Childbearing Family Exam #2-Study Guide

★ True Labor v. False Labor: true labor will end in a baby!� True Labor False Labor Contractions are at regular intervals Contractions are irregular Intervals between contractions gradually shorten. Usually no change Contractions increase in duration and intensity Usually no change Discomfort begins in back and radiates around to abdomen Discomfort is usually in abdomen Intensity usually increases with walking Walking has no effect on or lessens contractions Cervical dilation and effacement are progressive No change Contraction do not decrease with rest or warm tub bath. Rest and warm tub baths lessen contractions. 2 xtra strength tylenol, relax, hydrate. Cord prolapse: ○ when the umbilical cord is displaced, preceding the presenting part of the fetus, or protruding through the cervix. ○ This results in cord compression and compromised fetal circulation. ○ Expected findings ■ Client may report that she feels “something coming through her vagina � ”� ■ Visualization or palpation of the umbilical cord protruding from the introitus ■ FHR monitoring shows variable or prolonged decels ■ Excessive fetal movement followed by cessation; suggestive of severe fetal hypoxia. ○ Risk Factors ■ Rupture of amniotic membranes ■ Abnormal fetal presentation ■ Transverse lie: presenting part not engaged, leaving room for the cord to descend ■ Small for gestational age fetus ■ Unusually long cord ■ Multifetal pregnancy ■ Hydramnios or polyhydramnios ○ NURSING INTERVENTIONS ■ Call for assistance immediately/ notify provider ■ Use sterile gloved hand, insert 2 fingers into vagina, apply pressure on either side of the cord to the fetal presenting part to elevate it off of the cord. ■ Reposition the client in a knee-chest, trendelenburg, or side lying position with a rolled towel under the clients right hip to relieve pressure on the cord. ■ Apply a warm, sterile, saline soaked towel to the visible cord to prevent drying and maintain blood flow. ■ Continuous FHR monitoring for decels-which indicate fetal asphyxia/hypoxia ■ Give O2 @ 8-10L/min via face mask to improve fetal oxygenation 1 ■ Initiate IV access, and give IV bolus ■ Prep for immediate vag birth if cervix if fully dilated, or C-section if not. ■ Keep mom and partner informed and educated about interventions. Late decelerations-causes, interventions ○ Slowing of FHR after contraction has started with the return of FHR to baseline well after contraction has ended. ○ Nadir occurs after the peak of the contractions ○ CAUSES/COMPLICATIONS: uteroplacental insufficiency causing inadequate fetal oxygenation, maternal hypotension, placenta previa, abruptio placentae (DIC: too many clots to actually clot the blood), uterine hyperstimulation w/oxytocin, preeclampsia, late or post term pregnancy, maternal diabetes mellitus. ○ NURSING INTERVENTIONS: ■ Place client in side lying position ■ Insert IV cath and increase rate of fluid ■ Discontinue oxytocin if being used ■ Elevate the clients legs, lower head ■ Administer oxygen @ 8-10 L/min via nonrebreather face mask ■ Notify provider ■ Prepare for assisted vag birth or C-section ■ UNCOIL (change position, oxygen-rarely, Oxytocin off, IV fluids, Lower head) Fetal position how to access, what each station means (i.e. -1, 0, +1, etc.) ○ Refers to the relationship of the landmark on the presenting fetal part to the anterior, posterior, or R/L of the maternal pelvis. ○ Right or left side of the MOTHER ○ Fetal presenting part ■ Occiput ■ Mentum (fetal chin) ■ Sacrum ■ Acromion Process (scapula) ○ Anterior, Posterior or Transverse depending on whether the landmark is in the front, back or side of the pelvis. ○ OP: baby looking at pussy ○ OA: baby looking at ass. 2 ○ Fetal presentation- what part of the baby is “presenting” into the birth canal? ○ What are they? Risks? ■ CEPHALIC PRESENTATION: most common. Labor and birth are most likely to proceed normally. ● Vertex presentation: the most most common. The presenting part is the occiput, the fetal head is completely flexed onto the chest. The smallest part of the fetal head is presenting in the maternal pelvis. ● Sinciput presentation: fetal head partially flexed. Occipitofrontal diameter present