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Maternity Nursing

Factors influencing process of labor and birth (5 P's) Passenger, Passageway, Powers, Position of Mom, Psychological Aspects
P I Passenger = Fetus, Factors include: head, lie & attitude, presentation, position
Fetal Lie Relationship of fetal spine to maternal spine
Fetal Presentation Fetal part that is down and out first
Fetal Attitude Position of fetal body parts to each other, the way the fetus is curled up; relationship of fetal parts to one another; head flexed or extended
Fetal Landmarks Fontanels & SuturesPosterior (triangular), anterior (diamond), 6 bones
Molding Head shapes to fit through available space in maternal pelvis
Cephalic Presentation (Vertex) Crown first, chin well flexed on chest
Cephalic Presentation (Face or Brow) Chin is extended, diameter larger
Breech Presentation Feet and/or buttocks first
Shoulder Presentation Transverse lie
Station Measure of the degree of descent of the fetus through the birth canal
O Station Fetus is engaged, even with ischial spines
Minus # Stations Baby is higher up within the pelvis
Positive # Stations Baby is down toward the perineum
P II Passageway, Information about the passageway include: smallest diameter at ischial spines, fetus must pass beneath pubic arch, hormones soften cartilage and ligaments
Introitus External opening to vagina: tears, abrasions, hematomas, estrogen resp flex
P III Powers: Primary-involuntary uterine contractions & Secondary-voluntary abdominal muscles and diaphragm (bearing down)
Duration of contraction The amount of time the contraction lasts
Frequency of contraction From start of one to the start of the next
Intensity of contraction The strength of the contracation, how tight
P IV Position of mom - Tactics include squatting (gravity helps fetal descent), all fours (relieves backache), lateral (may help rotation of fetal head, turn mom to relieve pressure on cord, NO LYING FLAT
P V Psychosocial Considerations - Includes: perceptions/expectations (anxiety, fatigue, pain intolerance, cultural knowledge, educational preparation (prenatal classes), support (coach, doula)
Premonitory Signs of Labor Lightening, low back pain, Braxton-Hicks energy surg (nesting), weight loss, GI upset, vaginal discharge, bloody show, cervical changes, rupture of membranes
Lightening The uterus drops, promotes easier breathing and causes frequent urination
Onset of Labor Oxytocin-known to stimulate uterine contractions
Effacement Thinning of the cervix, expressed as 0%-100%Primiparas efface then dilateMultiparas efface as they dilate
Dilation Opening of the cervix, expressed as 0cm-10cm
Stage 1 of Labor Includes 3 phases. Effacement and dilation of cervix. Usually longest stage: 8-15 hours
Stage 2 of Labor Birth, pushing baby to +5 station. Lasts minutes or 2-3 hours
Stage 3 of Labor Delivery of placenta. Lasts 2 min to 1 hours
Stage 4 of Labor Recovery, Last about 2 hours
Labor Status Assessment Contraction history, cervical changes, membranes, and bloody show
Fetal Status Assessment Fetal position, heart rate, gestational date
Stage 1 of Labor, Phase 1 Latent: 0-3cm dilated, Contractions 5-30 min apart, mild to moderate, lasting 30-45 sec, 0 to -2 station. Mom alert, excited, walking, fluid intake
Stage 1 of Labor, Phase 2 Active: 4-7cm dilated, Contraction 3-5 min apart, mod to strong, lasting 40-70 sec, +1 to +2 station, Epidural may occur here. Mom working hard, may fatigue, serious, focuses, internalizes
Stage 1 of Labor, Phase 3 Transtion: 8-10 cm dilated, Contractions 2-3 min apart, strong to very strong, lasting 60-90 sec, +2 to +3 station. Mom irritable, tired, trouble following directions, hurting if no epidural, may fall asleep btwn contrax, awakes in pain, shakes and vomit
Rupture of Membranes May occur spontaneously or done artificially (amniotomy). May be done if: fetus is engaged, to prevent prolapse of cord, used to stimulate labor. Asses fetal heart rate and observe color, and consistency of fluid.
Ferguson Reflex The urge to push when the baby's head presses on receptors. Urge may be absent with epidural anesthesia.
Cardinal Movements (Baby mechanism of labor) Engagement (o station), Descent (downward), Flexion (chin tucked on chest), Internal rotation (head rotates after entering inlet sideways to exit outlets as it hits pelvic floor), Extension (baby stretches neck), External rotation (restitution), Explusion
Care of the Newborn Airway-suction mouth & nose, Warmth-dry and wrap, cover head, APGAR (0-10): heart rate, resp, tone, reflex, color @ 1 & 5 Min, ID
Placenta Delivry Separates from uterus, contractions cause the site to shrink, gush of blood, check for intact placenta, no retained pieces, leads to hemorrhage.
External monitor Non-invasive, ultrasound transducer, usually on fetal back, toco-transducer, over fundus, measures duration, frequency, NOT intensity
Internal monitor Requires: ROM, 2cm dilated, 0 station. Spiral electrode (invasive) directly to babies scalp, IUPC - reads intrauterine pressure, duration, and frequency, passes beside fetus
Fetal Heart Rate Baseline: avg rate in 10 min (110-160bpm)
Maternal Responses to labor BP rises during contractions, drops if aorta vena cava are compressed by uterine weight, O2 consumption up, possible resp. alkalosis, bladder (blocks babies descent if full), may have protein in urine (overworked muscles), Digestion slows, Pass stool
Visceral Pain Cervical changes and uterine ischemia, secondary to contractions, lower abdomen, back and thighs
Somatic Pain Perineal stretching, pressure on other structures
Referred Pain Felt in back, flanks, thighs
After Pain Contracting down of uterus
Factors influencing pain Knowledge, culture & traditions, fear & anxiety, past experiences, personal coping, significance of pain, fatigue
Pain Relief Measures Relaxation,, effleurage, counterpressure, massage, touch, music, water, aromatherapy, biofeedback, heat/cold
Narcotics and (Narcotic Antagonist) Demerol, Fentanly(Narcan)
Mixed narcotic agonist-antagonist Stadol, Nubain
Potentiators Phenergan, Largon, Vistaril
Blocks "Caines" (i.e. Novacaine), Fentanyl, Morphine
Systemic Drug Effects for Baby Timing (<1 hr or >4 hr before IM deliver). Too early-slows labor, Too late-may depress neonatal resp and may need narcan. Fetal liver may register 2-3 hr after admin.
Epidural Info Not given until active phase, IV fluids must be maintained, BP must be monitored, Empty bladder
Precipitous Labor Less than 3 hours from onset of contractions to birth. Maternal complications: ruptured uterus, placental hemorrhage, lacerations, amniotic fluid embolism. Fetal complications: hypoxia, intracranial hemorrhage
Augmentation/Induction Used for several concerns: PROM, PID, inadequate labor progression, postterm dates
Oxytocin Administration Concerns Must watch for danger, FHT, lack of uterine relaxation, poor perfusion, decreases or stop infusion, give Os, turn to side
BUBBLE H2 Breast, Uterus, Bladder, Bowels, Lochia, Episiotomy, Hemorrhoids, Homan's Sign
Lochia After birth up to 6 weeks later, no menstruation
Rubra 1-3 days after birthRed
Serous 3-10 days after birthPink, Brown
Alba 10-20 days after birthWhite, Creamy
Postpartum Assessments 1st hour, every 15 minutes (fundus check).2nd & 3rd hour, every 30 minutes
Vital Sign Assessment Increased temp (100.4) after delivery, after 24 hours increased temp = infection.BP decrease for labor or normal, sudden decrease=hemorrhage, increase BP & headache= PIHPulse=brady 1-6 days PPResp=norm
Factors that promote involution Breastfeeding, Voiding, Fundal massage, oxytoxic medications
Menstruation & Ovulation resumes when... 6-24 weeks before menstruation returns, but no ovulation.
Breastfeeding Positions Side-lying, Football, Cradle
To decrease milk in non-lactating mothers... Wear a supportive bra 24/7No nipple stimulation, do not express milkIce packs/analgesics for engorgementGreen cabbage leaves in the bra
1st degree episiotomy or laceration Vaginal mucous membrane and skin of perineum
2nd degree episiotomy or laceration Subcutaneous tissue of the perineal body
3rd degree episiotomy of laceration Involves fibers of the external rectal sphincter
4th degree episiotomy of laceration Through the rectal sphincter exposing the lumen of the rectum
Cesarean Assessments Incision care, Peri-care, Ambulation, Breast Care, Assess gas
To decrease milk in non-lactating mothers... Wear a supportive bra 24/7No nipple stimulation, do not express milkIce packs/analgesics for engorgementGreen cabbage leaves in the bra
1st degree episiotomy or laceration Vaginal mucous membrane and skin of perineum
2nd degree episiotomy or laceration Subcutaneous tissue of the perineal body
3rd degree episiotomy of laceration Involves fibers of the external rectal sphincter
4th degree episiotomy of laceration Through the rectal sphincter exposing the lumen of the rectum
Cesarean Assessments Incision care, Peri-care, Ambulation, Breast Care, Assess gas
RhoGam given when and why... Rh- mother and Rh+ babyGiven at 28 wks and within 72 hours after delivery
Rubella Virus Vaccine immune status and special notes... Ratio is _<1:8 = non-immuneIf given before pregnancy, must wait 3 months before getting pregnant. Can not take if sensitivity to neomycin or had blood transfusion in past 3 months
Deladumone Lactating suppressant used years ago that was found to cause reprodutive cancers in the offspring of mothers who took it
Rubin's early maternal responses (early 60's) Taking-in (touching baby, embracing and talking about L&D), Taking-hold (a week later, how to take care of baby), Letting-go (looking for resources)
Attachment An enduring two way bond or relationship affection between persons
Bonding A process of parent-infant attachement occuring at or soon after birth
Maternal role attainment Process by which a woman learns mothering behaviors and becomes comfortable with her identity as a mother
En Face The arrangement of mother or newborn so that her face and eyes and infants meet on the same vertical plane of rotation
Mutual Regulation Behaviors in which mother and baby modify their relationship in an attempt to make it as enjoyable as possible (non-verbal)
Reciprocity The process of communication in which a mother and infant monitor cues and respond to each other in rhythms of interaction (maternal instinct).
Postpartum Blues (lasts several days, 75-80% of new moms) Mini grief experience of loss of self and old ways, feelings of responsibility. Tearfulness, insomnia, moodiness, irritability, forgetfulness, appetite loss, anxiety.Encourage pt to discuss feelings and encourage private time when baby naps
Postpartum Depression (lasts weeks or months, 15-20% of new moms) Never gets over blues, happy about baby but have flat affect or show forced emotions. Personality changes, compulsive thoughts, feelings of inadequacy, inability to care for infant and/or self, suicidal thoughts, fears of hurting self/baby
Postpartum Psychosis (lasts weeks or months, 0.1-0.2% of new moms - rare, but many suffering bipolar) Break with reality, delusions, hallucinations, feeling that the baby is the devil or divine, plans to harm child (the lady that drowned her 5 babies)
Medical treatment for Postpartum depression Individual psychotherapy, antidepressants, lithium, group therapy, antipsychotics
Engrossment Father's sense of absorption, preoccupation, and interest in his infant.
Sexual activity should not be resumed until... The perineum is completely healed (2-4 weeks). External may heal in 2 weeks, but internal needs at least 4 weeks.
Created by: 5241830