-
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
-
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
-
how soon can lightening occur
as early as 2 weeks
-
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
-
irregular intermittent contractions felt toward end of pregnancy.
braxton hicks contractions
-
what would a Pt experienceing braxton hicks complain of
fairly regular tightening sensation in abdomen
-
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
-
when does the cervix usually mature or ripen (become softer and spongier)
34 weeks of gestation
-
thinning and shortening of the cervix
effacement
-
consists of cervical secretions, blood tinged mucus, and the mucuos plug that blocked the cervix during pregnancy
bloody show
-
when does labor usually begin after the bloody show
24-48 hours after
-
rupture of amniotic sac, tat usually occurs after labor has begun
rupture of membranes (ROM)
-
occurs naturally with a gush of amniotic fluid out of the vagina
spontaneuous rupture of membranes (SROM)
-
procedure known as amniotomy
artificial rupture of membranes (AROM)
-
widest diameter of the fetal presenting part (head) enters the inlet to the true pelvis
engagement
-
umbilical cord that washes out with the amniotic fluid
prolapsed cord
-
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
-
s/s of GI disturbance following near time of labor
- indigestion
- NVD
- 1-3 pound weight loss
-
when could a pt expect to experience sudden burst of energy
24-48 hours before labor begins
-
when a pt experiences sudden burst of energy what should be encouraged
- energy conservation
- small frequent nutritious meals
-
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
-
BP should be _____ during first adn second stages of labor due to contractions
increased
-
when is BP highest in pregnant women
during contraction
-
when should BP be taken when contractions are present
in between contractions
-
respiratory system during maternal systemic response to labor?
oxygen consumption during labor is equal to moderate or strenuous exercise. almost double the normal amount
-
if mother has a distended bladder what may happen? what should be done?
fetal decent is impeded
encourage client to void
-
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
-
Maternal Systemic Responses to Labor for
Fluid and electrolyte balance
–Mother’s body temperature increases
–Mother perspires profusely
-
Maternal Systemic Responses to Labor for Immune system
White blood count increases
-
Maternal Systemic Responses to Labor for integumentary system
Vagina and perineum have great ability to stretch
-
Maternal Systemic Responses to Labor for musculoskeletal system
–Relaxation of pelvic joints
- –May result in backache and leg
- cramps
-
Maternal Systemic Responses to Labor for Neurological system
- –Endorphins increase pain threshold
- •Produces sedative effect
- –Pressure at perineum
- •Produces physiologic anesthesia
-
Maternal Systemic Responses to Labor for labor pains
- –Individual
- –Subjective
- –Personal
- –Expressed in variety of ways
- –May be affected by culture
-
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
-
first stage of labor
Dilatation and Effacement
-
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
-
latent phase
- •Ends when cervix dilated to 3 centimeters
- (cm)
•Longest phase
- •Contraction every 10 to 20 minutes
- lasting 15 to 30 seconds
-
what phase should a nurse anticipate the mother to be talkative and usually alert
latent
-
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
-
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
-
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
-
second stage of labor is?
birth of baby
-
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
-
–Fetal head seen at vulva between contractions
crowning
-
mechanism of labor
- •Engagement
- •Descent
- •Flexion
- •Internal rotation
- •Extension
- •External rotation
- •Expulsion
-
third stage of labor
delivery of placenta
-
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
-
fourth stage of labor:
recovery
-
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
-
priorities for admission for client in labor
- –Establishing nurse-client
- relationship
- –Assessing condition of mother and
- fetus
-
client in labor subjective data assessment
Comfort of mother, her ability to cope, and her need to urinate/defecate
-
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
-
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
-
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
-
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
-
why breathing techniques
•Provide adequate oxygenation of mother and fetus
•Provide focus of attention
•Decrease anxiety
•Increase mental and physical relaxation
-
pharmacologic comfort measures
- •Systemic medications
- •Epidural block
- •Intrathecal block
- •Local infiltration
- •Pudendal block
- •General anesthesia
-
risks of labor and birth
- •Preterm labor and birth
- •Premature rupture of membranes
- •Dystocia
- •Abnormal duration of labor
- •Prolapsed cord
-
Stimulation of uterine contractions
before they begin spontaneously
induction
-
Stimulation of uterine contractions after they begin spontaneously
•But with unsatisfactory progress
augmentation
-
•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
-
if a client has a c-section can they have another vaginal birth
yes
-
–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
-
risks with assited forcep delivery
•Newborn may have facial bruising or edema
•Mother may have lacerations or hematoma
-
•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
-
care of the infant
- •Airway (A)
- •Breathing (B)
- •Circulation (C)
- •Warmth (W)
-
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
-
mechanical theories regarding onset of labor
–Once organ becomes filled and distended, empties itself
-
hormonal theories regarding onset of labor
–Maternal progesterone and estrogen levels change
–Maternal production of oxytocin & prostaglandin
–Increase in fetal cortisol
-
look up types of anesthesia!!!!!!!!!!
|
|
