T4 MATERNAL #3

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BHAVES
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144514
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T4 MATERNAL #3
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2012-04-02 09:54:33
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T4 MATERNAL
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T4 MATERNAL #3
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  1. Classifying a Woman's Pregnancy Hx
    • G - Gravida - total # of Pregnancies
    • P - Para - # of babies Born at 20 or > weeks
    • TPAL or FPAL
  2. Intrapartum - period during which labor & deliver take place
    • The Nurse collects ASSESSMENT DATA
    • The Cervic will AFFACE within an hour - TRUE LABOR
  3. Onset of Labor
    • Contractions begins with Irregular uterine - more INTENSE DURING WALKING - - starts on back & radiate to the front
    • Rupture of Membranes - when did it ruptures
    • CHECK V/S & FETAL HR
    • Rupture > 24 hrs before delivery ->infection
  4. Assessment of Amniotic Fluid
    • Nitrazine Paper
    • BLUE - amniotic fluid
    • YELLOW - URINE
    • Fernlike - when amniotic fluid is placed on a glass - IT LOOK LIKE FERN IN MICROSPCOPE
  5. Five Factors affecting Labor & Birth
    • Passenger - the Fetus & the placenta
    • Fetal Flexion - chin flexed to chest
    • Fetal Extension - chin extended away from chest
    • OCCIPUT - back of the head enters first
    • Station 0 - at the level of Imaginary line - OF THE ISCHIAL SPINES
    • - 5 - above / +5 below
    • The Cervix must DILATE & EFFACE - sign of true labor - cervix change
    • Involuntary urge to PUSH & VOLUNTARY bearing down - increase RECTAL PRESSURE
    • Effacement - thinning of the Cervix
    • Dilation - opening of the softened cervix
    • AVOID SUPINE -> Hypotension & Fetal Hypoxia - if Complain of Dizziness put on side
  6. Vaginal Examination
    • Cervical Dilation & Effacement - check Position of Baby
    • Membranes - Intact or Ruptured - IF BAG OF WATER RUPTURED OR INTACT
  7. Mechanism of Labor
    • Engagement - Usually Biparietal (largest) diamenter of the Fetal Head ->ISCHIAL SPINES (referred to as station 0
    • Descent, Flexion, Internal Rotation, Extension, Restitution & External Rotation, Expulsion --> CARDINAL MOVEMENTS OF LABOR
  8. Uterine Contractions - during each contraction, the muscle fibers of the uterus tighten - THE ONSET OF TIGHTENING TO RELAXATION
    • Assessment of Uterine Contractions
    • Frequency, Duration & Intensity - INTERNAL
    • Frequency & Duration - EXTERNAL
  9. LABOR
    • 4 Stages of Labor
    • Stage 1 -
    • Latent - 0-3 cm
    • Active- 3-7 cm
    • Transitional - 7-10 cm (shortest most difficult) - irritable withdrawn vomiting
    • Stage 2 - Expulsion - Baby Born
    • Stage 3 - Placental - Placenta Out
    • Stage 4 - Recovery

    • Latent Phase - Nx Considerations - Leopold's Maneuvers - POSITION & PRESENTATION
    • Transition -
    • Cervix @ 8-10 cm complete dilation
    • Mother is Tired restless irritable - FEEL WITHDRAWN - RESISTANT TO TOUCH
    • Shortest most difficult part of Labor - FOR TRANSITION
    • Nx Consideration - OBSERVE for PERINEAL BULGING/CROWNING

    • 2nd Stage of Labor
    • URGE TO BEAR DOWN - BEARING DOWN REFLEX - begins with full dilation & ends with Birth ->10 cm- B

    • 3rd Stage of Labor
    • Begins with delivery of the Infant & ends with delivery of the Placenta
    • Duration 5-30 minutes
    • Schultze Presentation - shiny surfaces - BABY SIDE
    • Duncan Presentation - dull surfaces - MOM SIDE
    • Nx Consideration - Placental separtion --> CORD IS LENGTHENING --> UMBILICAL CORD APPEARS TO LENGTHEN AS PLACENTA DESCENDS

    • 4th Stage of Labor
    • Nx Considerations - Massaging the Uterine Fundus and/or BOGGY UTERUS TX: MASSAGE FUNDUS
    • Encourage voiding to prevent bladder distention or DEVIATION TO THE SIDE - BLADDER UTERINE ATONY - SOFT BOGGY UTERUS

    • LEOPOLD MANEUVER - Identify Presenting Part of Position of the BOdy
    • Presenting part over lies the Pelvic Inlet
    • NORMAL FETAL HEART TONE - 110 - 160

    Fetal Scalp Electrode (FSE) an Internal Fetal Heart Monitor & Intrauterine Pressure Catheter (IUPC) an internal Contraction monitor --> MEMBRANES MUST BE RUPTURED
  10. Pain Management During Labor & Delivery - Supine Position only with wedge under client's hips to tilt the uterus - PUT ON SIDE TO PREVENT MATERNAL HYPOTENSION & FETAL HYPOXIA
  11. Epidural Block - May cause HYPOTENSION, FETAL BRADYCARDIA, INABILITY TO FEEL URGE TO VOID, ADMINISTER IV FLUIDS TO OFFSET HYPOTENSION (select all)
  12. FHR Pattern & Contraction Monitoring
    • Continous External Fetal Monitoring - DOES NOT MEASURE THE INTENSITY of Contraction
    • Continous Internal Fetal Monitoring - Measures FREQUENCY DURATION & INTENSITY --> MEMBRANES MUST RUPTURE , CERVIX OPEN 2-3 CBM
    • Indications for use of IExternal & Internal Fetal Monitoring -->PREVIOUS STILL BIRTH - is the indication for the needs of Electronic Fetal Monitor

    • Fetal Assessment during Labor
    • Decrease in Fetal Heart Rate are compression of - Fetal Head, Umbilical Cord, Uterine Myometrial Vessels

    • BASELINE FETAL HEART RATE - 110-160 BPM
    • Fetal Bradycardia may result from - FETAL HYPOXIA - TURN TO SIDE INCREASE O2

    • Fetal Heart Rate Variability
    • The Baseline rate should vary 10-15 beats over a period of 1 minute
    • Short Term Variability (BEAT TO BEAT) --> SINGLE MOST RELIABLE INDICATOR OF FETAL WELL BEING
    • Decreased variability may occur in the ff situations - HYPOXIA & ACIDOSIS <7.2 ACIDOSIS
    • Periodic/NonPeriodic HR changes --> Accelerations (IHR) Decelerations (DHR) Late & Prolonged
    • Early Decelerations - PRODUCES MIRROR IMAGE - COINCIDES TO CONTRACTION
    • Late Deceleration - begins after the Onset of the peak or Middle of Contraction

    • NX Criteria if an Ominous Pattern Occurs: STOP ANY OXYTOCIN/PITOSSIN, STOP LABOR, INCREASE IV FLUIDS
  13. INTERPRETING FHR DATA
    • Variability of 10-15 beats above or below FHR baseline is acceptable
    • Early Decelerations (coincide) occur at the same time as the contraction
  14. THERAPEUTIC PROCEDURES TO ASSIST WITH LABOR & DELIVERY
    • AMNIOTOMY - artificial rupture of the Amniotic Membranes (AROM) -->
    • ALWAYS CHECK INCREASE OF CORD PROLAPSE
    • MONITOR FOR LATE DECEL & FETAL BRADYCARDIA
    • RISK FOR PROLAPSE OF UMBILICAL CORD
  15. THERAPEUTIC PROCEDURES TO ASSIST WITH LABOR & DELIVERY
    • INDUCTION OF LABOR -
    • Administration of IV Oxytocin/Pitocin - (MONITOR I/O CAUSES H20 INTOXICATION

    • MEDICATIONS TO INDUCE LABOR
    • Prostaglandins
    • Intravenous Oxytocin/Pitocin -->
    • Contractions - STRONGER, > PAINFUL, ABRUPT PEAK
    • Monitor: WATER INTOXICATION & HTN (CHECK I/O) May cause uterine Hyperstimulation & serious uterine tetany (TETANY -> FETAL HYPOXIA

    • INDICATIONS for the Use of Episiotomy - SHOULDER DYSTOCIA - NOT A ROUTINE, NOT ALWAYS DONE & THEY ARE INVASIVE
    • Indications & Risk Factors for C-BIRTH
    • CPD - Cephalopelvic Disproportion
    • ACTIVE GENITAL HERPES
  16. PRETERM MEDICATIONS - GIVEN TO STOP LABOR
    RITODRINE (Yutopar) TOCOLYTIC given IV - STOPS PRETERM LABOR & PREVENT SEIZURES
  17. COMPLICATIONS OF LABOR & BIRTH
    • Prolapsed Umbilical Cord
    • Using Sterile Gloved hand insert 2 fingers into vagina & apply to the fetal presinting part to elevate it off the cord - GET PRESSURE OF CORD, TO RELIEF THE PRESSURE OF THE CORD

    • Amniotic Fluid Embolism
    • DIC is also associated with Internal Fetal Demise (Death) in Utero - THERAPEUTIC ABORTION

    • Fetal Distress
    • Activity Fetal Blood pH <7.2 - ACIDOSIS

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