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48 Cards in this Set

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what are the 4 P's of labor?
POWERS
PASSAGEWAY
PASSENGER
PSYCHE
mechanisms of labor-data collection
lightening or dropping of fetus(fetus descends in pelvis 2weeks b4 delivery primipara) (multipara fetus might engage in pelvis after labor)
appearance of a blood show(brown or blood tinged cervical mucous is passes)
^in braxton hicks
cervox rippen (soft, partly effaced, may dialate)
sudden burst of energy
Leopold's manuever
method of determining the presentation and position of the fetus. aid in location heart sounds.
what is the normal fetal HR?
120-160 beats per minute.
internal fetal monitoring
invasive- requires rupturing of the membranes and attaching an electrode to the presenting part of the fetus.
mother must be dilated 2-3cm
variability- FHR
fluctuations in the baseline FHR.
decreased variability can result from fetal hypoxia, acidosis or certain meds.
temp decrease can occur when infant is in sleep state(should be no longer than 30 min)
early decelerations
occurs during contractions as the fetal head is pressed against the pelvis or cervix, return to normal after contraction
REQUIRES NO INTERVENTION
late decelerations
nonreassuring patterns that reflect impaired placental exchange and uteroplacental insufficiency
INTERVENTION
improving fetal oxygenation and placental blood flow
variable decelerations
caused by conditions that restrict flow to the umbilical cord
their shape, duration, and degree fall below the baseline HR
they rise and fall abruptly with onset and relief of cord compression.
FHR repeatedly decreases <than 70 beats per min for at least 60 seconds
non reassuring patterns are
tachycardia, bradycardia
diminished or absent variability
late decelerations
variable decelerations falling to less than 70 beats p/m for more than 60 secs.
prolonged decelerations
hypertonic uterine activity
1st stage of labor(latent stage)
cervical dilation up to 3cm
contractions q 5-30mins 30-35secs in duration
Mother talkative eager to be in labor.happy excited.
1st stage of labor(active phase)
cervical dilation 4 to7 cm
contraction q 3-5 min last 40-70sec long
mother may exp. helplessness, restless and anxious as contrac. becomes stronger
1st stage of labor(transition phase)
cervical dilation8 to 10cm
contractions 2-3 mins, lasts 45-90 secs.
mother become tired, restless, irritable, may have N&V
2nd stage of labor
complete cervical effacement and full dilation, ends w babys birth.
contractions q 2-3min, lasts 60-75 secs.
increase in bloody show occurs
mother feels urge to bear down
3rd stage of labor
lasts from the birth of the baby until the placenta is expelled.
birth of placenta occurs 5-30 minutes after birth.
placenta data collection
schultze mechanism- the center portion separates first,and its shiny fetal surfaces emerges from vagina
duncan mechanism- placenta separates first, and the dull, red, rough material emerges from vagina
the surface of the placenta that appears first is no clinical importance.
After birth of the __, the uterine fundus remains __ and is located __ fingerbreadths __the umbilicus.
placenta
firm, 2, below
Examine the placenta to verify the __ are intact. Examine the umbilical cord for the presence of __ artery, __ vein.
membranes
2 arteries, 1 vein
4th stage of delivery- description and data collection
1-4 hours after delivery
lochia is moderate to heavy for the first 2hours.Bright red, small clots
4th stage of labor interventions
1. maternal assessments every 15 min-1st hour 30 min- 2nd hour hour-remainig 2hours
2. warm blankets
3, massage fundus- show mother
4. ice packs to perineum
what site is epidural injected?
L3-L4
Epidural
may cause hypotension, bladder distenstion and prolonged 2nd stage
does NOT cause headache(dura mater is not penetrated)
Subarachnoid (spinal)block
injection site subarachnoid space at L3-L5
usually causes hypotension
may cause postpartum headache
Mother must lie flat 8to12hours after injection
induction
the chemical or mechanical initiation of uterine contractions before their spontaneous onset for the purpose of bringing about the birth.
amniotomy
artificial rupture of membranes performed by the HCP to stimulate labor.
presenting part should be present b4 performed
increased risk of prolapsed cord or infection
bloody amniotic fluid may indicate abruptio placentae or fetal trauma
unpleasant odor=infection
external cephalic version (ECV)
external manipulation of fetus from a breech or shoulder into a vertex presentation.
indicated for an abnormal presentation after 37 weeks.
attempted only in labor or birthing setting
prepare non stress test to evaluate fetal well being.
Ultrasound is performed b4 to determine fetal position.
episiotomy
incision made into the perineum to enlarge the vaginal outlet and facilitate delivery.
instruct clean while cleaning area to blot area rather than wiping
Shower rather than bathe
Report any bleeding or discharge to physician
Forceps delivery
two double crossed spoonlike articulated blades are used to assist in the delivery of the fetal head.
Check neonate and mother after delivery for injury
vacuum extraction
a cap-like suction device is applied to the fetal head to facilitate extraction.
traction is applied during contraction until the descent of the head is achieved.
suction should be kept in place NO longer than 25 mins
Mon for cephalhematoma
Caput succedaneum is normal and will resolve in 24 hours
CESAREAN DELIVERY
birth of fetus through transabdominal incision of the uterus.
Preoperative-
prepare mother for foley catheter.
postop-
encourage turning, coughing, and deep breathing.
encourage ambulation to < the risk of DVT
Tender uterus, foul smelling lochia=may indicate endometritis
+ homans sign, pain, edema=may indicate thrombophlebitis
PROLAPSED CORD
umbilical cord is displaced between the presenting part and the amnion. or it is protruding through the cervix, causing compression of the cord and compromising fetal circulation.
PROLAPSED CORD- data collection
1.Mother has a feeling that something is coming thru the vagina.
2. Umbilical cord is visible and palpable.
3. FHR is irregular and slow
4. lIf fetal hypoxia is severe, violent fetal activity may occur
PROLAPSED CORD- interventions
1. Relieve cord pressure immediately
2. Place mother in EXTREME trendelenburgs position, modified sims positions, or knee chest position.
Elevate the fetal presenting part that is lying on the cord by applying finger pressure with a sterile glooved hand.
DO NOT ATTEMPT TO PUSH THE CORD INTO THE UTERUS!
prepare emergency c-section
precipitous labor and delivery
labor that last less than 3 hours from the onset of contractions to birth.
precipitous labor and delivery interventions
stay with the mother at all times.
preterm labor- description and intervention
cervical and uterine contractions occuring between 20-37 weeks.
rupture of amniotic fluids.
interventions-
focus is on STOPPING LABOR.
identify and treat infection, restrict activity, ensure hydration
tocolytic may be given to supress labor.
premature rupture of the membranes- description
the spontaneous rupture of amniotic memebrane before the onset of labor.
infection becomes a risk.
evidence of fluid pooling in the vaginal vault(nitrazine test is positive)
PLACENTA PREVIA- description and 3types
the placenta is improperly implanted in the lower uterine segment near or over the internal cervical os.
Total (placenta completely covers internal cervical os)
Partial (incomplete coverage of the internal os)
Marginal (only the edge of the placenta extends to the internal os)
placenta previa- data collection
sudden onset of painless, bright red vaginal bleeding during last half of pregnancy. Suspected when vaginal bleeding occurs after 24 weeks.
Soft, relaxed,nontender uterus
placenta previa interventions
prepare ultrasound to confirm diagnosis.
Avoid vaginal examsand other actions that would stimulate uterine activity
Bedrest in left lateral position
If bleeding is heavy(c-section may be performed)
Prepare RH immuno globulin if mother is RH negative and has not been given injection.
ABRUPTION PLACENTAE
premature separation of the placenta after 20 weeks gestation and b4 the birth of the baby.
ABRUPTIO PLACENTAE- data collection
dark red vaginal bleeding(if the bleeding is high in the uterus or minimal there can be a absence of visible blood)
uterine pain/tenderness
uterine rigidity
severe abd. pain
signs of fetal distress and maternal shock(if bleeding is excessive)
ABRUPTIO PLACENTAE- interventions
Place mother in trendelenburg position if indicated.
placental abnormalities
placenta accreta(abnormally adherent)
placenta increta(penetrates the uterine muscle itself)
placenta percreta(goes all the way through the uterus)
placental abnormalities- data collection and intervention
may cause delayed hemmorhage immediately after birth bc the placenta doesnt separate cleanly.
Interventions-
Mon. for hemorrhage, shock
prepare client for a hysterectomy if large portion if the placenta is abnormally adherent
uterine inversio description and data collection
uterus turns inside out during delivery or after delivery of placenta.
DC-
depression in fundal area, interior of cervix may be seen through the cervix or protuding thru vagina, severe pain, signs of shock, hemorrhage.
amniotic fluid embolism
occurs when the amniotuc fluid contains particles of debris(vernix, hair, skin, cells, meconium). Enters the maternal circulation and causes release of endogenous mediators, thus obstructing maternal pulmonary vessels.
Causes resp depression, circulatory collapes. FATAL TO MOTHER/ if she survives she is likely to have hemorrhage and DIC
SUPINE HYPERTENSIVE SYNDROME(vena cava syndrome)
occurs when the venous return to the heart is impaired by the weight of the fetus.
S/S
pallor, clammy, cool damp skin, sweatig.