Mdsmafe

22/05/2024

03/03/2024

STAGES OF LABOR


beginning of regular contractions or rupture of membranes to 10cm cervical dilation


10 cm cervical dilation to delivery of baby


birth to delivery of placenta


First 1-4 hours after deliver (recovery)


referred to as stage of dilation, begins with onset of regular contracts and ends with complete dilation of cervix. Contractions start slowly and are fairly tolerable, over time in frequency, duration, and intensity. Most often longest stage.

THE THREE FIRST STAGES OF LABOR?
1. latent phase
2. active phase
3. transition phase

❤️Latent Phase
-establishment with regular contractions
-contractions are five minutes apart and last 30-45 seconds (mild)
-woman excited about labor and remains chatty and sociable
-0 to 3 cm dilated
-can last as long as 10-14 hours as contractions are mild and cervical changes occur

What should the nurse recommend
during the latent What are the three first stages of labor??
Encourage relaxation, rest, patterned-paced breathing

❤️Active Phase
-contractions become more frequent (every 3-5 minutes) lasting 60 seconds, moderate to severe
-woman becomes more focused on each contraction and tends to draw and inward attempt to cope with increasing demands of labor
- 4 to 7 cm dilated
-increased anxiety and discomforts, unwilling to be left alone

What are the recommendation during the active phase?(mid-active IV meds, Epidural phase

❤️Transition Phase
-most intense stage of labor
-frequent, strong contractions that occur every 2-3 minutes and last 60-90 seconds
- feel that can no longer continue or question ability to cope with much more
-changed behavior (sudden nausea, extreme irritability, and unwillingness to be touched)
-from 8-10 cm dilated, contractions severe

Nursing interventions for stages of labor (7)
1. Bed rest
2. offer bedpan every 2 hrs (bladder dimmed labor)
3. patterned-paced breathing exercise and abdominal massage
4. provide mouth care, ice chips
5. pericare as needed
6. offer anesthesia/analgesia in mid-active phase

Second stage of labor
- 10 cm dilated, rapid fetal descent (urge to push) and birth.
-averages 1 hour for primigravidas and 15 min for multipara
-commences with full dilation of cervix and ends with birth of the infant

The urge to push is stimulated by what reflux?Ferguson Reflux

What are the two methods of pushing?
1. closed glottis "directed pushing"
2. open glottis "involuntary pushing"

Closed Glottis
traditional method, woman encouraged to begin pushing at full cervical dilation regardless urge to bear down (take deep breath and hold for at least 10 seconds while pushing as hard and as long as she is able through contraction)

Open Glottis
laboring woman encouraged to hold breath for only 5-6 seconds during pushing and to take several breaths between each bearing down effort

Assessment for Second Stage
1. FHR with every contraction (positioning and oxygen)
2. Observe for increase bloody show, bulging perineum and a**s, visibility of the presenting part (crowning)
3. palpate bladder for distention (empty if needed)
4. assess amniotic fluid for color and consistency

Nursing interventions for Second Stage of labor
1. VS every 15 minutes between contractions
2. continuous FHR
3. teach client with positioning (squat, lithotomy, side to side pushing)
4. teach client to hold breath for no longer than 5 seconds during pushing
5. set up delivery table (bulb syringe, cord clap, ID bands), baby warmer turned on
6. Record the exact delivery time

Precipitous Delivery
-reassure and support mother (don't leave client)
-send axillary personal for help and emergency OB pack
-delivery of infant ( support perineum by applying gentle counter pressure against the perineum)

Third Stage
-period of time from birth of the baby to complete delivery of the placenta
-lasts 5-10 minutes, can last up to 30
-once baby is born, uterine cavity immediately becomes smaller

The clinical indicators that the placenta has separated from the uterus
1. uterus becomes spherical in shape
2. uterus rises upward in the abdomen due to the descent of the placenta into the va**na
3. umbilical cord descends further through va**na

Shultz Mechanism "shiny schultz"
Occurs when the placenta separates from the inside to the outer margins with the shiny, fetal side of the placenta presenting first

Duncan Mechanism "dirty duncan"
occurs when the placenta separates from the outer margins inward, rolls up, and presents side ways

What is it important that the placenta continues to contract after it separates?
minimize the bleeding that results from open blood vessels left at placental attachment

Nursing Care for Third Stage Labor
1. uterus palpated to determine the risk upward as well as characteristic change in shape
2. 30 minutes passes and no placental discharge, considered "retained"
3. oxytocic medication administered to deliver placenta
4. monitor for signs of placental separation (globular shaped uterus, uterine volume shrinks, protrusion umbilical cord)

Oxytocin
Stimulate uterine contractions, minimizing bleeding from placental attachment site and reducing risk of postpartum hemorrhage
-IV 10-20 minutes
-IM 10 units
-excessie blood loss 40mg

1. monitor VS, (Especially BP and HR)
2. Any part of placenta missing report (lead to post partum depression)
Nursing assessment for placenta separation (2)

Nursing responsibilities for third stage of labor
1. encourage mom to relax while waiting for placenta to deliver
2. immediate care of newborn
3. encourage family bonding
4. document time of placental delivery, appearance, intactness, estimated blood loss
5. administer oyocic agent as ordered


Forth Stage
-maternal physiological adjustment that occurs from time of delivery of placenta through first 1-2 hours after birth
-physician examines mother' perineum, cervix, and va**na for evidence of tearing
-episiotomy or laceration are repaired
-initiate breast feeding with first hour

Nursing Interventions Forth Stage of Labor
1. examines uterus
2. Assess blood va**nal discharge (lochia) noting color, amount, and presence of clots
3. Assess mother VS frequently, every 5-15 minutes times four and then every 30 minutes times two hours
4. temperature taken to rule out infections
5. monitor urine output (distended bladder can displace uterus and impede ability to contract, resulting in hemorrhage)
6. provide meal, juice, ice water
Thank you ctto..bymdsmafe

19/10/2023

A movement disorder with co-contraction of agonist and antagonist muscles resulting in abnormal postures or twisting movements.

CHARACTERIZED PRIMARY DYSTONIA

Dystonic muscle contractions are the only abnormal finding. No underlying degenerative lesions and no other exogenous causes. If childhood onset, dystonia often begins in the lower body and later becomes generalized--commonly inherited. If adult onset, dystonia often begins as focal dystonia of the neck or face and can become segmental or multi-focal (but rarely generalized)--commonly sporadic.

LIST THE COMMON FOCAL DYSTONIAS

Cervical dystonia (which can include torticollis, anterocollis, retrocollis, laterocollis, or combinations of these movements; may also involve dystonic tremor), blepharospasm, oromandibular dystonia, laryngeal dystonia, and task-specific dystonias.

DEFINE Meige's SYNDROME

Simultaneous presentation of blepharospasm (dystonic contractions of the peri-ocular muscles) and oromandibular dystonia (contractions of jaw, mouth, or lower face).

CHARACTERIZED SECONDARY DYSTONIA

Dystonia associated with an underlying degenerative disease, lesion, or insult. Examples include stroke, encephalitis, head trauma, toxins, Huntington's disease, Wilson's disease, and PD.

COMPARE AND CONTRAST

childhood-onset dystonia with adult-onset primary dystonia
Childhood-onset dystonia often begins in the lower body and becomes generalized. It is commonly inherited. Adult-onset dystonia often begins as a focal dystonia of the neck or face and can become segmental or mutifocal, but rarely does it generalize. It is commonly sporadic.

DESCRIBE DYT1 DYSTONIA

The DYT1 mutation is the most common mutation causing primary dystonia; it is a CAG mutation in the torsin A gene on chromosome 9 (function unknown, although similar in structure to AAA+ ATPases that are molecular chaperones). Torsin A is highly concentrated in SNpc neurons. DYT1 dystonia presents in childhood and generally fits the childhood-onset dystonia model (lower limb dystonia-->generalized). Autosomal dominant inheritance, like most other genetic dystonias.

CHARACTERIZED DOPA -RESPONSIVE
DYSTONIA AND NAME THE ASSOCIATED MUTATION x

(AKA DYT5 dystonia). Presents as a generalized dystonia in early childhood, sometimes with a diurnal variation with reduced symptom severity in the morning and progression throughout the day. Sometimes associated with parkinsonian features such as bradykinesia or rigidity. This is the ONE dystonia responsive to therapy with L-dopa. Often misdiagnosed as cerebral palsy. Two genetic causes: autosomal dominant mutation in GTP cyclohydrolase gene (co-factor for tyrosine hydroxylase in DA synthesis)--most common; autosomal recessive mutation in tyrosine hydroxylase gene itself--less common

DESCRIBE THE PATHOPHYSIOLOGY OF PRIMARY DYSTONIAS

No clear neurodegenerative processes. Abnormalities are likely subtle mechanistic changes in neuronal signaling and communication. Basal ganglia implicated, with some evidence of reduced output from the GPi, although this is contradicted by symptom improvement following GPi lesioning. Also evidence of cortical dysfunction and abnormal sensory afferent processing.

WHAT IS THE MOST RECENT MODEL FOR THE PATHOPHYSIOLOGY OF DYSTONIA?

Alteration in the pattern of pallidal-thalamic activities during voluntary movement and abnormal sensory feedback lead to an increase in abnormally synchronous cortical output and thus co-contraction of multiple muscle groups or overactivation of intended muscle groups. In addition, abnormal thalamic activity synchronizes the intended movement as well as unwanted overflow movements in other muscles.

WHAT ARE THE PRIMARY PHARMACOLOGICAL THERAPIES FOR DYSTONIA?
Anticholinergics (in high doses), benzodiazepines, baclofen, and tetrabenazine (dopamine-depleting) have had moderate success. Dopa-responsive dystonia (DYT5) is treated with L-dopa. Botulinum toxin is the mainstay of dystonia therapy, whereby it is injected directly into the affected muscles (injections repeated every 3-6 mos., with occasional development of resistance).

WHAT ARE THE SURGICAL THERAPIES FOR DYSTONIA?

DBS is useful when all other therapies have failed. Unlike with tremor, the electrodes are implanted in the GPi (rather than the thalamus). In further contrast to DBS for tremor, the beneficial effects generally take weeks to manifest..Ctto..thank you by mdsmafe .

10/10/2023

MEDICAL TERMINOLOGY

03/09/2023