Give me the pain meds!
Name an example of non-pharmacological pain relief methods during labor and delivery
Massage, effleurage, touch, walking, music, childbirth classes, deep breathing, meditation, hot/cold therapy
What is occurring during the Latent Phase of Labor (1st Stage)
Mom is talkative and interested in process. Educate and establish rapport during this time.
Monitor FHR and mom VS
Ice chips if MD allows
Priority nursing care in 4th stage?
#1--Monitoring for and preventing hemorrhage (s/s of shock), VS q15mins
Massage Fundus until firm
Assess bladder function
Family bonding
What are the disadvantages of a home delivery?
Priority after rupture of membranes?
Check FHT!
What must be done before the mother receives an epidural?
Bolus of fluids to prevent hypotension
What occurs during the second stage of labor?
Stage of expulsion; from 10 cm dilation to the birth of the baby
Care: teach to only push with contractions and to deep breathe between contractions
cleanse the perineum/table set up
VS and FHR, contraction pattern
What are nursing interventions regarding baby immediately after delivery?
Suction mouth then nose
Dry off baby
APGAR (want 8-10)
ID bands, clamp cord
Vitamin K and erythromycin ointment
Bonding
Explain the difference between True and False (Braxton Hicks) labor?
True: contractions are regular, increase in intensity and duration while occurring all throughout the abdomen; Bloody show is present; discomforts are more in lower back; walking intensifies contractions; Cervix DILATES and EFFACES
False: Contractions are irregular, no pattern; Discomfort more in abdomen; pain lessened by walking; NO cervical change
Reassuring Patterns are...?
Nonreassuring patterns are...?
Stable FHR (110-160)
Moderate Variability (increase in 6-25 bpm)
Accelerations!
Tachy, Brady,
No variability or minimal
Late decels
Variable decels
How many centimeters must the mother be dilated in order to receive pain medication? Why?
Must be at least 4cm, it will effect her ability to push
Discuss the care during the transition stage of labor (1st stage)?
Mom is restless, talk her through the contractions and breathing patterns after contractions, monitor mom VS and FHR q15m
Don't leave mom alone
Where do we give newborn injections at?
Vastus lateralis
Describe the differences between increment, peak, and decrement.
What is the difference between duration and frequency?
Increment--increase in strength of contraction
Acme--greatest strength of contraction
Decrement--decreasing strength of contraction
Frequency: time from beginning of one contraction to the beginning of the next contraction (how often they are coming)
Duration: the time from the beginning of a contraction to the end of that same contraction (how long they are lasting)
What are two ways you can tell if the membranes have ruptured?
Positive Ferning
Nitrazine paper is blue
(smell, color, amount?)
Check VS q2h after ROM
Name some of the effects after mother receives analgesics and/or anesthesia?
Hypotension, Hypoxia, Vomiting/Aspiration risk, Fetal respiratory distress (Narcan)
What is the nursing care during the Active phase of labor? (1st Stage)
Monitoring of mom VS and FHT q30mins
Monitor for ROM and contractions
Void q1-2h, observe for full bladder because it can impede labor
Foley is in if epidural
Keep mom comfortable
How many arteries and veins should the placenta have?
AVA
2 arteries, 1 vein
What is the presenting part in a breeched baby?
Buttocks
Name an indication for having a cesarean section over a vaginal birth.
What is cord prolapse, difficult labor or past delivery, early separation of placenta, improper placement of the placenta, eclampsia.
Name the differences between a pudendal block, a spinal block, and general anesthesia.
Pudendal block: given right before a vaginal delivery, seen with episiotomies, and does not block contraction pains
Spinal block: affects from nipples down, causes similar effects as an epidural, may require blood patch!
General Anesthesia: Given in emergency situations usually; can lead to aspiration, injury to lungs in mother. In baby can lead to RDS and aggressive resuscitation is necessary (Narcan on hand)
What occurs during the 3rd stage of labor?
Expulsion of placenta, usually 5-30 mins later
What should you do should you encounter a boggy uterus?
Massage until firm
At ZERO station the baby is...
At +2-+3 station the baby is...
ENGAGED
CROWNING
Name a complication that could occur during the process of labor and delivery that a nurse must monitor for?
What is bleeding, slow progression of labor, appearance of cord, decrease in fetal heart rate.