Module 3 Guided Notes PDF - Nursing Care of Laboring Patients

Guided Notes Template for Module 3 Nursing care of the Laboring Patient Ricci Chapters 13, 14 1. Compare true versus false labor. What is the single indication that it is “true” labor? Contraction...

Guided Notes Template for Module 3 Nursing care of the Laboring Patient Ricci Chapters 13, 14 1. Compare true versus false labor. What is the single indication that it is “true” labor? Contractions get closer together, higher intensity. Changes in the cervix dilation and effacement. False labor- contractions are usually irregular, regular for short periods 2. What causes labor to begin? ➔ Uterine stretch - baby grows and fills more space in uterus, the uterine muscles can stimulate release of hormones that trigger contractions ➔ Progesterone withdrawal - hormone produced by the ovaries and placenta during pregnancy that helps with preventing contractions, levels decrease in process of childbirth ➔ Increased oxytocin sensitivity- oxytocin stimulates uterine contractions ➔ Increased release of prostaglandins- prostaglandins is a hormone that softens and thins the cervix (effacement) and initiations/progresses contractions 3. List signs labor is coming. ➔ Cervical changes- includes dilation and effacement ◆ Dilation refers to opening of cervix (0cm) to fully dilated (10cm) ◆ Effacement means thinning of the cervix where it’s thick (0%) and becomes thinner during childbirth (100%) ➔ Lightening- baby moving down to pelvis (fundal height changed) ➔ Increased energy level (nesting)- burst/surge in energy before labor begins ➔ Bloody Show- cervix begins to dilate and efface, then small blood vessels in the cervix rupture and can lead to small amount of blood-tinged mucus ➔ Braxton Hicks contractions- mild irregular contractions that occur throughout pregnancy and can become more intense, frequent, and regular ➔ Spontaneous rupture of membranes (water breaking)- amniotic sac (which surrounds the baby) ruptures and amniotic fluid is released. It can be a sudden gush or a slow trickle of fluid 4. How do you time contractions? ➔ Frequency (Time interval between start of one contraction to the start of the next contraction) & Durations (Beginning of contraction to end of same contraction) 5. What is the most favorable pelvis shape (we need to know for NCLEX but understand that we are going to stop teaching these classifications because they are based in racist ideologies) ➔ Gynecoid is more favorable vaginal delivery ➔ Andrioid-male shape (not favorable) ➔ Anthropoid-usually adequate ➔ Platypelloid- not favorable 6. Define the key terms related to the labor and birth process. Effacement- thinning and shortening of the cervix during the final stages of pregnancy and is a crucial part of the labor Dilation-dilation refers to the opening of the cervix during labor Lightening- process where the baby moves down into the pelvis as it prepares for birth. Station- Position of baby's head in relation to the ischial spines of the mother's pelvis 7. The cervix starts at __0-3cm__ and needs to dilate to ___1ocm___ for birth. 8. An example of trauma informed care would be informed consent before every vaginal exam. 9. How many bones does the fetal skull have? ➔ 6 main bones: two frontal bones, 2 parietal bones, and one occipital bone, and the mandible 10. What is the name of the intersection between the bones? ➔ Intersections between bones of the fetal skull are known as sutures. Sutures are essentially fibrous joints that allow for overlapping and changes in shape (flexibility/molding); help identify position of the fetal head. ◆ Fontanels are intersections of sutures, help in identifying position of fetal head and help with molding/flexibility 11. What do the bones do to allow the fetal head to navigate the pelvis? ➔ The fetal head navigates through the pelvis and the fontanelles allow for movement of the skull bones. The flexibility allows for the head to change shape slightly and pass through the pelvis. Also, the sutures allow for the skull to change shape and adapt to go through the pelvis. 12. Which fetal attitude makes it easier to navigate the maternal pelvis? ➔ Fetal attitude is the relation of the different body parts (head and body) of the fetus to one another (basically describes how the fetal head, limbs, body is positioned in the womb, relative to one another) ➔ Flexion is the universal attitude- where the head is bent forward toward the chest, arms and legs are toward/in the body ➔ Deflexed- baby’s head is tilted back/away from the chest. ➔ Extended- baby’s head is tilted back/away from the chest, and the neck is straightened/extended 13. Which fetal lie is most conducive to a vaginal delivery? ➔ Fetal lie- the relation of the long axis of the fetus to the mother (the lie of the fetus) and is either longitudinal or transverse. ➔ Longitudinal (vertex) lie is the most conductive to a vaginal delivery as the fetus is parallel to the mother’s spine and lines with their head towards the birth canal ◆ Military cephalic- head directly facing down in birth canal  ◆ Brow- baby’s head is positioned with forehead leading way into birth canal ◆ Face- baby’s face is positioned to enter the birth canal first ➔ Transverse- baby is transverse to the birth canal ◆ Shoulder- shoulder seen first ➔ Breech- baby’s bottom and feet are positioned to enter birth canal first ◆ Frank- buttocks first ◆ Full- baby's and legs are flexed, with the knees bent and feet near the buttocks ◆ Footling- baby’s feet are positioned to enter birth canal first 14. Where is the fetal occiput? ➔ The fetal occiput is located at the back of the fetal head, specifically at the base where the skull meets the neck. It corresponds to the occipital bone, which forms the lower rear portion of the skull. During labor and childbirth, the position of the fetal occiput is important as it helps determine the baby's presentation and the progress of labor 15. Describe fetal station. ➔ Fetal station- to the position of the baby's head (or presenting part) in relation to the mother's pelvis during labor ◆ We start with 0, where the baby’s presenting part reaches the level of the maternal ischial spines. Means that the widest part of the baby’s head has passed through the narrowest part of the pelvis. Then as labor progresses, the baby’s head will continue to descend into the pelvis (+1, +2..) eventually reaching vaginal opening (crowning) 16. Name the uterine assessments (describing contractions and in-between contractions). ➔ Uterine contractions (primary stimulus): ◆ Uterine contractions are the main mechanism by which labor progresses These contractions are involuntary muscular movements of the uterine muscle (myometrium) that occur rhythmically and regularly during labor. The primary purpose of uterine contractions is to efface (thin) and dilate (open) the cervix, allowing the baby to pass through the birth canal during childbirth. ◆ Intra-Abdominal Pressure from Mother Pushing and Bearing Down:During the second stage of labor (the pushing stage), the mother voluntarily pushes and bears down with her abdominal muscles, increasing intra-abdominal pressure. This pressure complements the force of uterine contractions, helping to propel the baby through the birth canal and facilitating delivery. ➔ In-between Contractions: ◆ Resting tone- baseline tone and firmness of uterus between contractions ◆ Relaxation phase- period between contractions where uterus relaxes and returns to its baseline tone (done with palpation) ➔ Main Uterine Assessments: Frequency, Duration, Intensity (done with palpation) 17. What is the name of the fetal monitor part used to assess the uterine tone?  ➔ Tocotransducer “TOCO” can assess uterine tone. It’s placed on upper part of the uterus to assess frequency and duration of contractions ➔ Palpation is done to determine the intensity and relaxation phase of contractions 18. Which prenatal labs are important to review with the labor admission? Why? ➔ Review of prenatal records, prenatal hx, and medical hx: ◆ HbsAg screening- hepatitis B surface antigen to help identify hep. B virus so it’s not transmitted to baby during childbirth (baby has life long infection) ◆ Rubella status- Measles immunity to ensure against infection and reduce risk of congenital rubella syndrome (can lead to defects with heart, deafness, developmental delay) ◆ GBS- screening for GBS to administer abx and prevent transmission (causes meningitis) ◆ HIV (with women’s consent)- HIV prevention through labor and breastfeeding ➔ Labs: ◆ Routine UA - nitrates (UTI), ketones (DM), proteins (pre-e) ◆ CBC- bleeding risks, infection ◆ 3rd trimester syphilis screening and possible drug screening- prevent congenital syphilis 19. List one benefit of encouraging a patient in early labor to go home? ★ Allows for empowerment to the mother and offers early labor comfort measures (being at home in their own setting can reduce anxiety and stress that’s associated with being at the hospital). ★ Sent home? 3 cm dilation, not high enough contractions, etc. 20. Why is a fundal height assessment part of the admission assessment? ➔ A fundal height assessment is part of the admission assessment during labor because it provides valuable information about the progression of pregnancy and fetal growth ➔ It can also help assess abnormalities with amniotic fluid (polyhydramnios, or oligohydramnios) 21. List the risk assessments for labor and include how the risk levels are assigned and interventions for each risk. ➔ Risk for Bleeding: ◆ Medium Risk: Induction of labor, multiples > 4 preg vag births, uterine fibroids, family hx of PPH, chorio, demise, EFW > 4000 grams, morbid obesity (BMI >35), polyhydramnios ◆ High Risk: 2 or more medium risk factors, active bleeding, suspected placenta accreta or percreta, previa, known coagulopathy, Hx of PPH, Hct < 30 and other risk factors, platelets < 100,000 ◆ Interventions: IVF, potential blood transfusion, promote uterine contractions (oxytocin), TXA, Methergine (CI: HTN), Hemabate (CI: asthma), Misoprostol, PPI (Cytotec) off labor use  ➔ Risk for Shoulder Dystocia ◆ High Risk: Maternal stature < 5 ft, Over 200 lbs, EFW > 4000 grams, DM, prolonged 1st or 2nd stage, previous difficult delivery, > 41.3 weeks gestation ◆ Interventions: monitoring fetal weight/size, repositioning to alleviate dystocia ➔ Risk for Preeclampsia ◆ High Risk: DTR: Expect +2/no clonus, Oliguria: < 30mL/2 hours, worried or concerned, “gut instinct” that she doesn’t look or act right, upper epigastric pain (near liver (up right)) ◆ Interventions: monitor BP, urine protein levels, antihypertensives (hydralazine), magnesium sulfate for seizure prophylaxis 22. Name a few factors that influence the birth experience for the patient? ➔ Support, Clear information on procedures, positive reaction to the pregnancy, personal control over breathing, developing trust/rapport, sense of mastery/self- confidence 23. Which physiological responses t0 labor are expected? ➔ Increased HR, CO, BP ( >110) ➔ Increased WBCs ➔ Increased RR, O2 (12-24 RR) ➔ Decreased gastric motility and food absorption ➔ Decreased gastric emptying and gastric pH ➔ Slight temperature elevation ➔ Muscle Aches/Cramps ➔ Decreased Blood Glucose Level (NPO status) 24. What are the warning levels for vital signs that may be cues something is wrong? Mother: ➔ SBP: 90-160 (report 150) ➔ SDP: 60-110 (report >90) ➔ HR: 60-120 (report < 50 or > 110) ➔ RR: 12-24 (report < 10 or > 30) ➔ SpO2: report if 2 hrs):