OB Test 4 Intrapartum Period of Preg.
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lantaniasrforme on April 15, 2011
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105 terms
Terms | Definitions |
|---|---|
 Passageway, Passanger, Powers, Position, Pyschological/Psychosocial Responses | 5 P's of Labor |
| Gynecoid | Favorable for vaginal delivery of newborn |
| Android | Not favorable for vaginal delivery of newborn Hint (A) |
| Anthropoid | 2nd Favorable for vaginal delivery of newborn |
| Platypelloid | Not favorable for vaginal delivery of newborn Hint (P) |
| Station | Relationship of the presenting fetal part to an imaginary line drawn between the pelvic ischial spines -5 to +5, -3 to +3 |
| Engagement | Ballottement, Dipping, Engagement |
| Ballottement or Floating | Fetal head is directed down toward the pelvis but can easily move away from the inlet |
| Dipping | Fetal head dips into the inlet but can be moved away by exerting pressure on the fetus |
| Engaged | Biparietal diameter (BPD) of the fetal head is in the inlet of the pelvis |
| Cervix | Dilatation, Effacement occurs here |
| Effacement | Thinning and shortening of the cervix that occurs late in pregnancy or during labor |
| Vertex Presentation | Most common presentation, fetal head is completely flexed onto the chest, and the smallest diameter of the fetal head (suboccipitobregmatic) presents to the maternal pelvis. The occiput is the presenting part. |
| Military presentation | Fetal head is neither flexed nor extended. The occipitofrontal diameter presents to the maternal pelvis (occipitofrontal diameter) is the presenting part. |
| Brow presentation | Fetal head is partially extended. The occipitomental diameter, the largest anteroposterior diameter, is presented to the maternal pelvis (submentobregmaticdiameter); the sinciput is the presenting part |
| Face presentation | Fetal head is hyperextended. The submentobregmatic diameter presents to the maternal pelvis (Occipitoental diameter); the face is the presenting part. |
| Complete Breech | Fetal knees and hips are both flexed, thighs on the abdomen, and the calves are on the posterior aspect of the thighs. The buttocks on feet of the fetus present to the maternal pelvis. |
| Frank Breech | Fetal hips are flexed, the knees are extended. The buttocks of the fetus present to the maternal pelvis. |
| Footing Breech | Fetal hips and legs are extended, and the feet of the fetus present to the maternal pelvis. In a single footing 1 foot presents, in a double footing 2 feet present |
| Transverse Lie | A shoulder presenting part, and the acromion process of the scapula is the landmark to be noted; but could be fetal arm, back, abdomen, or side may present |
| Fetal Lie | Relationship of cephalocausal axis of fetus to cephalocaudal axis of woman |
| Primary forces of Labor | Uterine Muscle Contractions Frequency, duration, intensity Contraction Phases: (Increment, Acme, Decrement, Resting Period) |
| Secondary force of Labor | Use of Uterine and abdominal muscles to push during second stage of labor cervical changes, dilatation, effacement |
| Frequency | Time between the beginning of one contraction and the beginning of the next contraction |
| Duration | Measured from the beginning of a contraction to the completion of that same contracction |
| Intensity | Strength of the contraction during acme |
| Progesterone | Causes relaxation of smooth muscle tissue (previous--the pregnancy hormone) |
| Estrogen | Causes stimulation of the uterine muscle contractions |
| Connective Tissue | Loosens and permits softening, thinning, opening of cervix |
| Muscles of the upper uterine segment | Shorten and cause the cervix to thin and flatten |
| Maternal positions during labor | Ambulation, Squatting, Side positioning |
| Psychosocial responses to labor | Understand & prepare for childbirth, Fantasies, Amount of support from others, Present emotional status (fears--losing control), Beliefs/values, If more relaxes, quicker labor |
| Possible cause for onset of Labor | ↓ Progesterone, ↑ Estrogen, Prostaglandins, Oxytocin, Corticotrpoin-releasing hormone Weakened cervix (collagen fibers break down) Fetus--- ↑ cortisol levels |
| Impending labor | Weight loss (1-3 lbs), N/V/D, indigestion, Observe changes in sensations (Restal pressure, ↑ leg cramps, ↓ SOB, Braxton Hicks contractions, Rupture of membranes, Lightening, Dilatation, Bloody Show, Sudden burst of energy |
| True labor | Contractions at regular intervals--increase in duration/intensity Discomfort begins in back and radiates to front of abdomen Walking intensifies contractions Resting or relaxing in wam water does not ↓ intensity Contractions produce cervical dilatation |
| False labor | Irregular contractions that do not ↑ in duration or intensity Contractions are lessended by walking, resting, or warm water Discomfors felt primarily in abdomen Contractions produce no effect on Cervix Drink large amounts of water |
| 1st stage, latent, physiologic | Regular mild contractions begin Frequency 5-7 minutes, duration 30-40 seconds Cervical effeactment and dilation begins 0-3 cm |
| 1st stage, latent, psychological | Relief that labor has begun High excitement w/some anxiety |
| 1st stage, active, physiologic | Contractions ↑ in intensity to moderate Frequency 2-3 minutes, duration 60 seconds Cervical dilation ↑ from 4-7 cm Fetus begins to descend into the pelvis |
| 1st stage, active, psychological | Fear of lossing control Anxiety ↑ |
| 1st stage, transition, physiologic | Contractions continue to ↑ in intensity Frequency 1 1/2 ti 2 minutes, duration 60-90 seconds Cervix dilates from 8 to 10 cm Fetus descends rapidly into the birth passage May experience reactal pressure, N/V |
| 1st stage, transition, psychological | ↑ feelings of anxiety, irritability Eager to complete birth experience Need to have support person or nurse at bedside |
| Cardiovascular changes during labor | Cardiovascular changes: Cardiac output B/P ↑ w/contraction, ↑ w/pushing : : Gatrointestinal |
| Respiratory changes during labor | ↑ oxygen demand/consumption, mild respiratory acidosis usually occurs by the time of birth |
| Renal system changes during labor | ↑ in renin, plasma renin activity, angiotensinogen Edema may occur at base of bladder due to pressure of fetal head |
| Gastrointestinal changes during labor | Gastric motility ↓ Gastric emptying is prolonged Gastric volume remains ↑ |
| Immune System?other blood values | WBC ↑ 4500- 20,000 Blood glucose ↓ |
| 2nd stage, labor, physiologic changes | Begins w/complete dilation and ends w/birth of infant Pushes due to pressure of fetal head on sacral and obturator nerves Uses intra-abdominal pressure Perineum begins to bulge, flatten and move anteriorly as fetus descends |
| 2nd stage, labor, psychological changes | May feel a sense of purpose May feel out of control, frieghtened, and irritable |
| Episiotomy | Surgical incicion of perineal body to enlarge outlet commonly used to avoid spontaneous laceration Usually performed w/regional or local anesthesia |
| Fetal Responses to Labor | labor may cause no adverse effects in healthy fetus Fetal HR may ↓ as head pushes against cervis Blood flow ↓ to fetus at peak of each contraction leading to ↓ in pH Further ↓ in pH occurs during pushing due to woman holding her breath |
| 3rd stage, labor, physiologic | Placental separation, uterus contracts and placenta begins to separate Placental delivery: bears down and delivers placenta--physician may put slight traction on cord to assist delivery of placenta |
| Placenta delivery, classic signs | Rounding up of uterus, upward movement of uterus, lengthening of umbilical cord, gush of blood from vagina |
| 3rd stage, labor, psychological | Woman may feel relief at completion of birth Woman usually focused on welfare of infant and may not recognize that placental expulsion is occurring |
| 4th stage, labor, physiologic | 1-4 hours--check V/S, Output, uterine contractions (involution) ↑ pulse, ↓ BP due to redistribution of blood from uterus and blood loss Uterus remains contracted/located between umbilicus/symphysis pubis May experience a shaking chill Urine may be retained due to ↓ baldder tone and possible trauma to the bladder |
| 4th stage, labor, psychological | May experience euphoria/energized at birth of child May be thirsty and hungry |
| 1 stage, Pain | Arises from dilation of cervix, stretching of lower uterine segment, pressure, and hypoxia of uterine muscle cells during contractions |
| 2nd stage, Pain | Arises from hypoxia of contracting uterine muscle cells, distention of vagina and perineum, and pressure |
| 3rd stage, Pain | Arises from contractions and dilation of cervix as placenta is expelled |
| Pain Medications--IV | nalbuphine (Nubain) butorphanol (Stadol) promethazine (Phenergan)--enhances effectiveness of pain meds and for nausea |
| Epidural check list | Check for low platelet count, spinal deformities or spinal surgeries Injection of anesthertic agent into epidural space Produces little or no feeling to area from uterus downward Hytotension is most common S/E |
| Epidural Nursing Care | VS q2 min thru medication bolus, q 5 min for 30 minutes, q 15 minutes until removed FHR q 15 minutes Have a crash cart available May preload w/crystalloid solution bolus Pushing during 2nd stage of labor maybe impaired due to lack of sensation May need urinary catheterization due to loss of bladder sensation Assess sensation motor control/orthostatic BP, T elevation |
| Spinal Block | Local anesthetic agent injected directly into spinal canal Leval of anesthesia dependent upon level of administration ---onset of anesthesia is immediate |
| Spinal Block--S/E | Severe HA Maternal hypotension, which can lead to fetal hypoxia requiring frequent BP monitoring health changes Indwelling urinary catheter usually needed due to ↓ bladder sensation/tone Woman's legs must be protected from injury for 8 to 12 hours due to ↓ movements/sensations |
| Pudendal Block | Local anesthesia injected directly into pudendal nerve, which produces anesthesia to lower vagina, vulva, perineum Only produces pain relief at end of labor Has no effect on fetus or progress of labor May cause hematoma, perforation of rectum, trauma to sciatic nerve |
| Loacal Infiltration | Local anesthesia injected into perineum prior to episiotomy Provideds pain relief only for episiotomy incision No effect on maternal/fetal VS Requires large amts of local anesthetic agents |
| Admission Nursing Care | Provide orientation to the unit and obtaining overall physical assessment of mother--Determine imminence of delivery, crowning, rectal pressure, grunting, ↑ bloody show, Assess maternal VS/FHR, Perform vaginal exam to determine stage of cervical dilatation/membranes--time, amt, color, odor, -- do not complete vaginal exam if bleeding, Nitrazine paper turns blue/green if ROM, determine frequency and intensity of contractions |
| Medical History | Maternal history and note presence of any high risk factors |
| Personal Data | Age, Due Date, Weight Medical problems or pregnancy complications Blood type and Rh factor Results of seroligical testing, Group B strep Allergies to medications, food, and other subs Note prescribed, OTC meds taken during pregnancy, and hx of sub abuse, use of alcohol and tobacco Last time ate or drank |
| Nursing Care--Cultural | Address and honor values and beliefs of laboring woman Nurses more effective when aware of---cultural beliefs of specific group |
| Nursing Responsibilities | Have client sign consent forms Start IV--18 ga catheter, Lactated Ringer's Obtain labs---CBC, RPR, Blood Type, U/A Complete Head to Toe Physical Assessment |
| Lab Assessment | Evaluate complete CBC for signs of infection, blood dyscrasia, or coagulation problems --Evaluate WBC, HGB, for ↓ in Oxygen carrying capacity, Platelet count Evaluate results of serologic testing Assess for Rh negative woman Assess, urine for glucose, ketones, protein--evaluate for possible UTI and instruct the woman in collection techniques |
| Psychosocial Assessment--admission | Laboring client has previous ideas, knowledge, and fears about childbearing--using assessment techniques, nurse can meet laboring client's needs |
| Psychosocial Assessment--Anxiety | Observe for rapid breathing, nervous tremors, frowning, grimacing, clenching of teeth, thrashing, crying, and ↑ pulse & respirations---teach relaxation, breathig, breathe into paper bag if hyperventilating |
| Support Assessment | Father or support person What are thrir caretaking activities, such as soothing conversation and touching Does relationship involve interactions? Is support person in close proximity? |
| Domestic Violence Assessment | Has anyone close to you ever threatened to harm you? Have you ever been hit, kicked, slapped or choked. If yes, by whom? What is the total number of times? Has anyone, including your partner, ever forced you to have sex? Are you afraid of your partner or anyone else? |
| Nursing Interventions--Labor | Determine imminence of delivery, VS Vaginal Discharge, Vaginal Exam Fetal Monitoring, Hydration--IV Fluids Elimination, When to notify MD, Midwife |
| Uterine Contractions | Assessed by palpation or continuous electronic monitoring Assess at least 4 successive contractions |
| Assess Contractions | For frequency--noting time from beginning of one contraction to beginning of next contraction Note time when tensing of fundus is first felt and again as relaxation occurs Intensity of contraction can be evaluated by estimating indentabiility of fundus Good time to assess laboring mother's perception of pain |
| Leopold's Maneuver Preparation | Empty client's bladder, lie on back w/feet on bed, knees bent |
| Leopold's Maneuver Purpose | Assist in determining fetal position, presentation, and lie |
| Abdominal Palpation | Facing client, palpate abdomen gently and deeply using palms of hands |
| External Contraction Monitor | Device placed against maternal abdomen, positioned against fundus, held in place w/belt Device has flexible disk that responds to pressure When fundus contacts pressure applied<"toco" and contraction displayed as pattern on monitor External monitoring does not accurately record intensity of uterine contraction May be difficult to obain fetal heart rate (hydramnious w/very active fetus Belt will require frequent readjustment |
| Electronic fetal monitoring | Provides continuous data and is routine for high-risk clients ---Also used for women experienceing an induction of labor ---May be done externally or w/an internal monitor Fetal heart rate heard most clearly at fetal back ---Useful to perform Leopold's maneuvers first to locate fetal HR, will help determine if multiple fetuses When fetal HR is located, count for 30 seconds and multiply by two ---Check client's pulse against fetal sounds |
| Normal Fetal Heart Rate | 110 to 160 BPM --rate below 110 bpm is termed bradycardia Sustained rate of 161 or above is tachycardia If rate is 180 bpm or above, is marked tachycardia |
| Variability | Variations in fetal HR, minimal moderate, marked |
| Accelerations | Transient ↑ in fetal HR normally caused by fetal movement--usually accompany uterine contractions due to fetal movement occurring in response to contractions |
| Decelerations | Periodic decreases in fetal HR from baseline---can be early, late, and variable according to time of occurrence in contraction cycle |
| Early Decelerations | Occur before the onset of uterine contraction, uniform in shape, benign, and ususally does not require intervention; usually related to fetal head compression leading to vaginal stimulation |
| Late Decelerations | Begin at peak of contraction and occur after contraction--means uteroplacental insufficiency |
| Variable Decelerations | Occur at any time, means umbilibal cord compression |
| Nursing Care, Nonreassuring FHR | Optimize maternal position, monitor maternal VS for hypotension and treat, administer IV fluids as needed, Give supplemental oxygen if indicated, Consider discontinuing Oxytocin, Initiate contrinuous monitoring |
| Nursing Care Assess--Nonreassuring FHR | Perform vaginal exam to assess for prolapsed cord or labor progress Have physician place internal monitors as appropriate --Fetat scalp electrodes, Intrauterine Pressure Catheter within uterus in resting state and with each contraction Assist physician w/fetal blood sampling Prepare for expeditious birth Provide client and family w/explanation Administer tocolytic (terbutaline) as ordered |
| Labor Induction | Deliberate starting of contractions before they begin on their own Stripping membranes, Cervidil insertion, indwelling cathetr to cervix, oxytocin infusion, amniotomy nipple stimulation |
| Labor Augmentation | Stimulation of labor which has begun spontaneously Oxytocin infusion, amniotomy |
| Nursing Intervention 2nd Stage Labor | Notify MD or midwife, Remain w/client, Assess maternal pulse, Respirations, BP q 5-15 minutes Assess FHR q 5-15 minutes, Set up delivery rooms Assist client w/breathing/pushing Cleanse perineum Prep for C-S if indicated |
| Nursing Intervention 3rd Stage Labor | Administer oxytocin as ordered, Assist MD as needed Take care of newborn, Monitor for firmness, Assess amt of lochia |
| Nursing Intervention 4th Stage Labor | Assess q 15 minutes until stable for 1 to 4 hours Maternal VS -- temperature maybe elevated due to dehydration, if pulse ↑ & BP ↓ monitor bleeding status Lochia--measure amount (light to moderate), color (rubra), presence of clots |
| Nursing Intervention 4th Stage Labor | Uterus--assess firmness/location--firm @ midline, Maybe 1-2 fingers below uterus, atony--inability to contract after delivery--PP hemorrhage |
| Nursing Intervention 4th Stage Labor | Perineum---episiotomy/lacerations--apply ice Bladder---monitor for distention Pain---administer meds |
| C-Section Delivery | Have consent signed, Prep abdomen Maternal VS, NPO Patent IV, Inser indwelling urinary catheter Obtain FHR and external monitor strip |
| Nursing Care General Anesthesia | Assess when mother ate or drank last Administer prescibed premedication such as antacid Place wedge under mother's right hip to diplace uterus/prevent vena cava compression |
| Nursing Care General Anesthesia | Provide oxygen prior to start of surgery Ensure IV access is established Assist anesthesiologist by applying cricoid pressure during placement of endotracheal tube |
| Complications of General Anesthesia | Fetal Depression---If mother receives general anesthesia, infant may have respiratory depression Method not advocated when infant is considered high risk Uterine relaxation: Most general anesthetic agents cause some uterine relaxation Vomiting, Aspiration--agents may also cause vomiting and aspiration |
| C-Section Recovery | VS q 5 minutes until stable, then q 15 minutes for 1 hr, q 30 minutes until discharged to PP Assess uterine fundus, peri pad and abdominal dressing q 15 minutes for 1 hr Assess level of anesthesia q 15 minutes Administer IV oxytocin Transfer client to PP when stable |
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