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Maternal Newborn Nursing: Stages of Labor, Fetal Assessment, and Pain Management, Quizzes of Nursing

Pharmacology, Maternity, Pediatrics, L+D

Typology: Quizzes

2021/2022

Uploaded on 02/27/2023

mbelfor
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~_-·:•
·=
-
MATERNAL
NEWBORN
NURSING
Physiological changes that precede labor
Backache
Weight loss ( 1-3 pounds)
Lightening (feeling that baby has dropped lower in pelvis)
Contractions (Irregular Braxton Hicks contractions that
become stronger and more regular).
Bloody show (brown
or
bloody mucus discharge)
Energy burst
GI
upset
Rupture
of
membranes (clear, watery fluid; Amniotic fluid
will cause Nitrazine paper to tum BLUE, paper remains
yellow with urine).
,..
<
c
"0
;o
z
n
0
3
6
"'
L...-
_____________________
__,
..
MATERNAL NEWBORN NURSING
Stages
of
Labor
First
Stage: Begins with onset
of
labor, ends with complete
dilation.
Latent Phase: Cervix 0-3cm ;
mild
to
moderate contractions ;
mom is talkative and eager.
Active Phase: Cervix 4-?cm; moderate
to
strong contractions;
mom
1s
anxious, restless, feeling helpless.
Transition: Cervix 8-10cm; strong
to
very strong contractions;
mom
feels need to push
or
have a bowel movement (i.e.
rectal pressure), feels like she "cannot continue".
Second Stage: Full dilation to birth
of
baby.
Third
Stage: Delivery
of
baby to delivery
of
placenta.
Fourth
Stage
: Delivery
of
placenta to stabilization
of
maternal vital signs.
'------
-
-----------------
MATERNAL NEWBORN NURSING
5 P's
Passenger: Consists
of
fetus and placenta.
Presentation (head, chin, shoulder, breech)
Lie (transverse, parallel/longitudinal)
Attitude (fetal flexion, fetal extension)
Position : Label with three letters:
o Right (R) or Left (L)
,..
m
<
m
c
"0
;o
z
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0
3
@
"'
..
o Occiput
(0),
Sacrum (S), Mentum (M), or Scapula (Sc)
o Anterior (A), Posterior (P), or Transverse (T)
5'
Station (station O is at level
of
ischial spines) !
Passageway: Birth canal
Powers: Uterine contractions, resulting
in
effacement, dilation. 8
Position: Upright, sitting, kneeling, squatting promotes fetal descent.
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Download Maternal Newborn Nursing: Stages of Labor, Fetal Assessment, and Pain Management and more Quizzes Nursing in PDF only on Docsity!

~_-·:• ·= - MATERNAL NEWBORN NURSING

Physiological changes that precede labor

  • Backache
  • Weight loss ( 1-3 pounds)
  • Lightening (feeling that baby has dropped lower in pelvis)
  • Contractions (Irregular Braxton Hicks contractions that become stronger and more regular).
  • Bloody show (brown or bloody mucus discharge)
  • Energy burst
  • GI upset
  • Rupture of membranes (clear, watery fluid; Amniotic fluid will cause Nitrazine paper to tum BLUE, paper remains yellow with urine).
  • <
  • c "0 ;o z n 0 3 6 L...-_______________________, "'..

MATERNAL NEWBORN NURSING

Stages of Labor First Stage: Begins with onset of labor, ends with complete dilation.

  • Latent Phase: Cervix 0-3cm; mild to moderate contractions; mom is talkative and eager.
  • Active Phase: Cervix 4-?cm; moderate to strong contractions; mom 1s anxious, restless, feeling helpless.
  • Transition: Cervix 8-10cm; strong to very strong contractions; mom feels need to push or have a bowel movement (i.e. rectal pressure), feels like she "cannot continue". Second Stage: Full dilation to birth of baby. Third Stage: Delivery of baby to delivery of placenta. Fourth Stage: Delivery of placenta to stabilization of maternal vital signs.

MATERNAL NEWBORN NURSING

5 P's

Passenger: Consists of fetus and placenta.

  • Presentation (head, chin, shoulder, breech)
  • Lie (transverse, parallel/longitudinal)
  • Attitude (fetal flexion, fetal extension)
  • Position: Label with three letters: o Right (R) or Left (L)

m < m "0^ c ;o z

"^0 3

@ "'

o Occiput (0), Sacrum (S), Mentum (M), or Scapula (Sc)

o Anterior (A), Posterior (P), or Transverse (T) 5'

  • Station (station O is at level of ischial spines)! Passageway: Birth canal

Powers: Uterine contractions, resulting in effacement, dilation. 8

Position: Upright, sitting, kneeling, squatting promotes fetal descent. t..:P=s:::!y::c=h=o=lo~g=ic=a=I=re=s=p=o=n=s::.e:s_t.....:re...::.s..:..s':_:a:.:.n~x:.:ie:.::ty:__c=a:.:..n:...:i:.:.:m~p=ai::r .:la::b,::or:..:. _ _J

True vs. False labor

True labor: Contractions that may start irregularly, but become stronger, more frequent, and regular. Walking increases intensity of contractions. Comfort measures (oral hydration, bladder emptying) do not stop contractions. Cervical changes present (dilation, effacement, bloody show). Presenting part of fetus engaged in pelvis. False labor: Painless, irregular, intermittent contractions. Walking or position changes decrease intensity/duration of contractions. Comfort measures (oral hydration, bladder emptying) often stop contractions. No cervical changes. ,__^ Presenting_____________________^ part^ of^ fetus^ not^ engaged^ in^ pelvis. _ MATERNAL NEWBORN NURSING

Pain management during labor

Nonpharmacological:

  • Effleurage: Stroking of mom's abdomen with fingertips during contractions.
  • Sacral counterpressure: Heel of hand or fist is pushed against mom's sacral ar~a to relieve ~ack labor_pain.
  • Others: breathing techniques (start with cleansing breath), imagery, hydrotherapy, music, heaUcold. ..^ r ..< "tJ^2 ;ti z ;, 0 3 6 "' 00 Pharmacological: r
  • Sedatives barbiturates : Can lead to neonate respiratory I epress1on. se on yin early or latent phase..
  • Opioid analgesics: Can lead to ~e~~t1on, tachycardia_, hypotension, decrease~ FHR_vanab1l1ty, neonate r~sp1ratory depression. Naloxone 1s antidote. Use when cervix 1s dilated at least 4cm and fetus is engaged. L---------------------------'"" MATERNAL NEWBORN NURSING

Epidural block, Spinal block

Epidural block: Eliminates sensation from umbilicus to thighs. Administer when mom is at least 4cm dilated.

  • Side effects: maternal hypotension, fetal bradycardia Spinal block: Eliminates sensation from nipples to feet. Used in cesarean births.
  • Side effects: maternal hypotension, fetal bradycardia, headache from leakage of CSF, risk of maternal bladder r .. and uterine atony. Nursing care: Administer IV fluids (to offset maternal ¥> z hypotension), position mom on side (to prevent supine z hypotension syndrome), monitor maternal vital signs and FHR continually. '------ - ------------------..J""

Internal Fetal Monitoring

Internal Fetal Monitoring: Scalp electrode attached to

the presenting part of fetus to monitor FHR. Can be

used with IUPC (intrauterine pressure catheter). Allows

for early and accurate assessment of FHR and uterine

contractions. Average pressure of contractions is

50-85 mmHg.

Disadvantages: Membranes must be ruptured, cervix

dilated >= 2cm, and presenting part descended to use

internal monitor. Risk of injury to fetus, and risk of

.___^ infection ____________________^ to^ mom^ or^ baby. _ MATERNAL NEWBORN NURSING

External Cephalic Version (ECV)

ECV: Ultrasound-guided manipulation of the abdominal wall to turn a baby in a breech or transverse position to the normal vertex presentation (i.e. head-down position). Performed after 37 weeks gestation. HIGH risk of umbilical cord compression or placental abruption. Nursing care: ,... ..< !!. C 'tJ ,::, z (^00) 3 @ N 0>

  • If mom is Rh-negative, ensure RhoGAM was administered at :;- <

28 weeks gestation. After ECV, perform Kleihauer-Betke test 2

to detect fetal blood in maternal circulation (if> 15ml present, i z

adminiser additional RhoGAM). 8

  • Adminster IV fluids and tocolytics to relax uterus.!
  • Continually monitor FHR, maternal vital signs. '------------------------- ---J"" MATERNAL NEWBORN NURSING

Induction of labor

Cervical ripening: Promotion of cervical softening, dilation, and effacement. Examples: balloon catheter, membrane stripping, dilators, chemical agents (ex: misoprostol, dinoprostone) administered orally or vaginally. Oxytocin: Uterine stimulant. Increases strength, frequency, and length of uterine contractions.

  • Closely monitor contractions and FHR.
    • DIC oxytocin for contractions that occur more i;- frequently than every 2 minutes, contractions lasting more than 90 seconds, contraction intensity greater } than 90mmHg w/lUPC, or uterine resting tone greater s than 20mmHg between contractions.!
    • Administer terbutaline to decrease uterine activity. ~ --- ---- - --- - - ---- ...;:__ __JOO
  • ~~MATERNALNEWBORN NURSING

Amniotomy and Amnioinfusion

A"!lniotomy: Rupture of amniotic membranes by provider,

using a sharp instrument.

  • Indications: Induction or augmentation of labor, or in preparation for aminoinfusion.
  • Increased risk for cord prolapse (ensure presenting

part of fetus is engaged prior to amniotomy) and

infection. ,...

Amnioinfusion: Infusion of NaCl or LR into amniotic cavity. I

  • Indications: Oligohydramnios, fetal cord compression z (causing variable decelerations). g
  • Nursing care: Assist with amniotomy (if membranes not al ready ruptured ) prior to infusion. L.-_______::...:...._-!...,!~------------_J a, MATERNAL NEWBORN NURSING

Vacuum and Forceps Assisted Delivery

Vacuum: Traction applied to fetal head using cuplike

suction device. Baby must be in vertex presentation.

  • Indications: Maternal exhaustion or ineffective pushing.
  • Increased risk for maternal lacerations, infant subdural hematoma, cephalohematoma, caput succedaneum (should resolve in 3-5 days). Forceps: Traction applied using curved spoon-like blades f to assist in delivery.
  • Indications: Abnormal fetal presentation, fetal distress. 0
  • Increased risk for perineum lacerations, bladder injury, l L,_______________________^ facial^ bruising^ or^ nerve^ palsy^ in^ infant. ___,m MATERNAL NEWBORN NURSING

Prolapsed Umbilical Cord

Prolapsed umbilical cord: Umbilical cord protrudes

through cervix ahead of the baby, causing cord compression and compromising fetal circulation.

Nursing care:

  • Call for assistance FIRST.
  • With a sterile-gloved hand, insert two fingers into (^) ,...

the vagina (one on either side of the cord) and i

elevate the fetal presenting part off of the cord.

  • Reposition mom in a knee-chest or Trendelenburg (^) 8 3

position. 11)

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