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Identify the components of childbirth education classes
- • Expectations during labor & delivery
- • Managing discomfort during labor
- • Conscious relaxation
- • Controlled breathing
- • Cutaneous stimulation
- • Focusing
- • Medications
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Componets of Stage 1 Labor
- Dilation and effacement
- Latent Phase
- Active Phase
- Transition
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Describe Stage 1 - Latent Phase of Labor
- Stage 1: Latent Phase
- • 4-6 hours
- • Cervix 1-4 cm
- • Amniotic membranes intact or ruptured
- • May be bloody show
- • Contractions Frequency: Every 20 min
- • Duration: 15-40 seconds
- • Intensity: mild to moderate
- • Cooperative, talkative, thirsty, urinaryfrequency
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Nurse's role: Stage 1 - Latent Phase
- -Interventions
- -Therapeutic nurse/pt. relationship
- -Encourage rest/activity; may shower
- -Assess FHR, contractions, vaginal discharge
- -Assess for urinary retention, encourage void
- -Provide lollipops for carb and fluid intake
- -Assess vital signs every 2 hours
- -Review birth plan; breathing patterns
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Describe Stage 1 - Active Phase of Labor
- Stage 1 - Active Phase of Labor
- • 2-6 hours
- • Cervix 4-7 cm
- • Amniotic membranes may rupture
- • Effacement occurs
- • Contractions Frequency: Every 2-5 min
- • Duration: 40-60 seconds
- • Intensity: moderate to firm
- • Apprehensive, anxious, introverted, lesssocial, facial flushing, requests pain relief,may need epidural, fears losing control, focused on breathing, perspiring
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Nurse's role: Stage 1 - Active
- -Interventions
- -Assist coach
- -Reassure and praise
- -Back massage, position changes, moisten mouth, maintain comfortable temp, shower?
- -Monitor IV, urinary retention, assess vaginal fluid
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Describe Stage 1 - Transition Phase of Labor
- Stage 1 - Transition Phase of Labor
- -30 min - 2 hours
- -Cervix 7-10 cm
- -Amniotic membranes ruputure
- -Effacement complete
- -Contractions:
- frequency: every 2-3 min
- duration: 60-90 seconds
- intensity: firm
- -irritable, rejects support person, introvert, restless, wants to give up, trembling legs, requests medication, vomits
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Nurse's role: Stage 1 - Transition Phase
- -Interventions
- -Firm coaching/support coach
- -Reassurance and praise
- -Monitor FHR & contractions
- -Accept negative comments from mom
- -Maintain positive approach
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Describe Stage 2 of Labor - Fetal Expulsion
- -30 minutes to 2 hours
- -Cervix 10 cm / bulging perineum
- -Contractions:
- Frequency: every 1.5 - 3 min
- Duration: 60-80 sec
- Intensity: firm
- -May pass stool, uncontrollable urge to push, States:"baby is coming", exhaustion after each contraction, difficulty following instructions, excitement concerning imminent birth
- -Episiotomy performed if necessary
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Nurse's role: Stage 2 - Fetal Expulsion
- -Interventions
- -Positioning for pushing
- -Support coach
- -Monitor contractions & FHR
- -Assess perineum and vaginal resuscitation
- -Prepare sterile supplies and equipment
- -Give mom and support person feedback
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Describe Stage 3 - Placental Expulsion
- -5-30 minutes
- -contractions: intermittent & mild to moderate
- -signs of placental separation
- lengthening of the cord
- Uterine fundus rises and becomes firm
- fresh blood expelled from vagina
- -Mom's side : dull and rough
- -Baby's side : shiny and smooth
- -Episiotomy is sutured is applicable
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Nurse's role: Stage 3 - Placental Expulsion
- -Interventions
- -Observe & document blood loss
- -Document delivery of placenta; examine
- -Vital signs every 15 minutes
- -Assess vaginal discharge/fundus & massage
- -Administer Oxytocin prn
- -Monitor Temp & Heart
- -Dry newborn; apply hat; place in radiant warmer
- -Proper id to mom, partner, infant
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Describe Stage 4 - Recovery
- -Uterus is midling, firmly contracted above, at or below umbilicus
- -Lochia rubra staturates peripad (no more than 1 per hour)
- -Cramping
- -Shaking chills
- -Bonding time for family
- -Mom may breastfeed
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Nurse's Role - Stage 4 - Recovery
- -Interventions
- -Continue interventions from stage 3
- -Encourage breast feeding
- -Assess for urinary retention
- -Assess baby for anomalies
- -Assess lochia (no more than 1 pad per hr)
- -Change Mom's gown and pads
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Care for Mom Immediately After Delivery
- -Observe for hemorrhage
- -VS
- -Skin color
- -Location and firmness of uterine fundus
- -lochia
- -Pain
- -Promoting comfort
- -Keep warm and dry
- -Ice to perineum to help reduce swelling and brusing
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Pharmacologic considerations related to pain control measures
- -Pregnant woman at higher risk for hypoxia
- -Sluggish GI tract can result in increased risk of vomiting and aspiration
- -Aortocaval compression increases risk of hypotension and shock
- -Effect on fetus must be considered
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Medications related to pain control
- Narcotics:
- -Fentanyl, Demerol (least preferred)
- Opioid Agonist-Antagonist:
- -Stadol (preferred)
- Opioid Antagonist:
- -Naloxone (Narcan): must always be available
- Ataractics/Anti-emetic(analgesic potentiators)
- -Hydroxyzine (Vistaril): may be given in early labor to help mom rest
- -Zofran & Reglan
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Types of Anesthesia for Childbirth
- -Local infiltration
- -Pudendal block
- -Epidural block
- -Subarachnoid (spinal) block
- -General anesthesia
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Non-pharmacological pain relief measures
- -Relaxation techniques
- -Positioning
- -Diversion & Distraction
- -Breathing
- Skin stimulation (3 kinds):
- -Effleurage: stroking/massage of abdomen
- -Skin stimulation
- -Sacral pressure
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Name the 4 components of the birth process
- Powers: contractions
- Passage: pelvis
- Passenger: fetus
- Psyche: mental state
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Describe Powers component of birth
- Powers: contractions
- -regular, rhythmic, and uncontrolable
- -uterine muscle shorten with each contraction
- -have increment, peak (acme), decrement
- -mild moderate and firm
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Assessment/Documentation of contractions
- Frequency: begining of contraction to begining of next
- Duration: length of one contraction in seconds
- Intensity: firmness of contraction
- Interval: the amt of time uterus is relaxed between contractions (Important: b/c O2 rich blood needs to resupply the uterus)
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Describe the Passage component of birth
- consists of:
- -bony pelvis
- False pelvis: upper flaring
- True pelvis: lower part
- -soft tissues
- cervis
- muscles
- ligaments
- fascia
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Describe the Passenger component of birth
- Passenger = Fetal Head, amniotic fluid, ambilical cord
- -the bones of head are not fused
- -Ant. fontanelle/ Post. fontanelle
- -Skull can change shape as it passes thru birth canal
- -Molding
- -fetal head is largest part of fetus
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Describe 4 positons of the Passenger
- Lie: how fetus is oriented to mom's spine
- Attitude: flexion (chin2chest, arms/legs flexed)
- Presentation: fetal part that enter pelvis 1st
- Position: reference pt. on fetal oriented (LOA/ROA)
- Station: the level of presenting part in the pelvis.
- -est in cm at the level of Ischial spines.
- -minus stations are above the ischial spines
- -plus stations are below the ischial spines
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Describe the Psyche component of birth
- Psyche: emotions/understanding
- -well prepared couple learned/work= best
- -anxious mother has more difficult labor and slow progress
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ID the signs of impending labor
- Braxton Hicks contractions:
- -irregular,
- -begin early in pregnancy, increases as delivery date approaches
- -False Labor (but prepares the cervix to adjust)
- -Increased vaginal discharge
- -Lightening
- -Bloody Show:mix of blood and mucus
- -Rupture of membranes (SROM)
- -Energy Spurt
- -Weight Loss
- Cervical Changes:
- -effecement: thinning
- -dilation: open
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Signs of False labor
- -contractions irregular
- -walking relieves contractions
- -no Bloody Show
- -No change in effacement/dilation of cervix
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Reassuring Patterns
- -stable FHR
- -Moderate variability
- -Accelerations
- Uterine contraction:
- -frequency: 2 minutes or more
- -duration: less than 90 sec
- -interval: at least 60 sec
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