Summary NCLEX Labor and Delivery In-class activity

NCLEX Labor and Delivery In-class activity Birth Plan - Tool that women can use to communicate choices for the child's birth. First trimester optimal time to initiate the dialogue. Plan is subject to change. Implemented only if the health care needs of the mother and baby are not compromised. Birth Setting Choices - 1. Hospital 2. Birthing Center 3. Home Hospitals - Where 99% of all deliveries in the US occur. Mother-Baby Unit - Newborn care unit combined with postpartum unit. LDRP (Labor, Delivery, Recovery, Postpartum) Unit - Single-room in which the woman labors, delivers, and receives postpartum care in one area. Birthing Centers - Emphasize family-focused care and try to incorporate the family and significant others into the care plan. LDRP format traditionally used. Offers childbirth outside of a hospital. Cost effective, provided by nurse-midwives and physicians. Limited to women considered to be low risk for development or complications. Home - Women interested in a more relaxed, family-centered, and relatively low-cost delivery experience. Risk of infection lower. Only an option for a woman in god health with a reasonable expectation of a positive outcome for both mother and baby. Must be approved by the attending physician and nurse-midwife. Normal Labor - Still trying to discover exact cause for onset. 2 Main theories: Mechanical and Hormonal. Mechanical Theory of Labor - Involves uterine stretching. Organ reaches a certain state of distention, it will spontaneously contract and empty. When the uterus stretches to a certain size, it will empty spontaneously. Hormonal Theories of Labor - Onset is based on either an increase or a decrease in hormones. 1. Oxytocin stimulation 2. Progesterone withdrawal 3. Estrogen stimulation 4. Fetal Cortisol Signs of Impending Labor - Lightening, urinary frequency, Amniotic sac rupture, Increased vaginal drainage, backache and contractions of the uterus, slight weight loss (1-3 lbs a few days before), last-minute burst of energy, true labor. Lightening - As early as 2 weeks before the onset of labor, fetus seems to have settled, or "dropped" into the pelvis. Urinary frequency then returns; may be able to breath more normally. Multiparas may not experience this until in active labor. Amniotic Sac Rupture - A seepage or sudden outflow of fluid from the vagina. Must be tested to distinguish from urine with a Nitrazine paper test. Delivery should occur 18-24 hours after membranes rupture. Prolonged rupture puts the woman and her fetus at risk for infection. Nitrazine Paper Test - After rupture of amniotic fluid, without washing the area, the paper is moistened with the discharge. If it reacts (turns blue), it is amniotic fluid. If it's nonreactive, membranes are probably intact. Bloody Show - Blood-tinged mucus observed as the amount of vaginal drainage increase as term approaches. It's the mucus that occluded the opening of the cervix during pregnancy (mucous plug). Cervix begins to soften, thin (efface) and open (dilate). Braxton Hicks Contractions (False Labor) - Backache and contractions of the uterus. Irregular tightening of the pregnant uterus that begins in the first trimester and increases in frequency, duration, and intensity as pregnancy progresses. Common. Severity from mild to moderate. Irregular. Frequently stop with ambulation or position change. May be felt in the back, most often in the fundus. Eventually stop with relaxation interventions. Cervix may soften, little or no change in effacement or dilation. No significant change in fetal position. True Labor - Contractions regular, closer together, stronger and last longer. Stronger with ambulation. Start in the lower back, travel to the lower abdomen. Not stopped by controlled breathing, sedation, or other relaxation interventions. Cervix softens, effaces and dilates. Fetus continues descent into the pelvis. Standard Precautions During Childbirth - Wash hands, wear gloves (clean or sterile), wear a cover gown and a mask with a shield or protective eyewear. Cap and shoe covers for cesarean birth, optional for vaginal birth. Primary health care provider should wear a sterile gown with a waterproof front and sleeves. Drape the woman with sterile towels and sheets as appropriate. Woman's partner put on appropriate coverings for the type of birth. Wear gloves and gown when handling the newborn immediately after birth. Appropriate method to suction the newborn's airway, such as a bulb syringe, mechanical wall suction or DeLee oral suction device. DeLee Oral Suction Device - Prevents the newborn's mucus from getting into the user's mouth or airway. Process of Labor and Delivery (Five Ps) - Passageway: Pelvis and soft tissues Passengers: Fetus and placenta Powers: Contractions Position of mother: Standing, walking, side lying, squatting, on hands and knees Psyche: Psychological response Iliac Segment of the Innominate Bones (Passageway) - Superior portion of the pelvis. Supports the uterus and fetus during late months of pregnancy. Aids in directing the fetus into the true pelvis. True Pelvis - Lower portion of the pelvis. Its size and shape are important because the fetal head must be able to pass through this section. There are 4 different types of pelves. It is divided into 3 segments: the inlet, the cavity or midpelvis, and the outlet.