First phase of stage one of labor - Latent phase. Cervical dilation is 0-3 cm, contractions are mild to moderate, every 5 to 30 minutes for 30-45 seconds.
... [Show More] Mother is talkative and eager
Second phase of stage one of labor - active phase, cervical dilation is 4-7 cm, contractions are moderate to strong every 3-5 minutes lasting 40-70 seconds, cervical dilation and effacement is rapid, mother feels helpless, restless, and anxious
Third phase of stage one of labor - -Transitional phase, cervical dilation cm, station 0 or -1, contractions strong to very strong every 2-3 minutes for 45-90 seconds, mother feels tired, out of control, rectal pressure, urge to push, irratible
Stage two of labor - from complete dilation to delivery of the baby, intense contractions every 2 to 3 minutes
Stage three of labor - from the birth of HBG and HCTthe infant to the delivery of the placenta, approx 5-30 minutes time
Stage four of labor - from the delivery of placenta to the return of vital sign homeostasis, approx 2-4 hours, lochia is scant to moderate
Important labs in labor - platelets within normal range (150,000-450,000)
HBG and HCT
UA for infections and drugs
Rh type
Group B Strep status
Reasons and findings of vaginal exams in labor - Determine cervical dilation and effacement
measure station of fetus in birth canal
fetal position, presenting part and lie
Are membranes intact or ruptured
When can sedatives be administered during labor - not typically given
can be used during early labor to induce sleep
When can opioid analgesics be administered during labor - Usually given during active labor when cervical dilation has reached 4-5 cm and fetus is engaged in pelvis
Given systemically at peak of contraction to decrease perfusion to fetus
Opioid analgesics used during labor - fentanyl, butorphanol, meperidine, and nulbuphine
Pitocin starting dose - 2 milliunits/min increased every 30 minutes or greater to 6 milliunits/min
Risk of rupturing amniotic membranes - Infection
umbilical cord prolapse
Nursing interventions with spontaneous rupture of membranes - if not already assessing FHR, begin immediately
baby should be delivered within 24 hours to decrease risk of infection
Fluid should be watery, clear, no foul odor
use nitrazine paper to confirm amniotic fluid
Nursing interventions with artificial rupture of membranes - Must ensure fetus is engaged to prevent cord prolapse
Monitor FHR prior to and post-rupture to assess for cord prolapse
Assess and document color, odor, and consistency of fluid
Obtain temperature every 2 hours
Risks of epidural block - maternal hypotension, fetal bradycardia and decelerations, loss of urge to void, loss of bearing down reflex
Nursing interventions with epidural block - administer bolus of IV fluids to offset hypotension
position patient in side-lying position and remain in that position post-procedure to offset hypotension
Coach mother in pushing efforts
MOnitor maternal BP, HR, and respirations
Assess bladder for distention
Monitor for return of sensation prior to standing
Preparation for epidural anesthesia - ensure consent form is signed
educate the patient on the procedure
administer IV fluid bolus
empty bladder
Indications for a cesarean section - breech presentation
cephalopelvic disproportion
non-reassuring fetal heart tones
placental abnormalities
placenta previa
previous c-section
dystocia
multiples
umbilical cord prolapse [Show Less]