-
Relationship to mother and baby's spine
Fetal Lie
-
Presentation
head down
Cephalic
-
Head down
-baby chin on chest, smallest part of head presents
- head normal, occipitalfrontal presents
-neck extended, occipital and largest anteropost presents
-neck is hyperextended, submentobreg,ato diameter presents
which ones usually end in c-section?
-
Knees and hips attitude, sacrum landmark noted on presentation
Breech presentation
-
hips and knees completely flexed, sacrum is presenting
complete
-
hips flexed, knees extented, buttocks presentation
Frank
-
Shoulder presenting, and acromion process of the scapula is landmark to be noted
Shoulder aka transverse lie
-
relationship of maternal pelvis and fetal presenting part
Postition
-
engagement
1st baby?
2nd+?
indicates what?
- 2 weeks before
- not dropping until labor
adequate inlet, but not midpelvis or outlet
-
relationship to baby and ischial spine
station, engagement is a 0 station
-
postion
1.
2.
3.
- 1. R or L of the maternal pelvis
- 2. The landmark of the fetal presenting part. O,M,S,A
- 3. Landmark is on the A,P,T of the pelvis
-
Position
2.
M:
O:
S:
A:
- M: mentum- face
- O: occipital
- S- Sacrum
- A: acromion process
-
Increment
the building up of a contraction (longest)
-
acme
the peak of the contraction
-
decrement
letting up of the contraction
-
frequency
time between the begining of one to the beginning of the next
-
Intensity
the strength of the contraction
-
Duration
bginning to the end of the the same contraction
-
physiology of labor
- Estrogen- stimulates uterine muscle to contact
- Progesterone - decreases
- Posteioglandins- increase
-
the drawing up of the internal os and the ervical canal into the uterine side walls
Effacement
-
First stage of labor
0-10 cm
-
Latent phase
How long for primigravida? Multigravida?
-
Active Phase
How long for nullipara? multipara?
-
active:
contrations have a frequency of ____
the duration of ___
intensity of____
- frequency of 2-5 minutes
- duration of 40-60 sec
- Intensity of 50-70mm Hg
-
Latent:
frequency
duration
intenstiy
- frequency: 10-30 minutes
- duration: 30 sec
- Intensity: 25-40
-
Transition phase
How long
nulli
multi
- 8-10 cm
- n: 3 hours
- M: less than an hour
-
Transition:
Frequency
Duration
Intensity
- Frequency: 1.5-2 min
- Duration: 60-90 sec
- Intesity: 70-90
-
Nursing responses to nonreassuring decilerations
- Change position
- increase iv fluids
- provide o2
- turn down or off pitocin
- notify the md and document
- prep for c section of vaccum birth
-
Second stage
10cm - birth of infant
-
pressure of the amnotic fluid
direct pressure of the uterine fundus
contraction of the abdominal muscles
extention and straightening of the fetal body
All cause what/
Descent
-
fetal head secends and meets resistance from soft tissures of pelvis, the muscle s of th pelvic floor and the cervix
flexion
-
fetal head must rotate to fit the diameter of the pelvic ccavity, which is the widest in the anteroposterior diameter
internal rotation
-
head passes under the symphysis pubis, emerge form the vagina
extension
-
neck untwists, turning the head to one side (resitiution) and aligns with the psition of the back in the birth canal
restitiution
-
as the shoulders rotate to the anteropsteriro position in the pelvis the head turns farther to one side
external rotation
-
shoulders meet the undersurface of the symphysis pubis and slips uner it, shoulders and body are born
expulsion
-
Third stage
after birth of baby and birth of the placenta
-
Placenta is shiny side up, released inside to outer margins
Schultze - aka shiny schultze
-
Placenta sperated outer to inner, mom side up
duncan, dirty duncan
-
What changes in vitals should you expect in fourth stage of labor
- Blood loss from 250-500mL
- Moderate decrease in bp
- increase in pulse pressure
- increase pulse
-
Factors for continuous fetal monitoring
- previous history of still birth at 38+
- Presence of complication
- Induction of labor
- decreased fetal movement
- meconium stained fluid
- trial of labor following c-section
- maternal fever
- placenta problems
-
baseline rated refers to the what
acerage fhr rounded to increments of 5bpm observed during a 10- minuted period of monitoring
-
-
causes of fetal tachycardia
- early fetal hypoxia
- maternal fever
- maternal dehydration
- beta- sympathomimetric drug
- amnionitis
- maternal hyperthyroidism
- fetal anemia
- tachydysrhythmias
-
fetal bradycardia causes
- late fetal hypoxia
- maternal hypotension
- prolonged umbilical cord compression
- fetal arrhythmia
- uterine hyperstimulation
- abruptio plancete
- uterine rupture
- vagal stimulation
- congential heart block
- maternal hypothermia
-
Absent variblitiy
amplitude undetectable
-
Minimal variability
amplitude detectable but less than 5bpm
-
Moderate variablity
amplitude 6-25 bpm
-
marked variablity
amplitude greated than 25 bpm
-
best single predictor for determining fetal compromise
reduced variablity
-
accelerations
2 15bpm above baseline lasting 20 sec
-
Cause of early decelerations
head compression
-
cause of late decelerations
uteroplacental insufficiency
-
Cause of variable decelerations
cord compression
-
if painless bleeding do not
do vaginal exam
-
Latent phase monitor vs
without complications
- temp: q4hours
- when waters break q1-2hrs
- bp, pulse, respirations- q1hr
- FHR q30min
-
Latent phase vs fhr
complications
fhr every 15 min
-
Active phase
vs and fhr
- bp, p, r q1hr
- if high risk q30 min
-
Transition
vs
- every 30 min if low risk
- every 15 minutes if high
-
s&s of hyperventelation
tingling or numbness in the tip of the nose lips fingers or toes, dizziness, spots, spasms in hand and feet
-
-
Drugs not to be given with opiate dependancy
- stadol
- nubain
- demerol
- sublimaze- fentanyl
-
Stadol contradiction
not to be given to mom with hypertension
-
fentanyl disadvantage
30-60min of effectiveness
-
advantages of nubain
- associated with less n&v
- lower incidence of respiratory distress
- mother sedation (rest)
-
advantages for fentanyl
- relieve pain and sedation immediately
- 50-100 times more potent than morphin
- doesnt cross the placenta
-
onset, peak, duration for stadol
-
fentanyl
onset
peak
duration
-
Drugs used for local
- nesacain
- xylocain
- prontocain
- carbocain
-
Risks for episotomy
increase prolapse bladder, uterus, bowel
-
rapid reduction in size and the return of the uterus to a nonprego state
involution
-
-
-
alba
additional week or 2
-
medications that may be on standing order for postpartum bleeding
- pitocin
- methergine
- hemabate
-
Postpartum monitor vs
- q15min for 1 hour
- q30 min X2
- then per protocal
-
postpartum prevention of bladder distention
encourage to void within 6-8 hours after birth
-
Chemical initial breath
increase in pCO2 and Decrease in pO2
-
mean blood pressure for newborn
50-55
-
NB neutral thermal environment
32-34*C
-
when does brown tissue develop?
26-30 weeks until 2-5 weeks after delivery
-
Accucheck for newborns
40
-
Iron storage for newborn
lasts 4-6 months, 270mg
-
Glucose storage for newborn
4-6 hours, only min if diabetic mom,
-
reason for low clotting facctors, lowest, increases when
- sterile gi
- lowest 2-3 days
- increases 5-8 days
- Vit k shot
-
Life span for newborn rbc
80-90 days
-
Causes for prenatal hyperbilirubinemia
- hemolytic disease of the newborn (rbc being attacked by antibodies combs +)
- diabetes
- intauterin infections
- oxytocin administration
- medication
-
Causes for newborn hyperbilirubinemia
- polycythenia (HbG >65)
- pyloric stenosis
- biliary atresia or obstruction
- uti
- sepsis
- Cephlahematoma - breaking down the blood
- hypoglycemia
-
Onset for physiologic jaundice
2-3 days of life
-
Causes for physiologic jaundice
- more frequent breakdown of rbc
- they need to poop to get rid of the conjugated
- immature liver- lower uptake
- lock of intestinal bacteria
- poorly hydrated from inital breastfeeding
-
incidence of physilogic jaundice
50% of term and 80% of preterm
-
Breastfeeding jaundice onset
2-3 days
-
prevention of breastfeeding jaundice
key is to feed the baby! encourage frequent (q2-3 hours) avoid supplementation and accessing materal lactation consultant
-
Breast milk jaundice onset
week after delivery
-
Breast milk jaundice cause
- extra fatty acids from mom
- takes more spots in albumin that were meant for bilirubin
-
Pathologic jaundice onset
@birth- 24 hours
-
Pathologic jaundice cause
blood incompatability, rh factor, ABO factor
-
Treatment for pathologic jaundice
phototherapy, exchanged transfusions
-
Babies at high risk for for jaundice
rh- moms, o moms, cephlahemmatoma, hypothermia, polycytothemia, 50% term babies
-
Nuring interventions for jaundice
- maintain temp
- monitor number of stools, enourage feeding
- keep well hydrated
- educate and support parents
- maintain phototherapy as ordered
-
what neurological assessments for babies with hyperbilirubienmia
hypotonia, diminished reflexes, lethargy or seizure
-
Capacity of the stomach
50-60ml
-
Bowel sounds of new born
present within the first 30-60 min
-
-
-
transitional poop
thin green and yellow next day or two
-
-
Cephelhematoma
- unilateral or bilateral
- does NOT cross suture lines
- onset and resolve
- associated with physiologic jaundice
- doesnt come and leave at the same time
-
Caput succedaneum
- serious fluid
- long and diffiult labor
- nautarl vs vacum extraction
- CROSSES SUTURE LINES
- present at birth
- goes away by discharge
-
average weightloss for babies
5-7% in the first 3-4 days
-
>10% body weight lost in newborns may indicate what?
inadequate fluid/caloric consumtion and mandates evaluation
-
would should expect to regain the weight to newborn weight
10-14 days after birth
-
Enfamil, Similac, Carnation good start
cows milk
-
prosobee, isomil
soy protein base
-
Nutramigen, pregestamil, alimenum
hypoallergenic
-
neocate, elecare
elemental amino acid
-
Medications that contradict breastfeeding
parlodel, chemotherapy drugs, ergotamine, lithum, methotrexate
-
how often is breast fed babies fed
- q1.5-3 hours
- 6-8 times in 24hrs
-
how often is formula babies fed
- q3-4 hrs
- 6-8 times in 24hrs
-
breast milk how long air? refridge? freeze
5hours, 5days, 5months
-
gaining goal for breastfed babies
4-8oz each week after the 1st week
-
how much bm and voids for adequate breastfed babies
at least 4 BM and >6 voids per day by day 5
-
cervidil post administration
remain in recumbant for 2 hours
-
Cardiovascular effects of pitocin
- bp initially decreases and then increase by 30%
- increase of cardiac output and stroke volume
-
expect pitocin to be decreased when
once cervical dialation reaches 6cm
-
max rate for pitocin
40milliunits/min
-
Assessment of woman undergoing inductionof labor
- fetal maturity
- cervial readiness- anterior, 50% effaced, soft, dialted greater than or equal 2cm. -1 - 1
- indicated to induce
- mom is more that 39 weeks
-
risk factor for episotomy
- macrosomia (9000g)
- vacuum
- forceps
- op position
-
indications for c- section
- breech
- transverse lie
- previous c/s
- placenta previa
- failure to decend
- emergency
- eclampsia
- cat 3 efm
- mi
- active herpes
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