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Chaminade Labor and Delivery 1

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by

Heather Schlessman

on 16 August 2013

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Transcript of Chaminade Labor and Delivery 1

The baby is at a 0 station, what will Angie say to you that helps you know your teaching about this has been understood:
1. 1 cm above the ischial spines
2. 1 fingerbreadth below the ischial spines
3. At the ischial spines
4. At the imperial spines
Labor and Delivery 1
When Angie was admitted you would have performed Leopold's maneuvers...why?
1. To assess fetal heart rate
2. To assess fetal presentation
3. To assess intensity of contractions
4. To assess frequency of contractions
What else would we have liked to have known about the amniotic fluid besides the color?
Is Angie's baby engaged? Why do you care?
What are we assessing about Angie's contractios?
1. pelvis type, duration, and frequency
2. Contraction frequency and pelvic type
3. Contraction duration, frequency, and intensity
4. Contraction duration and intensity
What stage/phase of labor is Angie in?
If Angie's membranes had not ruptured at home but instead had ruptured after you had done your SVE what would have been your first action?
1. Assess the contraction pattern
2. Note the color , amount and odor of the amniotic fluid
3. Prepare the client for immenent delivery
4. Change the clien'ts position
If Angie had been at a -4 station instead of 0 when her membranes had ruptured you would first:
1. Position her on her left side
2. Prepare for precipitous delivery
3. Determine her BP
4. Check for a proplapsed cord
Angie's baby is in the ROA position.
Which one of the following is her baby's position?:
1.



2.



3.



4.
What is the fetal lie of Angie's baby?
1. transverse
2. longitudinal
3. oblique
4. compound
What kinds of things could slow Angie's labor progress?
passageway
passenger
powers
position of the mother
psychological response
Signs and symptoms of impending labor:
lightening
slt wt loss
Braxton-Hicks
increased vag secretions
cervical changes
bloody show
increased energy/nesting
What is Angie's gravida/parity history?
1. Third pregnancy, 1 term child that is living, no preterm births, 1 miscarriage
2. Fourth pregnancy, 1 term child that is living, no preterm births, 1 miscarriage
3. Third pregnancy, 1 preterm birth that is living, 1 miscarriage
4. Fourth pregnancy, 1 preterm birth that died, 1 miscarriage
Is there anything concerning about her lab work?
What signs and symptoms might you have expected Angie to experience when she was getting ready to start labor?
Is there anything you are concerned about?
What orders would you expect?
A-vertex, B-military, C-brow, D-face
Here's Melody's strip. How does the baby look?
How are you going to help Melody be comfortable and progress in labor?
In report, Georgia learns that at 1830, Angie’s cervix was dilated to 6 cm and 80% effaced, the presenting part is at a zero station. The baby’s position is ROA. Spontaneous rupture of membranes occurred at home 6 hours ago, fluid was clear. Angie is having strong contractions every 2 minutes, lasting 60 seconds. Fetal heart tones are 140-150 with good variability. Vital signs: HR-90, RR-20, Temp-99.8, BP-122/72. She has an IV in her right arm that is saline locked and has received one dose of Ampicillin two hours ago.
Angie’s husband Steve is with her in labor, they have taken refresher childbirth preparation classes and Steve was also present for the vaginal delivery of their son Charlie who was born 2 years ago. They are using their breathing techniques and managing the contractions well. Angie hopes to have a natural childbirth without the use of drugs, which she also accomplished with her first delivery. She did relate that her contractions seem stronger this time and she may be rethinking that decision. The Certified Nurse Midwife that will be attending the birth is not currently on the unit. As the day shift RN leaves for home, Georgia plans her evening and thinks: “I anticipate a routine delivery within the next few hours.”
comfort during labor
Cardinal Movements
1. Descent
2. Flexion
3. Internal rotation
4. Extension
5. Restitution
6. External rotation
7. Expulsion
Montevideo Units – addition of amplitudes of contractions in 10 minutes
1st stage – 40-60 mm Hg
2nd stage – 80 mm Hg
closure of blood-vessels
veins : 20 mm Hg
artery: 60 mm Hg
Montevideo Units
Absent
undectable
Minimal
< 5bpm
Moderate
5-25bpm
Marked
>25bpm
Patterns of fetal heart rate monitoring
Absent
undectable
Minimal
< 5bpm
Moderate
5-25bpm
Marked
>25bpm
Patterns of fetal heart rate monitoring
Full transcript