wvc OB labor & delivery
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| Helping the woman manage the pain of birth is... | a crucial part of nursing care.
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| Nursing skills needed by intrapartum nurse: | *observation, *critical thinking *problem solving *therapuetic comm *comfort promotion *empathy *common sense
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| Intrapartum nurses must be careful to not convey... | negative attitudes to the laboring woman and her partner d/t nurses own inexperience or negative experiences with the birthing process.
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| Labor is a natural process that follows its own... | timetable--->some occurances simply are not easily predicted or explained.
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| The best approach for both male and female nurses with the birthing process is to... | maintain a professional conduct and take cues from the couple they are working with.
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| Labor and Birth affect the physiologic systems of... | both the pregnant woman and her fetus.--->these affects are most striking in the maternal reproductive system and in relation to the fetal and neonatal oxygenation.
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| Signifigant changes during lavor occur in the woman's... | *cardiovascular *respiratory *gastrointestinal *urinary *hematopoietic systems as well as her reproductive system.
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| Normal labor contractions are... | coordinated, involuntary, and intermittent.
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| Coordinated Contractions | when the uterus (which is a smooth muscle) contracts and relaxes in a coordinated manner.
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| As a woman approaches full term, contractions become... | organized and gradually assume a regular pattern of increasing frequency, duration, and intensity during labor.
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| Coordinated Contractions begin in the... | uterine fundus and spread downward toward cervix to propel fetus thru pelvis.
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| Involuntary Contractions | Because uterine contractions are not conciously controlled because they are smooth muscles, existing contractions can be stimulated by physical activity such as walking. Anxiety or stress can diminish them.
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| Intermittent Contractions | Labor contractions are intermittent rather than sustained, which allows the uterine muscle to relax and resumption of blood flow to and from the placenta to permit gas, nutrient, and waste exchange for fetus.
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| Each contraction consists of 3 phases: | *increment *peak or acme *decrement
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| increment phase occurs when... | the contraction begins in the fundus and spreads thruout the uterus.
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| peak or acme phase is the period when... | the contraction is most intense.
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| the decrement phase is the period of... | decreasing intensity as the uterus relaxes.
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| The contraction cycle and the overall pattern of contractions are also described in terms of... | *frequency *duration *intensity
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| frequency | the period from the beginning of one uterine contraction to the beginning of the next.
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| Duration | the length of each contraction from beginning to end.--->usually expressed in seconds.
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| Intensity | the strength of the contractions--->terms mild, moderate, strong are used to describe contraction intensity.
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| The interval is the period between... | the end of one contraction and the beginning of the next.
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| The interval is the time when most fetal exchange of... | oxygen, nutrients, and waste products occurs.
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| The uterine activity during labor is charectorized by... | opposing features.
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| The upper 2/3 of the uterus contracts actively to... | push the fetus downward.
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| The lower 1/3 of the uterus remains less active, allowing... | downward passage of the fetus.
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| The cervix is similar to... | the lower 1/3 of the uterus in that it is also passive.
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| The next affect of labor contractions is enhanced because of... | the downward push from the upper uterus that is accompanied by the reduced resistance of fetal decent into lower uterus.
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| Myometrial (uterine muscle) cells in the upper uterus remain... | shorter at end of each contraction.
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| Myometrial cells in the lower uterus... | become longer with each contraction.
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| These two charectoristics of the myometrial cells enable... | the upper uterus to maintain tension between contractions to perserve the cervical changes and downward fetal progress made with each contraction.
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| The opposing charectoristics of myometrial contraction in the upper and lower segments cause changes in... | the thickness of the uterine wall during labor.--->upper uterus becomes thicker while lower uterus becomes thinner.
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| Physiologic Retraction Ring | marks the division between the upper and lower segments of the uterus.
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| The opposing charectoristics of contractions change the shape of the uterus to elongated, which in turn... | straightens the fetal body and pushes it down into the pelvis.
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| Cervical Changes: Effacement | thinning and shortening of the cervix.
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| Dilation | opening of the cervix.
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| During each contraction, blood flow to the placenta gradually decreases, causing... | a relative increase in the woman's blood volume=increase in BP slightly and slows her pulse...Therefore the mothers vital signs are best assessed between contractions.
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| During labor, the mothers respiration... | increases...some may hyperventilate if she exhales too much CO2...help her slow breathing by using a paper bag or cupped hands to restore normal blood levels of CO2.
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| During Labor, gastric motility is... | reduced....food and large volumes of liquids usually avoided to prevent vomiting and aspiration if unexpected surgery is needed.
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| The most common change in the urinary system during labor is... | the reduced sensation of a full bladder d/t intense contractions, regional px, or px management like an epidural.
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| A full bladder may contribute to... | general discomfort, or inhibit fetal descent.
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| After birth, the fluid retention that is normal during pregnancy quickly reverses causing... | urine to be excreted in large amounts. The bladder may fill rapidly during the first few days after birth.
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| What authorities consider the maximum normal blood loss during a vaginal birth... | 500 mL
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| The leukocyte count during labor may be as high as... | 25,000 or higher (the average is 14,000-16,000)
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| Levels of several clotting factors, especially __________ are elevated during pregnancy and continue to be higher during labor and after delivery... | fibrinogen
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| Fibrinolysis | clot breakdown...this decreases during labor to promote coagulation a placental site.
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| Although the increase in clotting factors and decrease in fibrinolysis protect from hemorrhage, the combination also raises the mother's risk of... | venous thrombosis
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| Fetal responses are most notable in the... | *placental circulation *cardiovascular system *pulmonary system
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| Exchange of oxygen, nutrients, and waste products between mother and baby occur in the ... | intervillous spaces
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| Most placental exchange occurs during... | the period between contractions because blood flow is uninterrupted.
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| The fetus may not tolerate contractions well if... | conditions associated with reduced placental function, such as maternal diabetes or hypertension or in conditions associated with reduced fetal oxygen-carrying capacity like fetal anemia.
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| The fetal cardiovascular system reacts___________ to events during labor... | quickly
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| The fetal heart rate ranges from... | 110-160 bpm at term
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| Before birth the fetal lungs are filled with fluid, but as term approaches, production of fetal lung decreases and its absorption... | increases. ( absorbs into newborns pulmonary and lymphatic circulations after birth)
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| There are 4 major factors that interact during labor...they are often referred to as the "4 P's"... | *the powers *the passage *the passenger *the psyche
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| The powers.. | the 2 powers of labor are the uterine contractions and the maternal pushing efforts.
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| During the first stage of labor, what are the primary force moving the fetus through the maternal pelvis? | urterine contractions.
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| During the second stage of labor, the woman adds what to force the uterine contractions to propel the fetus through the pelvis? | voluntary pushing efforts.
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| what causes softening of the cartilage that connects the womans pelvic bones when she has reached term? | an increase in the hormone relaxin
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| the bony pelvis is divided by the linea terminalis into... | the false pelvis above and the true pelvis below
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| The true pelvis is ______________ _____________ in childbirth. | most important
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| The true pelvis has 3 subdivisions: | *inlet or upper pelvic opening *midpelvis or pelvic cavity *outlet or lower pelvic opening.
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| The passenger is... | the fetus plus the membranes and placenta
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| the bones of the fetal head involved in birth are... | the two frontal bones on the forehead, the two parietal bones at the crown, and the occipital bone at the back of the head.
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| Fontanels are... | wider spaces at the intersections of the sutures on the bones of the head.
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| anterior fontanel | diamond shaped, formed by the intersection of 4 sutures.
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| Posterior fontanel | triangular shape formed by intesection of 3 sutures. connect the two parietal bones and occipital bone together.Is very small, often like a small depression.
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| The sutures and fontanels allow for... | the bones to move slightly to move through birth canal...called molding.
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| Longitudinal Lie | either the head or buttocks of fetus enter the pelvis first.
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| Transverse Lie | when the long axis of the fetus is at a right angle to the womans long axis.
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| Oblique Lie | one at some angle between the longitudinal and transverse lies.
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| Attitude...The attitude of the fetus is... | the relation of the fetal body parts to each other
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| The normal fetal attitude is... | one of flexion-->head flexed toward the chest and the arms and legs flexed over the thorax.
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| The fetal part that enters the pelvis first... | the presenting part.
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| Presentation falls into 3 categories: | *cephalic *breach *shoulder
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| Cephalic presentation has 4 variations: | *vertex *military *brow *face
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| vertex | most common type of cephalic presentation. fetal head fully flexed, and is most favorable for normal progress of labor
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| military | head is in a neutral position, neither flexed nor extended.
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| brow | fetal head is partly extended.
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| face | head is fully extended and fetal occiput is near fetal spine.
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| breech presentation | occurs when the fetal buttocks or feet enter the pelvis first.
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| the breach presentation has 3 variations: | *frank breech *full(complete)breech *footling breech
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| frank breech | most common variation. fetal legs are extended across the abdomen toward the shoulders.
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| full(complete)breech | the reversal of the usual cephalic presentation. head, knees, and hips all flexed, but buttocks are presenting.
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| footling breech | occurs when one or both feet are presenting.
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| Shoulder presentation | a transverse lie, C-section neccessary.
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| Fetal position | describes the location of a fixed reference point on the presenting part in relation to the 4 quadrants of the maternal pelvis.
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| The fetal position is not fixed, but rather... | changes during labor as the fetus moves downward
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| a womans _________ plays a huge part in childbirth... | pysche...anxiety, fear, or fatigue decrease a womans ability to cope with pain...maternal catecholamines are secreted in response to anxiety which can inhibit contractions and blood flow to placenta.
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| the four P's (major factors in childbirth) are... | an integrated whole. so many variables in the laboring process...size of baby as opposed to size of birthing canal..ect.
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| A nurse can help a laboring woman and be an advocate by reducing fear and anxiety by... | allowing woman and her family to increase their sense of control and mastery over the labor.
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| nursing measures to empower families include... | teaching them about their choices in childbirth in an ubiased way and supporting the choices they make.
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| Factors that have a role in the onset of labor: | *increased fetal adrenal gland production of glucocorticoids and androgens *a change in the ratio of maternal estrogen to progesterone cuz it rises *stretching, pressure of irritation of the uterus and cervix.
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| Premonitary (warning) signs of labor: | *Braxton Hicks contractions increase *Lightening (dropping) *Increased clear and nonirritating vag secretions *"bloody show" *an energy spurt (nesting) *small wt. loss of up to 3 lbs (how hormones affect the water retention of the woman)
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| False labor is also called... | prodromal labor
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| Contractions that occur during false labor are simply... | preperation for the main event of true labor.
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| Several charectoristics distinguish true labor from false labor: | *contractions *discomfort *cervical change
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| the best distinction between false and true labor is... | that the contractions of true labor cause progressive changes in the cervix.> effacement and dialation occur.
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| the mechanisms(cardinal movements) of labor are... | when the fetus undergoes several positional changes to adapt to the size and shape of the mothers pelvis as it descends through the pelvis during birth.
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| The mechanisms of labor can.. | occure concurrently
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| In a vertex presentation, the mechanisms of birth are... | *Descent *Engagement *Flexion *Internal Rotation *Extension *External Rotation *Expulsion
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| Descent | descent of the fetal presenting part thru the true pelvis.
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| Engagement | the fetal presenting part at the widest diameter reaches the level of the ischial spines of moms pelvis.
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| Flexion | flexion of the fetal head so that the smallest head diameters pass thru the pelvis.
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| Internal Rotation | allows the largest fetal head diameters to match the largest maternal pelvic diameters.
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| Extension | extension of the fetal head as it passes beneath the mother's symphysis pubis.
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| External Rotation | of the fetal head to allow the shoulders to rotate internally to fit the mothers pelvis.
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| Expulsion | of the fetal shoulders and fetal body.
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| The first stage of labor is often called... | the stage of dilation-->because cervical effacement and dilation occur at this time.
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| The first stage of labor begins with... | the onset of true labor contractions and ends with complete dilation (10 cm) and effacement (100%) of the cervix.
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| The first stage of labor is the ______________ for both nulliparous and parous women. | longest
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| Labor progress is often times plotted on this type of graph... | Friedman Curve
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| First stage labor differs from the other stages because it has 3 phases: | *Latent (early) *Active *Transition
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| Latent Phase | the early phase that lasts from onset of labor until 3 cm of cervical dilation.-->cervical effacement and subtle fetal position also occur during this time. Mom still social and excited.
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| Active Phase | *cervix dilates from 4 to 7 cm and is more rapid *Effacement of cervix is completed *fetus descends into pelvis *internal rotation begins * discomfort usually increases mom anxious, feels helpless.
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| Transition Phase | *cervix dilates from 8 to 10 cm *fetus descends further into pelvis *Bloody show increases with complete dilation *short intense phase with very strong contractions *woman may feel urge to push as fetus reaches her pelvic floor
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| Second Stage of Labor | Expulsion
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| The second stage of labor begins when... | the woman is completed dilated (10 cm) with 100% effacement. This stage ends with the birth of the baby.
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| During the second stage of labor, which is expulsion, the woman starts to experience a... | involuntary pushing response. She may say she needs to have a bowel movement or "I have to push."
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| "Labor" also describes.... | this second stage.
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| Third Stage of Labor | Placental Stage..begins with birth of baby and ends with expulsion of placenta
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| Fourth Stage of Labor | the stage of physical recovery for mother and infant. lasts from delivery of placenta to 1-4 hours after delivery.
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| Leopold's Maneuvers | used to determine the presentation and position of the fetus and to aid in locating fetal heart sounds. they are less likely to yeild useful info if mom has a thick abdominal fat pad, excessive amniotic fluid or a very preterm fetus.
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| What is the most common measure to promote placental function during normal labor? | Maternal positioning.->a mom can choose any position other than supine to prevent aortocaval compression
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| The nurse clusters assessment data and considers both pain and anxiety when determining... | the best approach to pain relief.->several cues may suggest that anxiety is a major contributor to labor pain that the mom might otherwise easily manage.
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| Differnt comfort measures that the nurse might use to provide comfort and relaxation for the laboring mother... | *lighting(dimming) * temperature (cold wash cloths, fan) *cleanliness (change bedding, soiled pads) *mouth care (ice chips, popsicles, hard candy) *attention to the bladder(full=increases pain) * positioning
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| What other kinds of support can the nurse offer the mother during the laboring process? | *providing encouragement *giving of self *offering pharmacologic measures *caring for the birth partner
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| The nurse may use what tools for intrapartum fetal surveillance? | Intermittent Auscultation of FHR or Palpation of the Uterine Cavity.
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| What is the primary advantage of using auscultation and palpation for intrapartum fetal monitoring | Mobility->the moms ability to change positions especially in early labor or with the fetal occiput in the posterior position.
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| Disadvantages of Auscultation and Palpation... | *FHR and uterine activity are only assessed for a small part of the total labor * woman sometimes find these interruptions for auscultation/palpation distracting.
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| Electronic Fetal Monitoring may be __________ or ____________. | Continuous or intermittent.
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| Advantages of Electronic Fetal Monitoring | *supplies more data about the fetus than auscultation *provides a permanent record that may be printed/stored *shows gradual trends in FHR and uterine activity
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| Continuous electronic fetal monitoring shows teh fetal response _________, ____________, and ____________ every contraction. | before, during, and after.
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| What is the nurse to client ratio during the second stage of labor or is high-risk conditions exist? | 1:1->first stage of labor it is 2:1 and that is where electronic fetal monitors provide a great deal of help for nurses.
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| Electronic Fetal Monitoring Equipment consists of... | *Bedside Monitor Unit *Sensors for FHR and Uterine Activity
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| T or F? Simultaneous monitoring of twins is possible with the use of Electronic Fetal Monitoring? | True
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| Devices used for external fetal monitoring.. | *Ultrasound Transducer *Tocotransducer
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| Ultrasound Transducer | Detects fetal heart movement for rate calculation->one downside is that other movements such fetal or maternal activity or blood flow to the placenta can also be dectected.
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| Tocotransducer | detects changes in abdominal contour to measure uterine activity.
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| Devices for Internal Fetal Monitoring | *FHR monitoring with a scalp electrode *Uterine monitoring with intrauterine pressure catheter
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| The main adavantage of using internal monitoring devices? | accuracy->but they are invasive raising the risk for infection.
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| In order to use internal monitoring devices, what is required? | ruptured membranes and about 2 cm cervical dilation.
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| The fetal scalp electrode (FSE) detects... | electrical signals from the fetal heart.
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| Areas to avoid electrode application.. | fetal face, fontanels, and genitals. Usually it is placed somewhere on the scalp away from fontanels.
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| Two kinds of intrauterine pressure catheters used to measure uterine activity... | *solid catheter w/pressure transducer in tip *hollow, fluid filled catheter that connects to a pressure transducer at the side of the bed.
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| Both types of intrauterine pressure catheters sense... | intrauterine pressure and increases in intraabdominal pressure such as coughing or vomiting.
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| FHR and uterine activity patterns must be evaluated _____________ when assessing whether the fetal status is assuring... | together
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| The normal fetal heart rate is... | 110-160bpm
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| What is considered bradycardia in the fetal heart rate | less than 110 bmp, PERSISTING FOR AT LEAST 10 MINUTES
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| What is considered tachycardia in the fetal heart rate? | more than 160 bpm, PERSISTING FOR AT LEAST 10 MINUTES
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| Variability of the FHR describes the... | fluctuations in the baseline FHR
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| Variability in FHR may be decreased by several nopathologic and pathologic factors such as... | *fetal sleep * narcotics/sedative drugs *alcohol/illicit drugs *fetal tachycardia *gestation younger than 28 wks *fetal anomalies *hypoxia *abnormalities to CNS *maternal acidemia or hypoxia
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| Periodic patterns in the FHR are... | temporary, recurrent changes from baseline rate that are associated with uterine contractions.(both accelerations and decelerations)
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| An acceleration of the FHR is defined as... | a temporary increase in the FHR that peaks at least 15 bpm above baseline and lasts 15 seconds.
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| FHR accelerations often occur with... | fetal movement, vaginal examinations, uterine contractions, mild cord compression, or when fetus is in a breech presentation.
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| Accelerations are usually a __________ sign... | reassuring->reflects that the fetus has a responsive CNS system
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| Periodic decelerations in FHR are classified into 3 types: | *early decelerations * Late decelerations * Variable decelerations
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| Early Decelerations | *not associated w/ fetal compromise *require not intervention *occur during contractions as fetal head is pressed against womens pelvis *consistent in appearance and mirror the contraction * usually no lower than 30 to 40 bpm below babies baseline.
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| Late Decelerations | *d/t impaired exhange of oxygen and waste products in the placenta *fetus may develop acidemia which depresses cardiac fxn *caused by acute/transient maternal hypotension, excess uterine contr., maternal hypertension or diabetes.-> they are not assuring
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| Variable Decelerations | *caused by conditions that reduce bl. flow thru umbilical cord *dont have a uniform appearance like other decelerations *rise and fall is abrupt (30 sec) with relief of cord compression *unperiodic- occuring at times unrelated to contractions
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| Assessment of the uterine activity during labor enlists four components: | *frequency *duration *intensity of contractions *uterine resting tone
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| Palpation during a uterine activity assessment during labor is used to... | estimate contraction intensity and uterine resting tone
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| Contraction intensity is described as... | *mild *moderate *strong
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| Fetal heart rate patterns on the electronic monitor are classified as: | *reassuring *nonreassuring *equivocal (ambiguous)
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| Reassuring Patterns | such as accelerations with fetal movement are associated with fetal well-being.->nurse need only to support optimal oxygentation
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| Nonreassuring Patterns | those in which favorable signs are absent or signs that are associated with fetal hypoxia or acidosis are present.
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| Nonreassuring patterns indicate... | that steps need to be taken to identify possible causes and correct them.
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| Nonreassuring patterns are more signifigant if... | they occur together and are persistent.
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| A healthy fetus may demonstrate an occasional late deceleration, but a persistent pattern of late decelerations is more likely to represent... | compromise in a fetus.
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| Nonreassuring patterns include but are not limited to: | *tachycardia *bradycardia *absent/minimal variability *late decelerations *prolonged decel *hypertonic uterine activity *variable decel that persistently fall less than 60 bpm for longer than 60 sec.
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| Nonassuring patterns do not always indicate that... | labor should end immediately.->the use of other several interventions should be used first.
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