NURB 331 unit 3
NURB 331 unit 3 NURB 331
Popular in Lifespan 1
Popular in NURSING
verified elite notetaker
This 18 page Class Notes was uploaded by Kelsey Forbeck on Monday September 12, 2016. The Class Notes belongs to NURB 331 at University of Indianapolis taught by Professor Rairdon in Fall 2016. Since its upload, it has received 15 views. For similar materials see Lifespan 1 in NURSING at University of Indianapolis.
Reviews for NURB 331 unit 3
Report this Material
What is Karma?
Karma is the currency of StudySoup.
You can buy or earn more Karma at anytime and redeem it for class notes, study guides, flashcards, and more!
Date Created: 09/12/16
NURB 331: Lifespan 1 Unit 3 Labor and Birth Processes Factors Affecting Labor 1. Passengers: The way the fetus moves through the pelvis depends on: Size of fetal head Fetal presentation Fetal lie Fetal attitude Fetal position The fetal had has major effects in labor: Has to come through at the right angle or there will be a problem The positions of the head should be chin to chest Baby’s head may be molded or have a “cone head” which is normal There are sutures and fontanels (seems) o The fontanels are soft so the bones can overlap when coming out of the birth canal o Fontanels are also used to determine position of the baby’s head Fetal Presentation: o Determined by fetal lie and by body part of fetus that enters into maternal pelvis first Malpresentation: o Presentations associated with difficulties with labors that do not proceed as normal Cephalic Presentation: o Classified according to degree of flexion or extension of fetal head (attitude) 4 presentations: o Vertex presentation (head first) Position we want o Military presentation: Head upright o Brow presentation Coming through brow first o Face presentation “sunny side up” What is shoulder presentation also called? Transverse Fetal positions: Refers to the relationship pf the landmark on the presenting fetal part to the: o Front (anterior) o Back (posterior) o Sides (right and left) If a baby is positioned OA then the baby’s face will be towards the sacrum Fetal station is the relationship of the fetal head to the mother’s pelvis o Zero line is ischial spine Engagement: When the largest diameter of presenting part reaches or passes through pelvic inlet Never want the cord coming out first because it cuts off the oxygen line to the baby Synclitism- baby is coming down the right way Asynclitism- baby is not coming through at an appropriate way 2. The passageway Birth canal is composed of: Bony pelvis Soft tissue of cervix Pelvic floor Vagina Introitus (external opening to the vagina) Passageway types: o Android- male o Gynecoid- normal female 3. Powers: o Primary power- contractions Effacement- How thick or thin the cervix is Dilation- Opening. 10 is the magic number Ferguson reflex- uncontrollable urge to push o Secondary power- mom pushing Contractions are identified by: o Frequency o Duration o Intensity 4. Position Very important and can make a huge difference in labor 5. Psychological factors: Cultural beliefs Some refuse to have a male in the room Previous experiences If their first pregnancy was bad, then they may think the same thing for the next pregnancy Anxiety Worried about the outcome Environment: Too many people in the room may bother the mom Signs preceding labor: Lightening- baby drops down Return of urinary frequency Backache Stronger Braxton Hick’s contractions o False contractions o Basically workout for uterus to be ready for birth Weight loss of 0.5-1.5 kg Surge of energy Increased vaginal discharge Cervical ripening Rupture of membranes Prostaglandins- lipid compound that ripens cervix False versus true labor Signs of False Labor: Contractions begin and remain irregular Felt in the abdomen at first and remain in the abdomen and groin Usually disappear when ambulating (walking) or sleeping Do not increase in duration, frequency, or intensity Do not achieve cervical dilation Signs of True Labor Contractions begin irregularly but eventually become regular and predictable Contractions will first be felt in the lower back and sweep around abdomen in a wave (sort of like wearing a belt of pain) They will continue no matter what the woman’s level of activity is Increase in duration, frequency, and intensity Achieve cervical dilation Burst of energy Also known as nesting Some women say that they have a sudden burst of energy 24-48 hours before labor They may have a sudden desire to get things done and start becoming excited to have their baby. The Course of normal labor There will be a regular progression of uterine contractions Effacement (thinning) and dilation (opening) of the cervix Four Stages of Labor ** VERY IMPORTANT** Generally, the brain stimulates posterior pituitary to release oxytocin (love hormone), then the oxytocin will cause a smooth muscle that lines the uterus to contract, baby will then push against cervix which causes it to stretch. The stretching of the cervix will cause nerve impulses to be sent to the brain. This cycle continues until birth. Stage One: Will begin with the onset of contractions and end with full cervical dilation Three phases of stage one: o Latent phase (0-3 cm) The woman will usually still be at home during this point Onset of regular contractions SROM (rupture of membrane) may occur Early labor: Emotional changes occur and the woman may become excited Psychological changes o Active Phase (4-6 cm) The woman will most likely be kept in the hospital at this point Cervical dilation Duration increases Contractions more painful Does not feel good at this point Emotional changes: Becomes more serious Has difficulty following directions Focused on labor Decreased talking Wants focused emotional and physical support Irritated by noises Psychological changes: Only involved in what is going on in the room Decreased modesty More dependent on partner o Transition phase (8-10 cm) Basically the mom turns into a demon and the world is on fire This is the last part of the first stage Contractions are fast This phase lasts about 20-40 minutes Women may indicate high anxiety into this phase Copious bloody show mainly in inner thighs due to dilation Aware of increasing force and intensity of contractions Amnesia between contractions May fear of being “tore open” Fear losing control Hyperventilation We want to try to keep them calm without telling them to calm down Restlessness Difficulty understanding directions In too much pain Anger at contractions Statements such as “I can’t take this anymore” Hiccupping, nausea, vomiting Sweating Feels like they need to defecate Stage Two: o Simply begins when cervix is completely dilated and ends with birth of infant Stage Three: o Delivery of the placenta Usually 10-15 mins. after that o Signs of placental separation: Firmly contracting fundus Globular shaped uterus Rise of fundus in abdomen Sudden gush or trickle of blood Further protrusion of umbilical cord out of vagina Vagina fullness o Schultz mechanism: Holding placenta until it is expelled Expelled with fetal (shiny) side up Called shiny Schultz o Duncan mechanism: Maternal side delivering first Called “dirty Duncan” because placental side looks rough sort of like ground beef o Retained placenta: If it has been 30 minutes after birth and the placenta still hasn’t come out, drugs may be given to have it come out. Stage Four o Recovering o First 1-2 hours after birth o Blood loss causing low bp and tachycardia o Family with newborns o Assessment of mother and baby o Potential hemorrhage o Body attempts to regain homeostasis (balancing) Mechanism of Labor: Engagement and descent Flexion Internal rotation to OA position Extension External rotation (restitution) Expulsion Management of Discomfort Non pharmacological Pain Management: o Relaxation o Imagery and visualization o Various breathing techniques Different approaches to prepare for child birth using breathing exercises Paced breathing is what’s most common in prepared child birth Slow breathing with a partner o Music o Touch (counter pressure) Pushing Relief for women during first stage o Massage (Effleurage) Rubbing o Water therapy (hydrotherapy) Laying in a warm bath o Heat/ Cold The heat will relieve the muscle ischemia and increases blood flow to area of discomfort Cold may be effective in increasing comfort when woman feels warm Cooling relieves pain by lowering muscle temperature and relieving muscle spasms. o Aromatherapy Use oils distilled from plants, herbs, and trees to promote health and well being Lavender is an example, it helps sooth. Pharmacologic Management of Discomfort o Anesthesia STOPS pain by interrupting nerve impulses going to the brain o Analgesia Raises the threshold for pain perception but without loss of consciousness o Systemic analgesia: Opioid agonists Meperidine (Demerol) Fentanyl and Sufentanil are commonly used alone or with a local anesthesia Hydromorphone hydrochloride (Diladid) Butorphanol (Stadol) and Nalbuphine (Nubain), are used for labor. o They provide analgesia without causing respiratory depression in mother or neonate o Good to use for a starter drug Goal of pharmacological analgesia: Provide maximum pain relief with minimal risk to mother and fetus Increase coping ability o Analgesia given too early can make labor take longer and depress the fetus o Analgesia given too late doesn’t help the mother and can cause respiratory depression after birth o Opioid (Narcotic) antagonists Naloxone (Narcan) can reverse respiratory depression pf narcotics The duration of Narcan is shorter than narcotics which could result in a return of respiratory depression. o Nerve Block Analgesia and Anesthesia Local infiltration anesthesia Pudendal nerve block Spinal anesthesia block Epidural anesthesia block o Local Anesthesia Given to those moms who need repairs done after giving birth Effect of local anesthetics is temporary interruption of the conduction of nerve impulses o Pudendal block: Useful for late 2 stage of labor, epistomy, and birth Useful for low forceps or vacuum assisted devices o Epidural anesthesia/Analgesia Relieve pain by injecting mom with local anesthetic, an opioid analgesic, or both into epidural space. This will numb mom from the waist down o Technique for epidural block: Fetal monitor and automatic blood pressure devices are needed Oxygen and resuscitation equipment should be available IV is started with 500 mL given over 15- 30 minutes Decreases incidence of hypotension o Maternal positioning for epidural: Have her sit or lay with her back bent like a “mad cat” Nursing Car Management o Woman is positioned in a semi reclining position with left later tilt of uterus to make sure she won’t cut off blood supply to the baby. o Monitor BP every 1-2 minutes for first 10 minutes then ordering to protocol o Check bladder and keep empty with catheter so it is easier to give birth o Change position o Pruritus may occur o If respirations are less than 14 a minute, then Narcan may be given o Most common complication is maternal hypotension o Fetal bradycardia 100 blood stops flowing ro extremities 60 blood stops flowing to brain Spinal anesthesia May be given for surgical delivery Relives pain Cannot feel from waist down o Spinal headache Puncturing too far Mom will be light sensitive Fix it by an autologous blood patch Takes blood from mom and stick it in her spine to create a scab General anesthesia Starts with oxygen Put IV in place Administer drugs to prevent food from coming up Complications: Fetal depression Uterine relaxation Vomiting and aspiration Leading cause of death: Failure to establish patient airway Circulating nurse is responsible for remaining with patient until airway has establishes On Q Pump o Putting a catheter in incision site and it pumps in medicine at the site during C section o They tend to be leaky o It is local anesthesia
Are you sure you want to buy this material for
You're already Subscribed!
Looks like you've already subscribed to StudySoup, you won't need to purchase another subscription to get this material. To access this material simply click 'View Full Document'