CCTC NUR 220 UNIT 2 AND 3 (TEST 2) SOLVED CORRECTLY TO SCORE A+

CCTC NUR 220 UNIT 2 AND 3 (TEST 2) SOLVED CORRECTLY TO SCORE A+ Cervical Dilatation- widening of the cervical os and canal from less than 1 cm to 10 cm allowing birth of baby Cervical Effacement- the taking up of the internal os and the cervical canal into the uterine side walls - 0% - 100% Contractions- rhythmic tightening and shortening of the uterine muscles Duration- -length of time from the beginning of one contraction to the completion of the same contraction -how long that one contraction lasts Frequency- time between the beginning of one contraction to the beginning of the next Intensity- strength of the uterine contraction during acme (peak) Accelerations- periodic increases in the baseline FHR (15 beats lasting for 15 secs) Deceleration- decreases in FHR below the baseline presenting part- portion of the fetus felt through the cervix on exam Station- relationship of the presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis (narrowest point is 0) Engagement- occurs when the largest diameter of the presenting part reaches or passes through the pelvic inlet. Engagement confirms the adequacy of the pelvic inlet. It does not indicate whether the midpelvis and outlet are adequate Fetal lie- relationship of the long (spinal column) axis of the fetus to the long axis of the mother Critical Factors that Influence Labor: 1. Passageway (mom's vagina, pelvis) 2. Passenger (Fetus) 3. Presentation (Relationship between passage and fetus) 4. Powers of labor - physiologic forces 5. Psychosocial considerations (what mom and fetus is going through) Factors in labor: Components to look at with the birth passage: -Size of maternal pelvis -Type of maternal pelvis -Ability of the cervix to dilate and efface Gynecoid pelvis: inlet rounded with all inlet diameters adequate, favorable for vaginal delivery. Most common, 50%. (best one) Platypelliod Pelvis: inlet oval in shape with long transverse diameters, not favorable for birth. Head engages in transverse position. Delay of progress at outlet of pelvis. 5% Android Pelvis: heart-shaped inlet with short posterior sagital diameter, not favorable for delivery. Head enters pelvis in transverse or posterior position and stops. Same as in males. 20%. Forceps are usually required with extensive perineal lacerations. Anthropoid Pelvis: inlet oval in shape with long anteroposterior diameter, favorable for birth. 25% Factors in labor: Components to look at with the Passenger: -Fetal Head (size and presence of molding) -Fetal Attitude (flexion or extension of the fetal body and extremities) -Fetal Lie -Fetal Presentation (part of the fetal body entering the pelvis first in a single- or multiple- gestation pregnancy) Three parts of the fetal head: 1. base of the skull, fixed 2. roof- vault of the cranium, overlap under pressure (molding) to allow for birth 3. face- fixed Sutures of the fetal skull: membranous spaces between the cranial bones -Frontal (miotic): becomes the anterior continuation of the sagittal suture -Sagittal Suture: located b/t the parietal bones; divides the skull into left and right; runs anteroposteriorly, connecting the two fontanells -Coronal Sutures: located b/t the frontal and parietal bones; extend transversely left and right from the anterior fontanelle -Lambdoidal suture: located b/t the two parietal bones and the occipital bone; extends transversely left and right from the posterior fontanelle. fontanelles intersections of the cranial sutures Mentum- fetal chin Sinciput- anterior area known as the brow (forehead) Vertex- area b/t the anterior and posterior fontanells (top of head) Occiput- area of the fetal skull occupied by the occipital bone, beneath the posterior fontanelle (back of the head) Bregma The large diamond shaped anterior fontanelle. posterior fontanelle- intersection b/t posterior cranial sutures fetal attitude refers to the relationship of the fetal parts to one another Normal fetal attitude- moderate flexion of the head so that chin is on the chest, flexion of the arm onto the chest, and flexion of the legs at the knee onto the abdomen. Fetal lie- refers to the relationship of the cephalocaudal axis (spinal column) of the fetus to the cephalocaudal axis of the woman longitudinal fetal lie- occurs when the cephalocaudal axis of the fetus is parallel to the woman's spine transverse fetal lie- occurs when the cephalocaudal axis of the fetus is at a right angle to the woman's spine Fetal presentation- Determined by fetal lie and by the body part of the fetus that enters the pelvic passage first called the presenting part. Cephalic presentation- fetal head presents first breech presentation when the baby's buttocks and/or feet appear first during birth Complete breech- hips and knees flexed; the thighs are on the abdomen, and the calves are on the posterior aspects of the thighs; the buttocks and feet of the fetus present to the maternal pelvis. Frank Breech- The Fetal hips are flexed, and the knees are extended; the buttocks of the fetus present to the maternal pelvis. Footling breech- The fetal hips and legs are extended, and the feet of the fetus present to the maternal pelvis Narrowest diameter of the pelvis the fetus must pass through: ischial spines Where is the zero station? ischial spine Fetal position- refers to the relationship of a designated landmark on the presenting fetal part to the front, back, or sides of the maternal pelvis three notations used to describes fetal position: 1. right (R) or left (L) side of the maternal pelvis 2. The landmark of the fetal presenting part: Occiput (O), mentum (M), sacrum (S), or acromion process (A) 3. Anterior (A), posterior (P), or transverse (T), depending on whether the landmark is in the front, back, or side of the pelvis. Landmarks for fetal position: Landmark for vertex is occiput Landmark for face is mentum Landmark for breech is sacrum Landmark for shoulder is acromion process on scapula Engagement can be determines by: vaginal exam When does engagement occur with primigravidas? and Multiparas? Primigravidas- approximately 2 weeks before term Multiparas- may occur several weeks before the onset of labor or during the process of labor. Ballotable- When the presenting part is not engaged it is said to be floating Primary forces of labor- uterine muscular contractions, which cause the complete effacement and dilation of the cervix Secondary force of labor: The use of abdominal muscles to push during the second stage of labor How is intensity of a contraction measured? by palpating the uterine fundus during a contraction, but it may be measured directly with an intrauterine catheter. When estimating by palpation the nurse determines whether it is mild, moderate, or strong by judging the amount of indentability of the uterine wall during the acme of a contraction. This can be affected by maternal weight, adipose tissue, and positioning of monitor. When measured with an intrauterine catheter, the normal resting pressure (b/t contractions) in the uterus averages 10-12, during acme the intensity ranges from 25-40 in early labor to over 100 when pushing. When does "bearing down" occur? what happens if the woman bears down too soon? bearing down occurs after the cervix is completely dilated. If the cervix is not completely dilated, however, bearing down can cause cervical edema (which slows down dilation), possible tearing and bruising of the cervix and maternal exhaustion. Pathophysiology of labor: - Progesterone - relaxation of smooth muscle tissue - Estrogen - stimulation of uterine muscle contractions to soften, stretch, and thin the cervix. - Connective tissue loosens and permits softening, thinning, opening of cervix - Muscles of upper uterine segment shorten and cause cervix to thin and flatten - Fetal body straightened as uterus elongates with each contraction Pressure of fetal head causes cervical dilation - Rectum and vagina are drawn upward and forward with each contraction Possible causes of labor: Progesterone Withdrawal Hypothesis- progesterone relaxes smooth muscle by interfering with the conduction of impulses from one cell to the next preventing coordinated contractions. Progesterone is decreased later in pregnancy maybe because it is being used for lactogenesis. Possible causes of labor: Prostaglandin Hypothesis- We know that prostagladin E can be applied vaginally to start labor and an inhibitor of prostaglandin synthesis like Indomethacin can be used to stop labor. Once prostaglandin is produced, the stimuli for it's synthesis may include rising levels of estrogen, decreased availability for progesterone, and increased levels of oxytocin. Possible causes of labor: Corticotropin-Releasing Hormone Hypothesis- CRH increases throughout pregnancy with a sharp increase at term. May play a role in increased risk for preterm birth, and CRH levels are elevated in multiple gestations. Known to stimulate prostaglandin F and E by amnion cells. Hormonal changes during labor: -↑Estrogen, ↑ Oxytocin, ↑ Prostaglandins -↑ Corticotropin-Releasing Hormone -↑ Hyaluronic acid which loosely binds collagen fibrils and a ↓ in dermatan sulfate which tightly binds collagen fibrils -↑ water content of cervix -↓Progesterone -Fetus: ↑ cortisol What happens to the muscle of the upper uterine segment during true labor? they shorten and exert a longitudinal pull on the cervix with each contraction, causing effacement. The cervix changes from a long, thick structure to one that is tissue paper thin. Effacement- the drawing up of the internal os and the cervical canal into the uterine side walls. Goes from 1%-100% When do primigravidas usually efface? before dilation What happens as the uterus elongates and decreases in horizontal diameter? The fetus straightens up, pressing the upper portion against the fundus and thrusting the presenting part down toward the lower uterine segment and the cervix. The pressure exerted by the fetus is called the fetal axis pressure. As the uterus elongates, the longitudinal muscle fibers are pulled upward over the presenting part. This action and the hydrostatic pressure of the fetal membranes cause cervical dilatation. What happens with the musculature changes in the pelvic floor during labor?s the levator ani muscle and fascia of the pelvic floor draw the rectum and vagina upward and forward with each contraction, along the curve of the pelvic floor. Pressure from the head causes the perineal structure to decrease from 5 cm to 1 cm thick. The decreased blood supply causes anesthesia in the area. The anus everts and exposes the interior rectal wall. Premonitory signs of labor: - Cervical changes - Lightening - Increased energy level - "Bloody show" - Braxton Hicks contractions -Ruputure of membranes (SROM, PROM, PPROM) -other signs such as weight loss of 1-3 lbs dt/ fluid loss and electrolyte shifts produced by changes in estrogen and progesterone levels, diarrhea, indigestion, or N/V Lightening- -the sensation of the fetus moving from high in the abdomen to low in the birth canal -pt will notice: leg cramps or pains d/t pressure on the nerves that pass through the obturator foramen in the pelvis; increased pelvic pressure; increased venous stasis, leading to edema in the lower extremities; increased vaginal secretions resulting from congestion of the vaginal mucous membranes. Cervical changes during pregnancy: at the beginning of pregnancy, the cervix is rigid and firm, and it must soften so it can stretch and dilate to allow the fetus passage. The softening of the cervix is called ripening. As term approaches, collagen fibers in the cervix are broken down by certain enzymes. As the fibers change, their ability to bind together decreases, while the water content of the cervix increases. These changes result in a weakening and softening of the cervix. Bloody show with softening and effacement the mucous plug is often expelled, resulting in a small amount of blood loss from the exposed cervical capillaries. This is considered a sign that labor will begin within 24-48 hours. Women who are 34 weeks gestation or more who present with ruptured membranes w/out contractions are often started on what? this prevents what? started on an oxytocin infusion to decrease the incidence of chorioamnionitis. What is the risk if the membranes rupture and engagement has not occurred yet? there is a danger of the umbilical cord washing out with the fluid (prolapsed cord). Also increases the risk of infection. Signs of True labor -contractions are regular with increasing frequency (shortened intervals), duration, and intensity -discomfort radiates from back to abdomen -intensity usually increases with walking -cervix progressively effaces and dilates Signs of False Labor -Contractions are irregular -No change within contractions -Discomfort is usually in abdomen -Walking has no effect on or lessens contractions -No change within cervix -discomfort may be relieved by ambulation, changes of position, drinking a large amount of water, or a warm shower or tub bath Duration of each stage of labor: -first stage: begins with the onset of true labor and ends when the cervix is completely dilated to 10 cm -second stage: begins with complete dilation and ends with the birth of the baby -third stage: begins with the birth of the baby and ends with the expulsion of the placenta -fourth stage: lasts 1-4 hours after expulsion of the placenta, the uterus contracts to control bleeding at the placental site. First stage of labor: Latent- -starts with the beginning of regular contractions, which are usually mild. Pt is able to cope with the discomfort -Pt is often talkative and smiling and is eager to talk about herself and answer questions -Contractions may start as mild contractions lasting 30 secs with a frequency of 10-30