Quizlet Unit 12B-Threats to Neurosensory Integration During the Intrapartum (Dysfunctional Labor)

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  1. 5 P's of labor: Passenger, Passageway, Position, Powers, Pshyce
  2. CPD: Cephalopelvic disproportion (baby's head too large for mom's pelvis).
  3. dysfunctional labor: Abnormal uterine contractions that prevent the normal progress of cervical dilation, effacement (primary powers), or descent (secondary powers).
  4. dystocia: Prolonged, painful, or otherwise difficult labor caused by various conditions associated with the five factors affecting labor (powers, passage, passenger, maternal position, and maternal emotions).
  5. Dystocia: Occurs in 8-11% of women. Results from variations in the normal relationships between any of the essential factors of the labor (5 P's).
  6. Hypertonic labor: Primary dysfunctional labor-Involve ineffective contractions, uncoordinated in nature. Happens early in the labor process, usually in the latent stage. The muscle fibers of the uterine muscle do not repolarize after a contraction, so a new impulse arises from the uterine pacemaker before a previous one has subsided. Contractions are very painful, the myometrium becomes tender and anoxia to the uterine cells. Force may be in the mid-section instead of the fundus, therefore uterus is unable to apply downward pressure to push the presenting part against the cervix.
  7. hypertonic uterine dysfunction: Primary dysfunctional labor.
  8. Hypotonic labor: Secondary dysfunctional labor-Starts out as normal labor, but over time contractions become too weak, short, irregular, or infrequent. As a result, cervical dilation and effacement slow or stop. Most likely occur in active phase of labor. Contractions are not exceedingly painful, but greatly increase the length of labor. Uterus is easily indented, even at the peak of a contraction. Commonly due to CPD and malpositions.
  9. hypotonic uterine dysfunction: Secondary dysfunctional labor.
  10. Maternal and fetal risks of hypotonic labor: Revolve around prolonged ROM and frequent vaginal exams leading to increased infection risk.
  11. Medical treatment for hypertonic labor: Therapeutic rest.
  12. Medical treatment for hypotonic labor: R/O CPD, assessing fetal and maternal well-being. If normal, augment labor often with oxytocin infusion. Ambulation, hydrotherapy, enema, stripping of ROM, and nipple stimulation can help augment labor.
  13. Nursing interventions for hypertonic labor: Hydration, monitoring of I&O's, and promoting relaxation.
  14. Nursing interventions for hypotonic labor: Normal active labor interventions.
  15. Precipitate labor and birth: Because the uterine contractions are so strong, woman gives birth with only a few rapidly occurring contractions. Birth may be unattended by a physician, nurse will deliver. Most common in ages 35-39yo and least common < 20yo.
  16. precipitous labor: Labor that lasts less than 3 hours from the onset of contractions to the time of birth.
  17. Predisposing factors of dystocia: Short stature of mother, obesity, abnormalities of uterus (congenital malformations, overdistention as with multiple gestation or hydramnios), malpresentation or malposition of fetus, maternal anxiety or fatigue, anesthesia at the wrong time, CPD, too much oxytocin and uterine muscle is overstimulated and dehydration and electrolyte imbalance.
  18. Psychosocial aspects of precipitous birth: Women describe feeling of disbelief that their labor began so quickly, alarm that their labor progressed so rapidly, panic about the possibility they would not make it to the hospital in time, and finally relief when they arrived. Expressed frustration when nurses did not believe them when they reported their readiness to push.
  19. Risk factors to precipitous birth: Multiparity, hx of previous precipitous, hx of dilation > 5 cm/hr or 1 cm/12 min, or intense contractions with little relaxation between them.
  20. Risks of dystocia: Increases mother's risk of infection and hemmorhage and infant mortality.
  21. Risks to fetus in hypertonic labor: Fetal distress, due to uterine arteries having no time to fill properly and can lead to fetal anoxia. Also cephalohematoma, caput, or excessive molding due to prolonged pressure from the fetal head.
  22. Risks to mother in hypertonic labor: Prolonged labor, increased discomfort, fatigue, dehydration, and increased infection due to prolonged labor.
  23. Risks to the fetus in precipitate labor: Fetal hypoxia (due to rate of contractions), birth too quickly can result in intracranial hemorrhage.
  24. Risks to the mother in precipitate labor: Premature placental separation, uterine rupture, lacerations and tears, hemorrhage, and amniotic fluid embolism, nearly always fatal.
  25. Secondary powers: Voluntary expulsive forces (bearing-down) part. Analgesia or anesthesia can block the urge to push. Prolonged labor may create fatigue and inability to muster reserves to push. Lithotomy position requires pushing against gravity.
  26. therapeutic rest: Achieved with a warm bath or shower and the administration of analgesics such as morphine, Demerol, or Nubain to inhibit uterine contractions, reduce pain, and encourage sleep.
  27. When does dystocia occur?: Any time in the labor process. Primary-Occurs at onset (usually first time anxious mom) or Secondary-occurs later in labor process.