Fertilization and Implantation Study Guide PDF

EXAM #1 ~~ STUDY GUIDE FERTILIZATION AND IMPLANTATION: GENERAL KNOWLEDGE Define fertilization: when a sperm and ovum fuse to become a zygote a 3–4 day trip where the zygote travel...

EXAM #1 ~~ STUDY GUIDE FERTILIZATION AND IMPLANTATION: GENERAL KNOWLEDGE Define fertilization: when a sperm and ovum fuse to become a zygote a 3–4 day trip where the zygote travels the length of the uterine tube What is cleavage? into the uterus Define implantation. How long is it? when the blastocyst burrows into the endometrium; 6–10 days 1. ovum/preembryonic – conception through 14–day period of cellular replication 3 stages of fetal development: 2. embryo – day 15–8 weeks 3. fetus – 9 weeks until the end of pregnancy What happens in the embryonic stage of development? organ systems and main external features develop blastocyst formation, development of embryonic membranes, and What happens in the pre-embryonic stage of development? establishment of primary germ layers 1. ectoderm – upper layer 3 primary cell layers: 2. mesoderm – middle layer 3. endoderm – lower layer nongenetic factors that cause malformation and disorders in utero; Define teratogens. What stage are they most vulnerable? embryo Compression in utero of the cord and vessels within is prevented by Wharton’s jelly (special connective tissue) and the high blood what two things? volume that pulses through the cord True or False: There is sensory and motor innervation in the cord False the fetus loops around and through the cord; can cause fetal death if A true knot occurs when what happens? What can result from this? the knot tightens and constricts the blood flow True or False: The yolk sac is present throughout each stage of False. It is only in early embryonic life development Forms primitive red blood cells until the liver takes over at What does the yolk sac do? approximately 6 weeks forms at implantation; functions early as an endocrine gland to produce hormones - responsible for metabolic functions such as fetal respiration, nutrition, and excretion When does the placenta form? What does it do? - intakes oxygen and outputs carbon dioxide through the placental membrane from maternal blood - stores carbs, proteins, calcium, and iron for ready access to meet fetal needs True or False: The placenta causes a direct link to mom and fetus, True meaning that alcohol, nicotine, and other toxic substances go to the baby as well.  - human chorionic gonadotropin (hCG) - chorionic somatomammotropin/human placental lactogen What are the 4 hormones, provided by the placenta, that are (hPL) necessary to maintain and support pregnancy? - progesterone - estrogen it is the basis for pregnancy tests; preserves the function of ovarian What is the role of human chorionic gonadotropin during pregnancy? corpus luteum, ensuring continued production of estrogen and progesterone stimulates maternal metabolism to supply nutrients needed for fetal What is the role of chorionic somatomammotropin during growth; increases resistance to insulin, facilitates glucose transport pregnancy? across placental membrane, and stimulates breast development to prepare for lactation maintains endometrium (deciduas), decreases contractility of What is the role of progesterone during pregnancy? uterus to prevent spontaneous abortion, and aides in breast development stimulates uterine growth and uteroplacental blood flow, causes What is the role of estrogen during pregnancy? proliferation of breast glandular tissue, and stimulates myometrial contractility TORCH INFECTIONS: a group of congenitally acquired infections that caused significant What are TORCH infections? morbidity and mortality in the child True or False: TORCH infections are only transmitted during False. The infections are passed either transplacentally or during the pregnancy, not during the birthing process. birth process intrauterine growth restriction (IUGR), microcephaly, intracranial What are some conditions/signs to consider TORCH infections to be a calcifications, conjunctivitis, hearing loss, rash, cause? hepatosplenomegaly, or thrombocytopenia T – toxoplasmosis O – other (gonorrhea, syphilis, varicella, hep B, HIV, Zika) What are the perinatal infections that make up TORCH? R – rubella C – cytomegalovirus H – herpes simplex undercooked meat, raw seafood from contaminated water, DIRTY What causes toxoplasmosis? KITTY LITTER, contaminated soil; mom is exposed to the parasite and infects fetus/newborn purulent conjunctivitis with profuse exudate and swelling of eyelids; diagnosis is confirmed by a culture of the exudate What are identifiers of gonorrhea infection? How can it be - treated with newborn ophthalmic erythromycin within 1 hour of treated/prevented? birth - if infection is systemic, IV/IM antibiotics (i.e. Ceftriaxzone) are required the infection can lead to ulceration, scarring, and visual impairment What can happen if gonorrhea isn’t treated? due to depth of infection  signs and symptoms may occur 20 years later; hepato/splenomegaly, anemia, lymphadenopathy, rash, fever; saddle What are the identifiers of syphilis infection? How can it be nose, noisy ‘snuffly’ breathing, and Hutchinson Teeth (circle holes treated/prevented? on base of teeth) - treated with penicillin True or False: All cases of syphilis, whether mild or severe, are all False. Only severe cases are clinically apparent at birth clinically apparent at birth can result in stillbirth, prematurity, low birthweight, miscarriage, and What can happen if syphilis isn’t treated? developmental delays What are the identifiers of varicella-zoster infection? How can it be newborn chicken pox treated/prevented? - acyclovir may be administered intrauterine growth restriction (IUGR), limb abnormalities, CNS What can happen if varicella-zoster isn’t treated? abnormalities True or False: Newborns born to mother who are exposed to True varicella-zoster or have clinical disease manifestations within two weeks of delivery are at the greatest risk of infection How high/low is the mortality rate of neonatal varicella? up to 30% What are the identifiers of Hepatitis B infection? How can it be manifestations rarely show at birth treated? Hep B vaccines and HBIG are given within how many hours of birth if 12 hours suspected infection? newborn microcephaly, cardiac deficits , hypertonia/hyperreflexia, What is the newborn sequelae of Zika infection? clubfeet, ocular findings, hearing loss How is Rubella transmitted? respiratory secretions ‘blueberry muffin spots’, hearing loss, ocular (visual) problems, What is the newborn sequelae of congenital Rubella? cardiac defects Newborns with congenital rubella are considered infections for 1 year 2 negative cultures are obtained unless what? How is cytomegalovirus transmitted? secretions and body fluids hearing loss, vision impairment, mental disabilities; What is the newborn sequelae of Cytomegalovirus infection? How can - prevented by hand washing (working with young children it be treated/prevented? increases risk of infection) How is Herpes Simplex transmitted? sexually transmitted How can Herpes Simplex be prevented? avoid infection during pregnancy, antiviral medications What is the newborn sequelae of infection for Herpes Simplex? skin lesions, scarring, seizures, IUGR, mental retardation ANTENATAL CARE: FIRST TRIMESTER What is the difference between presumptive, probable, and positive presumptive – changes felt by the woman; could be caused by signs of pregnancy? something else  probable – changes observed by an examiner positive – signs that attributed only to the presence of the fetus - amenorrhea (absence of menstruation) - quickening (feeling fetus movement; not possible until 16 weeks) - nausea/vomiting Give examples of presumptive signs. What causes these? - urinary frequency - breast tenderness - fatigue Related to hormonal changes in the pregnancy What causes the skin pigmentation changes during pregnancy? increased production of melanocyte stimulating hormone (MSH) chloasma gravidarum – butterfly pigmentation/rash on the cheeks What is a “pregnancy mask”? and nose (usually disappears a few months after labor What is a linea nigra? the dark line extending from the umbilicus to symphysis pubis - Hegar’s sign – softening of the uterus and distinction between uterus and cervix (4–6 weeks) What are the 3 probable (titled) signs of pregnancy? - Goodell’s sign – softening of the cervix (6–8 weeks) - Chadwick’s sign – bluish hue to the cervix (after 6 weeks) Why does the cervix soften and become bluish? increased vascularity of the tissue - positive pregnancy test - enlarging abdomen (after 12 weeks) What are some further examples of probable pregnancy signs? - Braxton Hicks contractions - Uterine/Placental Souffle (blood flowing) - fetal heartbeat Give examples of positive signs of pregnancy: - fetal movement felt by palpation at about 20 weeks gestation - visual visualization of fetus by ultrasound G – gravidity; any pregnancy of any duration T – term (# of births) P – preterm (# of births) Define the 5-letter system: A – abortion; birth before completion of the 20th week (includes spontaneous, elective, medical, etc) L – # of currently living children (including step children) primigravida – pregnant for the first time or had one pregnancy What are the classifications for pregnancy count, regardless of the multigravida – a woman who has had 2 or more pregnancies carrying to term? nulligravida – a woman who has never been pregnant primipara – has had one pregnancy that reach viability and delivered (1 birth) What are the classifications for pregnancy count, specific to carrying multipara – has had 2 or more pregnancies that reached viability to term? and delivered (2+ births) grand–multipara – has had 5 or more pregnancies that reached viability and delivered  nullipara – has never completed a pregnancy to viability (may or may not have had a spontaneous or elective abortion before viability) how to calculate a due date: What is Naegele’s Rule? LMP (last period) + 7 days - 3 months = estimated due date 12 weeks; estrogen causes hypertrophy of muscle fibers and When does fundal height begin? What is it caused by? progesterone causes hyperplasia hyperplasia – increase in number of cells Define hyperplasia and hypertrophy. hypertrophy – increase in size of cells screening for/managing coexisting morbidities, health promotion What is the goal of prenatal care? and disease prevention, and monitoring fetal growth/well being protein – if +1 on a dipstick, indicates strenuous exercise, emotional stress, infection, or preeclampsia What is testing in the urine during pregnancy and why? ketones – ketonuria indicates inadequate calories for mom; may be due to nausea/vomiting or deliberate/involuntary skipping of meals glucose – trace amount is normal but more deserves evaluation Severe nausea and vomiting will affect what lab test/levels? urine specific gravity and ketone levels Why is blood typing for mom and baby? mom’s antibodies can attack baby’s blood cells the body can’t react quickly enough/make antigens fast enough in Why is Rh negativity an issue in the second pregnancy and not the the first pregnancy to attack, but by second baby, it can cause a first? specific type of anemia in the body and kill the fetus vaginal cultures/urine test for gonorrhea and chlamydia, blood test What tests do you use for each screening of STDs? for syphilis, HIV, and Hep B Why is a rubella screening important? What could happen if the fetus rubella could cause miscarriage, stillbirth, congenital rubella gets rubella? syndrome True or False: The rubella vaccine is allowed during pregnancy. False. It is a live vaccine (too dangerous) What two genetic conditions should mom and dad be screened for? sickle cell gene and/or cystic fibrosis cell free DNA (cfDNA) screening of matern. blood – after 9 weeks; checks for chromosomal issues and fetal sex nuchal translucency with matern. blood sample – between 11–13 weeks ONLY; indicates and increased risk for trisomy abnormalities What fetal testing should occur during the first trimester and when? in the fetus; blood screen for pregnancy–associated plasma protein A (PAPP–A) and human chorionic gonadotropin (hCg) chorionic villus sampling – between 10–13 weeks; placental biopsy to determine genetic deficits appropriate weight gain, vitamin and mineral supplementation, safe What are some components of healthy nutrition in pregnancy? food handling, Pregnancy is a(n) ________ state and results in an increased energy anabolic; 300 kcal need of how many calories? What should not be consumed during pregnancy and why? raw meat, seafood, soft cheese, or cold deli meats; can cause listeria Why are fat cells important during pregnancy? maintain estrogen levels required to maintain pregnancy How can you as a nurse help make a physical exam more help the woman relax, keep the legs apart, be conscious of exposure, comfortable? talk her through the process and educate ANTENATAL CARE: SECOND TRIMESTER - grow in response to estrogen and progesterone in preparation for breastfeeding - feeling of fullness/heaviness/tingling and more veins due to increased blood volume during pregnancy - striae (stretch marks) can form as a result of rapid increase What are some of the changes in the breast during the 2nd trimester? growth - milk ducts grow and stretch as they fill with sticky “pre-milk”, resulting from high amounts of luteal and placental hormones and preparation for milk production following birth - areola darken and nipples are more likely to erect True or False: Breast size/growth has no impact on lactation or milk True production - leukorrhea What are some reproductive system changes in mama through the - Braxton Hicks contractions 2nd trimester? - quickening - growing uterus odorless, milky white discharge that doesn’t cause itching/burning’ prevents microorganisms from harming baby What is leukorrhea? What should you teach mama about it? teach mama the difference between leukorrhea and an infection uterine contractions (cramps) that can be painless or mimic menstrual cramps; very common; can taper off if mama empties her What are Braxton Hicks Contractions? What should you teach mama bladder, puts her feet up, rests for 20 mins, and hydrates with water about it? teach mama the difference between these and pre-term labor term used to describe a woman’s perception of fetal movement; ask mama if they have felt fetal movement at every prenatal visit, What is Quickening? What should you teach mama about it? reassure that it is felt as soon as 16 weeks, sooner for multigravia moms) and assess fetal heart rate; expect to hear it 95% of the time after 12 weeks the uterus grows out of the pelvis and pushes other organs out of place (puts pressure/tension on surrounding muscles/ligaments) What should you educate mama about with uterine growth? teach mama bout pelvic floor exercises, tensing in a rhythmic fashion about 10–15 times several times a day to reduce the risk of hemorrhoids, shorten labor, and to decrease incontinence The 2nd trimester system changes can cause impacts in what smell, taste (food aversion/cravings), vision changes (blood volume senses? and flow to eyes increase) Why are physical changes important in pregnancy? To ensure that the woman has a healthy pregnancy and is ready for  childbirth and lactation supine hypotension, blood pressure adjustments, and femoral What are some cardiac changes in the 2nd trimester? venous pressure increased O2 consumption, shortness of breath, nasal What are some respiratory changes in the 2nd trimester? stuffiness/epistaxis to push blood flow to the growing uterus and placenta due to Why must the heart work significantly harder during pregnancy? increased needs for nutrition and profusion as the pregnancy progresses How much does cardiac output increase and when does it peak? 30–50%; peaks at 20–24 weeks and remains elevated until birth - 20 week ultrasound - fundal height check and FHR (fetal heart rate) - Glucose screen at 24–28 weeks What are some screening and diagnostic tests for the 2nd trimester? - amniocentesis: between 15–20 weeks - antibody screening at 24–28 weeks, prior to Rhogam for Rh negative women genetic/chromosomal conditions, such as Down’s or Edward’s What does an amniocentesis screen for? syndrome ANTENATAL CARE: THIRD TRIMESTER - backache - sciatica What are some 3rd Trimester system changes/miseries? - diastasis recti - Braxton Hicks Contractions - Lightening What is Lightening? when the fetus drops/settles into the pelvis drop in BP due to impaired venous return from the gravid uterus pressing on the ascending vena cava, when mom is lying flat on her What is Supine Hypotensive Syndrome? How is it prevented/treated? back position mom on her side until s/s subside and vitals stabilize - hyperpigmentation of breasts, nipples, inner thighs, and face - increased acne What are some integumentary system changes in the 3rd trimester? - varicose veins (spider nevi) - palmar erythema (part of capillary fullness) - twice daily at the same time every day, beginning at 28 weeks - record how long it takes to get 10 movements What is required of fetal kick counts? - if it takes longer than 2 hours, or takes longer than usual, call care provider - call for sudden changes in fetal movements - gestational diabetes screening – 28 weeks What are some labs and treatments in the 3rd trimester and when - antibody screen and Rh immunoglobulin (for Rh– pregnancies) – should they occur? 28 weeks - group beta strep testing – 36–37 weeks  - about 1 in 4 pregnant women carry GBS bacteria Why is Group B Beta Strep testing important? - plan to give IV antibiotics during labor to prevent most early–onset GBS disease in newborns LABOR AND DELIVERY What are the components of a vaginal exam? dilation(#), effacement (#%), station (#) the level of the presenting part in the pelvis, estimated in What does station(s) mean in terms of a vaginal exam? centimeters from the level of the ischial spine in the mother’s pelvis, which is considered “Zero station” When is a fetus “engaged in the pelvis”? when the presenting part of the fetus is at zero station minus stations are above the ischial spines and positive stations are What are minus stations and positive stations? below the ischial spines True labor requires what two things? regular uterine contractions and cervical change What does effacement mean? the thinning of the cervix If you had a patient who was in early labor, and had a vaginal exam of She is 3cm dilated, 80% effaced, and had a station of –2 (2 ischial 3 cm/80%/–2 , what does that mean? spines above the pelvis) What would be the vaginal exam of a woman who is ready to deliver? 10cm/100%/+2 (or +3/+4) Passage – pelvis type/soft tissues (cervix, vagina, perineum, etc.) Passenger – cardinal movement of fetus, fetal heal, presenting part, fetal lie, fetal attitude/posture, fetal size What are the 5 P’s of the Process of Labor? Define each term. Powers – involuntary contractions and secondary powers to “push baby out” Position – maternal position in relation to fetal position Psyche – of mama; her support people and healthcare providers good: gynecoid and anthropoid What pelvis types are good for labor? Which are not? bad: platypelloid and android gynecoid – most common; round, shallow, open android – resembles male pelvis; heart-ish shaped Define each pelvic type: anthropoid – narrow and deep; similar to an upright egg or oval platypelloid – narrow; baby can have trouble passing through pelvic inlet due to narrow appearance cephalic – head down, chin tucked, facing mama’s back; BEST What are the options for presentation of parts of the fetus? breech – footling, complete (butt and feet delivery), frank (only butt) What is the “true pelvis”? the area below the pelvic brim What is the “false pelvis”? the area within the entire pelvic “girdle” What is the largest transverse diameter of the fetal head? biparietal What is the smallest anteriorio–posterior diameter of the fetal skull? suboccipitobregmatic  suboccipitobregmatic because when the head is completely flexed it What is the most important diameter of the fetal skull and why? is the presenting diameter in the pelvis What is used to determine attitude of the passenger? fontanelles and sutures performed at 24 weeks in order to determine the position of the fetus inside the woman’s uterus in four steps: fundal grip, determining the What is Leopold’s Maneuvers and the purpose of it? side with the smallest parts, what is “in the pelvis”, and what part of the presenting part is most prominent. 1. Engagement – presenting part is at zero station 2. Descent – duh 3. Flexion – occurs during descent, brought about by resistance felt by the baby’s head against soft tissues of pelvis; brings flexion to baby’s head so that chin meets the chest and smallest diameter of baby’s head presents into the pelvis 4. Internal rotation – typical rotation of about 45 degrees so the face points posteriorly 5. Extension – head, face, and chin are born Explain the 7 to 8 cardinal movements during labor? 6. Restitution – head turns about 45 degrees so that the face moves from face-down to facing either of the inner thighs, realigning with the body as the shoulders move into the next step 7. External rotation – shoulders must fit around and under the pubic arch 8. Expulsion - anterior shoulder moves out from under pubic bone; rest of baby is born with an upward motion of baby’s body by the care provider Before walking onto the labor floor, what type of questions should you cultural/sociological ask yourself? safety of mom and fetus, comfort and psychological well–being of What are the goals of nursing care in Labor? mom, and advocating/empowering the family the physiologic process by which a fetus is expelled from the uterus to the outside world What is Labor? What causes it to happen? hormones; the uterine stretch, fetus, and placenta all play a role in starting labor True Labor: False labor: Contractions: regular irregular intervals Intensity: increases remains the same Compare the contractions, dilation, effacement, activity impact, sedation impact, and location of contractions between True Labor and Dilation/Efface: ++ change none False Labor (Braxton Hicks) Activity Impact: contractions intensify contractions decrease Sedation Impact: labor continues contractions fade Contract. Location: low front and back feels all over front involuntary, powerful, abdominal “lift” during contractions; the force What are some characteristics of uterine contractions? moves fetus down the birth canal What is the goal(s) of uterine contractions? dilate the cervix and push fetus through birth canal What are some premonitory signs of labor? lightening, bloody show, mucus plug, energy spurt, spontaneous  rupture of membranes False. Premonitory signs may occur even though onset of labor may True or False: Premonitory signs always begin at the start of labor. still be days or weeks away 1. labor (dilation) 2. birth (full dilation; pushing) What are the stages of labor? 3. delivery of placenta 4. postpartum recovery latent – 0–3cm dilation What are the cervical phases of the 1st labor stage? active – 4–7cm dilation transition – 8–10cm dilation The duration of the normal 2nd stage of labor is influenced by what? Parity and presence of an epidural AROM – artificial rupture of membranes What are the forms of membrane rupturement? SROM – spontaneous rupture of membranes PROM – premature rupture of membranes (before labor onset) What is PPROM? preterm premature rupture of membranes; occurs before 37 weeks PROM occurs in what percent of all pregnancies? 8–10% True or False: PPROM is a pregnancy complication. True When documenting amniotic fluid/membrane status, what should Time, amount, color, odor (TACO) you ALWAYS write down? What should always be checked after ROM (rupture of membranes) FHTs (fetal heart tones); umbilical cord prolapse and infection and why? chief complaint, review prenatal record, obtain history of current What is included on the initial assessment in Labor and Delivery? situation, vital signs (including FHTs), vaginal exam - discuss pain management What should be included in nursing care in the Latent Early phase of - evaluate FHR/membranes stage 1 of labor? - encourage walking, pelvic rocking, rest - hunger A mom in the Latent Early Phase of stage 1 of labor may be - backache/cramps experiencing what physical symptoms? - bloody show/mucus Contractions in the Latent Early Phase of stage 1 of labor may be how mild to moderate; every 3–10 mins. strong/long? How large is the cervix dilation in the Latent Early Phase in stage 1? 0–3 cm - not hungry A mom in the Active Phase of stage 1 of labor may be experiencing - moaning/vocalizing pain what physical symptoms? - deeply concentrating - increased pressure in the pelvis How large is the cervix dilation in the Active Phase of stage 1 of labor? 4–7 cm Contractions in the Active Phase of stage 1 of labor may be how intense/moderate–strong; every 3–5 mins. strong/long? may last 60 seconds or more - advocate for mom - stay with her and inform of progress - coach/praise - encourage movement, changes in position, hydration, urination, and rest between contractions What should be included in nursing care in the Active Phase in stage 1 - massage/touch of labor? - breathing patterns - evaluate patient needs - provide ice chips, cool washcloth, tub, shower - assess vitals and FHTs per standards - prep for delivery - sweaty, nauseated, hot, cold, vomiting, hiccoughing, burping, A mom in the Transition Phase of stage 1 of labor may be experiencing shaky what physical symptoms? - increased vocalizations - increased bloody show How large is the cervix dilation in the Transition Phase of stage 1 of 8–10 cm labor? Contractions in the Transition Phase of stage 1 of labor may be how strong; 1.5–3 min; may last up to 90 seconds strong/long? - remain with patient to promote comfort and reassurance to her and fam. - encourage to take one contraction at a time - expect yelling - reassure that changing sensations are normal and that she is What should be included in nursing care in the Transition Phase in almost done! stage 1 of labor? - massage, breathing exercises, pain measures - discourage pushing until she feel urge for entire contraction and at full dilation - assess vitals and FHTs per standards - change positions What is to be expected in the 2nd stage of labor? molding, rotation, and descent of fetus; pushing/expulsion 10cm dilation to birth of baby - pelvic/rectal pressure (ensure rectal pressure is present) What are the indications of the 2nd stage of labor? - mother’s bearing down is for the entire contraction - rectal flaring with maternal grunts A mom in the 2nd stage of labor may be experiencing what physical - increased bloody show as mom reaches 10 cm symptoms? - if FHR is fine, wait for pressure/urge to push - explain and assist with positions What should be included in nursing care of the patient in the 2nd - explain and assist with breathing during pushing (grunting, stage of labor? short breath-holds (4–5 secs), 5–7x/contraction) - discourage closed glottis pushing - STAY FOCUSED ON WOMAN What should be included in the medical care of the patient in the - cleanse/support perineum birthing process? - coach mother to ease baby out, not explosive effort  - offer opportunity for mom to touch the head herself - slow birth of the head, check for cord and reduce as needed (suction if there is meconium) - note time and positive that baby’s body is born and place baby to mother’s abdomen - clamp and cut cord - warm environment for baby (room temp, blankets, warmer) - newborn assessment/blood type What occurs in the 3rd stage of labor? begins after birth, and ends with placental delivery - lengthening of umbilical cord - gush of blood What are the 3 signs of placental separation? - fundus becomes firm and globular, more anteverted against abdominal hand - assess bleeding: measure fluid loss and record - vital signs/check fundus - prepare to give pitocin after placental delivery What are the steps of a normal placental delivery? - assess newborn ApGars - KEEP EVERYONE WARM AND COMFORTABLE - Help OB/Midwife as needed - one hand on umbilical cord with gentle downward traction; other Steps for emergent placental delivery: hand on abdomen supporting the uterine fundus - aggressive traction can cause cord avulsion or uterine inversion What is Uterine Inversion? EMERGENCY! When the uterus turns partially or entirely inside out - 1st degree – skin and structures superficial to muscle - 2nd degree – extends through muscles of perineum Define episiotomies and lacerations in terms of depth: - 3rd degree – extends through anal sphincter muscle - 4th degree – involves anterior anal wall Other: vaginal and periurethral tears (“skid marks”); cervical injuries - high risk for postpartum hemorrhage - record blood loss - WEIGH PADS What should be monitored in the 4th stage of labor? - Notify birth attendant if there is increased maternal HR, pelvic pain, or decreased BP - observe LOC - vital signs every 15 minutes - assess pain, perineum (comfort and swelling prevention), bladder, bonding/breastfeeding of mom and baby What is included in nursing care for the 4th stage of labor? - emotional needs - referee visitors What is Precipitous Labor? extremely rapid labor (less than 3 hours) - low resistance in maternal tissues, allowing rapid dilation and descent; large pelvis What are some indications of precipitous labor? - exceptionally strong contractions (induction/augmentations) - small fetus in favorable presentation True or False: Precipitous Labor predisposes mom to postpartum True hemorrhage. What should you NEVER do when a mom is in labor? NEVER LEAVE THEM!!! PAIN INTERVENTION FOR LABORING MOTHERS False. Pain is an unpleasant sensory and emotional experience True or False: Pain is a sensory modality, NOT an experience. associated with actual or potential tissue damage. What should be considered when offering pharmacologic intervention a woman’s culture, background, fear of potential complications, or for labor pain management? education It is the responsibility of health care providers to understand what of values and beliefs by taking into account medical and obstetric the woman during her plan for childbirth? considerations along with personal wishes visceral – deep organ pain of thoracic and abdominal cavities: passes of fetus through pelvic structure (T11–T12) What are the 3 types of labor pain? Give examples: somatic – experienced in skin, muscles, bones, and joints: passage of the head through the perineum (S1–S4) referred – lower abdominal and lumbar pain What is pain when thinking about each labor case? DIFFERENT! UNIQUE! - increased pulse and respirations - nausea/vomiting - diaphoresis, pallor What are some physical signs of pain? - muscular excitability - movement/writhing - vocal cues - hyperventilation What are some adverse consequences of Labor pain? - neurohumoral effects - psychological effects/trauma (could become PTSD) What is the prevalence of postpartum PTSD? at least 6% trusting and respecting relations with care providers and personal What is something that can impact labor pain? control (positively correlated with satisfaction) nonpharmacologic – to prevent or relieve suffering What are the types and purposes of labor pain relief? pharmacologic – to eliminate physical sensation of labor pain analgesia – to not feel pain (relief of pain without LOC) What are the two types of pharmacologic pain relief approaches? anesthesia – loss of feeling or sensation (motor ability and reflex activity); can include LOC scientific theory about psychological perception of pain; suggests that the spinal cord contains a neuro “gate” that either blocks pain What is the Gate Control Theory? signals or allows them to continue onto the brain can be used to explain phantom or chronic pain engaging laboring women in neuromuscular, motor, and cognitive How does the Gate Control theory help laboring women? activities  all of the above help activate and close the gating mechanism, inhibiting pain transmission - continuous labor support - breathing/relaxation techniques - heat/cooling therapy What are some examples of non–pharmacological pain management - hydrotherapy options? - effleurage/counterpressure - positioning - intradermal water block - TENS therapy - risk of un–planned C-section Studies show that nonmedical care decreases what? - risk of instrumental deliveries - length of labor What is an important detail to remember when applying heat/cool Protect the skin with layers of cloth therapy techniques? - standing/sitting = less pain What are the best methods of movement for the 1st stage of labor? - vertical/side lying position = reduced time - walking = satisfying for patient - supine position = MORE painful What are the best methods of movement for the 2nd stage of labor? - kneeling is preferred - NEED TRACTION - maternal comfort and relaxation - facilitates engagement and rotation What are some benefits for the upright position? - increased pelvic diameter - decreased incidence of perineal tears helpful for “back labor” pain; 4 intradermal injections of 0.5–1.0 mL sterile water with a 35g needle; just above or at the posterior superior What is the purpose/process of intradermal water injections? iliac spine, three cm below and 1 cm medial to the first sites, and given during a contraction relief lasts for 45–120 mins - opioid analgesics – morphine, fentanyl, remifentanil - co–drugs (sedatives/antiemetics) – promethazine, hydroxyzine What are some examples of first stage options for labor pain relief? - opioid antagonists/agonist–antagonists – butorphanol (Stadol), nalbuphine (Nubain) - inhaled nitrous oxide - morphine – 1–3 hours What are the durations of fentanyl, morphine, and remifentanil? - fentanyl – 30–60 minutes - remifentanil – 3–4 minutes What are some side effects of analgesics in the fetus? respiratory depression at birth, and feeding and behavioral problems What are some considerations to be recognized before administering proximity of medication administration to time of birth and fetal Analgesics? heart rate characteristics False. Opioids can cross the placenta and may decrease FHR True or False: Opioids cannot cross the placenta variability and affect the FHR pattern, eliminating accelerations or contributing to decels  - delayed respiratory depression - urinary retention - sedation What are the adverse effects of analgesics? - pruritus - postural hypotension - may slow labor if given