Nursing Care in Labor and Birth
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Questions and Answers

What are the four components of labor?

Passage, Passenger, Powers, and Psyche

What refers to the route a fetus takes during birth, from the uterus through the cervix and vagina to the perineum?

Passage

The passenger is the fetus. What is the widest part of the fetus?

Head

What are the forces that propel the fetus through the birth canal?

<p>Powers</p> Signup and view all the answers

What is the psychological state of the woman in labor?

<p>Psyche</p> Signup and view all the answers

What are the two important pelvic measurements?

<p>Diagonal conjugate and transverse diameter of the outlet</p> Signup and view all the answers

Which of the following is NOT one of the eight bones that make up the fetal cranium?

<p>Temporal</p> Signup and view all the answers

The anterior fontanelle is triangular.

<p>False</p> Signup and view all the answers

What is the space between the two fontanelles called?

<p>Vertex</p> Signup and view all the answers

What is the term for the change in the shape of the fetal skull during labor?

<p>Molding</p> Signup and view all the answers

Which fetal attitude describes complete flexion, where the chin touches the sternum?

<p>Good attitude</p> Signup and view all the answers

Engagement refers to the fetal presenting part being at the level of the ischial spines.

<p>True</p> Signup and view all the answers

What is the term for the presenting part being below the ischial spines?

<p>Plus stations</p> Signup and view all the answers

What is meant by 'crowning'?

<p>The baby's head appears at the vaginal opening during labor.</p> Signup and view all the answers

What is the relationship between the long axis of the fetal body and the long axis of the mother's body called?

<p>Fetal lie</p> Signup and view all the answers

What is the most frequent type of fetal presentation?

<p>Cephalic presentation</p> Signup and view all the answers

In a breech presentation, what part of the baby presents first?

<p>Buttocks or feet</p> Signup and view all the answers

What are the three letters that help determine fetal position?

<p>R, L, and A, P, or T</p> Signup and view all the answers

What are the stages of labor?

<p>Descent, Flexion, Internal rotation, Extension, External rotation, and Expulsion</p> Signup and view all the answers

What refers to the thickening and shortening of the cervical canal?

<p>Effacement</p> Signup and view all the answers

During labor, the cervix dilates from millimeters to about 10 centimeters.

<p>True</p> Signup and view all the answers

What does the psychological state, or the 'Psyche', involve?

<p>Apprehension, excitement, and a sense of awe</p> Signup and view all the answers

Study Notes

Learning Objectives for Labor

  • Describe the components of labor
  • Identify skills in identifying abnormal patterns in fetal heart rate in relation to uterine contractions
  • Monitor frequency, interval, and duration of uterine contractions
  • Identify maternal danger signs of labor
  • Distinguish early decelerations from late and variable decelerations
  • Assess a family's readiness, stage, and progression during labor and birth
  • Formulate nursing diagnoses related to the physiological and psychological aspects of labor and birth
  • Develop expected outcomes to meet the needs of a family throughout the labor process
  • Devise a nursing care plan using identified nursing diagnoses
  • Implement nursing care for a family during labor, such as teaching about the stages of labor
  • Evaluate expected outcomes for achievement and effectiveness of care
  • Integrate knowledge of labor and birth with the interplay of the nursing process to promote quality maternal and child health nursing care

Components of Labor

  • A successful labor process depends on four integrated concepts:
    • The Passage (the woman's pelvis)
    • The Passenger (the fetus)
    • The Powers (uterine factors)
    • The Psyche (the woman's view)

Passage (Pelvis)

  • Refers to the route the fetus takes from the uterus through the cervix and vagina to the external perineum
  • A fetus must pass through the bony pelvic ring
  • The pelvis must be of adequate size

Pelvic Measurements

  • Pelvic measurements help assess the pelvis' adequacy:
    • Diagonal conjugate (anteroposterior diameter of the inlet)
    • Transverse diameter of the outlet

The Pelvic Inlet

  • At the pelvic inlet, the anteroposterior diameter is the narrowest (12.5 cm)

The Pelvic Outlet

  • At the pelvic outlet, the transverse diameter is the narrowest (11 cm)

Passenger (Fetus)

  • The passenger is the fetus
  • The head is the widest part of the fetus and the part least likely to pass through the pelvic ring
  • Fetal skull structure (bones, fontanelles, and suture lines) and alignment with the pelvis determine if it will pass
  • The fetal cranium comprises eight bones, including the frontal, two parietal, and occipital

Fetal Skull Structure

  • Four superior bones, including the frontal (two fused bones), and the two parietal and occipital bones

Fontanelles

  • Membrane-covered spaces at the junction of the main suture lines
    • Anterior fontanelle (bregma): lies at the junction of the coronal and sagittal sutures, fusion of two frontal and two parietal bones, diamond-shaped
    • Posterior fontanelle: lies at the junction of the lambdoidal and sagittal sutures, triangular, smaller than the anterior fontanelle

Molding

  • Change in the fetal skull's shape produced by uterine contractions pressing the vertex against the cervix
  • Fetal skull bones overlap, making the head narrower and longer
  • Only lasts a day or two after birth

Fetal Attitude and Presentation

  • Attitude: describes the degree of flexion a fetus assumes during labor or the relation of the fetal parts to each other
    • Good attitude: complete flexion (chin touches sternum, arms folded, thighs flexed, calves pressed against thighs)
    • Moderate flexion: chin not touching sternum but in an alert or "military position"
    • Partial extension: brow of the head is presenting
    • Poor flexion: back is arched, neck is extended with occipitomental diameter presenting
  • Engagement: settling of the presenting part far enough into the pelvis to reach the level of the ischial spines
    • Floating: presenting part not engaged
    • Dipping: presenting part descending but hasn't reached the ischial spines
  • Station: refers to the relationship of the presenting part to the level of the ischial spines
    • 0 station: presenting part at the level of the ischial spines (synonymous with engagement)
    • Minus stations (-1 to -4 cm): presenting part above the ischial spines
    • Plus stations (+1 to +4 cm): presenting part below the ischial spines (+3 or +4 station, presents at the perineum and can be seen if vulva is separated- crowning)
  • Lie: relationship between the long (cephalocaudal) axis of the fetal body and the long axis of a woman's body
    • Horizontal (transverse) or vertical (longitudinal)- approximately 99% of fetuses assume a longitudinal lie
  • Types of Fetal Presentation
    • Cephalic (head first- most frequent 95%)
      • Vertex (full flexion), Brow, Face, Mentum
    • Breech (buttocks or feet first - 3%) - complete, frank, footling
    • Shoulder (shoulder first)

Fetal Position

  • Describes the relationship of the presenting part to a specific quadrant of a woman's pelvis.
  • Indicated by three-letter abbreviation
    • Middle letter: fetal landmark
    • First letter: mother's right (R) or left (L)
    • Last letter: landmark points anteriorly (A), posteriorly (P), or transversely (T)

Powers (Uterine Contractions)

  • Supplied by the fundus of the uterus to cause cervical dilation and expulsion of the fetus.
  • Phases of contraction:
    • Increment
    • Acme
    • Decrement
  • Interval: measured between the beginning of one contraction and the beginning of the next
  • Cervical Changes:
    • Effacement: shortening and thinning of the cervix
    • Dilatation: enlargement of the cervical os.

Psyche (Psychological State)

  • Refers to the woman's psychological state during labor.
  • Many women feel apprehension, fright, but many feel excitement, awe.

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Components of Labor PDF

Description

This quiz focuses on the essential components of labor, including the monitoring of fetal heart rate patterns and uterine contractions. It emphasizes the skills needed for assessing maternal signs of danger and formulating nursing diagnoses. Additionally, it covers the development of nursing care plans to enhance maternal and child health outcomes during the labor process.

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