Stages of Labor
Describe the difference between the first and second stage of labor.
The first stage of labor is when the cervix dilates from 0-10cm and the second stage of labor is marked by complete cervical dilation and ends with delivery.
When a client experiences ruptured membranes it is important to document?
The color, color, and amount of amniotic fluid. Document the time of ruptured membranes and FHR status.
Describe a variable FHR deceleration
An abrupt decrease in the FHR caused by umbilical cord compression.
Describe the behaviors typically observed in a newborn.
First period of reactivity - Birth to 30 minutes to 2 hours after birth. Newborn is alert, moving, may appear hungry
Period of decreased responsiveness - 30 to 120 minutes old. Period of sleep or decreased activity
Second period of reactivity - 2 to 8 hours. Newborn awakens and shows an interest in stimuli
What is a normal heart rate and respiratory rate in a newborn?
110-160bpm
30-60bpm
Describe the phases of the first stage of labor.
The latent (early) phase contractions are approximately 5 min apart and the cervix is 3cm dilated. In the active phase contractions are every 3 min, and cervical dilation is 7-8cm.
Describe the cardinal movements.
Internal rotation — Descent — Flexion — Extension
A gradual decrease from the FHR baseline that begins with the contraction and gradually returns to baseline when the contraction ends. Caused by head compression.
Early Deceleration
Identify three variations in the newborns head size.
Cephalohematoma
Molding
Caput Suuccedaneum
Describe heat loss in the newborn through evaporation, conduction, convection, and radiation
Evaporation - loss of heat when liquid turns into a vapor - changing wet linens.
Convection - flow of heat from body surface to cooler surrounding air or to air circulating over a body surface.
Conduction - transfer of heat from object to object when the two objects are in direct contact with each other. (preheat infant warmer, etc.)
Radiation - loss of body heat to cooler, solid surfaces in proximity but not in direct contact. (Crib near window).
Define the third stage of labor
Delivery of the placenta — signs of placental separation include, a rise in the uterus, a gush of blood, and lengthening of the umbilical cord.
Describe a late FHR decleration.
A gradual decrease from the baseline that begins at the end of the contraction with slow return to FHR baseline after the contraction has ended. Associated with placental insufficiency.
How should the nurse educate new parents on umbilical cord care.
Do not submerge the infant in water until the cord falls off; Expose the cord stump to air daily and notify the provider if you notice any odor or discharge from the stump.
Shallow, diaphragmatic, and irregular with symmetircal chest movements and apneic periods less than 10 seconds.
Abnormal - Grunting, nasal flarring, sternal retractions, cyanosis, tachypnea, and apneic periods exceeding 15 seconds.
What are the signs and symptoms of impending labor?
Blood show or increased production of cervical mucous, lower back pain, nesting (surge of energy), Braxton Hick's contractions, spontaneous rupture of memranes, lightening.
List three nursing interventions for FHR decelerations.
Change the client's position, administer a bolus of IV fluid, administer oxygen. If oxytocin is infusing it can be slowed down or discontinued.
Describe common skin variations in the newborn.
Mongolian spots - bluish markings across the newborn's lower back (common in asian descent), milia - fine hair covering the newborn's back, stork bites - mark on the newborns neck.
Describe two medications routinely administered to a newborn infant.
Vitamin K - given to promote clotting factors
Erythromycin - antibiotic administered to the newborns eyes as a prophylactic treatment.
The cervix dilates to approxinately 8cm; contractions are lasting around 90 secondays, maternal anxiety and trembling is very common.
What is FHR variability important.
Validates oxygenation status of the fetus. Moderate FHR variability 6-25bpm. Marked > 25 bpm, minimal 0-5bpm, absent - undetectable (non-reassuring).
Which nursing intervention will assist in thermoregulation in the newborn.
Drying the infant upon delivery
Describe the cascade of "cold stress" in the newborn.
•Decreased Environmental Temperature
•Decreased Body Temperature
•Increased Heart Rate & Respiratory Rate
•Increased Oxygen Consumption and Depletion of Glucose
•Decreased Surfactant
•Respiratory Distress