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Mat Ch7-8 CCC 105

Maternity Ch 7-8 CCC PN105

Types of classes gestational diabetes; early pregnancy; exercise; infant care; breastfeeding; sibling; grandparent; adolescent; refresher; cesarean; VBAC
Ideally, preparing for childbirth begins ____ before conception
Basic class content pregnancy changes; fetal development; prenatal care; hazardous substances; nutrition; discomforts; exercise; work; labor/delivery coping
How childbirth pain is different Part of normal birth process; several months to prepare; self-limiting and rapidly declines
pain threshold pain perception; failry constant; least amount of sensation that a person perceives as painful
pain tolerance amount of apin one is willing to endure; can change under different conditions
primary nursing responsibility regarding childbirth pain modify as many factors as possible so that the woman can better tolerate labor
sources of labor pain dilation and stretching of cervix; reduced uterine blood supply during contractions (ischemia); pressure of fetus on pelvis; stretching of vagina and perineum
Gate control theory how pain impulses reach the brain for interpretation; pain is transmitted through small nerve fibers, stimulation of large nerve fibers temporarily interferes with pain conduction through small fibers and "closes the gate"
gate control theory techniques stroking or massage; palm and fingertip pressure; heat and cold applications (gripping cool bedrail); foot rubbing; pressure;
endorphins natural body substances similar to morphine; increase during pregnancy and peak during labor
why can laboring women often tolerate more pain than usual increased endorphins and concern for infant's well-being
maternal condition during labor cervical readiness (dilation and effacement); size and shape of pelvis; labor intensity; fatigue
how does labor intensity effect labor short, intense labor is often more painful than gradual birth process
how does fatigue effect labor reduces pain tolerance and ability to use coping skills
what are common interruptors of sleep during pregnancy active fetus, frequent urination, shortness of breath why lying down
effect of fetus in abnormal presentation applies uneven pressure to cervis resulting in less effective effacement and dilation, prolonging labor and delivery
fetal occiput in posterior pelvic quadrant pushing again mother's sacrum results in ___ persistent and poorly relieved back pain, often longer labor
interventions that may add to labor pain IV lines, continuous fetal monitoring, anmniotomy, vaginal exams
advantages of nonpharmacological pain management do not harm mother or fetus, do not slow labor if provide adequate pain control, no risk of allergy or adverse effects
types of nonpharmacological pain management Dick-Read method; Bradley method; Lamaze method; relaxation techniques; skin stimulation; positioning; diverstion and distraction; breathing
importance of nonpharmacological pain management most medication do not eliminate pain and additional methods to manage remaining discomfort are needed
Dick-Read method education and relazation techniques interrupt the fear of childbirth cycle reducing labor pain
Bradley method "husband-coached method"; emphasizes slow abdominal breathing and relaxation techniques
Lamaze method "psychoprophylactic method"; mental techniques that condition woman to respond to contractions with relaxation rather than tension; uses mental and breathing techniques to occupy mind
Lamaze techniques breathing should be no slower than half of baseline respiratory rate and no faster than twice the baseline rate
method that is the basis of most childbirth preparation classes in US Lamaze method
relaxation techiniques require concentration thereby occupying the mind while reducing muscle tension; used in both pharmacological and nonpharmacological pain maagement
types of skin stimulation effleurage, sacral pressure, thermal stimulation
effleurage stimulates the large nerve fibers that inhibit painful stimuli traveling through small nerve fibers; storking abdomen in circular pattern; tracing figure 8 on bed
sacral pressure firm pressure against the lower back; helps with back labor
thermal stimulation heat applied with warm blanket or glove filled with warm water; warm shower; cool cloth on face
positioning frequent changing of position relieves muscle fatigue and strain and promotes labor
types of diversion and distraction techniques focal point, imagery, music, television
types of breathing techniques slow-paced, modified paced, patterned pace
technique to use for first-stage breathing do not use until needed; selected pattern begins and ends with cleansing breath
cleansing breath deep inspiration and expiration, similar to deep sigh
slow paced breathing beginning of first state breathing; slow breathing like during sleep; half the usual respiratory rate
modified paced breathing more rapid and shallow breaths, more more than twice usual rate
nursing considerations during modified pace breathing hyperventilation; watch for dizziness, tingling, numbness around mouth, spasms in fingers and feet; blurred vision
patterned paced breathing "pant-blow" or "hee-hoo" breathing; rapid breaths punctuated with intermittent slight blow - constant and/or stairstep patterns used
constant patterned pace breathing pant-pant-pant-blow; pant-pant-pant-blow; etc
stairstep patterned pace breating pant-blow; pant-pant-blow; pant-pant-pant-blow; etc
second stage breathing used when time to push; cleansing breath, deep breath, and push while exhaling to count of 10; blows out, deep breath, and pushes again while exhaling
do not interfere if woman is successfully using a safe, nonpharmacologic pain control technique
measures to correct hyperventilation slow breathing while exhaling; breathe into cupped hands; moist washcloth over mouth and mose while breathing; hold breath for few seconds before exhaling
in using analgesia and anesthesia, the pregnant woman is at higher risk for hypoxia due to pressure of enlarging uterus on diaphragm
in using analgesia and anesthesia, the pregnant woman is at higher risk for vomiting and aspiration due to sluggish GI tract
in using analgesia and anesthesia, the pregnant woman is at higher risk for aortocaval compression due to hypotension and development of shock
limitations of pharmacologic pain management effect and impact on fetus must be considered
advantages of pharmacologic pain management allows mother to be more comfortable and relaxed; increased relaxation aids in ability to participate in care
types of pharmacologic pain management narcotic (opiod) analgesic; narcotic antagonist; adjunctive drugs
most common type of labor analgesia in US systemic opiods (narcotic analgesics)
in using narcotic analgesics _____ avoided if birth expected with 1 hr; only small doses given to prevent fetal respiratory depression
narcotic antagonist reverses respiratory depression, usually in infant, caused by opiod drugs (not effective for other causes)
type of narcotic antagonist Narcan (naloxone)
adjunctive drugs enhance pain-relieving action of analgesic and reduce nausea
types of adjunctive drugs Vistoril, Phenergan
regional analgesics and anesthetics placement of an anesthetic in the epidural or subarachnoid space of spinal cord
epidural block provides analgesia and allows woman to ambulate with assistance; must have good blood counts; give 500mL Ringers solution immediately prior; constantly infused or intermittently repeated
regional anesthetics block _____ sensation to varying degrees, depending on type of block used, quantity of medication, and drugs injected
subarachnoid (spinal) block "one shot" block; provides analgesia but prevents ambulation; does not place catheter for reinjection; not used for vaginal births
types of regional anesthetics local infiltration; pudendal block, epidural block; subarachnoid (spinal) block
types of analgesics given right before delivery, do not help with contraction pain local infiltration and pudendal block
adverse effects of epidural maternal hypotension and urinary retention (palpate bladder q2h)
adverse effects of subarachnoid (spinal) maternal hypotension and urinary retention (palate bladder q2h); postspinal headache due to spinal fluid loss
treatment of spinal headache bed rest, analgesics, oral and IV fluids; blood patch if necessary
uses for general anesthesia emergency cesarean; cesarean birth in woman who refuses or has contraindication to epidural or subarachnoid block; always presume mother has fullo stomach
general anesthesia adverse maternal effects reguritation with aspiration; chemical injury to lungs; aspiration pneumonia
general anesthesia adverse neonate effects respiratory depression is main risk
nurse role in pharmacoloic techniques begins at admission; question about allergies to food and drugs; pain relief preferences; observe for hypotension if block is given
if pain relief drugs are given _______ keep side rails up for safety
amnioinfusion injection of warmed sterile saline or lactated Ringers solution into uterus via intrauterine pressure catheter during labor after membranes have ruptured
indications for amnioinfustion oligohydramnios (lower than normal amniotic fluid); umbilical cord compression; to reduce recurrent variable decelerations of fetal heart rate; to dilute meconium stained amniotic fluid
purpose of amnioinfusion to replace the cusion for the umbilical cord and relive variable decelerations of the fetal heart rate during contractions with decreased amniotic fluid
nursing considerations during amnioinfusion continuous monitoring of uterine activity and fetal heart rate (not below 110 or above 160); change underpands on bed as needed; document color, amount and odor from expelled fluid
amniotomy artificial rutpure of amniotic sac (AROM) by using a sterile sharp instrument to stimulate contractions
effects of amniotomy stimulates prostaglandin secretion which stimulates labor but can result in umbilical cord compression
amniotomy technique disposable plastic hook is passed through cervix and amniotic sac is snagged to create hole to release fluid
complications of amniotomy (or from spontaneous rupture SROM) prolapsed cord; infection; abruptio placentae
cord prolapse umbilical cord slips downward with the gush of amniotic fluid
infection from amniotomy membranes no longer block vaginal organisms from entering uterus; delivery must be within certain time frame
amniotomy and abruptio placentae more likely to occur if uterus is overdistended with amniotic fluid prior to rupture of membranes
nursing considerations of amniotomy observe for complications; record fetal heart rate for minimum 1 min; color, odor, amount of fluid; remp taken q2-4h; change underpads often to prevent growth of microorganisms
cloudy, yellow, or malodorous fluid suggests infection
green fluid fetus passed first meconium; associated with fetal compromise and distress
induction of labor intentional initiation of labor before it begins naturally
augmentation of labor stimulation of contractions after they have begun naturally
considerations prior to induction fetal maturity and status of cervix
Bishop score used to assess status of cervix in determining its response to induction; 6+ is favorable
nursing considerations during labor induction continuous monitoring of uterine activity and fetal heart rate
indications to induce labor hypertension, ruptured membranes, uterine infection, worsening medical problems, fetal problems, placental insufficiency, fetal death
contraindications to labor induction placenta previa, cord prolapse, abnormal fetal presentation, high station of fetus, active herpes infection, abnormal size/structure of pelvis, previous classic cesarean incision
pharmacological methods to stimulate contractions cervical ripening, oxytocin administration
cervical ripening (Cervidil) prostaglandin gel softens the cervix prior to induction; after insertion woman remains on bed rest 1-2h and uterine contractions monitored to watch for uterine hyperstimulation
uterine hyperstimulation contractions longer than 90s, more than 5 contractions in 10m
oxytocin administration most common method of induction and augmentation; in diluted IV solution; begins at low rate and is adjusted up or down according to fetal response to labor; dose is individual to every woman
nonpharmacological methods to stimulate contractions walking, nipple stimulation
walking to stimulate labor stimulation of contractions, eases pressure of fetus on back, adds gravity to downward force of contractions
nipple stimulation to stimulate labor causes posterior pituitary to naturally secrete oxytocin; pull/roll, brush with dry washcloth, water in whirlpool tyb/shower, suction with breast pump
augmentation complications most common complication is overstimulation of contractions leading to fetal compromise and uterine rurpure; impairment of placental exchange; water intoxication
evidence of excessive uterine contractions frequency greater than every 2m, duration longer than 90s, resting intervals shorter than 60s
nursing considerations during induced/augmented labor signs and symptoms of increased uterine activity; monitor fetal heart rate every 15m during active labor and every 5m during transitional phase; monitor BP, pulse, respirations every 30-60m, temp q2-4h, intake and output
version method of changing fetal presentation from breech to cephalic
version methods external and internal, external is more common
risks and contraindications of version fetus becoming entangled in cord and cord compression
external version technique done after 37 eks but before labor; physican pushes fetal buttocks up out of pelvis while pushing fetal head down toward pelvis in clockwise/counterclockwise turn
internal version technique emergency procedure usually performed to change position of twins for second twin birth
episiotomy surgical enlargement of vagina during birth
laceration uncontrolled tear of tissues that result in jagged wound
types of episiotomies first, second, third, and fourth degree
first degree episiotomy superficial vaginal mucosa or perineal skin
second degree episiotomy vaginal mucosa, perineal skin, deeper tissues of perineum
third degree episiotomy same as second but also involves anal sphincter
fourth degree episiotomy extends through anal sphincter into rectal mucosa
third or fourth degree episotomy considerations no enemas or suppositories; high fiber diet, stool softeners, and adequate fluids to prevent constipation
indications for episiotomy better control over where and how much vaginal opening is enlarged; clean edge rather than ragged tear
episiotomy techniques midline (median) and mediolateral
midline episiotomy extends directly from lower vaginal border toward anus; heals easier and easier to repair
mediolateral episiotomy extends from lower vaginal border toward mothers right or left
nursing care for episiotomy cold packs for first 12h to reduce pain, bruisin, and edema; sitz bath to increase blood circulation for comfort and healing; dermaplast spray to cool area
forceps and vacuum extraction provides traction and rotation to fetal head when mothers pushing efforts are insufficient to accomplids a safe deliver
forceps instrument with curved blades that fit around fetal head without unduly compressing it
vacuum extractor suction applied to fetal head so the physican can assist the mothers expulsive efforts
indications for use of forceps or vacuum to end second stage labor if in best interest of mother or fetus; cervis must be fully dilated, membranes ruptured, bladder empty, and fetal head engaged at +2 station
risks of forceps or vacuum trauma to maternal or fetal tissues is main risk; laceration or hematoma in vagina; vacuum causes harmless circular edema on fetal scalp
concern with forcep or vacuum marks on infant reassure parents that marks are temporary and usually resolve without treatment
nursing care for forceps or vacuum care is similar to episiotomy and perineal lacerations; infant head examined for lacerations, abrasions, bruising; infant facial asymmetry from forcep pressure
cesarean birth surgical delivery of fetus through incisions in mothers abdomen and uterus
indications of cesarean birth abnormal labor; inability of fetus to pass through pelvis; maternal conditions such as hypertension or diabetes; active herpes; previous uterine surgery; fetal compromise; placenta previa; abruptio placentae
maternal risks of cesarean birth anesthesia; respiratory complications; hemorrhage; blood clots; urinary tract injury; delayed intestinal peristalsis; infection
newborn risks of cesarean birth inadvertent preterm birth; respiratory problems; injury
cesarean births can be _________ planned, unplanned, or emergency
types of cesarean incisions vertical or transverse skin incisions; low transverse, low vertical, or classic uterine incisions - uterine incision is most important
vertical skin incision allows more room, done faster for emergencies
transverse skin incision (Pfannenstiel) nearly invisible when healed; cannot always be used in obese women or for large fetus
low transverse uterine incision preferred; not likey to rupture during another birth, causes less blood loss, easier to repair; VBAC possible
low vertical uterine incision minimal blood loss and allows delivery of large fetus; more likely to rupture during another birth
classic uterine incision rarely used; more blood loss and most likely to rupture during another pregnancy
cesarean sequence spinal anesthetic given; mother scrubbed and draped; physician makes skin incision and then uterine incision and ruptures membranes; lift out fetal head or buttocks; infant mouth and nose are quickly suctioned; cord is clamped
nursing considerations for cesarean birth mother needs greater emotional support due to grief, guild, or anger and change of expected outcome; feeling may resurface during another pregnancy
recovery room assessments for cesarean birth vital signs to identify hemorrhage or shock; IV site and rate of solution flow; fundus (GENTLY!) for firmness, height, and midline position; dressing for drainage; lochia (bleeding) quantity, color, and clot presence; urine output from catheter
assessing uterus after cesarean important because __________ causes much discomfort, but can determine relaxed uterus that causes excessive blood loss
abnormal labor (dysfunctional labor) does not progress
dystocia difficult labor
four Ps of labor abnormalities in Powers, Passengers, Passage, Psyche
risk factors in dysfunctional labor advanced maternal age, obesity, overdistention of uterus, abnormal presentation, CPD, overstimulation of uterus, maternal fatigue/dehydration/fear, lack of analgesia
hypertonic labor dysfunction (Powers) caused by frequent cramplike poorly coordinated contractions; increased muscle tone; during latent phase; painful but not productive; leads to reduced bloodflow to placenta
hypotonic labor dysfunction (Powers) labor begins normally but diminishes during active phase; decreased muscle tone; more like to occur if overdistended; stretched muscle finbers have reduced ability to contract effectively
ineffective maternal pushing may not understand proper technique
Created by: cmp12345