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38 Cards in this Set
- Front
- Back
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Labor
Initial Evaluation |
vitals
hydration voiding condition of the amnion N/V nutrition contraction duration, interval, strength,, resting tone FHTs, fetal position, |
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Labor
comfort measures |
Breath
positions warmth ice sterile water papuals tens unit hydrotherapy music soothing words |
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Labor initial evaluation of FHTs
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Using doppler
Listen for 5 -10 minutes, through at least two ctx, Listen for 5 second intervals and record # and then plot on AAT graph, Establish FHT baseline and listen for variable or late decelerations, bradycardia, tachycardia |
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Labor Cervical assesment
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location
effacement dilation presenting part position of presenting part |
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Labor
maternal dehydration |
Rising Fetal Heart tones
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FHTs
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baseline at term between 110 and 160 bpm
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FHT
Tachycardia causes |
maternal dehydration, fever,
fetal prematurity congential anomalies, medications |
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FHT
Bradycardia |
<100 bpm
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FHT
Tachy |
FHTs >160 BPM
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Bradycardia
causes |
occult cord prolapse, fetal hypoxia, cardia anomalies, medications, vagal response to rapid descent, vag exam or presentation.
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FHTs
Decelerations variable |
these deceleration
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FHT
Baseline Variability |
amplitude undetectable- absent variability
Amplitude undetectable to <or + to 5 bpm minimal variability Amplitude 6 to 25 bpm moderate variability Amplitude >25 bpm marked |
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FHT
Acceleration |
acme is > or + to 15 bpm above baseline, lasting >15 seconds and < 2 minutes
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FHT
prolonged acceleration |
an acceleration longer than 10 minutes is a baseline change
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FHT
Decelerations |
is an abrupt cchange in FHTs below base line > or = TO 15 BPM below base > 15 seconds but < 2 minutes
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FHT
Decels early |
Decels that begin before the beginning of ctx
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Decels Late
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decel whose nadir is deepest after the peak of the ctx, and that finishes after the ctx
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Decels
variable |
decels that may or may not be associated with contraction.
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Decel
prolonged |
a decel > 10 minutes is a baseline change
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Minimal Variability
causes |
fetal sleep cycle
prematurity medications anomalies Fetal Hypoxia (usually with Decels) |
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Accelerations
causes |
fetal movement,
scalp stim, acoustic stim, usually a reassuring sign of fetal welbeing |
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Decels early
causes |
fetal head compression,
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Decels Variable
causes |
umbilical cord compression. vary in depth and durations and vary from ctx to ctx
most common type of decel and not associated with abnormal outcomes when they return quckly to baseline |
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Variable decels
concerning |
variables become concerning if they become progressively longer, deeper, and lanst longer. and are associated with tachycardia or diminished variability
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Late Decels
causes |
uteroplacental insufficiency and a decrease in o2 available to fetus
due to hypertensive disorders diabetes, intrauterine infections, maternal hypotension (positional) Hypertonic uterine ctx. abnormal placentation |
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Late Decels
concerns |
fetal hypoxia cannot be assessed by the depth of the late decel,
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Prolonged Decels
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decels lasting longer 60 to 90 seconst
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prolonged decels
causes |
umbilical cord prolapse
uteroplacental insufficiency hypotension (maternal position), or epidural paracervical anesthesia hypotonic ctx medicaitons maternal hypoxia maternal valsalva rapid descentW |
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Wandering base
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onminous sign
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FHTs
Monitoring during labor |
Latent labor q 1 hour if present
early labor q 30 minutes active labor ctx 3-5 mins, mod q 20- 30 mins transition ctx 2-3 mins strong, q 15 - 20 mins 2nd stage q every other ctx |
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Assessment of FHTs
Tachy |
Assess for dehydration
assess for maternal fever |
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Assessment of FHTs
Brady |
Assess baseline carefully, change positions
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Assessment of FHTs
Transport guideline |
Unresolved Tachy or Brady
absent variability when accompanied with decelerations Late decelerations not resolved with position change. |
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assessment of FHTs
Birth eminent |
Facilitate delivery prepare for resuscitation
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Nuchal cord
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reduce cord
clamp and cut cord summersalt baby prepare to resus |
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Shoulder Dystocia
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Do not allow the shoulders to restitute to an antereoposterio position
reposition mother to McRoberts or Hands and Knees In McRoberts, suprapubic pressure, push hard let the weight of the baby's head pull the anterior shoulder. hands in vagina, cork screw baby birth posterior arm, sweeping across the body |
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Face presentation
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If birth is not imminent prepare for transport. Care should be take with vag exam so as not to damage eye
Prepare for resus mentum leads the way, then face and bregma, then occiput. |
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Face presentation
newborn considerations |
prepare for resus
bruising will be present, Arnica non allopathic tx arrange for assessment by pediatrician |
