NUR 2421 Maternity Nursing Exam 4 Labor

Keiser University NUR 2421 Maternity Nursing Exam 4 Labor Stages / Phases of Labor – First stage: Latent (early): onset of regular contractions. Nullipara about 8.6 hoge: Starts after 10 cm dilated and ends with the ...

Keiser University NUR 2421 Maternity Nursing Exam 4 Labor Stages / Phases of Labor – First stage: Latent (early): onset of regular contractions. Nullipara about 8.6 hoge: Starts after 10 cm dilated and ends with the birth of the child. Usually within 2 hours after fully dilated for primigravidas (multipara about 15 minutes). Epidural may increase the time an extra hour. Contractions continue at 1 ½ - 2 minutes, 60-90 seconds long and strong. Decent continues until it reaches perineal floor. As head decends, woman has urge to push because of pressure of fetal head on sacral and obturator nerves. Bloody show may increase. Crowning occurs when the fetal head is encircled by the external opening of the vagina (introitus) and means birth is imminent. “Push through the pain and burning” Stage 3: Involves placental descent and delivery. The placenta normal descends naturally with minor assistance from the clinician. Assessment of the mother and inspection of the placenta is crucial as this may be a dangerous time if any placental fragments remain, which can lead to hemorrhage. Stage 4: Recovery is the final stage of labor. Recovery begins with the delivery of the placenta and ends 3-4 hours later. Nursing assessment is important during this phase to monitor the wellbeing of the newborn and the stays of the mother.SROM - spontaneous rupture of membranes. The breaking of the “water” or membranes marked by the expulsion of amniotic fluid from the vagina. AROM - artificial rupture of membranes. Use of a device such as an amnihook or allis forceps to rupture the amniotic membrane. PROM - premature rupture of membranes. Spontaneous rupture of membranes and the leakage of amniotic fluid before the onset of labor at any gestational age. PPROM – preterm premature rupture of membranes. When the membranes rupture and the leakage of amniotic fluid from the vagina occurs before 37 weeks of gestation. True labor – the contractions produce progressive dilatation and effacement of the cervix. They occur regularly and increase in frequency, duration and intensity. The discomfort of true labor contractions usually starts in the back and radiate around to the abdomen. Pain is not relieved by ambulation (walking may increase pain) or resting. False labor – contra pain. Most common complication is hypotension. General anesthesia – a state of induced unconsciousness that may be achieved through IV injection, inhalation of anesthetic agents, or a combination of both methods. Stations / Engagement – (Cardinal Movements of Labor Mnemonic: EDFIEEE)E: Every = Engagement D: Dassage of the widest diameter fetal presenting part below the plane of the pelvic inlet. The head is said to be engaged if the leading edge is at the level of the ishial spines. Descent: Refers to the downward passage of the presenting part through the bony pelvis. Not steady process. Greatest at deceleration phase of first stage and during 2nd stage of labor. Flexion: Occurs passively as the head descends due to the shape of the bony pelvis. Partial flexion occurs naturally but complete flexion usually occurs only in the labor process. Complete flexion places the fetal head in optimal smallest diameter to fit through the pelvis. Internal Rotation: Rotation of the fetal head from occiput transverse to occiput either in anterior or posterior position. Occurs passively due to the shape of the bony pelvis. Extension: Occurs when the fetus has descended to the level of the vaginal introitus. When occiput is just past the level of the symphysis, the angle of the birth canal changes to upward position. External Rotation/Restitution: As the head is delivered, it rotates back to its original position prior to internal rotation. It aligns anatomically with the fetal torso. The release of the passive forces on the fetal head allows it to return to appropriate position. Expulsion: Delivery of the fetus. After delivery of the fetal head, descent and intraabdominal pressure by mother brings shoulder to the level of the symphysis. Downward traction allows release of the shoulder and the fetus is delivered. Early decelerations – periodic change in fetal heart rate pattern caused by head compression; deceleration has a uniform appearance and early onset in relation to maternal contraction. Variable decelerations – periodic change in fetal heart rate caused by umbilical cord compression; decelerations vary in onset, occurrence and waveform.Late decelerations – symmetrical decrease in fetal heart rate beginning at or after the peak of the Cervical Effacement – thinning and shortening of the cervix that occurs late in pregnancy or during labor. Lightening – moving of the fetus and uterus downward into the pelvic cavity. Elimination during labor – Episiotomy – incision of the perineum to facilitate birth and to avoid laceration of the perineum. “Back labor” Contraction assessment – Vital sign assessment of the laboring client – Labor Induction – the stimulation of uterine contractions when spontaneous onset of labor, with or without ruptured fetal membranes, for the purpose of accomplishing birth. Cesarean Section – Medication administration during labor:Pitocin/ Stadol Narcan Terbutaline Pitocin Cervidil antacid Duramorph