Mrs. Deethardt lecture
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| show | Guides fetus into the true pelvis
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| show | True pelvis
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| show | Inlet-Upper border allows fetal Head 2 easily navigate through it. WIDEST DIAMETER: TRANSVERSE & NARROWEST DIAMETER:A-P. Midpelvis-Narrowest part which fetus must pass during birth. Outlet-Lower border, WIDEST DIAMETER; A&P & NARROWEST DIAMETER:TRANSVERSE
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| show | Typical male pelvis with narrow dimensions. Heart shaped & not favorable for vaginal birth. Found in 20% of women.
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| ** What is the Anthropoid pelvis? | show 🗑
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| ** What is the gynecoid pelvis? | show 🗑
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| show | Flattened(narrowed) from front to back & widened from side to side. Not favorable for vaginal birth & found in 5% of women
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| show | Sutures & fontanelles allow the bones to move slightly; changing the shape of the fetal head so that it can adapt to the size and shape of the pelvis.
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| What are the landmarks that the fetal head is divided into? | show 🗑
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| **What is the fetal lie? | show 🗑
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| If the fetal lie is "Longitudinal" to mother; how is the fetus positioned? | show 🗑
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| show | Long axis of fetus to the mother is perpendicular; shoulder presentation
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| show | relationship of the fetal body parts (chest, chin, arms) to each other.
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| With fetal attitude; its said the fetus is in flexion; what does that mean? | show 🗑
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| With fetal attitude; its said the fetus is in Extension; what does that mean? | show 🗑
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| show | (or presenting part): Part of fetus that enters the pelvic inlet first and leads through the birth canal during labor.
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| show | Vertex-Top of head, head completely flexed onto chest, OCCIPUT is presenting part; Millitary-Head nor flexed or extension, eyes straight ahead, top of head presenting; Brow-slight extension, SINCIPUT presenting; Face-Head is hyperextended,face presenting
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| show | The buttocks/feet present first
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| show | Legs are flexed at the hips, knees & legs are extended against the abdomen & chest busttocks is presenting parts
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| What is considered "Complete or Full" Breech? | show 🗑
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| show | One or two legs are extended down; feet are the presenting first
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| What is the same as Shoulder presentation? | show 🗑
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| show | Measures degree of DESCENT of the presenting part of the fetus through the birth canal.
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| show | In terms of centimeters of the ischial spines of the maternal pelvis.
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| show | -5 to 0
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| show | Ischial spines
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| show | at the pelvic outlet, +5 fetal presenting below ischial spines
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| At what level is -5, -4, -3, -2, -1? | show 🗑
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| During labor, the presenting part should move progressively from the _______stations to the midpelvis at zero station & into the ______ stations. | show 🗑
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| What is meant by "Floating or Ballottable"? | show 🗑
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| What is Engagement? | show 🗑
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| show | The level of the ischial spines.
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| Engagement happens in a primigravida when? | show 🗑
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| show | May not occur until labor begins.
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| With fetal positioning; what does ROA mean? | show 🗑
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| What does LOA mean? | show 🗑
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| what does RMA mean? | show 🗑
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| show | Left mentum posterior; So the babies chin is against mom's left side of pelvis & chin facing posterior.(Chin facing mom's spine)
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| What does RSA mean? | show 🗑
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| What does LSP mean? | show 🗑
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| What presentation is it if it's Occiput(O), Mentum(M), Sacrum(S), & Accordion(A)? | show 🗑
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| Locations of the fetal heart tones; best heard where? | show 🗑
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| show | Involuntary, rhythmic,& intermittent tightening of the uterine muscles during labor.(Primary Force)
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| What is the purpose of contractions? | show 🗑
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| What are the three phases of contractions? | show 🗑
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| show | Need to have at LEAST 60 second resting interval between ctx; resting period becomes shorter as labor progresses
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| What is resting tone? | show 🗑
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| What is frequency? | show 🗑
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| What is duration? | show 🗑
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| show | Strength of ctx. (Mild, moderate, strong)
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| What is the secondary Force? | show 🗑
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| show | Her diaphragm & abdominal muscles & pushes the baby out.
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| What is Myometrial Activity? | show 🗑
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| show | Becomes active & thicker as labor progresses--exert strength to expel fetus downward.
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| show | Becomes thin-walled & passive--fetus can be pushed out of uterus easily.
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| What is effacement? | show 🗑
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| show | Long, thick to paper-thin
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| How is the progress of effacement expressed? | show 🗑
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| show | Widening of cervical opening and cervical canal from <1cm to 10cm.
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| show | For a multigravida patient.
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| What happens for a primigravida in relation to E&D? | show 🗑
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| The example: 5/90/+1; what does that mean? | show 🗑
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| When does the first stage of labor begin? | show 🗑
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| show | begins with the initiation of regular ctx & is completed when the cervix is dilated 3 cm.
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| show | 0-3cm
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| How long does it take a nullipara to get to the latent & how long for a multipara? | show 🗑
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| What is the frequency, duration, & intensity of ctx in the latent phase? | show 🗑
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| show | Usually happy, talkative, eager to be in labor, independence by taking care of own bodily needs & seeks info
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| What are some nursing care during latent phase? | show 🗑
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| What is the active phase? | show 🗑
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| How long does it take a nullipara & multipara to reach the active phase? | show 🗑
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| show | F- q2-3 mins; D- approx. 40-60 secs; I- moderate-strong.
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| ** In the active phase what is the cervical dilation like? | show 🗑
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| show | May feel helpless, increase fatigue, restless, more dependent, very tired & anxious
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| What are some nursing care for a woman in active phase? | show 🗑
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| show | Increase placental perfussion & helps with fetal descent.
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| show | Cervix is dilated 8-10cm
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| show | N- 3.6hrs; M- minutes to hours.
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| What is the frequency, duration, & intensity of ctx in the transitional phase? | show 🗑
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| show | Nullipara- 1cm/hr; Multipara- 2cm/hr
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| show | Very tired & irritable, may feel she can't keep up with labor & is out of control, fear of being left alone, may fear tearing open or splitting apart with ctx, N&V r/t ^inner abdomnial pressure
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| What are some nursing care for women in the transitional phase? | show 🗑
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| show | V/S-B/P MUST be taken between ctx, Temp is an indicator of hydration & infection-q4hrs until bag broken then q2 after; Pulse ^ is normal but >100 may indicate stess, RR may increase or decrease due to type of breating; EFM-assess duration, intensity, freq
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| What happens with GI in the 1st stage of labor? | show 🗑
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| ** How can newborn GBS infection be prevented? | show 🗑
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| ** What does SROM mean? | show 🗑
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| ** what does AROM mean? | show 🗑
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| show | Check fetal heart tones!! Because the umbilical cord could come out & get compressed
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| What other important assessment to do after the rupture of membranes? | show 🗑
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| show | When fetus is stressed- r/t relaxed anal spincter.
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| show | Dilation, effacement, station & position
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| What is the Leopold's Maneuvers? | show 🗑
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| show | Helps determine fetal presentation. If palpate hard-head; soft & irregular-butt
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| What does the second maneuver help with? | show 🗑
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| show | Helps validate the presenting part.
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| What does the fourth maneuver help with? | show 🗑
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| What does the second stage of labor begin with? | show 🗑
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| show | F-q1.5-2hrs; D-60-90secs; I-Strong & board like
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| What is the time frame before giving birth for the second stage of labor for a nullipara & multipara? | show 🗑
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| show | For the fetus to pass through birth canal, the fetal head & body must adjust to the passage by certain positional changes.
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| show | Continues downward movement of the fetus that is brought about by pressure of ctx. The head enters the inlet in occiput transverse or oblique position bc the pelvic inlet is widest from side to side
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| Waht is flexion? | show 🗑
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| What is internal rotation? | show 🗑
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| What is extension? | show 🗑
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| What is restitution? | show 🗑
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| What is external rotation? | show 🗑
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| show | The rest of the body is delivered.
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| What does the third stage of labor begin with? | show 🗑
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| ** Nursing care during third stage of labor? | show 🗑
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| show | 1-4 hours after the birth which the physiologic readjustment of the mother's body begins.
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| show | Focuses on observing for hemorrhage & relieving discomfort. Important to assess V/S, fundus, bladder, lochia.
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| During the 4th stage: Rising maternal pulse 7/or falling B/P; often accompanied by low or no urine output could mean what? | show 🗑
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| show | A poorly contracted uterus does not adquate compress large open vessels at the placental site, resulting in hemorrhage.
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| show | Suggest a full bladder, which can interfere with uterine contraction & result in hemorrhage.
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| show | Suggests hemorrhage; however, perineal pads vary in their absorbency, and this must be considered.
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| Intense perineal or vaginal pain, poorly relieved with analgesics | show 🗑
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