Wh exam 2

What are the psychosocial considerations in labor?

-hopes

-fears

-prep

-support system

What are the nursing actions for psychosocial considerations?

encourage them to share dreams and fantasies and use them as a tool to examine expectations, fears, and coping mechanisms

What are the critical factors in labor?

-passageway

-passenger

-position

-powers

-psychosocial considerations

What is the passageway?

birth canal; made up of pelvis, cervix, vagina, and pelvic floor muscles

What affects the sizes of the pelvis?

inlet, mid pelvis, and outlet

What are the shapes of the pelvis?

Gynecoid

Android

Anthropoid

Platypelloid

What is a gynecoid pelvis?

Most common type of female pelvis, inlet is rounded

What is android pelvis?

heart shaped pelvis

Which two pelvic shapes are best suited for vaginal delivery?

gynecoid and anthropoid

What is anthropoid pelvis?

oval long

What is platypelloid pelvis?

flat pelvis

How do the cervix and vagina adjust for birth?

the muscles must stretch

What are some passageway considerations for labor?

-tight pelvic inlet prevents engagement of the appropriate presenting part

-change in lumbar curve or decreased mobility of coccyx can inhibit progress

What makes up the passenger (fetus) considerations for labor?

head, attitude, lie, and presentation

What determines the position of the head?

fontanelles (soft spot)

What is the shape of the anterior fontanelle?

diamond shape

What is the shape of the posterior fontanelle?

triangle shape

What is molding of the head?

bones not fused at suture lines can overlap during labor

What is the normal attitude of the passenger?

flexion; aka fetal position

What are the two lying positions of the passenger?

longitudinal: parallel to mothers spine

transverse: perpendicular to mothers spine

What are the presentations of a fetus?

cephalic, breech, and shoulder

What is breech presentation?

the presenting part is the buttock or feet

What is shoulder presentation?

transverse lie, fetal shoulder enters pelvis first

What factors play a role in shoulder presentation?

abnormalities of pelvis, malformations of uterus like fibroids or septum, lax abdominal muscles, or over distention of uterus like polyhydraminos or multiple gestation

Why is a footling breech or shoulder presentation serious?

it puts baby at risk for prolapsed umbilical cord

What is engagement?

when the largest diameter of the presenting part reaches the pelvic inlet (two weeks before term)

What is station?

Relation of the presenting part to an imaginary line between ischial spines of the pelvis (-5 to +5)

How is fetal position expressed?

first letter is whether the presenting part is right or left side of maternal pelvis

second letter is the landmark of the presenting part

third letter tells whether the landmark is facing anterior, posterior, or transverse

Why is knowing fetal position important?

some positions can slow labor and it is helpful to know where to find the baby heart beat

What are the powers of labor?

physiologic forces of labor; contractions and bearing down

What are contractions?

tightening and shortening of the uterine muscles; thin and dilate the cervix as baby moves lower in the brith canal

What is the frequency of a contraction?

time from the beginning of one contraction to the beginning of the next

What is the duration of a contraction?

time from beginning to the end of a contraction (30-90 sec)

What is the intensity of a contraction?

strength of the contraction measured at its peak (acme)

How is the intensity of the contraction described for palpation?

if its indictable (mild), if its slightly indictable (moderate), and if its firm (strong)

What is bearing down?

voluntary pushing once the cervix is fully dilated; the mother tightens abdominal muscles during contractions and pushes baby through the birth canal

What are the signs of labor?

-Lightening ("dropping" of fetus into pelvis)

-braxton hicks

-Increase in levels of activity "nesting" (inform mom to rest and eat small nutritious meals)

-Ripening of the cervix (softening)

-Bloody show (mucus plug is expelled)

-Rupture of membranes

What is the main indication of true vs. false labor?

changes in the cervix (dilation and effacement)

What is the first stage of labor?

starts with onset of true labor and ends with full dilation of cervix

What are the three phases of stage 1 labor?

latent/early phase, active phase, and transition phase

What is expected in latent/early phase?

mom is often talkative, excited and smiling (0-3cm dilated and contractions 10 to 30 min apart)

What is expected in active phase of stage 1?

moms discomfort and anxiety incr. as labor intensity incr.

What is expected in the transition phase of stage 1?

mom may become restless and more anxious, labor intensifies, maintain continuous support for mom (don't leave mom alone, 8-10 cm dilated, contractions 1.5 to 2 min apart)

What are the parameters of the second stage of labor?

cervix is completely dilated and ends with birth of baby

What is expected in the second stage of labor?

-few min to several hours

-mothers feel urge to bear down

-crowning occurs

What are the fetal positions in the second stage of labor?

What are the parameters of the third stage of labor?

birth of baby and delivery of placenta

What is expected in the third stage of labor?

-5-30 min after birth

-placental separation

-delivery of placenta

What are the signs of placental separation?

1. fresh flow of blood from vagina

2. umbilical cord lengthens outside vagina

3. uterine fundus rises up and rounds in the abdomen

What is the fourth stage of labor?

time following delivery where the mothers body adjusts to sudden changes

What is expected in the fourth stage of labor?

-adjust to blood loss

-thirst and hunger

-chills

-uterus is tightly contracted

What are the CV maternal responses to labor?

stressed by anxiety or pain; HR and BP surge so CO decreases by 30%

What are the respiratory responses to labor?

Incr. demand for O2, hyperventilation can affect acid base balance, sweating and incr resp. can cause dehydration (F&E imbalance)

What are the renal responses to labor?

polyuria, proteinuria and hematuria

What are the GI responses to labor?

solid food absorption reduced; esp high in fat

What are examples of clear liquids allowed during labor?

water, juice w/o pulp, sports drinks, coffee, tea, and soda

What are the indications of placing a laboring woman supine?

-causes a drop in BP due to compression of vena cava

-place her supine only temporarily for exams

-use pillows in front and back to tilt the weight of the baby to the side

What factors affect the maternal pain response?

-culture

-hypoxia

-pressure and stretching of muscles

-personality type (loud vs. quiet)

-preparation for birth

What are risk factors in pregnancy?

multiples, abnormal presentation, placenta previa, diabetes, HIV, drug or alcohol use

What are abnormal findings in the initial assessment?

notify HCP if../

-vaginal bleeding

-acute abdominal pain that is not intermittent with contractions

-fever

-premature labor