Exam 1: Units 1 and 2 Flashcards
(180 cards)
1
Q
5 P’s affecting labor
A
Passenger
Passageway
Position
Powers
Psychology
2
Q
P of labor:
refers to the part of the fetus tat enters the pelvic inlet first through the birth canal during labor
A
Passenger
3
Q
A
4
Q
space between the bones of the skull that allow for molding
“soft spots”
A
fontanelles
5
Q
relationship of the fetus’ body parts to one another
A
attitude
6
Q
how the spine of the fetus corresponds with the spine of the mother
A
lie
7
Q
part of the fetus that is encountered first when doing a vaginal exam
A
presentation
8
Q
how the part of the fetus corresponds to the mother’s pelvis
A
position
9
Q
this occurs when the largest diameter of the fetus’ head settles into the largest diameter of the mother’s pelvis
A
engagement
10
Q
fetal presenting part in relation to the ischial spines
A
station
11
Q
the baby is considered “engaged” when their presenting part is at the ischial spines. This is fetal station ____
A
0
12
Q
station numbers will be ____ ABOVE the ischial spine
A
positive
13
Q
station numbers will be ____ BELOW the ischial spine
A
negative
14
Q
birth is about to happen when station reaches
A
+4 or +5
15
Q
Leopold’s Meneuvers are performed at this time
A
after 36 weeks
16
Q
this is done by the HCP after 36 weeks to determine fetal position and estimate birth weight
A
Leopold’s Meneuvers
17
Q
the first Leopold Maneuver involves
A
feeling for the buttocks and head
18
Q
the second Leopold Maneuver involves
A
palpating which side the fetal back is located
19
Q
the third Leopold Maneuver involves
A
- determining presentation
- palpating the area just above the pubis symphysis
20
Q
the fourth and final Leopold Maneuver involves
A
- determining attitude
- applying downward pressure in direction of the pubis symphysis
21
Q
this type of pelvis is the wider/outer aspect of the pelvic bones
A
false pelvis
22
Q
this type of pelvis is the inner/narrower space that the fetus must pass through
A
true pelvis
23
Q
the progress in descent is measured by
A
station
24
Q
7 cardinal movements during the stages of labor
“Every Day Fine Infants Enter Eager & Excited”
A
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
25
these allow the cranial bones to overlap during delivery
sutures
26
26
voluntary and involuntary forces used to expel the baby and placenta from the uterus
power
27
cervical dilation is measured in
CM (1-10 CM)
28
effacement is measured in
percentage (1-100%)
29
optimal maternal position for labor and delivery
upright
30
nitrazine paper will turn this color in presence of amniotic fluid
blue
31
yellow or green fluid from the vagina may mean
meconium
32
this kind of labor has regular contraction intervals, increase with intensity and frequency, and are unrelieved with rest
true labor
33
this kind of labor have irregular contraction intervals, no change in duration or frequency, and are relieved by rest
false labor
34
a nullipara is a
woman who has never given birth to a child
35
a multipara is a
woman who has given birth more than once
36
a nullipara should go to the birthing unit if her contractions are
5 minutes apart for 1 hour
37
a multipara should go to the birthing unit if her contractions are
6-8 minutes apart for 1 hour
38
the first stage of labor includes these three phases
latent
active
transition
39
the cervix dilates this much during the latent stage (CM and %)
0-3 CM
0% - 30%
40
the cervix dilates this much during the active stage
4-7 CM
30% - 80%
41
the cervix dilates this much during the transition stage of labor
8-10 CM
80% - 100%
42
contractions are _____ during the latent phase
irregular
43
contractions last this long in the latent phase and are this long apart
~30 seconds in duration
15-30 minutes apart
44
contractions last this long in the active phase and are this long apart
~1 minute duration
3-5 minutes apart
45
contractions during the transition phase are this long in duration and this long apart
60 - 90 second duration
2-3 minutes apart
46
the baby is born during this stage of labor
stage 2
47
stage 2 is AKA the
pushing stage
48
incision in the perineum to allow more room for delivery
episiostomy
49
the placenta is delivered during this stage of labor
stage 3
50
once the baby is born, an APGAR should be scored within
1-5 minutes of birth (and skin to skin)
51
3 essential things to monitor in the mother during stage 4 of labor
blood loss
BP
pulse
52
during the 4th stage of labor, the nurse should assess lochia at this rate
every 15 minutes
53
during the 4th stage of labor, this medication can be given to the mother to help the uterus contract back down
oxytocin
54
if the placenta stays in the mother for more than 30 minutes after the baby is born, this is called a
retained placenta
55
the umbilical cord should have
2 arteries and 1 vein
56
stage 4 of labor focuses primarily on
postpartum care
57
3 hallmark signs that the placenta is separating from the uterus
surge of blood
umbilical cord lengthens
fundus contracts
58
condition where something is blocking or putting too much pressure on the superior vena cava, which can lead to swelling in the head/neck, and difficulty breathing
Vena Cava Syndrome
59
this opioid agonist-antagonist can be given to a mother for pain
nalbuphine
60
opioid agonists given to the mother for pain can cause this in the fetus
decreased fetal HR
61
IV opioids for pain should only be given at this time
4 or more hours BEFORE delivery
62
an epidural is this kind of analgesic
regional
63
this is a short-acting, single injection directly into spinal fluid for analgesia
spinal block
64
this is a longer-acting catheter placed into the epidural space to provide continuous analgesia
epidural
65
this is the most common type of analgesic given, which uses a local anesthetic injection for immediate relief into the spinal fluid before insertion of an epidural catheter for continuous analgesia that can be controlled with PCA
Combined Spinal/Epidural (CSE)
66
2 types of fetal monitoring
external and internal
67
the external fetal monitor that monitors fetal HR
Ultrasound transducer
68
the external fetal monitor that monitors uterine activity
Tocodynamometer
69
the internal fetal monitor that monitors fetal HR
Fetal scalp electrode
70
the internal fetal monitor that monitors uterine activity
Intrauterine pressure catheter
71
in order for internal fetal monitors to be used, this must occur
membranes must be ruptured
72
normal baseline FHR should be
110-160 bpm
73
in order to determine an accurate and consistent baseline, there must be monitoring for this long
at least 10 minutes
74
normal irregularities in fetal cardiac rhythm
variability
75
these changes in fetal cardiac rhythm indicate good oxygenation and can be caused due to fetal movement or contractions
accelerations
76
early decelerations are caused by
VEAL CHOP
head compression
(usually benign, no tx needed)
77
variable decelerations are caused by
VEAL CHOP
cord compression
78
if the nurse sees variable decelerations in the monitor, the nurse should
turn the mother to her left side
79
late decelerations are caused by
VEAL CHOP
placental insufficiency
80
late decelerations need
STAT attention
81
normal/desired type of decelerations
early decelerations
"It's OK to be early!"
82
if there are late decels noted, the nurse should do this with the IV fluids
increase IV fluids
83
the nurse should do this with the oxytocin if late decels are present
d/c oxytocin
84
the nurse should give supplemental _____ if late decels are noted
oxygen
85
this is labor that progresses so rapidly, typically less than 3 hours from onset to delivery
precipitous delivery
86
delivery complication where the baby's shoulder gets stuck behind the pelvic bone after the head has been delivered
shoulder dystocia
87
treatment for shoulder dystocia
McRobert's Maneuver
88
Fetal Malposition:
most difficult FETAL position to deliver in
occiput posterier - the back of the baby's head is against the mother's back
89
occurs when the cord comes before the presenting part
prolapsed cord
90
the side of the placenta that was attached to the uterine wall is called the
Duncan - "Dirty Duncan"
91
the side of the placenta that is more shiny with the umbilical cord coming out of
Schultz - "Shiny Schultz"
92
cells in this kind of solution will have no change
isotonic
93
cells in this kind of solution will take on fluid and swell
hypotonic
94
cells in this kind of fluid will shrink
hypertonic
95
IV fluid D5W acts _____ in the bag and _____ in the body
acts isotonic in the bag and hypotonic in the body
96
IV solution concentration for an isotonic solution
0.9%
Like 0.9% NS
97
IV solution concentration for a hypotonic solution
LESS than 0.9%
(there is less salt)
98
IV solution concentration for a hypertonic solution
MORE than 0.9%
(there is more salt)
99
3 main isotonic solutions
0.9% NS
Lactated Ringers
D5W - ONLY in the bag
100
2 main hypotonic solutions
any NS UNDER 0.9%
D5W - in the BAG
101
overuse of isotonic fluids can lead to
fluid overload and edema
102
hypotonic IV solutions are contraindicated in patients with
increased intracranial pressure (ICP)
this can swell the cells and cause cerebral edema
103
when using a hypertonic solution, monitor for
fluid volume overload
(more fluid being drawn to the vessels)
104
equation for mean arterial pressure (MAP)
2(diastolic BP) + systolic BP
/
3
105
pain while urinating
dysuria
106
excessive urination at night
nocturia
107
bloody urine
hematuria
108
involuntary voiding during sleep
enuresis
109
abnormal amounts of protein in the urine
proteinuria
110
UOP <400 ml/day
oliguria
111
UOP <100 ml/day
anuria
112
normal GFR range
90-120 ml/min
113
adults should void this much per day
1-2 L per day
114
what triggers the RAAS system into effect
low BP
more specifically decreased renal perfusion and salt delivery to the renal tubules
115
during RAAS, the liver releases
angiotensinogen
116
during RAAS, the kidney releases
renin
117
renin converts angiotensinogen to
angiotensin-I
118
the lungs release ____ which converts ANG-I to ANG-II
angiotensin converting enzyme
119
what is the resulting product of RAAS
aldosterone from the adrenal glands
120
hormone that can increase BP by decreasing diuresis
antidiuretic hormone (ADH)
121
most accurate indicator of fluid loss or gain in an acutely ill patient
weight
122
1 kg of weight gain = ______ of retained fluid
1000 ml
123
1 lb weight gain = ______ of retained fluid
450 ml
124
most critical renal lab value that is a waste product of muscle metabolism
creatinine
125
range for creatinine
0.6 - 1.2
126
creatinine over ____ means bad kidney
>1.3
127
creatinine is a better indicator of _____ than a BUN
renal function
128
pregnancy can _____ GFR
increase GFR
129
this is the nitrogenous waste product of protein metabolism
urea
130
normal range for BUN
7 - 20
131
this renal lab is a measure of the kidney's ability to excrete or conserve water
specific gravity
132
normal range for specific gravity
1.005 - 1.030
133
diluted urine means a ____ SG
LOW specific gravity
134
concentrated urine means a ____ SG
HIGH specific gravity
135
normal urine should be this color
pale yellow
136
amber urine may indicate
bile in the urine
137
orange urine may indicate
alkaline/concentrated urine
138
burgandy urine may indicate
use of laxatives or tea
139
renal biopsies are contraindicated in these patients
morbidly obese patients
140
oliguria for pediatric patients is
less than 1 ml/kg/hr
141
adults minimum UOP
30 ml/hr
142
abrupt damage to the kidney that causes buildup of waste, fluid, and electrolyte imbalance
Acute Kidney Injury (AKI)
143
Acute Kidney Injury (AKI) is
reversible
144
AKI that remains untreated can lead to
chronic kidney disease
145
an increase of _____ serum creatinine is criterion for AKI
>50% increase
146
this kind of renal failure occurs before the kidneys and is due to decreased renal perfusion to the kidneys
prerenal failure
147
this kind of renal failure indicates damage in the kidneys
intrarenal failure
148
intrarenal failure is AKA
Acute Tubular Necrosis (ATN)
149
these two items can cause or worsen intrarenal failure
contrast dye
- "Contrast Kills the Kidney"
"-mycin" antibiotics
- "It is a SIN to give -mycin"
150
this kind of renal failure occurs in structures past the kidney due to an obstruction/blockage in the urinary tract
postrenal failure
151
4 phases of acute kidney injury
"Oh Oh Darn Renal"
Onset/Initiation
Oliguria
Diuretic
Recovery
152
for patients with oliguria in the acute-care setting, administer
100-500 mL isotonic fluids or passive leg raise
153
the most significant sign of acute renal injury is
decreased urine output
154
phase of acute renal injury that is most urgently needing attention
oliguria
155
during the oliguric phase of AKI, this will be the UOP
100-400 ml in a 24-hour period
156
during the oliguric phase of AKI, SG, BUN, and creatinine will
increase
157
2 diet mods for the oliguric phase of AKI
low-protein intake
restrict fluids
158
the nonoliguric form of the Oliguric phase of AKI still indicates decreased renal function and increased BUN, but has a
normal urine output
159
this phase of AKI is considered the start of recovery
Diuresis period
160
monitor for this during the diuresis period of AKI
hypokalemia (due to the significant increase in urination)
161
this permanent consequence is normal following the recovery phase of AKI
Permanent 3% reduction in GFR
162
most common cause of death in acute renal failure
hyperkalemia (due to retained potassium from low UOP)
163
this is the priority for patient with a high potassium level
assess ECG status (potassium affects the heart)
164
inflammation of the fibrous sac surrounding the heart
pericarditis
165
accumulation of excessive fluid in the pericardial space
pericardial effusion
166
life-threatening amounts of fluid in the pericardial sac that constricts pumping action of the heart
cardiac tamponade
167
the 5 stages of chronic kidney disease are characterized by
GFR
168
Stage 1 CKD GFR
>90
169
Stage 2 CKD GFR
60-89
170
Stage 3a CKD GFR
45-59
171
Stage 3b CKD GFR
30-44
172
Stage 4 CKD GFR
15-29
173
Stage 5 CKD GFR
<15
174
Stage 5 of CKD is AKA
End-Stage Renal Disease (ESRD)
175
as CKD worsens, ...
GFR decreases
176
2 main causes of chronic renal failure
DM
HTN
177
this may occur on the skin as a result of CKD
uremic frost due to crystallized urea deposits
178
this lab may occur as a result of CKD
hyperkalemia
179
normal adult GFR
>90 ml/min
