Week 3: L&D Complications Flashcards
Triaging patients
• Chief Complaint
• Determine Fetal Wellbeing (EDC)
• Rapid HTT Assessment (why are they here)
• Educate Patient (POC)
• Review of Medical History (G’s&P’s, delivery type, medical conditions, meds)
• Report to MD (Orders)
What are the 4 P’s of Labor?
•Power (uterine contractions)
•passageway (bony pelvis & soft tissue)
•passenger (baby, membranes, placenta)
•Psyche (woman’s emotional structure)
What is the fetal attitude?
The position on the baby in the uterus.
•head should be ‘flexed’ (head tucked)
•head extended (causes neck injury/problems)
What is fetal Lie?
The relationship of fetal spine to mothers.
•longitudinal (wanted! Can feel head upon vaginal exam)
•oblique (this baby may rotate/may not)
•Transverse (will need c-section)
What is fetal presentation?
•Cephalic/Vertex (head down; ideal)
•Face/brow (can be delivered vaginally with manipulation)
•breech (upside down. if baby comes out butt 1st the head can get stuck and the pelvis can clamp on the neck; c-section)
•Shoulder (c-section)
Explain Pelvis station
•”Station-measurement of the progress of decent in reference to the ischial spine”
-3 to -1 = still high in pelvis
0 station = baby is at bony pelvis
+1 to +3 = baby is passed bony pelvis and ready for delivery
Define Ballotable
Ballotable- Physical exam which the hand is inserted in the vagina and can push against the baby’s head which can be “bounced” back and forth
What factors affect a patient’s Psyche?
•Past experiences (affect current situations/feeling)
•Fatigue
•Fear/Anxiety
•Environment
•Support System
•Motivation
•Knowledge /Preparation
•Sense of Control
Mechanism of Labor
•Lightening or Dropping (physical drop of baby into pelvis)
•Braxton Hicks (exercise, dehydration. Won’t dilate cervix, normally painless).
•Vaginal discharge increases
•Cervix ripens (softens/ gets thin for delivery)
•Nesting (getting everything ready for the baby)
•Weight loss (Hormonal fluid shift 24-48 hours before the onset of labor)
•Rupture of membranes (SROM)
Stage 1 of labor
Stage 1 has 3 phases:
A) latent
-the longest phase
-cervix 1-4cm
-contractions (mild) 15-30 min apart
B) Active phase
-cervix dilation 5-7cm
-contractions (moderate) 3-5min apart
C) Transition Phase
-very intense
-cervix 8-10cm
-contractions (strong) 2-3min apart
Stage 2 of Labor
•Complete dilation
•Progress is measured by fetal station
•Increase in bloody show
•Urge to push begins (can’t really stop)
•Laboring down in the patient with an epidural (tell them to use muscles like they’re bearing down)
Stage 2 of Labor cont.
Delivery!
•RN Responsibilities for mother :
•Vital signs
•Preparation for delivery (beta-dine cleaning)
•Coaching (breathing, pushing)
•MD notification (when baby is crowning)
•RN newborn responsibilities :
•Assessments
•Resuscitation (code white)
•Documentation & Infant Identification •Facilitate bonding
What is a nuchal cord?
When the umbilical cord is wrapped around baby’s neck and cutting off circulation/oxygen. Dr may cut cord early at moms perineum to save baby
Stage 3 of Labor
“From the moment baby is born to the delivery of the placenta”
•Contractions began again until the placenta is expelled
•takes 5-30 min
•After expulsion, immediately began fundal massage & start Pitocin bolus to stop bleeding.
Stage 4 of Labor
•Recovery 1-4 hours after birth
•Monitor VS ( typically q15 for 1 hour)
•Monitor lochia
•Provide warmth and food
•Support breastfeeding
Why would we induce Labor?
•Over due date
•PIH / Maternal health
•Fetal demise
•PROM (Premature)
•Suspected fetal jeopardy
•Macrosomia (big baby)
•Post date (placenta ages)
•IUGR (interuterine growth restriction; small baby)
•Fetal compromise
What do we need to know about water breaking?
- Time it broke
- Is the fetal HR okay? (The break may affect this)
- Fluid characteristics (color: straw, odor: distinct, note the amount)