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1230 Unit 3 Notes 1

1230 Unit 3 Notes 1 of 2

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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