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5 Cards in this Set

  • Front
  • Back
First Stage of Labor
1. Extends from onset of true labor to complete dilation of cervix (0 to 10 cm) and is divided into three phases: latent, active, and transition
First Stage of Labor
2. Latent phase
a. 0 to 3 cm dilated, little descent occurs
b. Contractions usually begin irregularly and become more regular, with increasing frequency and duration and intensity (from mild to moderate)
c. Client is usually relieved labor has started; can recognize and express anxiety; may be happy, excited, and talkative; and changes position w/o reminder
d. Average duration is 8.6h for nulliparas and 5.3h for multiparas
6.NA: BP, pulse, resp q1h if nl; temp q4h if nl or membranes intact & q2h if abnormal or membranes ruptured; contractions q30min; FHR q1h for low-risk women or q30min if high-risk women or nonreassuring pattern
First Stage of Labor
3. Active phase
a. 4 to 7 cm dilated, effacement and descent are progressive
b. Contractions usually every 2 to 3 min, 60 sec in duration, and moderate to strong intensity
c. Client is usually serious, intense, has a need for inc. concentration, will answer ?s in short phrases only b/w contractions; fatigue increases and woman becomes more dependent; pain inc, relaxation becomes more difficult, and woman may need reminders to change positions
d. Average duration is 4.6h for nulliparas and 2.4h for multiparas
6.NA: BP, pulse, resp, temp, contractions same as latent phase; FHR q30min for low-risk or q15min for high-risk or nonreassuring pattern; look for bloody mucus or "show" from cervical dilation as active labor progresses toward transition
First Stage of Labor
4. Transition phase
a. 8 to 10 cm dilated, effacement is completed, and descent increases
b. Contractions q 1.5-2min, lasting 60 to 90 sec, strong intensity
c. Client is working hard with intense concentration; gives one-word answers to ?s only b/w contractions; anxiety inc, fears loss of control and abandonment, senses helplessness; relaxation is difficult as contraction time exceeds the resting phase; may experience intense low abdominal, pelvic, and rectal discomfort from fetal descent; n/v are common; may need reminders to empty bladder and change position
6.NA: BP, pulse resp q30min; temp same as latent phase; contractions q15min, FHR q15min
First Stage of Labor
5. Assessment upon admission: review medical, ob and prenatal hx; labor status (contractions, vaginal examination if indicated), fetal status (HR, variability, periodic changes), status of membranes (intact or if ruptured, length of time and amt, color, odor), maternal VS, lab testing if ordered (Hgb and UA), desired birth plan inc cultural considerations, preparation for childbirth, level of comfort and coping, and support system
First Stage of Labor
7. Collaborative management
a. Orient to environment, expected assessments, and procedures
b. Encourage ambulation (if presenting part is engaged) unless contraindicated
c. Provide comfort through freq position change, effluerage, focal point, hydrotherapy, caregiver presence, therapeutic touch, sacral pressure, back rub, or admin of analgesia as req by client and ordered by health care provider
d. Encourage voiding q2h
e. Monitor labor progress and fetal well-being
f. Provide ice chips and clear liquids to prevent dehydration
g. Teach, reinforce, or support use of relaxation, visualization, or breathing patterns
h. Encourage rest b/w contractions
i. Document in client record and provide continuing status reports to health care provider
First Stage of Labor
8. Outcome is that client states she is able to cope with contractions; maternal and fetal well-being are maintained throughout labor
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