1230 OB Test 3 Blueprint
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| What are the Four Ps of Labor? | Passageway, Passenger, Powers, psyche
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| Problem in any area of the Four Ps influences labor | negatively
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| Passageway consists of | bony pelvis and soft tissue
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| The pelvic shape most favorable for vaginal birth2 | gynecoid
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| Birth Canal is the | soft tissue of the cervix and vagina
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| Effacement occurs first | then dilation (thinning and opening of cervix
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| Passenger ingludes | Fetal skull and the fetal accomodation to the passageway.
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| The fetal accomodation to the passageway is how their spine is in conjunction with | the mothers spine.
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| Longitudinal Lie | the Long axis of the fetus is parallel to the long axis of the mother
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| Oblique Lie | In between longitudinal and traverse lie
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| traverse lie | the Long axis of the fetus is perpindicular to the long axis of the woman
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| Presentation | foremost part of the fetus that enters the pelvic inlet
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| Cephalic presentation | head
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| breech presentation | feet or buttocks
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| shoulder presentation | shoulder... (duh)
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| Attitude | relationship of fetal parts to one another: ovoid, military, brow, or face
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| Position | the relationship of the reference point on the presenting part to the quadrants of the maternal pelvis
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| Zero Station | Presenting part is at the level of iscial spines (at the door)
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| Minus Station | Presenting part is above the ischial spines (up in the body)
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| Plus station | presenting part is below the iscial spines (coming out)
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| Powers | Phases of involuntary uterine contraction
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| Parts of the contraction: Increment | building up of the contraction - longest phase
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| Parts of the contraction: Acme | Peak
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| Parts of the contraction: Decrement | letting up phase
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| Parts of the contraction: Relaxation | Rest period in between contraction
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| Psyche | Factors impacting the psyche of laboring woman Including: current prgnancy experienc, previous birth experiences, expectations, prep for birth, and process of labor
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| Cardinal Movements of Labor | Engagement - Descent - Flexion - Internal rotation - extension - external rotation - expulsion
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| When to go to a hospital | When the mother not only FEELS the baby coming but MENTALLY knows the baby is coming and even contraction
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| Early Stage of labor Activity | Excited and Talkative
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| During active labor activity | more introverted - focusing energies in coping with the stress of contraction
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| Spiral electrode is attached to | the presenting part just under the skina dn records a graphic representation of FHR. Easier to obtain consistent tracing. Increases risk of maternal and fetal infection and injury.
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| Baseline Fetal Heart Rate | measured between uterin econtractions during a 10 minute period.
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| Normally accepted baseline rate is between | 110 bpm and 160 bpm
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| Fluctuations of the baseline rate are normal if | greater than 6bpm amnd less than 25bpm
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| Periodic changes are variations in the FHR pattern that | occur in conjuctions with the uterine contractions
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| Episodic changes are variations in the FHR pattern | not associated with uterine contractions
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| Prodromal Labor | increase in braxton hicks contractions without cervical changes - can be uncomfotable
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| True Labor | progressive dilation and effacement of cervix
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| Early decelerations are | benign periodic changes.
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| Late decelerations indicate | uteroplacental insufficiency
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| variable decelerations indicate some type of | acute imbilical cord compression
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| Decelerations are changes of the FHR | below the baseline
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| The nurses role to help with decelerations | ongoing assessment of uterine contractions and FHR
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| Stages of Labor: | First STage: Dilation - Early, Active, Trasition. SEcond Stage: Birth. Third Stage: Delivery of Placenta. Fourth Stage: Recover.
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| Lightening | Sense that the baby has "dropped"
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| Assessment during the start of labor | FHR and contractions at least once every hour, maternal status, status of fetal membranes, the womans psychosocial state.
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| Ineffective breathing pattern: hyperventilation | related to anxiety and/or inappropriate application of breathing techniques.
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| Narcotics too late | Blast phase/trasition of labor - too late!
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| Bishop Scale | cervix is ripened or not and ready for inducement
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| Cesarean Section | Surgical delivery of fetus through incisions in the mother's abdomen and uterus
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| VBAC Contraindications | Previous classic Csection uterine scar, placenta previa, history of previous uterine rupture, lack of facitilites or equipment to perform immediate Csection
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| Indications of Cesarean | History of previous cesarean, labor dystocia, non-reassuring fetal status, fetal malpresentation
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| Nonpharmacologic Intervention for pain relief: Continuous labor support | Helped with a trained nurse or doula (trained layperson who coaches) increases the coping ability of the laboring woman. Fewer requests for pain meds. lower rate of Csections.
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| Nonpharmacologic Intervention for pain relief: Comfort Measures | Lip balm, ice chips, lollipops, clear liquids, Changing soiled linens, Warm perineal care
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| Nonpharmacologic Intervention for pain relief: Relaxation Techniques | These include: patterned breathing, attention focusing, movement and positioning, touch and massage, water therapy, hypnosis
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| Pharmacologic Interventions for pain relief: Analgesia and sedation | Opioids, help to tolerate labor contractions by causing relaxation and sleep between contractions.
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| Narcan | antidote for opidoids
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| Pharmacologic Interventions for pain relief: Anesthesia | Local, Regional, and general. Local numbs perineum just before birth. Regional pain relief during labor and birth (preferred for nonemergent cesarean), General for emergencies
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| Magnesium sulfate and brethine | Stops premature labor
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| Meconium aspiration is | respiratory distress due to poop aspiration
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| Two types of labor dystocia: Disorder of Protraction and disorder of arrest | protraction: abnormally slow progression of labor; arrest: total lack of progress
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| Diagnosis of labor dystocia is made after two hours of | no change in either dilation or descent
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| Nursing care for Hypotonic uterin dysfonction | Carefully assess fetal lie, presentation, and position. assess contraction pattern every 30 minutes. fetal response to uterin econtractions. thorough pain assess every hour. plot cervical changes. determine if woman might benefit from pain relief.
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| Nitrazine Paper | To test vaginal pH during late pregnancy to determine the breakage of the amniotic sac. While vaginal pH is normally acidic, a pH above 7.0 can indicate that the amniotic sac has ruptured.
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| Bloody SHow | the passage of a small amount of blood or blood-tinged mucus through the vagina near the end of pregnancy. It can occur just before labor or in early labor as the cevix changes shape. Freeing mucus and blood that occupied the cervix.
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| Rupture of Membranes (ROM) | rupture of amniotic sac. "spontaneously" occurs at full term at the onset of, or during, labor. aka breaking water. Production of the hormone prostaglandin increases speeding up contractions.
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| Umbilical Cord Prolapse | when the UC slips down in front of the presenting part. It occurs rarely in vertex presentations. Immediate Csection is treatment.
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| Shoulder dystocia treatments | Mcroberts maneuver (tried first) two nurses holding the leg up. Suprapubic manuever - Mcroberts plus applying pressure.
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