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Mat Ch7-8 CCC 105
Maternity Ch 7-8 CCC PN105
| Question | Answer |
|---|---|
| Types of classes | gestational diabetes; early pregnancy; exercise; infant care; breastfeeding; sibling; grandparent; adolescent; refresher; cesarean; VBAC |
| Ideally, preparing for childbirth begins ____ | before conception |
| Basic class content | pregnancy changes; fetal development; prenatal care; hazardous substances; nutrition; discomforts; exercise; work; labor/delivery coping |
| How childbirth pain is different | Part of normal birth process; several months to prepare; self-limiting and rapidly declines |
| pain threshold | pain perception; failry constant; least amount of sensation that a person perceives as painful |
| pain tolerance | amount of apin one is willing to endure; can change under different conditions |
| primary nursing responsibility regarding childbirth pain | modify as many factors as possible so that the woman can better tolerate labor |
| sources of labor pain | dilation and stretching of cervix; reduced uterine blood supply during contractions (ischemia); pressure of fetus on pelvis; stretching of vagina and perineum |
| Gate control theory | how pain impulses reach the brain for interpretation; pain is transmitted through small nerve fibers, stimulation of large nerve fibers temporarily interferes with pain conduction through small fibers and "closes the gate" |
| gate control theory techniques | stroking or massage; palm and fingertip pressure; heat and cold applications (gripping cool bedrail); foot rubbing; pressure; |
| endorphins | natural body substances similar to morphine; increase during pregnancy and peak during labor |
| why can laboring women often tolerate more pain than usual | increased endorphins and concern for infant's well-being |
| maternal condition during labor | cervical readiness (dilation and effacement); size and shape of pelvis; labor intensity; fatigue |
| how does labor intensity effect labor | short, intense labor is often more painful than gradual birth process |
| how does fatigue effect labor | reduces pain tolerance and ability to use coping skills |
| what are common interruptors of sleep during pregnancy | active fetus, frequent urination, shortness of breath why lying down |
| effect of fetus in abnormal presentation | applies uneven pressure to cervis resulting in less effective effacement and dilation, prolonging labor and delivery |
| fetal occiput in posterior pelvic quadrant pushing again mother's sacrum results in ___ | persistent and poorly relieved back pain, often longer labor |
| interventions that may add to labor pain | IV lines, continuous fetal monitoring, anmniotomy, vaginal exams |
| advantages of nonpharmacological pain management | do not harm mother or fetus, do not slow labor if provide adequate pain control, no risk of allergy or adverse effects |
| types of nonpharmacological pain management | Dick-Read method; Bradley method; Lamaze method; relaxation techniques; skin stimulation; positioning; diverstion and distraction; breathing |
| importance of nonpharmacological pain management | most medication do not eliminate pain and additional methods to manage remaining discomfort are needed |
| Dick-Read method | education and relazation techniques interrupt the fear of childbirth cycle reducing labor pain |
| Bradley method | "husband-coached method"; emphasizes slow abdominal breathing and relaxation techniques |
| Lamaze method | "psychoprophylactic method"; mental techniques that condition woman to respond to contractions with relaxation rather than tension; uses mental and breathing techniques to occupy mind |
| Lamaze techniques | breathing should be no slower than half of baseline respiratory rate and no faster than twice the baseline rate |
| method that is the basis of most childbirth preparation classes in US | Lamaze method |
| relaxation techiniques | require concentration thereby occupying the mind while reducing muscle tension; used in both pharmacological and nonpharmacological pain maagement |
| types of skin stimulation | effleurage, sacral pressure, thermal stimulation |
| effleurage | stimulates the large nerve fibers that inhibit painful stimuli traveling through small nerve fibers; storking abdomen in circular pattern; tracing figure 8 on bed |
| sacral pressure | firm pressure against the lower back; helps with back labor |
| thermal stimulation | heat applied with warm blanket or glove filled with warm water; warm shower; cool cloth on face |
| positioning | frequent changing of position relieves muscle fatigue and strain and promotes labor |
| types of diversion and distraction techniques | focal point, imagery, music, television |
| types of breathing techniques | slow-paced, modified paced, patterned pace |
| technique to use for first-stage breathing | do not use until needed; selected pattern begins and ends with cleansing breath |
| cleansing breath | deep inspiration and expiration, similar to deep sigh |
| slow paced breathing | beginning of first state breathing; slow breathing like during sleep; half the usual respiratory rate |
| modified paced breathing | more rapid and shallow breaths, more more than twice usual rate |
| nursing considerations during modified pace breathing | hyperventilation; watch for dizziness, tingling, numbness around mouth, spasms in fingers and feet; blurred vision |
| patterned paced breathing | "pant-blow" or "hee-hoo" breathing; rapid breaths punctuated with intermittent slight blow - constant and/or stairstep patterns used |
| constant patterned pace breathing | pant-pant-pant-blow; pant-pant-pant-blow; etc |
| stairstep patterned pace breating | pant-blow; pant-pant-blow; pant-pant-pant-blow; etc |
| second stage breathing | used when time to push; cleansing breath, deep breath, and push while exhaling to count of 10; blows out, deep breath, and pushes again while exhaling |
| do not interfere if woman is | successfully using a safe, nonpharmacologic pain control technique |
| measures to correct hyperventilation | slow breathing while exhaling; breathe into cupped hands; moist washcloth over mouth and mose while breathing; hold breath for few seconds before exhaling |
| in using analgesia and anesthesia, the pregnant woman is at higher risk for hypoxia due to | pressure of enlarging uterus on diaphragm |
| in using analgesia and anesthesia, the pregnant woman is at higher risk for vomiting and aspiration due to | sluggish GI tract |
| in using analgesia and anesthesia, the pregnant woman is at higher risk for aortocaval compression due to | hypotension and development of shock |
| limitations of pharmacologic pain management | effect and impact on fetus must be considered |
| advantages of pharmacologic pain management | allows mother to be more comfortable and relaxed; increased relaxation aids in ability to participate in care |
| types of pharmacologic pain management | narcotic (opiod) analgesic; narcotic antagonist; adjunctive drugs |
| most common type of labor analgesia in US | systemic opiods (narcotic analgesics) |
| in using narcotic analgesics _____ | avoided if birth expected with 1 hr; only small doses given to prevent fetal respiratory depression |
| narcotic antagonist | reverses respiratory depression, usually in infant, caused by opiod drugs (not effective for other causes) |
| type of narcotic antagonist | Narcan (naloxone) |
| adjunctive drugs | enhance pain-relieving action of analgesic and reduce nausea |
| types of adjunctive drugs | Vistoril, Phenergan |
| regional analgesics and anesthetics | placement of an anesthetic in the epidural or subarachnoid space of spinal cord |
| epidural block | provides analgesia and allows woman to ambulate with assistance; must have good blood counts; give 500mL Ringers solution immediately prior; constantly infused or intermittently repeated |
| regional anesthetics block _____ | sensation to varying degrees, depending on type of block used, quantity of medication, and drugs injected |
| subarachnoid (spinal) block | "one shot" block; provides analgesia but prevents ambulation; does not place catheter for reinjection; not used for vaginal births |
| types of regional anesthetics | local infiltration; pudendal block, epidural block; subarachnoid (spinal) block |
| types of analgesics given right before delivery, do not help with contraction pain | local infiltration and pudendal block |
| adverse effects of epidural | maternal hypotension and urinary retention (palpate bladder q2h) |
| adverse effects of subarachnoid (spinal) | maternal hypotension and urinary retention (palate bladder q2h); postspinal headache due to spinal fluid loss |
| treatment of spinal headache | bed rest, analgesics, oral and IV fluids; blood patch if necessary |
| uses for general anesthesia | emergency cesarean; cesarean birth in woman who refuses or has contraindication to epidural or subarachnoid block; always presume mother has fullo stomach |
| general anesthesia adverse maternal effects | reguritation with aspiration; chemical injury to lungs; aspiration pneumonia |
| general anesthesia adverse neonate effects | respiratory depression is main risk |
| nurse role in pharmacoloic techniques | begins at admission; question about allergies to food and drugs; pain relief preferences; observe for hypotension if block is given |
| if pain relief drugs are given _______ | keep side rails up for safety |
| amnioinfusion | injection of warmed sterile saline or lactated Ringers solution into uterus via intrauterine pressure catheter during labor after membranes have ruptured |
| indications for amnioinfustion | oligohydramnios (lower than normal amniotic fluid); umbilical cord compression; to reduce recurrent variable decelerations of fetal heart rate; to dilute meconium stained amniotic fluid |
| purpose of amnioinfusion | to replace the cusion for the umbilical cord and relive variable decelerations of the fetal heart rate during contractions with decreased amniotic fluid |
| nursing considerations during amnioinfusion | continuous monitoring of uterine activity and fetal heart rate (not below 110 or above 160); change underpands on bed as needed; document color, amount and odor from expelled fluid |
| amniotomy | artificial rutpure of amniotic sac (AROM) by using a sterile sharp instrument to stimulate contractions |
| effects of amniotomy | stimulates prostaglandin secretion which stimulates labor but can result in umbilical cord compression |
| amniotomy technique | disposable plastic hook is passed through cervix and amniotic sac is snagged to create hole to release fluid |
| complications of amniotomy (or from spontaneous rupture SROM) | prolapsed cord; infection; abruptio placentae |
| cord prolapse | umbilical cord slips downward with the gush of amniotic fluid |
| infection from amniotomy | membranes no longer block vaginal organisms from entering uterus; delivery must be within certain time frame |
| amniotomy and abruptio placentae | more likely to occur if uterus is overdistended with amniotic fluid prior to rupture of membranes |
| nursing considerations of amniotomy | observe for complications; record fetal heart rate for minimum 1 min; color, odor, amount of fluid; remp taken q2-4h; change underpads often to prevent growth of microorganisms |
| cloudy, yellow, or malodorous fluid | suggests infection |
| green fluid | fetus passed first meconium; associated with fetal compromise and distress |
| induction of labor | intentional initiation of labor before it begins naturally |
| augmentation of labor | stimulation of contractions after they have begun naturally |
| considerations prior to induction | fetal maturity and status of cervix |
| Bishop score | used to assess status of cervix in determining its response to induction; 6+ is favorable |
| nursing considerations during labor induction | continuous monitoring of uterine activity and fetal heart rate |
| indications to induce labor | hypertension, ruptured membranes, uterine infection, worsening medical problems, fetal problems, placental insufficiency, fetal death |
| contraindications to labor induction | placenta previa, cord prolapse, abnormal fetal presentation, high station of fetus, active herpes infection, abnormal size/structure of pelvis, previous classic cesarean incision |
| pharmacological methods to stimulate contractions | cervical ripening, oxytocin administration |
| cervical ripening (Cervidil) | prostaglandin gel softens the cervix prior to induction; after insertion woman remains on bed rest 1-2h and uterine contractions monitored to watch for uterine hyperstimulation |
| uterine hyperstimulation | contractions longer than 90s, more than 5 contractions in 10m |
| oxytocin administration | most common method of induction and augmentation; in diluted IV solution; begins at low rate and is adjusted up or down according to fetal response to labor; dose is individual to every woman |
| nonpharmacological methods to stimulate contractions | walking, nipple stimulation |
| walking to stimulate labor | stimulation of contractions, eases pressure of fetus on back, adds gravity to downward force of contractions |
| nipple stimulation to stimulate labor | causes posterior pituitary to naturally secrete oxytocin; pull/roll, brush with dry washcloth, water in whirlpool tyb/shower, suction with breast pump |
| augmentation complications | most common complication is overstimulation of contractions leading to fetal compromise and uterine rurpure; impairment of placental exchange; water intoxication |
| evidence of excessive uterine contractions | frequency greater than every 2m, duration longer than 90s, resting intervals shorter than 60s |
| nursing considerations during induced/augmented labor | signs and symptoms of increased uterine activity; monitor fetal heart rate every 15m during active labor and every 5m during transitional phase; monitor BP, pulse, respirations every 30-60m, temp q2-4h, intake and output |
| version | method of changing fetal presentation from breech to cephalic |
| version methods | external and internal, external is more common |
| risks and contraindications of version | fetus becoming entangled in cord and cord compression |
| external version technique | done after 37 eks but before labor; physican pushes fetal buttocks up out of pelvis while pushing fetal head down toward pelvis in clockwise/counterclockwise turn |
| internal version technique | emergency procedure usually performed to change position of twins for second twin birth |
| episiotomy | surgical enlargement of vagina during birth |
| laceration | uncontrolled tear of tissues that result in jagged wound |
| types of episiotomies | first, second, third, and fourth degree |
| first degree episiotomy | superficial vaginal mucosa or perineal skin |
| second degree episiotomy | vaginal mucosa, perineal skin, deeper tissues of perineum |
| third degree episiotomy | same as second but also involves anal sphincter |
| fourth degree episiotomy | extends through anal sphincter into rectal mucosa |
| third or fourth degree episotomy considerations | no enemas or suppositories; high fiber diet, stool softeners, and adequate fluids to prevent constipation |
| indications for episiotomy | better control over where and how much vaginal opening is enlarged; clean edge rather than ragged tear |
| episiotomy techniques | midline (median) and mediolateral |
| midline episiotomy | extends directly from lower vaginal border toward anus; heals easier and easier to repair |
| mediolateral episiotomy | extends from lower vaginal border toward mothers right or left |
| nursing care for episiotomy | cold packs for first 12h to reduce pain, bruisin, and edema; sitz bath to increase blood circulation for comfort and healing; dermaplast spray to cool area |
| forceps and vacuum extraction | provides traction and rotation to fetal head when mothers pushing efforts are insufficient to accomplids a safe deliver |
| forceps | instrument with curved blades that fit around fetal head without unduly compressing it |
| vacuum extractor | suction applied to fetal head so the physican can assist the mothers expulsive efforts |
| indications for use of forceps or vacuum | to end second stage labor if in best interest of mother or fetus; cervis must be fully dilated, membranes ruptured, bladder empty, and fetal head engaged at +2 station |
| risks of forceps or vacuum | trauma to maternal or fetal tissues is main risk; laceration or hematoma in vagina; vacuum causes harmless circular edema on fetal scalp |
| concern with forcep or vacuum marks on infant | reassure parents that marks are temporary and usually resolve without treatment |
| nursing care for forceps or vacuum | care is similar to episiotomy and perineal lacerations; infant head examined for lacerations, abrasions, bruising; infant facial asymmetry from forcep pressure |
| cesarean birth | surgical delivery of fetus through incisions in mothers abdomen and uterus |
| indications of cesarean birth | abnormal labor; inability of fetus to pass through pelvis; maternal conditions such as hypertension or diabetes; active herpes; previous uterine surgery; fetal compromise; placenta previa; abruptio placentae |
| maternal risks of cesarean birth | anesthesia; respiratory complications; hemorrhage; blood clots; urinary tract injury; delayed intestinal peristalsis; infection |
| newborn risks of cesarean birth | inadvertent preterm birth; respiratory problems; injury |
| cesarean births can be _________ | planned, unplanned, or emergency |
| types of cesarean incisions | vertical or transverse skin incisions; low transverse, low vertical, or classic uterine incisions - uterine incision is most important |
| vertical skin incision | allows more room, done faster for emergencies |
| transverse skin incision (Pfannenstiel) | nearly invisible when healed; cannot always be used in obese women or for large fetus |
| low transverse uterine incision | preferred; not likey to rupture during another birth, causes less blood loss, easier to repair; VBAC possible |
| low vertical uterine incision | minimal blood loss and allows delivery of large fetus; more likely to rupture during another birth |
| classic uterine incision | rarely used; more blood loss and most likely to rupture during another pregnancy |
| cesarean sequence | spinal anesthetic given; mother scrubbed and draped; physician makes skin incision and then uterine incision and ruptures membranes; lift out fetal head or buttocks; infant mouth and nose are quickly suctioned; cord is clamped |
| nursing considerations for cesarean birth | mother needs greater emotional support due to grief, guild, or anger and change of expected outcome; feeling may resurface during another pregnancy |
| recovery room assessments for cesarean birth | vital signs to identify hemorrhage or shock; IV site and rate of solution flow; fundus (GENTLY!) for firmness, height, and midline position; dressing for drainage; lochia (bleeding) quantity, color, and clot presence; urine output from catheter |
| assessing uterus after cesarean important because __________ | causes much discomfort, but can determine relaxed uterus that causes excessive blood loss |
| abnormal labor (dysfunctional labor) | does not progress |
| dystocia | difficult labor |
| four Ps of labor | abnormalities in Powers, Passengers, Passage, Psyche |
| risk factors in dysfunctional labor | advanced maternal age, obesity, overdistention of uterus, abnormal presentation, CPD, overstimulation of uterus, maternal fatigue/dehydration/fear, lack of analgesia |
| hypertonic labor dysfunction (Powers) | caused by frequent cramplike poorly coordinated contractions; increased muscle tone; during latent phase; painful but not productive; leads to reduced bloodflow to placenta |
| hypotonic labor dysfunction (Powers) | labor begins normally but diminishes during active phase; decreased muscle tone; more like to occur if overdistended; stretched muscle finbers have reduced ability to contract effectively |
| ineffective maternal pushing | may not understand proper technique |
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