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1230 Unit 3 Notes 1
1230 Unit 3 Notes 1 of 2
| Question | Answer |
|---|---|
| 4 P's of labor | passageway; passenger; powers; psyche |
| Problem in arny area of the 4 P's influences labor: | negatively |
| consists of bony pelvis and soft tissue | passageway |
| flared upper portion of the bony pelvis; not part of the bony passageway | false pelvis |
| portion of the pelvis below the linea terminalis; consists of the inlet, midpelvis, and outlet | true pelvis |
| most faborable pelvice shape for a vaginal birth; rounded shape pelvis | gynecoid |
| elongated shape pelvis | anthropoid |
| heart-shaped pelvis | android |
| flat-dimensioned pelvis | platypelloid |
| soft tissue of the cervix and vagina that form the | birth canal |
| thinning of the cervix (occurs before dilation) | effacement |
| opening of the cervix | dilation |
| most important in relation to labor and birth; molding is overlapping of bones | fetal skull |
| when long axis of the fetus is parallel to the long axis of the mother | longitudinal lie |
| when fetus lies between longitudinal and transverse | oblique lie |
| long axis of the fetus is perpendicular to the long axis of the woman | transverse lie |
| foremose part of the fetus that enters the pelvic inlet | presentation |
| baby presenting head first | cephalic presentation |
| baby presenting feet or buttocks first | breech presentation |
| baby presenting shoulder first | shoulder presentation |
| relationship of fetal parts to one another | attitude |
| most favorable attitude for vaginal delivery; same as vertex | ovoid (attitude of flexion) |
| no flexion or extension | military |
| partial extension (dangerous) | brow |
| full extension (dangerous) | face |
| relationship of the reference point on the presenting part to the quadrants of the maternal pelvis (pg. 173) | position |
| refers tot he side of the pelvis in which the reference point is found | first designation |
| reference point on the presenting part | second designation |
| refers to the part of the pelvis (front, back, or side) in which the reference point is found) | third designation |
| see page 172, Box 8-1 | |
| relationship of the presenting part to the ischial spines | fetal station |
| presenting part is at the level of the ischial spines (at the door) | zero station |
| presenting part is above the ischial spines (in the body) | minus station |
| presenting part is below the ischial spines (coming out) | plus station |
| phase of contraction that is the building up of the contraction - longest phase | increment |
| phase of contraction that is the peak fo the contraction | acme |
| phase of contraction that is the letting up phase | decrement |
| rest period between contractions | relaxation period |
| how often the contractions are occurring; measured by counting the time interval from the beginning of one contraction to the beginning of the following contraction | frequency |
| interval from the beginning of a contraction to its end | duration |
| strength of contraction | intensity |
| factors impacting the psyche of a laboring woman | current pregnancy experience; previous birth experiences; expectations for birth experience; preparation for birth; process of labor |
| theories of labor onset | progesterone-withdrawal theory; oxytocin theory; prostaglanding theory; maternal and fetal factors; cascade effect |
| anticipatory signs of labor | lightening (sense the baby has dropped); Braxton Hicks contractions; gastrointestinal disturbances; expelling the mucous plug; feeling a burst of energy; ripening (softening) and effacement (thinning) of the cervix |
| false labor; increase in Braxton Hicks contractions without cervical changes; can be uncomfortable | prodromal labor |
| progressive dilation and effacement of cervix | true labor |
| cardinal movements (mechanisms of delivery) | engagement, descent, flexion, internal rotation, extension, external rotation, expulsion |
| first stage of labor | dilation - includes early labor (latent phase), active labor (active phase), transition (transition phase) |
| second stage of labor | birth (begins when cervix is fully dilated |
| third stage of labor | delivery of placenta |
| fourth stage of labor | recovery |
| Maternal physiologic adaptation during labor | increased demand for O2 during the 1st stage; increased heart rate; incresed cardiac output; increased respiratory rate; gastrointestinal and urinary systems are affected |
| during the early stage of labor, the mother is usually | excited and talkative |
| during active labor, the mother is usually | more introverted; focusing her energies on coping with the stress of contractions |
| during transition, the mother usually feels | out of control |
| during the pushing phase, the mother usually feels | more in control |
| fetal adaptation to labor | increase in intercranial pressure; placental blood flow temporarily interrupted during uterine contractions; stresses in the cardiovascular system, resulting in a slowly decreasing pH throughout labor |
| Passing through the birth canal is beneficial in two ways: | stimulates surfactant production; helps clear the respiratory passageways |
| swelling of the soft tissues of the scalp | caput succedaneum |
| bleeding in the periosteum of the cranial bones; does not cross suture lines | cepalohematoma |
| abnormally slow progression of labor; occurs because of a malfunction in one or more of the four P's of labor | dysfunctional labor (dystocia) |
| When the pelvis may be small or contracted because of disease or injury, it is a problem with: | passageway |
| when the fetus may be malpositioned, excessively large (macrosomic), or have an anomaly, there is a problem with: | passenger |
| When uterine contractions may be of insufficient quality or quantity, the problem is with: | powers |
| when the woman may fight contractions due to tension cause by fear or intense pain, there is a problem with: | physche |
| most common maternal reasons for performing a primary cesarean delivery | fistula formation (an opening); pelvic floor injury; occurs most commonly once the woman is in active labor or when she reaches the second stage of labor |
| abnormally low slow progression of labor that may be a cause for a cesarean delivery | disorder of protraction |
| lack of progress during labor that could be a reason for cesarean delivery | disorder of arrest - refers to total lack of progress |
| disorders of arrest (primipara) could be due to: | protraction of dilation (less than 1.2 cm/hour); protraction of descent (less than 1 cm/hour) |
| disorders of arrest (multipara) could be due to: | protraction of dilation (less than 1.5 cm/hour cervical dilation); protraction of descent (fetal descent of less than 2 centimeters/hour) |
| how many hours indicate labor arrest? | 2 hours of no change in either dilation or descent |
| causes of labor dysfunction: | uterine dysfunction; cephalopelvic disproportion (CPD); fetal malposition |
| uterine dysfunction | hypotonic (muscle tone not good); hypertonic (irritability); precipitous labor (fast) |
| cephalopelvice disproportion (CPD) | diameters of the fetal head are too large to pass through the birth canal; macrosomia or hydrocephalus; non-gynecoid pelvice types |
| fetal malposition | occiput posterior; face presentation; breech presentation; transfverse lie; compound presentations |
| treatments for labor dysfunction could include: | cesarean sectionor external rotation |
| nursing care for labor: | assess fetal lie, presentation, and position; assess contraction pattern every 30 minutes; fetal response to uterine contractions; thorough pain assessment every hour; plot cervical changes and fetal descent on a labor graph |
| factors that predispose to fetal malpresentation: | multiparity, placenta previa, hydroamnios, contracted pelvis, uterine anomalies |
| 3 types of breech presentation | Frank (pike position), complete (tailor position), footling or incomplete (one or both feet presenting |
| Leopold's maneuvers | page 207 - determines position of baby, can also move baby |
| Treatment for breech presentation | external version, Piper forceps |
| treatment for transverse lie | external version, cesarean delivery |
| nursing care for external version | position patient, RhoGAM if ordered; neonatal resuscitation supplies |
| spontaneous rupture of the amniotic sac before 37 weeks gestation | premature rupture of membranes PROM |
| risk associated with of PROM | maternal and neonatal infections - monitor temperature, notify doctor if temp increases |
| risk factors for preterm PROM | African-American ethnicity, cigarette smoking, previous preterm delivery, vaginal bleeding, low socioeconomic conditions, sexually transmitted infections, and conditions causing uterine distension (bladder or bowel) |
| clinical manifestations and diagnosis of PROM | sometimes obvious; fern test - checks fluid under microscope - looks like fern pattern; Nitrazine test (more commonly done, stick of paper - if blue, it is positive for amniotic fluid) |
| treatment for term PROM | chorioamnionitis; induction of labor |
| treatment for preterm PROM | (no signs of infection) IV antibiotics followed by oral antibiotics; between 24 and 24 weeks - IM corticosteroids; strict bed rest and pelvic rest; fetal surveillance |
| nursing care for PROM | assess the woman; expect continuous fetal heart rate monitoring; temperature at lease every 2 hours - report to RN |
| labor that occurs after 19 weeks and before the end of 37 weeks gestation | preterm labor (PTL) |
| top 3 risk factors for PTL | history of previous preterm birth; current multiple gestation pregnancy (twins, triplets, or more), uterine or cervical abnormalities |
| diagnosis of PTL | assessment of contraction frequency; fetal fibronectin test; measurement of cervical length; admit to hospital; NS test; monitor |
| tocolytics to stop preterm labor will be given between: | 24 and 33 weeks gestation; weekly injections of progesterone; brethine (terbutaline) stops labor; see pg. 416 |
| Page 416 - | |
| Pregnancy is considered post-term: | at or past 42 completed weeks; treatment - biophysical profiles (BPPs), amnioinfusion; monitor for fetal distress |
| role of LVN during labor and delivery | recognize and manage complications that may arise during the process; intensive support to the woman and her partner; facilitate the labor process and ensure safe passage of the laboring woman and fetus through the event |
| Role of LVN at admission | birth imminence; fetal and maternal status; risk factors |
| role of LVN at admission if birth is not immenent | maternal health hx and physical assessment; status of labor; labor and birth preferences |
| health hx components | obstetric hx; current status; medical-surgical hx; social hx; desires/plans for labor and birth; desires/plans for newborn |
| Lab studies on admission | CBC; bloody type and Rh factor; serologic studies (VDRL or RPR to test for syphilis); rubella titer (not done if prenatal record indicates woman is immune); ELISA to detect HIV antibodies (requires informed consent); vag or cervical cultures; urinalysis |
| fundus feels like the tip of your nose at the peak of a contraction | mild contraction |
| fundus feels like touching your chin | moderate contraction |
| feels like you are pushing on your forehead | strong contraction |
| measures contraction frequency and duration of contractions; external FHR monitoring | tocodynamometer (toco) |
| internal methods of FHR monitoring | intrauterine pressure catheter (catheter tip placed above presenting part; connected to fetal monitor; records frequency, duration, and intensity of contractions |
| acceptable method in low-risk pregnancy; most common method is to place external fetal monitor for 20 minutes to get baseline data; if pattern is reassuring, then fetoscope or external monitor | intermittent auscultation of FHR |
| advantages of intermittent auscultation | woman has more freedom to move about; nurses should focus on the laboring woman and her support person, rather than the technology; associated with fewer medical interventions and fewer surgical deliveries |
| disadvantages of intermittent auscultation | takes more time; requires higher nurse staffing levels; many practitioners unaccustomed to using for fear of the potention of missing an ominous FHR pattern |
| external EFM | most common way to assess fetal status during labor; uses ultrasound; characteristics of FHR can be monitored continuously via video display and/or printout; toco monitors contraction pattern; helps screen for signs of fetal compromise |
| disadvantages of EFM | sometimes difficult to get a consisten tracing if the fetus is small or extremely active, or if the woman is obese |
| internal EFM | invasive procedure; sprial electrode attached to the presenting part just under skin; records graphic representation of FHR; easier to obtain consisten tracing; increases risk of maternal and fetal infection and injury |
| fetal heart rate (FHR) | measured between uterine contractions during a 10 minute period |
| baseline FHR | 110 bpm - 160 bpm |
| when monitoring FHR, look for: | baseline variability; evaluated visually as a unit; normal if fluctuations are greater than 6 bpm and less than 25 ppm; reassuring sign that the fetal nervous system is intact |
| three major deviations from a normal FHR baseline: | tachycardia (>160 bpm); bradycardia <110 ppm; absent or minimal variability is not reassuring; must continue for at least 2 minutes |
| variations in the FHR pattern that occur in conjuction with uterine contractions | periodic changes |
| variations in the FHR pattern not associated with uterine contractions | episodic changes |
| reassuring periodic changes | accelerations - above the baseline by at least 15 pbm for at least 15 seconds (15 x 15 window) |
| benign periodic changes | early decelerations (heart rate drops when contraction happens) |
| non-reassuring periodic changes | variable decelerations indicating some type of acute umbilical cord compression; late decelerations indicating uteroplacental insufficiency (obvious late decelaration) |
| measures used to clarify non-reassuring FHR patterns | fetal stimulation; fetal scalp sampling (checking pH of scalp); fetal scalp pulse oximetry |
| during first stage (dilation) of labor, nurse should: | provide physical care to the mother and fetus; provide physical; psychological care to the mother; keep practitioner informed about labor progress |
| during the latent phase (early labor) the nurse should: | assess FHR, maternal status, fetal membranes, woman's psychosocial state |
| nursing interventions during active labor: | assess woman's physchosocial state, labor progress, fetal status, maternal status; watch for risk for trauma, acute pain, anxiety, innefective coping, ineffective breathing, impaired oral mucous membranes, risk for infection |
| nursing interventions during transition phase of labor | assess for signs woman has reached transition phase, ability to cope, maternal status, fetal status |
| nursing interventions during second stage of labor (expulsion of fetus) | monitor bp, pulse, respirations every 15-30 minutes; assess contraction pattern every 15 minutes; assess the woman's report of uncontrollable urge to push; check FHR every 15 minutes for low risk and every 5 minutes for higher risk of complications |
| After delivery, monitor for: | woman's phychosocial state after giving birth, signs of placental separation (make sure it is complete), continue assessing woman for hemorrhage, assess lochia, suprapubic distention, woman's comfort level, initial bonding behaviors of new family |
Created by:
akgalyean
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