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45 Cards in this Set

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What is the progrsterone withdrawl hypothesis?
progesterone is placenta produced and right before labor levels drop
What is the prostaglandin hypothesis?
placenta produced levels increase during labor
What is oxytocin sensitivity?
receptors in the uterus increase sensitivity & accept the release of oxytocin.
What are the psychological responses to labor?
-fears increase labor
-support system
-her accomplishments of tasks of pregnancy
-usual coping mechanism of stress
-cultural influences
-preparation for childbirth
What are the 4 major tasks of labor?
1-mom assures self of healthy pregnancy
2-everyone accepting of baby
3-trust in self to be a comfident mom
4-ability to give of self & care for child
What are some of the maternal positions associated with the 1st stage of labor? 2nd stage?
1st stage
-sit up right hob 90 degrees
-sit over side of bed
-birthing bar
-rocking chair
-standing, walking, sit indian style
-side lying position, pelvic rock
2nd stage
-any of the 1st w/ limitations
-semi sitting
-side lying, hands & knees, squatting
Compare true vs. false labor.
Contractions:
T reg contractions
F irreg contractions
Intervals:
T gradually shorten
F no change in frequency
Duration & Severity:
T Increase F No change
Pain:
T starts in back & moves front
F pain in front
Walking:
T increases intensity
Cervical Changes
T change F no change
Sedation & contractions:
T will not stop them
F will stop them
Dysfunctional labor patterns

What is hypertonic uterine dysfunction? Signs & Symptoms? Treatment? Causes?
-cervix <4cm
-Prolonged latent phase
-painful & frequent uncoordinated contractions
-Treatment: analgesic & sedation
Causes:
not good baby position, not favorable pelvis size, polyhydraminos- too much fluid, more than 1 baby, twins, triplets,

Nsg considerations warm jacuzzi bath
Dysfunctional labor patterns

What is hyportonic uterine dysfunction? Signs & Symptoms? Treatment? Causes?
-prolonged active phase
-contractions become weak and ineffective during active phase
-Causes: CPD (cephalo pelvic disporportion) baby size too large for pelvis or vice versa (android/heart shape)or malposition- posterior, face, brow presentation
Treatment: oxytocin-incr contractions, amniotomy-break water
What is labor augmentation?
What is the purpose of it?
What are the methods?
*stimulation of uterine contractions after labor has started spontaneously but progress is unsatisfactory
-Implemented for hypotonic uterine dysfunction
-Methods-oxytocin, amniotomy, and nipple stimulation
What is labor induction?
What is the purpose of it?
What are the methods?
*Initiation of uterine contractions via chemical or mechanical mehtods
-Implemented for maternal medical problems, PROM, IUGR, Post-dates, incr BP
-Common Methods-oxytocin, amniotomy
What are some of the risks, concerns and contraindications associated with labor augmentation/induction?
*Classical incision- will not induce
*oxytocin-antidiuretic effect mom retains water, decreased urination water intoxication=side effect
*done anything beyone 42wks
*hyperextension of uterus mom does not rest, decrease blood flow to uterus
*risk for rupture of uterus but greater w/ previous c-section
What are some indications of labor readiness?
-Fetal maturity
-bishop scoring
What is bishop scoring?
assessment of dilation, effacement, station, cervical consistency, cervix position
-how favorable is induction?
-<6 unfavorable for induction
->6 favorable for induction
-Contractions >2min durtion and <2min apart.
-internal fetal monitoring higher than 80mmHg (peak of contract) not contracting pressure inside 20mmHg
What are the nursing interventions for oxytocin administration?
1)prepare oxytocin in IV by
adding 10U to 1000ml's of
LR (lactated ringers)
2)increse dosage q 30-60
min until contractions
are q 2-3 min apart.
3)Maternal/fetal assessment
q 30 min
4)Assess tolerance,progress
and pattern of labor
5)Cervical exams & how
often she is contracting
What is the 1st thing to check after the rupture of bag of water?
Fetal Heart Rate
What is amniotomy? What is it used for? How is it done?
What is the nursing care?
*artificial rupture of membranes (AROM)
-used to induce or augment labor
-membranes are ruptured withan amnihook
-Nursing care:
*Assess FHR before/after
*Assess color and odor of fluid (should never be odor)
*Assess temp q 2 hours
*Assess for s/s of infection
*Change pads as needed
What are some signs of infection?
Increased HR, Temp, FHR,
chills, sensitive to touch
What is meant by occult?
cord drops down towards vagina or so.
When do we never rupture a women's membranes?
A woman who has herpes, HIV, or when the head is not engaged b/c of the cord.
What are cervical ripening methods? What are the types? What are the risks involved?
-Use of a prostaglandin to soften and efface the cervix.
-3 common types
Prepidil, Cervidil, Cytotec (pill inserted into vagina-wait 4 hours for induction)
-Risks- hyperstimulation
What are the nursing interventions with cervical ripening agents?
*review contraindications
*maternal vs and health status
*assist woman to maintain a supine position with lateral tilt 30-40min after insertion.
*document all assessment findings
What is dystocia? What are some causes associated with the passageway?
*difficult labor
Causes:
-Pelvic constrictures
-Uterine Fibroids (may not cotnract properly)
-Full bladder-very common obstruction assess q2h
-Cervical edema-pushing way too early
-more common with pelvic problems android & platypelloid
What are some causes of dystocia associated with the passenger?
-Anomalies
-Cephalopelvic Disproportion CPD-large women, gestational diabetes, multiparity, presentation, malposition: OT,OA face, brow, breech
-Malposition
-Macrosomic infant
-Multifetal Pregnancy
-Shoulder-dystocia: anterior shoulder gets stuck =risk for fractured clavicle
What is McRobert's maneuvar?
the woman flexes her thighs sharpley against her abdomen, which straightens the pelvic curve
What is Marcrosomia?
The marcrosomia infant weighs more than 4000g (8.8lbs)(large baby)
What is the Friedman curve?
a labor curve that may be used to identify whether a woman's cervical dilation is progressing at the expected rate.
What are some causes of abnormal labor patterns?
-prolonged labor patterns
-protracted descent
-precipitous labor
What is breech presentation? What is it frequently associated with? What are some risks associated with it?
-Occurs 3-4%
-frequently associated with pre-term birth, multiple gestation
-Risks: -cord prolapse
-Increased risk of
birth trauma
-Increased
cesearean birth
What is cord prolapse?
What are the contributing factors? Nursing care?
-When a loop of cord lies below or beside or beside the presenting part.
-occult or visual
-Contributing factors: long cord, malpresentation or unengaged presenting part
-Nursing Care: vaginal exam, push presenting part up.
What are the 3 types of breech?
Frank: legs & feet up to ears

Complete: flex knees & but comes down 1st opposite of vertex

Footling: hanging foot can be single or double
In a cord prolapse where the water has been broken what is done?
4x4 with saline & cover presenting part- baby needs to be out in 5 minutes. becomes and emergency situation
What are the two powers of labor?
uterine contractions and maternal pushing efforts
What is external cephalic version?
-turning the fetus from breech or tranverse lie to vertex
-the physician gently pushes the breech out of the pelvis in a forward or backward roll
-success rate-60-70%
-informed consent is important
-should be done between 36-38 weeks
-contraindications-active labor,ROM,abruption, previa
What is Internal version?
is an unexpected and urgent procedure. physician reaches in to the uterus with one hand and the other on the maternal abdomen, maneuvers the fetus into a longitudinal lie (cephalic or breech) to allow delivery.
What is the difference between external and internal version?
-external: the physician gently pushes the breech out of the pelvis in a forward or backward roll
-internal: physician reaches in to the uterus with one hand and the other on the maternal abdomen, maneuvers the fetus into a
What is done before and during the external version?
-woman is usually given tocolytic to calm uterus
-epidural block or other analgesic may be given to incr comfort
-ultrasonography guides fetal manipulations during ext. version
-labor induction may be done immediately after ext. version
-bladder needs to be empty
what are the nursing interventions that meet the needs of a client experiencing a forceps assisted birth?
Forceps assisted:
-surgical instruments designed to assist in the birth fo the fetus
-Maternal indications
-Fetal indications

exhausted not pushing well, mom has cardiac dz-too dangerous to bear down & push, severe preeclampsia, fetal distress, baby has to be well engaged +1,+2, bladder empty
Risk bleeding, hematoma, nerve damage.
what are the nursing interventions that meet the needs of a client experiencing a Vaccuum assisted birth?
Vaccuum assisted:
-attachment of vaccuum cup to fetal head
-Contraindicated- baby is not engaged
bladder empty,vaccuum-keep time its applied & pump up pressure
What are the causes of labor pain during 1st stage? 2nd stage?
1st stage:
cervix dilates, tissue hurts, lower uterine segments, babies pressure
2nd stage:
pain of baby pressing into vagina, burning, perineal and vagina pain
What are the factors influencing pain response?
-physiologic factors
-culture
-anxiety/fear
-previous experience
-environment
-labor support
-childbirth education
What are the basic concepts in administering pain medication?
-medications given too early may prolong labor
-woman's choice
-VS stable
-Normal FHR tracing with no late decels
-contraction pattern should be well established
When should you never give pain medicine?
never give pain meds when you know the baby will be delivered within an hour b/c peak effect will be in baby's system and can cause repiratory distress.
What are some non-pharmacological pain relief methods?
-cutaneous stimulation strategies: touching-coutnerpressure on back, efleurage-rubbing the uterus, thereapeutic touch. hydrotherapy-can be just as effective as narcotic.
-sensory stimulation strategies: aromatherapy candles, music, focal points, pictures, application of cold-head, heat-back pain, changing position
-Cognitive strategies: learning -child birth education, hypnosis, biofeedback
-
What are the pharmacological usages of the following analgesics on the intrapartal client and fetus/neonate:Analgesics/Narcotics: Meperdine (demorol), sublimaze (fentanyl), nalbuphine (nubain), butophanol (stadol)?
-Meperdine (demoral: create resp depression in newborn
-sublimaze (fentanyl: create resp depression in newborn
-nalbupine (nubain):non-narcotic used more
note:if birth thought to occur w/in 1hr then narcotics held