intrapartum

• signs of impending labor: lightening, increased urinary frequency, leaking of amniotic fluid, effacement and/or dilation
• lightening is when the fetal head descends into the pelvis
• effacement is thinning out of cervix to prepare for birth
• true labor: regular contractions, contractions become closer together and stronger, contractions start in back and radiates to abdomen, effacement and dilation, intensity increases with walking
• false labor: irregular contractions, no cervical changes, contraction felt in the abdomen, walking lessens the pain
• positioning during labor: elevate HOB 30 degrees, turn patient side to side to prevent supine hypotensive syndrome, best position is on the left side to help increase fetal circulation
• with oxytocin (pitocin), how often do you monitor vitals and what vitals are you monitoring?

  q15 minutes; blood pressure, pulse, respiratory rate
• blood pressure, pulse, respiratory rate should be monitored q30 minutes during the active, transition, and second stage of labor
• what do you chart for amniotic fluid?

  time, fetal heart rate (fhr), character and amount
• nursing interventions for fetal distress: monitor fhr, fetal activity, fetal heart variability, position patient on the side, increase non-additive IV fluids, administer O2 as ordered (usually 8-10L/min.)
• if fetal distress occurs, what should you do?

  discontinue oxytocin, notify HCP if no improvement and prepare for cesarean birth
• what actions does the nurse take if the client develops hypotension with edpidural?

  stop epidural pump and initiate IV fluids
• nursing interventions for pain medication: assess and manage respiratory depression and hypotension, assess motor and sensory blockage
• what are the 3 phases of the 1st stage of labor?

  latent, active, and transitional
• what happens during the latent phase?

  0-3 cm dilated, contractions last from 30-45 seconds, the frequency of contractions is from 5-20 mins., true labor is considered to at 4 cm., patient is usually alert, talkative, and can walk
• what happens during the active phase of labor?

  4-7 cm. dilated, contractions occur every 3-5 mins. with a duration of 40-60 seconds, considered the onset of true labor, patient focuses more on breathing techniques, less talkative, unable to walk
• what happens during the transitional phase of labor?

  8-10 cm dilated, contractions occurs every 2-3 mins. with a duration of 60-90 seconds, intensity is strong, patient has the urge to push or have a bowel movement
• the primary goal in the 4th stage of labor is to prevent hemorrhage from the uterine atony and the cervical/vaginal lacerations.
• blood loss during the 4th stage of labor is usually between 250 mL and 500 mL.
• what are the impending signs during the 2nd stage of labor?

  bulging of perineum, dilation of the anal orifice, nausea, irritability, uncooperativeness, complaints of severe discomfort
• during the 2nd stage of labor, monitor the patient's BP and FHR every 5 minutes and after each contraction.
• what does cloudy, yellow, foul-smell from the amniotic fluid indicate?

  infection