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ppn301 > week 4 > Flashcards

week 4 Flashcards

1
Q

What is the Process of Labour

A

Labour is the process of moving the fetus, placenta, and membranes out of the uterus and through the birth canal.
Usually begins between the 37th and 42nd week of gestation.

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2
Q

Before Labour Begins

A

Increase Braxton Hicks Contraction
Cervical ripening
-estrogen, relaxin, and prostaglandins
Break down in cervical connective tissue
Increase in theexcitabilityof the uterine musculature
Mechanical stretching of the uterus also helps toincrease contractility
Increase oxytocin receptors and levels of oxytocin (Ferguson reflex)

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3
Q

Onset and Signs Preceding Labour

A

Lightening or dropping
Increase Vaginal discharge; Bloody show
Backache
Stronger Braxton Hicks contractions
Weight loss of 0.5 to 1.5kg
*Surge of energy (also called nesting)
*Flulike symptoms
*Increased vaginal discharge; bloody show
*Cervical ripening
*Possible rupture of membrane

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4
Q

True Labour

A

Contractions
-Increase in intensity
-Increase in duration
-Discomfort begins in back, radiates around abdomen
-Become progressively closer together
-Do not disappear with walking
Cervix
-Begins to efface and dilate
Show
-May/not be present

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5
Q

False Labour

A

Contractions
-Do not increase in intensity
-Do not increase in duration
-Discomfort usually in abdomen
-Do not become progressively closer
-May disappear with walking
Cervix
-No cervical change
Show
-Not present (may note brownish discharge if internal exam in previous 48 hrs

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6
Q

what are the 5 P’s?

A

-passenger
-passageway
-powers
-position of mothers
-psychological response

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7
Q

Passenger

A

Fetal presentation
Cephalic/Vertex – head as presenting part- optimal position to negotiate the pelvic curve by extending the head.
Breech – Buttocks as presenting part
Shoulder/Transverse – shoulder as presenting part

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8
Q

what is fetal lie ?

A

Relationship of long axis of fetus to long axis of mother
Longitudinal –long axis of fetus is parallel to long axis of mother.
Transverse – long axis of fetus is perpendicular to long axis of mother.
Oblique – fetal lie is at an angle between transverse & longitudinal lie.

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9
Q

what is fetal attitude?

A

Relationship of fetal head to its spine
Complete flexion – when the chin of the fetus is flexed and touches the sternum
Moderate flexion – “Military position” - chin is not touching the chest but is in an alert position
Deflection or extension – back is arched and head is extended

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10
Q

what is O station?

A

O Station refers to the head at the level of the ischial spines
Presenting part higher than the spines: negative sign
Below the spines: use a positive sign
Measurement of the fetal head in relation to the level of the maternal ischial spines
Measured cm
Ranges from -5 to +5 (at birth - +4 or 5)

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11
Q

passageway

A

Four basic types of pelves
Gynecoid (the classic female type)-circle
Android (resembling the male pelvis)-heart
Anthropoid (resembling the pelvis of anthropoid apes)-oval
Platypelloid (the flat pelvis)- like circular rectangle

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12
Q

Powers

A

-primary powers- contractions- responsible for delivery of the baby
-secondary powers- bearing down efforts

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13
Q

Position during labour

A

Position of labouring woman
Position affects woman’s anatomical and physiological adaptations to labour
Frequent changes in position
Relieve fatigue
Increase comfort
Improve circulation
Labouring woman should be encouraged to find positions most comfortable to her `
Gravity promotes descent of fetus

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14
Q

4 stages of labour

A

-first stage: Onset of contractions to full dilation of the cervix
Latent phase & Active phase
-second phase: Full dilation to birth & Pushing
-3rd stage: Birth of the fetus until delivery of the placenta
-4th stage: 2 hours postdelivery of the placenta

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15
Q

first stage: latent and active phase

A

-Latent phase: Onset of regular contraction, progress in effacement of the cervix and little increase in descent.
up to 3-4 cm of dilation (depending on whether nulliparous or multiparous)

-Active phase: rapid dilation of the cervix and increased rate of descent of the presenting part.
4 to 10 cm of dilation

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16
Q

why is sexual abuse important in caring for laboured mums?

A

use trauma informed care, consent to touch
Try to minimize any vaginal exam or further trauma

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17
Q

assessment of uterine contractions

A

Assessment of uterine activity- measured by palpation, external, internal monitoring
Intensity: strength of contraction
Mild contraction: Uterus can be indented with gentle pressure at the peak of the contraction – this feels like the tip of your nose.
Moderate contraction: Uterus can be indented with firm pressure at the peak of the contraction – this feels like the tip of your chin.
Strong contraction: Uterus feels firm and cannot be indented at the peak of the contraction – this feels like your forehead.

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18
Q

duration of a contraction during labor

A

Duration: Is the time between the onset to the end of one contraction (in seconds)

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19
Q

Assessment of amniotic membranes and fluid

A

Colour
-Normal: Pale, straw-coloured; may contain white flecks of vernix caseosa, lanugo, scalp hair
-Greenish-brown colour
Meconium in fluid from hypoxic episode in fetus or post-term gestational age
-May be normal finding in breech presentation as pressure is exerted on fetal abdominal wall during descent

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20
Q

abnormal assessment of amniotic membranes and fluid

A

-Yellow-stained fluid
Fetal hypoxia ≥36 hr before ROM; fetal hemolytic disease; intrauterine infection
-Port wine–coloured
Bleeding associated with placental abruption
-Thick, cloudy, foul-smelling
Intrauterine infection
Large amount of meconium can make fluid thick

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21
Q

effacement means?

A

Effacement means the shortening and thinning of the cervix during labour
expressed in %

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22
Q

what does dilation mean?

A

dilation of the cervix is the enlargement or widening of the
cervical opening
expressed in cm

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23
Q

Uterine contractions are the..

A

are the primary powers that act involuntarily
to dilate the cervix and expel the fetus and placenta from the
uterus.

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24
Q

what should always encourage the client to do q2h during labour

A

Encourage the patient to empty the bladder

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25
Q

what happens if BP is elevated during labour?

A

If blood pressure is elevated, it should be reassessed in 15 mins
between contractions

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26
Q

what is hydrotherapy?

A

Shower or warm water baths can be offered
o Water immersion may reduce the use of regional analgesia

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27
Q

nutrition and fluid intake in labour

A

pt is NPO, water is ok and ice chips
NPO to reduce the complications associated with anaesthesia

IV therapy- be careful of fluid overload can send pt to HF

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28
Q

elimination during labour

A

-Should be encouraged to void a minimum of every 2 hours
-A distended bladder may impede descent of the presenting part,
slow or stop uterine contractions, and lead to decreased bladder
tone or atony after birth

29
Q

Catheterization during labour

A

Nurse should insert the catheter between contractions and need to
avoid force if the resistance is felt
-use an intermittent catheter

30
Q

second stage of labour

A

Infant is born
Begins with full cervical dilation (10 cm) and complete effacement
Ends with baby’s birth
Nulliparous patients
*3 or more hours with no regional anaesthesia
*4 or more hours with regional anaesthesia
Multiparous patients
*2 hours with no regional anaesthesia
*3 hours with regional anaesthesia

31
Q

2nd stage of labour- 2 phases

A

Two phases:
Passive: delayed pushing, labouring down, passive descent
0 to +2
Active (descent): active pushing and urges to bear down
Ferguson reflex
4 to 5 contractions every 10 minutes lasting 90 seconds
Fetal head +2 to +4;
Rate of descent increases and Ferguson reflex† is activated
Fetal head becomes visible at introitus (Crowning) and birth occurs

32
Q

what is crowning?

A

occurs when the widest part of the head the biparietal diameter) distends the vulva

33
Q

Cardinal movements of the mechanism of labour

A

-Engagement– head into pelvic inlet
-Descent –fetal head is forced downwards on to the cervix and
-Flexion-this flexes the head so that the vertex is leading (chin to chest).
-Internal rotation – of fetal head (usually to OA-occipital anterior) fetal shoulders rotate 45 degree
-Extension – delivery of head – occiput, face then chin
-Restitution and External rotation - realigns head with back & shoulders

34
Q

what is the hardest stage during delivery?

A

crowning

35
Q

Nursing during the second stage of Labour
Passive phase

A

-Help patient to rest in a position of comfort; encourage relaxation to conserve energy.
-Promote progress of fetal descent and onset of urge to bear down by encouraging position changes, pelvic rock, ambulation, and showering.

36
Q

Nursing during the second stage of Labour
Active pushing (decent) phase

A

-Help patient to change position and encourage spontaneous bearing-down efforts.
-Help patient to relax and conserve energy between contractions.
-Provide comfort and pain-relief measures as needed.
-Coach patient to pant during contractions and to gently push between contractions when the head is emerging.
-Offer mirror to watch birth or encourage patient to feel top of fetal head as they are pushing

37
Q

how far should you/dad cut the cord?

A

cut the cord approximately 2.5cm above the clamp.

38
Q

assessment and care of a newborn

A

-Care focused on assessing and stabilizing the newborn
-Apgar scores
-Immediate skin-to-skin contact is recommended (healthy term newborn after vaginal birth or Caesarean birth).
-positively affect parent–infant bonding
-breastfeeding duration
-cardiorespiratory stability
-body temperature
-Delayed cord clamping recommended until 1 to 3 minutes after birth, or until after the cord stops pulsating
-Improves both the short- and long-term hematological status of the newborn
physiological transfer of blood to the newborn

39
Q

How do we know delivery of placenta is coming?

A

-1 big contraction will happen, dark blood = placenta is coming then the umblilical cord becomes longer

40
Q

third stage of labour-how does the placenta come out?

A

-A: Placenta begins the separation process in central portion, accompanied by retroplacental bleeding. Uterus changes from discoid to globular shape.
-B: Placenta completes separation and enters lower uterine segment.
-C: Placenta enters vagina, cord is seen to lengthen, and there may be increased bleeding. -Sudden gush of dark blood from introitus
-D: Expulsion (birth) of placenta and completion of third stage.

-Occurs 15 minutes after the birth of the baby.
If the third stage has not been completed within 30 minutes
-Placenta is considered retained, and interventions to hasten its separation and expulsion are usually instituted

41
Q

third stage of labour -passive management

A

-Passive management (expectant)
involves patiently watching for signs that the placenta has separated from the uterine wall spontaneously and monitoring for spontaneous expulsion.
- no meds given
-Separation and expulsion is facilitated by gravity or nipple stimulation promote the release of endogenous oxytocin

42
Q

Third Stage of Labour–active

A

-Administration of an oxytocic medication after the birth of the anterior shoulder of the fetus,
-decreases the rate of postpartum hemorrhage caused by uterine atony

43
Q

when examining the placenta - what do you want to keep in mind?

A

Ensure that no portion remains in the uterine cavity (i.e., no fragments of the placenta or membranes are retained
Vessels (2 arteries and vein)!!

44
Q

what is umbilical cord blood banking

A

-Cord blood collection is done after the birth and before delivery of the placenta.
contains hematopoietic stem cells
-Recommendations for certain genetic, hematological, and malignant disorders
-very expensive tho
-it’s the parents until 18, then it becomes the kids choice what they want to do with it

45
Q

4th stage of labour

A

-Begins with the expulsion of the placenta and lasts until the patient is stable within the first 2 hours.
crucial time for the patient and newborn to acquaint with each other and family members
-Nursing care include assessment: vital signs, uterus, bladder, bleeding, perineum

Vital Signs
-First hour every 15 minutes
-If all parameters are stabilized within the normal range repeat once every second hour

46
Q

Uterus -Fundus

A

-Firm with uterus located midline
-If the fundus is not firm, massage it gently to contract
-Place hands appropriately; massage gently only until firm.
observe perineum for amount and size of expelled clots.
-Expel clots while keeping hands placed over the uterus
With the upper hand, firmly apply pressure downward toward the vagina
-Observe perineum for amount and size of expelled clots
-Accompanied by discomfort-Advise patient to take deep breaths throughout

47
Q

how to perform a uterus massage

A

Palpating and massaging fundus of uterus. Note that upper hand is cupped over fundus; lower hand dips in above symphysis pubis and supports uterus while it is massaged gently.

48
Q

where is the fundal height after delivery?

A

midline
-if it is shifted or high, then it’s the bladder

49
Q

bladder after delivery

A

-Assess distension by noting location and firmness of uterine fundus
suprapubic rounded bulge that is dull to percussion and fluctuates like a water-filled balloon.
-Distended bladder is accompanied by a boggy uterus, located above the umbilicus, and deviated to the patient’s right side.
-Assist patient to void spontaneously and measure amount of urine voided.
-Catheterize as necessary.
-Reassess after voiding or catheterization to make sure that the bladder is not palpable and the fundus is firm and in the midline.

50
Q

Lochia after delivery

A

-Observe lochia on perineal pads and on linen under the patient’s buttocks.
-Determine amount and colour; note size and number of clots.
-Observe perineum for source of bleeding (e.g., lacerations, episiotomy

51
Q

Perineum after delivery

A

-Ask or assist patient to turn on their side and flex their upper leg on their hip.
*Gently lift upper buttock.
*Observe perineum in good lighting.
*Assess laceration repair or episiotomy site repair for
redness (erythema), edema, ecchymosis (bruising), drainage, and approximation (REEDA).
*Assess for presence of hemorrhoids.

52
Q

Visceral pain:

A

distension of the lower uterine segment, stretching of cervical tissues as it effaces and dilates, pressure and traction on adjacent structures (e.g., fallopian tubes, ovaries, ligaments) and nerves, and uterine ischemia. Located over lower portion of abdomen

53
Q

Referred pain:

A

originates in uterus, radiates to abdominal wall, lumbosacral area of back, iliac crests, gluteal area, and down thighs

54
Q

Somatic pain:

A

-intense, sharp, burning, and well localized
-Second stage of labour pain
-Distension of and traction on the peritoneum and uterocervical supports during contractions
-Pressure against the bladder and rectum
-Stretching and distension of perineal tissues and the pelvic floor to allow passage of the fetus
-Lacerations of soft tissue (e.g., cervix

55
Q

Nonpharmacological Pain Management

A

-Relaxation
-Imagery and visualization
-Music
-Touch and massage
-Breathing techniques
-Effleurage and counterpressure (long, stroking movements) and counterpressure
-Hydrotherapy
-Water birth
-Transcutaneous electrical nerve stimulation (TENS)
-Acupressure and acupuncture
-Application of heat and cold
-Hypnosis
-Biofeedback
-Aromatherapy
-Intradermal sterile water block
-Maternal position and movement

-gives a sense of control over childbirth

56
Q

What is the initial action?

A

gush of blood in 1 to 2 hrs post delivery, the patient
is getting dizzy and you as a nurse approach her, we should know there is something wrong with the uterus
- THE FIRST THING YOU DO IS UTERINE MASSAGE WITH ONE HAND AND THE OTHER HAND AT BOTTOM TO SEE IF BLOOD INCREASE/DECREASEOR YOU SEE ANY CLOTS

57
Q

Transcutaneous electrical nerve stimulation (TENS)

A

-involves the placement of two pairs of flat electrodes on either side of the labouring patient’s lumbar and sacral spine
-During a contraction, the patient increases the stimulation from low to high intensity by turning control knobs on the device not decrease pain, just makes the pain less disturbing

58
Q

Paced breathing

A

is the most associated with prepared childbirth and includes slow-paces, modified-paced, and pattern-paced (pant blow)
Relaxed breath in through the nose and out the mouth. Used at the beginning and end of each contraction.

59
Q

slow-paced P (8 to 10 breaths/min)

A

Performed at approximately half the normal breathing rate using deep breaths into the abdomen. IN-2-3-4/OUT-2-3-4/IN- 2-3-4/OUT-2-3-4

60
Q

modified paced (32 to 40 breaths/min)

A

performed at about twice the normal breathing rate using shallow breathing into the upper chest. Can use the mouth or nose for breathing in and out. IN-OUT/IN-OUT/IN- OUT …

61
Q

pattern-paced (same as modified)

A

Enhances concentration 3:1 Patterned breathing IN-OUT/IN-OUT/IN- OUT/IN-BLOW (repeat through contractions) 4:1 Patterned breathing IN-OUT/IN-OUT/IN- OUT/IN-OUT/IN- BLOW (repeat through contractions)

62
Q

Nitrous oxide

A

Nitrous oxide (laughing gas)- taste and smells sweet and so its like a distraction and anxiety relief
-can be used with other pharmacological methods

63
Q

Opioid agonist–antagonist analgesics

A

Opioid agonist–antagonist analgesics
Opioids decrease the heart rate, respiratory rate and blood pressure of the labouring patient, which affect fetal oxygenation.
Monitoring vital signs, FHR pattern before and after administration of opioids critical

64
Q

chloroprocaine hydrochloride

A

is sometimes injected into perineum to numb the area before episiotomy or repair of perineal lacerations

65
Q

Caesarean birth

A

-Spinal (block) anaesthesia
-spinal block is a single-shot, short-acting regional -anesthesiainjectedintothespinalcanal
-3rd, 4th or 5th lumbar interspace into the subarachnoid space
-Epidural (block) anaesthesia
-is a continuous, long-acting regional anesthesiainjectedintothespacearoundthespinalcanalthat provides anesthesia for a longer period of time
-Epidural space
-T10 to S5 for discomfort of labour and vaginal birth,
-T8 to S1 for Caesarean birth,
-General anaesthesia

66
Q

Contradications-Spinal and epidural Anaesthesia

A

-Active or anticipated hemorrhage
-Hypotension
-Coagulopathy
-Infection at injection site
-Increased intracranial pressure
-Refusal of patient
-Some cardiac conditions

67
Q

Potential side effects Spinal and Epidural anaesthesia

A

-Hypotension -20% drop from preblock baseline level or less than 100 mm Hg systolic
-Fetal bradycardia
-Absent or minimal fetal heart rate (FHR) variability,
-Impaired placental perfusion
-Ineffective breathing pattern may occur during
-Local anaesthetic toxicity
-Lightheadedness
-Dizziness
-Tinnitus (ringing in the ears)
-Metallic taste
-Numbness of the tongue and mouth
-Bizarre behaviour
-Slurred speech
-Convulsions
-Loss of consciousness
-High or total spinal anaesthesia
-Fever
-Urinary retention
-Pruritus (itching)
-Limited movement
-Longer second-stage labour
-Increased use of oxytocin
-Increased likelihood of forceps- or vacuum-assisted birth
-Postdural puncture headache

68
Q

Interventions for Spinal and Epidural anaesthesia

A

-Turn patient to lateral position or place pillow or wedge under one hip to displace uterus off the ascending vena cava and descending aorta.
-Maintain intravenous (IV) infusion at rate specified, or increase administration to provide fluid bolus per hospital protocol.
-Administer oxygen by nonrebreather face mask at 8 to 10 L/min if signs of hypoxia or hypovolemia in labouring patient.
-Elevate labouring patient’s legs.
-Notify the primary health care provider and anaesthesiologist.
-Administer IV vasopressor (e.g., ephedrine 5 to 10 mg or phenylephrine 50 to 100 mcg) as per primary health care provider’s order if previous measures are ineffective.
-Remain with the patient; continue to monitor maternal blood pressure and FHR every 5 minutes until condition

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