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L&D
Labor & Delivery Slides
| Question | Answer |
|---|---|
| Define Labor | Series of process by which products of conception are expelled from the uterus |
| Delivery | Birth of baby |
| What are the 5 P's | Passageway Passenger Powers Psyche Position |
| What is the passageway | Bony Pelvis & Soft parts (Cervix) |
| What is the Passenger | Baby & Placenta |
| Powers? | Contractions |
| Psyche? | Mental preparedness |
| Position | relationship of a designated point on presenting part to mom's pelvis |
| Types Of Pelvis | Gynecoid Android anthropoid Platypoid |
| Which pelvic type generally requires a c-section? | Android |
| "Female" Pelvis? | Gynecoid |
| Narrow inlet, but mid and outlet OK? | Anthropoid |
| Flat outlet? | Platypoid |
| Average length of cervix? | 4 cm |
| Risk factors for incompetent cervix | Short cervix (2 cm) Dysplasia Scarring d/t cone biopsy, leep, vaginal infections |
| Vertex | Distance between anterior/posterior fontanel |
| Attitude | Relationship of fetal parts to one another |
| Fetal lie | Relationship of baby's back to moms back |
| Longitudinal | Baby's back parallel to mom's back Baby is Vertex |
| Transverse Lie | Baby's back is perpendicular to mom's back Baby is Breech |
| Station | Relationship of presenting part to ischial spine of mother's pelvis |
| 0 Station | presenting part is at the ischial spines |
| - station | presenting part is above the ischial spines |
| + Station | presenting part is below the ischial spines |
| Cephalic | Presenting part is the head (Most with head down) |
| Breech | Presenting part is the something other than head or shoulder usu. bottom |
| Complete Breech | Baby's bottom is presenting, with hips & knees flexed |
| Footling (Incomplete) Breech | Breech position where the baby's hips & knees are extended, with legs in pelvis requires c-section Can be complete (2 legs) or incomplete (1 leg) |
| Position | Relationship of a designated point on presenting part to mom's pelvis |
| LOP | Left Occiput Posterior |
| ROP | Right Occiput Posterior |
| LOA | Left Occiput Anterior |
| ROT | Right Occiput Transverse |
| LOT | Left Occiput Transverse |
| 1st stage of labor | Dilation & effacement of Cervix |
| Latent Phase | Phase of 1st stage of labor where the cervix dilates from 0-3 cm Longest lasting stage can be 12 - 14 hrs Contractions are 5 to 10 min apart Lasting 30 to 45 seconds Mild to moderate intensity |
| Physical symptoms of Latent Phase | Nausea/vomiting Bloody show Possible ROM Back pain Mild to moderate discomfort - can talk through contractions Urinary frequency |
| Emotional state during Latent Phase | Excitement Relief that labor started Smiling Wants information/Able to follow instructions/Eager to answer questions Anxiety |
| Nursing Activities during Latent Phase | Orient to care environment Review Birth Plan Obtain Consents Start Documentation Verify reassuring fetal heart rate Complete assessments/Admission forms Determine dilation/effacement/station status Review info re: labor, breathing etc |
| Active Phase | Phase of 1st stage of labor where: Cervix dilates from 4 to 7 cm Lasts from 3 to 6 hrs Contractions are 3-5 min. apart Duration of 60 sec. with moderate to strong intensity |
| Physical symptoms of Active Phase | Nausea/vomiting Increased Bloody show Possible ROM Back pain Moderate to strong discomfort Urinary Frequency |
| Emotional state during Active Phase | Difficulty adjusting to stronger contractions Irritability Anxiety May lose temper Requests Pain meds |
| Nursing activities during Active Phase | Assist with comfort measures of woman's choice Monitor FHR Continue Documentation Review info re: labor, breathing etc as needed |
| Transition Phase | Phase of 1st stage of labor where the cervix dilates from 8-10 cm lasts from 1/2 to 3 hrs Contractions are 1.5 to 3 min apart Lasting 45 to 60 seconds Strong intensity |
| Physical Symptoms of the Transition Phase | Nausea/Vomiting Increased Bloody Show Spontaneous ROM Back Pain Moderate to Strong Discomfort Urinary Frequency Hyperventilation Rectal Pressure & Urge to bear down |
| Emotional State during Transition | Restless, wants to quit Irritable Sense of helplessness & Loss of control Doesn't want to be left alone, but doesn't want to interact Difficulty concentrating, following instructions & understanding information |
| Nursing Activities during Transition | Assist with relaxation & breathing techniques Monitor FHR Document Perform sterile vaginal exam only as needed Notify midwife/md of progress or difficulties Don't leave alone |
| Stage 2 of Labor | Delivery of Baby Dilation-10 cm Contractions 2-3 min apart Lasting 60-90 sec Very strong intensity |
| Physical Symptoms of Stage 2 | Rectal Pressure & urge to bear down Increased Bloody Show Spontaneous ROM Back Pain Extreme discomfort eased by pushing Perineal "burning/splitting" sensation |
| Emotional Symptoms of Stage 2 | Introspective Calmer Return of sense of control |
| Nursing Activities during Stage 2 | Review Birth Plan Offer encouragement Assist with pain relief Monitor FHR Do perineal support/massage Notify Midwife/MD of progress/difficulties Note Time of Birth Document Delivery Info |
| Stage 3 of Labor | Placental Expulsion Cervix Closing Lasts 5 - 30 min Intermittent, brief contractions with mild crampin |
| Physical Symptoms of Stage 3 | Renewed Energy Gush of blood as placenta detaches Rise of fundus in abdomen Perineal Discomfort |
| Emotional States of Stage 3 | Talkative Anxious to interact with baby Relieved |
| Nursing Activities during Stage 3 | Provide desired care Document time placenta was delivered Admin. Oxytocin if ordered |
| Stage 4 of Labor | Recovery Lasts 1 hour after vaginal, 2-3 c-section |
| Physical symptoms of Stage 4 | Uterine cramping Perineal Soreness Exhaustion Hunger,thirst Fundus midline & firm @ umbilicus Temp slightly elevated Shaking/chills |
| Emotional State during Stage 4 | Relieved Emotional (Tears, gratitude, happiness) Excited to have infant |
| Nursing Activities of Stage 4a | Monitor VS, fundus, bleeding, & episiotomy Assess Bladder & assit in voiding Provide clean clothing, bedding, face clothes & towels |
| Nursing Activities of Stage 4b | Answer questions & listen Encourage Breastfeeding & parental-infant interaction Monitor infant's well being Provide perineal care Offer food & drink Provide family support |
| Psyche | Mom's readiness for labor |
| Variability | Interplay between sympathetic & parasympathetic nervous system Minimal: 0-5 Moderate: 5-24 Marked: over 25 |
| Acceleration | FHR increases by at least 15 beats, stays up 15 sec. from baseline - HAPPY BABY |
| Deceleration | FHR decreases by at least 15 beats, lasting 15 sec. below baseline |
| Frequency of Contractions | Beginning of 1 contraction to the beginning of the next |
| Duration of Contractions | How long it lasts from the beginning to the end of 1 contraction |
| Variables | Variable shape & onset of FH beat Cord Compression |
| Early Decelerations | HR decreases as contraction starts, goes back to baseline Head compression |
| Late Decelerations | HR decreases after contraction starts Placental insufficiency - not enough O2 stores |
Created by:
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