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4 Ps
Intrapartal
| Question | Answer |
|---|---|
| What happens to the active and passive uterus during labor? | Upper segment becomes thicker, the lower segment and the cervix becomes thinner and are pulled upward. |
| What happens to the active and passive uterus during contraction? | The upper 2/3 contracts actively, the lower third and the cervix is passive. |
| What is the reason for passive contraction? | To allow the baby to go thru. |
| Define effacement. | Cervix gets shorter and thinner. |
| Uterine contraction and mother's pushing efforts is considered what part of intrapartal? | Powers |
| Maternal pelvis is considered what part of intrapartal? | Passage |
| What hormone is secreted during passage? | Increased relaxin hormone |
| Which pelvic shape is considered the best for labor and the degree? | Gynocoid at greater than 90 degree |
| Fetus, membranes, and placenta is considered what part of intrapartal? | Passenger |
| What 2 fontanelles do doctors look for during delivery? | Anterior and Occipital |
| Best way for a baby to be positioned during delivery is? | Flexion |
| Complete flexion as a type of cephalic presentation is considered? | Complete flexion |
| Moderate flexion as a type of cephalic presentation is considered? | Military presentation |
| Poor flexion as a type of cephalic presentation is considered? | Brow presentation |
| Full extension as a type of cephalic presentation is considered? | Face presentation |
| Describe position of baby during Frank breech. | Both feet near in front of the faced and crossed |
| Leopoids Maneuvers 1 | 1 |
| Leopoids Maneuvers | 2 |
| Leopoids Maneuvers | 3 |
| Leopoids Maneuvers | 4 |
| Describe right occipitoposterior position of baby | Back facing mom's anterior side with head facing left side |
| Describe right occipitoanterior position of baby | Front of face facing mom's anterior with face facing mom's left side |
| what part of the baby do you auscultate FHR when positioned LSA or RSA (left or right sacrum area)? | Upperback |
| Anxiety, fear, pain, prep for childbirth, and impact of technology is considered what part of intrapartal | Psyche |
| When there is too much sympathetic action, what chemical can inhibit uterine contractility and placental blood flow? | Catecholamines |
| What hormones are triggered from prostaglandin caused by fetal membranes? | Estrogen |
| Define lightening | descent |
| What signs would you look for when laboring? | Braxton Hicks contractions, lightening, energy spurt, small weight loss, increase in clear and nonirritating vaginal secretions. |
| What are the mechanisms of labor? | Descent, engagement, flexion, internal rotation, extension, external rotation, expulsion |
| First stage of labor is? | Dilation and effacement of the cervix. |
| Begins and ends with? | Begins with onset of true labor and ends with complete dilation and effacement of cervix. |
| What are the phases of the first stage of labor? | Latent, active, and transition. |
| Latent (early stage) - size of cervical dilation? | 3cm |
| Latent (early stage) - how often do contraction occur? | To about 5 minutes apart |
| Latent (early stage) - what happens to the intervals of the contractions? | decrease |
| Latent (early stage) - what happens to the duration of contraction? | increases to 30-40 seconds |
| Latent (early stage) - what are the strength of the contractions? | mild to moderate |
| Latent (early stage) - what happens to the back and abdomen? | back discomfort progresses to the lower abs with each contraction |
| Latent (early stage) - how is the mom's response? | sociable, excited, cooperative |
| Active phase - size of cervix? | 4-7cm |
| Active phase - what happens to the pace of labor? | increase |
| Active phase - what happens to the effacement? | complete |
| Active phase - what happens to the contraction intervals? | average of 2-5 minutes between them |
| Active phase - what happens to the duration of the contraction? | 40-60 seconds each |
| Active phase - what is the intensity of the contractions? | moderate to strong |
| How are the contractions different from latent phase? | they reach their peak faster and stay there longer |
| Active phase - what is the response of the mother? | more anxious or helpless, less sociable |
| Active phase - what is given at this stage? | pain meds and anesthesia |
| Transition phase - what is the size of the cervix? | 8-10cm |
| Transition phase - describe fetus and blood | fetus descends further into the pelvis and bloody show increases |
| Transition phase - describe phase | short but intense |
| Transition phase - what is the intensity of the contractions? | strong |
| Transition phase - what is the duration and frequency of the contractions? | 60-90 seconds duration and 1.5-2 minutes apart |
| Transition phase - side effects? | leg tremors, nausea & vomitting |
| Transition phase - what is mom's reaction? | irritable & lose control |
| What takes place in the 2nd stage? | expulsion |
| 2nd stage - size of cervix? | 10cm |
| 2nd stage - effacement %? | 100% |
| 2nd stage - begins and ends with? | begins with dilation & full effacement of cervix and ends with the birth of the baby |
| 2nd stage - average time for nullipara? | 30 min - 3 hrs |
| 2nd stage - average time for multipara? | 5-30 min |
| 2nd stage - what happens to the intensity of the contraction? | diminish slightly |
| 2nd stage - what happens to the fetal head? | causes pressure on rectum & pelvic floor that causes involuntary pushing response from mom like a bowel movement |
| 2nd stage - what is mom feeling pysically & emotionally? | feel sensation of splitting or stretching; regains feeling of control to complete birthing process |
| What takes place in the 3rd stage? | placental |
| 3rd stage - begins and ends with? | begins with baby delivered already and ends with expulsion of the placenta |
| 3rd stage - duration? | 5-10 min & up to 30 min |
| 3rd stage - what happens to the uterus? | size decreases with birth & causes separation of placenta edges |
| 3rd stage - what are the sx of separation of the placenta? | uterus has spherical shape, rises upward in abs as placenta descends, cord descends further from the vagina, a gush of blood appears |
| 3rd stage - most common type of placenta delivery? | Schultz "shiny" side first |
| 3rd stage - least common type of placenta delivery? | Duncan "dirty" side first |
| What takes place in the 4th stage of labor? | physical recovery for mother & infant |
| 4th stage - how long for the recovery? | delivery through first 1-4 hours after birth |
| 4th stage - what should be done with the uterus | palpated through the abs |
| 4th stage - what may occur to mom that is natural? | chills & shivering |
| 4th stage - what is mom's reaction? | excited & exhausted |
| 4th stage - time for? | bonding |
| What do you look for when during artificial rupture of membranes? | babies |
| IV push Fentanyl for contractions - what is the onset time, physical advantage, not use for which pt, and antagonist for? | quick onset, physical advantage - less n/v/resp depression, not for pt opiate dependent, narcotic antagonist |
| List 3 adjunctive drugs for deliver? | Phenergan, Benadryl, Hydroxyzine |
| What is the opiate antagonist when babies HR drops? | Narcom |
| Purpose of Phenergan? | antinausea |
| Purpose of Benadry? | relieve pruritus (itching) caused by epidural narcotics |
| Purpose for Hydroxyzine? | nausea and vomiting |
| What are some ways in providing comfort measures? | Lignthing, temperature, mouh care, clenaliness, bladder, positioning, teaching & encouraging, pharmacologic measures, carin for birth partner |
| What are 2 ways in preventing injury for mom during birth? | postioning & perineum |
| What is a priority responsibility of a nuse after birth? | administer meds to contract uterus after delivery |
| After AROM what are the top 3 things you look for? | Babies HR, check color & odor of fluid, meconium |
| What can be done to prevent pushing? | blowing, must slow breath or at risk of hyperventilation |
| What can be done to help with second stage breathing and what is the purpose? | closed glottis pushing to increase intrathoracic pressure and reduce O2 supply to fetus during contraction |
| What main med is given during 2nd stage? Advantage? Not for what type of pt? | Fentanyl; less N/V/resp depression Opiate dependent pt |
| Purpose of Phenergan | anti-nausea |
| Purpose of Benadryl | anti-itching for epidural |
| When is Iv push administered during labor? | during contraction so less meds go to the baby |
| What med to you administer to babies when HR dec? | Narcom, an opiate antagonist |
| Name meds for short & long acting local anesthesia | Novocaine & Lodocaine |
| Name 2 types of analgesics for labor | Fentanyl & Morphine |
| What med is given for SVD and duration? | Fentanyl - rapid onset, 1-4h |
| What med is given that takes 30-60 min onset? | morphine |
| What contraindicates anesthesia? | back surgery, bleeding disorder, infx, allergies |
| what are advantages of regional anesthesia? | less N/V; repeated doses; less fetal respiratory depression |
| what are disadvantages of regional anesthesia? | Need anesthesiologist or nurse anesthetist; decreased progress in labor, loss of bladder sensation, possible need for forceps or vacuum, inc incidence of c-section |
| what are adverse rx of regional anesthesia? | respiratory paralysis, toxicity, infx, headache, back pain, hypotension, pruritus, N/V |
| How do you prevent hypotension during birth? | prehydrate, side lying |
| s/s of hypotension? | low bp, inc p, N/V, feel funny |
| What are tx for hypotension? | IV fluids, L side, o2, call MD, ck FHR |
| What is the antitode for anesthesia? | epinephrine; sympathetic blocking & brinb BP back up |
| Prior to anesthesia, what must be done? | empty bladder or FC |
| What stage is epidural given and what cm dialation? | during active stage (1)@ 4-6 cm dilation |
| How long is epidural good for? | 12-24 hours |
| What needs to be monitored for mom after epidural is given? | Resp sedation, puritis, nauses |
| What happens when epidural is given at a later stage? | baby will depress; cause early labor |
| Spinal Anesthesia - used for, effect & how long, blocks, risk for? | c-sections, rapid effect for 1-2 hours, sensory & motor, risk for spinal headache |
| Tx of spinal headaches? | blood patch, keep pt supine, inc fluids, give caffeine |
| Cause of dystocia and results in? | CPD or weak contractions; results in fluid or electrolyte imbalance, hypoglycemia, CPD or uterin overdistention |
| Tx for dystocia | depends on cause, oxytocin, AROM, fluids, walking |
| When is labor induced with pitocin? what is assess first? | above 40 weeks fetal fibronection |
| What is Bishop Score and requirements? what score is needed? | readiness of labor; requires effacement, dilation, station, softness of cervix, position of cervix >6 favorable |
| When is pitocin augmentation given? | when labor is too slow, increase frequency of contractions, ideal dilation 1 cm/hr |
| Norms for montevideo? | 180-250 |
| What are signs of hypertonic uterine for contractions and FHR? | contractions duration more than 90 sec & occuring less than 2 minutes FHR - late decel |
| Interventions for hypertonic uterine? | reduce or stop oxytocin, turn her sideways, give her O2, notify physician |
| Cause of PTL? | infx or medical conditions, drug abuse, uterine distension/irritability |
| What med is given to stop PTL? | tocolytics, terbutaline, magnesium sulfate, calcium antagonists |
| Side affect of calcium antagonists? | dec bp & dec hr; therefore, baby gets less perfusion |
| What med given to baby for PTL & give definiton? | betamethasone; to speed up a preterm fetus's lung development |
| Interventions for precipitous labor? | side lying to dec vena cava compression, dec labor by giving tocolytics, O2 for mom, IV fluids, DC pitocin |
| PASSENGER/PASSAGE Macrosomia weight? | 8.8 lbs |
| Type of maneuver for shoulder dystocia? what location does it get stuck? | McRobert's maneuver symphysis pubis |
| What can be injured on baby during precipitous delivery? s/s? | intracranial hemorrhage, nerve damage, hypoxia bradycarida or tachycardia |
| Signs of concealed hemorrhage in abruptio placentae r/t fundal, uterine, abdominal, fhr, vaginal bleeding | inc fundal height high uterine baseline persistent abdominal pain persistent late decel vaginal bleeding that may be slight or absent |
| S/S of hypovolemic shock due to blood loss as it r/t emotions pr, rr, bp urine hgb & hct mental | anxiety inc pr & rr falling bp weak pulses dec urinary output of <30 ml/hr dec hgb & hct change in mental status |
| how does hypovolemic affect baby as it r/t: hr amniotic fluid contractions - duration uterine bp temp | no variability in hR AF meconium-stained contractions more than 90 sec incomplete uterine relaxation, intervals between contrc shorter than 60 sec hypo/hypertension fever |
| Signs of intrapartum infx as it r/t: heart temp smell color infx name | fetal tachycardia 100.4F foul, smellling cloudy or yellow chorioamnionitis |
| Med name given to mother so it reduces HIV rate of transmission to baby | zidovudine |
| Congestive Heart Failure s/s as it r/t: |
Created by:
jjcarmelbeach
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