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Flashcards

Nurse 203

Mary Brooks Ducl English 63 cards

Cards in this deck (63)

  1. 1Warning signs of laborcervical changes soften dilation Lightening Increased energy Nesting Bloody show Braxton hicks spontaneous rupture of membranes
  2. 2Critical factors affecting Labor and Birththe 5 Ps Passageway canal pelvis and soft tissue Passenger fetus and placenta Powers contractions Position maternal Psychological response 5 Additional factors Philosophy partner patience patient preparation pain control
  3. 3Passageway; Bony pelvislinea terminalis; division of false and true pelvis True below inlet mid outlet pelvic measurement False above
  4. 4Pelvic shapesgynecoid favorable Android male not favored Anthropoid usually adequate Platypelloid not favored
  5. 5Passageway;soft tissuescervix pelvic floor muscles vagina
  6. 6passenger; fetusskull attitude lie presentation position station engagement
  7. 7Passenger; skulllargest and least compressible structure Sutures; allow for overlapping and changes in shape (molding) helps identify position of fetal head Fontanelle; intersections of sutures help in identifying position of fetal head and in molding
  8. 8Passenger;fetal presentation majority born in vertex non vertex increases chance of CsectionCephalic(vertex) Military straight brow hyperextended Face really hyper Breech; Frank butt first Full or complete footling both or incomplete one Shoulder; transverse lie
  9. 9Passenger; fetal positionlandmarks; Occipital bone; 0 vertex presentation Chin M face presentation Buttocks sacrum S breech presentation Scapula acromion process A shoulder presentation Three letter abbreviation for identification
  10. 10Fetal positionsLOP ROP LOA ROA LOT ROT if facing L going to be R if baby face up posterior if baby face down anterior ROA LOA best position posterior difficult
  11. 11Fetal stationhow low baby is in pelvis go by skull not swelling baginal exam to feel station Labor station in + cephopelvic distortion skull position not fitting thru the pelvis -3 baby above occipital spine +3 below occipital spine 1 centimeter baby floating not into pelvis cervix can be posterior
  12. 12passenger; fetal engagementpresenting part reaching 0 station ( entrance of the largest diameter of the presenting part usually the fetal head into the smallest diameter of the maternal pelvis determined by vaginal exam Floating; no engagement; presenting part freely moveable about pelvic inlet
  13. 13cardinal movements of laborengagement descent flexion internal rotation extension external rotation expulsion
  14. 14Powers; ContractionsUterine contractions; primary stimulus Intra abdominal pressure from mom pushing and bearing down Contractions; involuntary thin and dialate cervix Three Parameters; Frequency how often beginning of one to beginning of next Duration how long 1 min Intensity; feel with fingertips
  15. 15Psychological ResponseFactors influencing a Positive birth Experience clear info on procedure support not being alone sense of mastery self confidence trust in staff positive reaction to pregnancy personal control over breathing prep for childbirth experience
  16. 16Physiological response to labor (Maternal)Increase HR CO BP during contractions Increased WBC RR oxygen consumption decreased gastric motility food absorption decreased gastric emptying and PH slight temp elevation muscle aches increased BMR decrease blood glucose levels
  17. 17physiologic responses to labor (fetal)periodic FHR accelerations and slight decelerations decrease in circulation and perfusion increase in arterial carbon dioxide pressure decrease in fetal breathing movements decrease in fetal oxygen pressure; decrease in partial pressure of oxygen. give mom 02 to help baby.
  18. 18Stages of LaborFirst; true labor to complete cervical dilation (10 cm) Longest of all stages Three Phases Latent 0-3 Active 4-7 Transition (8-10) Second stage cervix 10 cm dilated birth to baby Third birth of infant to placental seperation Placental separation;(uterus takes on a globular appearance and rises up umbilical cord lengthens trickle of blood Placental expulsion Fourth stage 1 to 4 hrs following delivery (begins with delivery of placenta) focus on prevention of hemorrhage bladder distention and venous thrombosis Frequent fundal checks & provision of massage/pitocin if indicated 15 mins first hour contraction involution shrinking
  19. 19Maternal assessment during labor and birthmaternal status; vitals pain prenatal record review Vaginal exam cervical position dilation faced membrane status fetal descent and presentation Uterine contractions mild moderate strong palpate with fingers Leopolds maneuvers; 1 palpate the funds for the buttocks or head 2 fetal back best location of FHR 3 presenting part 4 fetal head flexed engaged in pelvis?
  20. 20Vaginal examCervical positon anterior posterior Cervical defacement what % effaced Cervical dialation Membranes intact bulging ruptured if ruptured spontaneous or artifical how long
  21. 21Uterine contractions IntensityPalpation; using pads or fingers on the funds; tip of nose mild like the chin moderate like the forehead strong Electronic monitoring; External tocotransduter placed on fundus picks intensity of contraction up Internal more accurate than external in terms of measuring intensity mm of mercury of how strong contractions are need to be 2-3 cm dilated and membranes ruptured
  22. 22Continuos external electronic fetal monitoringcontractions; placement of not on belly button tocotransducer on fundus FHR; ultrasound transducer placed between symphysis pubis and umbilicus
  23. 23Fetal Assessment during labor and birthamniotic fluid analysis color odor ph FHR monitering ; hand held vs electronic; intermittent vs continous; external vs internal FHR patterns baseline other assessment methods fetal scalp sampling pulse oximetry stimulation
  24. 24Amniotic Fluidsample of fluid from bagina tested with Nitrazine paper to determine PH Amniotic fluid alkaline turns paper blue green to deep blue Fern test; if test not conclusive microscope slide fluid should be clear not cloudy or smelly
  25. 25Internal electronic fetal moniteringcervical dilation of 2 cm or more must be present Ruptured membranes presenting part low enough to allow placement of scalp electrode skilled practitioner for insertion of spiral electrode most accurate way to monitor fetus Continuos internal electronic fetal monitoring (IUPC) to measure uterine pressure and fetal scalp electrode for FHR measurement
  26. 26Summary of FHR patternsreassuring pattern; indicates fetal well being Non reassuring; indicates fetal problems Ominous; fetal distress Baseline FHR; average FHR over a 10 min. segment excluding periodic rate changes tach brady assessed when woman is not having contractions Normal baseline FHR 110 160 Periodic baseline changes; normal in response to stimuli (such as contraction Ex; FHR accelerations assoc. with fetal movement or stimulation consider reassuring basis for Non stress test
  27. 27Fetal bradycardyaFHR below 110 for 10 mins. or longer may be benign if isolated but ominous if there is a decrease in long term variabiltiy and late decellerations fetal hypoxia prolonged umbilical cord compression maternal hypotension
  28. 28fetal tachycardiaFHR above 160 for 10 mins or longer ominous if accompanied by decreased variability and late decelerations fetal hypoxia maternal fever nicotine cocaine prematurity
  29. 29Variability; important indication of fetal well being normal physiologic variations in heart rateminimal or absent; intervention nessecary Moderate; considered a good sign or fetal well being no intervention necessary Marked; intervention necessary CAT 1 normal CAT2 abnormal fetal acid bases not 1 or 3 CAT 3 abnormal predicted prompt evaluation 02 position change stop piton
  30. 30Significance of Decelerations; notice timing of decal in relation to contractionsEarly Late Variable Prolonged Early; fetal head compression doesn't require intervention Late uteroplacental insufficiency placenta not perfusing give 02 variable; cord compression around neck body Prolonged; many factors abrupt declines of atlas 15bpm that last longer than 2 minutes but less than 10
  31. 31Late decelsdecreased FHR after contraction begins without return to baseline until well after contraction ends Repetitive late decals are non reassuring CAT 3 no good interventions; turn client on left side to increase placental perfusion admin o2 increase IV fluid rate assess underlying cause
  32. 32Variable Decelsabrupt decrease in FHR unpredictable possible no relation to contractions Most common and usually transient and corrective can be nonreasuring not as concerning Interventions change the clients position to relieve compression on the cord provide reassurance that interventions are to effect pattern change give o2 and fluids as ordered
  33. 33Interventions for non reassuring deceleration such as variable or late decalsgeneral interventions Notify HC provider reduce or d/c Oxytocin as per facility protocol if being administered Provide reassurance Left side give 02 off vena cava
  34. 34Comfort and pain managementpain as universal experience; intensity highly variable mandate for pain assess in all clients admitted to HC facility numerous non pharm and pharm choices avail. support acupuncture touch massage imagery breathing techniques positing
  35. 35Pharmocologic measuressystemic anelgesia Route; oral IM IV drugs opiods butophanal stadol Nubain fetanyl Sublimaze Ataractics; hydoxyzine (Vistaril promethazine (phenergan w opiods helps nausea and vomiting Benzos varvs
  36. 36systemic analgesia nursing considerationsopiods effective for moderate to sever pain not to close to delivery Least amount necessary should guide administration because systemic analgesia cross the placentas Birth should occur within 1 hour or after 4 hrs of admin to prevent fetus from receiving peak concentration Naloxone Narcan to reverse CNS depression including resptroy depression in newborn
  37. 37Regional analgesia/anestesiaepidural block; continuos infusion or intermittent infection usually started wen dilation greater than 5cm Combined spinal epidural block walking epidural Local infiltration for episiotomy repair Prudenal block 2nd stage episiotomy inthrathecal spinal anegelsa anestesia during labor and c section spinal you can't push
  38. 38Nursing considerations; epidural blocksapprox 60% of women receive epidural block most receive continous lumber epidural infusion of a local caine med with an opiod Complications Maternal N/V hypotension fever pruritus Fetal; distress secondary to maternal hypotension
  39. 39nursing care during first stages of laborgeneral measures obtain admission history check rusults of routine lab tests and any special test ask about childbirth plan complete a physical assessment initial contact either by phone or in peston
  40. 40First stages of Labor phone assessmentestimated date of birth fetal movement;frequency past few says other premonitory signs of labor experienced Parity gravid and previous childbirth experiences time frame in previous labors characteristics of contractions bloody show and membrane status whether ruptured or intact presence of supportive adult in household or is she alone
  41. 41First stages of Labor: admission assessmentMaternal health history Physical assess/ body systems vitals heart and lung sounds height weight Fundal height measurement Uterine activity including contraction frequency duration and intensity status of membranes intact or ruptured Cervical dilation and degree of effacement FHR position station pain level Fetal assess; Labs Routine Urinalysis CBC Hbsag screen; GBS HIV drug screen assess of psychological status
  42. 42First stages of Labor ; Continuing AssessmentWomens knowledge experience and expectations Vitals Vagina exams uterine contractions pain level coping ability FHR during active stage every 30 mins intermittent monitoring Amniotic fluid
  43. 43Nursing Management; Second stageAssessment typical signs of 2nd stage contraction frequency duration intensity vitals fetal response to labor via FHR Amniotic fluid with rupture of membranes coping status of women and partner
  44. 44Nursing Management; second stage Interventionssupporting woman and partner in active decision making supporting involuntary bearing down efforts encouraging no pushing until strong desire or until descent and rotation of fetal head well advanced Providing instructions assistance pain relief Using maternal position to enhance decent and reduce pain preparing for assisting with delivery Interventions with birth; cleansing perineal area and vulva assisting with birth suctioning of newborn and umbilical cord clamping provide immediate care of newborn Drying Apgar score Identification
  45. 45Nursing Management; Third stageAssessment; placental seperation; placenta and fetal membranes exam; perineal trauma episiotomy lacerations Interventions; instruction to push when separation apparent; giving oxytocin if ordered assisting woman to comfortable position providing warmth applying ice to perineum if episiotomy; explaining assessment to come monitoring mothers physical status recording birthing statistics documenting birth in birth book
  46. 46Nursing Management; Fourth stageAssessment Vital fundus perineal area comfort level loch bladder status Interventions support and information Fundal checks perineal care and hygiene bladder status and voiding comfort measures parent newborn attachment Teaching
  47. 47Forceps/Vacuum Assisted Birthassisted birth by providing traction or by providing means to rotate head to OA position; Outlet; applied when fetal skull reached perineum want to prevent section Indication; presence of any threatening condition threatening Rxd by birth Risks; maternal bleeding fetus fractured skull prereqs; forceps low outlet Nursing care offer support no pain but pressure utilize breathing teq need adequate regional anestesia MD; traction during ctx/pushing mom may need to be told wen to push if she can't feel urge
  48. 48AmnioinfusionIndications;sterile saline hang on pump replacing amniotic fluid that is lost put fluid back so cords not getting compressed
  49. 49Induction of labor at risk over duestimulation of uterine contractions before spontaneous onset of labor with or without ROM Elective Indicated pre existing maternal fetal conditions cervical readiness bishops score
  50. 50labor induction/ augmentationIndications DM renal disease percales post term fetal demise IUGR poor BPP mild abruption of placenta with no fetal stress or unreassuring FHR Evaluate maternal pelvis position and presentation of fetus and fetal gestation and weight Contra; wasn't gynecoid not vertex breech risks; piton water intoxication too many contractions fetal distress make sure vertex summersault
  51. 51Bishop scoring system to determine whether a cervix is ripe or ready for dilationdialation o 1-2 3-4 5 + efface 0-30 40-50 60-70 80 + Station -3 -2 -1/0 +1 or lower consistency Firm Moder soft position Posterior Mid position anterior a score of 0 1 2 3 given to each assessed characteristic. the higher the total score for all the criteria the more favorable the cervix. The lower the total score, the higher the failure rate
  52. 52Versionv
  53. 53Cesearian birthDefine
    Two types
    Rates
    Indications maternal placental fetal factors Short term Long term risks Pre op care VS FHR NST ab shave foley meds IV dentures Nursing responsibilities surgical incisions classical transverse advan/disadvant delivery psychological concerns
  54. 54Discuss the post op care of the c section mom post op and postpartum issues/needspreventing complications deep breathing incentive spirometer TCDB continuous compression machine/Ambulation pain control hemorrhage monitor funds for firmness and position monitor amount and quality of lochia monitor vital signs 5-10 mins compression boots until ambulation Alteration in elimination monitor UO avoid distended bladder Bowel activity appetite flatus no carbonation teach ambulation straws Interruption in parental behaviors feeding and caring for newborn Infection monitor incision s.s infection monitor skin integrity breasts iv monitor lichen UTI IV
  55. 55Anestesia in L and DOverview systemic drugs; cross placenta by simple diffusion regional analgesia/anestesia=block; pain relief to certain part of body by injecting local anesthetic non phamologic pharmologic preps to low discomfort high relax re establish self control may effect fetus stress too goal provide pain relief with minimum risk for mom/baby risk vs benefit
  56. 56systemic drugs narcoticsmrphine Nubain stadol adverse side effects confusion sedation Fentanyl parities Narcan sedatives tranq seconal/nembutal barbituat fast acting 10-15 lasting 3 4 hrs. used for false labor
  57. 57Epiduralepidural space extending from base of skull to end of sacral cavity access thru lumbar area continuous block provides analgesia anesthesia thru cath drugs used combination near advan helps with pain disadvan. slows labor contra platelet low can't have hypotensive
  58. 58Nursing care for epiduraloffer emotional support IV bolus accurate IO continuos fetal monitoring monitor BP either side lying or sitting change position antiemetic before antacid document when in med pump VS 15 mins may be on continuos pump
  59. 59Spinal Blocklocal anesthetic injected directly into spinal fluid in spinal canal; provides total anesthesia for c section vaginal birth advan/disadvan contra Nursing care IV sit side lying continuous EFM wedge R hip displace uterus protect Recovery room
  60. 60Intrathecala intrathecal narcotic injection is a narcotic such as morphine or fetanyl injected into spinal canal subrachnoid space by way of cathteter adv disadvan SE
  61. 61Localinjection of anesthetic agent into intracutaneous/subcutaneous intra muscular area of perineum done at tim of birth for episiotomy repair does not alter VS dis may need a lot of med to numb tissue
  62. 62General anestesiafor complicated deliveries emergency c section primary concern is for fetal depression great psychologically emotional effect on mom partner gasses cross placenta
  63. 63pudendal Blockintercepts signal to pudendal nerve transvaginal method provides perineal anestesia for later part of 1st stage of labor 2nd stage birth repair doesn't alter VS dis broad ligament hematoma trauma sciatic nerve

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nurse 203
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