysystole
A
greater that 5 contractions in 10 minutes
19
Q
presentation
A
which direction the fetal spine/ baby is facing
20
Q
signs of labor
A
- energy spurt
- lightening: subjective
- engagement: objective
- increase in vaginal secretions
- loss of mucus plug
- bloody show
- ruptured membranes
- cervical changes
21
Q
rupture of membrane assessments
A
ROM, nitrazine test for pH, fern test, amnisure
22
Q
ROM assessment
A
- SROM
- AROM
23
Q
nitrazine test for pH
A
- amniotic fluid is alkaline
- amniotic fluid pH of 6.5-7.5
- vaginal pH of 3.8-4.2
- blue= positive; yellow= negative
24
Q
fern test
A
- sterile vaginal swab
- if positive the sample will look like a fern under the microscope
25
amnisure
works like a pregnancy test
26
true labor signs
- cervical contractions
- contractions are consistent and get stronger
- increase in pressure
27
false labor signs
- no cervical change
- irregular contractions that are not equal in strength
- can get relief
28
baseline FHR
110-160 BPM
29
elective induction of labor
after 39 weeks
30
medical induction of labor
- maternal conditions
- maternal infections
- fetal demise
- fetal conditions
- post-term
31
pharmacological cervical ripening
- dinoprostone (cervidil)
- oxytocin (Pitocin)
- misoprostol (cytotec)
32
dinoprostone (cervidil) dosing
every 12 hours
33
oxytocin (Pitocin) dosing
low dose over night
34
misoprostol (cytotec) dosing
every 4 hours
35
non-pharmacological cervical ripening
- foley bulb
- striping of membrane
36
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
37
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
38
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
39
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
40
cesarian section indications
- hypertensive disorders, active herpes, HIV, DM, malpresentation, placental abnormalities, prolapsed cord, multifetal pregnancy, dysfunctional labor
- advocate, assessment, Reeda, post-op complications
41
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
42
non pharmacological pain management
- music/ relaxation, guided imagery, massage, hydrotherapy, hypnotherapy, yoga, heat/ cold, TENS, intradermal water block, acupressure
43
nursing priorities for epidural
- maternal blood pressure
- administer fluid bolus before administering
- void after 30 minutes
44
nursing priorities for narcotics
- cervical dilation
- will cross the placenta and effect the baby
45
G.I. system
- usually, NPO or clear liquids during labor
- decreased GI motility and absorption, can lead to N/V
- fluid requirements
46
cardiovascular system
- large increase in cardiac output
- CV workload increases with pain and anxiety
- blood pressure increases during contractions
47
respiratory system
- oxygen demand and consumption increase
- hyperventilation may occur
48
musculoskeletal system
- diaphoresis, fatigue, proteinuria (1+), and possibly increased temperature
- backache and joint aches
- leg cramps
49
postpartum period
- period between birth and the organs return to pre-pregnancy state
- 6 weeks
- physical adaptation
- adjustment to maternal role
- new family dynamics
50
elemination
change peri-pad every time void to decrease infection risk
51
temperature
normal up to 100.4 for 1st 24 hours
52
pulse
can lower HR (50-70 BPM)
53
respirations
normal 12-20 BPM
54
BUBBLE-HE
breasts, uterus, bladder, bowel, lochia, Episiotomy (perineum, Homan sign, emotion
55
breast complications
engorgement, mastitis
56
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
57
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
58
bowel
- assess Bowel Sounds, Especially in C-Section Patients
- pain Medication May Cause Constipation
- moms are Fearful of First BM
59
lochia rubra
bright red like a period, small clots
60
lochia serosa
brownish pink discharge, more stringy clumps, more like end of period
61
lochia alba
while/ yellow discharge, no blood or clots, spotty
62
episiotomy
- REEDA: redness, edema, ecchymosis, discharge, approximation
- ask mom to lay on her side with top leg bent at the knee (sim side-lying)
63
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
