Intrapartum I Review_Updated24 PDF

INTRAPARTUM I Dr. Angela Clark, DNP, RNC-OB, MSN, BSN Assistant Professor University of Kentucky College of Nursing Which of the following are part of the 5 Ps essential for labor and birth? A. Positivity B. Psyche C. Position D. Power E. Pressure The 5 P’s...

INTRAPARTUM I Dr. Angela Clark, DNP, RNC-OB, MSN, BSN Assistant Professor University of Kentucky College of Nursing Which of the following are part of the 5 Ps essential for labor and birth? A. Positivity B. Psyche C. Position D. Power E. Pressure The 5 P’s Essential for Labor and Birth 1. Passage/Passageway: pelvis, cervix 2. Passenger: fetal head, attitude, lie, presentation 3. Position: station, engagement, position 4. Powers: primary and secondary 5. Psyche: emotions, energy, support 1. Passage/Passageway Size & type of the maternal pelvis Ability of the cervix to dilate and efface and ability of the vaginal canal and the external opening of the vaginal to distend. Based on the following pelvic and fetal assessment, which should BEST indicate probable success for a vaginal delivery? A. Anthropoid B. Gynecoid C. Platypelloid D. Android Which of the following pelvic types would MOST likely lead to cesarean delivery? A. Anthropoid B. Gynecoid C. Platypelloid D. Android Which of the following accurately describes the progression of: a) Cervical dilation b) Cervical effacement A. -5 to +5; 0-10 cm B. 0-10 cm; 0-100% C. 0-100%; 0-10 cm D. 0-100%; -5 to +5 Which sign indicates that labor is beginning? A. Involuntary contractions B. Full cervical dilation C. 100% cervical effacement D. Pain in pelvic joints Cervical Changes Dilation o Opens/gets wider o Measured from 0 cm (closed) to 10 cm (fully dilated) Effacement o Softens, thins, shortens o Measured from 0% (long and thick) to 100% (fully effaced) *Cervix usually dilates faster than it effaces. Must be fully dilated (10 cm) and effaced (100%) before pushing can A woman enters triage who states she “thinks” she is in labor. Which assessment BEST demonstrates TRUE labor? A. Fetus is ballotable B. Contractions are every 20-30 minutes C. Change/progress in cervical dilation/effacement D. Fetal heart rate accelerations Premonitory signs of impending labor: Lightening Braxton Hicks contractions Cervical changes Bloody show/expulsion of mucus plug ROM (SROM) Sudden burst of energy Weight loss GI upset *** False Labor 2. Passenger: Fetus Fetal head Fetal attitude Fetal lie Fetal presentation Which statement by the student indicates effective learning about the structure of the fetal head during labor and birth? A. Fetal skull bones are firmly united during labor B. Fetal skull bones are united by membranous sutures C. Two important fontanels are the parietal and temporal D. Sutures and fontanels restrict brain growth after birth The biparietal diameter is the largest _________ diameter of the fetal skull. A. Transverse B. Longitudinal C. Vertical D. Diagonal 3. Position Station Engagement Fetal position Which station of the presenting part indicates that birth of the fetus is imminent? A. -1 B. +1 C. +2 D. +4 When assessing fetal station during a vaginal examination the nurse should assess which pelvic structure? A. Cervical OS B. Pelvic Inlet C. Ischial Spines D. Ischial Tuberosity Fetal position Right (R) or left (L) side of the maternal pelvis Landmark: occiput (O), mentum (M), sacrum (S), or acromion process- (A) (scapula) Anterior (A), posterior (P), or transverse (T) What is the position notation for the following picture? A. LOA B. LSP C. RSP D. LSA What is the position notation for the following picture? A. ROT B. ROP C. LOA D. LOP What is the position notation for the following picture? A. LOT B. ROA C. ROP D. LOP TRUE OR FALSE: A woman bearing down to push the baby out is an example of primary powers. A. True B. False 4. Powers Primary forces—uterine muscular contractions (until complete dilation) contraction phases—increment, acme, decrement described with frequency, duration, and intensity Secondary forces—abdominal muscles used in pushing (bearing down) Primary Forces: Uterine Contractions Frequency of contractions is noted: A. From the beginning of one contraction to the end of the same contraction B. From the beginning of one contraction to the beginning of the next contraction C. From the end of one contraction to the beginning of the next contraction D. As total number of contractions in 20 minutes Mechanisms of Labor A. Descent B. Flexion C. Internal rotation D. Extension E. External rotation. 5. Psyche Fear & anxiety: Pain of labor, loss of control, injury of self or infant Excitement: Feelings of joy and anticipation Exhaustion Level of social support: Is FOB involved? Who is the support system? Abnormalities potentially affecting the process of labor Passageway—too small Passenger—malpresentation Position-posterior (occiput posterior) Powers—inadequate (contractions/pushing) Psychological factors—intense fear, anxiety, poor support system, exhaustion. First Stage- onset of labor until 10 cm Latent Phase -Occasionally referred to as “early labor”. -1st stage: begins with onset of true labor and ends when cervix is fully dilated Cervical dilation- 0-3 cm Feels able to cope with the discomfort May be relieved that labor has finally started Able to recognize and express feelings of anxiety Excitement is high, eager to talk First Stage-Active Phase Cervical dilation- 4-7 cm Anxiety increases Sense of need for energy & focus Fears loss of control May have decreased ability to cope Helplessness Support- greater satisfaction & less anxiety First Stage- Transition Phase Cervical dilation- 8-10 cm Withdraws into herself to focus Acutely aware of intensity of contractions Doubts ability to cope Apprehensive, restless & irritable Frequent change of position Terrified of being alone Does not want anyone to talk to her or touch her Second Stage -Referred to as the “pushing stage” -Begins with complete cervical dilation and effacement and ends with birth of infant Urge to push Crowning Relieved acute pain is over Relieved she can push Sense of control because actively involved May become frightened Fatigue Third Stage After birth of baby until complete delivery of placenta Should last no longer than 30 min (risk for hemorrhage and placenta retention) Pitocin IV bolus infusion begun after delivery of placenta to decrease blood loss Fundal massage to see if continues to be firm Signs of Placental Separation Signs of placental separation globular uterus rises in abdomen gush or trickle of blood increased protrusion of umbilical cord Delivery of placenta “dirty” Duncan “shiny” Shultz Fourth Stage From the time of delivery of placenta until up to 4 hours after birth. Vaginal delivery average blood loss- 250-500 ml (EBL) C/S average blood loss-