Promotions Exam 2(labor/delivery, post-partum)
A nursing student is learning about expected postpartum anatomic and physiologic changes. Which statement made by the nursing student indicates a need for further learning?
"After birth, the vagina gradually decreases in size and returns to its pre-pregnancy state."
A nonstress test (NST) is scheduled for a client with mild preeclampsia. During the test, the client asks the nurse what it means when the fetal heart rate goes up every time the fetus moves. How should the nurse respond?
"These accelerations are a sign of fetal well-being."
A pregnant client has a positive group B Streptococcus (GBS) test at 36 weeks' gestation. What is the priority instruction that the nurse will include in the client's teaching plan?
"This information will be in your prenatal record; however, please remind your labor and delivery nurse of this finding."
A client who is pregnant for the first time and is carrying twins is scheduled for a cesarean birth. What should the nurse tell the client to expect?
"We'll be encouraging you to walk early after surgery."
What are complications from epidural for pain management
*decrease BP(hypotension) due to vasodilation, don't stop because of this, give caffeine, increase fluids to increase BP *bladder distention (foley cath) watch for infection -headache, backache, nausea, itching
Real/True labor
*has progressive dilation and effacement of cervix -contractions come at regular intervals and get closer as time goes on
BPP
-Biophysical Profile -Fetal breathing movement -Fetal movements of body or limbs -Fetal tone -Amniotic fluid volume Reactive fetal heart rate (FHR) with activity (reactive non-stress test [NST]) *Scores of 8 (with normal amniotic fluid) and 10 considered normal*
Medications for Induction
-Prostaglandin(Cervidil) : inserted vagina, softens and ripens cervix, requires EFM after insertion and risk of hyper stimulation (need monitoring) -Misoprostyl (Cytotec) : administered orally or vagina, cervical ripen, stimulates contractions, risk of fetal distress, can cause hyper stimulation (need monitoring) -oxytocin(pitocin): thru IV pump, induces and augments labor, requires EFM and IFM, can increase pain, fetal distress, risk of exhaustion
Nursing care after c/s
-Vitals ever 15 mins for first 1-2 hours -pulse ox for 12 hours -IV site 24 hours and rate of solution -check fundus for firmness, height and midline position -check dressing for drainage -lochia -monitor urine output, from indwelling catheter usually for 24 hours(at least 30ml per hours) -watch for blood in urine -pain management and infant bonding
Ferning
-Whether or not the mom has ruptured -wet prep slid of vaginal fluid to check for presence of ferrying patter which indicate ROM(rupture of membranes) -Woman often feelings a trickle of urine -helpful to do pooling method to get sample fluid
preeclampsia
-affects about 5-8% of US pregnancies -often will cause IUGR and in rare cases prenatal dealth -changes in the women causes vasospasm: decrease blood glow to major organs, increase in BP. Symptoms: increase BP, increase liver enzyme levels, protein in urine, swelling, right epigastric (liver pain), vision changes, headaches, increase in reflexes, clonus -cure: delivery of infant, but woman needs to quiet, dark environment, and magnesium sulfate t prevent seizures
Pain assessment
-common, gets worse with more children Cramping -worse often with breastfeeding due to release of oxytocin -ibuprofen, heat, ice, warm bath, relaxation techniques Breasts -if engorgement and not breastfeeding use ice and supportive bra, don't stimulate milk let down -if breastfeeding, bra without underwire(can clog milk ducts), heart to let milk down and ice in between feeding Perineum -ice for the first 24 hours, then switch to sitz bath and pain relievers, encourage side lying, and not to sit for long periods of time -watch for increase ecchymosis or signs of hematoma Incision -check for signs of hematoma, bleeding, swelling and infection -keep clean and use water bottle and pat dry -use of topical medications and pain relievers may help
Leopold's Maneuvers
-determines the position of the fetus 1. first to feel the fundus tell if head or butt 2. feel down the side to see what side back is on 3. feel for head or butt above suprapubic area 4. only done if head down to check for head flexion -non invasive
timing contractions
-frequency: measure from beginning one contraction to beginning of next -duration: length contraction beginning to end -intensity: mild(nose) moderate(chin) strong (forehead) only way to know the strength of an contraction is to palpate it or use an internal monitor (IUPC) -interval end of on beginning of another(uterine relaxation) when uterus is relaxed baby needs 1 1/2-2 mins for oxygen
What happens if mom ruptures at home and she calls you
-have her check for prolapsed cord -if she can feel the cord or see the cord this will be a medical emergency -have mom go on her hands and knees, put her head to the floor and butt in the air, then have her call 911 -this brings the baby up to the moms chest and will allow the baby to still get oxygen
Pooling
-helpful with sample fluid for ferning -may be a big gush or small trickle not usually how labor starts -women will lay on side and membranes pool in vagina, when she stands up it will gush out
Nursing intervention during during the third stage of labor
-monitor vitals signs of mother and infant -monitor perineum and vaginal area for extra bleeding, tears, trauma or swelling -monitor fundus (should be FIRM) at all times to prevent excess bleeding -assess neonate and make sure adjusts to birth, stays warm and bonds with mother
Medications for pain relief
-narcotics IV or IM does cross to infant, can depress drive to breath, tone, and breastfeeding -may need narcan after brith -want to give early in labor not at the end -regional anesthetics: intrathecal, epidural, pudendal, local, spinal
Induction
-only done for medical reasons -usually not considered prior to 39 weeks gestation -always a risk for: fetal distress, uterine rupture, maternal exhaustion, bleeding, infection and increased risk of c/s -benefits: (if done correctly) avoiding c/s, preventing fetal distress if postdates, preventing complications to mother if she has medical issues
Cesarean Births
-primary vs repeat -elective(scheduled) vis emergency -most emergencies c/s are not emergent to the point of needing general anesthesia -surgical incision in abdomen and uterus -low transverse incision (most common) -low vertical incision -classical incision
Nursing intervention during the second stage of labor
-pushing stage -assess maternal/fetal status -provide emotional support -assist with positioning in pushing -monitoring hydration -prepare for delivery -encourage frequent position chawed and water -pushing can last 1-4 hours
immune system
-rogham: needed if Rh negative mom has a Rh positive baby, need to give to prevents formation of permanent antibodies (after delivery) -vaccinations given during postpartum and prior to discharge from hospital : rubella, Tdap, flu shot
normal postpartum lochia
-small amount on pad less then 4 inch stain -moderate amount on pad less then 6 inch stain -heavy amount on pad, saturated within 1 hour (BAD)
How to encourage labor without medication
-stripping membranes -nipple stimulation -use of essential oils -pressure points -acupunture -massage -AROM -dont advise without providers consent
uterine contractions: opposing characteristics
-the upper 2/3 of uterus contracts and the lower 1/3 is passive -upper segment of uterus gets thicker and the lower segment and cervix are getting thinner and pulled up
Nursing interventions in the fourth stage
-vital signs every 15 mins (BP, P, T) -fundus assessment -bladder assessment -amount and character of the lochia expect rubra lochia(less than 1 pad per hour) -status of perineum( monitor for swelling, hematoma, apply ice packs if desired) -hygiene and comfort
how should the fundus be after delivery
-want fundus firm -you want this after delivery because you want the blood vessels to constrict after placenta comes out
How should the fundus be during labor
-you want the fundus to be soft -if firm this is bad and causes blood vessels to constrict which means the baby is not getting 02
A nurse is caring for a postpartum client. Where does the nurse expect the fundus to be located if involution is progressing as expected 12 hours after birth?
1 cm above the umbilicus
how much blood is lost during a c/s
1000ml
Normal fetal heart tones
110-160
Postpartum depression
13% of mothers in first year postpartum symptoms: excessive guilt, anxiety, depressed mood, insomnia, suicidal ideation and fatigue occurs especially in the winter worried about everything partner will see first, need to educate families
How high can WBC count be during labor and postpartum
30,000 mm3 will fall back to normal values 6 days after birth
postpartum blues
50-85% mothers in first 2 weeks postpartum symptoms: irritability, anxiety, fluctuating mood and increased emotional reactivity occurs in almost every mother
how much blood does a women lose on an average with a vaginal delivery
500ml
The nurse assists a client to the bathroom to void several times during the first stage of labor. Why is this is an important component of nursing?
A full bladder may inhibit the progress of labor.
A nurse is caring for four mother-baby couplets on the postpartum unit. Which new mother is at the greatest risk for postpartum hemorrhage?
A grand multipara who experienced a labor that lasted 1 hour
A nurse on the postpartum unit is assessing several newly delivered postpartum clients. Which clinical finding requires immediate investigation?
A slow trickle of blood from the vagina
On the third postpartum day, the nurse enters the room of a client who had an unexpected cesarean birth and finds her crying. The client says, "I know my baby is fine, but I can't help crying. I wanted natural childbirth so much. Why did this have to happen to me?" What should the nurse consider when responding?
A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this.
diastasis recti abdominis
Abdominal wall muscles separated is painful, may need surgery if it stay separated may be minimal or severe usually resolves within 6 weeks abdominal exercises may help
A nurse is checking the external fetal monitor of a client in active labor. Which fetal heart pattern indicates cord compression?
Abrupt decreases in fetal heart rate that are unrelated to the contractions
The nurse is preparing a client in active labor for epidural anesthesia. Which prescribed intervention should the nurse initiate before the anesthesiologist initiates the epidural?
Administering a 500-mL bolus of lactated Ringer solution intravenously
A client undergoes a cesarean birth because of cephalopelvic disproportion. What care is needed for this client in addition to the routine nursing care given to all postpartum clients during the first 24 hours?
Administering the prescribed pain medication
While monitoring the fetal heart rate (FHR) of a client in labor, the nurse identifies an increase of 15 beats more than the baseline rate of 135 beats per minute that lasts 15 seconds. How should the nurse document this event?
An acceleration
A laboring client experiences a spontaneous rupture of membranes. What is the nurse's priority?
Assessing the fetal heart rate
Rupture of Membranes
COAT color, odor, amount, timing
The nurse instructs a pregnant woman in labor that she must avoid lying on her back. The nurse bases this instruction on the information that the supine position is primarily avoided because it can do what?
Cause decreased placental perfusion
A nurse is teaching a class of expectant parents regarding potential complications that may result in the need for a cesarean birth. What common indication for a cesarean birth should the nurse discuss?
Cephalopelvic disproportion
The postpartum nurse has just received report on four clients. Which client should the nurse evaluate first?
Client who vaginally delivered a 9-lb (4082 g) baby 1 hour ago
Rhesus disease
Condition of fetus in which the mother's cells are producing antibodies to the fetal red blood cells.
External fetal uterine monitoring is started for a client in active labor. A nurse identifies fetal heart rate decelerations in a uniform wave shape that reflects the shape of the contraction. What is the nurse's next action?
Continuing to monitor the client for the return of the fetal heart rate to baseline when each contraction ends
DIF acronym for contractions
DIF Duration (how long) Intensity (how strong) Frequency (how often) External monitors cannot measure strength of contractions(only way to know strength is by palpitation of the abdomen or internal monitor-which measures in mm/hg)
A client in labor is receiving an oxytocin (Pitocin) infusion. Which intervention is a priority for the nurse when repetitive late decelerations of the fetal heart rate are observed?
Discontinue the oxytocin infusion.
Is it not necessary to always rupture a patient to do internal monitoring
False
fetal heart tones
Fetal hypoxia: -late deceleration (first sign) -acceleration disappears (second sign) -NST-non reactive -fetal breathing movement stops or fetal movement stops (late sign) -fetal tone absent (compromised infant)
The nurse admits a client in active labor to the birthing center. She is 100% effaced, dilated 3 cm, and at +1 station. What stage of labor has this client reached?
First
Stages of Labor
First Stage: (3 phases) -latent phase cervix 0-3cm, patient social and easy to distract -active phase cervix 4-7cm, patient needs breathing and active relaxation -transition phase cervix 8-10 cm(last about an hour, early deceleration, most intense phase, often feel out of control, mom wants to give up) Second phase -from full dilation to delivery of neonate Third Stage -from delivery of neonate to delivery of the placenta(15 mins) Fourth stage -first 4 hours after delivery of the placenta as women recovers(monitoring mom)
The nurse is caring for an assignment of postpartum clients. Which factor puts a client at increased risk for postpartum hemorrhage?
Giving birth to a baby weighing 9 lb 8 oz (4309 g)
While caring for a client during labor, what does the nurse remember about the second stage of labor?
It ends at the time of birth.
A client tells a nurse that she does not want an episiotomy and would rather tear naturally. What information should be offered to the client regarding each of these birthing methods?
Lacerations are easier to repair than an episiotomy.
Which information should be reinforced with a new father who is acting as a coach during labor?
Let his wife know the progress she is making and tell her that she is doing a good job
The nurse is assessing several postpartum clients at the very beginning of her shift. Which problem does the nurse identify that might predispose a client to postpartum hemorrhage?
Multifetal pregnancy
A nurse in the birthing suite has just admitted four clients. Which client should the nurse anticipate may require a cesarean birth?
Multipara with a shoulder presentation
Safety with newborns
Newborn ID bands security alarms teaching parents transport in the hospital setting staff need appropriate photo ID encourage 24 hour rooming in infant must always be in visual range of health care professionals when not with parents
NST
Non stress test monitors babies heartbeat
The nurse is assessing the rate of involution of a client's uterus on the second postpartum day. Where does the nurse expect the fundus to be located?
One or two fingerbreadths below the umbilicus
The practice of separating parents from their newborn immediately after birth and limiting their time with the infant during the first few days after delivery contradicts studies related to what?
Parent-child attachment
The nurse in the postpartum unit is teaching self-care to a group of new mothers. What color does the nurse teach them that the lochial discharge will be on the fourth postpartum day?
Pinkish brown
A postpartum client is being prepared for discharge. The laboratory report indicates that she has a white blood cell (WBC) count of 16,000/mm 3. (16 X 10 9/L) What is the next nursing action?
Placing the report in the client's record because this is an expected postpartum finding
Components of the birthing process
Powers: contractions, maternal pushing effort Passage: pelvis and soft tissue Passenger: fetus, membranes and placenta Psyche: emotional facts and preparation for birth(powerful part of birthing process) -need all of these for vaginal birth
A client is admitted in active labor at 39 weeks' gestation. During the initial examination the nurse identifies multiple red blisterlike lesions on the edges of the client's vaginal orifice. Once the nurse has spoken to the primary healthcare provider and received prescriptions, what is the priority nursing action?
Preparing for a cesarean birth
What is the priority nursing intervention for a laboring client with a sudden prolapse of the umbilical cord protruding from the vagina?
Preparing the client for surgery
A nurse explains preterm labor to a group of nursing students. Which description of preterm labor indicates effective teaching?
Preterm labor is defined as contractions between 20 and 36 weeks of gestation.
The nurse is admitting a client in active labor. When the fetal monitor is applied to the client's abdomen, it records late decelerations. What should the nurse do first?
Reposition her on her left side.
mother-infant bonding
Rubins psychological changes pf the postpartum stage: stage 1: -taking in -mother is passive, willing to let others do it for her, she is focused on her own needs for food, fluids and sleep -right after brith, hours after Stage 2: -taking hold -mother begins to initiate action and becomes interested in caring for the infant and doing her own cares Stage 3: -letting go -mothers and fathers work through giving up their pervious lifestyle and family arrangements to incorporate new infant, also giving up on the idealizations of birth and infant
A woman at 40 weeks' gestation is having contractions. Wondering whether she is in true labor, she asks, "How will you know if I'm really in labor?" Which information should the nurse provide to the client at this time?
The cervix dilates and becomes effaced in true labor.
4 T's of postpartum hemorrhage
Tone Trauma Tissue Thrombin
A few hours after being admitted in early labor, a primigravida perspires profusely and becomes restless, flushed, and irritable. The client reports that she feels as though she is going to vomit. Which phase of the first stage of labor does the nurse suspect the client has entered?
Transition
the best incision for c/s is horizontal incision as it decrease changes of uterine rupture
True
At 38 weeks' gestation a client is admitted to the birthing unit in active labor, and an external fetal monitor is applied. Late fetal heart rate decelerations begin to appear when her cervix is dilated 6 cm, and her contractions are occurring every 4 minutes and lasting 45 seconds. What is the likely cause of these late decelerations?
Uteroplacental insufficiency
fetal accelerations and decelerations acronyms VEAL and CHOP
VEAL CHOP Variable cord compression early head compression acceleration OK late placental insufficiency
Is pain a normal part of birth process
YES
What makes a contraction hypertonic(late decelerations) and therefore decreases utter-placental exchange
a series or single contraction lasting 2 mins or more, or a contraction frequency of 5 mins or more too powerful too frequent *if occurring STOP Pitocin
diastasic recti
abdominal seperation
Nursing Intervention in the first stage of labor
admission procedure check vital signs check cervix support woman and partner exam breathing support lab assess infants status interventions help with discomfort
AROM
artificial rupture of membranes induce or accelerate labor preformed by a midwife or OB
cephalic position
birth position in which any part of the head emerges first (head down)
breech presentation
birth position in which the buttocks, feet, or knees emerge first increase hip dysplasia
lochia
bleeding, tissue, cells should not have a bad odor
ecchymosis
brusing
Induction contraindication
cephalopelvic disproportion (babies head and moms pelvic disproportional) malpresentation fetal distress cord presentation pelvic tumor
Cervical dilation and effacement
cervix must efface or thin and dilate, or open in order for the infant to pass thru into vagina needs to be dilated to 10cm and 100% effaced for vaginal birth
False labor
contractions are irregular and don't get closer together
EFM
electronic fetal monitoring
Regional Anesthesia Epidural and Spinal
epidural: catheter left in back (last as long as she has it in) will get headaches, backaches, nausea, itchy, need a catheter in! spinal: nothing left in(last a couple of hours) will get spinal headache afterwards can decrease contractions
diaphoresis
excessive sweating
newborn attachment behaviors
eye contact with prolonged intense mutual gazing eye movements with attempts to track parents face grasping and holding of parents finger rooting and sucking reflex being comforted by voices of parents
EFM is always superior to auscultation and palpitation
false
Episiotomy should be routinely done to prevent tearing
false
3 facts about afterpains
feel like contractions may be worse if uterus is over distended oxytocin being released during breastfeeding may cause strongwomen contractions
primip
female during her first pregnancy
multip
female who has given birth twice or more
Conditions associated with fetal compromise
fetal heart rate outside normal range meconium-stained amniotic fluid(babies bowel movement, can cause pneumonia in baby if they inhale) cloudy, yellowish or foul odor to amniotic fluid excessive frequency or duration of contractions mother who is GBS positive (during labor mom needs 2 doses or IV antibiotics during her labor each 4 hours apart to protect the infant from getting GBS)
How often do you need to check FHT for low risk patients
first stage: 15-30 mins second stage: 5-15 mins other: less then 15 ins while pushing every 5 mins
Postpartum attachment
golden hour right after birth, mom and baby skin to skin for 1 hour breast crawl will be seen, if a healthy baby, the baby will try to push up to moms nipple and lick/taste
Early decelerations
good decelerations early onset head compression uniform shape waveform consistently uniform inversely mirrors contraction just prior to or early in contraction consistently at or before midpoint of contraction usually within normal range of 120-160 bpm can be single or repetitive
complications postpartum
hemorrhage infection thrombolytic disease (pre-ecclampsia, HELLP) postpartum psychiatric disorders
vaginal hematoma
hemorrhage inside
Boggy
in reference to the uterus soft only want when in labor
Episiotomy
incision into the perineum and vagina mediolateral and midline controversial, not routinely done
diuresis
increase of excessive production of urine
mastisis
infection in the breast occurs in patients breastfeeding milk duct clogs-will need antibiotics
IUGR
intrauterine growth retardation
IUPC
intrauterine pressure catheter
1st degree laceration
least dangerous-heals on own superficial vaginal mucous membrane and or perineal tissue
Signs of impending labor
lightening: baby dropping down in pelvis burst of energy contractions cervical changes: effacement/dilation passage of mucus plug: "bloody show" fills the cervix and protects from bacteria SROM (spontaneous rupture of membranes)
factors that affect adaptation and attachment
lingering discomfort or pain chronic fatigue knowledge deficit of infant needs available support system expectations of the newborn
bladder distention
location of the fundus above baseline level, determine with empty bladder fundus displaced from midline excessive lochia/clots bladder discomfort bulge of bladder above pubis symphysis frequent voiding less then 150ml want fundus to be firm and midline
what are priorities of infant after birth
maintain temperature adapt to extra uterine environment (APGAR) maintain normal respirations
A woman at 40 weeks' gestation is admitted in active labor. When the client reaches 5 centimeters dilation, the woman asks for and receives epidural analgesia. Once the epidural catheter has been inserted, which assessments and interventions should be performed?
maintaining intravenous fluid administration having oxygen available in case of hypotension checking the bladder for distention every 2 hours monitoring fetal heart rate and labor progress per hospital protocol
medication considerations
may affect progress of labor timing in relation to delivery is important potential/actual side effects narcotics reduce respiratory effect in newborns caution material hypotension with epidural and spinal preload with fluid bolus may affect breastfeeding ABC pregnancy drug classes: sometimes used DX pregnancy drug classes rarely used only if mom will pass away
Forceps
metal blades used to grasp the head of the fetus
Late decelerations
most dangerous and most concerning compression of vessels Uteroplacental insufficiency uniform shape late onset waveform uniform, shape reflects contraction consistently after the midpoint of the contraction usually within normal range 120-130 bpm occasional, consistent, gradually increase-repetitive -dont match with contractions, placenta is not giving baby enough 02
What is our role in regards to labor pain
non-pharmacological pain management, and medication
anemia signs and symptoms
normal blood loss after delivery 500ml soaking 1 pad per hour is too much clots bigger than a golf ball need to be seen patient c/o of dizziness low BP, pallor, increase in HR, SOB may be hemorrhaging
postpartum red flags
over distended uterus prolonged labor(muscle fatigue) oxytocin induction(muscle fatigue) retained placenta operative procedures decreased platelets PROM urinary cauterization history of depression
A client at 39 weeks' gestation is admitted for induction of labor. Knowing that several medications are used to induce labor, a nurse identifies those that may be prescribed.
oxytocin misoprostol dinoprostone
The nurse is caring for a client who is in the taking-in phase of the postpartum period. What area of health teaching will the client be most responsive to?
perineal care
facts that affect maternal and family adaptation
pervious experience with infants maternal temperament infant characteristics c/s, ill infant, previous infant loss, multiple births
Lochia serosa
pink 3-10 days postpartum blood, mucus, and invading leukocytes
Fetal indication for induction
post dates (t+10) IUGR rhesus disease intrauterine death placental insufficiency
c/s assessments
post op and postpartum care increased risk of clots, depression, infection, altered mobility, and attachment difficulties establish early mother and infant reaction do not want blood in urine
maternal indications of induction
pre-eclampsia hypertension deteriorating or uncontrolled diabetes hemorrhage previous still birth
PROM
premature rupture of membranes breakage of the amniotic sac before the onset of labor common complication of pregnancy in which the amniotic sac breaks prior to the onset of labor but at or after 37 weeks of gestation
PTL
preterm labor
Induction Caution
previous c/s (risk of uterine rupture) previous precipitate labor (risk of hyper stimulation)
clonus
push back on moms foot, when you let go moms foot with pulse
homans sign
pushing back on foot to see if there is pain behind knees(indicates blood clot)
breast-feeding
recommended to breastfeed for first 6 months and continue to breastfeed for 2 years baby cannot have cow milk under 1 years old they will have an allergic reaction dont force a mom to breastfeed this is painful for moms but there should not be any bruising baby will need vitamin D supplements due to mom not excreting enough
lochia rubra
red color 1-3 day postpartum blood, fragments of decidua and mucus
rubra
red color of lochia
Nonpharmacological pain management
relaxation techniques cutaneous stimulation hydrotherapy position change mental stimulation breathing techniques
SROM
spontaneous rupture of membranes
vacuum extraction
suction cup applied to fetal head
Sources of pain in labor
tissue ischemia cervical dilation pressure and pulling on pelvis dissension of vagina and perineum
What are the 4 sources of potential labor pain
tissue ischemia cervical dilation pressure and pulling on pelvis distention of vaginal and perineum
Why would you need to do internal fetal monitoring
to find the strength of the contraction(can also do this by palpitation) -external will NOT show this -need to be ruptures (going internally)
TOLAC
trial of labor after cesarean term for an attempted birth in a patient who has had a previous caesarean section The main risks of TOLAC are emergency caesarean section and uterine rupture.
another word for false labor is prodromal labor
true
The nurse is assessing her assignment of four postpartum clients. Which conditions increase the risk for postpartum hemorrhage?
twin birth over distended bladder retained placental fragments
variable deceleration
umbilical cord compression variable shape(V) variable onset waveform variable, generally sharp drop and returns abrupt with fetal insult, not related to contraction variable around midpoint not usually within normal range variable-single or repetitive
Bishops score
used method to rate the readiness of the cervix for induction of labor -score 8 or greater BETTER CHANCE OF VAGINAL BIRTH -less then 6 CERVICAL RIPENING -highest score is 13 -if doing an induction the higher the score to start the bestir chance of successful vaginal delivery -Cervix: position, consistency, effacement, dilation, station(- number baby is coming out, + number baby is still high
What starts labor
uterine stretching pressure on cervix oxytocin stimulation (mom releases) placental age increased fetal cortisol levels prostaglandin production by fetal membranes
uterine atony
uterus is completely soft bad
involution of the uterus
uterus returns to pre-uterus size when checking fundus should go down with post party days day 3=FFU 3 if it is going up then be worried about bladder, infection or hemorrhage 1/U 1 finger above uterus U/U above U/1 under
VBAC
vaginal birth after cesarean section
2nd degree laceration
vaginal mucous, perineal tissue and deeper tissue possible muscle
4th degree laceration
vaginal mucous, perineal tissue and deeper tissue possible muscle, anal sphincter and rectal mucous membrane
3rd degree laceration
vaginal mucous, perineal tissue and deeper tissue possible muscle, and anal sphincter
What is the nurse's most critical assessment for a client with preeclampsia during the immediate postpartum period?
vital signs
lochia alba
white 10-14 days (may last 6 weeks) mucus, leukocyte count high
Why do you need to use an IUPC
you need this for internal fetal monitoring, strength of contraction(mmhg)