Study Guide for Exam 2 OB

8/16/2019 Study Guide for Exam 2 OB

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Study Guide for Exam 2, Intrapartum The fve P’s o Intrapartum Labor and birth processes.

Passenger:1) Lie, presentation, attitude:

Fetal lie is the relation o the lon a!is o the etus to that o themother, and is either lonitudinal or transverse."ccasionall#, the etal and maternal a!is ma# cross at a $%&deree anle, ormin an obli'ue lie, (hich is unstable andal(a#s becomes lonitudinal or traverse durin the course olabor.Fetal presentation: it is the presentin part that portion o theetal bod# that is either oremost (ithin the birth canal or incloset pro!imit# to it. It can be elt throuh the cervi! on vainale!amination. ccordinl#, in lonitudinal lies, the presentencinpart is either the etal head or breech, creatin cephalic and

preach presentations, respectivel#. *hen the etus lies (ith lona!is transversel#, the should is the presentin part and is eltthrouh the cervi! on vainal e!amination.

Attitude: In the later months o prenanc# the etus assumes acharacteristic posture described as attitude or habitus. s a rule,the etus orms an ovoid mas that corresponds rouhl# to theshape o the uterine cavit#. The etus becomes a olded or bentupon itsel in such a manner that the bac+ becomes mar+edl#conve! the head is sharpl# -e!ed so that the chin is almost incontact (ith the chest.

) Fetal Position- /be able to dra( diaram and identi# (here

bab# is based on description o position o head in maternalpelvis).Position reers to the relationship o an arbitraril# chosen portiono the etal presentin part to the riht or let side o thematernal birth canal. ccordinl#, (ith each presentation therema# be t(o positions, riht or let. 0ecause the presentin partma# be in either the let or riht position, there are let and rihtoccipital, let and riht mentum, and let and riht sacralpresentations.


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Passage: The (hole pelvis, cervi! and vainaPowers: 2’s Primar# involuntar# uc contractions, 3econdar#&pushin


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Position: 4escribes landmar+s o the presentin part o the eusto the mothers bod#. 5 6 L side o maternal pelvis. Landmar+"7"cciput 87mentum, 373acrum or acromion /scapula 32)process . nterior7, posterior 7 P, or transverse /T), side omaternal pelvis.

Psyche: reduce her an!iet#6ear6ambivalence

9) Stages of laor, phases of the !rst stage of laor, andassociated characteristics of the contraction patternduring each stage. The frst stae o labor is rom the onset o reular contractions

to the ull dilation o cervi!. The frst stae is sinifcantl# lonerthan the second and third staes combined. The second staelast rom ull dilation o the cervi! to the birth o the etus. ou+no( birth is close (hen the vulva bules and encircles the heado the etus. The third stae o labor last rom the deliver# o theetus to the deliver# o the placenta. The ourth stae is recover#and lasts about hours ater the deliver# o the placenta


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$) "i#erences etween the stages and nursing careassociated with each stage.

Early First Stage of $aor: /Latent):;&1; cm dilated. Pt eels ableto cope (ith the discomort. 8a# be relieved that labor has fnall#started. Is able to e!press eelins o an!iet#. 0einnin cervicaldilation and e


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Intervie(&revie( prenatal data

• 2’s /onset, timin, strenth, 5"8, describe

Ph#sical =3, F>5 moniteorin, 2’s Leopolds

maneuver, cervical alarm chec+ Labs& , 202, 0" 5h t#pe and cross match, ?03

status, 35"8 @itriAin, mnisure.%dmission:

?o(n, collect labs, monitor, I= start, -uid bolus, eatB$eopold&s maneu'er : 4etermines etal presentation and

positionLonitudinal6tranverse, (here is etal bac+, (here aresmall parts6e!tremitiesB *hat is the inletB 4oes in confrm(hat I ound in the undusB

Encourage amulation terine contraction increase inre'uenc# in contractions allo( pt to chane positions re'uentl#,to relieve atiue, and increase comort o laborin client.

*al+in is ood at this point as lon as the (ater has not bro+en.Pt ma# be hunr#, 8a# have bo(el movements and re'uenc# o urination.Position changes:

o 3upine (6(ede

o 3'uat

o >ands and +nees

o Lateral

o 0irth ball

o Peanut ball /ver# ood i mom has epidural)

o

Laborin in tubEmotional support, physical care and comfort measureso >elpin maintain control

o Listenin

o dvocatin

o 2onservin ener#

o Cncourain e


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o suall# beins around D1 station

Positioning /om Fre'uent position chanes

sin ravit#

Lithotom#

priht positionin• 3ittin, +neelin, s'uattin

Lateral positionin

3emi&recombant

3tandin

Preparing for irth: 4eliver# table /see fure 1E&1)

Prepare6set up (armer, chec+ " e'uiptment,

resuscitation e'uipment, e!tra personnel iresuscitation is anticipated.

8echanism o verte! presentation:2ro(nin0irth o head0irth o bod# and e!tremities

Do not use fundal pressure to assist birth!!!

.hird Stage: 4eliver# o placenta@ursin interventions:

ssist (ith deliver# o placenta

5evie(ed sins o placental separation in lecture %,

please see

Pitocin bolus iv /;&$; Pit in %;;&1;;;ml L5) Fundal massae

"ther medications P5@ to help control bleedin

and6or manae PP> /will cover in complications)Fourth Stage: /1& hrs ater birth up to $ hrs) bondin,

@ursin interventions: =3 '1%min&1st hr,

=3 '9; min second hour, then hourl# ater that.

Palpate6massae undus G1% min or 1st hour.

ssess =ainal bleedin

ssess perineum

o Perineum care, numbin spra#, ice, tuc+s,

Cncourae bondin and breasteedin

2omort measures:

>eated blan+et

Provide ood and li'uids

Cncourae rest

Cncourae breasteedin in frst hour as inant (ill be alert


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3+in to s+in contact

0ondin

Cvaluate mom6bab# interactions%) "i#erences etween a laoring primipara 's a laoring

multipara *approx0 duration of stages of laor, relati'e to

parity)Primipara much loner e


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11) E#ects of uteroplacental insu8ciency on the fetus,as seen on the fetal monitoring strip, e#ect of supinehypotension on the fetusB

1) 9isceral 's somatic pain, stage of laor is moreli3ely to experience which typeB

19) ursing care support measures for laor pain,including ac3 laorB Fourth P of $aor:PositionMhelp mom chane positions re'uentl#. 3upineposition put pressure on abdominal aorta, no 0ueno. n# uprihtposition (ill increase cardiac abilit#. >elp pt (ith slo( pacedbreathin and rela!ation e!ercises. 5ubbin her bac+ (ill help(ith NateO controlled pain. 3pecifc to lo(er bac+ pain,counterpressure aainst the sacrum ma# help in alleviatin pain.lternative approaches to rela!ation:

o romatherap#

o 8assae

o >#pnosiso 0ioeedbac+

1$) itrous oxide, Fentanyl, aloxone.@itrous o!ideFentan#laloxone is an opioid antaonist. Pain (ill return to patientonce iven. It is also iven to the ne(born to stop the e


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Patient reusal

ncorrected h#povolemia

Increased intracranial pressure

Inection at the site

ller# to local anesthetic

2oaulopath# Platelet count 1;;,;;;

ncooperative patient

3pine abnormalities and sureries

3epsis

nstable spine rom trauma

Positionin problems

?eneral anesthesia /controversial)

+= Fetal monitoring, 3now 9E%$ )4>P=& variable 2 2ord 2ompressionC &Carl# decels >& >ead 2ompression &ccels "&Q L& Late 4ecels P& Placental insuHcienc#

;) 9ariaility, de!ne categories of 'ariaility.=ariabilit# is irreular (aves or -uctuation in the baseline F>5 ot(o c#cles per minute or reater.2ataories: bsent, minimal moderate, and mar+ed.bsent: d

2+ )ategory of tracing *I)4" ?-tier system, "@ )

@%9%"> acronym, practice charting strips

)ategory I: ormal F4@ .racingo 0aseline 11;&1; bpm

o 8oderate baseline variabilit#

o Late or variable decelerations absent

o 5e-ective o normal acid6base balance in etus

)ategory II: Indetermininate F4@ .racingNot all tracings are I or III, so are placed in this category :C!amples:

8inimal or mar+ed variabilit# bsent variabilit# (6o recurrant variable or late

decelerations bsence o induced accels (ith etal stim

5ecurrent variable decels (ith mimimal or

moderate variabilit# 5ecurrent late decels (ith moderate variabilit#

http://www.medscape.com/resource/sepsishttp://emedicine.medscape.com/article/1271543-overviewhttp://emedicine.medscape.com/article/1271543-overviewhttp://www.medscape.com/resource/sepsis


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=ariable decels (6 slo( return to baseline,

overshoots or shoulders /will leap after decel) Proloned decelerations

"@ & 4etermine 5is+ /lo(, med, hih ris+)

) 2ontractions: timin, reular, re'uenc#, variationra& Fetal >eart rate 0aseline9 =ariabilit#%- ccels" 4ecels> overall /cateor# I, II, III)

)ategory III: %normal F4@ .racingbsent variabilit# and an# o the ollo(in:

• 5ecurrent late decelerations

• 5ecurrent variable decelerations

• 0rad#cardia• 3inusoidal pattern

o Fetal anemia, Fetal 5h disease a+a

>#drops Fetaliso @arcotics

o Fetal asph#!ia6h#po!ia

o Fetal inection

o Fetal 2ardiac nomolies

) Steps of intrauterine resuscitation:• 5eposition mom

• ?ive I= -uids

• " 1; liter b# rebreather mas+

• 3top Pitocin

• dminister Terbutaline P5@

• @oti# 4r i steps do not resolve problem.

• Cphedrine i lo( 0P and causin late decels

• mnio&inuser or variable decels. /throuh IP2)

2? %sent or decreased 'ariaility and methods of fetalstimulation1. Fetal scalp stimulation and. . =ibro coustal /Probe (6buAAer)

$) @upture of memranes /5"8)/+no( normal T2" or5"8), proloned rupture o membranes and associated ris+s


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%) Aterine atony( de!ne, and when post partum is awoman most li3ely to experience increased leeding dueto atonyBton# o the uterus, also called uterine aton#, is a seriouscondition that can occur ater childbirth. It occurs (hen the

uterus ails to contract ater the deliver# o the bab#, and it canlead to a potentiall# lie&threatenin condition +no(n aspostpartum hemorrhae.

ter the deliver# o the bab#, the muscles o the uterus normall#tihten, or contract, to deliver the placenta. The contractionsalso help compress the blood vessels that (ere attached to theplacenta. The compression helps prevent bleedin. I the muscleso the uterus don’t contract stronl# enouh, the blood vesselscan bleed reel#. This leads to e!cessive bleedin, orhemorrhae.

) Signs of placental separation.Placental abruption ma# or ma# not be painul and ma# evenremain as#mptomatic in rare cases. part rom vainal bleedin/in revealed abruption), classic sins include:R0ac+ pain SRbdominal crampin and painRbdominal tendernessR5apid uterine contractions SRterine tendernessRPallorR4isproportionatel# enlared uterus

R@ausea and vomitinR5estlessness

) E#ects of reastfeeding on the uterus post partum,(hat hormone in-uences exytocin ;&$; per %;;&1;;; ml o L5

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Study Guide for Exam 2 OB