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39 Cards in this Set
- Front
- Back
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What are the 3 theories of the initiation of labor?
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Hormonal
Distention Placental Aging |
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What are the 3 theories under hormonal?
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Progesterone withdrawal theory
Estrogen Stimulation Theory Oxytocin Theory Prostaglandin Theory |
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Progesterone withdrawal theory -
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Progesterone is dominant during gestation - maintains pregnancy. In labor progesterone decreases so estrogen becomes dominant.
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Estrogen Stimulation Theory -
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When estrogen becomes dominant it produces hypertrophy of miometrial cells (increases their size so they get stronger)Estogen enhances regular rhythmic uterine contractions.
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What 2 enzymes does estrogen stimulate?
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Actin and myosin - contractile enzymes
and ATP (energy source for contraction) |
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Oxytocin Theory -
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Estrogen increases uterus response to oxytocin. Oxytocin is released from pituitary gland of mother where it's stored from hypothalmus production.
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Prostaglandin theory -
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Prostaglandin stimulates smooth muscle contraction - is used to stimulate labor. Prostaglandin present in increasing amount in maternal blood and amniotic fluid during labor and just before labor.
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2nd theory category: Distention Theory -
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When uterus is overdistended (multiple babies, large baby, increased amniotic fluid) for some reason, contractions are stimulated because uterus very irritable and contractible.
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Overproduction of what hormone
can cause distention because it increases amniotic fluid? |
Prostoglandins.
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3rd category - Placental Aging
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As term approaches, placenta getting ready to detach. Function gets poorer - insufficiency.
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A decrease in what hormone causes placental aging.
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Progesterone
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When placental function decreases, what changes occur?
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Placenta may start to detach around edges (small contractions) - causes miometrial cells to clamp down around edges.
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What will you see on the monitor if the miometrial cells clamp down around edges?
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rising baseline - placental abruption. Will see decrease heart rate and late decelerations from placental insufficiency.
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When admitting a labor pt. what info do you need?
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1st put external monitor on.
Pregnancy history - GTPAL EDC BOW - if ruptured, time. Show Contractions - frequency, when started, when became regular (considered when labor started) |
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What are some other pieces of info needed?
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Last time ate solid food -
Last BM Problems during pregnancy (diabetes, infections) Current medications Smoke? (Risk of preterm labor) STD's? drink? Alcohol relaxes miometrium |
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Why is it important to know the time of BOW rupture?
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over 24 hrs. risk for infection. Take temp Q2 if ruptured, Q4 if not.
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Should you do a vaginal exam if show is heavy?
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Not until an MD assesses
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Why do you need to know when she last ate?
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From 6 cm to complete dilitation pt. may become nauseated; when labor starts, digestion stops. Watch for aspiration if nauseated.
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Why is it necessary to know last BM?
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If there is a lot of feces it could obstruct baby's decent. Don't want to contaminate the vagina with feces.
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What is involved in Stage I?
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Assess: FHR; contractions; Comfort (pain), breathing techniques. Before 4cm may not use drugs.
Progress of labor VS-active labor Qh;induced q15 |
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Stage II - Delivery of the neonate. What is assessed on the neonate?
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Airway-patent-suction PRN
Color-dry immediately-warmer VS - q15min APGAR-watch color & airway. adequately suction don't oversuction-stim.vagal nerve, decreases heart rate. Identification Bonding with parents |
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During stage II what is assessed on the mother?
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VS - q5-10 minutes
bleeding may draw cord blood - 10cc |
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What is involved in stage III?
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Signs of placental separation - trickle or rush of blood. Uterine shape changes.
Drugs for uterine contraction Placental delivery |
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How does the placenta deliver?
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Placental side or maternal side 1st usually - shiny, placental edges separate 1st.
Duncan method - maternal side - placenta separates in midddle 1st, then edges. |
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Stage IV - Recovery. What is assessed and how often?
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every 15 minutes.
Bleeding - fundus, HT, and consistency Lochia Bladder - will start to diurese after delivery. Vulva(edema, tears, hematomas) Episiotomy Hemorrhoids VS |
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What nursing care is provided during stage III?
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massage fundus PRN
Ice for edema Pain meds liquids PO Bonding-breast feeding if desired. |
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Why does the bladder diurese after delivery?
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IV fluids.
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What does a distended bladder do to the fundus?
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Displaces it.
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How much urine can bladder hold during labor?
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1500 ccs. May need to do an in and out catheter.
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What are you looking for when assessing the vulva?
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unusual pain - may not be able to see hematoma.
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What will an enema do for labor?
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good warm one will stimulate labor in addition to clearing out feces.
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What are some things to remember in an emergency delivery?
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Try to have sterile, controlled delivery. (don't allow head to pop out) Put gentle pressure on baby's head to help it come out slowly.
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What do you do once baby is delivered?
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Sweep mouth with help of gravity to help clear airway. Babies are nose breathers so clear mouth first. Keep baby warm - dry first, then wrap. If on roadside and going to hospital, wrap baby up and placenta and take.
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What are some signs of stage II?
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Urge to push
Show increases as dilatation increases Urge to use bathroom (could be pressure from baby) When she pushes you'd see baby if 2nd stage. Sudden belching "The baby is coming" - they feel decent and change from 8-10 cm. |
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What can happen of mom pushes too early?
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Can cause edema and laceration of cervix -can prolong labor.
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What drugs are given in Stage III?
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Oxytocin, pitocin, syntocinon(synthetic)after placental delivery. Run wide open by gravity. Primip may not need as much - better tone.
Ergetrate-drug that causes uterus contraction-strong, sustained contraction, not intermittent - never give before delivery. |
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What drug precautions should be taken with an hypertensive pt.?
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Don't give Oxytocin, eregetrates to - may increase BP. Don't give before delivery.
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What could happen if you overly massaged fundus?
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Could cause hemorrhage.
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What are some influences on pain perception?
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Cultural background; fatigue and sleep deprivation lowers tolerance; previous experiences; anxiety; your ability to distract yourself (breathing techniques) - psychoprophylactic methods.
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