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Intro to Labor and Delivery
Test 1
54
Nursing
Undergraduate 3
07/11/2014

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Cards

Term
What are Premonitory signs of labor?
Definition
LIGHTENING
BRAXTON HICKS CONTRACTIONS
CERVICAL CHANGES
BLOODY SHOW
RUPTURE OF MEMBRANES
BURST OF ENERGY
WEIGHT LOSS-2.2-6.6 LBS.(1-3 KGS)
URINARY FREQUENCY
INCREASED BACKACHES OR SACROILIAC PRESSURE
DIARRHEA
N/V
LOSS OF MUCOUS PLUG
Term
What is TRUE labor?
Definition
CERVICAL EFFACEMENT AND DILATION
UC-REGULAR, STRONGER, LONGER
LOCATION- BACK TO FRONT
WALKING WILL NOT LESSEN UC MAY INTENSIFY
Term
What is FALSE labor?
Definition
NO CERVICAL CHANGES
UC- IRREGULAR AND NO CHANGE IN FREQ., INTENSITY, DURATION
POSITION CHANGE OR WALKING WILL LESSEN UC
Term
What are the 5 P's of labor?
Definition
-Pathway
-Passenger
-Powers
-Position
-Psyche
Term
What is passageway?
Definition
REFERS TO THE MATERNAL STRUCTURES-BONES OF THE PELVIS, SACRUM AND COCCYX AND THE SOFT STRUCTURES CERVIX AND VAGINA
THE TYPE OF PELVIS AND ITS DIAMETERS CAN INFLUENCE THE DESCENT OF THE FETUS, THE PROGRESSION OF LABOR AND TYPE OF DELIVERY.
Term
What is passenger?
Definition
SIZE, ATTITUDE (relationship of the fetal parts to one another, flexion, extension), LIE (vertex, transverse, breech), PRESENTATION (cephalic, face, brow, breech, shoulder, compound, fetal part),POSITION, ENGAGEMENT (floating, ballotable, engaged), STATION
Term
What is powers?
Definition
Primary--Involuntary cxs (frequency, duration, intensity)effacemen (thinning and shortening of cervix, 0%-100%)t and dilation (opening of the cervix, 0-10 cm) of cervix
Secondary—voluntary use of abdominal muscles of second state of labor, results in descent and delivery of fetus/pushing.
Term
What is position?
Definition
Maternal position in labor, descent of fetus, comfort of mother, uterine blood flow
Term
What is psyche?
Definition
Psychological component of childbearing, excitement, fear, anxiety, percieved loss of control
Term
What are the types of maternal pelvis?
Definition
GYNECOID
ANDROID
ANTHROPOID
PLATYPELLOID
Term
What are the positions of the fetus?
Definition
LONGITUDINAL LIE- VERTEX OR BREECH
TRANVERSE LIE- LATERALLY ACROSS UTERUS.
OBLIQUE LIE –DIAGONALLY
Term
What are the fetal stations?
Definition
-3
-2
-1
0
+1
+2
+3
Term
What does a 0 station mean?
Definition
The baby's head is at the ischial spine aka READY TO BIRTH
Term
What are the positions of the baby when being birthed?
Definition
-Right occipitoposterior
-Left occipitoposterior
-Right occipitotransverse
-Left occipitotransverse
-Right occipitoanterior
-Left occipitoanterior
Term
What position is best for birthing a baby?
Definition
left occiputoanterior
Term
What happens in the 1st stage of labor?
Definition
-Stage of cervical dilation
-Begins w/ onset of regular contraction and ends w/ compete dilation
Term
What is the latent step of 1st stage labor?
Definition
0-3 cm
Term
What is the active step of 1st stage labor?
Definition
4-7 cm
Term
What is the transitional step of the 1st stage of labor?
Definition
8-10 cm
Term
What is the 2nd stage of labor?
Definition
-Stage of expulsion
-Begins with complete cervical dilation and ends with delivery of fetus
Term
What is the 3rd stage of labor?
Definition
Placental stage
Begins immediately after fetus is born and ends with the placenta being born
Term
What is the 4th stage of labor?
Definition
Maternal Homeostatic Stabilzation
Begins after delivery of placenta and continues for 1-4 hours after delivery
Term
What are the s/s of active labor?
Definition
Intense, regular contractions,40-60 secs, mod to stron intensity, nullips 4-5 hrs, multios 2. hrs
Serious, intense pain, doesn’t tak through cxs.
get into “the zone” or get drugs
Term
What are the s/s of transitional labor?
Definition
1 ½-2 min frequency, 60-90 secs, strong
Very difficult, less relief with contractions, anxiety, focus only on her needs.
“I’m dying” “I can’t do this anymore”
First stage may last a few minutes or days.
Term
What are the s/s of latent labor?
Definition
Onset of Ucs to complete effacement and dilation
Irregular, bothersome contractions
Mild to moderate in intensity
Longest phase (nullips 8-9 hrs, multips 5 hr)
Relieved that labor has started, anxious, excited, talkative
Term
What are the s/s of the 2nd stage of labor?
Definition
Normal length—5 mins to 3 hours
UC—q 1 ½-2mins; 60-90 secs, intensity is strong
Involuntary efforts to expel fetus
Signs: grunting, bearing down, vomitting, bloody show, FHR changes, crying/screaming.
Positioning: Squating is best for progress, lateral is best for perineum, kneeling best for back labor, semi-fowlers is most common.
Renewed energy, determined, focused, unable to control pushing
Term
What are the s/s of the 3rd stage of labor?
Definition
Relief labor is over, excited about infant, fatigue
Signs of placental separation: gust of blood, lengthening of the cord, cessation of cord pulsation.
Time: under 30 minutes (or retained).
Major risk: hemorrhage
Prevention: empty bladder, breastfeed, fundal massage, recheck H/H, T&S.
Rx: Pitocin IV or IM, Methergine IM or PO, Hemabate IM, Cytotec
Term
What are the cardinal movements?
Definition
THE ADAPTATIONS THE FETUS UNDERTAKES TO MANEUVER THROUGH THE PELVIS DURING LABOR AND BIRTH
Term
What are the actual cardinal movements?
Definition
ENGAGEMENT
DESCENT
FLEXION
INTERNAL ROTATION
EXTENSION
RESTITUTION
EXTERNAL ROTATION
EXPULSION
Term
What is Every Darn Fool In Rotterdam Eats Rotten Egg Rolls Everyday?
Definition
ENGAGEMENT
DESCENT
FLEXION
INTERNAL ROTATION
EXTENSION
RESTITUTION
EXTERNAL ROTATION
EXPULSION
Term
What is the body's response to labor?
Definition
Cardia output—significant increase during labor
BP increased
Pulse increases during Ucs
Term
What are the fetal responses to labor?
Definition
HEART RATE 110-160
CO2 INCREASES
PH DECREASES-SLIGHTLY ACIDITIC-7.25-7.35
Term
What are the 2 ways labor presents?
Definition
10% will have ruptured membranes:
Call MD/CNM

90% will have contractions:
Early labor vs. false labor
Active labor
Term
How are ruptured membranes diagnosed?
Definition
Gross rupture with/without increased intra-abdominal pressure
Nitrazine test
Fern Test
Ultrasound
Term
What is the nitrazine test?
Definition
pH is a measure of the acid-base balance of whatever substance is being tested.
Vaginal secretions are normally slightly acid (pH <5.0). 
In testing for the presence of amniotic fluid (during pregnancy, to rule in/out ruptured membranes), the more basic amniotic fluid will turn nitrazine paper a dark blue, indicating a pH of >6.0, and confirming ruptured membranes.
In testing for the presence of bacterial vaginosis, vaginal infections with anaerobic bacteria are often associated with a pH >5.0.
Term
What is ferning?
Definition
Observe for "fern-like" crystals. Presence of crystals indicates that the fluid is amniotic fluid.
Record the results: Write your name, the date, time and findings on the patient record.
Term
What is the technique involved with ferning?
Definition
- avoid the use of any lubricants or antiseptics
- use a sterile swab and do not touch the mucus plug
- prepare a thin smear on a glass microscope slide by spreading evenly.
Allow the slide to air dry- do not apply heat and do not coverslip the slide.
Examine the fully-dried slide microscopically, using the 10X objective
Term
What influences labor?
Definition
Stages of labor and positioning of mother and baby
Anxiety/fear
Endorphins
Culture
Support/environment
Term
What are the nonpharmacologic methods of pain management of labor?
Definition
Positioning
Breathing Techiques
Relaxation Techiques
Gate Control Methods
Hydrotherapy
Term
When is analgesia and anesthesia used?
Definition
Can Be Given To Decrease Or Eliminate Pain During The Labor Process When Nonpharmacologic Methods Of Pain Management Are Ineffective
Term
What is the goal of analgesia/anesthesia use?
Definition
Goal Is To Maximumize Pain Relief With Minimal Risk For The Woman Or Fetus
Term
What happens if A/A is given to slowly?
Definition
If Given Too Early May Slow Labor Process
Term
What happens if A/A is given to rapidly?
Definition
If Too Much Is Given Can Effect The Neonate Respirations.
Term
What are the IV opiods used in labor?
Definition
Agonists: Fentanyl, Demerol, Morphine
Agonist-antagonist: Stadol, Nubain
Co-drugs/Narcotic Potentiates: Phenergan, Vistaril, Reglan
Term
What are the regional anesthetics used?
Definition
Epidural/Spinal
Pudendal nerve block
Paracervical block
Local
Term
When is general anesthesia used?
Definition
Only For Emererncies
Watch For Bleeding
Effect Of Baby
Term
How do narcotics effect the baby?
Definition
Easier transfer through blood-brain barrier in fetus
Longer half-life in fetus and newborn
Term
What do narcotics to do the fetus respiration rate?
Definition
Watch for respiratory depression, delayed sucking, decreased alertness
Narcan 0.1 mg/kg IV/IM/ SC/ET q2-3 mim prn
Term
What are the steps of placement of an epidural?
Definition
Local anesthetic (marcaine) and opioid (fentanyl)
Anesthesiologist inserts ito epidural space, into CSF if spinal
Sitting or side-lying
Insertion take 5-10-mins
Bolus given, then epid catheter is attached to a pump
Term
What bloodwork is checked before epidural?
Definition
PLAELETS AND WBC
Term
What are the benefits of epidurals?
Definition
most effective way to alleviate or eliminate labor pain;
No change in level of consciousness
Muscular relaxation may result in labor progress
Vaginal delivery or c/s—used in both procedures
Term
What are the disadvantages of an epidural?
Definition
Limited mobility (numbness, IV, monitoring)
Maternal hypotension
Urinary retension (catheter)
Restriction of PO intacke
Discomfort—shaking, itching, thirst/hunger
Postpartum soreness at insertion site
Longer labor
More pitocin
Increased likelyhood of vaccum/forceps delivery
Fever
Fetal distress
:bloody tap”
Spinal headache
Postpartum parastesias
Term
What type of epidural is given in the 1st stage of labor
Definition
Paracervical
Term
What type of epidural is given in the 2nd stage of labor?
Definition
Pudendal
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