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68wm6 p2 Car Lab Bir

Nursing Care During Labor and Birth

What are the traditional labor practices of Southeast asia (China, Japan, Korea)? *Father usually is not present *Stoic response to pain *Side-lying position preferred
What are the traditional labor practices of Laos? *Squat for birth *Prefer female attendants
What are the traditional labor practices of India? *Natural childbirth methods used *Female relatives present as caregivers
What are the traditional labor practices of Iran? *Father not present *Female caregivers and support people present at birth
What are the traditional labor practices of Mexico? *Stoic about pain until second stage *Father and female relatives present
What are the traditional labor practices of American Indians? Bury placenta for good luck.
What are the advantages of traditional hospital settings for birth? *Safe *All emergency equipment and personnel are available
What are the disadvantages of traditional hospital settings for birth? *Impersonal *Multiple moves (up to 4) create discomfort and separate mom and baby *Medically oriented *Visitors are limited
What are the advantages of Labor, Delivery and Recovery (LDR) settings for birth? *Normal uncomplicated labor, delivery and recovery is in the same room *The rooms are home-like and comfortable *The significant other and family members are allowed in the room.
What are the disadvantages of Labor, Delivery and Recovery (LDR) settings for birth? *Technical aspects *Less equipment
What are the advantages of Free-Standing Birth Centers? *Less technical *Less expensive
What are the disadvantages of Free-Standing Birth Centers? Most are not equipped to handle obstetric emergencies
What are the Guidelines for Reporting to a Birthing Facility? *Contractions 5 minutes apart for 1 hour for first labor *Contractions 10 minutes apart for 1 hour for second and subsequent labors *Ruptured membranes *Bleeding other than bloody show *Decreased fetal movements *Other concerns.
What are the characteristics of true labor? Contractions are regular, closer together, stronger, and last longer *Contractions start in lower back and then travel. *Contractions cannot be stopped *The cervix softens, effaces and dilates *The fetus descends into the pelvis
What are the characteristics of false labor? *Contractions: Rarely follow a pattern, Vary in length and intensity, stop with ambulation and position changes, and eventually stop with relaxation interventions. *Cervix does not change *No significant change in fetal position
What is the average Fetal Heart Rate (FHR)? 110-160 beats/min with 5-15 beat fluctuations
How are ruptured membranes confirmed? *Nitrazine paper *Fern test
What are contractions assessed for? frequency, duration and intensity
What are the 'Four Ps'? *Powers *Passage *Passenger *Psyche
In the Four Ps: Components of the Birth Process, what is Powers? uterine contractions which cause the cervix to open and that propel the fetus downward through the birth canal
What are the primary powers? Coordinated uterine contractions with the effects of Cervical Effacement (thinning) and Cervical Dilation
What are the secondary powers? Bearing down efforts of the woman which add to the power of the expulsive forces but have no effect on cervical dilation
What are hypertonic contractions? *Less than 2 mins apart *Longer than 90-120 secs *Intervals shorter *Incomplete relaxation of the uterus
In the Four Ps: Components of the Birth Process, what is Passage? Anatomy and Physiology of the birth canal and the effects of birth on it
In the Four Ps: Components of the Birth Process, what is Passenger? The child, placenta, and membranes
What is the ideal position of the fetus for birth? Head down, back is bowed outward, chin touches the sternum and arms are crossed on the chest with thighs flexed onto the abdomen (Fetal position with arms and legs crossed)
In the Four Ps: Components of the Birth Process, what is Psyche? *Crucial part of childbirth *Marked anxiety and fear decrease a woman’s ability to cope with pain in labor *Catecholamines inhibit uterine contractions and divert bloodflow from the placenta.
What is the only Fetal Heart Rate Assessment method possible if the mother is using a whirlpool or shower during labor, and is the method used with home deliveries? Intermittent auscultation
What are the advantages of Continuous Electronic Fetal Monitoring (EFM)? *Allows the nurse to collect more data about the fetus than intermittent auscultation *Written recording that becomes part of the mother’s chart *Show how fetus responds in labor *Allows one nurse to observe two laboring women
What is external fetal heart monitoring done with? Doppler transducer
What internal Continuous Electronic Fetal Monitoring (EFM) detects electrical signals from fetal heart by penetrating scalp? Fetal Spiral Electrode (Requires ruptured membranes)
On the labor monitoring paper, where is the fetal heart rate and contractions located? FHR is recorded on the upper grid of the paper, Contraction pattern is recorded on the bottom grid
What is the first intervention to correct a rapidly accelerated/decelerated fetal heart rate during labor? Repositioning the mother
This type of fetal heart rate decreases with a contraction and always returns to the baseline by the end of the contractions. They are caused by fetal head compression. What kid of fetal heart rate pattern is this? Early decelerations
What is acceleration and what does it indicate? : an abrupt, temporary increase in rate by at least 15 beats/min lasting for at least 15 seconds. They suggest a fetus that is well oxygenated
What do variable decelerations indicate? that the umbilical cord is being compressed, often because of a cord around the fetal neck or low amniotic fluid.
What are variable decelerations? do not have a uniform appearance: their shape, duration and degree of fall below baseline rate vary. They begin and end abruptly (within 30 sec) they may be V, W, or U-shaped Do not always exhibit a consistent pattern in relation to contractions
What do late decelerations indicate? deficient exchange of oxygen and uteroplacental insufficiency
What FHR changes require no intervention other than continued observation? Accelerations and early decelerations
When does the 'First Stage: Dilation' begin? with the onset of contractions until full dilation of the cervix (10cm)
What is the longest stage of labor? Dilation (averaging 10 to 12 hours for the nullipara and 6-8 hours for the multipara)
What is the first phase of dilation and what can be expected? Early Latent Phase (0-3cm), Contractions mild and infrequent, Woman sociable & excited; cooperative but anxious, Pain is usually mild
What is the second phase of dilation and what can be expected? Mild/Active Phase (4-7cm), Complete effacement, Contractions moderate to firm every 3-5 mins, Woman less sociable, turns inward, May ask for pain medication
What is the third phase of dilation and what can be expected? Transitional Phase (7-10cm), Shortest phase. Contractions firm; q2-3min & lasting up to 80 seconds. Woman may become uncooperative & hostile, feeling of losing control
When does the 'Second Stage: Delivery' begin? Full dilation to birth
How long does delivery usually last? 30 mins to 2 hours nullipara; 20-90 mins multiparas
When does the 'Third Stage: Delivery of the placenta' begin? Begins with delivery of baby and ends with delivery of the placenta
What is the average time of the third stage of childbirth? Average time is 5 to 20 minutes
What is the fourth stage of the process of childbirth? Stabilization (2-4 hours following birth)
When is APGAR monitored? at 1 and 5 minutes after birth
Within how long after childbirth must a complete assessment be done? Within 1 hour
What is precipitous labor? Labor that is completed in less than 3 hours
What are the fetal risks of precipitous labor? *Hypoxia resulting from decreased periods of uterine relaxation between contractions *Intracranial hemorrhage *Nerve damage *Low apgar score
What are the maternal risks of precipitous labor? *Uterine rupture *Postpartum hemorrhage *Abruptio placentae can be associated with precipitate labor
What is precipitous birth? Birth that occurs unexpectedly, with no trained birth attendant present. Precipitous birth may occur after a labor of any duration
Created by: Shanejqb