Chapter 8

___ cross the placental barrier and should be avoided 1 hour before delivery

opiods

5 Ps Includes bony pelvis and soft tissues of the cervix, pelvic floor, vagina, and introitus Bony pelvis is greatest denominator

passage

The preferred method of delivery includes which

the pt in a comfortbale position of her choosing while open glottis pushing

fetal positions

1. first letter L or R is the side the back is towards 2. second letter specifies specific part Occiput (O), sacrum (S), mentum (M), shoulder (A) 3. third letter is which way is the presenting part facing posterior (P), anterior (A), transverse (T)

active phase of labor

6cm to complete dilation About 1-6 hours (median 2 hours), much quicker in multips Decreased energy and fatigue, more serious, turn attention to internal sensations Fetal descent occurs Contractions more intense, q 2-5 minutes

identify the stage of labor being discussed Estimation of blood loss, begin the initiation of the golden hour.

third stage

5 Ps of labor

Powers (contractions) Passage (pelvis and birth canal) Passenger (fetus) Psyche (response of woman) Position (maternal postures, physical positions)

medical interventions during second stage of labor

Prepare for delivery Provide reassurance to woman while she pushes Support fetal head and maternal perineum to avoid episiotomy Assist the woman in birthing

degrees of lacerations

A first-degree laceration involves the perineal skin and vaginal mucous membrane A second-degree laceration involves skin, mucous membrane, and fascia of the perineal body A third-degree laceration involves skin, mucous membrane, and muscle of the perineal body and extends to the rectal sphincter A fourth-degree laceration extends into the rectal mucosa and exposes the lumen of the rectum (see Fig. 8-30E).

when are APGAR scores done

1 minute after birth 5 minutes after birth

six birth practices that support and promote normal physiologic birth

1. Labor begins on its own: Support the normal physiologic process. 2. Freedom of movement throughout labor: Allow women to move around and adapt positions of their choosing. 3. Continuous labor support from family, friends, doulas, or nursing staff. 4. Minimize interventions to allow healthy labor progress. 5. Spontaneous pushing in non-supine positions. 6. NO separation of mother and baby.

two theories that support the use of companionship durnig labor

1.During labor, women may be uniquely vulnerable to unfamiliar environmental influences; current obstetric care frequently subjects women to institutional routines, high rates of intervention, unfamiliar personnel, and lack of privacy, resulting in stress 2.enhanced passage of the fetus through the pelvis and soft tissues, and decreased stress response. Enhanced feto-pelvic relationships may be accomplished by encouraging mobility and effective use of gravity, supporting women to assume their preferred positions, and recommending specific positions for specific situations.

Normal blood loss for a vaginal birth is approximately _____ mL within a 24 hr period

500

With every contraction, _____ mL of blood leaves the utero-placental unit and moves back into maternal circulation thus ridding the utero-placental unit of waste and bringing in a replenished oxygen supply

500

ABCD for resusitation

A. Airway Perform initial steps to open the airway (reposition, open mouth, clear secretions if necessary). B. Breathing Newborns with apnea or bradycardia may need positive-pressure ventilation, and newborns with labored breathing or low-oxygen saturation may need continuous positive airway pressure (CPAP) or oxygen therapy. C. Circulation If the newborn has severe and persistent bradycardia despite assisted ventilation, perform chest compressions coordinated with PPV. D. Drug If assisted ventilation and coordinated compressions are unsuccessful and severe bradycardia persists, administer epinephrine and continue with PPV and chest compressions.

fetal factors influencing onset of labor

As the placenta ages, it begins to deteriorate, triggering initiation of contractions Prostaglandin synthesis by the fetal membranes and the decidua stimulates contractions. Fetal cortisol, produced by fetal adrenal glands, rises and acts on the placenta to reduce progesterone that quiets the uterus and increases prostaglandin that stimulates the uterus to contract.

interventions during labor

Assess rupture of membranes - speculum exam, Ferning (testing fluid under microscope), AmniSure, Nitrazine paper (place in fluid- changes to blue=ROM) Assess color, amount, and odor of amniotic fluid Asses FHR Document time of SROM, fluid, and FHR

medical interventions during third stage of labor

At delivery, place neonate on mother's chest if able Await delivery of placenta If complications with third stage, order medications, manual removal of placenta, order antibiotics Inspect placenta after delivery Order medications and uterotonics if necessary

third stage of labor

Begins after delivery of fetus Involves separation and expulsion of placenta and membranes 1-20 minutes Management - uterotonic drugs (oxytocin first line) recommended for all births for prevention of PPH, controlled cord traction, fundal massage

transition phase of labor

Beginning to be phased out - previous was 8-10cm Women are discouraged, overwhelmed, panicky, may feel out of control Intense contractions q 1-2 minutes

fourth stage of labor

Begins after delivery of placenta and typically ends within 4 hours or with stabilization of the mother Nurse is caring for mother and newborn Beginning of the post-partum period The Golden Hour: allow and encourage early contact with the newborn, place skin to skin with mother with warm blanket, initiate breastfeeding if appropriate, promote family bonding

While caring for a client, which interventions would the nurse include in the nursing care plan to provide culturally competent care? A. describe hospital protocols that will be followed during the delivery B. provide teaching on non pharmacological pain management options as they are preferred by women of the clients culture C. identify who the woman prefers to care for her during labor D. provide the client preferred foods as appropriate or encourage the clients family to bring foods from home E. determine who is the clinets support person and how they will participate in her care

C. identify who the woman prefers to care for her during labor D. provide the client preferred foods as appropriate or encourage the clients family to bring foods from home E. determine who is the clinets support person and how they will participate in her care

types of pushing

Closed glottis (involuntary) refers to spontaneous pushing against a closed glottis (Valsalva) in response to the descent of the fetal presenting part on the perineum. Closed glottis (voluntary), also referred to as the Valsalva technique, involves a voluntary directed strenuous bearing-down effort against a closed glottis for at least 10 seconds. The woman is instructed to take a deep breath and hold it for as long as she can (during each count of 10) using the entire contraction. This method usually involves two to three pushes of 10 seconds each with each contraction Directed pushing refers to instructions from care providers to the woman concerning how to push and often includes directions to "hold your breath" (closed glottis or Valsalva technique) to a count of 10 or more seconds. Instructions also may be given concerning positioning during pushing; often a supine or semi-Fowler's position is advised rather than encouraging the woman to choose her own position of comfort. Nondirected pushing refers to care providers encouraging the woman to choose whatever method she feels is effective to push her baby out, including choosing the position during pushing, deciding whether to hold her breath during pushing efforts, and determining the duration of each pushing effort. Open glottis refers to spontaneous, involuntary bearing-down accompanying the forces of the uterine contraction and is usually characterized by expiratory grunting or vocalizations. The spontaneous method usually involves three to four pushes of 6 to 8 seconds with each contraction

classifications of breech presentations

Complete breech: Complete flexion of the thighs and the legs extending over the anterior surfaces of the body Frank breech: Complete flexion of thighs and legs Footling breech: Extension of one or both thighs and legs so that one or both feet are presenting

second stage of labor

Complete dilation to delivery of baby Average 1-2+ hours for primigravida, less than 1 hour for multigravida Women may have a burst of energy, more focused, can actively participate with active pushing Wait until the woman has the urge to bear down/push - shorter pushing time Can wait about 2 hours for baby to descend spontaneously Pushing - spontaneous pushing has benefits, encourage open glottis pushing Woman should be encouraged to push for 6-8 seconds, slight exhale, repeat 3-4 times per contraction Perineal stretching - no evidence that this decreases perineal trauma

3 techniques of labor management

Dick-Read method: Advocates birth without fear by education and environmental control and relaxation. Lamaze: Promotes psychoprophylaxis with conditioning and breathing. Bradley: This is husband-coached childbirth and support focused on working with and managing the pain rather than being distracted from it.

APGAR score meanings

Each component is given a score of 0, 1, or 2 An Apgar score of: 0 to 3 indicates severe distress 4 to 6 indicates moderate difficulty with transition to extrauterine life 7 to 10 indicates stable status.

nursing care during third stage of labor

Facilitate family bonding Assess maternal vital signs and pain Assess maternal stability Prepare for delivery of placenta and need for uterotonics

Nursing care of women in early or latent labor should incorporate the following types of support and interventions

Encourage her to do normal, distracting activities and rest as needed. Provide emotional support, including continuous presence, reassurance, and praise. Provide information about labor progress and advice regarding coping techniques. Offer comfort measures (e.g., comforting touch, massage, warm baths/showers, promoting adequate fluid intake and output). Serve as an advocate, including assisting the woman in articulating her wishes to others.

cardinal movements of labor

Engagement: When the greatest diameter of the fetal head passes through the pelvic inlet; can occur late in pregnancy or early in labor Descent: Movement of the fetus through the birth canal during the first and second stages of labor Flexion: When the chin of the fetus moves toward the fetal chest; occurs when the descending head meets resistance from maternal tissues; results in the smallest fetal diameter to the maternal pelvic dimensions; normally occurs early in labor Internal rotation: When the rotation of the fetal head aligns the long axis of the fetal head with the long axis of the maternal pelvis; occurs mainly during the second stage of labor Extension: Facilitated by resistance of the pelvic floor that causes the presenting part to pivot beneath the pubic symphysis and the head to be delivered; occurs during the second stage of labor External rotation/restitution: During this movement, the sagittal suture moves to a transverse diameter and the shoulders align in the anteroposterior diameter. The sagittal suture maintains alignment with the fetal trunk as the trunk navigates through the pelvis Head and shoulders rotate to move under the symphysis pubis. Expulsion: The anterior shoulder usually comes first followed by the remainder of the body

nursing care during fourth stage of labor

Facilitate family bonding Assess maternal vital signs and pain Assess maternal stability, fundus, lochia, bladder, perineum Provide comfort measures and pain meds. Initiate breastfeeding Provide food and fluids for patient when stable

stages of labor

First: onset of labor to complete cervical dilation Second: complete dilation to delivery of baby Third: delivery of baby to delivery of placenta Fourth: immediate postpartum

how are contractions described

Frequency: Beginning of one to the beginning of another (minutes) Duration: Beginning to end of the contractions (seconds) Intensity: Mild, Moderate, Strong (felt via palpation) mild- easily indented moderate- resistant to indentation strong- cannot be indented

what does APGAR evaluate

Heart rate based on auscultation Respiratory rate based on observed movement of chest Muscle tone based on degree of flexion and movement of extremities Reflex irritability based on response to tactile stimulation Color based on observation

nursing care with epidural

IV fluid bolus Monitor vital signs and FHR (hypotension is common) Assess pain and loss of sensation Assess for itching, n/v, headache Catheterize Assist anesthesia provider Risks - lower incidence of spontaneous vaginal delivery, higher rate of instrumental vaginal delivery, longer labor, increased risk of intrapartum fever/sepsis

three phases of a contraction

Increment phase: Ascending or buildup of the contraction that begins in the fundus and spreads throughout the uterus; the longest part of the contraction. Acme phase: Peak of intensity but the shortest part of the contraction. Decrement phase: Descending or relaxation of the uterine muscle.

medical interventions in first stage latent

Laboratory tests, which may include complete blood count (CBC), urinalysis, and possible drug screening. Order IV or saline lock. Order intermittent fetal monitoring or continuous fetal and uterine monitoring.

signs of impending labor/premonitory signs of labor

Lightening - descent of fetus into true pelvis (2 wks before term in first pregnancy) woman may feel like she can breather easier, will experience urinary infrequency from increased bladder pressure Braxton-Hicks - irregular UCs that do not result in cervical change- not painful, do not occur at regular intervals, don't get closer together, can stop with activity, Cervical changes - cervix becomes soft and may begin to efface and/or dilate, loss of mucous plug Nesting: burst of energy preparing for baby 1-3 lb weight loss, diarrhea, nausea, indigestion Low back pain, sacroilliac discomfort rt relaxation of pelvic joints Bloody show (brownish, blood-tinged cervical mucous)

nursing care during second stage of labor

More frequent maternal and fetal assessment Review prenatal records Assess FHR and uterine activity Assess maternal vital signs and pain Encourage open glottis pushing efforts Provide comfort measures for pushing efforts Provide ongoing assessment and encouragement of labor progress Communicate with interdisciplinary team Prepare for delivery

medical interventions for first stage of labor

Order laboratory tests Order IV/Saline lock Order intermittent or continuous fetal and uterine monitoring Rupture membranes if indicated Evaluate fetal status Perform internal monitoring if indicated Pain assessment - order meds or epidural Evaluate labor progression Assess fetal position and cervix Prepare for delivery

maternal factors influencing the onset of labor

Pressure on the cervix (releases oxytocin) stretching of uterine muscles (releases prostaglandin and oxytocin) increase in estrogen stimulating the uterine response, decrease of progesterone, oxytocin release (stimulates contractions), oxytocin and prostaglandin work together to inhibit calcium binding in muscle cells, raising intracellular calcium levels and activating contractions

physical and psycosocial factors influencing labor pain response

Rate of cervical dilation and strength of contractions. Size and position of fetus impacts length of labor Sleep deprivation and exhaustion from long labor increases pain perception. Culture of the woman influences her response to labor and pain. Pain behaviors are culturally bound. The woman's labor support system can affect her anxiety level and perception of pain. Previous birth experiences may increase or decrease anxiety. Childbirth preparation may decrease anxiety and decrease pain. The woman's expectations influence her satisfaction with her birth experience.

medical interventions during the fourth stage of labor

Repair episiotomy/laceration Inspect placenta Assess fundus for firmness Order uterotonics Order pain medication if necessary

For women in labor, continuous support can result in the following:

Shorter labor Decreased use of analgesia/anesthesia Decreased operative vaginal births or cesarean births • Decreased need for oxytocin/uterotonics Increased likelihood of breastfeeding Increased satisfaction with the childbirth experience

3 questions to consider the need for resusitation

Term gestation? Crying or breathing? Good muscle tone?

a federal regulation enacted to ensure treatment for a woman seeking care in an emergency or if she thinks she is in labor, regardless of her ability to pay.

The Emergency Medical Treatment and Active Labor Act (EMTALA)

4 stages of labor

The first stage begins with onset of labor and ends with complete cervical dilation. The second stage begins with complete dilation of cervix and ends with delivery of the baby. The third stage begins after delivery of the baby and ends with delivery of the placenta. The fourth stage begins after delivery of the placenta and is completed 4 hours later; it is the immediate postpartum period

gate control theory of pain

This theory states that sensation of pain is transmitted from the periphery of the body along ascending nerve pathways to the brain. Because of the limited number of sensations that can travel along these pathways at any given time, an alternate activity can replace travel of the pain sensation, thus closing the gate control at the spinal cord and reducing pain impulses traveling to the brain

true labor vs false labor

True - regular contractions with cervical changes False - irregular contractions, no cervical change

signs that signify the impending delivery of the placenta include

Upward rising of the uterus into a ball shape Lengthening of the umbilical cord at the introitus Sudden gush of blood from the vagina

early/latent phase of labor

Usually longest phase May be shorter for multip Dilation to 4cm (6 now considered active) Mild contractions q 5-10 minutes Women are excited, apprehensive Best to hold off admission until active phase

culture impacts factors of a womans labor like

Who is with the woman in labor, their role, and who participates in decision making Preferences for use of pharmacological and non-pharmacological pain management in labor Who the woman wants to care for her in relation to gender and modesty Response to labor

The nurse is instructing a woman and her partner on non-pharmacological pain relief interventions such as effleurage and using heat/cold. The client asks how these techniques work to manage pain. Which is the best statement by the nurse? a. only a certain number of sensations can travel down to the brain at once. we replace pain signals with pleasure signals to reduce discomfort b. massage and heat reduce blood flow to tissues, and temporarily numb the nerve fibers c. the placebo effect makes the client believe their pain is less, even though there is no physiologic benefit of the techniques d. the effects are only useful in latent labor phase. as active labor starts, she will likely need opioid pain medication

a. only a certain number of sensations can travel down to the brain at once. we replace pain signals with pleasure signals to reduce discomfort rationale: gate control theory of pain states that because of the limited number of sensations that can travel along these pathways at any given time, an alternative activity can replace travel of the pain sensation, thus closing the gate control at the spinal cord and reducing pain impulses travelling to the brain

Which nursing interventions would support a normal, physiologic birth? Select all that apply. a. waiting until 40 weeks gestation to induce labor b. assisting the mother to change positions frequently c. collaborating with a doula or other support person to manage discomfort d. encouraging the mother to lie on her back and place her feet in stirrups for delivery e. allowing the bag of waters to rupture spontaneously

a. waiting until 40 weeks gestation to induce labor b. assisting the mother to change positions frequently c. collaborating with a doula or other support person to manage discomfort e. allowing the bag of waters to rupture spontaneously

a rapid, non-invasive monoclonal immunoassay that detects PAMG-1, an amniotic protein that appears in vaginal secretions if ROM has occurred

amnisure

Measures proposed to enhance perineal stretching and decrease perineal trauma include

application of warm compresses, gentle perineal massage and stretching, and perineal massage with warm oil during the second stage of labor

complementary therapy for pain management during labor

aromatherapy massage birthing ball hydrotherapy self hypnosis music therapy acupuncture sterile water injections

The nurse is assessing a laboring client. Which signs and symptoms does the nurse recognize that indicate movement into the transition phase of labor? Select all that apply. a. contractions every 3 to 4 minutes b. contractions lasting 60 to 90 sec c. cervix dilated to 8 cm d. noted tremling of the client e. increase in client anxiety

b. contractions lasting 60 to 90 sec c. cervix dilated to 8 cm d. noted tremling of the client e. increase in client anxiety during transition phae contractions occur every 1-2 min

largest transverse measurement of the fetal skull and an important indicator of head size

biparietal diameter

facilitates an upright position, opens the pelvis, and allows the woman to roll or bounce as she deems necessary to manage her contractions and pain.

birthing ball

how is true labor defined

cervical change

the soft tissue of the cervix does what soft tissue of the pelvic floor soft tissue of the vagina

cervix- effaces and dilates, allowing descending fetus into vagina pelvic floor- helps the fetus in an anterior rotation as it passes through the birth canal vagina- expands to allow passage of the fetus

the period from the conclusion of the pregnancy to the start of the infant's extrauterine life.

childbirth

Normal amniotic fluid is

clear or cloudy with a normal odor that is similar to that of ocean water or the loam of a forest floor.

dilation described in effacement described in

cm %

first time pregnancy- when to go to hospital

contractions are 5 minutes apart, last 60 second, regular for at least an hour Immediately if: Rupture of membranes Intense pain Bloody show increases

actions that minimize pain according to the gate theory

cutaneous stimulation such as effleurage (gentle stroking of the abdomen) or the use of heat or cold breathing, focusing, and visual and auditory stimulation may affect whether pain impulses reach the level of conscious awareness.

epidural vs combined epidural

epidural goes in between 4th and 5th vertebrae combined is that + anesthetic in the subarachnoid space, called "walking" anesthetic

hormones that soften cartilage and increase elasticity of the ligaments, allowing room for the fetal head

estrogen and relaxin

why is it better to wait for the mom to have the urge to push

evidence shows that there is improved fetal oxygenatoin, optimal maternal energy, and improved APGAR scores from laboring down or physiologic second stage labor care

cephalic presentations indicates that the neck is sharply extended and the back of the head (occiput) is arching to the fetal back. The denominator is the mentum-chin.

face

pelvis shape

false pelvis- shallow upper section of the pelvis true pelvis- lower part of the pelvis which has three planes--- the inlet, midpelvis, and the outlet

During a sterile speculum exam, a sample of fluid in the upper vaginal area is obtained, placed on a slide, and assessed for a pattern which confirms rupture of membranes

ferning

meconium stained amniotic fluid can indicate

fetal compromise

identify the stage of labor being discussed Assess fetal heart rate and uterine contractions per protocol, and use Leopold's maneuver to determine fetal position. Many patients choose to stay home during this phase.

first stage

what stage The bag of waters or fetal membranes usually ruptures during this stage. The woman's cardiac output increases. The woman's pulse may increase. Gastrointestinal motility decreases, which leads to increase in gastric emptying time The woman experiences pain associated with UCs that result in the dilation and effacement of the cervix

first stage

identify the stage of labor being discussed Nursing actions will include reviewing the birth plan, orienting the patient and her support to the labor room, and reinforcing comfort measures and breathing techniques.

first stage During the latent phase of the first stage of labor is the best time to review plans and have a thorough discussion about the labor process and the expectations of the patient. Contractions are usually far apart and the patient is able to express her wishes for her labor and birth calmly.

A client was recently admitted to the labor and delivery unit in active labor. The nurse performs Leopold's maneuvers during the assessment. During the third maneuver, the nurse notes a firm and fixed fetal part. Which position correlates with this assessment finding?

occiput during leopolds manuevers the fetal head will palpate as firm and fixed

identify the stage of labor being discussed The patient is encouraged to breathe through contractions, fetal heart rate and uterine activity are recorded every 15 minutes, and maternal response is often irritable, overwhelmed, and panicky.

first stage During the transitional phase of the first stage of labor, when the patient is transitioning from 8 to 10 cm, it's normal for moms to feel and act out of control. They may start to tremble with contractions and have a strong urge to push. It's imperative that you remain at the bedside and provide calming guidance during this time.

Women in this phase may have decreased energy and experience fatigue. They become more serious and turn attention to internal sensations Fetal descent continues. Contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. Discomfort increases; this is typically when the woman comes to the birth center or hospital if she has not done so already

first stage active

the early and slower part of labor with an average length of 9 hours for primiparous and 5 hours for multiparous women. Women in this phase are usually both excited and apprehensive about the start of labor. They are talkative and able to relax with the contractions

first stage latent Cervical dilation from 0 to 4 cm with effacement from 0% to 40%. Mild intensity contractions occur every 5 to 10 minutes, lasting 30 to 45 seconds.

The discussion of comfort measures, breathing techniques, and the patient's birth plan should take place at which stage of labor?

first stage latent phase

women are easily discouraged and irritable, and may be overwhelmed and panicky. They often feel and act out of control. Characteristics of this phase are cervical dilation 8-10 cm, intense contractions every 1 to 2 min lasting 60-90 sec, increase of bloody show, n/v, backache, trembling, sweating, strong urge to bear down

first stage transition

Mary is a G1P0 who has been in active labor for about 9 hours. She has been breathing through her contractions and doing well until about 20 minutes ago, when she started to tremble, cry, and say she just can't do it anymore. Where is Mary in the labor process?

first stage, transitional phase

cephalic presentations indicates partial extension of the neck with the brow as the presenting part. The denominator is the frontum.

frontum/brow

most common type of pelvis- more suitable for labor

gynecoid least common- platypelloid

anatomical structures of the pelvis

ileum, ischium, pubis, sacrum, coccyx

3 phases of the first stage of labor

latent, active, transition

signs of impending labor include

lightening (dropping of the baby into the pelvis) nesting (burst of energy near end of pregnancy) bloody show (tinger or brown mucous discharge that occurs as the cervix begins to ripe)

most common position for birth

lithotomy

greatest determinante in the vaginal delivery of the fetus

maternal pelvis (dependent on the measurements of the inlet, midpelvis, and the outlet)

Upon admission, the nurse instructed a 39-week gestation client to lie on her back in bed for assessment and placement of the fetal monitor. After going through the medical history, the nurse assesses the client's blood pressure at 76/42. Which is the appropriate intervention?

move the client on her left side when lying flat on the back the client may have supine hypotension due to compression of the aorta and ascending vena cava

By the third trimester, the ___________ _______ increase by more than 300%, while uterine sensitivity of oxytocin also increases

myometrial receptors

the uterine muscle is known as the

myometrium contracts and shortens during the first stage of labor the upper segment composes two-thirds of the uterus and contracts to push the fetus down. The lower segment composes the lower third of the uterus and the cervix and is less active, allowing the cervix to become thinner and pulled upward.

The paper turns blue when in contact with amniotic fluid. Can be dipped in the vaginal fluid or fluid-soaked Q-tip can be rolled over the paper

nitrazine paper

self-administered by the laboring woman using a mouth tube or face mask when she determines that she needs it, about a minute before she anticipates the onset of a strong contraction until the pain eases. Its use can be started and stopped at any point during labor according to the woman's needs and preferences. It takes effect in about 50 seconds after the first breath and the effect is transient—essentially gone when no longer neede

nitrous oxide

5 Ps the fetus

passenger affected by: Fetal Skull: Fetal Attitude: relation of fetal parts to one another, noted by the flexion or extension of the fetal joints Fetal Lie: relationship of the maternal and fetal spine: longitudinal (ideal) or transverse (c section) Presentation: part that enters pelvic inlet first- cephalic (head first) breech (butt first) shoulder Presenting Part: --cephalic: vertex (head is flexed) frotum/brown (partial extension of neck) face (neck is extended) --breech: complete, frank, footling --transverse: shoulder is presenting --compond: arm or hand presents along w presenting part Fetal Position: relationship of the denominator to maternal pelvis ---First letter: R or L ---Second letter: O (occiput), S (sacrum), M (mentum), A (shoulder) ---Third letter: A (anterior), P (posterior), T (transverse) Fetal Size:

A client is admitted to the labor and delivery unit in active labor. There has been no prenatal care for the current pregnancy, and the on-call provider estimates the pregnancy to be around 35 weeks' gestation. Which medication will the nurse anticipate being ordered for on this client?

penicillin with no prenatal care the group b strep status is unknown. penicillin is the drug of choice to use during labor to prevent GSB infection in neonate

where is maternal oxytocin secreted from

pituatary gland

A sudden gush of blood and a lengthening of the umbilical cord indicate _____________.

placental delivery in the third phase

5 Ps of labor maternal position during labor and birth

position encourage walking, moving, changing positions position can help w pain management and with labor progress

5 Ps of labor Involuntary UCs and voluntary pushing/bearing down

powers contractions are responsible for cervical change bearing down powers- triggered by feguson reflex (involuntary urge to bear down- activated when the presenting part stretches the pelvic floor muscles. Stretch receptors are activated, releasing oxytocin and stimulating contractions

initial steps for resucitation after low APGAR score

provide warmth by placing the baby under a radiant heat source, positioning the head in a "sniffing" position to open the airway, clearing the airway if necessary with a bulb syringe or suction catheter, drying the baby, and stimulating breathing

5 Ps of labor response of the woman

psyche factors that affect a womans coping mechanisms --Culture --Expectations --Support System --Labor Support

increased risk of cord prolapse with

rupture of membranes- especially if presenting part is not engages

identify the stage of labor being discussed The fetus is traversing the pelvic outlet and stretching the maternal soft tissues with an obvious bulging of the vagina and rectum. This stage usually lasts 1 to 2 hours for a primigravida and often less than an hour for the multigravida.

second stage

identify the stage of labor being discussed Open glottis bearing down, comfortable positioning of the patient's choosing, and positive encouragement should happen during this stage.

second stage As the patient is bearing down in order to expel the infant, it's important that she determine how and when she pushes and the position that she assumes to do so. Open glottis pushing refers to spontaneous, involuntary bearing down and is the preferred method of pushing. Continual, positive, and calm encouragement should be offered by the nurse and support persons at this time.

which position increases blood flow to the baby

side lying decreases vena cava compression and increases blood flow to the uterus and placenta. especially helpful if the fetus is not tolerating pushing well

Contractions are intense, occurring every 2 minutes and lasting 60 to 90 seconds. Bloody show increases. The perineum flattens and the rectum and vagina bulge what stage

stage 2

position for second stage of labor

standing, kneeling, squatting

when does the intrapartum period begin

starts with regular uterine contractions and lasts until expulsion of the placenta. called labor

refers to the relationship of the ischial spines to the presenting part of the fetus and assists in assessing for fetal descent during labor

station Station 0 is the narrowest diameter the fetus must pass through during a vaginal birth.

SQ injection of .5 ml of ______ gives about 60-90 minutes of lower back pain relief

sterile water

culturally-based responses to pain are often divided into two categories

stoic and emotive Stoic patients are less expressive of their pain and tend to "grin and bear it." They may tend to withdraw. Emotive patients are more likely to verbalize their expressions of pain.

pelvic joints

symphisis pubis, right and left sacroiliac joints, sacrococcygeal joints

identify the stage of labor being discussed Assess maternal vital signs every 15 minutes, administer IV or IM oxytocin (10 international units) if indicated, and administer pain medications or other uterotonics as needed.

third stage As the medical team awaits the delivery of the placenta, it's important to remain vigilant for signs of complications in the patient. Monitoring the patient and administering uterotonics to assist in the expulsion of the placenta will help to insure good patient outcomes.

identify the stage of labor being discussed The uterus will rise up into a firm ball and contract. Often, a sudden gush of blood will be seen.

third stage The time from delivery of the infant to the delivery of the placenta is the third stage of labor. After the infant is delivered, the uterus will rise into a ball shape and contract in order to expel the placenta. Signs that delivery of the placenta is imminent are a gush of blood and a lengthening of the umbilical cord at the introitus. The placenta will usually be delivered within 20 minutes of delivery of the infant.

goal of nursing for the intrapartum period

to achieve a safe delivery for mother and baby, provide emotional support, and to manage maternal pain.

A fetus cannot be delivered vaginally in the _______ lie

transverse

characterized by regular uterine contractions that result in progressive dilation and effacement of the cervix and fetal descent into the pelvis

true labor

what risk increases with rupture of membranes or when the presenting part is not engaged

umbilical cord prolapse

position for first stage of labor

upright and lateral position

Active management of the third stage of labor (AMTSL) includes

uterotonic drugs (oxytocin is the gold standard), controlled cord traction, and late cord clamping performed 1-3 minutes after delivery. These interventions decrease postpartum hemorrhage (PPH) and cause uterine contractions and placenta expulsion

cephalic presentations indicates that the head is sharply flexed and the chin is touching the thorax. The denominator is the occiput.

vertex