childbirth
Terms
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Theories on the onset of labor
1 -
Estrogen/v Progesterone
Oxytocin
Prostaglandins
Uterine Distension
Relaxin
Fetal Cortisol -
Higher oxytocin
2 - contraction, cervical efacement
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Highter Prostaglandins
3 - Vasodilator (potent) smooth muscle contractility
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Uterine Distension
4 - Irritable/contraction causes cervical pressure
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Lower Relaxin
5 - Relaxes intervertebral joints and higher contracting
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Fetal Cortisol
6 - For fetal long surity
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Passage
7 - Maternal pelvis and soft tissue that the baby must pass through
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True Pelvis
8 - Pelvic inlet/mid pelvis/pelvic outlet
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False Pelvis
9 - Supports weight/directs presenting part into true pelvis
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Pelvis Type
10 -
Gynecoid: Common NSVD
Android: Heart Shape
Platypelliod: C-section 20%
Anthropoid: Common OP position/NSVD -
Gynecoid:Common NSVD
11 - 50% of women, common for vaginal delivery
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Android: Heart Shape
12 - Men have vacume or forceps to help with delivery
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Anthropoid: Common OP positino/NSVD
13 - 5% baby spine is same position with mom spine
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Station
14 -
-3
-2
-1
0
+1
+2
+3
Once Head reaches 0 the head is in pelvic inlet. Engagment to pelvic brim. 0 is the ischial spine of pelvis -
Fetal Head
15 - Largest Part
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Fetal Attitude
16 -
State of flexion knees to chest
Normal state of flexion of arms legs and neck = knee to chest -
Fetal Lie
17 - Vertex/breech/transverse
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Transverse
18 - Baby lies horizontal in uterus- no vaginal delivery
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Vertex
19 - Head is first (cephalic)
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Breech
20 - Butt is first
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Fetal Presentation
21 -
What part of fetus enters the pelvis
What examiner feels first -
Fetal Posistion
22 - Fetal presenting part to the maternal pelvis (three letter notation)
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Fetal Position 3 Letters
23 -
1. Baby spine on right or left side
2. Fetus presenting part 0-oxyput head M-mentum chin S-sacrum SC-scapula
3. Land mark of presenting part of the front or back side of pelvis to babys back.
EX: LOT= left side, head down, transverse to mother pelvis. -
Frequency
24 - begining of one contractino to the begining of the next contraction
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Duration
25 - The length of the contraction
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Intestity
26 - Strenght of contraction at acme 100 highest
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Effacement
27 - Thinning and shortening of cervix measured from 0-100%
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Dilation
28 - Opening of the cervix/measured from 0-10cm
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Primary forces
29 - Involuntary contractions
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Secondary forces
30 - Voluntary use of abdominal muscles
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Time Contractions
31 - Second or min duration from beginging to end lasting how long.
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Common emotions during the L&D process
32 -
Excitement
Fear
Perceived loss of control
Anxiety
Support system, trust person at bedside.
Increase BP, Increase Pulse. -
External Monitoring
33 -
Ultra sound
transducer
Tocodynamomoeter
Computer assisted auditory and visual
Try to know fetal well being, fetal heartones -
Internal montering
34 -
FSE-Fetal Scalp Electrode
IUPC- Intrauterine Pressure Catheter
If laboring for to long, deceleration more acurate fetal heart tones. Contraction , no on soft spot, Dialate 2 cm intrafuterine. -
Long term variablity
35 - Rhythmic fluctuations in H/R occuring 2-6 times per minutes 6-25 bpm
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Short Term Variablility
36 - Change in H/R between one fetal heart beat and the next 2-3 bpm
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Tachycardia
37 - 160 bpm
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Bradycardia
38 - 120 bpm
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Acceleration
39 - Increase FHR
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Deceleration
40 - Decrease FHR
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Early
41 - Begins at onset of ctx and returns to baseline by end of contraction
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Variable
42 - Occurs suddenly, varies in duration and intensity, resolves abruptly
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Late
43 - Begins with or after the acme of the contraction and does not return to baseline until after contraction is over
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First stage
44 -
Dilation of cervix
Phase 1- latent, 0-3cm
Phase 2- Active, 4-7cm, give meds here.
Phase 3- Transition, 8-10cm, if give meds here, could have resp distress. -
Second Stage
45 -
Complete dilation of cervix, delivery of fetus
Starts to push -
Third Stage
46 -
Birth of newborn to delivery of placenta
Delivery of placenta -
Forth Stage
47 -
Immediate recovery phase
postpartum 1-4 hours after delivery -
Cervical Change
48 - 0-100%
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ROM
49 - Rupture of Membrane- Intact, bulging, artifical rupture or spontaneous
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Bloody Show
50 - Absence of baginal exam, slight show, mucous with streaks of blood.
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Contractions
51 - true contract start from lower back, radiate to front of abdomen.
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Lightening
52 - Dropping of graivida uterus into pelvis
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Nesting Instinct
53 - Burst of energy to due things, usually 24 hours before labor. Increase back discomfort thinks got flu.
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Second Stage of Labor
54 -
Complete Dilation- Birth of Infant
Crowning- Outward bulging and thinning of perineum
Full bladder- straight cath her if cant go on own decent of fetal head. -
Cardinal Movements
55 -
Adaption that the fetus has to do to manuever through pelvis during birth.
Engagement
Descent
Flexion
Internal Rotation
Extension
Restitution
External Rotation
Expulsion -
Third Stage of Labor
56 -
Birth of newborn to delivery of the placenta.
B/P
Pulse
RR every 5 min.
Assess fundus for tone, for contractin pattern. Cant be boggy massage it. Need empty bladder. -
Episotomy
57 - Cut a bit so baby come out.
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Midline
58 - Less blood loss less painful. Heals quicker .
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Medial lateral
59 - 4-5 cm bigger, turn oblique towards buttock. Get more room. More painful, more blood loss, longer to heal.
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Forth Stage
60 - From delivery of placenta to 1-4 hours after birth
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Vital Signs
61 -
Every 15 min 1st hour
Every 30 min 2nd hour
Every hour for 4 hours -
Fundus Check
62 -
1-2 fingers below umbilicus for every postpartum day.
Involution process takes to get to normal. Time 2 weeks uterus is back to prepreg state. Uterus cant be felt back in pubic.
Massage uterus to bring back. 1-2 finger breaths eery day, postpartum, midline firm, write 2FB lower u firm, midline. -
Lochia Check
63 -
Red-Rubra-1st 48 hours. 1-2 days. Lot of blood, al in pad, take care 3-4 hours when take care of baby, take care of self. Pad dry, cahnge pad.
3-4 day it is serousa-pink
Up to 3-6 weeks Alba yellowish to white -
Perineum Incsision check
64 - Episiotomy, hemmhoids, sututures, ice, edema present give some ice.
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Intake Output
65 - Monitor
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Emotional assessment
66 - Family support.
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Effleurage
67 -
Gentle stroking down middle of abdomen and around sides
Focal Point
Lamaze breathing techniques -
Comfort suggestion for labor
68 -
Position change
Cool or warm washcloths
Therapeutic touch
Words of Encouragement
Lip Balm
Soft Music.
Ice Chips if allowed -
Analgesics used in labor
69 - Demerol, Statdol, Nubain
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Angalgesic Side effects
70 -
Maternal Side effects- Respiratory depression
Fetal Side effects- Respiratory depression -
Contraindications
71 - Poor FHR, Maternal respiratory depression, known allergy
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Nursing implications
72 -
Monitor Fertal Maternal Response
Administer narcan(anidote) reverse respiratory depression. -
Anesthisa in labor
73 -
Epidural
Given first stage, Phase #2, Active labor 4-7cm
Advantage- Excellent pain relief redosing of medication, no neonatal respiratory depression. May provide few hours of postpartum relief
Disadvantage. Inserted by anesthsia, causes numbness to lower extremities, and little to no urge to push
Nursing interveention Monitory urinary output, retention. -
Pitocin
74 -
Indication- Induce labor
Contraindication- CPD
Malpresentation (breech)
Fetal Distress
Preterm Infant
Side Effects- Fetal Hypoxia/abruption placenta/ hx. of rapid labor/ Uterine rupture.