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L/d Exam 2 > Week 6 > Flashcards

Week 6 Flashcards

1
Q

Mild contraction feels like…

A

Tip of nose

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2
Q

Strong contraction feels like…

A

Your forehead

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3
Q

2 main changes during first stage of labor

A

Effacement and dilation

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4
Q

Effacement

A

Shortening and thinning of the cervix

First stage of labor

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5
Q

What effacement % is ready to deliver

A

100%

Paper thin

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6
Q

Dilation

A

Enlargement of cervical os/canal

Rates 0-10

First stage of labor

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7
Q

Station

A

Measure present spine

The measurement of the progress of descent in cm above or below the mid plane from the presenting part to the ischial spine

0
Means the baby is dropping(lightning)

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8
Q

When do you take mother’s vital signs

A

During the rest period between contractions

B/c HR and RR increase during contraction

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9
Q

What should mother eat during labor

A

Gastric mobility is slowed

Lite meal to keep energy
Ice chips
Water
Popsicles

W/ epidural only clear liquids

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10
Q

Placental circulation during labor

A

Maternal supply of blood to placenta stops during STRONG contraction

Give pain meds during contractions so fetus does not get the medication.

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11
Q

Normal fetal heart rate is

A

110-160

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12
Q

Components of birthing process …. the 4Ps

A

Powers: contractions, pushing
Passage: birth canal
Passenger: baby, placenta
Psyche: mom feel tired or excited, anxiety, fatigue an affect w/labor

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13
Q

Variations of passenger

A

LIE
ATTITUDE
PRESENTATION
POSITION

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14
Q

LIE

A

The way the fetus is lying in the the uterus

Longitudinal (vertical) up and down
or
transverse(horizontal) side to side

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15
Q

Attitude

A

Flexion: curled up (ideal)

Extension: sprawled out

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16
Q

Presentation

A

Cephalic
Shoulder
Breech

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17
Q

Presentation cephalic

A
  1. Ideal: vertex presentation (crown of head)
    Complete flexion (curled up)
    OCCIPUT
  2. Face presentation
    full extension(sprawled out)
    MENTUM
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18
Q

Presentation shoulder

A

Baby is LIE transverse

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19
Q

Presentation breech

A

Buttock presentation (sacrum)

Deliver by c-section

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20
Q

Position anterior

A

Baby looks at mommy’s spine

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21
Q

Position posterior

A

Baby looks thru mommy’s belly button

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22
Q

TRUE LABOR

A 
Contractions:
Back pain
Menstrual cramps
Regular
Stronger 
Last longer

Dilation and effecement

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23
Q

FALSE LABOR/ Braxton Hicks

A

Contractions felt in abdomen and groin
More annoying than painful
No progression
Irregular

ACTIVITY SUCH AS WALKING RELIEVES FALSE LABOR

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24
Q

Contractions

A

Start from the top of the uterus

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25
Q

What is needed for cervical dilation

A

Strong consistent contractions

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26
Q

Warning signs for labor

A 
Lightening(dropping) 2-3 weeks before
Braxton Hicks increase
Clear discharge increases
Bloody show (mucus plug)
Nesting- cleaning, organizing
Spontaneous rupture of membrane (water breaks)
27
Q

What should you monitor when the waters brakes

A

Fetal heart rate

28
Q

What helps make the cervix dilate easier

A

The bloody show/ lose mucus plug

29
Q

Assessment of amniotic fluid (ROM)

COAT

A

C-color
O-odor
A-amount
T-time

30
Q

Quickening

A

Can feel the fetus drop

31
Q

Stage 1-latent phase

A

Longest
Dilation: 1-3 cm
Contractions: every 15-30 minutes and last 15-30 seconds
Mild intensity

32
Q

Stage 1- latent phase interventions

A
  1. Encourage mother/partner to participate in care
  2. Assist w/comfort-change position and ambulate
  3. Keep mother/partner informed of progress
33
Q

Stage 1- active phase

A

Dilation: 4-7

Contractions: occur every 3-5 minutes and last 30-60 seconds

Moderate intensity

34
Q

Stage 1-active phase interventions

A

1.Encourage maintenance of effective breathing patterns

2.Promote comfort w/
Back rubs
Sacral pressure
Pillow support
Position changes

Can Offer epidural

35
Q

Stage 1-transition phase

A

Dilation: 8-10 cm

Contractions: occur every 2-3 minutes and last for 45-90 seconds

Strong intensity

36
Q

Stage 1- transition phase interventions

A
  1. Encourage rest between contractions

2. Encourage voiding every 1-2 hours (unless epidural)

37
Q

2nd stage- baby comes out (expulsion of the fetus)

A

Cervical dilation is complete

Change in fetal station(-3,-2,-1,0,+1,+2,+3)

Contractions: occur every 2-3 minute, lasting 60-75 seconds

Strong intensity

Increase bloody show / mother feels urge to bear down

38
Q

2nd stage- pushing baby out interventions

A

Provide encouragement and praise for rest between contractions

Assist mother in positions to help pushing

MONITOR FOR PERINEAL BULGING

39
Q

3rd stage- expulsion of the placenta

A

Occurs 5-30 minutes after delivery of the baby

Examine placenta

40
Q

3rd stage- what side of placenta shows first?

A

Schultze mechanism -shiny (fetal side)

Duncan mechanism- dull, dirty (maternal side)

41
Q

4th stage- physical recovery

A

1-4 hrs after delivery

B/P returns to prelabor level

Pulse lowers

Fundus remains contracted, midline 1 or 2 fingers below the umbilicus

42
Q

4th stage interventions

A

Monitor lochia discharge-moderate and red

Provide blankets
Apply ice to perineum
Massage uterus if needed
Provide breast-feeding support as needed

43
Q

Antepartum

A

During pregnancy

44
Q

Risk factors for fetal compromise antepartum maternal hx

A 
Previous stillbirth
Previous c-section
Poor nutrition, poor wt gain
Multiple pregnancies close together
Chronic disease
Acute infection
Drug use
Psychosocial stress, domestic violence
45
Q

Fetal compromise antepartum- problems identified

A 
Gestation greater than 42 weeks
Decrease in fetal movement
Multifetal gestation
Preeclampsia, eclampsia
Diabetes
Placenta issues
Maternal severe anemia
Maternal trauma
46
Q

Intrapartum

A

During L/D

47
Q

Risk factors for fetal issues -intrapartum maternal issues

A 
High BP, low BP
Hypertonic uterine contractions
Abnormal labor
Prolonged ROM
Chorioamnionitis
Fever
48
Q

Risk factor fetal issues intrapartum- fetal/ placenta problems

A 
Fetal anemia
Persistent abnormal or no reassuring FHR or pattern
Meconium-stained amniotic fluid
Abnormal presentation or position 
Prolapsed cord
Abruptio placentae
49
Q

External electronic fetal monitor

A

Displayed on computer or printed strip

At the bedside and nurses station

FETAL DOPPLER TRANSDUCER lower abdomen

TOCOTRANDUCER placed on upper abdomen, monitors uterine activity

50
Q

Internal electronic fetal monitor

A

ROM has to happen before insertion
Cervix has to be dilated

FETAL SCALP ELECTRODE-attached to the scalp, used for accurate FHR, very obese woman

INTRAUTERINE PRESSURE CATHETERS(IUPCs) monitors contraction intensity (strength of contraction)

51
Q

PATTERN OF FHR

A

BRADYCARDIA: FHR below 110 for 10 minutes or longer!!

TACHYCARDIA: FHR higher than 160 for 10 minutes or longer!!!

52
Q

Interventions for Fetal bradycardia or tachycardia

A

Change mothers position

Administer oxygen

Assess VS

Notify HCP ASAP

53
Q

Reasons for Fetal bradycardia

A

Due to Cord Pain meds

Mom change position

54
Q

Reasons for Fetal tachycardia

A

Due to infections…. see if mom has a fever then change position

If infection start antibiotics

55
Q

Variability

A

Fluctuations in baseline FHR

absent or undetected FHR is nonreasuring

56
Q

Non stress test reassuring results mean…

A

FHR goes up

57
Q

Decreased variability causes

A

Fetal hypoxemia
Acidosis
Maternal alcohol/drug use
Certain medications

58
Q

Temporary decrease in variability (FHR) due to….

A

Fetus is in sleep state

Fetus doesn’t sleep more than 30 minutes at a time

59
Q

Accelerations- normal

A

Brief temporary increases in FHR of at least 15 bpm more than baseline for at least 15 seconds

Reassuring sign 
Occurs during fetal movement 
Contractions
Vaginal exams
Mild cord compression
Breech presentation
60
Q

Early deceleration

A

decrease in FHR below baseline but still greater than 100 bpm

Head compression agains soft tissue(cervix) or pelvis!!!!

Not associated with fetal compromise

NO REQUIRED INTERVENTIONS
During contraction HR decrease due to head compression

61
Q

Late deceleration

A

Placenta exchange impaired (uteroplecental insufficiency)

Nonreassuring

Decreased HR begins well after the contraction begins and returns to baseline after the contraction ends

62
Q

Intervention for late decelerations- fetus not getting oxygen

A 
Change mothers position
Stop oxytocin if on it
Notify HCP
Increase iv fluids 
Give mom oxygen via mask 8-10 l
Might need c-section
Document
63
Q

Variable decelerations

A

Cord compression!!!
Don’t have a uniform appearance(goes up and down)
Falls and rises abruptly when relief of cord compression

64
Q

reassuring variable decelerations

A

Less than 60 seconds with rapid return to baseline

L/d Exam 2 (2 decks)

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