6-28-20096-28-2009

Labor & Delivery Labor & Delivery ~ Clinical Rotation Quiz ~~ Clinical Rotation Quiz ~

1.1. Discuss the four stages of labor and what happens in each Discuss the four stages of labor and what happens in each stage. Define primigravida and multigravida and state how thestage. Define primigravida and multigravida and state how the stages are different for each.stages are different for each.

Labor occurs in four stages, and may occur quicker in multigravida than in theLabor occurs in four stages, and may occur quicker in multigravida than in the woman who is primigravida. Primigravida women have only been pregnant woman who is primigravida. Primigravida women have only been pregnant one time; Multigravida women have been pregnant more than one time. The one time; Multigravida women have been pregnant more than one time. The first stage of labor is the longest stage for both the multi and primigravida first stage of labor is the longest stage for both the multi and primigravida woman averaging 8 - 10 hours. This stage of labor begins with the onset of woman averaging 8 - 10 hours. This stage of labor begins with the onset of true labor and ends with the complete effacement and dilation of the cervix. true labor and ends with the complete effacement and dilation of the cervix. The first stage is divided into 3 phases; latent, active and transitioning The first stage is divided into 3 phases; latent, active and transitioning phases. The latent phase of labor is the first 3 cm of dilation of the cervix. Thisphases. The latent phase of labor is the first 3 cm of dilation of the cervix. This phase can be quite long, and may also be painless resulting in the woman not phase can be quite long, and may also be painless resulting in the woman not even realizing much of this phase. Changes theven realizing much of this phase. Changes that at occur during this phase occur during this phase include: fetal positioning changes, cervical effacement, dilation of up to 3 cm, include: fetal positioning changes, cervical effacement, dilation of up to 3 cm, and contractions that gradually increase in intensity, duration, and frequency,and contractions that gradually increase in intensity, duration, and frequency, the contractions become about 5 minutes apart. Woman may have mild the contractions become about 5 minutes apart. Woman may have mild discomfort or pain during this phase, most often felt as low back-ache, or discomfort or pain during this phase, most often felt as low back-ache, or moderate intensity menstrual-like cramps. The laboring woman during this moderate intensity menstrual-like cramps. The laboring woman during this phase is usually quite excited, sociable, and cooperative, she is also anxious phase is usually quite excited, sociable, and cooperative, she is also anxious about the birth of her baby. The second phase of labor known as the Active about the birth of her baby. The second phase of labor known as the Active phase is where the cervix dilates at a more rapid rate from 4 cm to 7 cm. This phase is where the cervix dilates at a more rapid rate from 4 cm to 7 cm. This phase usually lasts on average 4.6 hours for the nullipara woman, and 2.4 phase usually lasts on average 4.6 hours for the nullipara woman, and 2.4 hours for the multipara woman. The cervix becomes completely effaced, and hours for the multipara woman. The cervix becomes completely effaced, and the fetus has begun to descend into the pelvis. Contractions have become the fetus has begun to descend into the pelvis. Contractions have become stronger, and are about 40 - 60 seconds in duration, they are also much more stronger, and are about 40 - 60 seconds in duration, they are also much more painful for the laboring woman during this phase. If she has chosen to receive painful for the laboring woman during this phase. If she has chosen to receive an epidural or another type of pain medication this is the time she will be an epidural or another type of pain medication this is the time she will be given it. The behavior of the woman changes also from excitement, to feeling given it. The behavior of the woman changes also from excitement, to feeling of helplessness, anxiety, and she also becomes much more quiet, she is of helplessness, anxiety, and she also becomes much more quiet, she is concentrating on the task at hand. The third phase or Transitional stage is concentrating on the task at hand. The third phase or Transitional stage is usually very intense, but is also short in length, average time is 3.6 hours in usually very intense, but is also short in length, average time is 3.6 hours in the nullipara. The cervix is dilating from 8 cm to 10 cm, the fetus is the nullipara. The cervix is dilating from 8 cm to 10 cm, the fetus is descending further into the pelvis, contractions have become very strong and descending further into the pelvis, contractions have become very strong and last from 60 - 90 seconds each. Contractions are usually 1.5 - 2 minutes apart last from 60 - 90 seconds each. Contractions are usually 1.5 - 2 minutes apart in this phase. This phase is the most difficult phase, the woman may have in this phase. This phase is the most difficult phase, the woman may have nausea, vomiting, leg tremors, as well as being irritable. Women may also losenausea, vomiting, leg tremors, as well as being irritable. Women may also lose control of their behaviors during this phase if the pain is intense. control of their behaviors during this phase if the pain is intense. Second stage of labor begins with the complete effacement and dilation of theSecond stage of labor begins with the complete effacement and dilation of the cervix, and ends with the birth of the baby. This stage lasts 30 minutes to 3 cervix, and ends with the birth of the baby. This stage lasts 30 minutes to 3 hours in the nulliparous woman, and 5 - 30 minutes in the multipara woman. hours in the nulliparous woman, and 5 - 30 minutes in the multipara woman. Contractions are still strong and are about 2 - 3 minutes apart, lasting 40 - 60 Contractions are still strong and are about 2 - 3 minutes apart, lasting 40 - 60 seconds each. The pressure on the pelvic floor caused by the decent of the seconds each. The pressure on the pelvic floor caused by the decent of the fetus causes the mother to feel the urge to push. She may feel she needs to fetus causes the mother to feel the urge to push. She may feel she needs to

have a bowel movement at this time. As crowning begins the woman may feelhave a bowel movement at this time. As crowning begins the woman may feel stretching or tearing even if no trauma is occurring. Behavior of the laboring stretching or tearing even if no trauma is occurring. Behavior of the laboring woman in this phase goes from uncontrolled to feeling more in control of the woman in this phase goes from uncontrolled to feeling more in control of the situation. She is sometimes not even aware of what is going on around her, situation. She is sometimes not even aware of what is going on around her, she is solely focused on pushing the baby out. This stage demands intense she is solely focused on pushing the baby out. This stage demands intense physical exertion, and energy demands. physical exertion, and energy demands. Third stage of labor or the placental stage begins with the birth of the baby Third stage of labor or the placental stage begins with the birth of the baby and ends with the placenta being expelled from the uterus. This is the and ends with the placenta being expelled from the uterus. This is the shortest stage of labor, averaging 5 - 10 minutes, but up to 30 minutes. The shortest stage of labor, averaging 5 - 10 minutes, but up to 30 minutes. The uterus still contracts firmly but with minimal pain at this time, the woman is uterus still contracts firmly but with minimal pain at this time, the woman is usually so excited at what she has just done and anxious to see her baby. The usually so excited at what she has just done and anxious to see her baby. The placenta separates from the uterine wall after birth due to the decrease in the placenta separates from the uterine wall after birth due to the decrease in the size of the uterus, which also decreases the size of the placental site. After thesize of the uterus, which also decreases the size of the placental site. After the expulsion of the placenta the uterus must contract firmly and remain expulsion of the placenta the uterus must contract firmly and remain contracted for the compression of open vessels to occur at the implantation contracted for the compression of open vessels to occur at the implantation site, otherwise the birth may result in hemorrhage and/or maternal demise. site, otherwise the birth may result in hemorrhage and/or maternal demise. Fourth stage of labor occurs during the first 1 - 4 hours after birth. This stage Fourth stage of labor occurs during the first 1 - 4 hours after birth. This stage includes the physical recovery of the mother and infant. Bonding between the includes the physical recovery of the mother and infant. Bonding between the mother and infant occurs, uterine contractions are still occurring to help mother and infant occurs, uterine contractions are still occurring to help control bleeding, some pain due to the mild contractions or traumas due to control bleeding, some pain due to the mild contractions or traumas due to the birth may also be present. The woman is usually exhausted but finds it the birth may also be present. The woman is usually exhausted but finds it hard to sleep with all of the excitement, and eagerness to get acquainted withhard to sleep with all of the excitement, and eagerness to get acquainted with her new baby. her new baby.

2.2. Describe the 3 phases of a contraction. Define frequency, Describe the 3 phases of a contraction. Define frequency, duration and intensity as it relates to the contraction.duration and intensity as it relates to the contraction.

The normal characteristics of contractions are coordinated, involuntary and The normal characteristics of contractions are coordinated, involuntary and intermittent. Contractions occur in three phases; increment, which occurs as intermittent. Contractions occur in three phases; increment, which occurs as the contraction begins in the fundus and spreads to the rest of the uterus; the contraction begins in the fundus and spreads to the rest of the uterus; peak, where the contraction is the strongest or most intense; and decrement, peak, where the contraction is the strongest or most intense; and decrement, which is the period of the contractions decrease in intensity, the uterus has which is the period of the contractions decrease in intensity, the uterus has begun to relax again. The contraction cycle is also described in terms of begun to relax again. The contraction cycle is also described in terms of frequency, duration and intensity. Frequency is the time in between the start frequency, duration and intensity. Frequency is the time in between the start of 2 contractions, it is measured in minutes. Duration refers to the length of of 2 contractions, it is measured in minutes. Duration refers to the length of the contraction from the beginning to end. It is expressed in seconds. The the contraction from the beginning to end. It is expressed in seconds. The intensity refers to the strength of the contraction(s), terms used to describe intensity refers to the strength of the contraction(s), terms used to describe the strength are mild, moderate and intense. the strength are mild, moderate and intense.

3.3. What is an epidural? State the nursing care for the client that What is an epidural? State the nursing care for the client that has received an epidural.has received an epidural.

An epidural is a regional analgesia and anesthesia that provides adequate An epidural is a regional analgesia and anesthesia that provides adequate pain relief without sedating the woman during labor and birth. The epidural pain relief without sedating the woman during labor and birth. The epidural block is best when started in women who are in active labor, as giving it prior block is best when started in women who are in active labor, as giving it prior to has been shown to slow the progress of labor. Epidural blocks are usually to has been shown to slow the progress of labor. Epidural blocks are usually performed by an anesthesiologist or nurse anesthetist. A local anesthetic is performed by an anesthesiologist or nurse anesthetist. A local anesthetic is injected into the small epidural space and is usually combined with opiod injected into the small epidural space and is usually combined with opiod analgesics to provide substantial pain relief. The epidural is given via an analgesics to provide substantial pain relief. The epidural is given via an epidural catheter that is inserted into the woman's L3 or L4 interspace, the epidural catheter that is inserted into the woman's L3 or L4 interspace, the catheter allows a continuous infusion of medication so that pain relief can be catheter allows a continuous infusion of medication so that pain relief can be maintained during labor and birth. The epidural can also be individualized maintained during labor and birth. The epidural can also be individualized depending on the level of pain relief the woman is wanting to achieve, the depending on the level of pain relief the woman is wanting to achieve, the medication can also be given intermittently or by PCA. Nursing care of the medication can also be given intermittently or by PCA. Nursing care of the

woman who has received an epidural includes: recording maternal vital signs woman who has received an epidural includes: recording maternal vital signs and FHR to use as a baseline to compare with vitals taken after the epidural is and FHR to use as a baseline to compare with vitals taken after the epidural is given, assessment of the woman's bladder must be done frequently as a full, given, assessment of the woman's bladder must be done frequently as a full, distended bladder can inhibit the descent of the fetus, urinary catheterizationsdistended bladder can inhibit the descent of the fetus, urinary catheterizations are performed as ordered, observing for signs and symptoms related to any are performed as ordered, observing for signs and symptoms related to any adverse effects or catheter migration, and to ensure adequate intravenous adverse effects or catheter migration, and to ensure adequate intravenous access is in place with the proper fluids running at the correct rate. access is in place with the proper fluids running at the correct rate.

4.4. What are the two types of electronic fetal monitoring? Hint: What are the two types of electronic fetal monitoring? Hint: External and Internal! When is each used? What conditions External and Internal! When is each used? What conditions have to be present for internal monitoring?have to be present for internal monitoring?

The two types of electronic fetal monitoring are external and internal fetal The two types of electronic fetal monitoring are external and internal fetal monitoring. The external fetal monitor is commonly used during labor to monitoring. The external fetal monitor is commonly used during labor to assess the fetal heart rate and uterine activity. The external monitor is appliedassess the fetal heart rate and uterine activity. The external monitor is applied to the woman's belly and secured in place with an elastic belt, it usually needsto the woman's belly and secured in place with an elastic belt, it usually needs to be readjusted to the correct position when the mother or fetus is active. No to be readjusted to the correct position when the mother or fetus is active. No special conditions have to be present to use the external monitor, the woman special conditions have to be present to use the external monitor, the woman just has to be pregnant. There are some factors that can affect the apparent just has to be pregnant. There are some factors that can affect the apparent intensity of a contraction: fetal size(small), abdominal fat thickness, position intensity of a contraction: fetal size(small), abdominal fat thickness, position of the mother, and location of the transducer. of the mother, and location of the transducer. Internal fetal monitoring is used for a more accurate assessment of the fetal Internal fetal monitoring is used for a more accurate assessment of the fetal heart rate and uterine activity. This monitor is an invasive device, and requiresheart rate and uterine activity. This monitor is an invasive device, and requires the membranes to be ruptured as well as at least 2 cm of cervical dilation. the membranes to be ruptured as well as at least 2 cm of cervical dilation. This type of monitor since it is invasive increases the risk of infections. This type of monitor since it is invasive increases the risk of infections. Internal monitoring uses an electrode that is attached under the skin about 1 Internal monitoring uses an electrode that is attached under the skin about 1 mm on the scalp of the fetus, but in a breech presentation it may be applied mm on the scalp of the fetus, but in a breech presentation it may be applied to the buttocks. The electrode only records the fetal heart rate, another deviceto the buttocks. The electrode only records the fetal heart rate, another device called an intrauterine pressure catheter is used to measure the uterine called an intrauterine pressure catheter is used to measure the uterine activity. This pressure catheter senses the changes in the intrauterine activity. This pressure catheter senses the changes in the intrauterine pressure, it is also sensitive enough to pick up intra-abdominal pressure pressure, it is also sensitive enough to pick up intra-abdominal pressure changes as seen with coughing and/or vomiting. changes as seen with coughing and/or vomiting.

5.5. Give the normal ranges for the fetal heart rate. What is Give the normal ranges for the fetal heart rate. What is bradycardia and a possible cause? What is tachycardia and a bradycardia and a possible cause? What is tachycardia and a possible cause?possible cause?

The normal range of the fetal heart rate is from 110 - 160 bpm, and the rate isThe normal range of the fetal heart rate is from 110 - 160 bpm, and the rate is variable by the age of the fetus, premature fetuses of 26 - 28 weeks are at thevariable by the age of the fetus, premature fetuses of 26 - 28 weeks are at the higher end of the range due to the immature parasympathetic nervous higher end of the range due to the immature parasympathetic nervous system. system. Bradycardia is a fetal heart rate less than 110 bpm, that lasts for 10 minutes Bradycardia is a fetal heart rate less than 110 bpm, that lasts for 10 minutes or longer. Possible causes of fetal bradycardia include: fetal head or longer. Possible causes of fetal bradycardia include: fetal head compression, fetal hypoxia, fetal heart block, fetal acidosis, compression of compression, fetal hypoxia, fetal heart block, fetal acidosis, compression of the umbilical cord, and/or late second-stage labor with maternal pushing.the umbilical cord, and/or late second-stage labor with maternal pushing.Tachycardia is a fetal heart rate more than 160 bpm for at least 10 minutes. Tachycardia is a fetal heart rate more than 160 bpm for at least 10 minutes. Possible causes of fetal tachycardia: maternal dehydration, maternal fever, Possible causes of fetal tachycardia: maternal dehydration, maternal fever, maternal or fetal hypoxia, maternal or fetal hypovolemia, maternal maternal or fetal hypoxia, maternal or fetal hypovolemia, maternal hyperthyroidism, fetal cardiac arrhythmias, severe maternal anemia, fetal hyperthyroidism, fetal cardiac arrhythmias, severe maternal anemia, fetal acidosis, or drugs that were given to the mother (decongestants, acidosis, or drugs that were given to the mother (decongestants, bronchodilators, or stimulant drugs).bronchodilators, or stimulant drugs).

6.6. Define variability and baseline as they are related to the fetal Define variability and baseline as they are related to the fetal heart rate. Why is variability important?heart rate. Why is variability important?

The fetal heart rate baseline is the average heart rate in two minutes, and The fetal heart rate baseline is the average heart rate in two minutes, and then rounded to the nearest 5 bpm. The uterus must be at rest, between then rounded to the nearest 5 bpm. The uterus must be at rest, between contractions, and there must not be any significant fluctuations in the rate contractions, and there must not be any significant fluctuations in the rate with in the time it is being measured. with in the time it is being measured. Variability denotes the fluctuations in the baseline fetal heart rate that cause Variability denotes the fluctuations in the baseline fetal heart rate that cause the printed paper to have an irregular rather than smooth appearance. the printed paper to have an irregular rather than smooth appearance. Variability occurs because of the multiple factors that affect the fetal heart Variability occurs because of the multiple factors that affect the fetal heart rate. Evaluating variability is important to help in determining how tolerant rate. Evaluating variability is important to help in determining how tolerant the fetus is of labor. Variability is used during electronic fetal monitoring the fetus is of labor. Variability is used during electronic fetal monitoring because with adequate oxygenation the normal function of the autonomic because with adequate oxygenation the normal function of the autonomic nervous system is promoted which helps the fetus tolerate and adapt to the nervous system is promoted which helps the fetus tolerate and adapt to the stresses of labor.stresses of labor.

7.7. Define decelerations. State the three major types of Define decelerations. State the three major types of decelerations, possible causes and treatments for each.decelerations, possible causes and treatments for each.

The three types of decelerations are; early decelerations which are not The three types of decelerations are; early decelerations which are not associated with fetal compromise, and have a gradual decrease from the associated with fetal compromise, and have a gradual decrease from the baseline FHR. These decelerations are thought to be caused by fetal head baseline FHR. These decelerations are thought to be caused by fetal head compression that normally occurs during a contraction, the deceleration compression that normally occurs during a contraction, the deceleration should be no more than 30 - 40 bpm less than the baseline; late decelerationsshould be no more than 30 - 40 bpm less than the baseline; late decelerations indicate a deficient exchange of oxygen and waste products in the placenta, indicate a deficient exchange of oxygen and waste products in the placenta, these are non-reassuring patterns. If late decelerations are seen it indicates these are non-reassuring patterns. If late decelerations are seen it indicates the fetus is intolerant of contractions during labor. The cause may be maternalthe fetus is intolerant of contractions during labor. The cause may be maternal hypotension, diabetes, or maternal hypertension. This type of deceleration hypotension, diabetes, or maternal hypertension. This type of deceleration usually start after the peak of a contraction with the FHR returning to the usually start after the peak of a contraction with the FHR returning to the baseline after the contraction has ended; variable decelerations occur when baseline after the contraction has ended; variable decelerations occur when flow is reduced in the umbilical cord. This type of deceleration may or may notflow is reduced in the umbilical cord. This type of deceleration may or may not occur during contractions, and rise and fall abruptly as the umbilical cord is occur during contractions, and rise and fall abruptly as the umbilical cord is compressed and then relieved. Variable decelerations last up to 15 seconds compressed and then relieved. Variable decelerations last up to 15 seconds and decrease in the fetal heart rate is at least 15 bpm. Causes of variable and decrease in the fetal heart rate is at least 15 bpm. Causes of variable decelerations may include: nuchal cord, prolapsed cord, oligohydraminios or decelerations may include: nuchal cord, prolapsed cord, oligohydraminios or other conditions causing insufficient blood flow in the umbilical cord.other conditions causing insufficient blood flow in the umbilical cord.

8.8. If a pattern of late decelerations is detected, what nursing If a pattern of late decelerations is detected, what nursing actions should be initiated? If the deceleration does not actions should be initiated? If the deceleration does not improve, what action will probably be taken?improve, what action will probably be taken?

If late decelerations are seen or other non reassuring fetal heart rate patterns,If late decelerations are seen or other non reassuring fetal heart rate patterns, the nurse should try to identify the cause, by evaluating the patterns, the nurse should try to identify the cause, by evaluating the patterns, monitoring maternal vital signs, and perform a vaginal exam for evidence of a monitoring maternal vital signs, and perform a vaginal exam for evidence of a prolapsed cord. If oxytocin is being given via IV it needs to be stopped, fluids prolapsed cord. If oxytocin is being given via IV it needs to be stopped, fluids need to be increased to increase the mothers blood volume, the mother need to be increased to increase the mothers blood volume, the mother should be put in a non-supine position, give Oshould be put in a non-supine position, give O22

by face mask at 8 - 10 L/min, start continuous electronic fetal monitoring if notby face mask at 8 - 10 L/min, start continuous electronic fetal monitoring if not already begun, notify the physician or mid-wife as soon as possible. If the late already begun, notify the physician or mid-wife as soon as possible. If the late decelerations are severe the nurse and staff should prepare for immediate decelerations are severe the nurse and staff should prepare for immediate delivery via cesarean section, the staff should include persons to resuscitate delivery via cesarean section, the staff should include persons to resuscitate the neonate if needed. the neonate if needed.

9.9. What is pitocin and when is it used in labor and delivery? How What is pitocin and when is it used in labor and delivery? How is it given and what nursing actions are necessary during its is it given and what nursing actions are necessary during its use? Why/how is it used after the delivery?use? Why/how is it used after the delivery?

Pitocin also known as Oxytocin, is an identical synthetic compound to a Pitocin also known as Oxytocin, is an identical synthetic compound to a natural hormone produced by the posterior pituitary. It stimulates smooth, natural hormone produced by the posterior pituitary. It stimulates smooth, uterine muscles, which results in increases in the strength, frequency, and uterine muscles, which results in increases in the strength, frequency, and duration of a contraction. It is used to induce or augment labor contractions atduration of a contraction. It is used to induce or augment labor contractions at or near term. It is also used to help control and maintain postpartum bleeding,or near term. It is also used to help control and maintain postpartum bleeding, by stimulating the uterus to contract, which helps in compressing blood by stimulating the uterus to contract, which helps in compressing blood vessels. It can also be used to induce labor of an inevitable or incomplete vessels. It can also be used to induce labor of an inevitable or incomplete abortion. Nursing actions needed during pitocin administration include: abortion. Nursing actions needed during pitocin administration include: assessing fetal heart rate, maternal vital signs, observe for effective labor assessing fetal heart rate, maternal vital signs, observe for effective labor patterns by watching contraction frequency, duration, and intensity, and patterns by watching contraction frequency, duration, and intensity, and observe for hypo or hypertonic uterine contractions. The pitocin is usually observe for hypo or hypertonic uterine contractions. The pitocin is usually given IV piggypack or by intramuscular injections. When pitocin is continued given IV piggypack or by intramuscular injections. When pitocin is continued or given postpartum nursing actions should include: observing firmness of the or given postpartum nursing actions should include: observing firmness of the fundus, as well as the height and deviation, massaging the fundus if boggy, fundus, as well as the height and deviation, massaging the fundus if boggy, watch for signs of hemorrhage, such as more than one peri-pad an hour watch for signs of hemorrhage, such as more than one peri-pad an hour and/or large clots. Monitor vital signs, intake and output, signs of cramping, and/or large clots. Monitor vital signs, intake and output, signs of cramping, breath sounds and for other signs of fluid retention. breath sounds and for other signs of fluid retention.

10.10. Define effacement and tell how it is measured. Define dilation Define effacement and tell how it is measured. Define dilation and tell how it is measured. How do both of these indicate and tell how it is measured. How do both of these indicate progress in labor?progress in labor?

Effacement is the thinning and shortening of the cervix that occurs during Effacement is the thinning and shortening of the cervix that occurs during labor. It occurs because of the descending fetus which pushes down on the labor. It occurs because of the descending fetus which pushes down on the cervix making it shorten and thin. The nulliparous woman completes cervix making it shorten and thin. The nulliparous woman completes effacement earlier in the laboring process than the multiparous woman, effacement earlier in the laboring process than the multiparous woman, because the multiparous woman has a thicker cervix. Measurement of cervicalbecause the multiparous woman has a thicker cervix. Measurement of cervical effacement is estimated as a percentage or the original cervical length, with aeffacement is estimated as a percentage or the original cervical length, with a fully thinned cervix being 100% effaced. fully thinned cervix being 100% effaced. Dilation is the opening of the cervix that occurs during labor. 10 cm dilation is Dilation is the opening of the cervix that occurs during labor. 10 cm dilation is considered complete cervical dilation. The 10 cm dilation is sufficient enough considered complete cervical dilation. The 10 cm dilation is sufficient enough to allow the passage of the full term fetus. to allow the passage of the full term fetus.

11.11. What are some of the different types of analgesia given to the What are some of the different types of analgesia given to the mother while she is in labor and how do these affect the fetus?mother while she is in labor and how do these affect the fetus?

Labor and delivery includes a great deal of pain, and laboring women all deal Labor and delivery includes a great deal of pain, and laboring women all deal with the pain differently. However most will want some type of pain relief, with the pain differently. However most will want some type of pain relief, some of these analgesics include: Demerol, Fentanyl, and Nubain, these are some of these analgesics include: Demerol, Fentanyl, and Nubain, these are opiod analgesics. The opiod analgesic Demerol given for pain relief may causeopiod analgesics. The opiod analgesic Demerol given for pain relief may cause dysphoria rather than any significant effect on pain. This analgesic is also of dysphoria rather than any significant effect on pain. This analgesic is also of concern because its metabolite normeperidine has a half-life of 15 - 23 hours concern because its metabolite normeperidine has a half-life of 15 - 23 hours in the newborn which can result in neonatal respiratory depression or low in the newborn which can result in neonatal respiratory depression or low Apgar score. The opiod analgesics are usually given in frequent, small doses Apgar score. The opiod analgesics are usually given in frequent, small doses via IV, to ensure quick pain relief with a predictable duration of action, and it via IV, to ensure quick pain relief with a predictable duration of action, and it also reduces the risk of neonate respiratory depression. Other medications also reduces the risk of neonate respiratory depression. Other medications such as, Phenergan are usually given with opiod analgesics to help relieve such as, Phenergan are usually given with opiod analgesics to help relieve nausea and vomiting that is common when opiates are given. Phenergan can nausea and vomiting that is common when opiates are given. Phenergan can also add to the opiod's effect on respiratory depression. Sedatives such as also add to the opiod's effect on respiratory depression. Sedatives such as

barbituates may be given in small doses to help a fatigued, laboring woman barbituates may be given in small doses to help a fatigued, laboring woman rest, but these are not commonly given because of their prolonged depressantrest, but these are not commonly given because of their prolonged depressant effects on the newborn. effects on the newborn.

12.12. What is PIH and describe the treatments and care of the What is PIH and describe the treatments and care of the mother in labor with PIH?mother in labor with PIH?

PIH is pregnancy induced hypertension also known as preeclampsia. It is PIH is pregnancy induced hypertension also known as preeclampsia. It is characterized by a systolic blood pressure of 140 mmHg and a diastolic of 90 characterized by a systolic blood pressure of 140 mmHg and a diastolic of 90 mmHg that develops after 20 weeks gestation. It is also accompanied by mmHg that develops after 20 weeks gestation. It is also accompanied by proteinuria of proteinuria of 0.3g collected in a 24 hour period, and random testing done by0.3g collected in a 24 hour period, and random testing done by using a urine dipstick of using a urine dipstick of 1+. Treatment and care of the intrapartum woman 1+. Treatment and care of the intrapartum woman with PIH includes: administration of oxytocin to induce labor if not with PIH includes: administration of oxytocin to induce labor if not contraindicated, keeping the woman in a lateral position to promote placental contraindicated, keeping the woman in a lateral position to promote placental circulation, pain relief should be well managed to help prevent the woman circulation, pain relief should be well managed to help prevent the woman from getting agitated which can increase the blood pressure and thus from getting agitated which can increase the blood pressure and thus increasing the risk for seizures, the woman must also be on seizure increasing the risk for seizures, the woman must also be on seizure precautions (bed rails up, close monitoring of vitals, dim lights), Magnesium precautions (bed rails up, close monitoring of vitals, dim lights), Magnesium sulfate is given with the oxytocin in a secondary infusion to offset seizures sulfate is given with the oxytocin in a secondary infusion to offset seizures from occurring, continuous electronic fetal monitoring should be initiated if notfrom occurring, continuous electronic fetal monitoring should be initiated if not already, and during the birth a pediatrician, neonatologist, or neonatal nurse already, and during the birth a pediatrician, neonatologist, or neonatal nurse practitioner must be present to care for the newborn, a resuscitation team practitioner must be present to care for the newborn, a resuscitation team must also be ready if needed. must also be ready if needed.

13.13. What assessment and nursing care is given to the mother in What assessment and nursing care is given to the mother in the immediate recovery period after her delivery?the immediate recovery period after her delivery?

Care during the immediate recovery period following birth focuses on Care during the immediate recovery period following birth focuses on observing for hemorrhage and relief of any pain or discomfort. When observing for hemorrhage and relief of any pain or discomfort. When observing for hemorrhaging it is important to assess the woman's vital signs, observing for hemorrhaging it is important to assess the woman's vital signs, bladder for distention, amount and color of lochia, and uterine fundus. bladder for distention, amount and color of lochia, and uterine fundus. Assessment of the fundus should include the fundal height, firmness, and Assessment of the fundus should include the fundal height, firmness, and position, this should be assessed with each vital sign assessment. The fundusposition, this should be assessed with each vital sign assessment. The fundus is one of the most important aspects to assess when observing for signs of is one of the most important aspects to assess when observing for signs of hemorrhage, as it is the most common cause of excess bleeding in the post hemorrhage, as it is the most common cause of excess bleeding in the post partum woman. If the uterus does not continue to contract firmly it inhibits partum woman. If the uterus does not continue to contract firmly it inhibits the compression of blood vessels that are open at the placental separation the compression of blood vessels that are open at the placental separation site. During this exam, the fundus should be firm, midline, positioned below site. During this exam, the fundus should be firm, midline, positioned below the umbilicus, and about the size of a large grapefruit depending on the the umbilicus, and about the size of a large grapefruit depending on the normal anatomy of the woman and also if she was pregnant with multiple normal anatomy of the woman and also if she was pregnant with multiple fetuses. Bladder distention can cause the uterine contractions to stop or slow, fetuses. Bladder distention can cause the uterine contractions to stop or slow, which can also lead to hemorrhaging. If distention is felt the woman should bewhich can also lead to hemorrhaging. If distention is felt the woman should be given a bedpan so that she can empty her bladder, if she is unable to due to given a bedpan so that she can empty her bladder, if she is unable to due to swelling of the urinary meatus related to trauma caused by birth she may swelling of the urinary meatus related to trauma caused by birth she may need to be catheterized. The lochia should also be assessed each time vital need to be catheterized. The lochia should also be assessed each time vital signs are taken. The lochia should not exceed one peri-pad an hour signs are taken. The lochia should not exceed one peri-pad an hour immediately following birth, nor should it have any large clots. If either of immediately following birth, nor should it have any large clots. If either of these are noticed the physician should be contacted immediately. The these are noticed the physician should be contacted immediately. The perineum and labial areas should also be assessed for hematoma formation, perineum and labial areas should also be assessed for hematoma formation, and can be inhibited by application of ice packs to the areas. Comfort of the and can be inhibited by application of ice packs to the areas. Comfort of the post partum woman is also important following birth. Ensure the woman has post partum woman is also important following birth. Ensure the woman has clean bedding, if they were soiled, ice packs for her perineal areas (some peri-clean bedding, if they were soiled, ice packs for her perineal areas (some peri-pads have ice packs in them which just need to be put in the freezer or pads have ice packs in them which just need to be put in the freezer or fridge), she may also need to be given analgesics for afterpains common afterfridge), she may also need to be given analgesics for afterpains common after birth. Nurses should instruct the woman to ask for pain medication prior to thebirth. Nurses should instruct the woman to ask for pain medication prior to the

pain level getting uncomfortable. It is common for women to be chilly after pain level getting uncomfortable. It is common for women to be chilly after giving birth so ensuring they are warm by providing extra blankets and warm giving birth so ensuring they are warm by providing extra blankets and warm drinks. The nurse also allows privacy for the family so that the mother and drinks. The nurse also allows privacy for the family so that the mother and father and if any siblings may start the bonding process. If the infant has a father and if any siblings may start the bonding process. If the infant has a normal Apgar score the infant may be allowed to stay with the mother for its normal Apgar score the infant may be allowed to stay with the mother for its first assessment and bath (depending on the facilities policy). Mothers who first assessment and bath (depending on the facilities policy). Mothers who have chosen to breastfeed are allowed to do so at this time, the sucking of thehave chosen to breastfeed are allowed to do so at this time, the sucking of the infant during breastfeeding stimulates oxytocin secretion which helps in infant during breastfeeding stimulates oxytocin secretion which helps in contracting the fundus as well as maintaining the firmness of the fundus.contracting the fundus as well as maintaining the firmness of the fundus.

14.14. What are the three main causes and treatments for What are the three main causes and treatments for postpartum hemorrhage?postpartum hemorrhage?

Postpartum hemorrhaging is a leading cause of maternal demise. Three main Postpartum hemorrhaging is a leading cause of maternal demise. Three main causes include: Uterine atony which is responsible for about 80% of post causes include: Uterine atony which is responsible for about 80% of post partum hemorrhage. This condition is caused by the lack of uterine muscle partum hemorrhage. This condition is caused by the lack of uterine muscle tone resulting in the inability of the uterus to contract. Treatment for this tone resulting in the inability of the uterus to contract. Treatment for this condition includes massaging the uterus and expressing any clots that have condition includes massaging the uterus and expressing any clots that have accumulated, ensuring that the bladder is not full as this too may inhibit the accumulated, ensuring that the bladder is not full as this too may inhibit the uterus from contracting properly, administration of oxytocin may be given uterus from contracting properly, administration of oxytocin may be given diluted in a rapid IV infusion to induce uterine contractions, if blood loss has diluted in a rapid IV infusion to induce uterine contractions, if blood loss has caused blood pressure to fall Methergine may be given to help increase the caused blood pressure to fall Methergine may be given to help increase the blood pressure, if the oxytocin is not effective in controlling the uterine atony blood pressure, if the oxytocin is not effective in controlling the uterine atony a drug named Prostin or Hemabate may be given IM or injected right into the a drug named Prostin or Hemabate may be given IM or injected right into the uterine muscle. If bleeding is unable to be controlled arteries may have to be uterine muscle. If bleeding is unable to be controlled arteries may have to be cauterized or even complete and radical hysterectomy. cauterized or even complete and radical hysterectomy. Trauma is the second common cause of post partum hemorrhage, and can Trauma is the second common cause of post partum hemorrhage, and can include trauma to the vagina, cervix, as well as perineal lacerations or include trauma to the vagina, cervix, as well as perineal lacerations or hematomas. Surgical repair is often needed for hemorrhaging caused by hematomas. Surgical repair is often needed for hemorrhaging caused by trauma.trauma.Subinvolution, which is the most dangerous due to the time period it happens,Subinvolution, which is the most dangerous due to the time period it happens, occurs 7 - 14 days after birth and is due to the delayed return of the uterus to occurs 7 - 14 days after birth and is due to the delayed return of the uterus to its non-pregnant size, and fragments of the placenta that remained attached its non-pregnant size, and fragments of the placenta that remained attached to the myometrium. Excessive bleeding occurs when the clots start to slough to the myometrium. Excessive bleeding occurs when the clots start to slough away several days after birth. This is the most dangerous post partum away several days after birth. This is the most dangerous post partum hemorrhage because the woman is unaware and unsuspecting of any hemorrhage because the woman is unaware and unsuspecting of any complications this far after birth. Treatment is usually done immediately after complications this far after birth. Treatment is usually done immediately after birth by ensuring the placenta is intact once expelled, if it is not the physician birth by ensuring the placenta is intact once expelled, if it is not the physician or mid-wife may manually explore the uterus to locate the missing fragments, or mid-wife may manually explore the uterus to locate the missing fragments, and then remove them. If this condition does occur and able to be treated, theand then remove them. If this condition does occur and able to be treated, the treatment includes: controlling the bleeding by administering oxytocin, treatment includes: controlling the bleeding by administering oxytocin, methylergonovine, or prostaglandins. Placental fragments are usually expelledmethylergonovine, or prostaglandins. Placental fragments are usually expelled with the bleeding, but a sonogram may be done to locate any placental with the bleeding, but a sonogram may be done to locate any placental fragments. If bleeding continues a D&C may be necessary to remove the fragments. If bleeding continues a D&C may be necessary to remove the fragments. Broad spectrum antibiotics are also given if infection is suspected. fragments. Broad spectrum antibiotics are also given if infection is suspected.