Week 8 and 9

JULLIANNE DANDAN · 43問 · 2年前

通報

問題一覧

Assessment using Sonogram Criteria for score of _

Presence of 1 episode of 30 seconds of sustained breathing movements in a period of 30 minutes.

Fetal Breathing

3 separate episodes of fetal limb or trunk movement in a period of 30 minutes

Fetal Movement

Fetus must show extension and then flexion of the extremities or spine at least once in a period of 30 minutes

Fetal Tone

Presence of pocket of amniotic fluid that measures more than Icm in vertical diameter.

Amniotic Fluid Volume

Assessment using non-stress test 2 or more FHR accelerations of at least 15 beats/min above baseline and of 15 sec duration with fetal movement in 20-minute period

Fetal heart reactivity

_____: Effect of fetal movement to FHR _____ :Effect of uterine contractions produced by nipple stimulation on FHR

1. Criterion for measurement 2 Non stress 3. Contraction

___: Presence of 2 or more accelerations of FHR of 15 beats/min for 15 sec or more occurring after fetal movements in a period of 20 min. ____: No late deceleration with contractions

1. Normal Findings 2. Non stress 3. Contaction

Stages of development ___: Conception to 2 weeks ____: 2 weeks to 2months ___: 2 months to term

1. Zygote 2. Embryo 3. Fetus

Emphasis on development 1"tri : _____ 2nd tri: _____ 3d tri: ______

1. Organogenesis 2. Fetal length 3. Rapid G&D

1. Germ layer formation • Ectoderm • Mesoderm • Endoderm 2. Brain or nervous system development 3. Fetal heart beat not audible 4. Development of trachea and esophagus

1* month

1. Organogenesis is complete 2. Development of the placenta 3. Development of sex organs

2nd month

1. Complete placenta and barrier 2. Production of amniotic fluid 3. Audible FHT by Doppler 4. Bone formation

3rd month

1. Audible FHT by fetoscope 2. Visualization of skeletal outline 3. Human face appearance 4. Development of external genitalia 5. Lanugo - fine

4th month

1. Quickening 0 fist fetal movement felt by mother 2. Vernix 3. Audible FHT by stethoscope

5" month

1. Term size 2. Scalp hair 3. Pinkish, wrinkled skin (premature)

6" month

1. Development of alveoli 2. Production of surfactant

7 month

1. Decreased lanugo and vernix caseosa 2. Rapid fat deposition 3. Viable for delivery

8 month

1. Disappearance and vernix caseosa disappearance 2. Amniotic fluid decreases 3. Birth position assumed 4. Lightening

9 month

location: Attached to uterus function: Gas exchange during fetal life

Placenta

Location: Two arteries in the cord Function: Carry unoxygenated blood from the fetus (descending aorta) to the placenta.

Umbilical Arteries

Location: One vein in the cord Function: Carry oxygenated blood to the fetus

Umbilical Vein

Location: Opening in the interatrial septum (between the right and left atrium) Function: To shunt blood from the right atrium to the left atrium so that blood can be supplied to brain, heart and kidney

Foramen Ovale

Location: Accessory vein connecting umbilical vein into fetal liver and inferior vena cava Function: To supply blood to liver. A bypass to the fetal liver.

Ductus Venosus

Location: Connection between fetal lungs and the aorta Function: Shunting of the larger portion of the blood away from the lungs and directly into the aorta.

Ductus Arteriosus

• A.K.A. Childbirth/Parturition • Series of events by which uterine contractions & abdominal pressure expel a fetus & placenta from a woman's body. • EUTOCIA _______

1. INTRAPARTUM (PROCESS OF LABOR & DELIVERY) 2. Normal labor

Any hollow organ such as uterus tends to contract and empty itself when distended.

Uterine Stretch Theory

Oxytocin increases before pregnancy comes to term size and initiates labor due to its contraction in the myometrium. Oxytocin stimulates contraction which facilitates sealing of rupture capillaries which then stops the bleeding.

Oxytocin Theory

Decreased amount of progesterone inhibits the relaxation effect of prostaglandin.

Progesterone Deprivation Theory

cannot anymore support the growing fetus

Aging placenta Theory

Sources of prostaglandin: _____ & ______ Rising fetal cortisol level increases the formation of prostaglandin which stimulates contraction. Prostaglandin causes the smooth muscles contractions.

1. Prostaglandin Theory 2. amnion & deciduas

• Descent of the fetal presenting part into the pelvis. Uterus becomes lower and more anterior. May experience shooting leg pains and increased venous stasis and increased vaginal secretions, urinary frequency, and pelvic pressure.

Lightening

Irregular, intermittent contractions Felt in the abdomen or inguinal region and patients may mistake them for true labor

Braxton Hicks Contraction

Internal sign which can be determined only on pelvic examination Throughout pregnancy, the cervix feels softer than normal (goodell's sign). At term, the cervix becomes still softer (describe as butter soft) and it tips forward.

Cervical Ripening

Pink - tinged secretions and the mucous plug is often expelled, resulting in a small amount of blood loss from the exposed cervical capillaries.

Bloody show

Clear/odorless and contains white specks (vernix caseosa) and lanugo Yellow-green tinged amniotic fluid= _____ or fetal passage of meconium → give to the pediatrician → Signals need for further assessment and FHR monitoring Amniotic membranes rupture once labor is well established, either spontaneously or amniotomy

1. Rupture of Membranes 2. infection

Burst of energy approximately __-__ hours before labor. Prepares a woman's body for the work of labor ahead.

1. Sudden Burst of energy 2. 24-28 hours

Contractions _____: Regular, Contractions do not decrease with rest or warm tub bath _____: Irregular,Rest and warm tub bath lessen contractions

1. True 2. False

Intervals _____: Shortened _____: Long

1.True 2. false

Intensity Increases with change in activity _______ No change and walking may lessen the pain_______

1. true 2. false

Dilatation/effacement _____: Progressive _____: No changes in the cervix

1. True 2. False

Discomfort Lower back radiating to the abdomen _______ lower abdomen _____

1. True 2. False

Causes of Labor onset 1. ________ placental function due to aging placenta 2. _______ prostaglandins 3. _______ progesterone 4. _______ oxytocin 5. _______ uterine stretch

1. Decreased 2. Increases 3. Decreased 4. Increased 5. Increased

COMPONENTS OF LABOR 1. The ____ (birth canal) 2. The _____ (fetus) 3. The _____ between the maternal pelvis and ____ part of the fetus 4. The ____ of Labor 5. _____ of the mother 6. _______ outlook

1. passage 2. passenger 3. relationship and presenting 4. powers 5. Position 6. Psyche/psychological

• The route a fetus must travel from the uterus through the cervix & vagina to the external perineum • Must be of adequate size

PASSAGE

Two pelvic measurements important to determine the adequacy of the pelvic size: Critical factors: • ________ (diameters of the pelvic inlet, midpelvis, and outlet) • ________ (Gynecoid, Android, anthropoid, platypelloid) • Ability of the cervix to ____ and _____ • Ability of the vaginal canal and introitus to _____

1. Diagonal conjugate (the AP diameter of the inlet) 2. Transverse diameter of the outlet Critical Factors: • Size of maternal pelvis • Type of maternal pelvis • dilate and efface • distend

• The movement of the fetus, through the birth canal.

PASSENGER "The FETUS"

1. • Part of the fetus in the lower pole of the uterus overlying the pelvic brim. • Cephalic, vertex, breech 2. • Posture of the fetus • Flexion, deflexion, extension

1. Presentation 2 Attitude

1. • Relation of the long axis of the fetus to the mother • Normal: Longitudinal lie 2. • Relationship of the presenting part to the mother's pelvis • Expressed by referring to the position of one area of the presenting part

1. Lie 2. Position

- spaces between cranial bones

Sutures

1. _____ - between 2 frontal bones 2. ____ - between frontal & parietal bones 3. _____ - between 2 parietal bones (midline suture) most important suture - overrides in labor (molding) decreasing biparietal diameter by 0.5 to 1 cm. 4. ______ - posterior suture; between parietal & occipital bones.

1. Frontal 2. Coronal 3. Sagittal 4. Lambdoidal

-filled spaces called fontanels/fontanelles are located where the sutures intersect.

Membrane

FONTANELLES: 1. ———— fontanelle 2. ______ fontanelle • ________ & _______ FONTANELLES are clinically useful along with the SUTURES in identifying the position of the fetal head in the pelvis and in assessing the status of the

FONTANELLES: 1. Posterior 2. Anterior • ANTERIOR & POSTERIOR FONTANELLES

- degree of flexion

FETAL ATTITUDE / HABITUS

• _______: head flexed on chest • _______: head extended; occiput touches the back

• FLEXION • EXTENSION

Types:

TYPES: 1. Complete flexion: A 2. Moderate flexion: B 3. Poor flexion: C 4. Hyperextension: D

It is the relation of the long axis of the fetal body and the long axis of the mother body.

FETAL LIE

Fetal Lie • ________: cephalic or breech - parallel • ________: shoulder - perpendicular • ________: becomes longitudinal or transverse during labor.

• Longitudinal/vertical lie • Transverse/horizontal lie: • Oblique lie:

Types of cephalic presentation 1. ______ - occiput is the presenting part 2. ______ - fetal head is partially flexed, with the anterior fontanel, or bregma, presenting 3. _____ - fetal head is partially extended; the sinciput (forehead) is the presenting part. 4. _____ - fetal head is hyperextended; the face is the presenting part.

1. Vertex 2. Sinciput 3. Brow 4. Face

Types of Breech Presentation 1. _____ - both legs are flex 2. _____ - 1 leg is flexed, the other leg is extended 3. _____ - both legs are extended 4. _____ - 1 foot

1. Complete 2. Incomplete - 3. Frank - 4. Footing -

- The relationship of the presenting part to a specific quadrant of the woman's pelvis.

FETAL POSITION

4 quadrants of maternal pelvis

1. Right anterior 2. Left anterior 3. Right posterior 4. Left posterior

• First letter defines whether the landmark is pointing to the mother's right (R) or (L) • Middle letter denotes the fetal landmark (0) for a _____ , M for _____ or _____ , Sa for ______ & A for _______ process. • Last letter defines whether the landmark points ______ (A), ______(P) or ______ (T)

• right or left • 0 - OCCIPUT, M - MENTUM OR CHIN, Sa - SACRUM, A - acromion process. • anteriorly (A), posteriorly(P), transversely (T)

Four parts of fetus as landmarks: 1. _____ presentation - occiput 2. _____ presentation - chin (mentum) 3. _____ presentation - sacrum 4. _____ presentation - acromion process

1. Vertex presentation 2. Face presentation 3. Breech presentation 4. Shoulder presentation

It is relationship of presenting part to the level of the ischial spine (IS) and measure of the degree of descent of the presenting part of the fetus through the birth canal.

STATION

• ___ (-3) - presenting part above the inlet, in false pelvis • ___ (-2) • ___ (-) - presenting part above the IS • ____ (-1) - presenting part below the inlet, in true pelvis, no longer moving but not yet engaged. • ____ (-5) - presenting part at pelvic inlet • ____ 0 - PRESENTING PART AT IS • ____ (+) station - presenting part below IS • (+4) - ______ - presenting part at perineum • ______ (+5) - presenting part at pelvic outlet

• Floating (-3) • Dipping (-2) • Minus (-) • Fixed (-1) • Station (-5) • ENGAGED/ STATION 0 • Plus (+) station • (+4) - crowning • Station (+5)

• Systematic method of observation and palpation to determine fetal position. Nursing Responsibilities 1. Ask patient to empty the bladder 2. Position patient in supine position with her knees flexed slightly so abdomen is relaxed. 3. Warm hands to avoid contraction of abdominal muscles. 4. Gentle but firm touch

Leopold's Maneuver

Fetal Presentation _____ Fetal Back, FHR, Fetal Lie_______ Fetal Engagement ______ Fetal Attitude ______

1. First Maneuver (Fundal Grip) 2. Second Maneuver (Umbilical Grip) 3. Third Maneuver (Pawlick's Grip) 4.Fourth Maneuver (Pelvic Grip)

Involuntary and voluntary powers combine to expel the fetus, the fetal membranes and the placenta from the uterus

POWERS OF LABOR

Primary power/ primary force 3 phases of contraction:

1. Increment 2. Асте 3. Decrement

: beginning to end of one contraction

DURATION

: beginning of one contraction to the beginning of the next contraction.

FREQUENCY

INTENSITY: • _____ intensity fundus indents easily & feels like a tip of your nose. • ______ intensity fundus indents less easily (firm fundus that is difficult to indent) and feels like chin. • _____ intensity fundus cannot be indented & feels like a forehead.

• Mild • Moderate • Strong

: Contractions occurring more often than every two minutes and persistent contraction duration longer than 90 seconds may reduce fetal oxygen supply

WOF (Warrant of Fitness)

1. Use of abdominal muscles to push during the second stage of labor. 2. The voluntary bearing down the efforts by the woman 3. As soon as the presenting part reaches the pelvic floor, the contractions change in character and become expulsive. 4. If the cervix is not fully dilated, bearing down can cause cervical edema (which retard dilatation) possible tearing and bruising of the cervix, and maternal exhaustion.

Secondary power/ secondary force

Positions:

Upright position Lateral position Lithotomy position Semi recumbent position Sitting position kneeling or squatting position

STAGES OF LABOR

I - onset of true labor up to full cervical dilatation II - full cervical dilatation up to the birth of the baby (pushing stage) III - birth of the baby up to placental delivery IV - puerperium (up to 6 weeks post-partum)

0-3 cm Latent 4-7 cm Active 8 to 10 cm Transitional

Dilatation

Every 5 - 10 minutes Latent Every 3-5 minutes Active Every 2 - 3 minutes Transitional

Frequency

20 - 40 seconds (Latent) 40- 60 seconds (Active) 60 - 90 seconds (Transitional)

Duration

Mild (Latent) Moderate-severe (Active) Severe (Transitional)

Intensity

Decrease FHR at the onset of uterine contractions (UC) then returns to baseline at the END of UC Cause: Head compression Nurse Interv: Continue monitoring maternal VS FHR

Early deceleration

Decrease in FHR after the onset of UC, continues beyond the end of the UC Cause: Placental Insuificiency due to IVC compression on RL part Nurse Interv: L side lying position, Give oxygen, Increase fluids

Late Deceleration

Decrease FHR is unpredictable times in relation to UC Cause: Cord compression and cord prolapse Nurse Interv: Knee chest position, Trendelenburg, Give Oxygen, Increase Fluids

Variable Deceleration

- light massage (abdomen/thigh)

Effleurage

Breathing technique: • _____ - chest breathing • ______ - Abdominal breathing • _______ - pant pant blow

LATENT ACTIVE TRANSITIONAL

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