OB Ch 6: Nursing Care of Mother and Infant During Labor and Birth Ch 7: Nursing Management of Pain During Labor and Birth

Continue to monitor (not bad, this is a 'high' score)

-What would an apgar score between 8-10 mean?

fetal condition maternal condition nearness to birth / impending birth

3 key assessments on admission are:

expulsion (30 minutes to 2 hours)

4 stages of labor, second stage is the stage of:

placental (5 to 30 minutes)

4 stages of labor, third stage is the __ stage.

dilation (and effacement, can last 4-6 hours)

4 stages of labor, first stage is the stage of:

uterine contractions

A fetal heart rate tracing demonstrates the relationship between the baseline fetal heart rate and ___ ______.

injury

A goal of fetal monitoring is to allow prompt interventions that will avoid fetal _____.

fetal hypoxia

A goal of fetal monitoring is to enable early detection of ____ ____

metabolic acidosis

A goal of fetal monitoring is to prevent fetal ____ ___.

2 Grunting sounds and bearing down suggest that the woman is about to give birth. The nurse must stay with the woman and observe for other signs of impending birth, such as increased bloody show or perineal bulging, as well as monitor maternal and fetal well-being. The nurse may use the call bell to summon assistance or request the physician.

A laboring woman suddenly begins making grunting sounds and bearing down during a strong contraction. The nurse should initially: - leave the room to find an experienced nurse to assess the woman - look at her perineum for increased bloody show or perineal bulging - ask her if she needs pain medication - tell her that these are common sensations in late labor

1 Contractions every 3 minutes that last 60 seconds, a uterus that relaxes between contractions, and an FHR of 90 beats/min that lasts 20 seconds during a uterine contraction all describe early decelerations, which result from compression of the fetal head and are a reassuring sign of fetal well-being.

A woman in active labor has contractions every 3 minutes lasting 60 seconds, and her uterus relaxes between contractions. The electronic fetal monitor shows the FHR to reach 90 beats/min for periods lasting 20 seconds during a uterine contraction. The appropriate priority nursing action is to: - continue to monitor closely - administer oxygen by mask at 10 L/min. - notify the health care provider - prepare for a cesarean section

The fluid is alkaline and most likely amniotic fluid. A blue-green or deep blue color of the nitrazine paper indicates the fluid is alkaline and most likely amniotic fluid. A yellow to yellow-green color of the strip paper indicates the fluid is acidic and is most likely urine. The nitrazine paper test does not indicate stage of labor nor can it identify placenta previa.

A woman reports that she thinks her membranes have ruptured. The physician performs a nitrazine paper test and the nurse observes the strip paper to be deep blue in color. What is the significance of this assessment? The woman is at risk for placenta previa. The woman is in the active phase of labor. The fluid is acidic and is most likely urine. The fluid is alkaline and most likely amniotic fluid.

3 When the amniotic sac ruptures, infection can become more likely if many hours elapse between the rupture of membranes and birth. In addition, the umbilical cord may slip down and become compressed. For these reasons, women should go to the birth facility when their membranes rupture, even if there are no other signs of labor.

A woman who is pregnant with her first child phones an intrapartum facility and says her "water broke." The nurse should tell her to: - wait until she has contractions every 5 minutes for 1 hour. - take her temperature every 4 hours and come to the facility if it is over 38 C (100.4 F) - come to the facility promptly, but safely - call an ambulance to bring her to the facility

apply ice

Action to prevent/relieve perineal bruising and edema after delivery

-monitoring the fetus -monitoring the laboring woman -helping the woman cope with labor

After admission to the labor unit, nursing care consists of the following elements: -monitoring the -monitoring the -helping the

uterine contractions from the placenta

Anxiety and fear also cause the secretion of stress compounds from the adrenal glands. These compounds, called catecholamines, inhibit ___ ____ and divert blood flow ___ ___ ____.

decrease - increase +

As the fetus descends, the minus numbers ____ (^ or v) and the plus numbers ___. (^ or v)

The cervix is fully dilated at 10 cm. Stage 2 is from full dilation of the cervix until birth of the fetus. Pushing before full dilation can be dangerous to the fetus and exhausting to the mother. The +1 station is too high. Delivery of the placenta is stage 3.

At what point during the labor process does the health care provider know that the second stage of labor has begun? The fetus is at +1 station. The placenta is delivered. The woman feels the urge to push. The cervix is fully dilated at 10 cm.

american indian

Birth Practices of _____: is stoic may have indigenous plants in room may wear special necklaces may commonly use meditation chants prefers water at room temp to drink prefers chicken soup and rice postpartum - husband may provide support during labor

cuban

Birth Practices of _____: is vocal but passive during labor and delivery uses formal name at introduction must stay at home 41 days post partum and sheltered from stress

chinese

Birth Practices of _____: may be vocal during labor don't pause in doorway prefers breastfeeding needs to be encouraged to ask questions do not use first name of woman

arabic

Birth Practices of _____: passive but expressive views keeping body covered as important may wear protective amulets may have low pain tolerance - husband must be present if male HCP examines woman

eritrean or ethiopian

Birth Practices of _____: stoic but takes active role modesty very important prefers breastfeeding for 2 years remains in seclusion 40 days postpartum all food and drinks during puerperium must be warm

cambodian

Birth Practices of _____: stoic in labor if walking during labor, must not pause in doorway colostrum discarded wil not nurse after delivery or eat vegetables in first week

central american

Birth Practices of _____: vocal and active during labor, may prefer to wear red (protective color) if more affluent, prefers bottle feeding avoids "cold" foods

yes

Can a woman's mental state influence the course of her labor?

hospital

Continuous electronic fetal monitoring is most common in __ births, but intermittent auscultation is a valid method of fetal assessment.

efface/thin dilate/open

Contractions cause the cervix to ___(thin) and ____(open).

frank (legs folded toward head, butt first) full (legs crossed, butt first) single footling (one foot out) transverse = shoulder presentation see also box 6-1 p125

Describe the main breech presentations: frank full single footling transverse lie

scant moderate large

Descriptive terms for amniotic fluid: ___ - trickle ___ - about 500 mL ___ - greater than or equal to 1,000 mL

1 Anxiety can increase a woman's perception of pain and reduce her tolerance of it. Anxiety and fear also cause the secretion of stress compounds from the adrenal glands. These compounds, called catecholamines, inhibit uterine contractions and divert blood flow from the placenta.

Excessive anxiety and fear during labor may result in a(n): - ineffective labor pattern - abnormal fetal presentation or position - release of oxytocin from the pituitary gland - rapid labor and uncontrolled birth

latent (4-6 hrs) active (2-6 hrs) transition (30 min - 2 hr)

First-stage labor is subdivided into three phases:

c, d, b, e, a

Five factors are evaluated at 1 minute and 5 minutes after birth and are ranked in order of importance: (put in order) (a) Skin color (b) Muscle tone (c) Heart rate (d) Respiratory effort (e) Reflex response to suction or gentle stimulation on the soles of feet

amnioinfusion

If membranes have ruptured, this may be performed, a technique in which IV fluid is infused into the amniotic cavity through an intrauterine pressure catheter, may be performed to add a fluid cushion around the cord.

right sacrum posterior The first word refers to what side of the mom's pelvis the presenting part is facing, the second is the fetal reference point (occiput for vertex presentations, mentum for face, and sacrum for breech), and the third references the front (anterior) or back (posterior) of the mother's pelvis. If the fetus is neither anterior nor posterior, then it is transverse.

If the sacrum of the fetus in a breech presentation is in the mother's right posterior pelvis, it is described as ____________ _____________ ____________.

no, because there are no large vessels in the recommended injection site

Is aspiration necessary when performing an injection on a newborn? Why or why not?

Descent Engagement Flexion Internal rotation Extension External rotation Expulsion

Mechanisms of Labor As the fetus descends into the pelvis, it undergoes several positional changes so that it adapts optimally to the changing pelvic shape and size. Many of these mechanisms, also called cardinal movements, occur simultaneously (DEFIEEE)

vastus lateralis (thigh)

One single dose of vitamin K is injected into the ___ ____ muscle before the infant leaves the delivery room, usually at age 1 hour.

oxygenated

Periodic changes in the FHR are temporary changes from the baseline rate associated with uterine contractions that occur in a pattern over time. The presence of accelerations and moderate variability in the FHR pattern reassures that the fetus is well:

1!

Post delivery, the mother shouldn't saturate more than _ perineal pads in an hour.

cephalic

Presentation refers to the fetal part that enters the pelvis first. The ___ presentation is the most common.

reassuring #15 on test plan

Reassuring or Nonreassuring pattern?: Accelerations: abrupt increase of FHR more than 15 beats/min lasting 30 seconds or less

nonreassuring

Reassuring or Nonreassuring pattern?: Decreased or absent variability; little fluctuation in rate

nonreassuring

Reassuring or Nonreassuring pattern?: More than 5 uterine contractions in a 10-minute segment; duration more than 90 seconds, less than 60 seconds relaxation between contractions

reassuring

Reassuring or Nonreassuring pattern?: Uterine contraction frequency greater than every 2 minutes; duration less than 90 seconds; relaxation interval of at least 60 seconds

birth of the infant

Second-stage labor the stage of expulsion, extends from full cervical dilation until:

Yes!

Should you believe the person in labor if they say the baby is coming?

Yes, because it is better to have another "trial run" than to wait at home until she is in advanced labor. Guidelines for coming to the facility should be reinforced before she leaves.

Should you encourage the woman in false labor to return to the facility when she thinks she should? Why or why not?

supine

The ___ position should be discouraged, because it causes the heavy uterus to compress the mother's main blood vessels, which can reduce fetal oxygen supply.

10

The first stage of labor is the stage of dilation, lasting from labors onset to full cervical dilation -- ___cm

the Powers, the Passage, the Passenger, and the Psyche

The four P's of the birth process are... All interrelate during labor either to facilitate or to impede birth.

1 - 4

The fourth stage is the immediate postbirth recovery period and includes the first _ to _ hours after placental delivery.

warmth cardioprespiratory anomalies bonding identification

The immediate care of the newborn after birth includes: maintaining ___ maintaining _____ function assessing for major ______ encouraging parent-infant ___ providing proper ____ and documentation

fetal compromise caused by interruption to the fetal oxygen supply.

The main fetal risk during first- and second-stage labor is:

hemorrhage caused by uterine relaxation

The main maternal risk during fourth-stage labor is:

longitudinal

The most common orientation is the ____ lie (greater thn 99%).

110 and 160

The normal baseline FHR should between ___ and ___ beats/min.

Leopold's maneuver

The nurse may assist the health care provider in determining the fetal position and presentation by abdominal palpations called:

the mother's bony pelvis and soft tissues (cervix, muscles, ligaments, and fascia) of her pelvis and perineum

The passage consists of:

the fetus, the placenta (afterbirth), amniotic membranes, and amniotic fluid.

The passengers are:

5 nullipara 10 multipara

The person in labor should go to the hospital if they are having persistent, regular contractions; every __ minutes for nulliparas every __ minutes for multiparas

rupture

The person in labor should go to the hospital if they are having persistent, regular contractions; if their membranes ______.

decreases

The person in labor should go to the hospital if they are having persistent, regular contractions; if their membranes rupture, if they have bleeding other than normal bloody show; if fetal movement ____ (^ or v).

bleeding ; bloody show

The person in labor should go to the hospital if they are having persistent, regular contractions; if their membranes rupture; if they have _____ other than normal ___ ____.

cause the cervix to open and that propel the fetus downward through the birth canal.

The powers of labor are forces that:

molding

The sutures and fontanelles of the fetal head allow it to change shape as it passes through the pelvis.

the placenta is delivered

The third stage of labor, the placental stage, is from the birth of the infant until:

the uterine contractions and the mother's pushing efforts

The two powers are:

4

There are _ stages of labor.

vertex (head other than face) face breech box 6-1 p125

There are three classifications of presentation:

bloody show

Thick mucous mixed with pink or dark brown blood. It may begin a few days before labor, or a woman may not have one until labor is under way.

3 Frequency is the time it takes from the beginning of one contraction to the beginning of the next contraction. Duration is from the beginning to the end of the same contraction. Interval is from the end of one contraction to the beginning of the next contraction.

To determine the frequency of uterine contractions, the nurse should note the time from the: - beginning to end of the same contraction - end of one contraction to the beginning of the next contraction - beginning of one contraction to the beginning of the next contraction - contraction's peak until the contraction begins to relax

true labor results in cervical change (effacement and/or dilation)

True labor and false labor have several differences; however, the conclusive difference is that...

true

True or False Labor: bloody show often present

false

True or False Labor: bloody show usually not present

true

True or False Labor: contractions become stronger and more effective with walking

true

True or False Labor: contractions gradually develop a regular pattern

false

True or False Labor: contractions irregular

true

True or False Labor: discomfort in lower back/abdomen

false

True or False Labor: discomfort is felt in the abdomen and groin

false

True or False Labor: no change in effacement/dilation of cervix

true

True or False Labor: progressive effacement and dilation of cervix

false

True or False Labor: walking relieves contractions

False; parallel to the spine in longitudinal lie

True or False: When the fetus is lying transversely, they are parallel with the parent's spine.

False, if it smells it may indicate infection.

True or False: it is normal for amniotic fluid to have a distinct smell/odor.

observing the fetal and maternal conditions and on assisting the woman to cope with labor

What does nursing care focus on during the first and second stages of labor?

Can inhibit/slow the fetus' passage

What effect can a full bladder have on the labor process?

- greater pain - inhibit the progress of labor - reduce blood flow to the placenta and fetus

What effects can excessive anxiety and fear cause during the labor process?

The stick that looks like a crochet hook that is for performing an amniotomy (rupturing the amniotic sac).

What is an amnihook?

nuchal cord

What is it called when the umbilical cord is around the fetal neck?

acrocyanosis is the bluish color of hands and feet of the newborn that is normal and is caused by sluggish peripheral circulation

What is the appropriate nursing action when assessing acrocyanosis in the neonate?

(Shiny) Schultze: the fetal side of the placenta, which is shiny and smooth, is delivered first (Dirty) Duncan: the maternal side of the placenta, which is dull and rough, is delivered first.

What is the difference between the Schultze and Duncan delivery of the placenta?

Clear - may have white specks (vernix) - may have green streaks (fetal stool) (meconium)

What is the normal color of amniotic fluid?

Blood clotting Vitamin K (AquaMephyton) is required by the newborn to assist in blood clotting. A newborn lacks vitamin K at birth because of a sterile gastrointestinal tract. Newborns receive a single dose of vitamin K into the vastus lateralis muscle before leaving the delivery room, usually at age 1 hour.

What is the purpose of the administration of Vitamin K (AquaMephyton) to a newborn? Cord healing Blood clotting Respiratory status Infection prevention

Full dilation (and effacement)

What must happen before the person in labor can begin pushing?

Grunting respirations Correct Flaring of the nostrils Respiratory rate higher that 60 breaths/min Some signs of respiratory distress that should be immediately reported include grunting respirations, persistent cyanosis (other than hands and feet), flaring of the nostrils, retractions, sustained respiratory rate higher than 60 breaths/min, and sustained heart rate greater than 160 beats/min or less than 110 beats/min.

What signs of respiratory distress in the neonate should be reported immediately? (Select all that apply.) Grunting respirations Flaring of the nostrils Heart rate above 110 beats/min Cyanosis of the hands and feet Respiratory rate higher that 60 breaths/min

infant needs gentle stimulation possibility of narcotic-induced respiratory depression should be considered

What would an apgar score between 4 - 7 mean?

Firm and at the umbilicus During the fourth stage, recovery of labor, the uterus is normally found firmly contracted at or below the umbilicus level. *Deviation to the right can indicate a full bladder.* A boggy or soft uterus can indicate a potential complication. The uterus is not usually found deviated to the left.

What would the nurse expect a normal finding to be during assessment of the fundus of the uterus every 15 minutes during the fourth stage of labor? Firm and at the umbilicus Soft and deviated to the left Firm and deviated to the right Soft to touch, but firm with massage

crowning

When 3 to 4 cm of the fetal head is visible at the vaginal opening, this is known as ___________________.

100.4

When assessing a woman's vital while she is in labor, a temperature of ____ or higher should be reported.

contractions ruptured membranes bleeding other than bloody show decreased fetal movement other concerns (i think i made this card twice)

When to go to the hospital:

Mouth then Nose (m comes before n in the alphabet)

Which do they suction first on the neonate?

Increased vaginal discharge Braxton Hicks contractions (increasing in intensity), increased discharge, and bloody show are always signs of impending labor. Diarrhea is not a sign of impending labor.

Which is a sign of impending labor? Increased vaginal discharge Baby dropping Increased libido Diarrhea

Help the mother push effectively. The second stage of labor is the pushing stage. The nurse should help the mother push effectively. The mother cannot breastfeed in the second stage of labor. Checking fetal position is not the highest priority during the second stage of labor. Pain medication should not be administered in the second stage because it will cause a lethargic neonate and possibly depress the newborn's respirations.

Which nursing action has the highest priority for a patient in the second stage of labor? Check the fetal position. Administer pain medication. Help the mother push effectively. Prepare the mother to breastfeed on the delivery table.

"I know that there will be a delay in emergency care if there is a complication." Mothers will not have access to technology at home. Most physicians will not come to the home for medical care. Most emergency procedures can only be performed in the hospital per standard of care. It is important that this mother understands that there will be a delay, creating significant risk, if there is a complication.

Which statement made by an expectant mother demonstrates understanding of the significant risks of home delivery? "I know I will have access to the technology that monitors my well-being." "I know that there will be a delay in emergency care if there is a complication." "The physician will only come to my home if I have a complication." "The midwife can perform most emergency procedures at home."

it is vitamin k, and newborns need it to assist in blood clotting. Vitamin K is naturally produced from intestinal flora, which is absent in the newborn.

Why would aquaMEPHYTON be ordered for the newborn?

Upright

___ (laboring) positions add gravity to the forces promoting fetal descent .

fetal tachycardia (nonreassuring pattern)

___ ___ is a baseline FHR greater than 160 beats/min that lasts 2 to 10 minutes or longer. It can be caused by maternal fever or maternal dehydration.

baseline fetal heart rate

___ ____ ___ ___ is the average FHR that occurs for at least 2 minutes during a 10-minute period and are averaged over 30 minutes. It is assessed while there are no uterine contractions. It should be 110 beats/min to 160 beats/min for at least a 2-minute period.

station

___ describes the level of the presenting part (usually the head) in the pelvis. It is estimated in centimeters from the level of the ischial spines in the mother's pelvis (0)

Duration

___ is from the beginning to the end of the same contraction.

Frequency

___ is the time it takes from the beginning of one contraction to the beginning of the next contraction.

minus plus 0 station is at the pelvis

___ stations are above the ischial spines, and ___ stations are below the ischial spines.

squatting

____ (position during labor) facilitates fetal descent during the second stage.

fetal bradycardia (nonreassuring pattern)

____ ____ occurs when the FHR is below 110 beats/min for 10 minutes or longer. Causes can be fetal hypoxia, maternal hypoglycemia, maternal hypotension, or prolonged umbilical cord compression.

Interval

____ is from the end of one contraction to the beginning of the next contraction.

abnormal FHR patterns

________ ____ ______ must be reported to the HCP promptly to ensure a favorable outcome.

hands-and-knees or leaning-forward

________ or _______ positions promote normal internal rotation of the fetus if "back labor" is a problem.

fontanelles

openings at the point of union of skull bones, often referred to as soft spots

permits/consent lab tests iv infusion perineal prep determine fetal position and presentation

place these admission procedures in order: perineal prep laboratory tests permits/consents intravenous infusion determine fetal position and presentation

sutures

separation between fetal skull bones that permits molding during the birth process

nose chin forehead

what contractions feel like ___ - mild ___ - moderate ___ - firm