OB EXAM 4 Flashcards
true labor contractions
• Occur regularly, becoming stronger, lasting longer, and occurring closer together
in true labor: contractions do what with walking
get more intense
where are contractions felt in true labor?
• Are usually felt in the lower back, radiating to lower portion of the abdomen
true labor & comfort measures
• Continue despite use of comfort measures
true labor & the cervix
• Shows progressive change (softening, effacement, and dilation signaled by the appearance of bloody show)
position of cervix in true labor
anterior position
fetus in true labor
• Presenting part usually becomes engaged in the pelvis, which results in increased ease of breathing; at the same time, the presenting part presses downward and compresses the bladder, resulting in urinary frequency
contractions in false labor
• Occur irregularly or become regular only temporarily
false labor contractions with walking or position change
stop with walking or position change
false labor contractions can be felt where?
back or abdomen above the navel
false labor contractions with comfort measures
can be stopped
cervix with false labor
• May be soft but with no significant change in effacement or dilation or evidence of bloody show
cervix with false labor is in which position
posterior
fetus is presenting how in false labor
Presenting part is usually not engaged in the pelvis
stoic response to labor pain
fathers usually not present
south korea
natural childbirth methods practiced
may labor silently
may eat during labor
father may be present
japan
stoic response to pain
fathers usually not present
side-lying position preferred for labor and birth because this position is thought to reduce infant trauma
china
natural childbirth methods preferred
father is usually not present
female relatives usually present
india
father not present
female support & female caregivers preferred
iran
may be stoic about discomfort until second stage
may request pain relief after that
fathers & female relatives may be present
mexico
may use squatting position for birth
fathers may or may not be present
female attendants preferred
laos
how many stages of labor?
4
stage 1 starts & ends with what?
starts with active contractions
ends with 10 cm dilated
stage 1 is the ______ stage of labor for a woman
longest
phases of stage 1
latent phase
active phase
transition phase
latent phase is through ____cm of dilation
3
nursing Dx for latent phase
anxiety
latent phase is the best time to?
teach her
how long is latent phase
6-8 hours long
contractions in latent phase
mild to moderate irregular contractions occurring 5-10 minutes apart lasting 30-45 seconds
active phase is ___-___cm of dilation
4-7cm
nursing dx in active phase
alteration in comfort
interventions for active phase
focused breathing
effleurage
massage
the status of amniotic membranes, such as a gush or seepage of fluid
SROM
use amniohook to rupture
AROM
vitals in active phase
every 30 min
FHR in active phase
15-30 min
latent phase vitals & FHR
30-60 min
uses a cotton tip applicator impregnated with Nitrazine dye for determining pH
nitrazine test
differentiates amniotic fluid
nitrazine test
amniotic fluid is?
slightly alkaline
urine & purulent material (pus) is?
acidic
yellow fluid pH
5.0
olive-yellow pH
5.5
olive-green pH
6.0
blue-green pH
6.5
blue-gray pH
7.0
deep blue pH
7.5
spread a drop of fluid from the vagina on a clean glass slide with a sterile cotton-tipped applicator
ferning or fern pattern test
what to look for on the slide in a fern test
observe for appearance of ferning
fetus diagnosis
risk for impaired gas exchange r/t placental insufficiency.umbillial cord compression
goal for fetus diagnosis
maintains a FHR of 110-160, moderate variability, and no decal’s throughout the labor process
interventions of the fetus
observe FHR for non-reassuring signs of fetal hypoxia such as bradycardia, tachycardia, decreasing variability;
institute intrauterine resuscitation measures such as turning off piton
reposition mom
increase IV fluids
begin oxygen with tight fitting mask at 8-10 L/min
___-___cm of dilation in transition phase
8-10cm
nursing dx in transition phase
risk for ineffective coping r/t increasing frequency, longer duration, and stronger contractions
contracts during transition phase
very strong regular contractions 2-3 min apart lasting 45-90 seconds
interventions for transition phase
assess pain level
quiet environment
support
encouragement
stage 2 begins with _______ and meds with
begins with complete dilation and effacement of the cervix
ends with birth of the baby
nursing dx for stage 2
risk for acute pain r/t bearing down efforts & distention of the perineum
don’t asses for ____ in stage 2
pain
if the mom is 100% effaced and 10 cm dilated instruct her to do what?
push with the contraction.
tell her when to push and when to relax
if the mom isn’t 100% effaced and 10cm dilated do what?
pant and blow air with her
interventions for stage 2
iron the perineum
side-lying position for delivery
iron the perineum with?
olive oil
tear during stage 2
lacerations
cut with scissors the area between the vagina and anus-perineum body
episiotomy
1st degree involves
epidermis
2nd degree involved
dermis, muscle, fascia
3rd degree extends into
the anal sphincter
4th degree extends ?
up the rectal mucosa
stage 3 begins and ends when?
begins with birth of baby and ends when the placenta is expelled
nursing diagnosis for stage 3
risk for deficient fluid volume r/t blood loss occurring after placental separation/expulsion
interventions for stage 3
open up IV piton
massage fundus
put NB to mom’s breast
medications during stage 3
pitocin
methergine
hemabate
stage 4 is ___-____ hours after the baby is born
2-4
nursing diagnosis during stage 4
risk for fatigue r/t energy expenditure associated with childbirth
during stage 4 the fetus is now a ______.
neonate
what would the RN report to the midwife
VS
Fetal HR
Contraction pattern
non-english speaking client & the father won’t go in the room. RN finds the translator to do what?
assess his cultural beliefs about childbirth
2nd stage of labor has begun when the nurse does what?
the cervix cannot be felt during a cervical exam
a 19 y/o with membranes intact. cervix 50% effaced. 1 cm dilated: -3 station. wants to go pee:
go to BR
5 P’s of labor and delivery
passage passenger powers psyche position
birth canal
composed of the mother’s rigid bony pelvis and the soft tissues of the cervix, the pelvic floor, the vagina, and intoitus
passage
the external opening to the vagina
introitus
the 4 basic types of pelvis are classified as the following:
gynecoid
android
anthropoid
platypelloid
the classic female pelvis
gynecoid
resembling the male pelvis
android
resembling the pelvis of anthropoid apes
anthropoid
the flat pelvis
platypelloid
The women that you saw in labor and they just push that baby out in a matter of 2 hours with no problems, they probably had this pelvis. Shaped like a heart that is more wide and long
gynecoid pelvis
. In the shape of a small heart.
android pelvis
A long interior-posterior diameter
anthropoid pelvis
The baby will get stuck up there. Has a wide transverse diameter
platypeltoid pelvis
• The way the passenger, or fetus, moves through the birth canal is determined by several interacting factors:
size of the fetal head
fetal presentation
fetal lie
fetal attitude
fetal position
Because the bones are not firmly united, slight overlapping of the bones, or _______ of the shape of the head, occurs during labor.
molding
Molding can be extensive but the heads of most newborns assume their normal shape within ____ days after birth.
3
♣ The fetus’ bones are joined by membranous ligaments called sutures
- Lambdoid suture
- Sagittal suture
- Coronal suture
- Frontal suture
♣ ________ refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor.
presentation
♣ The three main presentations are:
cephalic
breech presentation
shoulder presentation
cephalic presentation
head first
breech means?
buttocks, feet, or both first
shoulder presentation means?
baby’s lying horizontally with shoulder presenting first
is the part of the fetus that lies closest to the internal os of the cervix
presenting part
in the Cephalic presentation the presenting part is usually the
occiput
in breech presentation the presenting part is?
sacrum
in cephalic presentation what presents first?
scapula
when the presenting part is the occiput the presentation isn noted as ____.
vertex
is the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother
Lie
the 2 primary lies are?
longitudinal or vertical
is the relation of the fetal body parts to each other.
attitude
is the normal attitude and is characterized by the back of the fetus being rounded so that the chin is flexed on the chest, the thighs flexed on the abdomen, and the legs are flexed at the knees
general flesion
is the largest transverse diameter and an important indicator of fetal head size
biparietal diameter
biparietal diameter is usually ___ cm at term
9.25
is the widest part of the head entering the pelvic inlet
biparietal diameter
of the several anteroposterior diameters, the smallest and the most critical one is the ______ ______.
suboocipitobregmatic diameter
when the head is in complete ____ this diameter allows the fetal head to pass through the true pelvis more easily.
flexion
is the relationship of a reference point on the presenting part, or sinciput to the four quadrants of the mother’s pelvis.
position
is the relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines and is a measure of the degree of descent of the presenting part of the fetus through the birth canal.
station
is the term used to indicate that the largest transverse diameter of the presenting part has passed through the maternal pelvic brim or inlet not the true pelvis and usually corresponds to station 0
engagement
engagement can be determined by?
abdominal or vaginal examination
involuntary and voluntary ____ combine to expel the fetus and the placenta from the uterus.
powers
involuntary uterine contractions, called the _____ _____, signal the beginning of labor.
primary powers
augment the force of the involuntary contractions
secondary powers
terms used to describe the involuntary contractions include
frequency, duration, & intensity
the time from the beginning of one contraction to the beginning of the next
frequency
