wvc OB labor & delivery
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| show | a crucial part of nursing care.
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| Nursing skills needed by intrapartum nurse: | show 🗑
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| show | negative attitudes to the laboring woman and her partner d/t nurses own inexperience or negative experiences with the birthing process.
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| show | timetable--->some occurances simply are not easily predicted or explained.
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| show | maintain a professional conduct and take cues from the couple they are working with.
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| show | both the pregnant woman and her fetus.--->these affects are most striking in the maternal reproductive system and in relation to the fetal and neonatal oxygenation.
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| show | *cardiovascular *respiratory *gastrointestinal *urinary *hematopoietic systems as well as her reproductive system.
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| show | coordinated, involuntary, and intermittent.
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| Coordinated Contractions | show 🗑
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| As a woman approaches full term, contractions become... | show 🗑
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| Coordinated Contractions begin in the... | show 🗑
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| show | Because uterine contractions are not conciously controlled because they are smooth muscles, existing contractions can be stimulated by physical activity such as walking. Anxiety or stress can diminish them.
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| show | Labor contractions are intermittent rather than sustained, which allows the uterine muscle to relax and resumption of blood flow to and from the placenta to permit gas, nutrient, and waste exchange for fetus.
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| show | *increment *peak or acme *decrement
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| show | the contraction begins in the fundus and spreads thruout the uterus.
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| peak or acme phase is the period when... | show 🗑
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| the decrement phase is the period of... | show 🗑
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| The contraction cycle and the overall pattern of contractions are also described in terms of... | show 🗑
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| frequency | show 🗑
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| Duration | show 🗑
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| Intensity | show 🗑
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| show | the end of one contraction and the beginning of the next.
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| show | oxygen, nutrients, and waste products occurs.
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| show | opposing features.
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| show | push the fetus downward.
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| The lower 1/3 of the uterus remains less active, allowing... | show 🗑
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| The cervix is similar to... | show 🗑
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| show | the downward push from the upper uterus that is accompanied by the reduced resistance of fetal decent into lower uterus.
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| show | shorter at end of each contraction.
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| show | become longer with each contraction.
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| show | the upper uterus to maintain tension between contractions to perserve the cervical changes and downward fetal progress made with each contraction.
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| show | the thickness of the uterine wall during labor.--->upper uterus becomes thicker while lower uterus becomes thinner.
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| show | marks the division between the upper and lower segments of the uterus.
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| The opposing charectoristics of contractions change the shape of the uterus to elongated, which in turn... | show 🗑
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| Cervical Changes: Effacement | show 🗑
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| Dilation | show 🗑
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| During each contraction, blood flow to the placenta gradually decreases, causing... | show 🗑
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| During labor, the mothers respiration... | show 🗑
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| show | reduced....food and large volumes of liquids usually avoided to prevent vomiting and aspiration if unexpected surgery is needed.
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| show | the reduced sensation of a full bladder d/t intense contractions, regional px, or px management like an epidural.
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| show | general discomfort, or inhibit fetal descent.
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| show | urine to be excreted in large amounts. The bladder may fill rapidly during the first few days after birth.
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| What authorities consider the maximum normal blood loss during a vaginal birth... | show 🗑
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| The leukocyte count during labor may be as high as... | show 🗑
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| Levels of several clotting factors, especially __________ are elevated during pregnancy and continue to be higher during labor and after delivery... | show 🗑
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| Fibrinolysis | show 🗑
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| Although the increase in clotting factors and decrease in fibrinolysis protect from hemorrhage, the combination also raises the mother's risk of... | show 🗑
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| show | *placental circulation *cardiovascular system *pulmonary system
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| Exchange of oxygen, nutrients, and waste products between mother and baby occur in the ... | show 🗑
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| Most placental exchange occurs during... | show 🗑
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| The fetus may not tolerate contractions well if... | show 🗑
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| show | quickly
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| The fetal heart rate ranges from... | show 🗑
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| show | increases. ( absorbs into newborns pulmonary and lymphatic circulations after birth)
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| There are 4 major factors that interact during labor...they are often referred to as the "4 P's"... | show 🗑
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| show | the 2 powers of labor are the uterine contractions and the maternal pushing efforts.
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| During the first stage of labor, what are the primary force moving the fetus through the maternal pelvis? | show 🗑
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| During the second stage of labor, the woman adds what to force the uterine contractions to propel the fetus through the pelvis? | show 🗑
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| what causes softening of the cartilage that connects the womans pelvic bones when she has reached term? | show 🗑
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| the bony pelvis is divided by the linea terminalis into... | show 🗑
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| The true pelvis is ______________ _____________ in childbirth. | show 🗑
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| The true pelvis has 3 subdivisions: | show 🗑
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| show | the fetus plus the membranes and placenta
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| the bones of the fetal head involved in birth are... | show 🗑
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| show | wider spaces at the intersections of the sutures on the bones of the head.
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| anterior fontanel | show 🗑
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| Posterior fontanel | show 🗑
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| The sutures and fontanels allow for... | show 🗑
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| show | either the head or buttocks of fetus enter the pelvis first.
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| Transverse Lie | show 🗑
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| Oblique Lie | show 🗑
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| Attitude...The attitude of the fetus is... | show 🗑
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| show | one of flexion-->head flexed toward the chest and the arms and legs flexed over the thorax.
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| The fetal part that enters the pelvis first... | show 🗑
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| show | *cephalic *breach *shoulder
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| show | *vertex *military *brow *face
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| vertex | show 🗑
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| military | show 🗑
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| show | fetal head is partly extended.
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| face | show 🗑
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| show | occurs when the fetal buttocks or feet enter the pelvis first.
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| the breach presentation has 3 variations: | show 🗑
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| show | most common variation. fetal legs are extended across the abdomen toward the shoulders.
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| show | the reversal of the usual cephalic presentation. head, knees, and hips all flexed, but buttocks are presenting.
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| show | occurs when one or both feet are presenting.
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| Shoulder presentation | show 🗑
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| Fetal position | show 🗑
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| show | changes during labor as the fetus moves downward
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| show | pysche...anxiety, fear, or fatigue decrease a womans ability to cope with pain...maternal catecholamines are secreted in response to anxiety which can inhibit contractions and blood flow to placenta.
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| show | an integrated whole. so many variables in the laboring process...size of baby as opposed to size of birthing canal..ect.
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| show | allowing woman and her family to increase their sense of control and mastery over the labor.
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| nursing measures to empower families include... | show 🗑
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| Factors that have a role in the onset of labor: | show 🗑
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| show | *Braxton Hicks contractions increase *Lightening (dropping) *Increased clear and nonirritating vag secretions *"bloody show" *an energy spurt (nesting) *small wt. loss of up to 3 lbs (how hormones affect the water retention of the woman)
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| False labor is also called... | show 🗑
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| show | preperation for the main event of true labor.
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| show | *contractions *discomfort *cervical change
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| show | that the contractions of true labor cause progressive changes in the cervix.> effacement and dialation occur.
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| show | when the fetus undergoes several positional changes to adapt to the size and shape of the mothers pelvis as it descends through the pelvis during birth.
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| show | occure concurrently
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| In a vertex presentation, the mechanisms of birth are... | show 🗑
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| Descent | show 🗑
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| Engagement | show 🗑
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| show | flexion of the fetal head so that the smallest head diameters pass thru the pelvis.
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| show | allows the largest fetal head diameters to match the largest maternal pelvic diameters.
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| show | extension of the fetal head as it passes beneath the mother's symphysis pubis.
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| External Rotation | show 🗑
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| show | of the fetal shoulders and fetal body.
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| show | the stage of dilation-->because cervical effacement and dilation occur at this time.
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| The first stage of labor begins with... | show 🗑
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| The first stage of labor is the ______________ for both nulliparous and parous women. | show 🗑
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| Labor progress is often times plotted on this type of graph... | show 🗑
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| First stage labor differs from the other stages because it has 3 phases: | show 🗑
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| Latent Phase | show 🗑
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| Active Phase | show 🗑
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| Transition Phase | show 🗑
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| show | Expulsion
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| show | the woman is completed dilated (10 cm) with 100% effacement. This stage ends with the birth of the baby.
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| During the second stage of labor, which is expulsion, the woman starts to experience a... | show 🗑
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| "Labor" also describes.... | show 🗑
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| Third Stage of Labor | show 🗑
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| Fourth Stage of Labor | show 🗑
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| Leopold's Maneuvers | show 🗑
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| show | Maternal positioning.->a mom can choose any position other than supine to prevent aortocaval compression
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| show | the best approach to pain relief.->several cues may suggest that anxiety is a major contributor to labor pain that the mom might otherwise easily manage.
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| Differnt comfort measures that the nurse might use to provide comfort and relaxation for the laboring mother... | show 🗑
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| What other kinds of support can the nurse offer the mother during the laboring process? | show 🗑
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| The nurse may use what tools for intrapartum fetal surveillance? | show 🗑
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| show | Mobility->the moms ability to change positions especially in early labor or with the fetal occiput in the posterior position.
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| show | *FHR and uterine activity are only assessed for a small part of the total labor * woman sometimes find these interruptions for auscultation/palpation distracting.
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| show | Continuous or intermittent.
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| show | *supplies more data about the fetus than auscultation *provides a permanent record that may be printed/stored *shows gradual trends in FHR and uterine activity
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| Continuous electronic fetal monitoring shows teh fetal response _________, ____________, and ____________ every contraction. | show 🗑
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| show | 1:1->first stage of labor it is 2:1 and that is where electronic fetal monitors provide a great deal of help for nurses.
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| Electronic Fetal Monitoring Equipment consists of... | show 🗑
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| show | True
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| Devices used for external fetal monitoring.. | show 🗑
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| show | Detects fetal heart movement for rate calculation->one downside is that other movements such fetal or maternal activity or blood flow to the placenta can also be dectected.
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| Tocotransducer | show 🗑
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| show | *FHR monitoring with a scalp electrode *Uterine monitoring with intrauterine pressure catheter
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| show | accuracy->but they are invasive raising the risk for infection.
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| show | ruptured membranes and about 2 cm cervical dilation.
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| The fetal scalp electrode (FSE) detects... | show 🗑
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| Areas to avoid electrode application.. | show 🗑
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| show | *solid catheter w/pressure transducer in tip *hollow, fluid filled catheter that connects to a pressure transducer at the side of the bed.
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| Both types of intrauterine pressure catheters sense... | show 🗑
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| FHR and uterine activity patterns must be evaluated _____________ when assessing whether the fetal status is assuring... | show 🗑
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| The normal fetal heart rate is... | show 🗑
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| What is considered bradycardia in the fetal heart rate | show 🗑
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| What is considered tachycardia in the fetal heart rate? | show 🗑
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| show | fluctuations in the baseline FHR
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| show | *fetal sleep * narcotics/sedative drugs *alcohol/illicit drugs *fetal tachycardia *gestation younger than 28 wks *fetal anomalies *hypoxia *abnormalities to CNS *maternal acidemia or hypoxia
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| show | temporary, recurrent changes from baseline rate that are associated with uterine contractions.(both accelerations and decelerations)
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| An acceleration of the FHR is defined as... | show 🗑
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| FHR accelerations often occur with... | show 🗑
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| Accelerations are usually a __________ sign... | show 🗑
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| Periodic decelerations in FHR are classified into 3 types: | show 🗑
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| show | *not associated w/ fetal compromise *require not intervention *occur during contractions as fetal head is pressed against womens pelvis *consistent in appearance and mirror the contraction * usually no lower than 30 to 40 bpm below babies baseline.
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| Late Decelerations | show 🗑
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| Variable Decelerations | show 🗑
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| show | *frequency *duration *intensity of contractions *uterine resting tone
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| show | estimate contraction intensity and uterine resting tone
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| Contraction intensity is described as... | show 🗑
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| show | *reassuring *nonreassuring *equivocal (ambiguous)
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| Reassuring Patterns | show 🗑
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| show | those in which favorable signs are absent or signs that are associated with fetal hypoxia or acidosis are present.
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| Nonreassuring patterns indicate... | show 🗑
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| show | they occur together and are persistent.
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| A healthy fetus may demonstrate an occasional late deceleration, but a persistent pattern of late decelerations is more likely to represent... | show 🗑
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| Nonreassuring patterns include but are not limited to: | show 🗑
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| Nonassuring patterns do not always indicate that... | show 🗑
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