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Week6: Chp 16-Labor and Birth Processes, Chp 19., Chp.32 labor and birth complications(EXAM 3)

Terms in this set (54)

Explanation:
Involuntary and voluntary powers combine to expel the fetus and the placenta from the uterus.

Involuntary uterine contractions , called PRIMARY POWERS SIGNALS THE BEGINNING OF LABOR

Once the cervix has dilated, voluntary bearing down effort by the woman, called the SECONDARY POWERS , argument the force of involuntary contractions.

A.Involuntary:
1.Primary powers of labor:(Effacement,Dilation,Decent)
note the primary powers are responsible for
a. Effacement(Shortening/thining of cervix)
note: when this is complete only a thin edge of the cervix can be palpated
b. Dilation(Widening of Cervical opening)
-the diameter of the cervix increases from being fully closed to full dilation (10cm) to allow birth of term fetus
-When the cervix is fully dilated (n retracted) it can no longer be palpated
-Full cervical dilation marks the end of the first stage of labor
C. initiate decent

-so primary powers Dilate and efface the cervix and initiate descent

B. Voluntary powers:
-Secondary Powers
1.Bearing down: aids in expulsion of the fetus as she contracts her diaphragm and abdominal muscles and pushes.
2.Augment the force of the primary contractions
3. Involuntary urge to bear down (Ferguson reflex)
-Stretch receptors cause release of endogenous oxytocin that triggers the maternal urge to bear down or the FERGUSON REFLEX.

4.Endogenous oxytocin release
-Closed Versus open glottis pushing
NO CLOSED GLOTTIS PUSHING!

note: Secodary powers have NO EFFECT ON CERVICAL DILATION, but are important of the expulsion of the infant from the uterus
1.Terbutaline (Brethren : most commonly admin
-beta adrenergic agonist used for tocolysis,
-relaxes smooth muscle, inhibiting uterine activity and causing bronchodilation
- can be given to suppress uterine tachysystole and to suppress contractions prior to cesarean birth.
tx: does not last longer than 24 hrs
-Discontinue if Intolerable events occur

Intolerable:
-Tachycardia greater than 130bpm
-bp less than 90/60
-chest pain
-cardiac arrhythmias
-Myocardial infaction
-Pulmonary edema

Nurse:
-should not be used in women with a hx of cardiac disease, pregestational or gestational diabetes , hypertension, preeclampsia or hyperthyroidism, significant hemorrhage


2.Indomethacin(Indocin)
-NSAID
-SERIOUS FETAL OR NEONATAL side effects have cause major concerned
-Limiting use of INDOMETHACIN to a period of 48 hours or less in women with preterm labor at less than 32 weeks.

Nurse:
-use only if gestational age is less than 32 weeks
-Administer for 48 hours or less
-Do not use in women with renal or hepatic disease, PUD , hypertension, asthma, coagulation disorders
-Can mask maternal fever so, constant temperature checks
-Assess women and fetus
-Give food to minimize GI Distress
- Monitor signs of Postpartum hemorrhage
-Determine Amniotic fluid volume and function of fetal ductose arterioles before initiating therapy and within 48 hours of discontinuing therapy

3.Nifedipine (Adalat, Procardia)
-CCB
- Relaxes smooth muscle by preventing calcium from entering smooth muscle

Nurse :
-Avoid concurrent use with magnesium sulfate because skeletal muscle blockade can result
-Can cause orthostatic hypotension and dizziness, so instruct women to slowly change positions
-Maintain adequate fluid balance to reduce the drop in blood pressure
-Should not be given simultaneously with or immediately after Tebutaline because of effects on heart rate and blood pressure
-Assess women and fetus
-Do not use sublingual route.

4.Magnesium sulfate
CNsS Depressant relaxes smooth muscle
Intolerable s/s:
Respiratory rate fewer than 12 breaths/min
-Pulmonary edema
-Absent DTRs
-Chest pain
-Severe hypotension
-Altered LOC
Extreme muscle weaknes
Nurse:
-Assess women and fetus to obtain baseline
-moniter serum magnesium levels
therapeutic range is :4 and 7.5
- Discontinue infusion and notify physcian if intolerable adverse effects occur
-Ensure that calcium gluconate or calcium chloride is available for emergency administration to reverse magnesium sulfate toxicity
-Total intake should be limited to 125ml/hr

4.Antenatal glucocorticoid (p 769)
-given as a IM to mom to accelerate fetal lung maturity by stimulating fetal surfactant production

-Betamethasone
two doses..24 hours apart

Dexamethasone
four douses 12 hour apart

Nursing"
-Give DEEP IM in Ventral gluteal or Vastus laterals muscle
-Assess maternal blood glucose levels. women with diabetes may require increased insulin doses for several days.