saunders

coordinated sequence of involuntary, intermittent uterine contractions

Labor

4 major factors (4 Ps) interact during normal child birth; the 4 Ps are interrelated and depend on each other for a safe birth. What are the 4 Ps?

power

passageway

passenger

psyche

“Power”

uterine contractions

forces acting to expel the fetus

contractions

effacement

shortening and thinning of the cervix during the first stage of labor

dilation

enlargement of cervical os and cervical canal during the first stage of labor

“passenger”

the fetus, membranes, and placenta

“psyche”

A patients emotional structure that can determine their entire response to labor and influence physiological and psychological functioning; the pt may experience anxiety or fear

“attitude”

is the relationship of the fetal body parts to one another.

normal intrauterine attitude is _________, in which the fetal back is _______ __, t__he head is forward on the chest, and the arms and legs are folded in against the body. The other attitude, extension, tends to present _________ fetal diameters.

flexion

rounded

larger

“lie”

relationship of the spine of the fetus to the spine of the pregnant person.

What lie is this

Longitudinal lie

What lie is this

Transverse lie

Fetal spine is parallel to the clients spine.

Fetus is in cephalic or breech presentation.

Longitudinal or vertical

fetal spine is at right angle, or perpendicular, to patients spine.

presenting part is the shoulder.

delivery by cesarean section is necessary

Transverse or horizontal

“presentation”

portion of the fetus that enters the pelvic inlet first.

-cephalic (head first)

-breech (buttocks first)

-shoulder (arm, back, abdomen, or side first)

lightening or dropping (aka engagement)

occurs when the fetus descends into the pelvis about 2 weeks before birth

The pregnant person may have a sudden burst of energy known as __________ , often 24-48 hours before on set of labor

nesting

prodromal labor

false labor

LOT

left occipitotransverse

LOP

left occipitoposterior

ROA

right occipitoanterior

ROT

right occipitotransverse

ROP

right occipitoposterior

LOA

left occipitoanterior

fetal vertex (occiput) positions

_____________ is the mechanism whereby the fetus nestles into the pelvis

engagement

engagement occurs when the presenting part reaches the level of the ?

ischial spines

________ is the process that the fetal head undergoes as it begins its journey through the pelvis

descent

descent is a continuous process, from before engagement until birth , and is assessed by the measurement called _________

station

mechanisms of labor

__________ is a process of nodding of the fetal head forward toward the fetal chest

flexion

__________ of the fetus occurs most commonly from the occipitotransverse position, assumed at engagement into the pelvis, to the occopitoanterior position while continuously descending

internal rotation

leopold’s maneuvers

-methods of palpation to determine presentation and position of the fetus and aid in location of fetal heart sounds

Gestation is time from ______ of the ovum until the date of _______

fertilization.

delivery.

the first preception of fetal movement by the pregnant individual may occur at the 16th to 20th week of gestation

quickening

changes to skin pigmentation such as linea nigra, melasa.

is this presumptive or probable sign

presumptive sign

what is the GTPAL ?

client is pregnant for the 4 th time. she had one elective abortion in first trimester, a child who was born at 40 weeks gestation, and a child born at 36 weeks gestation.

G4 T1 P1 A1 L2

rebounding of the fetus agaisnt the examiners fingers on palpation

ballottement

To measure fundal height, client will be _______ position

supine

fundal height is measured to evaluate the gestation ____ of the fetus

age

When assessing fundal height, monitor the client closely for supine ______ when placed in the supine position after 20 weeks gestation

hypotension

ask the client to ____ before measurement of fundal height

void

(because of possible uterine displacement from a full bladder)

during pregnancy, circulating blood volume increases ( how much % ?)

40-50 %

premature rupture of the membranes is spontaneous rupture of the amniotic membranes before the onset of _________

labor

when the premature rupture of membranres is before term and birth will be delayed, ______ becomes a risk

infection

if the membranes are ruptured, ________ test is positive

nitrazine

prolapsed umbilical cord

umbilical cord is displaced between the presenting part and the amnion or protruding through the cervix, causing compression of the cord and compromising fetal circulation

prolapsed umbilical cord….. fetal heart rate may be ?

irregular and slow

Prolapse of umbilical cord.

Occult (hidden) prolapse of cord.

Prolapse of umbilical cord.

Complete prolapse of cord. Note that membranes are intact.

Prolapse of umbilical cord.

Cord presenting in front of fetal head may be seen in vagina.

Prolapse of umbilical cord.

Frank breech presentation with prolapsed cord.

preterm labor occurs after the __ th week but before the _th week of gestation

20

37

precipitous labor and delivery

labor lasting less than 3 hours

encourage client to _____ between contractions

pant

Position for patient with prolapsed umbilical cord

extreme trendelenburg’s or modified left lateral position or knee-chest position

dystocia

difficult labor that is prolonged or more painful

Nurse is performing an assessment on a client who has just been told that her pregnancy test is positive. which woman is at risk for preterm labor?

-35 y old primigravida

-client has history of cardiac disease

-clients hemoglobin is 135 mmol/d

-20 y old primigravida of average weight and height

-client has history of cardiac disease.

A client is experiencing labor dystocia.

which risk factors in the clients history places them at risk for this complication?

-age 45

-bmi of 28

-previous difficulty with fertility

-administration of oxytocin for induction

-potassium level of 3.6 mmol/L

-age 45

-bmi of 28

-previous difficulty with fertility

the nurse in a labor room is preparing to care for a client with hypertonic uterine contractions. the nurse is told that the client is experiencing uncoordinated contraction that are erratic in their frequency, duration, and intensity. what is the priority nursing action?

-provide pain relief measures

-prepare the client for an amniotomy

-promote ambulation every 30 mins

-monitor oxytocin infusion closely

-provide pain relief measures

the nurse has made a plan of care for a client experiencing dystocia and includes several nursing actions in the plan of care. what is the priority nursing action?

-providing comfort measures

-monitoring the fetal heart rate

-changing clients position frequently

-keeping significant other informed of the progress of the labor

-monitoring the fetal heart rate

________ are meds that produce uterine relaxation and suppress uterine activity

tocolytics

tocolytics are used for?

to halt uterine contractions and prevent preterm birth

fetal contraindications for the use of tocolytics

-gestational age greater than 37 weeks

-cervical dilation greater than 4cm

-fetal demise (fetal death)

-lethal fetal anomaly

-chorioamnionitis

-acute fetal distress

-chronic intrauterine growth restriction

client contraindications for the use of tocolytics

-severe preeclampsia and eclampsia

-active vaginal bleeding

-intrauterine infection

-cardiac disease

-placental abruption

-poorly controlled diabetes

For a client receiving tocolytics, position them how

on the side to enhance placental perfusion and reduce pressure on the cervix

Indomethacin (type of tocolytic)

Relaxes uterine smooth muscle by inhibiting prostaglandins.

prostaglandins are used for

-preinduction cervical ripening

induction of labor

oxytocin is used for

-induces or augments labor

-controls postpartum bleeding

late decelerations vs early decelerations of fetal heart rate

late decelerations = fetal distress

early decelerations = reassuring sign and do not indicate fetal distress

_____ ________ is a poorly contracted uterus that does not adequately compress large open vessels at the placental site…. this can result in hemorrhage

uterine atony

uterine atony : assessment:

a soft (boggy) uterus noted on palpation of the uterine fundus

interventions for uterine atony

1. massage the uterus until firm

2. empty the patients bladder (void or catheterization) if that is contributing to the uterine atony

3. notify doctor

when is the greatest risk for postpartum hemorrhage?

4 hours immediately after delivery.

second greatest risk is 24 hours following delivery.

causes of postpartum hemorrhage

-uterine atony

-laceration of cervix or vagina

-hematoma development

-retained placenta fragments

-obesity

s/s of postpartum hemorrhage

-significant bleeding (pad is soaked in 15 mins)

-restlessness and increased pulse rate

-rapid and shallow respirationss

-decrease in blood pressure

-cool clammy skin

-ashen greyish skin

-decreased urine output

-change in loc

pt has endometriosis (infection of lining of the uterus in post partum)… what position should you put her in

fowlers position (to facilitate the drainage of lochia).

pt gets pulmonary embolism… an intervention is to administer ______

oxygen

Nurse is monitoring pt in the immediate postpartum period for signs of hemorrage. which sign would be an early sign of excessive blood loss?

a. temp of 38

b. increase in pulse from 88 to 102

c. blood pressure changes from 130/88 to 124/80

d. rr increases from 18 to 22 breaths per minn

b

nurse is assessing pt who delivered by c/s, for signs of superficial venous thrombosis. which sign would the nurse note if svt were present?

1. paleness of calf

2. coolness of calf

3. enlarged hardened veins

4. palpable dorsalis pedis pulses

3,

Who is at most risk for hemorrage?

1. a primiparous who delivered 4 hours ago

2. a multiparous who delivered 6 hours ago

3. a multiparous who delivered a large baby after oxytocin induction

4. a primiparous who delivered 6 hours ago and had epidural anesthesia

3

Bishops score

used to determine maternal readiness for labor and evaluates cervical status and fetal position

-score of 8 or greater indicates that the chance of a successful vaginal delivery is good

____________ is a deliberate initiation of uterine contractions that stimulates labor

induction

amniotomy

artificial rupture of the membranes

__________ is an incision made into the perineum to enlarge the vaginal outlet and facilitate birth

episiotomy

forceps delivery

used to assist in the delivery of the fetal head

vacuum extraction

-cap like suction device is applied to the fetal head to facilitate extraction

nurse is assessing a client who has a scheduled cesarean at 39 weeks. what assessment finding indicates you gotta call the doctor?

1. fetal heart rate of 180

2. maternal pulse of 85 beats

3. mother wants pizza

4. father wants pizza

1. (normal fetal hr is 110-160)

a pt is brought to the delivery room and preped for a c section. the nurse would place patient in what position on the table?

supine with a wedge under the right hip.