Chapter 33 Obstetrics and Neonatal Care Flashcards
(186 cards)
1
Q
Page 1192
A
Test
2
Q
Questions to ask when taking a pregnant woman’s history
A
Due date Any complications Prenatal care Fetal movements Frequency of contractions History of previous pregnancies Multiples Drugs or medications during pregnancy If water broke, was the fluid green
3
Q
Meconium
A
Fetal stool
4
Q
The presence of meconium
A
Can indicate fetal distress and can be aspirated during delivery
5
Q
How the length and frequency of contractions is assessed
A
By asking the patient and placing a hand on the abdomen
6
Q
A woman’s blood pressure typically drops slightly during these trimesters
A
The first two
7
Q
In a scenario where you are transporting a pregnant patient with complaints unrelated to childbirth, the hospital will want to know these things
A
Weeks of gestation, due date, and complications of pregnancy
8
Q
The three stages of labor
A
Dilation of the cervix, delivery of the fetus, delivery of the placenta
9
Q
Signals the beginning of the first stage of labor
A
Onset of contractions
10
Q
Signals the end of the first stage of labor
A
When the cervix is fully dilated
11
Q
Usually the longest stage of labor
A
1st
12
Q
Average length of the first stage of labor in a first pregnancy
A
16 hours
13
Q
Other signs of the beginning of labor
A
Bloody show(blood-streaked mucus) and rupture of the amniotic sac(water breaking)
14
Q
Initially, uterine contractions may not occur at regular
A
Intervals
15
Q
In true labor, contractions increase in
A
Frequency and intensity overtime
16
Q
Uterine contractions become more regular and last about this long
A
30 to 60 seconds each
17
Q
Labor lasts longer in _______ than in a ______.
A
Primigravida, multigravida
18
Q
Primigravida
A
A woman who is experiencing her first pregnancy
19
Q
Multigravida
A
A woman who has experienced multiple pregnancies
20
Q
Another name for false labor
A
Braxton-Hicks Contractions
21
Q
The number of characteristics that define Braxton-Hicks contractions
A
5
22
Q
First characteristic of Braxton-Hicks contractions
A
Irregular and do not increase in intensity or frequency
23
Q
Second characteristic of Braxton-Hicks contractions
A
Pain and contractions start and stay in the lower abdomen
24
Q
Third characteristic of Braxton-Hicks contractions
A
Contractions and pain may be alleviated by physical activity or a change in position
25
Fourth characteristic of Braxton-Hicks contractions
If present, bloody show is brownish
26
Fifth characteristic Braxton-Hicks contractions
If leakage of fluid occurs, it is usually urine. It will be in small amounts and smell of ammonia
27
Number of characteristics of true labor
Five
28
First characteristic of true labor
Contractions, one started, consistently get stronger and closer together
29
Second characteristic of true labor
Pain and contractions may start in the lower back and “wrap around” to the lower abdomen
30
Third characteristic of true labor
Physical activity may intensify the contractions. A change in position does not relieve contractions
31
Fourth characteristic of true labor
The bloody show is pink or red in general a company by mucus
32
The fifth characteristic of true labor
The amniotic sac may break before contractions start or may break during contractions. A moderate amount of fluid that may smell sweet will be present, and fluid will continue to leak.
33
Should you transport in the presence of Braxton-Hicks contractions?
Yes
34
Premature rupture of the amniotic sac can occur as early as
Several months before they are due to deliver
35
Premature rupture of the amniotic sac may or may not cause ____
The woman to go into labor
36
A woman who experiences a premature rupture of the amniotic sac needs ___
Transport to the hospital
37
Lightening
When the head of the fetus descends into the woman’s pelvis as the fetus positions for delivery, toward the end of the third trimester
38
Following lightening, it becomes easier to _____
Breathe
39
Why does it become easier to breathe after lightening?
Because the fetus has moved from under the rib cage
40
This marks the beginning of the second stage of labor
When the fetus enters the birth canal
41
This marks the end of the second stage of labor
The delivery of the newborn
42
During the second stage of labor, the fetus goes to positional changes as it moves through the birth canal. This causes ____
Contractions to become closer together and last longer
43
During the second stage of labor, the woman may feel as if she needs to have a bowel movement. This is because
The fetus puts pressure on the rectum
44
Crowning
When the top of the fetus his head begins to appear at the vaginal opening
45
This marks the beginning of the third stage of labor
The birth of the newborn
46
This marks the end of the third stage of labor
The delivery of the placenta
47
Delivery of the placenta may take up to this long
30 minutes
48
During the delivery percent of contractions continue. This functions to ____
Assist in the separation process and in clamping down and closing the blood vessels that connected the placenta to the uterine lining
49
The number of questions the textbook lists in order to determine whether delivery is imminent
Eight
50
First question the text book lists in order to determine whether delivery is imminent
How long have you been pregnant?
51
The second question the text book lists to help determine whether delivery is imminent
When are you due?
52
The third question the text book lists to help you determine whether delivery is imminent
Is this your first pregnancy?
53
The fourth question the text book lists to help you determine whether delivery is imminent
Are you having contractions? How far apart are the contractions? How long do the contractions last?
54
The fifth question the textbook lists in order to help you determine whether delivery is imminent
Have you had any spotting or bleeding?
55
The sixth question the textbook lists in order to help you determine whether delivery is imminent
Has your water broken?
56
The seventh question the text book lists in order to help you determine whether delivery is imminent
Do you feel as though you need to have a bowel movement?
57
The eighth question the text book lists in order to help you determine whether delivery is imminent
Do you feel the need to push?
58
The number of questions in the textbook lists in order to help you determine any potential complications in pregnancy
Five
59
The first question the textbook lists in order to help you determine any potential pregnancy complications
Were any of your previous deliveries by cesarean section?
60
Second question the textbook lists to help determine any potential pregnancy complications
Have you had any problems in this or any previous pregnancy?
61
The third question the textbook lists in order to determine any potential pregnancy complications
Do you use drugs, drink alcohol, or take any medications?
62
The fourth question listed by the textbook to help you determine any potential pregnancy complications
Is there a chance you will have multiple deliveries (having more than one baby)?
63
The fifth question listed by the textbook to help you determine any potential pregnancy complications
Does your physician expect any other complications?
64
Three scenarios in which you should prepare for immediate delivery
If the patient says she’s about to deliver, so she has to move her bowels, or feels the need to push
65
During delivery, put a blanket or pillow under the patient tips so that they are elevated about
2 to 4 inches
66
How should the patient’s hips, legs, knees, and feet be positioned?
Hips and legs flexed. Feet flat on the ground. Knees apart
67
The number of steps in preparing for a field delivery
Four
68
First step in preparing for a field delivery
If time allows, put on a face shield and gown and place towels or sheets on the floor around the delivery area to help soak up body fluids and to protect the woman and the newborn
69
The second step in pairing for a field delivery
Open the OB kit carefully so its contents remain sterile
70
Third step in preparing for a field delivery
Put on sterile gloves. After this, handle only sterile materials
71
Fourth step in preparing for a fuel delivery
Using sterile sheets in drapes from the OB kit to make a sterile delivery field. Place one sheet under the women’s buttocks and unfold it toward her feet. Wrap another behind the patients back and drape it over each thigh. Drape one sheet across the abdomen
72
Precipitous labor
Fast labor
73
What type of woman is at greater risk for precipitous labor
Women who have previously had children
74
When laborers to fast
The tissues do not have time to stretch and the patient is at risk for tears in the peroneal area
75
Frequency of contractions is measured
By starting your time at the beginning of one contraction and ending at the beginning of the next contraction
76
The duration of each contraction is measured
By feeling the patient’s abdomen. Contractions begin with uterus and abdomen tightening and end with uterus and abdomen relaxing
77
During contractions, you want to remind the patient to breathe this way.
In quick, short breaths but not to strain
78
Between contractions, you want the patient to breathe this way
Rest and breathe deeply through her mouth
79
The number of steps in delivering a newborn according to skill drill 33–1
10
80
Step one in delivering a newborn
Crowning is the definitive sign that delivery is imminent and the transport should be delayed until after the child has been born
81
Step two in delivering a newborn
Allow the woman to push the head out. Use your hands to support the bony parts of the head as it emerges. The child’s body will naturally rotate to the right or left at this point in the delivery. Continue to support the head to allow it to turn in the same direction. Avoid the eyes and fontanelles. Feel at the neck to see if the umbilical cord is wrapped around it. If it is, gently lift it over the head without pulling hard on the cord.
82
Step three in delivering a newborn
Once the head is delivered, it will rotate on its own to one side. At the next contraction, the upper shoulder will be visible. Guide the head down slightly by applying gentle downward traction to help the upper shoulder deliver.
83
Step four in delivering a newborn
Support the head and upper body as the shoulders deliver. You may need to guide the head up slightly to help deliver the lower shoulder.
84
Step five in delivering a newborn
Once the body is delivered, support the newborn firmly but gently. The newborn will be very slippery. Support the newborn’s head with the neck in a neutral position to keep the airway open.
85
Step six in delivering a newborn
If the mother is willing and able, place the new one directly on the mother’s abdomen, with the cord still intact. The skin to skin technique keeps the newborn warm and perfused; the mother’s skin provides warmth while the placental perfusion continues until the pulsations in the cord stop.
86
Step seven in delivering a newborn
After delivery and prior to cutting the cord, if the child is gurgling or shows other signs of respiratory distress, suction the mouth and oropharynx to clear any amniotic fluid and facilitate the infant’s initiation of air exchange.
87
Step eight in delivering a newborn
Place a clamp on the umbilical cord. Milk the blood from a small section of the cord on the placental side of the clamp. This prevents the cord blood located between the clamps from spilling onto the floor when you eventually cut the cord. Then place a second clamp 2 to 3 inches away from the first.
88
Step nine in delivering a newborn
Cut between the two clamps
89
Step 10 in delivering a newborn
The placenta will deliver itself, usually within 30 minutes of birth. Never pull on the end of the umbilical cord in an attempt to speed the delivery of the placenta.
90
Cephalic presentation
When the fetus is positioned head first in the birth canal
91
The risk of peroneal tearing during labor can be reduced by
Applying gentle pressure across the perineum with a sterile gauze pad
92
The location of the two primary fontanelles
One at the top of the head and one near the back of the head
93
And unruptured amniotic sac is potentially life-threatening for the fetus because
The sac will suffocate the fetus if it is not removed
94
Two ways you can puncture the amniotic sac
With a clamp or by twisting it between your fingers
95
If you puncture the amniotic sac, make sure that the puncture site is where
Away from the fetus’ face
96
Do not puncture the sac if the fetus’ head is not
Crowning
97
After you’ve punctured the sac, push it
Away from the fetus’ face
98
Nuchal cord
When the umbilical cord was wrapped around the fetus’ neck
99
How to check for a nuchal cord
Use one finger to feel whether the umbilical cord is wrapped around the neck
100
How to release a new cord from around the neck
Slip the cord gently over the delivered head, or shoulder if necessary. If the cord is too tight, you must cut the cord by placing two clamps about 2 inches apart on the cord and cutting between the clamps.
101
If a new cord is wrapped more than once around the neck
You still only cut once, but then you unwrap the cord from around the neck
102
Once the nuchal cord is cut
You must attempt to speed delivery by encouraging the women to push harder and possibly more often because the fetus will have no oxygen supply until it is delivered and breathing spontaneously
103
Vernix caseosa
A white, cheesy substance that covers the body of the fetus
104
After delivery, aspiration can be prevented by
Keeping the head slightly lower than the rest of the body
105
For the newborns birth certificate and as the starting point from which to time the intervals for Apgar scores, it is important that you record this
Time of birth
106
Post delivery care of the umbilical cord is important because
Infection is easily transmitted through the cord to the newborn
107
When the umbilical cord is typically cut
After the cord has stopped pulsating
108
How far away from the newborns body that you want to place the first umbilical clamp
6 inches
109
If handled roughly, the umbilical cord could be torn from the newborn’s abdomen, resulting
In fatal hemorrhage
110
Before the delivery of the placenta, this amount of bleeding is normal
500 mL or less
111
Characteristics of a normal placenta
Round, about 7 inches in diameter, and about 1 inch thick. One surface is smooth and covered with a shiny gray membrane. The other surface is rough, divided into lobes, and is a dark reddish brown color similar to raw liver
112
What you do with the placenta and umbilical cord after they have been delivered
Wrap them in a towel and place them in a plastic bag. Take them to the hospital
113
If a piece of the placenta has been retained inside the woman
It could cause persistent bleeding or infection
114
Fundal massage
Massaging the woman’s abdomen with a firm, circular, kneading motion.
115
Fundal massage is used to
Slow vaginal bleeding
116
Fundus
A firm, grapefruit sized mass in the lower abdomen which is actually the upper end of the uterus
117
Another way in which the uterus can be stimulated to contract
Breast-feeding
118
The release of which hormone during fundal massage and breast-feeding helps to contract uterus and slow bleeding
Oxytocin
119
Three emergency scenarios listed by the book that occur during the third stage of labor
The placenta has not delivered after 30 minutes, more than 500 mL of bleeding occurs before delivery of the placenta, and significant bleeding occurs after delivery of the placenta
120
Expectations of a newborns breathing and circulation within 15 to 30 seconds after birth
The newborn will be breathing spontaneously and its heart rate will be 120 bpm or higher
121
If a newborn’s breathing is not spontaneous and their heart rate is not 120 bpm or higher
Gently tap or flick soles of the newborn feet or rub the back to stimulate breathing
122
Begin newborn resuscitation efforts if
They do not breathe after 10 to 15 seconds of stimulation
123
The number of measures you can take to stimulate breathing and circulation in a newborn
Five
124
First measure you can take to stimulate breathing and circulation in a newborn
Position the newborn on his or her back with a towel or blanket under the shoulders so that the head is down and the neck is slightly extended
125
The second measure you can take to stimulate breathing and circulation and a newborn
Drying
126
The third measure you can take to stimulate breathing and circulation in a newborn
Warming
127
The fourth measure you can take to stimulate breathing and circulation in a newborn
Suction the mouth and then the nose using a bulb syringe or an eight or 10 French catheter. Avoid deep suctioning of the mouth and throat, as this can cause the heart rate to slow down. Aim blow by oxygen at the newborns mouth and nose during resuscitation.
128
The fifth measure you can take to stimulate breathing and circulation in a newborn
Tactile stimulation. Rub the newborns back and gently flick or slap the soles of their feet
129
If newborn respiratory effort appears appropriate, this vital sign becomes the most important measure in determining the need for further resuscitation
Heart rate
130
If a newborn’s heart rate is more than 100 bpm
Keep the newborn warm, transport, and reassess
131
If a newborn’s heart rate is 60 to 100 bpm
Begin assisted ventilation with a BVM and room air. Reassess the newborn after 90 seconds and if the heart rate and respirations are not normal, begin to ventilate with 100% oxygen. Continue to reassess the newborn. Call for ALS back up if available. Keep the newborn warm
132
If a newborn’s heart rate is fewer than 60 bpm
Begin assisted ventilation with a BVM and 100% oxygen. Reassess the newborn every 90 seconds until heart rate and respirations are normal. Begin chest compressions. Call for ALS back up is available. If the heart rate does not increase, medication and ALS will be needed
133
How chest compressions and ventilations should be delivered on a newborn
Use the hand-encircling technique for 2 person resuscitation. Use a 3 to 1 ratio of compressions to BVM ventilations.
134
A 3 to 1 ratio of compressions to ventilations should produce a total of
90 compressions in 30 ventilations per minute
135
If you see meconium in the amniotic fluid or meconium staining in the newborn is not breathing adequately,
Consider quickly suctioning the newborns mouth and then nose after delivery before providing rescue ventilation
136
Meconium aspiration can lead to
Significant lung disease and even death
137
Any newborn who requires more than a routine resuscitation requires transport to
A hospital with a level three neonatal intensive care unit
138
Apgar score
Used to assess the status of a newborn
139
Five areas of activity in the Apgar scoring system
Appearance, pulse, grimace or irritability, activity or muscle tone, and respiration
140
Apgar score of 0 in appearance
Entire newborn is blue or pale
141
Apgar score of 1 in appearance
Body is pink, but hands and feet remain blue
142
Algae score of 2 in appearance
Entire newborn is pink
143
Apgar score of 0 in pulse
Absent pulse
144
Apgar score of 1 in pulse
Fewer than 100 bpm
145
Apgar score of 2 in pulse
More than 100 bpm
146
Apgar score of 0 in grimace or irritability
Newborn does not cry or react stimulus
147
Apgar score of 1 in grimace or irritability
Newborn gives a weak cry in response to stimulus
148
Apgar score of 2 in grimace or irritability
Newborn cries and tries to move foot away from finger snap against sole of foot
149
Apgar score of 0 in activity or muscle tone
Newborn is completely limp, with no muscle tone
150
Apgar score of 1 in activity or muscle tone
Newborn makes weak attempts to resist straightening
151
Apgar score of 2 in activity or muscle tone
Newborn resists attempts to straighten hips and knees
152
Apgar score of 0 in respiration
Absent respirations
153
Apgar score of 1 in respiration
Slow respirations
154
Apgar score of 2 in respiration
Rapid respirations
155
Newborns often have cyanosis where for a few minutes after birth
Extremities
156
Apgar should be calculated when
One minute after birth and again at five minutes after birth
157
Reassess respirations in heart rate at least every
30 seconds
158
Blow by oxygen should be administered
Using oxygen tubing or an oxygen mask close to the newborn’s face at a flow rate of 5 L per minute
159
Bag valve mask ventilation should be performed on a neonate at a rate of
40 to 60 breaths per minute or 1 breath every 1 1/2 seconds to 1 breath a second
160
You may need to bypass the pop off valve
To accomplish good chest rise and fall
161
Do not give up!
Many newborns have survived without brain damage after prolonged periods of effective CPR
162
Presentation
The position in which an infant is born or the body part that is delivered first
163
Headfirst presentation
Vertex presentation
164
When the buttocks are delivered first
Breech presentation
165
Breeched presentations are dangerous because
The infant is at risk of trauma and also prolapsed cords are more common
166
The relative length of breech deliveries compared to normal deliveries
Breech deliveries are usually longer
167
During a breech presentation you should reach into the vagina and
Make a V with your gloved fingers and position them to keep the walls of the vagina from compressing the fetus’ airway
168
Limb presentation
When a single arm or leg exits first
169
Limb presentations require
Surgical intervention and cannot be delivered in the field
170
The position that a mother with limb presentation should be placed in
On her back, with her head down, and her pelvis elevated
171
A mother with limb presentation should be given
High flow oxygen
172
Prolapse of the umbilical cord
When the umbilical cord presents first
173
The first position in which a patient with a prolapsed umbilical cord can be placed
With the foot end of the cot raised 6 to 12 inches higher than the head and her hips elevated on a pillow or folded sheet.
174
Second position in which a patient with a prolapsed umbilical cord can be placed
Knee chest position: kneeling and bent forward, face down.
175
How a fetus’ head is kept off of a prolapse in umbilical cord
Using a gloved hand, reach into vagina and gently push the fetus’ head away from the umbilical cord. This position may need to be maintained until the patient is in the operating room.
176
This should be used to cover a prolapsed cord
Sterile towel moistened with saline
177
Spina bifida
A developmental defect in which a portion of the spinal cord or meninges may protrude outside of the vertebrae and possibly outside of the body
178
What you do with the exposed portion of spinal cord in a patient with spina bifida.
Cover the open area of spinal cord with moist, sterile dressing and then an occlusive dressing to seal the area. It should be done immediately after birth to prevent a potentially fatal infection
179
Full term gestation
Between 39 weeks and 40 weeks, six days. This is approximately nine calendar months. On average full-term newborns weigh 7 pounds
180
Preterm gestation
Any newborn who delivers before eight months (36 weeks of gestation) or weighs less than 5 pounds
181
Post term gestation
Gestation period is longer than 42 weeks
182
Delivery without sterile supplies should occur this way
Using freshly laundered sheets and towels, if possible. A gloved finger should be used to clear away blood and mucus from the mouth as soon as the newborn is delivered. The placenta should not be cut, but instead should be wrapped in a clean towel or put in a plastic bag. It should be kept at the same level as the newborn
183
A normal amount of blood loss during childbirth
That which is below approximately 500 mL
184
Postpartum patients are at increased risk of this
Embolism. Particularly pulmonary embolism
185
The length of time in which a woman is susceptible to a postpartum pulmonary embolism
Days to several months after childbirth
186
Blood vessels in the umbilical cord
2 arteries and 1 vein, from the perspective of the fetus/infant
