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OB Exam 1
OB chapter 14 pt 2
| Question | Answer |
|---|---|
| Comfort and Pain Management | Pain as universal experience; intensity highly variable Mandate for pain assessment in all patients admitted to health care facility Numerous nonpharmacologic and pharmacologic choices available |
| The physical causes of pain during labor include | Cervical stretching Hypoxia of uterine muscle Pressure on structures (bladder, urethra, rectum) Distention of pelvic floor muscles |
| Nonpharmacologic Measures for Pain Management | Continuous labor support Hydrotherapy Ambulation and position changes Acupuncture and acupressure Attention focusing and imagery Therapeutic touch and massage; effleurage Breathing techniques |
| what stage are non pharm measures used in | stage 1: active and latent phase |
| Pharmacologic Measures | Systemic analgesia Regional or local anesthesia Neuraxial analgesia/anesthesia techniques Shift in pain management |
| Neuraxial analgesia/anesthesia techniques | use of analgesic or anesthetic, continuously or intermittently into epidural or intrathecal space |
| Systemic Analgesia route | typically administered parenterally through existing IV line |
| Systemic Analgesia drugs | Opioids (butorphanol, nalbuphine, remifentanil, fentanyl) Antiemetics (hydroxyzine, promethazine) Benzodiazepines (diazepam, midazolam) |
| antidote for analgesia | comparable to Narcan and can because given for fetus if analgesia was given too late |
| when is it too late to give analgesia | when head is crowning |
| Regional Analgesia/Anesthesia | Local Pudendal Nerve Block Spinal Epidural |
| Epidural block | continuous infusion or intermittent dosing; may be initiated at any stage of labor based on patient preference and clinical judgment |
| Combined spinal–epidural block aka | walking epidural |
| Local infiltration | usually for episiotomy or laceration repair |
| Pudendal block | usually for second stage, episiotomy, or operative vaginal birth |
| Intrathecal (spinal) analgesia/anesthesia | during labor and cesarean birth |
| spinal considerations | pain relief and blocked motor function, for c section |
| epidural considerations | pain blocked but motor function not affected |
| General Anesthesia is for | Emergency cesarean birth or patient with contraindication to use of regional anesthesia |
| General Anesthesia is administered | IV injection, inhalation, or both |
| steps of general anesthesia | Commonly, first thiopental IV to produce unconsciousness Next, muscle relaxant Then intubation, followed by administration of nitrous oxide and oxygen; volatile halogenated agent also possible to produce amnesia |
| First Stage of Labor: Phone Assessment | EDD Fetal movement; freq in past few days Other signs of labor experienced Parity, gravida, and previous births Time frame in prev labors Characteristics of contractions Bloody show and ROM or not Pt alone or have support? |
| Nursing Care During First Stage of Labor | Obtain admission history Check results of routine laboratory tests and any special tests Ask about childbirth plan Complete a psychosocial assessment Complete a physical assessment |
| Complete a psychosocial assessment | Plan for culturally competent care during labor and birth |
| Maternal Needs: Special Considerations | hx of SA stress in labor cultural considerations LGBTQIA non english speaking |
| First Stage of Labor: Admission Assessment #1 | Maternal health history Physical assessment Fundal height measurement Uterine activity, including contraction frequency, duration, and intensity ROM? Cervical dilatation and effacement FHR, position, station Pain level |
| Physical assessment | body systems, vital signs, heart and lung sounds, height and weight |
| Nursing management: 1st stage interventions | hygiene, nutrients and fluids, elimination, ambulation and positioning, supportive care, monitoring |
| First Stage of Labor: Admission Assessment #2 | Fetal assessment Lab studies Assessment of psychological status |
| Lab studies during 1st stage | Routine: urinalysis, CBC Syphilis screening, HbsAg screening, GBS, HIV (with patient’s consent), and possible drug screening if not included in prenatal history |
| First Stage of Labor: Continuing Assessment | Patient's knowledge, experience, and expectations Vital signs Vaginal examinations Uterine contractions Pain level Coping ability FHR Amniotic fluid |
| Nursing Management: Second Stage Assessment | Assessment: Typical signs of second stage Contraction frequency, duration, intensity Maternal vital signs Fetal response to labor via FHR Amniotic fluid with rupture of membranes Coping status of patient and partner |
| second stage of labor is | complete dilation to birth of baby |
| if cervix is not ready during 2nd stage, | med given to break down cartilage to open the cervix |
| Nursing Management: Second Stage interventions | Supporting pt and partner in active decision making Providing instructions, assistance, pain relief Using maternal positions to enhance descent and reduce pain Preparing for assisting with delivery |
| Nursing Management: Second Stage interventions with birth | Cleansing of perineal area and vulva Assisting with birth, suctioning of newborn, and umbilical cord clamping Providing immediate care of newborn |
| Providing immediate care of newborn | Drying Apgar score Identification bands |
| Nursing Management: Third Stage assessment | Placental separation; placenta and fetal membranes examination; perineal trauma; episiotomy; lacerations |
| Nursing Management: Third Stage interventions | Instructing to push when appropriate; oxytocin if ordered; assisting patient to comfortable position; providing warmth; ice to perineum if tear; explain assessments; monitor moms physical status; record birthing statistics; document birth in birth book |
| Tear degrees | 1 – skin 2 – muscles 3 – anal sphincter 4 – rectum |
| Episiotomy | a surgical incision made in the perineum during childbirth to enlarge the vaginal opening |
| 4th stage begins | after placenta is delivered |
| what is 4th stage | lasts 1-4 hrs, attachment process and breastfeeding begin, fundus is firm and contracted |
| 4th stage assessment | vital signs, fundus, perineal area, comfort level, lochia, bladder status |
| 4th stage interventions | Support and information Fundal checks; perineal care and hygiene Bladder status and voiding Comfort measures Parent–newborn attachment Teaching |
Created by:
leh195