Stages of labor

Stage 1: 0-3(latent phase), 4-7(active phase), 8-10(transition

phase)
Stage 2: start pushing
Stage 3: delivery of placenta- there will be a rise in the fundus,
cord extends, and gush of blood
Preterm Labor- Need bed rest
VEAL CHOP
V- Variable
E- Early
A- Accelerated
L- Late
C- Cord Compression
H- Head compression
O- these are okay
P- Placental insufficiency
Mag Sulfate- Check reflexes
Put mother on left side- Promotes kidney perfusion and more O2
for the baby
**Family is who they say they are**
Stages of Family- School aged children family
Roles- Financial person, person home with children is nurturer, if both
of them work one or the other is still the nurturer.
Quality Safety- QSEN- know 6 areas. Identify
Are they ready for education? - They will ask questions if so.
Blended Family- Most valuable resource is support persons.
Single Moms- Best bond but financial resources are not always good.
Lack of support as well.
Brow position? - Baby is lacking flexion
2020 Health goals- Promotion and prevention around prenatal care

Content for 2nd trimester expectant parent classes- 1. Birthing

location 2. Birthing process
Vegetarians- Know that they need supplements
Frequency- The frequency of the contractions is the time from the
beginning of one contraction to the beginning of the next.
Ovulation- Mucous can stretch to 6cm (thinning)
Tell patient it is normal to have blood tinged mucous plug
expelled
Anthropoid- Narrow transverse
Hyperemesis gravidarum- delay breakfast til midmorning
You want 15 beats for 15 seconds in 20 minutes to be
considered reactive during non stress test
Leopolds- we do to determine presentation and position, use this to
locate babys back for monitor
Changing locations to give birth- Patient would be concerned with
disappointing healthcare provider
Morning sickness, constipation, low back pain- how would the
mother fix these things? Tailor sitting, squatting? Where do they
stretch and why are they important?
No pushing while exercising
Hormone LH- ovulation
Estrogen and progesterone- regulate pregnancy
You cannot have sex if you are high risk or if you have
ruptured membranes
Smokers and patients with Hx of blood clots- should not take BC
oral pills
Tubal ligation- cannot be reversed** Must educate patient about this
Ask male if he has attempted to quit smoking- What has he done
in the past to stop

You can use Paci for SIDS

OTC supplements- deficient knowledge r/t teratogenic effects
Headache for 2 days- go see the doctor
Facial/ hand edema- preeclampsia**, notify doctor
Alpha feta protein(low)- chromosomal abnormalities
2 vessel cord- heart/kidney issues
breastfeeding helps reduce risk for SIDS
PROM= fluids, bed rest, antibiotics, NO sex
Sister with downs, second cousins and Mediterranean
descent= may need genetic testing
Milia and red popular rash will disappear
Balling up- pre term labor
Hemorrhage can be caused by placental fragments, DIC,
lacerations
Bleeding but firm fundus- laceration
She didnt want to gain weight- imbalanced nutrition
If temp is 97.6- put hat on and two blankets
Phototherapy- need eyewear and diaper only, only take them
out when feeding. We worry about temps (hyperthermia)
Puedenal block- if they have to use forceps, used to block pain
Anterior sacral prominence and posterior symphasis pubisdiagonal conjugate
Let adolescent weigh themselves
School age kids- accidents

Patient says, get away from during transition phase- RN

stands back and encourages them through contractions
Mom needs teaching if baby is ONLY latching to nipple. Need
areola as well
Dont take meds in front of kids
Low birth weight- at risk for sepsis
Weighing pads 1gram= 1 milliliter
Sitz bath brings blood to the perineum and provides relief
Implant 8-10 days after for implantation
Fertilizes in fallopian tubes
38 weeks second trimester- increase in blood volume
If saturated pad in 15min- massage fundus
Drink 8 glasses of water
Husband will be upset that Im on bed rest and cant have
sex
Chadwicks= purple, Goodells= cervix, Haeger- uterus
Misoprostol- cytotec- ripens cervix- causing contractionsadverse S/E is uterine hyper sensitivity
Oxytocin-proximal end- begin at 0.5-1 then increase to 12mu/min SE= watch BP and urine output (I havent voided in 8
hours= bad)
Mag sulfate- tocyltic to stop contractions- absent reflexes,
toxic= stop mag and call doctor, give calcium gluconate
Methotrexate dissolves an ectopic pregnancy
Mag sulfate prevents seizures
Control blood glucose in 1st trimester OR mom may get
congenital abnormalities

Goal for htidaform mole- cancer free for a year

Ectopic pregnancy- lower quadrant pain or right should pain,
you will prep her for surgery
Minimal variability- D/T analgesic medication
Terb- tachy and tremors S/E- take pulse greater than 100, call
doctor
Betameth- IM 12mg twice in 24 hours
Successful cerlage would be delivery at 39 weeks because
cervix was strong enough to get the baby full term
Sonogram- has them drink water every 15min for 90 min prior
to
Nurse to assess contractions- palpate for strength, duration
Transverse decreases risk for hemorrhage and infection
Fundal height was higher than umbilicus- massage fundus and
empty bladder
Over 70 seconds is too long for a contraction
Tachysystole (hyperstimulation)= greater than 90 secondsstop pitocin, side lye position, O2, and give Terb if ordered
Butorpohanol or nubain- will cause withdrawal symptoms if
they are an addict
Clomid- SE hot flashes and nausea
30 weeks and wants to have baby in the next 2 days- nurse
educates her that it would put her at higher risk for infant
mortality
Alveoli open during expiration
Dont do external cephalic version if she has a previa
I dont know why it happened but I will do whatever I can to
help

Narcan if we gave mom IV med much too late

Never give meds in latent period
Rhogam- prevents maternal D antibody
Give rhogam at 28 weeks if she is negative mom- always or if
any bleeding event
Maternal hypertension for 10 years, previous treatment for
gonnorhea, history of seizures. Abnormal pap was NOT a
correct answer on this one
Purpose of pap- detection of cancerous cells in cervix, vagina,
and vulva
you do know you can stay during labor, right
Amniocenteses- do sonogram first so they do not rupture
membrane
Probable- pregnancy test
Increase fiber for constipation in pregnant mom
Mom will more than likely accept the pregnancy when she feels
quickening( 16 weeks)
Absolute- feels fetal movement, fetal HR, and visualized on
sonogram
Prevent jaundice- early breastfeeding. They need to poop
Biophysical profile- even numbers only
Bishop- 8 (possibly good candidate for induction of labor)
Know glucose levels- diet and exercise always comes first if
they are diagnosed with gestational
1 hour glucose test- over 140 do a 3 hour test
Fasting greater than 95= abnormal
You have to fail either the fasting or two of the 3 hours tests to
be diagnosed

Previa- painless bleeding- never do a digital exam- calm the

uterus and stop bleeding
Abruption- tender, rigid abdomen- possibly no bleeding
Taking babies vitals- you can use gloved finger to calm them
(sucking reflex)
Chin-chest for abdominal muscles after birth
Monozygotic- identical
Clear drainage from base of babies umbilical cord is bad
Foul odor from umbilical cord- bad
Breech= at risk for prolapsed cord
Maternal death rates after WW2 and fetal death rate have
BOTH DECREASED in recent years
Active labor is a good time to give meds
Epidural- low BP- give fluids and caffeine once they are PO
Give ephedrine if BP bottoms out
Meconium aspirations- subcostal retractions and grunting
Craving starch= PICA- do a hemoglobin less than 3
Complete protein- eggs
Need lots of protein and iron
No live vaccines
No strenuous exercise for longer than 20min
Patient needs to eat, then do kick counts, up to 10 in 1 hour=
ideal
History of UTIs= gather this info on first prenatal visit= more
susceptible to getting them again

Alternate birthing centers= seen as a wellness event

Methergine- if history of High BP then dont give it OR if they
are pre-eclamptic
Contraindications for induction- if they have a previa
Clubfoot- casts should be changed weekly
Amniotomy- immediately check fetal HR
Breastfeed immediately to create oxytocin release and uterine
contraction- hemorrhage prevention
Epidural- have IV access, Lactated Ringers, and check vitals
baseline- they are now at risk for falls
Babinski reflex- lateral side of foot beneath toes
Unilateral arm movement in moro= clavicle fracture
Cephalohemtoma should not cross suture line- disappears
after 7 days
Breastfeeding for the Hispanic woman- education
Clonus- pre-eclampsia is getting worse
Epidural- intravascularly will have ringing in ears, metallic
taste in mouth- CRNA needs to redo
Endometritis- high fowlers, extreme tenderness when you
palpate fundus
Risk for PROM- twins
Pressure at birth/ edema causing frequent urination
Know neonatal normal- 70/40 BP
10-15 seconds of apnea is normal- any longer is bad
Family needs to learn CPR if baby does have apnea (beyond 20
sec)
Cardiac moms schedule C-section way in advance

Normal platelets 150,000-400,000- question had 70,000, which

is low
Know apgar scores
Evaporation- bathing baby causing temperature to decrease
Post term pregnancy- my baby will have more mature lungs
WRONG
Post term babies have more wrinkles because loss of sub Q fat
(brown fat)