1. 1st Degree Vaginal Lacerations: - involves the perineal skinand vaginal mucosa

2. 1st Stage: Active Phase: (Labor Song)*4-7cm dilated (1cm per hr)-incr. anxiety-incr. discomfort-unwillingness to be left alone-Ctxs mod-severe, freq 3-5 min, 30-60 sec duration

3. 1st Stage: Latent Phase: Onset of true labor or ROM (LaborDance)*0-3cm dilated-Mildly anxious, conversant-Able to continue ADLs-Mild ctxs, freq 10-30 min, 15-20 sec duration, later freq 5-7min, 30-40 sec

4. 1st Stage of Labor: onset of reg contractions to completedilation of the cervix-latent phase-active phase-transition phase

5. 1st Stage: Transition Phase: (No Epid)8cm to complete dilation-Changed behavior-Extreme irritability, don't touch although desirous of help-Ctxs severe, freq 2 min, 60-90 sec duration

6. 2nd Degree Vaginal Lacerations: involves the perineal skin,vaginal mucosa and perineal muscles

7. 2nd Stage: Descent Phase: desire to push "Ferfusons Reflex"8. 2nd Stage: Latent Phase: laboring down "rest"9. 2nd Stage: Nursing Care: -Vitals q 15 min

-FHR q 5 - 15 min-Palpate bladder for distension-Monitor amniotic fluid for color, consistency-Continue comfort measures -Never leave patient unattended-Instruct on bearing down efforts-Call for DR table: gown, gloves, bulb syringe, cord clamp andscissors-Perform perineal cleansing-Gentle counterpressure as needed-Record birth time / Note nuchal cord

10. 2nd Stage of Labor: complete dilation of the cervix to the birthof the fetus (max 2-3 hours)-latent phase-descent phase-transition phase

11. 2nd Stage of Labor "Pushing Phase": Begins with completedilation and ends with the birth of the newborn-Latent - "laboring down"-Active - "Ferguson's Reflex"-Transition- process of crowning

12. 2nd Stage: Transition Phase: head is on perineum

13. 3rd Degree Vaginal Lacerations: involves the skin, mucusmembrane, perineal muscle and anal sphincter

14. 3rd Stage Nursing Care: -Check BP, pulse pre & postseparation-Following complete expulsion - Increase Pitocin flow rate-Assess blood loss-Fundal assessment-Inspect placenta &membranes-Check 3 vessel cord/obtain cord blood -Note repair of episiotomy & vaginal tears

15. 3rd Stage of Labor: birth of the fetus to expulsion of theplacenta (max 30 minutes)

16. 4th Degree Vaginal Lacerations: extends through rectalmucosa

17. 4th Stage Focused Assessments: -VS-Orthostatic Hypotension-Fundus -Lochia -Bladder / Elimination-Perineum-Breasts-Lower extremities-Homan's sign if needed-Pain -Bonding

18. 4th Stage Focused Assessments Frequency: -q15min x4 -then q30min until stable

19. 4th Stage of Labor: expulsion of the placenta to 1 - 4 hourspostpartum

20. 4th Stage of Labor: Physical Recovery: begins followingexpulsion of placenta to 1-4hr after birth

21. 4th Stage Vitals: -BP < 140/90-Pulse (50 - 100) -Respirations < 24-Temperature < 100.4 F

22. The 5 P's Affecting the Process of Labor: 1) Passenger(fetus)2) Passageway (pelvis)3) Power (contractions/pushing)4) Position of the mother5) Psyche (level of fear, anxiety)

23. Additional Assessments: -Immediately after ROM-Before and after medication-Before and after any procedure

24. Amniotic Fluid: Assessment Tests: -Nitrazine -Ferning

25. Amniotic Fluid: Color Assessment: -normal-meconium-bloody

26. Amniotic Membranes: Assessment: 1) SROM -spontaneous2) AROM - artificially induced with amniohook

Maternal Child: Intrapartum (Exam 2)Study online at quizlet.com/_lqbe9

27. APGAR: A SCORING SYSTEM FOR ASSESSING THE STATUSOF A NEWBORN THAT ASSIGNS A NUMBER VALUE TOEACH OF THE 5 AREAS OF ASSESSMENT (1) APPEARANCE(2) PULSE (3) GRIMACE (4) ACTIVITY (5) RESPIRATIONS

28. AROM increases risk for: -Frequent vaginal exams -Prolonged labor > 16 hours

29. Arrest of Progress: *Prolonged latent: G1 > 20 hrs, G3 > 14hrs*Arrest of labor: no cervical change in > 2 hrs or no descent in >1 hour

30. Bearing Down Efforts: -involuntary response to FergusonReflex; maternal exertion of downward pressure by contractingabd muscles & relaxing pelvic floor muscles-deep cleansing breath before and after contractions-open glottis pushing helps to maintain oxygen levels andprevent Valsalva maneuver-should never hold breath >5 sec

31. Birth: -Extension in OA position-Check for nuchal cord-Restitution and Ext.-Rotation Bulb suction of mouth and nose -Hands over ears -Exert downward pressure

32. Birthing Positions: -lithotomy-semirecumbent-lateral recumbent-squatting

33. Bloody Amniotic Fluid: abruption34. Boggy Uterus: -Uterine atony

-Fundal massage, empty bladder35. Breastfeeding: -Encourage immediate breastfeeding while

mother and baby are excited and alert as both will soon want tosleep-Thermoregulation- skin-to-skin contact-Release of oxytocin: stimulates milk ejection reflex; contractsuterus and reduces lochia

36. Cardinal Movements: -Engagement-Descent-Flexion-Internal Rotation to OA-Extension-Restitution-External Rotation to align w/ shoulders

37. Comfort Measures/Coaching: -Ambulation-Position changes q 30 - 60 minutes-Diversional activities: music, talking, imagery, breathingtechniques (do what works for pt)-Massage, counterpressure, efflurage-Hydrotherapy: shower, hot/cold packs-Perineal & Mouth care- keep pads dry, ice chips-Void q 2 hours, catheterize if necessary-Enema in early labor if constipated-Malposition: squat or hands/knees

38. Dilation: opening of the os, measured from closed to 10cm

39. Effacement: shortening of the cervix, measured from 0 - 100%40. Engagement: when the lowermost portion of the head is passed

the ischial spines, the BPD is in the pelvic inlet41. Factors Prolonging Second Stage: -Pushing prior to 10cm

dilated - Inadequate secondary powers- Anesthesia/analgesia - Position of fetus - Primipara - LGA fetus

42. False Labor: -Reg contractions 80mmHgper IUPC OR -resting tone > 20mmHg, Duration > 90 sec or < 2 min apart

49. Hyperventilation: Results in respiratory alkalosis due toblowing off too much CO2

50. Hyperventilation Nursing Interventions: Instruct patientto deep breathe into cupped hands in order to rebreathe CO2

51. Intense Perineal Pain: -Hematoma, vaginal wall or perineum-Ice pack, notify MD, monitor for hypovolemia

52. Labor Progress: Active Phase: 3-6hrPrimip avg 1.2cm/hr; Multip avg 1.5cm/hr

53. Labor Progress: Latent Phase: 6-8hrPrimip

57. Leopold's Maneuvers: 1) What is in the fundus- determinepresenting part 2) Where is the back v. small parts- lie, locate PMI for FHR3) What is in the pelvis- presenting part, position, engaged orfloating4) Where is the cephalic prominence- attitude

58. Maternal Positions: -walking-sitting/leaning-trailor sitting-semirecumbent-hands and knees-standing-squatting-kneeling and leaning forward with support

59. Meconium in Amniotic Fluid: green-brown, thick indicatesfetal BM r/t fetal stress, increased risk of RDS and infection

60. Nitrazine: pH paper turns deep blue with vaginal pH of 7.5(Vagina is acidic pH of 4.5 and amniotic fluid is alkaline.

61. Normal Amniotic Fluid: straw-colored, distinct smell w/oodor, vernix

62. Normal Fetal HR: 110-16063. Normal Maternal BP during Labor:

86. S/S of Placental Separation: Sudden trickle of blood-Lengthening of umbilical cord-Contraction of the uterus (globular shape)-Mother "full" feeling, desire to push

87. Station: -Relation of the presenting part to the maternal ischial spines-A measure of the degree of descent

88. SX of Hyperventilation: -dizziness-tingling of extr-stiff mouth

89. Tachycardia: -Hypovolemia, excessive blood loss-Attempt to find cause-Most common uterine atony, hematoma, high lac, retained POCs

90. Third Stage of Labor: Placental Phase: -Begins after the birth of the baby and ends with the expulsion of the placenta91. True Labor: -Stronger, longer lasting, closer contractions that increase with walking

-Pain in lower back radiates to abdomen-Progressive cervical change

92. Uterine Activity: Assessment: Palpates with fingertips at the fundus-Mild: easy to indent-Moderate: difficult to indent-Strong: rigid, board-like

93. Uterine Activity Assessment: Determine: -frequency-intensity-duration of resting tone

94. Vertex Presentation: The fetal head is fully flexed. This is the most favorable cephalic variation because the smallest possible diameter ofthe head enters the pelvis. It occurs in about 96% of births

Maternal Child: Intrapartum (Exam 2)