intrapartum

Created by

Kaitlyn Grainger

Cards (34)

What are signs of labor?
- nesting
- lightening (baby drops down from around lungs to lower pelvis area)
- bloody show
- Braxton-hicks contractions
- cervical changes
- spontaneous rupture of membranes
What is lightening?
the fetal head descends into true pelvis about 14 days before labor; causing feelings that the fetus has "dropped", easier breathing, but more pressure on the bladder resulting in urinary frequency, more pronounced for primigravida pts
What is nesting?
a sudden burst of energy that usually occurs prior to the start of labor
What are the stages of labor?
Firs stage- 3 phases: latent, active, transition
Second stage- pushing
Third stage- placental delivery
Fourth stage- Recover
What happens during the second stage of labor?
full dilation, pushing and fetal descent
What occurs during the third stage of labor?
placental delivery
What 3 phases make up the first stage of labor?
- latent
- active
- transition
What is the fourth stage of labor?
recovery (maternal stabilization of vitals)
What are the 5 P's affecting labor?
- Passenger (fetus and placenta)
- Passageway (birth canal)
- Powers (contractions)
- Position (of the client)
- Psychological response
Stage 1- latent phase
the cervix dilates from 0-3cm (0-5cm ATI) and contraction duration ranges from 30-45sec. Contractions are also irregular and usually tolerable to the pt, frequency 5-30 min.
Nursing care during stages of labor
- vitals
- review prenatal records for risk factors
- assess cervical dilation
- evaluate pain
- assess contractions- frequency, duration, intensity
What can be given during first stage of labor?
- opioid agonist analgesics
- opioid agonist- antagonist
- epidural analgesia
- nitrous oxide
What can be given during second stage of labor?
- nitrous oxide
- spinal anesthesia
- combined spinal- epidural analgesia
- nitrous oxide
What can be given during vaginal birth?
- epidural anesthesia or analgesia
- nitrous oxide
- spinal anesthesia
- combined spinal-epidural analgesia
- local infiltration anesthesia
- pudendal bloc
what can be given during a cesarean birth?
- epidural anesthesia
- spinal anesthesia
- general anesthesia
Fetal assessment during labor
- assess FHR patterns
- accelerations
- decelerations (early, variable, late)
- assess amniotic fluid color and odor
Fetal heart rate patterns : VEAL CHOP
Variable deceleration
Early deceleration
Acceleration
Late acceleration

Cord compression
Head compression
Okay
Placental insufficiency
What are therapeutic procedures to assist with labor and delivery?
- external cephalic version
- amniotomy
- bishop score
- amnioinfusion
- cervical ripening
- vacuum-assisted delivery
- induction of labor (over 39 weeks, prolonged ROM, fetal demise)
- episiotomy
- augmentation of labor
- cesarean birth
What is done during an episiotomy?
an incision is made into the perineum to enlarge the vaginal opening to facilitate birth and minimize soft tissue damage
What are complications related to the labor process?
- dystocia (dysfunctional labor)
- fetal distress
-precipitous labor
- meconium- stained amniotic fluid
- prolapsed umbilical cord
- uterine rupture
- amniotic fluid embolism
- hypotonic contractions
- hypertonic contractions
Why is oxytocin given after the end of stage 3 of labor?
to facilitate uterine contractions and prevent bleeding
What are maternal characteristics during the latent phase of labor?
- scant amount of brownish discharge, pale pink mucus, or mucus plug
- talkative or calm
- thoughts are focused on labor, self , and baby
- ability to talk and walk through most contractions
- easily follow directions
- can be apprehensive
What are maternal characteristics during the active phase of labor?
- becomes more serious
- feelings of helplessness, anxiety, apprehension, and attention are more of an inward focus
- pain may be more severe and may feel out of control, irritable, and doubt ability to continue
- can have nausea and vomiting, urge to push, increased rectal pain and feelings of needing to have a bowel movement
- increased blood show
- most difficult part of labor
Stage 1 - active phase
6-10cm
contractions: - more regular, moderate to strong
- frequency: 3-5 min
- duration: 40-90 seconds
complete dilation
A nurse is completing an admission assessment for a client who is at 39 weeks of gestation and reports fluid leaking from the vagina for 2 days. Which of the following conditions is the client at risk for developing?
A. Cord prolapse
B. Infection
C. Postpartum Hemorrhage
D. Hydramnios
B. Infection3 multiple choice options
A client calls a provider's office and reports having contractions for 2 hr that increased with activity and did not decrease with rest and hydration. The client denies leaking of vaginal fluid but did notice blood when wiping after voiding. Which of the following manifestations is the client experiencing?
A. Braxton hicks contractions
B. Rupture of membranes
C. Fetal descent
D. True contractions
D. True contractions3 multiple choice options
How long after membrane rupture does the pt need to give birth?
24 hours, if not the pt is at risk for infection
Nursing care with oxytocin
- vital signs every 30-60 min
- FHR every 15 min and change in dose
- I & O
- increase dose until normal contraction pattern
- DISCONTINUE IF SIGNS OF FETAL DISTRESS
What is the first priority/consideration of the nurse when planning pain management during labor?
the safety of the mother and fetus
Pain during the first stage of labor
internal visceral pain that can be felt as back and leg pain
CAUSES:
- dilation, effacement, and stretching of cervix
- distention of lower segment of uterus
- contractions of the uterus with resultant uterine ischemia
Pain during second stage of labor
Pain that is somatic and occurs with fetal descent and expulsion
CAUSES:
- pressure and distention of the vagina an the perineum, described by the client as burning, splitting, and tearing
- pressure and pulling of the pelvic structures
- lacerations of soft tissue
Pain during the third stage of labor
pain with the expulsion of the placenta is similar to experienced during first stage
CAUSES:
- uterine contractions
- pressure and pulling of pelvic structure
Nursing care for complications of labor (fetal distress?)
- side- lying
- oxygen
- DC oxytocin
- increased iv rate
- cesarean as indicated
what is a pudendal block?
a transvaginal injection of local anesthetic that anesthetizes the perineal area for the episiotomy and repair, and expulsion of the fetus