Chapter Summary on Fetal Assessment and Labor & Birth by Loreyce Sanchez https://padlet.com/190137c/fah3ohft3i4nd89o By Loreyce Sanchez BSN 2-B en-us 2020-10-02 13:16:37 UTC 2020-10-06 05:23:50 UTC hello@padlet.com https://padlet.net/icons/png/1f476.png Labor and Birth Module 190137c https://padlet.com/190137c/fah3ohft3i4nd89o/wish/797497397
4 P's of Labor:
  1. Passage - should be adequate in size & contour 
  2. Passenger - should be appropriate in size & in an advantageous position & presentation 
  3. Power of labor - should be adequate 
  4. Woman's psyche - should be preserved, so that afterward labor can be viewed as a positive experience 

A point to remember: 
  • Each contraction squeezes the blood vessels that supply the placenta, thereby decreasing the amount of oxygen that flows to the fetus. The relaxation period allows the vessels to fill with oxygen-rich blood to supply the placenta.

3 Theories of Labor Onset (a result of changes in the following hormones/chemicals)
  1. Decrease in PROGESTERONE
  2. Release of OXYTOCIN
  3. Production of PROSTAGLANDINS

Preliminary Signs of Labor:
  • Lightening
  • Braxton-Hicks Contractions
  • Nesting Instinct
  • Ripening of Cervix
  • Weight loss
  • Bloody show
  • Rupture of membranes

True Labor signs:
  • Uterine contractions
  • Show
  • Rupture of membranes

Mechanisms of labor:
  • Descent -  a continuous process from engagement until birth 
  • Flexion - nodding of the fetal head toward the chest. 
  • Internal Rotation - occipitotransverse to the occipito anterior position while descending 
  • Extension - begins when the head crowns to head passing under the symphysis pubis
  • External Rotation (Restitution) -  realignment of the fetal head with the body after the head emerges
  • External Rotation (Shoulder Rotation) - shoulders externally rotate after the head emerges and restitution occurs 
  • Expulsion - birth of the entire body

Duration of labor:
  1. Primipara - 14 to 20hrs
  2. Multipara - 8 to 14

Fetal Presentation
  • Refers to the foremost part of the fetus that enters the pelvic inlet.

Fetal attitude: Degree of Flexion
Good Attitude
  • Advantageous for birth because it helps the fetus present the smallest AP diameter of the skull to the pelvis
  • Also puts the whole body into an ovoid shape, occupying the smallest space possible o Complete flexion: spinal column bowed forward, head is flexed forward, chin touches the sternum, arms are flexed & folded on the chest, thighs are flexed onto the abdomen, and the calves are pressed against the posterior aspect of the thighs

Complete flexion 
  • The most common attitude; most favorable for vaginal birth; - Skull smallest diameter to the bony pelvis: Sub-occipto bregmatic 

Stages of labor 
  1. First - active labor to full cervical dilatation
  2. Second - full cervical dilatation to delivery of infant
  3. Third - delivery of infant to delivery of placenta
  4. Fourth - delivery of placenta up to 1-4 hrs

Fetal lie
  • Relationship between the spine of the fetus to the spine of the mother; whether the fetus is lying in a horizontal (transverse) or vertical (longitudinal) position. 99% assume a longitudinal lie.

Cephalic
  • Most frequent type, 95%
  • 4 types: vertex, face, brow & mentum presentation
  • Vertex is the ideal part because the skull is capable of molding
  • Effectively; aid in cervical dilatation & prevents complications such as prolapsed cord.
  • Fetal skull that contacts the cervix becomes edematous (capput succedaneum) due to continued pressure against it.

Shoulder
  • Fetus lie horizontally (transverse) in the pelvis – longest fetal axis is perpendicular to that of the mother, 1% of births
  • Presenting part is usually the acromion process, iliac crest or elbow. 
  • Caused by: relaxed abdominal walls, pelvic contraction, placenta previa (placenta located low in the uterus).
  • Must be born by caesarian birth 

A point to remember:
In true labor, contractions are accompanied by cervical dilatation and effacement.

Fetal Station
  • How far the presenting part descended into the pelvis
  • Ischial spines→ 0 station “engaged”
  • Above ischial spines→ negative
  • Below ischial spines→ positive
  • +3-+4 crowning

Molding
  • Change in contour of fetal head due to uterine force with undilated cervix
  • Overlapping of sutures
  • May be palpable at birth, lasts 1-2 days

Effacement
  • The softening and thinning of cervical canal recorded in percentage.

Dilatation
  • The widening of the external cervical os to 10 cm 
  • Primipara: 1st effacement then dilation 
  • Multipara: Both processes occur at the same time 

A point to remember:
  • If an infant can’t be born vaginally, emphasize to parents that it is the pelvis that is too small, not that the fetal head is too big. 


]]> 2020-10-02 13:17:47 UTC https://padlet.com/190137c/fah3ohft3i4nd89o/wish/797497397 Chapter Summary of Piliteri's Assessment of Maternal and Fetal Health 190137c https://padlet.com/190137c/fah3ohft3i4nd89o/wish/799552995 Prenatal care 
  • Essential for ensuring overall health of newborns and their mothers 
  • A major strategy for helping to reduce complications of pregnancy such as number of low-birth-weight babies born yearly 
  • Begins during a woman’s childhood 
  • Includes balanced nutrition with adequate intake of calcium & vitamin D 
  • Adequate immunizations against contagious diseases and maintenance of an overall healthy lifestyle is also included to ensure best state of health 
  • Lack of prenatal care is associated with the birth of preterm infants and various complications for a woman such as hypertension of pregnancy 
 
Purposes of prenatal care
  • Establish a baseline of present health  
  • Determine the gestational age of the fetus  
  • Monitor fetal development and maternal well-being  
  • Identify women at risk for complications  
  • Minimize the risk of possible complications by anticipating and preventing problems before they occur  
  • Provide time for education about pregnancy, lactation, and newborn care 
 
Several National Health Goals speak directly to the importance of prenatal care  
  • Increase the proportion of pregnant women who receive early and adequate prenatal care from a baseline of 74% to a target of 90% 
  • Increase the proportion of pregnant women who attend a series of prepared childbirth classes from a baseline of 66% to a target of 77% 
  • Increase to at least 90% the proportion of all pregnant women who receive prenatal care in the first trimester of pregnancy from a baseline of 83% (http://www.nih.gov) 
 
Nursing Process
1. Assessment 
  • First prenatal visit is a time to establish baseline data relevant to health assessment and health-promotion strategies 
  • Begins with obtaining health history, including screening for presence of teratogens 
  • Explaining why specific assessment data are relevant to the pregnancy is important 
  • Relay assessment information to help keep a woman and her family well informed 
 2. Nursing Diagnosis 
  • Usually focuses on the response of a woman and her family 
  • Decisional conflict related to desire to be pregnant and risk for ineffective coping related to confirmation of unplanned pregnancy would be an example 
  • Health-seeking behaviors related to guidelines for nutrition and activity during pregnancy is a nursing diagnosis appropriate to prenatal care 
 3. Outcome Identification and Planning 
  • Be certain to reserve sufficient time at prenatal visits so care can be thorough 
  • There should be enough time to set realistic goals and expected outcomes 
  • Establishing a pattern of regular appointments is crucial to providing effective prenatal care 
  • Reliable Internet sites to use for referral on preconceptual or prenatal care are the National Institute of Health and Human Development 
 4. Implementation 
  • Teaching women and their families about a safe pregnancy lifestyle is an important nursing intervention 
  • It may be helpful to give a woman and her partner pamphlets or books that cover the same topics 
  • Be certain that you have read all the printed material you give families to ensure that a pamphlet’s advice is consistent with what you have said and with the views of a woman’s primary care physician or nurse-midwife 
5. Outcome Evaluation  
  • Evaluation during prenatal visits should concentrate on a woman’s initial progress  
  • Couple state they have reached a mutual decision to both stop smoking is an example of expected outcome 
 
The Preconceptual Visit 
  • Ideally, women should schedule an appointment with a physician or nurse-midwife 
  • This is done to obtain accurate reproductive life planning information, receive reassurance about fertility, and detect any problems that may need correction 
  • Consists of thorough health history, and physical and pelvic examinations 
  • A woman can be counseled on the importance of a good protein diet 
 
Choosing a Health Care Provider for Pregnancy and Childbirth 
  • Once a woman is or suspects that she may be pregnant, her next step is to choose a primary health care provider 
  • Various options are available, including a prenatal clinic, her health maintenance organization (HMO) or preferred provider (PPO) 
  • Regardless of the type of health care provider chosen, prenatal care needs to be initiated early and continued throughout pregnancy 
  • Nurses contribute to the success of prenatal care by listening, counseling, and teaching, three areas of nursing expertise 

Health Assessment During the First Prenatal Visit
  • An important focus of all prenatal visits is to screen for danger signs that might reveal any risky conditions
  • Screening includes an extensive health history, a complete physical examination, including a pelvic examination, and blood and urine specimens for laboratory work. Manual pelvic measurements can be taken to determine pelvic adequacy

The Initial Interview
  • Good interviewing technique is important to obtain thorough and meaningful health histories
  • Interviewing expectant women often elicits contradictory information
  • Interviewing them should go smoothly and be productive
  • It is best accomplished to interview in a private, quiet setting

Components of the Health History
An initial interview serves several purposes:
  • Establishing rapport
  • Gaining information about a woman’s physical and psychosocial health
  • Obtaining a basis for anticipatory guidance for the pregnancy

Demographic Data
  • Demographic data usually obtained include name, age, address, telephone number, e-mail address, religion, and health insurance information.

Chief Concern
  • The chief concern is the reason a woman has come to the health care setting.

Family Profile
  • Obtaining this information early in an interview can help you get to know a woman earlier, identify important support persons, shape the nature and kind of questions to be asked, and evaluate the possible impact of a woman’s culture on care.

History of Past Illnesses
  • Questions about a woman’s past medical history are an important part of an interview because a past condition can become active during or immediately following pregnancy.

History of Family Illnesses
  • A family history documents illnesses that occur frequently in the family and so can help identify potential problems in a woman during pregnancy or in her infant at birth.

Day History/Social Profile
  • Information about a woman’s current nutrition, elimination, sleep, recreation, and interpersonal interactions can be elicited best by asking a woman to describe a typical day of her life. 

Gynecologic History
  • A woman’s past experience with her reproductive system may have some influence on how well she accepts a pregnancy.

Obstetric History
  • For each previous pregnancy, document the child’s sex and the place and date of birth. 

Review of Systems
  • a review of systems completes the subjective information
  • it helps women recall concerns they forgot to mention earlier
  • use a systematic approach, such as head to toe, and explain what you will be doing

Conclusion
  • End an interview by asking if there is something you have not covered that a woman wants to discuss.

Pelvic Assessment
  • common pelvic types include gynecoid (well-rounded with a wide pubic arch), anthropoid (narrow), platypelloid (flattened), and android (male or with a sharp pubic arch)
  • a gynecoid pelvis is ideal for childbearing

Points to remember
  • the true conjugate (conjugate vera) is the measurement between the anterior surface of the sacral prominence and the posterior surface of the inferior margin of the symphysis pubis (the anterior-posterior diameter of the pelvic inlet) the average is 10.5 to 11 cm 
  • the ischial tuberosity diameter is the distance between the ischial tuberosities or the transverse diameter of the outlet the average is 11 cm

Pelvic Examination
  • Pregnant women should remain in a lithotomy position for as short a time as possible to help prevent thromboembolism and supine hypotension syndrome.

Danger signs
  • Danger signs for women to report during pregnancy are vaginal bleeding, persistent vomiting, chills and fever, escape of fluid from the vagina, abdominal or chest pain, swelling of the face and fingers, vision changes or continuous headache, burning with urination, or a pronounced decrease in fetal movement.
]]> 2020-10-03 07:18:57 UTC https://padlet.com/190137c/fah3ohft3i4nd89o/wish/799552995 Summary on Uterus 190137c https://padlet.com/190137c/fah3ohft3i4nd89o/wish/805571661 Uterus
  • undergoes involution
  • uterine contraction begins immediately after birth 
  •  uterus of a breast-feeding mother may contract more quickly. 
  • area where placenta was implanted is sealed off 
  • organ is reduced to pre-pregnant size (approximately) 
  • fundus of the uterus may be palpated at certain areas/levels at a specified time to determine contraction 

Uterine involution
  • assessed by  measuring fundus by fingerbreadths
  • uterine involution maybe delayed in several conditions 
  • intermittent contractions enhance involution
  •  involution will occur most dependably if a woman is well nourished & who ambulates early 

Nursing Consideration
  • Position the patient in supine position and assess for contour striae & diastasis; measure width & length in fingerbreadths
  • Uterus is firm/contracted, uterine atony if relaxed
  • At a specific location
  • Uterus is in midline
  • Presence of after pains maybe normal

Important points to consider:
  • the 1st hour after birth is potentially the most dangerous
  • ask the patient to empty bladder 

Menstruation
  • 6 weeks after birth in non-nursing moms
  • 24 weeks in nursing moms

Breasts 
  • this is where lactation begins
There are 2 hormones involved:
  1. Prolactin - stimulates milk production
  2. Oxytocin - initiates let-down reflex with milk ejection as the baby suckles

Point to remember:
  • Women may ovulate without menstruating, so breastfeeding should not be considered a form of birth control 
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