Maternity Ch 7-8 CCC PN105
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| Types of classes | show 🗑
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| Ideally, preparing for childbirth begins ____ | show 🗑
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| Basic class content | show 🗑
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| show | Part of normal birth process; several months to prepare; self-limiting and rapidly declines
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| pain threshold | show 🗑
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| pain tolerance | show 🗑
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| primary nursing responsibility regarding childbirth pain | show 🗑
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| show | dilation and stretching of cervix; reduced uterine blood supply during contractions (ischemia); pressure of fetus on pelvis; stretching of vagina and perineum
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| Gate control theory | show 🗑
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| gate control theory techniques | show 🗑
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| show | natural body substances similar to morphine; increase during pregnancy and peak during labor
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| why can laboring women often tolerate more pain than usual | show 🗑
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| maternal condition during labor | show 🗑
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| how does labor intensity effect labor | show 🗑
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| show | reduces pain tolerance and ability to use coping skills
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| show | active fetus, frequent urination, shortness of breath why lying down
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| show | applies uneven pressure to cervis resulting in less effective effacement and dilation, prolonging labor and delivery
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| fetal occiput in posterior pelvic quadrant pushing again mother's sacrum results in ___ | show 🗑
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| interventions that may add to labor pain | show 🗑
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| show | do not harm mother or fetus, do not slow labor if provide adequate pain control, no risk of allergy or adverse effects
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| show | Dick-Read method; Bradley method; Lamaze method; relaxation techniques; skin stimulation; positioning; diverstion and distraction; breathing
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| show | most medication do not eliminate pain and additional methods to manage remaining discomfort are needed
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| show | education and relazation techniques interrupt the fear of childbirth cycle reducing labor pain
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| Bradley method | show 🗑
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| show | "psychoprophylactic method"; mental techniques that condition woman to respond to contractions with relaxation rather than tension; uses mental and breathing techniques to occupy mind
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| Lamaze techniques | show 🗑
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| show | Lamaze method
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| relaxation techiniques | show 🗑
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| types of skin stimulation | show 🗑
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| effleurage | show 🗑
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| sacral pressure | show 🗑
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| thermal stimulation | show 🗑
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| positioning | show 🗑
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| types of diversion and distraction techniques | show 🗑
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| types of breathing techniques | show 🗑
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| show | do not use until needed; selected pattern begins and ends with cleansing breath
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| cleansing breath | show 🗑
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| show | beginning of first state breathing; slow breathing like during sleep; half the usual respiratory rate
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| modified paced breathing | show 🗑
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| nursing considerations during modified pace breathing | show 🗑
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| patterned paced breathing | show 🗑
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| show | pant-pant-pant-blow; pant-pant-pant-blow; etc
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| show | pant-blow; pant-pant-blow; pant-pant-pant-blow; etc
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| show | 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
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| show | successfully using a safe, nonpharmacologic pain control technique
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| measures to correct hyperventilation | show 🗑
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| show | pressure of enlarging uterus on diaphragm
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| show | sluggish GI tract
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| show | hypotension and development of shock
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| limitations of pharmacologic pain management | show 🗑
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| show | allows mother to be more comfortable and relaxed; increased relaxation aids in ability to participate in care
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| show | narcotic (opiod) analgesic; narcotic antagonist; adjunctive drugs
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| most common type of labor analgesia in US | show 🗑
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| in using narcotic analgesics _____ | show 🗑
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| narcotic antagonist | show 🗑
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| show | Narcan (naloxone)
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| adjunctive drugs | show 🗑
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| show | Vistoril, Phenergan
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| show | placement of an anesthetic in the epidural or subarachnoid space of spinal cord
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| epidural block | show 🗑
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| regional anesthetics block _____ | show 🗑
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| show | "one shot" block; provides analgesia but prevents ambulation; does not place catheter for reinjection; not used for vaginal births
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| types of regional anesthetics | show 🗑
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| types of analgesics given right before delivery, do not help with contraction pain | show 🗑
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| adverse effects of epidural | show 🗑
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| adverse effects of subarachnoid (spinal) | show 🗑
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| show | bed rest, analgesics, oral and IV fluids; blood patch if necessary
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| show | emergency cesarean; cesarean birth in woman who refuses or has contraindication to epidural or subarachnoid block; always presume mother has fullo stomach
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| show | reguritation with aspiration; chemical injury to lungs; aspiration pneumonia
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| show | respiratory depression is main risk
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| show | begins at admission; question about allergies to food and drugs; pain relief preferences; observe for hypotension if block is given
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| if pain relief drugs are given _______ | show 🗑
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| show | injection of warmed sterile saline or lactated Ringers solution into uterus via intrauterine pressure catheter during labor after membranes have ruptured
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| indications for amnioinfustion | show 🗑
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| show | to replace the cusion for the umbilical cord and relive variable decelerations of the fetal heart rate during contractions with decreased amniotic fluid
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| show | 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
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| amniotomy | show 🗑
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| show | stimulates prostaglandin secretion which stimulates labor but can result in umbilical cord compression
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| amniotomy technique | show 🗑
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| show | prolapsed cord; infection; abruptio placentae
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| cord prolapse | show 🗑
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| show | membranes no longer block vaginal organisms from entering uterus; delivery must be within certain time frame
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| amniotomy and abruptio placentae | show 🗑
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| show | 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
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| cloudy, yellow, or malodorous fluid | show 🗑
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| show | fetus passed first meconium; associated with fetal compromise and distress
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| induction of labor | show 🗑
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| show | stimulation of contractions after they have begun naturally
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| considerations prior to induction | show 🗑
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| Bishop score | show 🗑
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| nursing considerations during labor induction | show 🗑
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| show | hypertension, ruptured membranes, uterine infection, worsening medical problems, fetal problems, placental insufficiency, fetal death
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| contraindications to labor induction | show 🗑
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| show | cervical ripening, oxytocin administration
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| show | 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
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| uterine hyperstimulation | show 🗑
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| show | 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
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| show | walking, nipple stimulation
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| show | stimulation of contractions, eases pressure of fetus on back, adds gravity to downward force of contractions
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| nipple stimulation to stimulate labor | show 🗑
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| augmentation complications | show 🗑
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| evidence of excessive uterine contractions | show 🗑
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| show | 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
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| show | method of changing fetal presentation from breech to cephalic
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| show | external and internal, external is more common
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| show | fetus becoming entangled in cord and cord compression
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| external version technique | show 🗑
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| internal version technique | show 🗑
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| show | surgical enlargement of vagina during birth
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| show | uncontrolled tear of tissues that result in jagged wound
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| types of episiotomies | show 🗑
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| show | superficial vaginal mucosa or perineal skin
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| second degree episiotomy | show 🗑
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| show | same as second but also involves anal sphincter
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| show | extends through anal sphincter into rectal mucosa
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| third or fourth degree episotomy considerations | show 🗑
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| show | better control over where and how much vaginal opening is enlarged; clean edge rather than ragged tear
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| show | midline (median) and mediolateral
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| show | extends directly from lower vaginal border toward anus; heals easier and easier to repair
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| mediolateral episiotomy | show 🗑
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| nursing care for episiotomy | show 🗑
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| show | provides traction and rotation to fetal head when mothers pushing efforts are insufficient to accomplids a safe deliver
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| forceps | show 🗑
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| vacuum extractor | show 🗑
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| show | 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
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| risks of forceps or vacuum | show 🗑
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| concern with forcep or vacuum marks on infant | show 🗑
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| nursing care for forceps or vacuum | show 🗑
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| cesarean birth | show 🗑
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| indications of cesarean birth | show 🗑
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| show | anesthesia; respiratory complications; hemorrhage; blood clots; urinary tract injury; delayed intestinal peristalsis; infection
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| newborn risks of cesarean birth | show 🗑
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| cesarean births can be _________ | show 🗑
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| types of cesarean incisions | show 🗑
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| vertical skin incision | show 🗑
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| show | nearly invisible when healed; cannot always be used in obese women or for large fetus
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| show | preferred; not likey to rupture during another birth, causes less blood loss, easier to repair; VBAC possible
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| show | minimal blood loss and allows delivery of large fetus; more likely to rupture during another birth
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| classic uterine incision | show 🗑
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| show | 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
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| nursing considerations for cesarean birth | show 🗑
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| recovery room assessments for cesarean birth | show 🗑
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| show | causes much discomfort, but can determine relaxed uterus that causes excessive blood loss
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| abnormal labor (dysfunctional labor) | show 🗑
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| dystocia | show 🗑
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| show | abnormalities in Powers, Passengers, Passage, Psyche
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| risk factors in dysfunctional labor | show 🗑
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| hypertonic labor dysfunction (Powers) | show 🗑
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| show | 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
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| ineffective maternal pushing | show 🗑
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