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37 Cards in this Set
- Front
- Back
4 P's of Labor
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-Powers: uterine contractions, effacement, dilation
-Passageway: pelvis, soft tissue of pelvic floor, cervix and vagina -Passenger: fetus, membranes, and placenta -Psyche: perception of pain, fear, anxiety |
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Leopold's Maneuver
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-A method of determining the presentation and position of the fetus, an aid for locating the FHR
-If head is in the fondus, a hard, round, movable object is felt; buttocks will feel soft, irregularly shaped, and difficult to move -Fetal back should be felt on one side of abdomen (smooth, hard surface) -On opposite side of abdomen, hands, feet, elbows and knees will be felt (irregular knobs and lumps) |
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True Labor
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-Contractions occur regularly; become stronger, last longer, and occur closer together
-Cervical dilation and effacement are progressive -Fetus usually becomes engaged in the pelvis and begins to descend -Walking has no effect on contractions |
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False Labor
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-No dilation or effacement or descent
-Contractions are irregular and w/o progression -Walking often relieves the condition |
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Fetal Monitoring
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-Displays FHR and uterine activity, frequency, and duration of contractions (only internal monitor can monitor the intensity of contractions
-FHR in relation to maternal contractions -Baseline FHR is measured between contractions (normal 120-160 beats per minute) -Internal monitoring is invasive and requires rupture of membranes and attaching an electrode to presenting part of fetus; mother must be dilated 2-3cm |
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First Stage Breathing Techniques
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-Cleansing breath: each contraction begins and ends with a deep inspiration and expiration
-Slow-paced breathing: a slow deep breathing that promotes relaxation, used as long as possible during labor -Modified-Paced Breathing: used when slow-paced breathing is no longer effective, shallow fast breathing -Pattern-paced breathing: "pant-blow", after a certain number of breaths, the woman exhales with a slight emphasis or blow and then begins again -Breathing to prevent pushing: short puffs when urge to push |
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Second Stage Breathing Techniques
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-Several variations fo breathing can be used in the pushing stage of labor
-Woman may groan, grunt, moan, or sigh as she pushes -Prolonged holding of breath while pushing may result in a decrease in cardiac output -Limit holding breath to 6-8 seconds |
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4 Phases of Labor
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-Stage 1: effacement and dilation of cervix
-Stage2: pushing stage -Stage 3: separation of the placenta -Stage 4: physical recovery |
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First Stage of Labor
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-Latent: dilation 3cm; contractions every 5-30 seconds for 30-45 seconds; mother talkative, excited, happy and eager to be in labor; assist with comfort measures; void every 1-2 hours; rest or sleep if possible
-Active: dilation 4-7cm;contractions every 3-5 min for 40-70sec with moderate to severe intensity; mother feeling helpless, restless, and anxious; help with breathing pattern, comfort; void 1-2 hours -Transition: dilation 8-10cm; contractions every 2-3 min for 45-90 seconds of strong intensity; mother tired irritable, may have nausea and vomiting; rest between contractions, help with breathing patterns (prompt panting respirations if she begins to push prematurely); encourage voiding 1-2hrs |
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Interventions Through Stage 1 of Labor
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-Vitals; FHR before, during and after contractions (normal 120-160)
-Monitor contractions -Prepare for Nitrazine or fern test to ***** for rupture of membranes -Check the color of the amniotic fluid if the membranes have ruptured |
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Second Stage of Labor
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-Begins with complete cervical effacement and full dilation and ends with birth of baby
-Contractions every 2-3 minutes for60-75 minutes -Increase in the bloody show -Mother feels urge to bear down; assist with pushing efforts -Monitor for s/sx of approaching birth (i.e. perineal bulging, visualization of fetal head) -Prepare for birth |
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Third Stage of Labor
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-Lasts from birth of baby to expulsion of placenta
-Birth of placenta occurs 5-30 minutes later -Schultze mechanism: the center of placenta separates first and the dill, red, rough maternal surface emerges from the vagina -Examine placenta for cotyledons and membranes to verify that it is intact -Examine umbilical cord for 2arteries and 1vein -After, the uterine funds is firm and approximately 2 finger breadths below the umbilicus |
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Fourth Stage of Labor
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-1-4 hours after delivery
-BP returns to pre labor level -Pulse is slightly lower that during labor -Lochia is moderate to heavy fro the first 2 hours and bright red and may contain small clots, should steadily decrease -Maternal assessments are preformed every 15 minutes for 1 hour, every 30 minutes for 1 hour, then hourly for 2 hours -Provide warm blankets -Apply ice packs to perineum -Massage the fondus if needed -Breast feeding support - |
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Anesthesia For Labor
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-Local
-Pudendal block -Lumbar epidural block -Subarachnoid (spinal) block -General anesthesia |
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Local Anesthesia
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-Block pain during episiotomy
-Just before birth of baby -No effect on fetus |
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Pudendal block
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-Administered just before birth of baby to pudendal nerve through a transvaginal route
-Blocks perineal area for episiotomy -Lasts about 30 minutes -No effect on contractions or fetus |
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Lumbar Epidural Block
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-Administered after labor is established or just before cesarean birth in epidural space at L3-L4
-Relieves pain from contractions and numbs the vagina and perineum -May cause hypotension, bladder dissension and prolonged second stage -Does not cause headache b/c dura matter is not penetrated -Maintain mother in side lie posit or place rolled blanked beneath the right hip to displace the uterus from the vena cava -Increase IV fluids if hypotension occurs |
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Subarachnoid (Spinal) Block
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-Acts quickly, administered just before the birth in the subarachnoid space at L3-L5
-Relieves uterine and perineal pain and numbs vagina, perineum, and lower extremities -Usually causes maternal hypotension (increase fluids if prescribed) -May cause postpartum headache -Mother must lie flat 8-12 hrs after injection |
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Bishops Score
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-Used to determine the readiness for labor induction
-Evaluates fetal position and cervical status -Score of 6 or more indicates readiness for labor induction |
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Factors of the Bishop Score
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-Dilation of cervix: 0=0cm; 1=1-2cm; 2=3-4 cm; 3=>5cm
-Effacement of cervix: 0=0-30%; 1=40-50%; 2=60-70%; 3=>80% -Consistency of cervix: 0=firm; 1=medium; 2=soft -Position of cervix: 0=posterior; 1=mid position; 2=anterior -Station of presenting part: 0=-3; 1=-2; 2=-1; 3=1,2 |
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Induction
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-The chemical or mechanical initiation of uterine contraction before their spontaneous onset for the purpose of bringing about the birth
-Elective induction accomplished by infusion of oxytocin (Pitocin) or amniotomy -Obtain baseline uterine contractions and FHR -Rate of infusion is not increased after desired contraction pattern is reached -Discontinue immediately if uterine hyper stimulation or non reassuring FHR |
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Amniotomy
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-Artificial rupture of membranes to stimulate labor
-Presenting part of fetus should be engaged before -Increased desk of prolapsed cord and infection (monitor FHR before and after) -Record characteristics of fluid -Bloody may indicate abrupt placentae or fetal trauma -Unpleasant odor associated with infection -Polyhydramnios (increased amniotic fluid) is associated with maternal diabetes and certain congenital disorders -Oligohydramnios (decreased amniotic fluid) is associated with intrauterine growth restriction and congenital disorders -Limit activity after |
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External Cephalic Version (ECV)
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-External manipulation of the fetus from a breech or shoulder position into vertex presentation
-Only in a labor or birth setting -Women should receive RoGam -Fetal nonstress test -Ultrasound to rule out placenta previa, determine fetal position, locate cord, evaluate adequacy of maternal pelvis, assess amount of amniotic fluid, fetal age and presence of anomalies -IV fluids and tocolytics may be administered to relax the uterus and permit easier manipulation of fetus -Exert gental, consistant pressure on abdomen to direct fetus into cephalic presentation -Monitor uterine activity, bleeding, ruptured membranes and decrease in fetal activity |
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Episiotomy
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-Incision made into the perineum to enlarge the vaginal outlet and facilitate delivery
-Institute pain relief -Provide icepack for first 24 hrs -Sitz bath, blot not wipe, analgesic spray or ointment as prescribed, clean technique, shower rather than bathe -Peri-pad w/o touching inside -Report bleeding or discharge |
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Vacuum Extraction
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-The suction device should not be kept in place any longer than 25 minutes
-Monitor FHR every 5 minutes -Monitor newborn for signs of cerebral trauma, or cephalhematoma -Caput saccedaneum (swelling of scalp) is normal and will resolve in 24 hours |
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Dystocia
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-Difficult labor
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Prolapsed Cord
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-Umbilical cord is displaced between presenting part of the fetus and the amnion or protruding through the cervix, causing compression of the cord and compromising fetal circulation
-Mother feels something coming out of her vagina, palpable or visible cord, FHR slow and/or irregular -If fetal hypoxia is sever, violent fetal activity may occur then stop -Relieve cord pressure immediately, place in extreme trendelenburg's, modified sims, or knee to chest, administer O2, prepare for cesarean birth |
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Precipitous Labor
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-Labor that lasts less than 3 hours
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Preterm Labor
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-Cervical changes and uterine contractions between 20-37 weeks
-Focus on stopping labor: identify and treat infection; restrict activity; ensure hydration; tocolytics may be prescribed to suppress labor |
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Premature Rupture of the Membranes
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-Spontaneous rupture of amniotic membrane before onset of labor
-If before term, delivery will be delayed, and infection is a risk -Evident by pooling in the vaginal vault; positive nitrazine test -Record amount, color, consistency and odor of fluid -may prescribe antibiotics |
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Placenta Previa
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-Placenta is improperly implanted in the lower uterine segment near or over the internal cervical os
-Total, partial, marginal -Data: sudden onset of PAINLESS, bright red, bleeding during last half of pregnancy; suspect whenever vaginal bleeding occurs after 24 weeks; soft nontender uterus; fundal height may be greater than expected for gestational age -Prepare ultrasound, avoid vaginal exam or any other action that would stimulate uterine activity, maintain bed rest in left lateral, monitor amount of bleeding and s/sx shock; IV fluids, blood products and/or tocolytics may be prescribed; prepare to administer RoGram |
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Abruptio Placentae
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-Premature separation of placenta after 20 weeks and before birth
-Dark red bleeding (however if bleeding is high in uterus there can be an absence of blood); uterine pain or tenderness, uterine rigidity, severe abdominal pain; fetal distress, shock if bleeding is excessive; increase in fundal height -Maintain bedrest, administer O2, IV fluids and blood as prescribed; monitor any uterine activity, prepare for the delivery of the fetus; monitor for DIC postpartum |
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Placental Abnormalities
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-Placenta accreta: abnormally adherent placenta
-Placenta increta: placenta penetrates the uterine muscle -Placenta perceta: placenta all the way through the uterus -May cause hemorrhage afterbirth because placenta does not completely separate -Prepare for hysterectomy if large portion of placenta is abnormally adherent |
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Uterine Inversion
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-May be partial or complete
-Occurs during delivery or after delivery of placenta -Depression in the fundal area; Interior of uterus may be seen through cervix; severe pain; hemorrhage, shock -Prep pt for return of uterus to correct position via the vagina; laparotomy with replacement if unsuccessful |
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Amniotic Fluid Embolism
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-When amniotic fluid containg debris (vernis, hair, skin, cells, meconium) enter the maternal blood stream
-Causes resp distress, circulatory collapse and usually fatal to the mother; if mother survives she is likely to have hemorrhage and DIC -Data: abrupt onset of resp distress and chest pain; cyanosis; seizures; heart failure; pulmonary edema; if delivery has not occurred, fetal distress -CPR; administer O2 at 8-10L/min by face mask or 100% by resuscitation bag as prescribed -Prepare client for intubation and mechanical ventilation; position on side; IV fluids, blood products, and medications may be administered to correct coagulation failure and maintain cardiac output; prep for emergency delivery once mother is stable |
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Supine Hypotensive Syndrome
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-"Venal cava syndrome"
-Venous return to the heart is impaired by weight of uterus -Faintness, lightheadedness, dizziness, breathlessness, pallor, clammy skin, sweating, hypotension, tachycardia, nausea, fetal distress -Position on left side |
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Fetal Distress
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-FHR of less than 120beats/ min or more than 160
-Meconium stained amniotic fluid; fetal hyperactivity, severe variable in baseline -Place mother in lateral position and elevate legs; administer O2 8-10L/min via face mask as prescribed, discontinue oxytocin infusion, prep for emergency cesarean |