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Labor (Exam 2)

Analgesia given too early.. may prolong labor and depress fetus
Analgesia given too late.. may causes neonatal respiratory depression w/ no benefit to mother
Safest form of anesthesia? Local Infiltration
General Anesthesia Used for emergency c section or vaginal birth - give just before birth to limit fetal exposure **risk of aspiration**
For moms given general.. - place wedge under hip, tilt to side - give 30 ml of Bicitra before a c-section
Bicitra (SODIUM CITRATE-CITRIC ACID) - Alkalizing agent that decreases acidity of gastric contents to minimize pneumonia if aspiration should occur
Regional Anesthesia - temporary and reversible loss of sensation by injection of an agent into an area with direct contact to nervous tissue
Epidural Block - given b/t contractions in L2-L5 - Marcaine or Xylocaine - Maternal hypotension possible - GOLD STANDARD FOR PAIN MANAGEMENT - Position on side with feet to chest for administration
Spinal Anesthesia - may be used in low or midforceps & vacuum delivery - often used for c-sect -injected into l3-l5 Side effects: spinal headache, need a "blood patch"
Pudenal Block - minor regional block that is effective & safe - given through vagina by placing local into the area of the pudenal nerve - use for spontaneous vaginal delivery Advantages: no neonatal respiratory depression
Paracervical block - LA injected into lateral aspects of the cervix during active or transition phases -Monitor FHR for bradycardia
opoids - Morphine has a depressive effect on fetus. - Meperidine (Demerol) has lesser impact on infant
Fentyl - more potent but has a shorter duration of action than Morphine
Stadol & Nubain - Stadol given if mom itches because of epidural - DO NOT GIVE WITH LATE DECELERATIONS
Precipitate labor - Rapid labor less than 3 hours resulting in precipitous unattended birth/nurse attended - risk oh hemorrhage, & hypoxia to newborn
Pitocin drip too high.. - may cause hypertonic uterine dyfunction
Tocolytic drugs.. - prolong pregnancy for 2-7 days - Mg sulfate & nifedipine (Procardia) mg sulf antidote= calcium gluconate
Steroids are given.. to assist with lung maturity
Postterm Labor after 42 weeks - non stress test 2x weekly - daily fetal movement counts
Umbilical Cord Prolapse - partial/ total occlusion of cord w/ rapid fetal demise - knee chest position (?? give o2 & place pt on left side??)
Uterine rupture - onset marked by sudden fetal bradycardia
Amniotic fluid embolism - respiratory distress in mother
Labor induction & augmentation - Induction: stimulating contractions via medical or surgical means Augmentation: enhancing ineffective contractions after labor has begun (Pitocin) - cervical ripening to assist Pitocin
Amniofusion - indications severe variable decelerations due to cord compression oligohydramnios thick meconium fluid preterm labor w/ premature rupture of membranes
Forceps/ Vacuum uses: prolonged second stage of labor, non-reassuring FHR pattern, ect
Cesarean Birth - classic or low transverse incision
Vaginal birth after c-sec (VBAC) - Controversy related to risk of uterine rupture & hemorrhage
External monitoring - ultrasound transducer placed over fetal back and detects movements of the fetal heart
Internal Monitoring - inserted through cervix - must be 2 cm dilated
Baseline Heart rate - average heart rate between contractions - Normal 120-160 - Tachycardia >160 - Bradycardia <120 or <110 in book
Nursing interventions for early deceleration - perform vaginal exam
Baseline Variability measure of interplay b/t sympathetic & parasympathetic nervous system
Short Term Variability - change in rate between one fetal heart beat & the next - creates jaggedness or zig-zag - AKA beat to beat variability ONLY measured by internal electrode - Classified as present or absent
Long term Variability - waviness or rhythmic fluctuations (cycles) - classified as absent, decreased, average, increased, marked
Most important aspect is LVT - Even in presence of abnormal FHR, if variability is normal, fetus is NOT suffering from cerebra asphyxia -Occurs 2-6 times per minute
Causes of decreased variability - hypoxia & acidosis - demerol, valium, vistaril that depress fetal CNS - Fetal sleep - fetus less than 32 weeks
causes of increase variability - early/mild hypoxia - fetal stimulation - accoustic stimulation
Ominous sign - decreasing variability that does not appear - associated w/ fetal sleep cycle or drugs
Accelerations - transient increases in the FHR normally caused by fetal movements -sign of WELL-BEING
Non stress test - accelerations w/ fetal movement form basis for nonstress test
Decelerations - periodic decreases in FHR from the normal baseline
early decelerations - decrease in FHR beginning at onset of a contraction and return to baseline by the end of contraction - caused by fetal head compression, usually benign
Late decelerations - onset of deceleration occurs after onset of the contraction & is considered a non assuring pattern - occurs as result of uteroplacental insufficiency - results from decrease blood flow & o2 transfer **DISCONTINUE OXYTOCIN***
Variable deceleration - occurs if umbilical cord becomes compromised - fetal hypertension
Sinusoidal pattern includes presence of LTV, absence of STV, and accelerations with fetal movements -associated w/ RH isoimmunization fetal anemia, chronic fetal bleed
Amnio-infusion - installation of warm saline through intrauterine pressure catheter & may be used to recreate cushioning effect of the umbilical cord during contraction
Scalp Stimulation - done by applying pressure w/ finger to the fetal scalp through dilated cervix - tactile response - assessment of acid-base balance
Acoustic stimulation - sharp sound next to women's abdomen - used w/ nonstress test - used during labor to demonstrate fetus is reactive
Fetal blood sampling - determine hypoxia - no pain - sample of capillary blood taken from fetus scalp **FETUS SHOULD NOT BE DELIVERED W/ VACUUM AFTER THIS TEST**
Ataratics: decrease n& v, anxiety, decrease narcotic requirements - Vistaril (hydroxyzine) - Phenrgan (promethazien
Oxytocin - plays important role in onset & maintenance of labor estrogen also increased myometrial sensitivity to oxytocin
Passageway - relaxin & estrogen soften cartilage & increase strength & elasticity of pelvic organs - allows pelvic joints to seperate slighty
False pelvis - shallow upper section of pelvic
true pelvis - lower curved bony canal that includes the inlet, cavity, & outlet
Station - relationship b/t ischial spines in the passage & the presenting part of the fetus - Ischial spines are at "station 0"
Wide suprapubic arches (gynecoid & platypelloid) - allow for normal delivery * gynecoid most common
Narrow Arches (android & anthropoid) - increase risks for forceps & c-section
Fontanels points of intersection of membranous sutures
Anterior fontanel - diamond shape
Posterior fontanel - triangle shape
Fetal presentation can be determined by.. locating the fontanel
Molding overlapping of the fetal skull that helps the skull adapt to size & shape of the maternal pelvis - may take up to 3 days for effective molding to resolve
Fetal presentation - refers to anatomic part that is either closest or in the canal
Fetal lie - describes the relationship of the fetal long (head to toe) axis - in breech or cephalic presentation, lie is longitudinal - should presentation = transverse= unlikely vaginal birth
Oblique lie - indicates the fetus is at a 45 degree angle to the maternal long axis & is unstable - often converts to longitudinal or transverse lie
Fetal attitude - relationship of fetal body parts to one another
Typical fetal attitude.. - flexion of the head wherein the chest rest on the sternum & arms and legs are flexed against the chest & back is bowed out
Largest diameter? biparietal diameter @ 9.25 cm
fetal postion - relationship of fetal presenting part to the left or right side of the maternal pelvis
1st maneuver - determine which fetal pole is present in fundal area
2nd maeuver - In a vertex/ breed presentation, one side will feel smooth & firm which indicates the back
3rd maneuver - fetal attitude can be determined in a cephalic presentation
4th maneuver - Dr will face clients feet to assess further fetal attitude
Primary powers - uterine contractions are involuntary & generally independent of extrauterine control
Physiological retraction ring - divides itself into two portions upper part thickens & lower segment thins out
Whats responsible for effacement and dilation of the cervix? - uterine contractions
Effacement shortening & thinning of the cervix - described in terms of %
Dilation - widening of the cervical opening that occurs from myometrial contractions in labor - cervix is closed and then opens 10cm as labor advances
Cervix is no longer palpable when..? - it is fully dilated & retracted
In primigravida.. - effacement of the cervix begins before dilation
In multipara.. - effacement & dilation progress together
Position Lateral recumbent is most comfortable & best for fetal well being
First task of maternal role attainment.. - mother seeks safe passage for herself & child during pregnancy
Early signs of labor - lightening - 1-3 pound weight reduction - energy boost - false labor - bloody show - nesting
Lightening - descent of fetus & uterus into the pelvic cavity 2-3 weeks before onset of labor
Braxton hicks contractions - produce no cervical change
bloody show - thick tenacious mucus forms inside cervical canal to act as protective barrier - as cervix begins to soften & dilate, mucus plug is expelled 24-48 hours before labor begins
Nesting occurs 24-48 hours prior to labor
1st stage of labor longest in duration - begins w/ reg. contractions & ends when cervix is completely dilated
latent stage - begins with onset of contractions - 15-20 mins apart lasting 20-30 secs - begins w/ little or no dilation and ends w/ cervix dilated 3 - 4 cm
Active phase - 3 - 4 cm dilated & ends when she is 8 cm dilated - contractions q 2-3 mins lasting 60 seconds apart - pain relief requested
trasnition stage - contractions q 1.5 - 2 mins lasting 60-90 seconds
2nd stage of labor - begins when cervix is completely dilated 7 effaced and ends when fetus is expelled - AKA pushing stage
Crowning - point at which the fetal head is visible at the vulvar opening - birth is imminent - Lithotomy most common position for this stage
Descent - progression of fetal head into the pelvis
flexion - occurs when fetal head meets resistance from the pelvic floor and walls as well as the cervix causing head to flex w/ chin against fetal chest
internal rotation - rotation of head from occiput transverse to occiput anterior
extension - passing of fetal head under symphysis pubis
Restitution - after birth of the head, head turns to realign w/ shoulder
external rotation - rotation of shoulders so they are in an anteroposterior position
expulsion - birth of entire body
3rd stage of labor - begins as soon as fetus is delivered & ends when placenta is delivered - after expulsion of fetus, uterus contracts q 3-4 mins - within 10-15 minutes of baby, placenta is expelled
schultz fetal side
Duncan uterine side
4th stage of labor first hour after delivery
Labor induction - stimulation of uterine contractions before spontaneous onset of labor for the purpose of accomplishing delivery - most common reason is post term gestation
Bishop Score - score of 6 or more = likelihood of successful induction - 13 point scoring scale
Cytotec (Misoprostol) - synthetic prostaglandin administration orally / vaginally to produce contractions - side effects: hypertonic contractions, elevated resting tone **25-50 mg dose**
Pitocin (Oxytocin) **ALWAYS 2NDARY MEDICATION) - helps induce labor, continue labor, or control bleeding after delivery. - produced naturally by the posterior pituitary gland and stimulates contraction of uterus - diluted w/ 10 units in 1 liter of isotonic solution
Pitocin continued.. - DOES NOT cross placenta
Pitocin SIDE EFFECTS - FHR decelerations - uterine hyperstimulation - uterine rupture - hypotension - diuresis (H20 intoxication)
Stripping of membranes - assists w/ spontaneous labor - placing finger through cervical & sweeping in a circular motion
Aminiotomy - artificial rupture of membrane - performed early in labor for urgent induction - (preeclampsia) -
Spontaneous rupture of membranes - CHECK FHR first!!!
Outlet forceps when head is crowning
low forceps when head is at +2 station or lower but NOT crowning
Traction of forceps.. only applied during contractions
Supine hypotension syndrome - decreases cardiac output & stroke volume - heavy uterus can cause vena cava compression - MOTHER SHOULD LIE ON HER SIDE OR BACK W/ UTERUS TILTED TO ONE SIDE
PMI.. - slightly more to the left
IV site 18-20 gauge - need 1000 cc LR or D5wLR
Nitrazine paper yellow paper turns blue when in contact w/ amniotic fluid
Fern Test - amniotic fluid dries into a fernlike pattern on the microscope
DTR OF 3+ INNDICATES.. - Clonus associated w/ preeclampsia
Test for clonus - knee is supported in a partially flexed position while nurse applies sharp dorsiflexion to the foot
Hemoglobin below 11 or hematocrit below 32% relfects.. anemia or hemmorhage
If a woman has an epidural does she need a cath?? YES
Episiotomy - surgical cut at opening of vagina during child birth * midline- cut from vagina directly toward anus * mediolateral- cut from vagina at an angle off to one side of the anus
Brethine - for preterm labor & uterine hyperstimulation - prevents and slows contractions of the uterus
Amnisure test - test for premature rupture of membrane
Apgar Score - 0,1,2 for Activity, pulse, grimace. appearance, & respiration - 10 is best possible score
fetal station +5 - fetal head fills vaginal canal, right before birth
amount of blood lost in vaginal birth - 500 ml
amount of blood lost in csection 1000
Created by: KristinL
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