Term
| What is labor pain the result of? |
|
Definition
Physical effort!
The uterus is contracting, the cervix is dilating (opening), and labor is progressing |
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Term
| What are the pains associated w/ the 1st stage of labor? |
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Definition
Pain from cervix and lower uterine segment
Characteristics like other pain
Diffuse in nature
Occurs in the lower abdomen
May be referred to the lower back, buttocks, and thighs |
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Term
| What are the pains associated w/ 2nd stage of labor? |
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Definition
Pain from perineum and birth canal (as the fetus descends)
Described as “coming in waves” |
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Term
| What are the pains associated w/ birth? |
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Definition
Described as most extreme pain
“Burning” pain in perineum |
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Term
| What psychosocial factors effect pain? |
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Definition
The level of the woman’s fear and anxiety
The woman’s culture
The circumstances surrounding the birth experience (planned or unplanned, wanted or not wanted, preterm or term) |
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Term
| What physiologic factors effect pain? |
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Definition
Physical condition of the woman
Use of pharmacologic methods
Age of the woman
Length of labor experience |
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Term
| What is the pain threshold? |
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Definition
| The level of pain necessary for an individual to perceive pain |
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Term
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Definition
| The ability of an individual to withstand pain once it is recognized |
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Term
| What are the principles of pain relief during laboR? |
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Definition
Women are more satisfied when they have control over the pain experience
Caregivers commonly underrate the severity of pain
Women who are prepared for labor usually report a more satisfying experience than do women who are not prepared |
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Term
| What are the non-pharmalogical ways to help pain? |
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Definition
Continuous labor support-doula
Comfort measures-do not underestimate
Relaxation techniques-helps to facilitate labor process
Patterned breathing
Attention focusing (imagery)
Movement and positioning
Touch and massage
Water therapy
Hypnosis
Intradermal water injections-sterile water injections
can effectively relieve pain of back labor
Acupressure and acupuncture |
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Term
| What is the birthing ball? |
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Definition
Birthing ball--Sitting on the birthing ball keeps the baby properly aligned in the pelvis.
• The ball encourages pelvic mobility.
• Pregnant women find it easier to get up and down from the ball than a standard chair or sofa during labor.
• The ball encourages the baby to drop down further (descend) into the pelvis by allowing gravity to work with the laboring mother.
• The ball allows the laboring woman to shift her weight, rock her pelvis, and find comfortable positions to labor in more easily.
• The ball can be used when in the hands and knees position. This decreases the pressure and stress on the hands and wrists that traditionally affect the length of time the position can be used.
Patterned Breathing
These breathing techniques provide comfort and focus while enhancing labor progress. Patterned breathing enhances oxygen flow to your baby and is also vital to the contracting uterus.
Beverages
You should stay well hydrated while laboring. Laboring women may have clear liquids such as water, juice, broth, ice, and Popsicles.
Movement and position changes---Laboring women tend to find upright positions most comfortable such as sitting, standing, and walking. Many choose a lying down position as labor advances. t may also relieve pain by shifting pressure and allowing the baby to move. You may try sitting, kneeling, standing, lying down, getting on your hands and knees, and walking.
Heat and cold---Hot compresses applied to the lower abdomen, groin or perineum, a warm blanket over the entire body and ice packs to the lower back or perineum can help alleviate labor pain.
Counter-pressure consists of steady, strong force applied to one spot on the lower back during contractions using the heel of the hand, or pressure on the side of each hip using both hands. Counter-pressure helps alleviate back pain during labor, especially in those women experiencing “back labor.”
Touch and massage---Touch can convey pain-reducing messages |
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Term
| What are the advantages of non-pharm methods? |
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Definition
Noninvasive
Address emotional and spiritual aspects of birth
Promote women’s sense of control over pain |
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Term
| What are the disadvantages of non-pharm methods? |
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Definition
Many of the interventions require special training and/or practice before birth
These methods are not effective for every woman |
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Term
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Definition
| to promote sedation and relaxation |
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Term
|
Definition
| to promote analgesia during labor |
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Term
|
Definition
The use of medication to partially or totally block all sensation to an area of the body
Local
Regional
General |
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Term
|
Definition
An increased ability for a woman to cope with labor
The medications may be nurse-administered |
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Term
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Definition
Frequent occurrence of uncomfortable side effects, such as nausea and vomiting, pruritus, drowsiness, and neonatal depression
Pain is not eliminated completely |
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Term
| What are the characteristics of narcotics? |
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Definition
Feel effect 2-4 mins after infusion
“take the edge off”
Feel relaxed and drowsy
Minimal effects of baby (respiratory depression) |
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Term
| What are the characteristics of local anesthetics? |
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Definition
Injection used to numb perineum, allows for episiotomy or repair
No affect on baby
Do not relieve labor pains |
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Term
| What are the characteristics of regional anethsita? |
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Definition
| Involves blocking a group of sensory nerves that supply a particular organ or area of the body |
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Term
| What are the characteristics of general anesthesia? |
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Definition
Not used frequently in obstetrics because of the risks involved
Cause loss of consciousness
Used in emergency Cesarean sections |
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Term
| What is the dosage of morphine? |
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Definition
|
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Term
| What is the action of morphine? |
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Definition
| Crosses placenta; causes a decrease in FHR variability; can cause maternal and neonatal CNS depression; decreases uterine cxs |
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Term
| What is the dosage of mereperedine? |
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Definition
| Meperedine (Demerol) 25-75 mg IV |
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Term
| What is the action of mereperedine? |
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Definition
| Maximal effet 2-3 hrs after admin, CNS depression, decreased fetal HR variability |
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Term
| What is the dosage of Butophanol> |
|
Definition
| (Stadol)-1-2 mg IV, Q 2-4 hrs, |
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Term
| What is the action of Stadol? |
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Definition
| rapidly crosses placenta, causes neonatal respiratory depression |
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Term
| What is the dosage of Nalbuphine (Nubain)? |
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Definition
| Nalbuphine (Nubain)—10-20 mg IV |
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Term
What is the action of Nalbuphine (Nubain)
? |
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Definition
| Causes less maternal nausea, causes fetal bradycardia, decreases variability, resp depression |
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Term
| What is the dosage of Fentanyl> |
|
Definition
50-100mcg IV or epid
Can cause maternal hypotension, maternal and fetal resp depression, crosses placenta |
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Term
| Why are anti emetics given? |
|
Definition
DO NOT RELIEVE PAIN, GIVENTO POTENTIATE EFFECT OF OPIOID MEDS, REDUCE ANXIETY
Decrease nausea and vomiting
Can cause sedation |
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Term
| What are the dosages of anti emetics? |
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Definition
Vistaril 50-100 mg IM
Phenergan 25-50 mg IM
Compazine 5-10 mg IM, can be given IV |
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Term
| What is the dosage of Dizempam? (Valium) |
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Definition
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Term
| What are the characteristics of Diazepam (Valium)? |
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Definition
Enhances pain relief, causes sedation,
may be used to stop eclamptic seizure
decreases nausea and vomiting,
can cause newborn depression—give lowest possible dosage |
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Term
| What is the dosage of Midazolam? (versed) |
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Definition
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Term
What are the characteristics of Midazolam?
(versed) |
|
Definition
Used for anmesia effect
Used in adjunct for anesthesia
Excreted in breast milk |
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Term
| What does a pudendal epidural do? |
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Definition
| block-pain relief for the birth |
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Term
| What does a paracervical epidural do? |
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Definition
| block-pain relief during labor |
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Term
| What does an epidural do? |
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Definition
| anesthesia-pain relief during labor |
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Term
| What are the characteristics of an regional anesthesia? |
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Definition
Most effective method of pain control during labor
Placement of tiny catheter into epidural space by anesthesiologist
Continuous infusion of medications
Hypotensionfetal decrease in FHT
IVF bolus prior to epid placement
Continuous monitoring of mother and baby |
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Term
| What are the characteristics of a spinal block? |
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Definition
Injection into spinal fluid in lower back, no catheter is placed
Most often used in Cesarean section
Starts working faster than epid |
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Term
| What are the complications associated w/ epidermal and spinal anesthesia? |
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Definition
Hypotension
Maternal fever
Shivering
Pruritus
Inadvertent injection into the blood stream
Spinal headache
Fetal distress |
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Term
What are the Life-Threatening Complications Occurring With General Anesthesia
? |
|
Definition
Failed intubation-due to physiological changes: trachea and thorax
Aspiration-often premedicated
Malignant hyperthermia-(rare) inherited condition that causes sustained muscle contractions in the presence of certain anesthetic agents |
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Term
| What are the early signs of malignant hypothermia? |
|
Definition
Early signs:
severe muscle rigidity, tachycardia, irregular heart rhythm, decreased O2 saturation, cyanosis |
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Term
| What are the late signs of malignant hypothermia? |
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Definition
| Body temperature can rapidly increase to lethal levels |
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Term
| What are the mechanical dilators for labor? |
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Definition
-Hygroscopic Dilators
-Balloon Dilators |
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Term
| What are hygroscopic dilators? |
|
Definition
absorb fluids and expand within the endocervix, causing constant, controlled mechanical pressure.
Laminaria |
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Term
| What are balloon dilators? |
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Definition
Foley catheter or specifically designed balloon device is placed into the endocervix. Balloon is filled with water at a constant rate to produce dilation.
Cook’s catheter |
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Term
| What are the risks associated w/ mechanical dilators? |
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Definition
| These methods have an increased risk of infection, bleeding, ROM, and placental disruption. |
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Term
| What are the surgical methods to induce labor? |
|
Definition
Stripping of the Membranes: Causes mechanical dilation as well as increases in phospholipase A2 and Prostaglandin F2a. Associated with increased rate of normal deliveries when used with low-dose oxytocin.
Amniotomy: causes an increase in local prostaglandins. Not supported by evidence, and rarely used for cervical ripening. |
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Term
|
Definition
prostaglandin analog that can be inserted into the cervix. It has a string attached and can be easily removed if necessary. Can cost up to $200.
Labor inducer/cervical rippener
Prostiglandin E2-2.5 mg vaginally/repeated in 6-12 hrs/begin PIT 6-12 hr
Dinoprostone (Cervidil)-10 mg time released vaginal insert/PIT 30 min after removal |
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Term
|
Definition
Synthetic PGE1 effective in cervical ripening, although not labeled by FDA for that purpose. Cost is less than $1.
Labor induction/Cervial Rippening
Misoprostol (Cytotec)-1/4 100mcg tab/repeat every 3-6 hr/start PIT after 4 hr |
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Term
| What is uterine hyper stimulation? |
|
Definition
is the major side effect of both of these meds. Therefore, Cervidil is used often despite its cost, as it can be quickly and easily removed.
Terbutaline 0.25 mg SC or IV |
|
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Term
|
Definition
| a synthetic oxytocin which stimulates uterine contractions by increasing intracellular calcium levels. |
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Term
| What are the risks associated w/ piton? |
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Definition
The greatest risks of Pitocin include uterine rupture and placental abruption.
For this reason, continuous FHR monitoring is used. |
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Term
| What is postpartum hemorrhage |
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Definition
| blood loss of more than 500 ml following the birth of a newborn. |
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Term
| What is early post partum hemorrhage? |
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Definition
| usually due to uterine atony, laceration or retained placenta fragments, occurs in the first 24 hours after delivery (primary). |
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Term
| What is late post partum hemorrhage? |
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Definition
| occurs after 24 hours after delivery to 6 weeks after birth and is generally caused by retained placental fragments or bleeding disorder (secondary). |
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Term
| What causes postpartum hemorrhage? |
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Definition
| Delayed uterine atony or placental fragments prevent the uterus from contracting effectively. The uterus is unable to form an effective clot structure and bleeding continues. |
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Term
| What nursing interventions are r/t hemorrhage? |
|
Definition
prevent excessive blood loss and resulting complications.
assist the client and family to deal with physical emotional stress of postpartum complications.
4 T’s
Tone
Tissue
Thrombin
Trauma |
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Term
| What is important to note about tone? |
|
Definition
Previous PPH
Prolonged labour
Age > 40 years
Big baby
Multiple pregnancy
Placenta previa
Obesity
Asian ethnicity |
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Term
| What is important to note about tissue? |
|
Definition
Retained placenta/
membrane/clot |
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Term
| What is important to note about Thrombin? |
|
Definition
Abruption
Coagualtion disorders
Pyrexia
Intrauterine death
Amniotic fluid embolism
------DIC |
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Term
| What is important to note about trauma? |
|
Definition
Caesarean section
(emergency > elective)
Perineal trauma
Operative delivery
Vaginal and cervical tears
Uterine rupture |
|
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Term
| What is trauma associated w/ hemorrhage? |
|
Definition
Damage to genital tract
Laceration
Infection
Retained tissue—POC or clots
Hematoma
Uterine inversion
Uterine rupture
Prolonged vigorous labor
Cervical lacerations, forceps delivery
THROMBIN—clotting disorders |
|
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Term
| What clotting disorders are associated w/ hemorrhage? |
|
Definition
Thrombocytopenia
Von Willebrand Disease
DIC (Disseminated Intravascular Coagulation) |
|
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Term
|
Definition
| It is delayed return of the enlarged uterus to normal size and function. |
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Term
| What does sub involution result from? |
|
Definition
| retained placental fragments and membranes, endometritis, or uterine fibroid tumor. |
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Term
| What prevents the uterine from contracting effectively? |
|
Definition
| Uterine atony or placental fragments |
|
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Term
| What are the clinical manifestations of sub involution? |
|
Definition
prolonged lochial discharges.
Irregular or excessive bleeding.
Larger than normal uterus. |
|
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Term
| What is uterine inversion? |
|
Definition
| Prolapse of the uterine fundus through the cervix, uterus is turned inside out |
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Term
|
Definition
| abnormal adherence of the placenta, excessive traction of the umbilical cord, or vigorous manual removal of the placenta |
|
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Term
| How is uterine inversion treated? |
|
Definition
| Rapid treatment of replacement of uterus |
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Term
| What is the goal associated w/ uterine inversion? |
|
Definition
|
|
Term
| What nursing interventions are r/t uterine inversion? |
|
Definition
Massage uterus
Administer uterotonic drugs (judgement of provider)
Oxytocin—Im or IV
Cytotec
Metherine—not given if woman is hypertensive
Hemabate—contraindicated with asthma (causes bronchospasms)
Page 776; Drug guide 22.1
Maintain primary IV infusion
Empty bladder (foley cath)
Bimanual compression, ect.
Hysterectomy |
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Term
|
Definition
| Rho (D) immune globulin suppresses the stimulation of active immunity by Rh-positive foreign RBC |
|
|
Term
|
Definition
Given IM at 28 weeks antepartum and within 72 hours of delivery – 1 vial
Before 13 weeks give ½ dose after amniocentesis, miscarriage, ectopic pregnancy |
|
|
Term
| What is important to note before administration of RhoGAM? |
|
Definition
Never administer intravenously
Never administer to a neonate
Never administer to an Rh negative patient who has been previously sensitized to the Rh antigen
Confirm that the mother is Rh negative
Confirm infant is Rh positive and assess direct coombs test |
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Term
|
Definition
| Indirect coombs test on mother to determine the presence of antibodies against fetal blood. |
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Term
| What if the Coomb's test is positive? |
|
Definition
| If the test is positive, amniocenteses may be performed to determine the fetal Rh factor and degrees of hyperbilirubinemia. |
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Term
| How is the Coomb's test performed? |
|
Definition
| Direct coombs test is performed on the cord blood. Positive coombs test indicates that antibodies from the mother have attached to the infants RBC. Bilirubin levels are followed closely for changes that indicate that treatment should be initiated or changed. |
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