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82 Cards in this Set
- Front
- Back
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Preliminary signs that labor is about to start
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Lightening
Nesting Braxton-Hicks contractions |
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Lightening
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baby settling down into pelvix
Can occur up to 2 weeks prior to labor |
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Nesting
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Sudden burst of energy; need to conserve that energy for labor.
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Braxton Hicks contractions
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can occur regularly but never get stronger, closer together or do anything to cause the cervix to change.
Loss of mucus plug |
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True labor
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true labor contractions are regular, increase in frequency, & intensity; cause cervical change.
True labor contractions usually start at the back and come around to the front. False labor is usually in the abdominal area |
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Issues for new RNs
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Pain - RNs taught to alleviate pain first but mom needs some pain to deliver baby
Inexperience of new mom - hard to be empathetic to pts who have never experienced labor Unpredictability of labor Intimacy - L&D is very intimate area. |
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CV responses to labor
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at the peak of a contraction, the blood flow to the uterus is cut off so more circulating blood volume in baby; BP can increase as much as 15 pts if taken during contraction.
During pushing phase, cardiac output can increase as much as 50%. Baby will accelerate heart rate 15-20bpm before contraction (normal) to ensure he/she has enough O2 to last thru contraction |
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Respiratory responses to labor
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O2 consumption increases during labor, especially during 2nd stage of labor. The process of labor speeds up surfactant production which speeds up lung maturity for baby. As baby comes thru birth canal, the walls of the vagina squeeze on chest to get rid of mkost of the fluid in the baby's chest, the rest is pushed down to the bottom of the lobes & is absorbed by the body.
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Hematological responses to labor
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white count is increased during labor, can be as much as 30,000; doesn't mean there is an infection just the normal response to the stress of labor
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Pain response to labor
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pain reduces the pts ability to cope, they become quick-tempered, have a tendency not to listen
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Fatigue response to labor
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most laboring moms come in already tired.
hard for them to go through a long labor if already tired |
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fear response to labor
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anxious about slow or fast progression
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Cultural responses to labor
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Pain responses different in each culture
Nourishment choice - hot/cold Position - how they want to deliver their baby Proximity of support person customs r/t PPD period - no shower til bleeding stops, certain foods during PPD *address differences and try to accommodate as much as possible |
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4 Ps of labor
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Passage - pelvis
passenger - baby powers - contractions psyche - mental status |
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Passage
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2 pelvic measurements to determine if pelvis is adequate for delivery
1. diagonal conjugate 2. transverse diameter **if disproportionate, usually b/c either baby is too large to fit thru pelvis OR b/c pelvis is not adequate size. |
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Diagonal conjugate
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narrowest portion is at pelvic inlet (top part of pelvis)
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transverse diameter
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narrowest portion is at pelvis outlet
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fetal attitude
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the degree of flexion that the fetus assumes or the relationship of the fetal parts to each other.
Are the limbs flexed? Usually knees & arms drawn up nice & tight. |
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Station
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the relationship of the presenting part to the ischial spines. Goes from a minus (-)4 to a plus (+)4. If engaged, it is at a zero (0) station. All above the ischial spines are minus 1,2,3,4; all below ischial spines are plus 1,2,3,4.
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Crowning
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when the presenting part (not necessarily the head) reaches the perineum.
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Fetal lie
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relationship of the baby's spine to the mother's spine.
Want longitudinal lie, baby's spine is lined up in the same direction as mom's spine. |
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Cephalic presentation
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vertex
military brow face |
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Vertex presentation
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ideal presentation
completely flexed, chin on chest, would feel the posterior fontanel when doing exam. |
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Military presentation
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baby's head is not tucked quite as tight as it should be (in a straight position)
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Brow presentation
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head extended back a little bit further, the brow is presenting
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Face presentation
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face is presenting
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Frank breech
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feet are up next to head, butt first, hips are hyperextended, heads resemble hammerheads
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full breech
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butt first, arms/legs crossed
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single (or double) footing breech
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feet deliver first
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transverse presentation
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shoulder is presented (shoulder presentation)
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Positioning of fetus - vertex positions
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Ideal is ROA or LOA
LOA/ROA - occipital presentation with spine facing the anterior LOT/ROT - occipital presentation with spine facing laterally LOP/ROP - occipital presentation with spine facing posterior |
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positioning of fetus - breech positions
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LSA - sacrum presenting. spine facing anterior
LSP - sacrum presenting, spine facing posterior |
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Mechanisms of labor
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procedures that the baby must go through to be able to be delivered.
Descent Flexion Internal Rotation Extension External Rotation Expulsion |
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Descent
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lightening
descent into pelvis forces baby into a state of flexion |
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flexion
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flexes baby's head
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internal rotation
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baby has to turn head iinto transverse position to get through the narrowest portion of the pelvis (pelvic inlet)
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extension
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head goes under the pubic bone, crowns
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external rotation
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shoulders/body rotate right or left after head is delivered & then shoulders deliver. Shoulders can get stuck under pubic bone if large baby.
MD puts pressure on shoulder to try and get it under the pubic bone, if doesn't work then they have to break the baby's clavicle. |
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expulsion
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expulsion of the rest of the baby's body
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Contraction ring
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pathological riing
Bandl's ring *when contractions are very strong, indicative of an impending uterine rupture. *Can look at abdomen and see a divide b/t upper & lower uterus |
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3 phases of a contraction
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Increment - building up portion of contraction
Acme - peak of the contraction Decrement - decreases in the contraction |
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Early labor
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contractions are 10-15 mins apart
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Active labor
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contractions are 2-3 mins apart
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effacement
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the thinning out of the cervix.
normally 1-2cm in length/thickness; completely disappears during labor process |
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dilation
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measured in CM from 0-10. Contractions are pushing/pulling at the same time which cause the dilation/effacement of cervix. Do NOT let mom push until cervix is completely gone (can lacerate cervix).
MUST be 10cm and 100% effaced before they can start pushing. |
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Stage 1 of labor
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from onset of labor to complete dilation
Divided into 3 phases: latent, active, transition |
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Latent phase
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dilation from 1-4cm.
Contractions about every 15-30mins, lasting about 30 secs, usually mild. Do not give analgesia during this phase, will slow down labor. Women usually stay home during this phase. Usually lasts 6 hrs for primigravida & 4 hrs for multigravida. |
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Active phase
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dilated 4-7cm
contractions 3-5 mins apart & more intense, lasting about 30-60 secs. Mom is becoming more dependent, restless, anxious, tiring. Usually lasts 3 hrs for primigravida & 2 hrs for multigravidas. Reduce visitation; allow support person to take a break; maintain breathing patterns |
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Transition phase
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Contractions coming rapidly, 2 mins apart, lasting 45-90 seconds. Advancing rapidly, feel need to push but cannot push until fully dilated.
DO NOT LEAVE PT ALONE |
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Stage 2 of labor
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full dilation to delivery of baby
Extremely strong urge to push. Contractions space out once fully dilated. Look for signs that baby is coming through birth canal (perineum starts to bulge, rectal area becomes everted while mom is pushing). Can take minutes to hours before delivery. |
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Stage 3 of labor
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from delivery of fetus to delivery of placenta (usually only takes a few minutes)
Signs of placental separation: lengthening of cord & a spurt of blood. Gently tugging on cord should deliver placenta. Doesn't matter which side of placenta delivers first as long as all pieces of placenta are there. |
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Placental expulsion
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(Dirty) Duncan - side attached to mother comes out first
(Shiny) Schultz - side attached to baby comes out first. |
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Tachycardia
Fetal Danger Signs |
Tachycardia - anything over 160; if mom not having prob look to see if baby is hypoxic.
Is he/she active? 1st sign of hypoxia is baby very active b/c moving around to try and get O2 |
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Bradycardia
Fetal Danger signs |
anything under 110
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Decels in FHR
Fetal Danger Signs |
could be indicative of cord compression (variable decels), placental insufficiency (late decels), head compressions (early decels & normal)
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Meconium Stained Fluid
Fetal Danger Signs |
never a good sign
membranes should be clear & nonoderous. If green (pea soup) then has meconium which means that baby has either been exposed to a hypoxic espisode or is currently hypoxic |
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Hyperactivity
Fetal Danger Signs |
may indicate hypoxia
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Acidosis
Fetal Danger signs |
repeated occurences of hypoxia.
If baby suspected of having probs, MD can do a fetal scalp nick to do a PH on baby's blood. If less than 7.2 = acidosis, must deliver baby |
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BP Change
Maternal Danger signs |
140/90+ (or 30/15 pt change) or decrease in BP (indicating shock)
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Abnormal HR
Maternal Danger signs |
over 100 = possible hemorrhaging
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Stage 3 of labor
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from delivery of fetus to delivery of placenta (usually only takes a few minutes)
Signs of placental separation: lengthening of cord & a spurt of blood. Gently tugging on cord should deliver placenta. Doesn't matter which side of placenta delivers first as long as all pieces of placenta are there. |
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Placental expulsion
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(Dirty) Duncan - side attached to mother comes out first
(Shiny) Schultz - side attached to baby comes out first. |
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Tachycardia
Fetal Danger Signs |
Tachycardia - anything over 160; if mom not having prob look to see if baby is hypoxic.
Is he/she active? 1st sign of hypoxia is baby very active b/c moving around to try and get O2 |
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Bradycardia
Fetal Danger signs |
anything under 110
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Decels in FHR
Fetal Danger Signs |
could be indicative of cord compression (variable decels), placental insufficiency (late decels), head compressions (early decels & normal)
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Abnormal contractions
maternal danger signs |
greater than 90 secs duration, the uterus does not have time to relax & baby is not getting adequate O2.
Hypotonic contractions are not effective & increase the risk of c-section. Hypertonic contractions decrease the O2 to baby leading to fetal distress (try to stop contractions to allow uterus to relax & then start back again) |
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Add'l maternal danger signs
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Pathological retraction ring (Bandl's ring)
Abnormal lower abdominal contour - full bladder can keep baby from moving down into pelvis Increased apprehension |
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Assessments - Stage 1
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Initial interview
Hx of this & prior PGs Physical Exam |
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Stage 1 care
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respect contraction time
promote position changes promote voiding offer support amniotomy |
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Stage 2 care
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stay with client
give good support assess FHR throughout pushing efforts |
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Pushing
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Push with contractions to be effective
Do NOT do fundal pressure no matter what MD says Legs must be pulled up and out to widen pelvis Do not hold breath but breathe out while pushing Have pt pant to prevent pushing |
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Birth
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Suction mouth then nose once head is delivered
Check for nuchal cord around neck Record delivery time when entire body is delivered Clamp cord Obtain cord blood specimen (cut b/t the two clamps) - automatically sent to lab if mom is Type O or Rh-. |
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Apgar Score
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Assigned at 1 minute & 5 minutes after birth.
Checking heart rate, color, reflexes, cry & muscle tone. Score 0-10; 10 rarely given b/c hands/feet usually bluish. BEST is 7-10; If less than 7 then recheck in 10 mins (if still probs,move to NICU) |
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Heart Rate - Apgar
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No heart rate = 0
Heart rate <100 = 1 Heart rate >100 = 2 |
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Respiratory effort - Apgar
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No resps = 0
slow resps/weak cry = 1 spont resps/strong cry = 2 |
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Muscle tone - Apgar
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limp = 0
minimal flexion/sluggish movement = 1 flexed body posture w/spont & vigorous movement = 2 |
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Reflex response - Apgar
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no response to bulb syringe suction or slap on soles = 0
minimal response (grimace) to suction or gentle slap = 1 responds promptly to suction or gentle slap with cry or active movement = 2 |
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Color - Apgar
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Pallor/cyanosis = 0
bluish hands/feet only = 1 pink (light skiinned) or absence of cyanosis (dark skinned) = 2 |
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RN assessment of newborn
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*Apgar
*Check umbilical cord to ensure 3 vessels; 2 bean sprouts are arteries & blood will be seen around vein *Physical defects - head-to-toe assessment looking for defects; VS, listen to heart/lungs; look at spine; rectal temp; gest age assess *ID of baby - putting on bracelets & footprinting baby *Attachment - wrap up and give to parents |
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Stage 3
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delivery of placenta
Usually delivers spontaneously & takes 10 mins at most. Must ensure all pieces are delivered. Oxytocin added to IVFs after placenta is delivered to get uterus to contract (placenta will not separate while uterus is contracting) Perineal repair |
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Stage 4
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immediate postpartum period.
1-4 hrs after delivery is most critical. Watch moms closely. Assessments q 15 mins for 1st hour. VS, fundus checks (s/b nice & hard), check bleeding (look at her pads), look at her bottom to check for excessive swelling or bruising; check bladder & pain level. Clean perineum Offer clean gown & make her feel comfortable Shaking is normal |
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Immediately report the following to MD if occur w/i 1st hour
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BP decrease
tachycardia uterine atony excessive bleeding (complete saturation of pad in 15mins) Temp > 100.4 |
