OB and Peds Notes

Topics: Childbirth, Obstetrics, Pregnancy Pages: 26 (6148 words) Published: October 14, 2013
* Getting Ready Signs of Labor: happens 2-3 weeks prior to true labor ~ lightening (engagement): baby drops down and presses on bladder
~nesting: mom has sudden burst of energy
~Braxton Hicks contractions
~cervical ripening (softening and dilating)
~bloody show
* Effacement: the thinning of the cervix; measured from 0-100% * Dilatation: the opening of the cervix; measured from 0-10 cm * Stages of Labor:
~1st Stage
-Early/Latent:
-0-3 cm dilatation
-contractions 5-30 min apart
-lasting 30-45 seconds
-mild to moderate intensity
-lasting 6-8 hours
-Active:
-4-7 cm dilatation
-contractions 3-5 min apart
-lasting 40-70 seconds
-mild to strong intensity
-lasting 3-6 hours
-inwardly directed, focused, serious
-Transition:
-8-10 cm dilatation
-contractions 2-3 min apart
-strong intensity
-lasting 45-90 seconds
-lasting about 20-30 min
-severe pain, N/V, irritable
~2nd Stage: Pushing
-from complete dilatation until the birth of the baby
-Early/Latent:
-contractions are weak; no urge to push yet
-Active:
-strong contractions resume; urge to push comes (Ferguson
reflex)
~3rd Stage: Placenta
-from the delivery of the baby to the delivery of the placenta
-usually occurs within 10 min
-uterus changes shape; globular right before it detaches; sudden gush
of blood; cord lengthens
~4th Stage: Post partum Recovery
-1st hour after birth
-Post partum period: 1st 6 weeks
*Cardinal Movements:
~Descent: head enters the pelvis
~Flexion: occurs as head meets resistance
~Internal Rotation: head rotates L to R
~Extension: head extension as it goes under the symphysis pubis
~Restitution: shoulders enter pelvis and head rotates; neck twists then
untwists and head aligns with back
~External Rotation: shoulder rotates; head is turned farther to 1 side
~Expulsion: anterior shoulder moves under symphysis and is delivered; then
posterior shoulder, then rest of body
* Gravida: # times woman has been pregnant
* Para: # times woman had pg. that reached viability
* Multipara (M): has had a baby before
* Primipara (P): first time having a baby
* Contractions are timed from the beginning of one contraction to the beginning of the next! ~Frequency
~Duration
~Intensity (mild, moderate, strong)
*Fetal Position: 3 Magic Letters:
1st letter: mother’s left or right
Middle letter: presenting part
-O= occiput (vertex)
-M= mentum (face)
-S= sacrum (breech)
Third letter: pelvis quadrant
-A= anterior
-P= posterior
-T=transverse
* Station: the descent of the presenting organ thru the pelvis and measured from a -4 to a +4 with 0 at the point of the ishchial spines…+4 ON THE FLOOR!!! * BOW: bag of waters
~SROM: spontaneous rupture of the membranes
~AROM: artificial rupture of the membranes
~PROM: premature rupture of the membranes
*1st nursing action: check FHT!!!!; risk of infection after 24 hours have passed

* Normal Fetal HR: 110-160 bpm
* Variability: normal irregularity of the fetal heart beat could be due to hypoxia; rx depression of the CNS; sleep cycle for 20-30 min; prematurity ~Absent: 0
~Minimal: 25
* Reassuring or Non-Reassuring Pattern: pattern of the relationship of the fetal heart rate pattern to the mother’s contraction pattern (how well is the baby handling contractions) ~Early Decelerations: Reassuring

-late in labor; HEAD COMPRESSION; no intervention needed
~Late Decelerations: Non-Reassuring
-FHR decreases after onset of contraction
-fetal hypoxia from DECREASED PLACENTAL PERFUSION
-utereoplacental insufficiency (usually from high BP)
~Variable Decelerations: Non-Reassuring
-varies in shape in relation to contraction; sharp onset; looks like a V or U
-due to CORD COMPRESSION
Nursing Interventions for Non-Reassuring Patterns:
-turn on Pitocin
-change maternal position side...
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