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OB EXAM 3.. 7 8 9

Tpoics that focus on the mother and infant Birthing classes
Exercises that relieve back pain common during late pregnancy conditioning- pelvic rock, tailor sitting, shoulder circling
Factors that distinguish child labor pain from other types of pain part of the normal birthing process several months to prepare for pain self limiting and rapidly declnes after birth
almost universal part of the normal process of birth pain
least amount of sensation that a person percieves as painful pain threshold - pain perception
amount of pain one is willing to endure pain tolerance
sources of pain during labor dilation and stretching of cervix reduced uterine blood supply during contractions (ischemia) pressure of the fetus on the pelvis stretching of the vagina
Gate Control Theory explains how pain impulses reach the brain for interpretation transmitted through small-diameter nerve fibers. stimulation of large-diameter nerve fibers temporarily interferes with conduction of the impulses through the small-diameter fibers
natural body substances similar to morphine endorphins peak during labor- may explain why women in labor often need smaller amounts of analgesics or anesthetic
cervix naturally under goes prelabor changes that facilitate effacement and dilation in labor, if the cervix does not make these changes more contractions are needed to cause effacement and dilation
significantly influences how readily the fetus can descend through the pelvis size and shape
pelvic abnormalities can result in longer labor and greater maternal fatigue
reduces pain tolerance and a woman ability to use coping skills fatigue
most effectively cause effacement and dilation of the round cervix fetal head- smooth and rounded
when does the fetus turn during labor ealry labor- occiput is in the front L or R or right quadrant of the mothers pelvis
fetal occiput that is in a posterior postion results in back pain (back labor) labor is often longer with this fetal position
interventions that add to pain during labor IVS continuous fetal monitoring Amniotomy vaginal examinations
influences how a woman feels about pregnancy and birth and how she reacts to pain during childbirth culture
help the woman to cope with labor before it has advanced far enough for her to be given medication nonpharmacological methods
cannot be given until labor is well- established bc they tend to slow the progress of labor pharmacological methods
concept of a fear-tension-pain cycle during labor Dick-Read method
Husband- coached childbirth and was the first to include the father as apart of labor Bradley method
Psychoprophylatic method, basis of most child birth prep classes- uses mental techniques that condition the woman to respond to contractions with relaxation rather than tension Lamaze method
Lamaze breathing technique should be no more than half of the woman baseline respiratory rate and no faster than twice the baseline resp rate
to reduce fear and anxiety the woman is oriented to the labor area, any procedures that are done, and what is happening
stimulates the large-diameter nerve fibers that inhibit painful stimuli traveling though the small-diameter fibers Effleurage
firm pressure against the lower back helps to relieve back pains (back labor)
focus on an object or closing eyes to focus on an internal focal point
each breathing pattern begins and ends with a cleansing breath- deep inspiration and expiration- similar to a deep sigh
cleansing breaths help the woman to relax and focus on relaxing
signs and symptoms of hyperventilation dizziness, tingling of the hands and feet, cramps and muscle spams of hands, numbness around the nose and mouth, blurring vision
how to correct hyperventilation breath slowly- esp in exhalation breathe into cupped hands place moist wash cloth over the mouth and the nose while breathing hold breath before exhaling
nure role in nonpharmacological techniques assess knowledge, teach and control stimuli
systemic drugs that affect the entire body- reduce pain without loss of consciousness analgesics
loss of sention, especially of pain anesthetics
systemic drugs that cause loss of consciousness and sensation of pain general anesthetics
physician who specializes in giving anesthesia anesthesiologist
registered nurse who has advanced training in anesthetic administration CRNA
pregnant women are at higher risk for ________ caused by the pressure of the enlarging uterus on the __________ hypoxia diaphragm
sluggish gastrointestional track results in increased risk for vomiting and aspiration
never lay a pregnant woman in this position bc the heavy uterus puts pressure on the abdominal aorta and causes hypotension supine
most common means of labor analgesia in the US opiods
the use of narcotics are avoided if labor is expected within one hour
used to reverse respiratory depression on the infant caused by opiod drugs such as meperidine- not effective against respiratory depression from other causes (like intrauterine hypoxia) Naloxone (Narcan)
enhannce pain relieving action of analgestics and reduce nausea adjuctive drugs- hydroxyzine or phenergan
injection of the perineal area for an episiotomy is done just before birth- when fetal head is visible, may be done after placental erxpulsion to repair laceration, allow the anesthetic to become effective before beginning the episiotomy local infiltration
used for vaginal births, does not block pain of contraction given just beofre birth- delay between injection and paresthesia- injects into the nerves on each side of the mothers pelvis- needle guide (trumpet) Pudendal block
adverse effect of Pudenal block vaginal hematoma or an abscess may occur
small space just outside the dura (outer most membrane covering the brain and spinal cord) epidural space
if the test dose of an epidural is normal no side effects and catheter is in right place
numbness or loss of movement after the smallest dose in the Epidural indicates dura matter was punctured and the drug was injected into the subarachnoid block
numbness around the mounth, ringing in the ears, visual disturbances or jitteriness are symptoms that suggest injection is in the vein
when the dura matter is punctured it is referred to as wet tap
if the dura matter is punctured spinal fluid can leak from the hole resulting in HA
do not use epidural block if the woman has abnormal bleeding infection in the area of injection or systemic infection hypovolemia
most common side effect of epidural block maternal hypotension and urinary retention
to counter act hypotension _______ is infused rapidly before the bloack is began LR = 500 ml, 1000 ml or more
this in the mother can cause compromise fetal oxygenation maternal hypotension
palpate the bladder every _______ to assess for full bladder 2 or more hours
this can delay and cause hemorrhage after birth full bladder
postion for this block is similar to an epidural except her back is curled around her uterus in a C-shape- dura is punctured with spinal needle- a few drops of spinal fluid confirm entry subarachnoid (spinal) block
not often used for vag births but for C-sections- called "one shot" block bc it does not involve placing a catheter for reijection of the drug subarachnoid (spinal) block
done by the CRNA or anesthesiologist to provide relief from postspinal HA blood patch
the womans blood ( ___ - ___ ) is withdrawn from her vein and is injected into epidural space in the area of the subarachnoid puncture- blood clots and forms a seal 10- 15 ml
adverse effects of the mother from General Anesthsia regurgitation with aspiration
Adverse effects of the neonate from General Anesthesia respiratory depression bc drugs given to mother may cross placenta
nurses responsibilty in pain management begin at admission- question the womans allergies to food, drugs (including dental anesthetics) latex, last oral intake (time and type)
anesthetic drugs are injected between contractions
if woman is given epidural or subarachnoid block you shoudl observe the woman for hypotension- do BP every 5 min after block begins and with each reijection until BP is stable
injection of warmed sterile water or LR into the uterus via intrauterine pressure catheter during labor after the membranes have ruptured amnioinfusion
for Amnioinfusion the nurse should change the underpads on the bed as needed to maintain patient comfort and should document color, amount, and any odor expelled
Artificial Rupture of Membranes by using a sterile sharp intrument Amniotomy- done to stimulate contractions
three complications associated with amniotomy may occur if a womans membranes rupture spontaneously #1 prolapse of umbilical cord #2 infection #3 Abruptio placentae
nursing care after amniotomy or spontaneous membrane rupture promote comfort and observe for complications
after amniotomy fetal heart rate is recorded for one minute
amniotic fluid should be clear, possibly with vernix, and no odor (color, odor, amount, characteristics)
amnio fluid that is cloudy, yellow and odorous suggest infection
green amnio fluid suggest meconium
how often is womans temp taken after her membranes rupture 2-4 hours maternal temp of 100.4 or higher suggest infection
change underpads often to reduce the moist, warm enviroment that favors growth of microorganisms
intentional initiation of labor before it begins naturally induction
stimulation of contractions after they have begun naturally augmentation
used to access the status of the cervix in determining its response to induction- score of 6 or more indicates favorable prognosis of induction Bishops score
continuous _______ activity and ______ _______ ______ monitoring during labor is essential uterine fetal heart rate
labor is not induced if placenta previa, umbilical cord prolapse, abdominal fetal presentation, high station of fetus (pre term fetus or small maternal pelvis), active herpes infection
labor is induced if GH, ROM without spontaneous onset of labor, infection uterus, medical problems of mother that worsen, fetal problems, placental insufficiency or fetal death
induciton of labor is easier if the cervix is soft, partially effaced and beginning to dilate
form of a gel or commercially prepared vaginal insert softens the cervix when applied before labor induction prostaglandin
examples of pharmacologic methods to stimulate contractions cervial ripening (prostaglandins and laminara) oxytocin
examples of nonpharmacologic methos to stimulate contractions nipple stimulation walking
oxytocin solution is a piggyback solution and can be stopped quickly while an open IV line is maintained
most placental exchange of o2, nutrients, watse products occur between contractions
occurs when oxytocin inhibits the excretion of urine and promotes fluid retention water intoxication
most common signs of fetal compromise fetal heart rate is outside the normal range (110-160), late decelerations, loss of variability
fetal heart rate is assessed every _____ minutes during active labor and every _____ minutes during transition 15 5
mehtod of changing fetal presentation, usually from breech to cephalic version
a successful version reduced the likelihood that the woman will need cesarean
contraindications for version disproportion between the mothers pelvis and fetal size, abnormal pelvis or uterin size, abnormal placental placement, previous VERTICAL cesarean, Active herpes infection, low amnio fluid, poor placental function, multifetals, malfuctioning placenta
in version, the main risk of the fetus is tangled umbilical cord (more likely to occur with inadequate room to turn or presence of twins or low amniotic fluid
done at 37 weeks gestation- but before onset of labor- begins with NST OR BBP to determine if the fetus is in good condition external version
to relax the mothers uterus during version she is given tocolytic drug
emergency procedure- done during vaginal birth of twins to change fetal presentation of the second twin internal version
surgical enlargement of the vagina during birth episiotomy
uncontrolled tear of the tissues- jagged wound laceration
involves superficial vaginal mucosa or perineal skin first degree
involves vaginal mucosa, perineal skin, and deeper tissues of the perineum second degree
same as the second degree plus involves the anal shpincter thrid degree
extends through the anal sphincter into rectal mucosa fourth degree
helps prevent constipation high fiber and increase fluids
episiotomy that is easier to repair and heals neatly median episiotomy
provides more room, greater scarring during healing - may cause painful sexual intercourse mediolateral incision
cold packs should be applied to perineum for at least 12 hours to reduce pain, bruising and edema
after 12 - 24 hours of cold applications, warmth form of heat packs or sitz bath increase blood flow, enhance comfort and healing
vacuum extractor is only used with an occiput presentation
women with cardiac or pulmonary disorders often have forceps or vacuum extraction births bc prolonged pushing can worsen these symptoms
main risk when forceps or vacuum extraction is used trauma to maternal tissue or to fetal tissue
newborn sclap edema caused by vacuum extractor chignon
before forceps or vacuum are used- the mother is catheterized to prevent trauma to her bladder and make room in her pelvis
nopt usually done if the fetus is dead or too premature to survive or if the mother has abnormal blood clotting cesarean
the physician often perfoms ______ to help prevent the unintentional birth of preterm fetus before a planned cesarean to determine lungs amniocentesis
womans abdomen may be shaved from just above her umilicus to her mons pubis and where thighs come together vertical incision
upper border of the shave is about 3 inches above pubic hair line Pfanneristiel (transverse)
during C-section- the womans catheter bag is placed at the head of the operating table so the anesthesiologist can monitor output- important indicator of woman blood volume
two incisions for c-section birth skin and uterine
allows more room if a large fetus is being delivered and is usually needed for obese women vertical incision
nearly invisible when healed but cannot always be used in obese women or in women with a large fetus transverse
recovery room assessment after c-section vitals-identify hemorrhage or shock, pulse ox is used to better identify depressed respiratory function, IV site and rate of solution flow, fundus for firmness, height, and midline position, dressing for drainage, lochia for color and presence of clots
labor that evidences a regular progression in cervical effacement, dilation, and descent of the fetus
abnormal labor- does not progress dysfuntional labor
term used to discribe difficult labor dystocia
abnormalities in and length of labor ________ may result in a dysfunctional labor powers, passengers, passage or psyche
risk factors for dysfuctional labor maternal age, obesity, over distention of uterus (hydraminos or multifetal preg), abnormal presentation, CPD, overstimulation of the uterus, maternal fatigue, dehydration, fear, lack of analgesic assistance
usually occurs during latent phase of labor (before 4 cm of dilation) and characterized by contractions that are frequent, cramplike, and poorly coordinated- painful but nonproductive increased uterine muscle tone
hypertonic labor dysfunction is less common than hypotonic dysfunction
woman with increased uterine muscle tone are uncomfortable and frustrated
help the woman sustain the energy level needed for effective pushing promote relaxation, reduce fatigue, change positions, increase hydration
a large fetus (macrosomia) is generally considered to weigh more than 4000 g (8.8lb) at birth
common cause of abnormal labor is that the fetus remains in persistant occiput posterior postion
most favorbale pelvis for vaginal birth gynecoid pelvis
the body responds to stress with "fight or flight" reaction that impedes normal labor by using glucose the uterus needs for energy\ diverting blood from the uterus incresing tension of the pelvic muscles, which impedes fetal descent increasing perception of pain, creating greater anxiety and stress and thus worsening the cycle
promoting relaxation and helping the woman conserve her resources for the work of childbrith are the principal nursing goals
average rate for cervical dialtion during active phase of labor 1.2 cm/hr for woman having first child 1.5 cm/hr for woman who has given birth before
descent is expected to occur at a rate of at least 1.0 cm/hr in fist time mom 2.0 cm/hr in woman who has had child before
used to graph the progress of cervical dialtion and fetal descent Friedman curve
prolonged labor can result in several problems maternal and fetal infection maternal exhaustion postpartum hemorrhage greater anxiety and fear in a ensuing pregnancy
birth completed in less than 3 hours and there may be no health care provider present precipitate birth
spontaneous rupture of membranes at term (38 weeks of gestation) more than 1 hour before labor contractions begin premature rupture of membranes (PROM)
rupture of membranes before term preterm premature rupture of membranes
how is it tested to see if it is amniotic fluid diagnosis is confirmed by testing the fluid with nitrazine paper, turns blue in the presence of amniotic fluid
inflammation of the fetal membranes chorioamnionitis
oligohydramnios is confirmed if the amniotic fluid index is less than 5 cm
oligohydraminos in gestation less than 24 weeks can lead to pulmonary and skeletal defects
occurs after 20 weekd and before 37 weeks gestation- main risk are the problems of the newborn preterm labor
protein produced by the fetal membranes that can leak into vaginal secretions if the uterine activity, infection, or cervical effacement occurs fibronectin
presence of fibronectin in vaginal secretions occur between 22-24 week of gestation- predictative of preterm labor
drug of choice for initiating therapy to stop labor. continuous IV infusion is given and therapeutic levels are monitored magnesium sulfate
if it looks like preterm birth is inevitable, the physician may give the woman steroid drugs (glucocorticoids) to increase fetal lung maturity if the gestation is between 24 and 34 weeks
as the placenta ages, it delivers oxygen and nurtients to the fetus less efficiently - the fetus may lose weight and the skin may begin to peel- characteristics of postmaturity
period of 6 weeks following childbirth postpartum - puerperium
placental site is fully healed in 6-7 weeks
the uterine lining (called endometrium when not pregnant and the decidua during pregnancy)is shed when the placenta detaches
when should the uterus return to prepregnant size? 5-6 weeks after delivery
failure of the uterus to return to prepregnant state after 6 weeks is called subinvolution
refers to the changes that the reproductive organs, partiularly the uterus, undergo after birth to return them to their pregnant size and conition involution
this portion of the uterus descends at a predictable rate as the muscle cells contract to control bleeding at the placental insertion site and as the size of each muscle cell decreases uterine fundus
after 24 hours the fundus begins to descend about 1 cm each day -- by 10 days it should no longer be palpable
when assessing the fundus:::: control bleeding first and then keep it controlled by emptying the bladder
vaginal discharge after delivery composed of endometrtial tissue, blood, and lymph lochia
lochia that is red bc it is composed mostly of blood, last for about 3 days after birth lochhia rubra
lochia that is pinkish bc of it blood and mucous content- last from about the third through the tenth day after birth lochia serosa
lochia that is mostly mucous and is clear and colorless or white- last from the tenth day through the twenty-first day after birth lochia alba
when massaging the fundus be sure the keep the other hand on the lower part of the uterus to keep from inverting it
constant trickle of brighter red lochia is associated with bleeding from lacerations of the cervix or vagina
rugae reappear how long after postpartum 3 weeks
acronym that is used to assess the perineum for normal healing and signs of complication REEDA
REEDA redness-edema-ecchymosis-discharge-approximation
ovulation may occur at any time after birth, with or without menstrual bleeding and pregnancy is possible
% increase in blood volume during pregnancy 50
normal blood loss during 500 ml in vaginal birth 1000 ml in cesarean birth
when given the rubella vaccine the woman should not get pregnant for one month after vaccine
a woman who has undergone a cesarean birth has a greater risk for thrombophlebitis
when the woman is confined to the bed, the woman should take deep breaths and turn from side to side ever 2 hours
normal blood pressure for infants 65-95 systolic 30-60 diastolic
the cord is assessed for the number and type of vessels soon after it is cut (AVA)
when can you tub bathe the infant 10-14 days after birth
bleeding from the cord during the first few hours usually indicates the clamp is too loose
a blood glucose less than _______ in the infant indicates hypoglycemmia 40
until the infants first sponge bath and shampoo, the nurse must wear gloves when hadling the infant
refers to a strong emotional tie that forms soon after birth between the parents and the newborn bonding
affectionate tie that occurs over time as an infant and caregivers interact attachment
certain drugs that decrease breast milk volume levodopa, barbituates, antihistamines, pyridoxine, estrogens, androgens, bromocriptine
can a mother breast feed her infant if she is Hep A positive? yes, it is not contraindicated to breast feed bc the infant can recieve immunoglobulin and Hep A vaccine therapy
secreted by the breast during late pregnancy and for the first few days after birth colostrum
when does transitional milk emerge from breast app 7-10 days after birth, breast gradually shift from production of colostrum to production of mature milk
mature milk is secreted by 14 days after birth
how many calories does breast milk have 20 kcal/ oz and all the nurtients the infant needs
advatages of breastfeeding promotes mother-infant bonding maintains infant temp infant suckling stimulates oxytocin release to contract the mothers uterus and control bleeding
newborn should be put on the breast within the first hour of delivery when alert for suckling and bonding- breastfeeding should not be delayed beyond _______ hours 6
focus of the nurse during the early hours of breastfeeding is to help the mother position the infant correctly and help the infant have an open, gaping mouth in preperation for suckling
in breastfeeding early, regular, and frequent nursing promotes milk production and lessens engorgement
the nursing mother needs _________ extra calories each day plus enough fluid to relieve thirst 500
duration of nursing on the first breast should be at least ______ minutes to stimulate milk production 10
postpartum check should include status of fundus, lochia, breast, perineum, bowel and bladder elimination, vital signs, Homans sign, pain and evidence of parent-infant attachment
Created by: sweaver