OB

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sanchez
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109529
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OB
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2011-10-18 15:00:55
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OB 56
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OB 56
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  1. premonitory signs of labor
    (signs that labor will begin soon)
    • cervical changes
    • braxton hicks contractions
    • bloody show
    • GI disturbance
    • lightening
    • rupture of membranes
    • sudden burst of energy
  2. the decent of the fetus into the pelvis with the downward movement of the fetus that relieves pressure on the diaphragm making the mom breathe better.
    lightening
  3. how soon can lightening occur
    as early as 2 weeks
  4. lightening can be accompanied by?
    leg cramps from pressure on pelvic nerve

    urinary frequency from bladder pressure

    increased venous stasis from vein pressure

    increased vaginal secretion
  5. irregular intermittent contractions felt toward end of pregnancy.
    braxton hicks contractions
  6. what would a Pt experienceing braxton hicks complain of
    fairly regular tightening sensation in abdomen
  7. braxton hicks may be percieved as true labor contractions, but when seen by an MD the cervix is not dilated and contractions stop this is called?
    false labor
  8. when does the cervix usually mature or ripen (become softer and spongier)
    34 weeks of gestation
  9. thinning and shortening of the cervix
    effacement
  10. consists of cervical secretions, blood tinged mucus, and the mucuos plug that blocked the cervix during pregnancy
    bloody show
  11. when does labor usually begin after the bloody show
    24-48 hours after
  12. rupture of amniotic sac, tat usually occurs after labor has begun
    rupture of membranes (ROM)
  13. occurs naturally with a gush of amniotic fluid out of the vagina
    spontaneuous rupture of membranes (SROM)
  14. procedure known as amniotomy
    artificial rupture of membranes (AROM)
  15. widest diameter of the fetal presenting part (head) enters the inlet to the true pelvis
    engagement
  16. umbilical cord that washes out with the amniotic fluid
    prolapsed cord
  17. if labor does not begin 12-24 hours after ruptured membranes in term labor what should be done next
    induce labor bc of risk for infection
  18. s/s of GI disturbance following near time of labor
    • indigestion
    • NVD
    • 1-3 pound weight loss
  19. when could a pt expect to experience sudden burst of energy
    24-48 hours before labor begins
  20. when a pt experiences sudden burst of energy what should be encouraged
    • energy conservation
    • small frequent nutritious meals
  21. cardiac maternal systemic response to labor?
    cardiac output increases bc 300-500 ml of blood is squuezed from the uterus into maternal circulation with each contraction
  22. BP should be _____ during first adn second stages of labor due to contractions
    increased
  23. when is BP highest in pregnant women
    during contraction
  24. when should BP be taken when contractions are present
    in between contractions
  25. respiratory system during maternal systemic response to labor?
    oxygen consumption during labor is equal to moderate or strenuous exercise. almost double the normal amount
  26. if mother has a distended bladder what may happen? what should be done?
    fetal decent is impeded

    encourage client to void
  27. GI system for maternal systemic response to labor?
    peristalsis and absorption decrease

    client should not eat solid food bc of risk for aspirating vomitus

    lips and mouth become dry bc of mouth breathing
  28. Maternal Systemic Responses to Labor for
    Fluid and electrolyte balance
    –Mother’s body temperature increases

    –Mother perspires profusely
  29. Maternal Systemic Responses to Labor for Immune system
    White blood count increases
  30. Maternal Systemic Responses to Labor for integumentary system
    Vagina and perineum have great ability to stretch
  31. Maternal Systemic Responses to Labor for musculoskeletal system
    –Relaxation of pelvic joints

    • –May result in backache and leg
    • cramps
  32. Maternal Systemic Responses to Labor for Neurological system
    • –Endorphins increase pain threshold
    • •Produces sedative effect

    • –Pressure at perineum
    • •Produces physiologic anesthesia
  33. Maternal Systemic Responses to Labor for labor pains
    • –Individual
    • –Subjective
    • –Personal
    • –Expressed in variety of ways
    • –May be affected by culture
  34. variables affecting labor
    (Four Ps)

    • 1.Passageway
    • •Bony pelvis, uterus, cervix, vagina, and perineum

    • 2.Passenger
    • •Fetal size, attitude, lie, presentation, and position affect ease of advance through passageway

    • 3.Powers
    • •Primarily involuntary contractions of uterus
    • •Secondarily voluntary use of
    • abdominal muscles by mother to push

    • 4.Psychological response
    • •Mother’s attitude toward labor
    • •Mother’s preparation for labor
  35. first stage of labor
    Dilatation and Effacement
  36. First Stage of Labor: Dilatation and Effacement begin with?
    • onset of regular contractions and ends
    • with cervical dilatation

    •Longest stage of labor

    • •Divided into three phases:
    • 1.Latent
    • 2.Active
    • 3.Transition
  37. latent phase
    • •Ends when cervix dilated to 3 centimeters
    • (cm)

    •Longest phase

    • •Contraction every 10 to 20 minutes
    • lasting 15 to 30 seconds
  38. what phase should a nurse anticipate the mother to be talkative and usually alert
    latent
  39. active phase
    •Begins when cervix dilated to 4 cm

    •Ends when cervix dilated to 8 cm

    • •Contractions occur every 3 to 5 minutes
    • with duration of 40 to 60 seconds

    •Intensity progresses to strong

    • •Client focuses more on breathing
    • techniques during contractions
    • –Less talkative
  40. transition phase
    •Begins when cervix dilated to 8 cm

    •Ends when cervix dilated to 10 cm

    • •Contractions occur every 2 to 3 minutes
    • with duration of 60 to 90 seconds

    •Intensity of contractions strong

    • •Client needs to be reminded to focus,
    • relax, and breathe with each contraction
  41. characteristics of transition phase
    • •Irritability
    • •Nausea/vomiting
    • •Very warm feeling
    • •Perspiration
    • •Increasing rectal pressure
    • •Restlessness
    • •Hyperventilation
    • •Bewilderment and anger
    • •Difficulty following directions
    • •Focus on self
  42. second stage of labor is?
    birth of baby
  43. second stage of labor: birth of baby begins/end with
    •Begins when cervical dilatation complete

    •Ends with birth of baby

    • •When cervix completely dilated, mother
    • can actively push

    • •Crowning
    • –Fetal head seen at vulva between contractions

    • •Episiotomy may be performed
    • –Incision in perineum
  44. –Fetal head seen at vulva between contractions
    crowning
  45. mechanism of labor
    • •Engagement
    • •Descent
    • •Flexion
    • •Internal rotation
    • •Extension
    • •External rotation
    • •Expulsion
  46. third stage of labor
    delivery of placenta
  47. 3rd stage: delivery of placenta begins with
    • •Begins with birth of baby
    • •Ends with delivery of placenta
    • •Should occur in 5 to 30 minutes
    • •Birthing facility disposes of placenta
    • after delivery
    • •Occasionally, client asks to have
    • placenta to uphold cultural expectations
  48. fourth stage of labor:
    recovery
  49. fourth stage of labor: recovery begins with
    • •First four hours after birth
    • •Blood loss usually between 250 and 500 ml
    • •Uterus should remain contracted to
    • control bleeding
    • –Positioned in midline of abdomen
    • •Level with umbilicus
    • •Mother may experience shaking chills
    • •Bonding important at this stage
  50. priorities for admission for client in labor
    • –Establishing nurse-client
    • relationship

    • –Assessing condition of mother and
    • fetus
  51. client in labor subjective data assessment
    Comfort of mother, her ability to cope, and her need to urinate/defecate
  52. client in labor objective data assessment
    –Vital signs, fetal heart rate (FHR), contractions’ frequency, duration, interval, and intensity, fetopelvic relationships, condition of membranes, maternal behavior, and maternal verbalizations
  53. planning and outcome identification
    client will:

    –Shows progress through labor

    –Expresses satisfaction with assistance

    –Maintains adequate hydration

    –Voids at least every two hours

    –Actively participates in labor process

    –Does not experience any injury
  54. nursing interventions for client in labor
    • •Assessment, timing contractions, and
    • listening to FHR regularly

    •Comfort measures

    •Hygiene measures

    •Ambulation and position

    •Food and fluid intake

    •Elimination
  55. nursing Dx for client in labor
    •Risk for deficient fluid volume

    •Gas exchange impaired (fetal)

    •Risk for infection

    •Risk for injury

    •Deficient knowledge (specify)

    •Acute pain

    •Impaired physical mobility

    •Social isolation

    •Impaired urinary elimination
  56. why breathing techniques
    •Provide adequate oxygenation of mother and fetus

    •Provide focus of attention

    •Decrease anxiety

    •Increase mental and physical relaxation
  57. pharmacologic comfort measures
    • •Systemic medications
    • •Epidural block
    • •Intrathecal block
    • •Local infiltration
    • •Pudendal block
    • •General anesthesia
  58. risks of labor and birth
    • •Preterm labor and birth
    • •Premature rupture of membranes
    • •Dystocia
    • •Abnormal duration of labor
    • •Prolapsed cord
  59. Stimulation of uterine contractions
    before they begin spontaneously
    induction
  60. Stimulation of uterine contractions after they begin spontaneously

    •But with unsatisfactory progress
    augmentation
  61. •Birth of infant through incision in
    abdomen and uterus

    •Scheduled or unscheduled

    •Pediatrician usually present to care for
    infant

    •Some clients may be able to have vaginal
    birth with next pregnancy
    c-section
  62. if a client has a c-section can they have another vaginal birth
    yes
  63. –Metal instruments used on fetal
    head to assist in delivery

    •Cervix must be completely dilated

    •Membranes must be ruptured

    •Position and station of fetal head must
    be known
    assisted birth= forceps
  64. risks with assited forcep delivery
    •Newborn may have facial bruising or edema

    •Mother may have lacerations or hematoma
  65. •Indications same as for forceps-assisted
    birth

    •Maternal risks:
    –Vaginal and rectal lacerations

    •Fetal risks:
    –Cephalohematoma, brachial plexus palsy, retinal
    and intracranial hemorrhage, and hyperbilirubinemia
    vacuum assisted delivery
  66. care of the infant
    • •Airway (A)
    • •Breathing (B)
    • •Circulation (C)
    • •Warmth (W)
  67. care of the mother
    • •Take blood pressure before and after
    • administration of oxytocic medication

    • •Fundus of uterus should be firm, size of
    • grapefruit, in midline, and below umbilicus

    •Episiotomy must be washed and dried

    •Maternity vaginal pads applied

    •Mother and infant allowed to bond
  68. mechanical theories regarding onset of labor
    –Once organ becomes filled and distended, empties itself
  69. hormonal theories regarding onset of labor
    –Maternal progesterone and estrogen levels change

    –Maternal production of oxytocin & prostaglandin

    –Increase in fetal cortisol
  70. look up types of anesthesia!!!!!!!!!!

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