Latent- from beginning of true labor to 3-4 cm dilation

Active- From 4-7 cm dilation

Transition- From 8-10 cm dilation

True:

Pain in lower back radiating to abdomen, regular rhythmic contractions that intensify with ambulation, progressive cervical dilation and effacement.

False:

Discomfort localized in abdomen, NO LBP, contractions decrease in intensity and/or frequency with ambulation

Prodromal Signs of labor: false labor

>Lightening- fetus drops into true pelvis

>Braxton Hicks contractions

>Cervical softening and slight effacement

>Bloody show or expulsion of mucous plug

>burst of energy "nesting instinct"

Normal findings VS for pt in labor:

FHR- 110-160 BPM

Maternal BP: <140/90

Maternal HR: <100 BPM

Maternal temp: <100.4 degrees F

Slight elevation is r/t dehydration and work of labor. Anything higher indicates infection and must be reported STAT

Define frequency, duration, and strength of contraction

Frequency- (how often)from beginning of one to beginning of next contraction; measured in min

Duration- (how long)From beginning to end of one contraction

Strength- Intensity of strongest part (peak) of contraction.

Remember that they vary with stage of labor

Dizziness, tingling of fingers, stiff mouth

Have her breath into cupped hands or paper bag to rebreath the CO2

Mid-active phase of first stage.

If too early, will retard progress of labor.

If too late, narcotics increase risk of neonatal respiraroty depression

To determine:

Cervical dilation (measured in 1-10cm)

Cervical effacement (thinning; expressed in 0-100%)

Cervical position (anterior to paltate is what's preffered. If posterior, it's hard to palpate)

Cervical consistency (firm to soft)

Stage I: from beginning of regular contractions or rupture of membranes to 10cm dilation and effacement. Latent, Active, Transition

Stage II: 10cm to delivery

Stage III: Delivery of placenta

Stage IV: First 1-4 hrs following delivery (recovery)

*Assess BP and pulse Q15 min- remember in RESTING phase of contraction

*Determine FHR with every contraction

*Observe perineal area for increased bloody show, bulging perineum/anus, and visibility of presenting part

*Palpate bladder for distention

*Assess amniotic fluid for color and consistency

-Lengthening of umbilical cord outside vagina

-Gush of blood

uterus changes from oval (discoid) shaped to globular

-Mother describes 'full' feeling in vagina

-Continued firm uterine contractions

-Place 2 on perineum

-DO NOT Touch inside of pad (can contaminate)

-DO apply from front to back, being careful not to drag pad across anus

-Oxytocin/Pitocin:

-Methergine:

-Hemabate:

For- Uterine atony

Adverse Effects- HTN

Nx Implications- given immediately after delivery of placenta

Failure of uterine muscles to contract normally after baby and placenta are delivered, and bleeding continues.

Administer uterine stimulants; Oxytocin/Pitocin, Methergine, or Hemabate

Used for prevention of uterine atony

-Adverse effect:HTN

-NOT given to pts with HTN

-Take BP prior to giving; withhold if 140/90 or above and notify HCP

To prevent uterine atony:

S/E: HA, N/V, fever, bronchospasm wheezeng

Not for: asthmatic pts, check temp Q1-2hrs, auscultate breath sounds frequently

Full bladder: most common reasons for uterine atony and/or hemorrhage in firs 24 hrs after delivery. Perform massage (if soft/boggy) then have ct empty bladder

Pale, clammy, tachycardia, light-headed, hypotension

Place in order the 7 cardinal movements of the mechanism of labor that occur in a vertex presentation:

1.Descent

2.Engagement

3.Flexion

4.Expulsion

5.Extension

6.External rotation

7. Internal Rotation

2,1,3,7,5,6,4

Analgesics during labor:

Demerol, Fentanyl, and Morphine Sulfate

FOR/ADVERSE REACTIONS/NX IMPLICATIONS

FOR- produce analgesia, euphoria, sedation in labor

Reactions- Resp depression, fetal narcosis/distress, hypotension, itching, urinary retention,

Implications-Do NOT give if resps <12/min, Narcan is antagonist, monitor resps, pulse, BP closely

Analgesics during labor:

Stadol and Nubaind:

opioid agonist/antagonists

Indications/Adverse reactions/Nursing implications

Indications- For analgesia in labor, narcotic analgesic

Adverse reactions- women with preexisting narcotic dependency will experience withdrawal symptoms immediately (abstinence syndrome)

Nursing implications- IV/IM, obtaing drug hx before administration (drug dependence), monitor resps/pulse

Narcan:

Indications/Adverse reactions/Nursing implications

Indications- for narcotic antagonist used to counteract narcotic effects on mother/fetus

Adverse reactions- decreased respirations rarely occur

Nursing implications- Monitor resps closely since drug action is shorter than the narcotic (may need to readminister), pain returns after administration to mother, can be administered to newborn after delivery to counteract narcotic depression

Hypotension:

-Turn client to L

-Increase IV infusion

-Begin O2 at 10L/min facemask

-Notify HCP STAT and have ephedrine available

-Assess FHR

a. ct's refusal or fear

b. anticoagulant therapy or presence of bleeding disorder

c. presence of antepartum hemorrhage causing acute hypovolemia

d. infection or tumor at injection site

e. allergic to _caine drugs

f. CNS disorders, previous back surgery, or spinal anatomic abnormality