UNIT 5 EXAM
58 Questions
2 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is a common sign that labor may be approaching, characterized by a significant change in the position of the baby?

  • Braxton-hicks contractions
  • Rupture of membranes
  • Cervical dilation
  • Lightning (correct)

    • Which factor is NOT associated with the onset of labor?

  • Uterine stretching
  • Increased release of prostaglandins
  • Cervical effacement
  • Increased progesterone levels (correct)

    • What describes Braxton-hicks contractions?

  • Contractions indicating cervical dilation
  • Contractions related to ruptured membranes
  • Preparatory contractions that do not lead to labor (correct)
  • True labor contractions

    • What is a critical emergency sign indicated by the rupture of membranes if the fluid is green?

    <p>Presence of meconium</p> Signup and view all the answers

    What does the term 'bloody show' refer to in the context of labor?

    <p>Discharge of cervical mucus with blood</p> Signup and view all the answers

    What is the primary focus of nursing management during the fourth stage of delivery?

    <p>Assessing maternal vitals every 15 minutes</p> Signup and view all the answers

    Which of the following is NOT a method for preventing anal sphincter trauma during delivery?

    <p>Immediate fundal pressure</p> Signup and view all the answers

    When should outlet forceps be applied during assisted delivery?

    <p>When the fetal skull has reached the perineum and is visible</p> Signup and view all the answers

    What is a key consideration in the care of the family during a Cesarean birth?

    <p>Delivery through incision on abdomen and uterus</p> Signup and view all the answers

    Which of the following statements about vacuum-assisted delivery is correct?

    <p>It is indicated for maternal exhaustion and prolonged second stage.</p> Signup and view all the answers

    What characterizes contractions during false labor as opposed to true labor?

    <p>Contractions are irregular and frequently weak.</p> Signup and view all the answers

    Which position is considered optimal for fetal presentation during birth?

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

    What is the primary force of labor during the contractions phase?

    <p>Uterine contractions</p> Signup and view all the answers

    Which pelvic shape is most favorable for vaginal births?

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

    Which factor does NOT belong to the 5 P's of labor?

    <p>Placenta position</p> Signup and view all the answers

    What is a common psychological factor that can affect labor?

    <p>Coping with physical demands</p> Signup and view all the answers

    How is the fetal station measured?

    <p>In relation to the maternal ischial spines</p> Signup and view all the answers

    What is indicated by the term 'engagement' in labor?

    <p>The fetal head is engaged at the level of the ischial spines.</p> Signup and view all the answers

    What happens during the third stage of labor?

    <p>Separation and delivery of the placenta occur.</p> Signup and view all the answers

    Which method assists in determining fetal positioning during labor?

    <p>Leopold's maneuvers</p> Signup and view all the answers

    Which of the following describes the latent phase of labor?

    <p>Initial stage characterized by early contractions and 0-6 cm dilation.</p> Signup and view all the answers

    What is a common change in maternal cardiovascular response during labor?

    <p>Increase in cardiac output</p> Signup and view all the answers

    During which cardinal movement does the fetal head flex to allow passage through the birth canal?

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

    Which fetal heart rate variability indicates a healthy response during labor?

    <p>Moderate variability</p> Signup and view all the answers

    What does an early deceleration of fetal heart rate typically indicate?

    <p>Fetal head compression</p> Signup and view all the answers

    Which positioning change is recommended in response to variable decelerations?

    <p>Left lateral position</p> Signup and view all the answers

    What is a common sign that may indicate a potential infection affecting the baby?

    <p>Baby bradycardia</p> Signup and view all the answers

    What does the lower graph on a fetal heart monitor tracing represent?

    <p>Contraction data</p> Signup and view all the answers

    What is the purpose of an intrauterine pressure catheter (IUPC)?

    <p>To provide specific pressure readings for contractions</p> Signup and view all the answers

    Which of the following is NOT a component of non-pharmacologic measures during labor?

    <p>Epidural anesthesia</p> Signup and view all the answers

    What happens to maternal blood pressure when an epidural is administered?

    <p>It decreases due to vasodilation</p> Signup and view all the answers

    What is the primary purpose of cervical dilation and effacement assessments during labor?

    <p>To determine the progress of labor</p> Signup and view all the answers

    What does a marked fetal heart rate variability indicate?

    <p>Abnormal heart response; may indicate distress</p> Signup and view all the answers

    Which of the following factors is associated with increased sensitivity of the uterus to oxytocin during labor onset?

    <p>Withdrawal of progesterone</p> Signup and view all the answers

    What is the primary purpose of cervical effacement during the labor process?

    <p>To prepare for fetal descent</p> Signup and view all the answers

    Which sign indicates that the baby has moved into the pelvic cavity as labor approaches?

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

    During which premonitory sign of labor should a healthcare provider be most cautious about immediate hospital admission?

    <p>Rupture of membranes with meconium-stained fluid</p> Signup and view all the answers

    What physiological change primarily contributes to the uterine contractions during labor?

    <p>Increased prostaglandin release</p> Signup and view all the answers

    What does the term 'bloody show' signify in the context of labor?

    <p>Release of the mucus plug</p> Signup and view all the answers

    Which factor is least likely to contribute to the initiation of labor?

    <p>Elevated progesterone levels</p> Signup and view all the answers

    Which heart rate variability range is considered the ideal indicator of fetal well-being during labor?

    <p>Moderate: range from 6-25 bpm</p> Signup and view all the answers

    What is the primary intervention for addressing late decelerations in fetal heart rate?

    <p>Change maternal position to left lateral</p> Signup and view all the answers

    Which type of variable deceleration is characterized by sharp, unpredictable drops in fetal heart rate?

    <p>Variable deceleration</p> Signup and view all the answers

    What potential complication is indicated by fetal tachycardia during labor?

    <p>Infection in the mother</p> Signup and view all the answers

    During labor, what is the significance of conducting a palpation of the mother's abdomen?

    <p>To assess fetal position and engagement</p> Signup and view all the answers

    Which classification of deceleration occurs in relation to the peak of uterine contractions and is considered a positive sign during labor?

    <p>Early deceleration</p> Signup and view all the answers

    What is the main purpose of spinal anesthesia in obstetric care?

    <p>To provide pain relief without affecting motor function</p> Signup and view all the answers

    Which of the following describes the correct interpretation of the upper graph in a fetal heart monitor tracing?

    <p>It shows fetal heart rate data</p> Signup and view all the answers

    What is the initial nursing intervention when experiencing variable decelerations in fetal heart rate?

    <p>Change maternal position to relieve cord compression</p> Signup and view all the answers

    What is the key difference in contraction discomfort experienced during false labor compared to true labor?

    <p>Discomfort is usually localized at the front of the abdomen</p> Signup and view all the answers

    Which pelvic shape is considered least favorable for vaginal birth?

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

    During the second stage of labor, what is the primary focus regarding fetal presentation?

    <p>Encouraging the vertex presentation</p> Signup and view all the answers

    What effect does the psychological response have on the labor process?

    <p>Increases perception of pain and discomfort</p> Signup and view all the answers

    What role do the abdominals play during the labor process?

    <p>They exert secondary forces for pushing</p> Signup and view all the answers

    What is the primary action during the descent phase of cardinal movements of labor?

    <p>Fetal head moves downward through the birth canal</p> Signup and view all the answers

    Which of the following statements regarding the relationship between fetal position and maternal pelvis is true?

    <p>The position of the fetus can influence maternal contractions</p> Signup and view all the answers

    How does engagement of the fetal head relate to the ischial spines during labor?

    <p>Engagement means the fetal head is at level 0 of ischial spines</p> Signup and view all the answers

    What physiological change can be observed in the maternal cardiovascular system during labor?

    <p>Increased cardiac output</p> Signup and view all the answers

    Study Notes

    Factors Influencing the Onset of Labor

    • Uterine stretching: As the uterus grows, it stretches and creates pressure on the cervix, triggering labor.
    • Cervical effacement: The cervix thins and stretches, making room for the baby to pass through.
    • Cervical dilation: The cervix opens, expanding from 0 to 10 centimeters.
    • Progesterone withdrawal: Progesterone levels decrease, allowing estrogen to take over, initiating contractions.
    • Increased oxytocin sensitivity: The body becomes more sensitive to oxytocin, a hormone that stimulates contractions.
    • Increased release of prostaglandins: Prostaglandins, hormone-like substances, further stimulate uterine contractions.

    Premonitory Signs of Labor

    • Lightning bolt: The baby descends into the pelvis, causing a sensation of the belly dropping.
    • Braxton-Hicks contractions: These are irregular practice contractions that prepare the body for labor.
    • Cervical changes: The cervix softens, thins, and effaces, making it more pliable for the baby's passage.
    • Bloody show: The mucus plug that protects the baby dislodges, potentially pulling capillaries and causing bleeding.
    • Rupture of membranes: The amniotic sac breaks, releasing clear fluid. Green fluid indicates meconium release, and a foul odor suggests infection.
    • Sudden burst of energy: A surge of energy known as "nesting," preparing the home for the baby's arrival.

    True vs. False Labor

    • Contraction timing: True labor contractions are regular and consistent, while false labor contractions are irregular and unpredictable.
    • Contraction strength: True labor contractions increase in strength and intensity over time, while false labor contractions remain weak.
    • Contraction discomfort: True labor pain starts in the back and radiates to the front, while false labor pain is often felt in the front of the abdomen.
    • Change in activity: True labor contractions continue regardless of position changes, while false labor contractions may slow down or stop with activity.

    Factors Affecting Labor Process - The 5 Ps

    • Passageway: The birth canal, which includes the pelvis and soft tissue.
      • Pelvic size: The true pelvis (inlet) is the narrowest part the baby must pass through.
      • Pelvic shape:
        • Gynecoid: The most common and favorable shape for vaginal delivery.
        • Android: Not favorable for vaginal birth due to a narrow shape.
        • Anthropoid: Narrower than gynecoid, but may still allow for vaginal birth.
        • Platypelloid: Not favorable due to a flat shape.
      • Cervix: Dilates and effaces during labor.
      • Pelvic floor muscles: Provide resistance and assist in directing the baby's descent.
    • Passenger: The fetus, including its head, attitude, lie, presentation, and position.
      • Fetal head: The presenting part, with reference points for determining position during vaginal examinations.
      • Fetal attitude: The relationship of fetal body parts; flexion is crucial for optimal descent.
      • Fetal lie: The orientation of the baby's spine in relation to the mother's spine.
        • Longitudinal: Parallel to the mother's spine (ideal).
        • Transverse: Perpendicular to the mother's spine.
        • Oblique: Diagonal to the mother's spine.
      • Fetal presentation: The part of the fetus entering the pelvis first:
        • Cephalic: Head first (optimal).
        • Breech: Butt or feet first (not ideal).
        • Shoulder: Not safe for vaginal delivery.
      • Fetal position: Determined by the side of the pelvis (R or L), presenting part (Occiput, Mentum, Sacrum), and relationship to the maternal pelvis (Anterior, Posterior, or Transverse).
    • Powers: The forces of labor, including primary contractions and secondary pushing efforts.
      • Primary powers: Contractions causing dilation, effacement, and descent.
      • Secondary powers: Abdominal muscles used for pushing.
    • Position: Maternal positions can greatly impact labor progress and comfort.
      • Standing and walking: Can promote cervical changes.
      • Squatting: Opens the pelvis and aids in descent.
      • Kneeling: Brings the baby forward, relieving pressure on the back.
      • Side recline: Increases pelvic opening.
      • Peanut ball: Provides support and pelvic opening.
    • Psychological response: A positive attitude, willingness to birth, and coping with physical demands are crucial for a successful labor experience.
      • Sociocultural: Beliefs and practices surrounding childbirth can influence experience.
      • Socioeconomic: Access to prenatal care and support systems impacts labor experience.

    Fetal Station

    • The level of the presenting part in relation to the maternal ischial spines.
      • Zero station: The presenting part is at the level of the spine.
      • Floating: Above the level of the spine.
      • Dipping: The presenting part dips into the pelvis.
      • Engaged: The presenting part is at the level of the ischial spines.

    Stages of Labor

    • First stage: The longest stage, divided into two phases:
      • Latent phase (0-6 cm): Characterized by mild contractions and cervical dilation up to 6 cm.
      • Active phase (6-10 cm): More intense contractions and cervical dilation from 6 cm to full dilation (10 cm).
    • Second stage: From full dilation to the birth of the baby.
      • Pelvic phase: Period of fetal descent.
      • Perineal phase: Period of active pushing.
    • Third stage: Placental separation and delivery.
      • Placental separation: Detaching from the uterine wall.
      • Placental expulsion: Coming outside the vaginal opening.
    • Fourth stage: The first 1-4 hours after birth, focusing on maternal recovery.

    Cardinal Movements of Labor

    • Engagement: The fetal head enters the pelvis.
    • Descent: The fetal head descends through the pelvis.
    • Flexion: The fetal head flexes to present the smallest diameter.
    • Internal rotation: The fetal head rotates to align with the pelvic outlet.
    • Extension: The fetal head extends as it emerges under the pubic arch.
    • External rotation: The fetal head rotates to align with the shoulders.
    • Expulsion: The baby is completely delivered.

    Maternal Assessment During Labor and Birth

    • Vaginal examination: Assesses cervical dilation, effacement, fetal descent, and rupture of membranes.
    • Uterine contractions: Palpated to determine intensity, frequency, and duration.
    • Leopold maneuvers: Used to determine fetal position and presentation.
    • Fetal assessment: Includes analysis of fetal heart rate, fetal movement, and amniotic fluid.

    Fetal Assessment During Labor and Birth

    • Amniotic fluid analysis: Determines color and odor, indicating fetal well-being.
    • External fetal monitoring: Uses belts to monitor fetal heart rate and contractions.
    • Internal fetal monitoring: Involves inserting a fetal scalp electrode and an intrauterine pressure catheter for more precise readings.

    Fetal Heart Rate Analysis

    • Variability: The fluctuation in fetal heart rate, indicating fetal health:
      • Absent: Undetectable range.
      • Minimal: Range less than 5 bpm.
      • Moderate: Range from 6-25 bpm (ideal).
      • Marked: Range over 25 bpm.
    • Periodic changes: Indicate fetal response to labor:
      • Accelerations: Temporary increases in fetal heart rate, indicating good oxygenation.
      • Decelerations: Temporary decreases in fetal heart rate:
        • Early: Occur at the same time as the peak of the contraction, usually due to head compression (expected finding).
        • Late: Occur after the peak of the contraction, suggesting uteroplacental insufficiency (needs intervention).
        • Variable: Sharp, unpredictable drops, suggesting cord compression (needs intervention).

    Nonpharmacologic Pain Management Measures

    • Continuous labor support
    • Hydrotherapy
    • Ambulatory and position changes
    • Acupuncture and acupressure
    • Attention focusing and imagery
    • Therapeutic touch and massage
    • Breathing techniques

    Pharmacologic Pain Management Interventions

    • Neuraxial analgesia/anesthesia: Epidurals, spinal blocks, combined spinal epidural.
    • Systemic analgesia: Medications given intravenously or orally.
    • Inhaled analgesia: Nitrous oxide.
    • Regional analgesia/anesthesia: Local anesthetics used for regional pain relief.
    • General anesthesia: Used in emergencies only.

    Nursing Management of Labor

    • Maternal assessments:
      • Admission & first stage: Assess maternal history, physical status, psychosocial concerns, and laboratory tests.
      • Second stage: Monitor breathing, pushing techniques, contractions, VS, FHR, and coping.
      • Third stage: Monitor VS, observe for placental separation, assess perineal trauma, and provide newborn care.
      • Fourth stage: Monitor VS, assess fundus, perineum, provide bonding and education, and manage postpartum complications.

    Assisted Delivery

    • Forceps delivery: Instrumental assistance used to aid in vaginal delivery.
    • Vacuum-assisted delivery: Uses a vacuum extractor to assist in vaginal delivery.

    Cesarean Birth

    • Delivery of the baby through a surgical incision in the abdomen and uterus.
    • Indications include fetal distress, maternal health conditions, or labor complications.

    Key Points

    • The uterus stretches, and the cervix dilates and effaces to facilitate the baby's passage.
    • The baby's position and descent play a significant role in labor progress.
    • Contractions are the primary force driving labor, while pushing efforts are secondary.
    • Different positions can promote labor progression and comfort.
    • Maternal and fetal assessments are crucial throughout the process.
    • Pain management options can be nonpharmacologic or pharmacologic, tailored to the individual needs of the laboring woman.
    • Cesarean birth is a surgical option when a vaginal delivery is not possible or safe.

    Factors Influencing Labor Onset

    • Uterine stretching: As the uterus expands, it releases prostaglandins, which trigger labor.
    • Cervical effacement and dilation: Softening, thinning, and opening of the cervix are crucial for the baby's descent.
    • Progesterone withdrawal: This hormone's decline increases uterine sensitivity to oxytocin.
    • Increased oxytocin sensitivity: Oxytocin triggers stronger uterine contractions.
    • Increased release of prostaglandins: These hormones stimulate uterine contractions.
    • Contractions happen fundus down: Contractions start at the top of the uterus and push the baby down.

    Premonitory Signs of Labor

    • Lightning bolt: The baby drops deeper into the pelvis, feeling like a shift in weight.
    • Braxton-Hicks contractions: These are practice contractions that prepare the body for labor.
    • Cervical changes: Softening, thinning, and effacement of the cervix indicate labor preparation.
    • Bloody show: The mucus plug is expelled, sometimes with a bit of blood from ruptured capillaries.
    • Rupture of membranes: “Water breaking” should be clear fluid; any coloration or odor could indicate issues. A green tint indicates meconium passage.
    • Sudden burst of energy: The “nesting instinct” is common, involving heightened energy and preparation for the baby's arrival.

    True vs. False Labor

    • Contraction timing: True labor contractions are regular and closer together.
    • Contraction strength: True labor contractions get stronger over time.
    • Contraction discomfort: True labor pain starts in the back and radiates to the abdomen.
    • Activity change: True labor contractions continue regardless of position change.
    • Stay or go: Stay home if contractions are 5 minutes apart, last 45–60 seconds, and are strong enough to make conversation difficult. If contractions become weaker with walking, stay home.

    Factors Affecting the Labor Process: The 5 Ps

    • Passageway: The birth canal, including the pelvis and soft tissues, determines the baby's path. The true pelvis needs to be large enough for the baby to pass through.

      • Pelvic shape:
        • Gynecoid: The most common and most favorable shape.
        • Android: Not favorable for vaginal delivery.
        • Anthropoid: Narrower, but vaginal delivery may still be possible.
        • Platypelloid: Not favorable for vaginal delivery.
      • Cervix: Dilation (opening) and effacement (thinning) are essential for delivery.
      • Pelvic floor muscles: These muscles provide resistance, helping the baby turn and descend correctly.

    • Passenger: The baby's position and size influence the labor process.

      • Fetal head: The presenting part, ideally the occipital bone, helps determine fetal descent.
      • Fetal attitude: Relationship of the fetal body parts (flexion or extension).
      • Fetal lie: The orientation of the baby's axis relative to the mother's axis.
        • Longitudinal: Baby's spine is parallel to the mother's.
        • Transverse: Baby's spine is perpendicular to the mother's.
        • Oblique: Baby's spine is diagonally aligned.
      • Fetal presentation: The body part that enters the pelvis first.
        • Cephalic: The head is the presenting part, preferred for vaginal delivery.
        • Breech: The buttocks or feet are the presenting part.
        • Shoulder: The shoulder is the presenting part (not safe for baby, requires C-section).
      • Vertex presentation: The smallest diameter of the head presents.
      • Military presentation: The head is less flexed than in vertex, a larger diameter presents.
      • Brow presentation: The larger fetal brow presents.
      • Face presentation: The largest diameter faces the cervix.
      • Shoulder presentation: Requires immediate C-section.
      • Frank Breech: Buttocks present, legs flexed.
      • Complete Breech: Buttocks present, legs flexed and crossed.
      • Footling Breech: One or both feet are the presenting part (requires C-section).
      • Fetal position: Describes the relationship of the baby's presenting part to the mother's pelvis.
        • R or L: Right or left side of the pelvis.
        • Presenting part: Occiput (back of head), Mentum (chin), or Sacrum.
        • Part-Pelvis: Anterior (front), Posterior (back), or Transversal (sideways).

    • Powers: The forces that move the baby through the birth canal.

      • Primary powers: Contractions cause cervical dilation and effacement.
        • Frequency: Time between the onset of one contraction and the next.
        • Duration: Length of the contraction from beginning to end.
        • Intensity: Strength of the contraction, assessed by palpation (mild, moderate, or strong).
      • Secondary powers: Abdominal muscles used for pushing during the second stage of labor.

    • Position: Mother's positioning during labor can affect progress.

      • Optimal positions include standing, walking, squatting, kneeling, and side recline.
      • These positions open the pelvis, help baby descend, and minimize back pain.

    • Psychological response: Maternal mental and emotional state impacts labor.

      • Positive attitude and willingness to birth: Key for successful labor.
      • Sociocultural and socioeconomic factors: Influence labor experience.
      • Ability to cope with physical demands: Important for managing pain and staying focused.
      • Maintaining physiological and emotional balance: Crucial throughout labor.

    Other Ps to Consider

    • Philosophy: The mother's (and provider's) beliefs about birth, such as natural childbirth or medical interventions.
    • Partners: The support person's role in emotional and physical support during labor.
    • Patience: Being prepared for the unpredictable nature of labor.
    • Patient preparations: Physical and emotional readiness for birth, including classes, support groups, and other resources.
    • Pain management: Methods used to alleviate discomfort during labor.

    Systemic Responses to Labor

    • Maternal:

      • Cardiovascular: Increased blood volume, cardiac output, and blood pressure during labor.
      • Respiratory: Hyperventilation can lead to respiratory alkalosis, while pushing causes respiratory acidosis.
      • Gastrointestinal: Slowed stomach emptying, leading to nausea and vomiting.
      • Lab values: Increased white blood cell count during labor.

    • Fetal:

      • Heart rate: Fluctuations in fetal heart rate indicate well-being (accelerations) or stress (decelerations).
      • Fetal movement: A sign of well-being.

    Stages of Labor

    • First stage: Longest stage, divided into:

      • Latent phase (0-6cm): Early stages with mild contractions.
      • Active phase (6-10cm): Contractions become more frequent, stronger, and longer.

    • Second stage: Complete dilation to birth of the newborn, divided into:

      • Pelvic phase: Descent of the baby through the pelvis.
      • Perineal phase: Baby's head visible, active pushing.

    • Third stage: Placental separation and delivery:

      • Placental separation: Detaching from the uterine wall.
      • Placental expulsion: Exiting the vaginal opening.

    • Fourth stage: 1-4 hours after birth:

      • Time for monitoring and stabilizing the mother and newborn.

    Cardinal Movements of Labor

    • Engagement: The baby's presenting part settles into the pelvis.
    • Descent: The baby gradually moves down the birth canal.
    • Flexion: The baby's head flexes to present the smallest diameter.
    • Internal rotation: The baby's head rotates to align with the pelvic outlet.
    • Extension: The baby's head extends as it moves past the pubic bone.
    • External rotation: The baby's head rotates to align with the shoulders.
    • Expulsion: The baby is born.

    Maternal Assessment During Labor and Birth

    • Vaginal examination: Sterile gloves are crucial to assess:

      • Cervical dilation and effacement: How open and thin the cervix is.
      • Fetal descent: How far the presenting part has descended.
      • Rupture of membranes (ROM): When the amniotic sac breaks.

    • Uterine contractions: Assess by palpation or monitoring:

      • Intensity: Strength of the contraction during the peak.
      • Frequency: Time between contractions.

    • Leopold maneuvers: Abdominal palpation to determine:

      • Fetal position and presentation.

    Fetal Assessment During Labor and Birth

    • Amniotic fluid analysis: Color, odor, and consistency can indicate fetal well-being.

    • External fetal monitoring: Two devices are belted to the mother:

      • Tocodynamometer: Measures contractions.
      • Ultrasound transducer: Detects fetal heart rate, placed over the baby's back.

    • Internal fetal monitoring: More invasive methods:

      • Fetal scalp electrode: Attached to the baby's scalp for continuous heart rate monitoring.
      • Intrauterine pressure catheter (IUPC): Measures contraction intensity and frequency.

    Analysis of Fetal Heart Rate

    • Variability: The fluctuation of the fetal heart rate, an important indicator of well-being.

      • Absent: No detectable variation.
      • Minimal: Less than 5 bpm variation.
      • Moderate: 6-25 bpm variation (ideal).
      • Marked: Over 25 bpm variation.

    • Periodic changes: Temporary fluctuations in fetal heart rate in response to stimuli.

      • Accelerations: Short-term increases in heart rate, usually good.
      • Decelerations: Temporary decreases in heart rate.
        • Early decels: Occur at the peak of the contraction, usually due to head compression, considered normal.
        • Late decels: Dip in heart rate after the peak of the contraction, potential sign of fetal distress.
        • Variable decels: Sharp, unpredictable drops in heart rate, often due to cord compression.

    • Tachycardia: Fast fetal heart rate (over 160 bpm), can indicate maternal infection.

    • Bradycardia: Slow fetal heart rate (below 110 bpm), can indicate fetal distress.

    Fetal Heart Monitor Tracing

    • Upper graph: Fetal heart rate data.
    • Lower graph: Uterine contraction data.
    • Dark line to dark line: Represents one minute of time.

    Interventions for Fetal Heart Rate Issues

    • Cord compression: Change mother’s position to her side.
    • Late decels: Position the mother on her left side, increase IV fluids, administer oxygen, stop oxytocin if signs persist, consider internal monitoring if interventions fail.

    Nonpharmacologic Measures for Labor Pain

    • Continuous labor support: Having a partner, doula, or nurse present for emotional and physical support.
    • Hydrotherapy: Using water immersion for pain relief.
    • Ambulatory and position changes: Moving around and changing positions to promote labor progress and comfort.
    • Acupuncture and acupressure: Alternative therapies for pain relief.
    • Attention focusing and imagery: Techniques to help focus the mind and manage pain.
    • Therapeutic touch and massage: Manual techniques for pain reduction.
    • Breathing techniques: Controlled breathing methods to cope with pain.

    Pharmacologic Interventions for Labor Pain

    • Neuraxial analgesia (pain relief) and anesthesia: Medication delivered through a catheter into the spinal canal.
    • Systemic analgesia: Medication given by mouth or intravenously.
    • Inhaled analgesia: Nitrous oxide, a gas administered via a mask.
    • Regional analgesia/anesthesia: Local anesthetics used for pain relief in specific areas.
      • Epidural: Injection into the epidural space surrounding the spinal cord.
      • Combined spinal epidural: A combination of spinal and epidural anesthesia.
      • Pudendal block: An injection into the pudendal nerve that provides pain relief to the perineum.
    • General anesthesia: Only used in emergencies, as it can affect the baby.

    Nursing Assessments During Labor

    • Admission and first stage:
      • Prenatal record: Review of maternal history and risk factors.
      • Physical assessment:
        • Vital signs (VS)
        • Fundus and contractions (palpation, external monitoring, IUPC)
        • Cervical dilation and effacement
        • Amniotic fluid
        • Presenting part and descent
      • Cultural assessment: Understanding the mother's beliefs and preferences.
      • Laboratory tests: Blood work and urine tests.
      • Psychosocial concerns: Identifying and addressing any emotional or mental health needs.

    Nursing Management During the Second Stage

    • Breathing techniques: Promote efficient pushing.

    • Pushing techniques: Guidance on effective pushing methods.

    • Contractions: Monitor frequency, duration, and intensity.

    • Maternal VS: Check for any changes.

    • Fetal HR: Monitor closely.

    • Amniotic fluid: Observe for any changes in color or odor.

    • Coping: Support the mother's emotional and physical well-being.

    • Episiotomy: Surgical incision of the perineum to enlarge the vaginal opening.

      • Indications: Large baby, vacuum or forceps delivery, maternal exhaustion.
      • Assessment and interventions: Assess for REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation) and provide comfort measures (ice, tucks, sitz bath).

    • Lacerations: Tears of the perineum during delivery.

      • First degree: Vaginal mucosa and perineum.
      • Second degree: Perineal muscles and fascia.
      • Third degree: External anal sphincter.
      • Fourth degree: Internal and external anal sphincters, anal mucosa.

    • Prevention of lacerations: Perineal massage, various pushing positions, warm compresses.

    Assisted Delivery

    • Forceps: Instruments used to assist with delivery.

      • Outlet forceps: Applied when the baby's head is at the pelvic outlet.
      • Low forceps: Applied when the baby's head is at station +2 or greater.

    • Vacuum extraction: A suction device used to assist with delivery.

      • Indications: Prolonged second stage, non-reassuring FHR tracing, inability to push effectively, maternal exhaustion.

    Nursing Management During the Third Stage

    • Maternal care:

      • Vital signs every 15 minutes.
      • Observe for placental separation.
      • Assess for perineal trauma and repairs.
      • Provide comfort measures.

    • Newborn care:

      • Maintain airway and breathing.
      • Provide warmth.
      • Perform APGAR score at 1 and 5 minutes.
      • Physical assessment.
      • Identification measures.
      • Facilitate bonding and breastfeeding.

    Nursing Management During the Fourth Stage

    • Assess vital signs: Every 15 minutes for the first hour after delivery.
    • Assess temperature: If indicated.
    • Palpate fundus and lochia: Every 15 minutes for the first hour.
    • Assess perineum: Check for any bleeding, pain, or swelling.
    • Perineal care: Provide ice packs, tucks, or sitz baths for comfort.
    • Encourage bonding and breastfeeding: Support the mother and baby in initiating breastfeeding or other feeding methods.
    • CSM: Check for circulation, sensation, and movement in the mother's legs.
    • Education: Provide information about recovery and postpartum care.

    Care of the Family During Cesarean Birth

    • Delivery through incision: A surgical procedure involving an incision in the abdomen and uterus.
    • Maternal-fetal indications: Reasons for choosing a C-section.
    • Pre/post-operative care: Preparing the mother for surgery and providing care after delivery.
    • Risks: Infection, hemorrhage, aspiration, ileus, urinary trauma.
    • Anesthesia: Spinal anesthesia is common; monitor CSM after surgery.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    This quiz covers essential concepts related to nursing management during labor and delivery. It includes questions about signs of labor, contractions, delivery methods, and critical emergency signs. Test your knowledge to ensure effective nursing practices in obstetrics.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser