Maternal Child Health Exam 2, Rasmussen College

First phase of stage one of labor - Latent phase. Cervical dilation is 0-3 cm, contractions are mild to moderate, every 5 to 30 minutes for 30-45 seconds. Mother is talkative and eager Second phase of stage one of labor - active phase, cervical dilation is 4-7 cm, contractions are moderate to strong every 3-5 minutes lasting 40-70 seconds, cervical dilation and effacement is rapid, mother feels helpless, restless, and anxious Third phase of stage one of labor - -Transitional phase, cervical dilation cm, station 0 or -1, contractions strong to very strong every 2-3 minutes for 45-90 seconds, mother feels tired, out of control, rectal pressure, urge to push, irratible Stage two of labor - from complete dilation to delivery of the baby, intense contractions every 2 to 3 minutes Stage three of labor - from the birth of HBG and HCTthe infant to the delivery of the placenta, approx 5-30 minutes time Stage four of labor - from the delivery of placenta to the return of vital sign homeostasis, approx 2-4 hours, lochia is scant to moderate Important labs in labor - platelets within normal range (150,000-450,000) HBG and HCT UA for infections and drugs Rh type Group B Strep status Reasons and findings of vaginal exams in labor - Determine cervical dilation and effacement measure station of fetus in birth canal fetal position, presenting part and lie Are membranes intact or ruptured When can sedatives be administered during labor - not typically given can be used during early labor to induce sleep When can opioid analgesics be administered during labor - Usually given during active labor when cervical dilation has reached 4-5 cm and fetus is engaged in pelvis Given systemically at peak of contraction to decrease perfusion to fetus Opioid analgesics used during labor - fentanyl, butorphanol, meperidine, and nulbuphine Pitocin starting dose - 2 milliunits/min increased every 30 minutes or greater to 6 milliunits/min Risk of rupturing amniotic membranes - Infection umbilical cord prolapse Nursing interventions with spontaneous rupture of membranes - if not already assessing FHR, begin immediately baby should be delivered within 24 hours to decrease risk of infection Fluid should be watery, clear, no foul odor use nitrazine paper to confirm amniotic fluid Nursing interventions with artificial rupture of membranes - Must ensure fetus is engaged to prevent cord prolapse Monitor FHR prior to and post-rupture to assess for cord prolapse Assess and document color, odor, and consistency of fluid Obtain temperature every 2 hours Risks of epidural block - maternal hypotension, fetal bradycardia and decelerations, loss of urge to void, loss of bearing down reflex Nursing interventions with epidural block - administer bolus of IV fluids to offset hypotension position patient in side-lying position and remain in that position post-procedure to offset hypotension Coach mother in pushing efforts MOnitor maternal BP, HR, and respirations Assess bladder for distention Monitor for return of sensation prior to standing Preparation for epidural anesthesia - ensure consent form is signed educate the patient on the procedure administer IV fluid bolus empty bladder Indications for a cesarean section - breech presentation cephalopelvic disproportion non-reassuring fetal heart tones placental abnormalities placenta previa previous c-section dystocia multiples umbilical cord prolapse