Test 3
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| Essential components of labor (4) | 4P's - passageway, passenger, powers, pshyche
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| passageway pelvic structures (2) and def | false pelvis - upper flare part - not part of bony pelvis; true pelvis - below linea terminalis - bony passage fetus must pass thru during delivery
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| 4 pelvic shapes | gynecoid, anthropoid, android, platypelloid
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| Gynecoid def | most favorable vaginal birth - 50% of moms have it and allows fetus to pass thru
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| Anthropoid def | elongated in shape, usually allows vaginal birth. anthropoid diameter is generous but transverse diameter is narrow. 25% of moms have it usually can delivery vaginally
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| android def | heart shaped, looks like male pelvis, not favorable for vaginal delivery - most likely c-section
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| platypelloid def | flat in dimension, narrow anthropoid diameter with generous transverse diameter. usually requires c-section
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| pelvic measurements | calculate the likelihood of delivering vaginally includes the obstetric conjugate and diagonal conjugate
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| obstetric conjugate | measures the smallest diameter of the inlet through which the fetus must pass. determined by subtracting 1.5 from the diagonal conjugate. A measurement of 11 is considered adequate
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| diagonal conjugate | symphisis pubis to sacral promontory
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| mid pelvis | distance between the ischial spines
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| angle of pubic arch | at least 90 degrees
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| birth canal | soft tissues making up the "passageway" includes the cervix and vagina
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| what are the 2 processes making up the cervix? | effacement - cervix gets shorter and thinner in % - 100% is complete thinning of membranes; dilation is from 1cm up to 10cm dilated
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| fetal adaptations to delivery (2) | skull bones have cartilage between them which can overlap to decrease the diameter of the skull and helps adjust to the shape of the pelvis; molding - skull can elongate via pressure from the vaginal walls to decrease the diameter of the skull (cone head)
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| fetal orientation (3) | fetal lie,fetal presentation, fetal attitude
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| fetal lie | relationship to long axis of the mother (longitudinal - up & down, transverse - side to side and oblique - at an angle)
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| fetal presentation | 1st part of the body entering pelvic inlet (cephalic, breech, and shoulder)
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| fetal attitude | position of the head in a cephalic presentation including vertex (chin into chest), military (chin - no flex at all or extension - wider dilation), brow (partially extended back - cone out bruised face), face (head fully extended - extremely bruised face
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| fetal position | position of presenting in relation to quadrants of maternal pelvis.
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| 3 designations | 1st designation which side the presenting part is facing (left or right), 2nd designation - reference pt on presenting part, 3rd designation front, back, or side of the maternal pelvis in which the reference is found
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| what is the most favorable fetal position? | LOA - left occipital anterior
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| fetal station | describes the position of the widest part of the presenting part in relation to the level of the ischial spines - "floating" - ballottable - bounce
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| To what degree is the baby "engaged" or drops | 0 also known as lightening - baby is at the level of the ischial spine
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| Powers - describe contractions | frequency - interval of time from beginning of one to the beginning of another, duration - how long they last, strength/intensity - strength of contraction; involuntary - uterus, voluntary - abdominal muscles
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| Psyche | mental state of the laboring woman including current pregnancy experience, previous birth experiences, expectations, preparation, support system, culture
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| signs that labor may begin soon (4) | lightening, braxton-hicks contractions, loss of mucous plug, nesting behavior
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| lightening def | presenting part sets in pelvic cavity at zero station - baby drops - easier for lungs to expand, can eat larger meals and increase urination
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| braxton-hicks contractions def | false/irregular labor pain - practice contractions getting ready for labor - toward end more intense
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| loss of mucous plug | prevents bacteria from entering uterus, some women have huge chunk come out; can come out 1 week before labor
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| nesting behavior | burst of energy before labor - important to conserve for labor and delivery
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| clinical signs of labor (3) | cervical ripening or softening, cervical effacement, dilation
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| 3 components of vaginal exam | dilation, effacement, fetal station
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| how many stages of labor are there? | 4
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| 1st stage of labor and components (3) | aka dilation stage - begins w/ the onset of true labor and ends when pt is fully dilated - 3 phases - early/latent, active phase & transition stage
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| early/latent phase | contractions mild to moderate, more frequent - early labor.
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| active phrase | contractions are moderate to strong - baby drops to pelvis
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| transition | most intensive usually fastest - contractions very strong - strong urge to push - if not 10 cm DONT push b/c can cause cervical edema and laceration - get very discouraged and want to quit
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| 2nd stage | begins when pt is fully dilated and ends with delivery of infant - most common position is dorsal recumbent
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| dorsal recumbent def | most common position for L & D, laying on back with head at 45 degree angle and legs held w/support
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| 3rd stage | begins once fetus is expelled and ends when placenta is delivered - placental separation
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| signs of placental detachment | blood discharge from vagina & uterus takes on globular shape - important to inspect placenta to make sure intact and nothing left b/c it could lead to infection
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| 4th stage | begins when placenta is delivered and continues for 4 hours
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| how many hours recovery is for a vaginal delivery? c-section delivery? | vaginal - 1 hour; c-section - 4 hours
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| factors influencing pain mgmt (8) | amt of support, age, level of inexperience, other parities/babies, length of labor, fear, amt of anxiety, culture
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| definitions r/t pain mgmt (3) | unique - normal physiologic process, increasing intensity is desirable and positive, predictable; threshold - amt of pain necessary to perceive pain, pain will last 60-90 seconds then rest; tolerance - ability to withstand pain once recognized
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| paint mgmt techniques - pharmacologic | analgesic - reduce sensation of pain - dont give too early because could cause respir distress in baby; anesthesia - block sensation;
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| paint mgmt techniques - non-pharmacologic (9) | labor support, comfort measures, relaxation techniques, breathing, attention focusing, movement & positioning, apply counter pressure, hypnosis, water injections
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| priorities of fetal monitoring | establish a baseline heart rate (110-160), assess variability (fluctation of FHR), variability results from the interplay between the sns and psns - shows goog oxygenation - LPN must know difference between reassure and nonreassuring interplay
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| periodic FHR changes | accelerations - an increase of at least 15 beats above baseline for 15 seconds or more. If acceleration lasts longer than 10 min then it is considered a change of baseline. Accelerations are a reassuring sign which indicate that the fetus is doing well
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| benign changes | early decels - have U shaped appearance and begin at the start of ctx and end at the end of the ctx. Must hit its lowest pt at the peak of a ctx. results from head compression during ctx. continue to monitor as long as baseline and variability are WNL
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| benign changes | closer to delivery - when d-cells are at lowest pt, its at the highest part of contractions
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| nonreassuring changes | variable decels - may occur any time during a monitoring pd. variables have a jagged appearance & be described as U,V, or W shaped. indication of cord compression. if variables resolve quickly & arent severe, NI is minimal - aimed at relieving compression
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| late decels | appear smooth and U shaped but are offset from the ctx. they begin after the onset of ctx and dont resolve until ctx ends. later decels result from a prob w/ BF from uterus to placenta. non-reassuring sign. NI aimed @ improving utero-placental perfusion
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| NI of late decels | uterus relax, ocygen on face, increase IV fluids
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| reasons for induction | post-dats (2wks after due date), premature rupture of membranes (PROM), fetal indication (IUGR, defect), maternal indication (HTN), elective. Usually arent allowed to induce prior to 39 weeks
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| methods of induction (3) | cervical ripening - med which is vaginal suppository for 12hrs which softens the cervix; AROM - artifical rupture of membranes; Pitocin - synthetic form of oxytocin which stimulates uterine ctx
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| assisted delivery methods (4) | episotomy, vacuum, forceps, cesarian section
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| episotomy | surgical cut into the perineum to allow room for delivery of fetus; high risk for infection - not acceptable anymore unless distress; most times allow them to tear on their own
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| vacuum delivery | suction applied to fetal head to assist in delivery
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| forceps delivery | metal tongs applied to either side of baby's head to assist in delivery; high risk for injury; nurse is responsible for pumping up pressure
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| cesarean section | baby is delivered through an incision in the lower abdomen' roughly 25% of births in the USA; high risk
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| common indications for c-section | hx of c-section, labor dystocia (not moving/progressing - cant get passed 4cm), fetal distress, malpresentation - breech/shoulder showing, previa, abruption, cephalopelvic disproportion - pelvis isnt big enough to deliver head, herpes lesion, DM, HTN
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