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Maternal Health > EXAM #2 > Flashcards

EXAM #2 Flashcards

1
Q

Powers:

A

Primary:
-Uterine contractions
-Causes dilation and effacement
-Increment, acme, decrement, relaxation
Secondary:
-Maternal pushing
-Urge to bear down
-Should NOT push if the cervix is not fully dilated.

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2
Q

What devices measure uterine contractions?

A

Tocodynamometer (TOCO): external
Intrauterine pressure catheter (IUPC)

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3
Q

What is Increment, acme, decrement?

A

-Increment: building of contraction
-Acme: Peak
-Decrement: decrease of the contraction

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4
Q

Frequency of contractions is defined as:

A

The beginning of one contraction to the beginning of the next one.

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5
Q

A mild contraction feels like the…

A

nose

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6
Q

A moderate contraction feels like the…

A

chin

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7
Q

A strong contraction feelss like the…

A

forehead

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8
Q

Define Effacement:

A

Process of shortening and thinning of the cervix.

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9
Q

Passageway

A

Baby must pass through the Inlet, midpelvis and the outlet.

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10
Q

Passenger:

A

Fetal lie:
*Longitudinal: baby is upside-down
*Transverse: baby is coming out shoulder first
*Oblique: baby is coming out bottom first
Fetal attitude/presentation:
*Flexion: Vertex. Fetal head is flexed so that the chin is tucked to the chest
*Moderate flexion: Military, straight up
*Poor flexion or extension: Brow presentation
*Full Extension: face presentation

*Breech presentation:
-Frank: legs are extended up
-Footling
-Complete: Legs are flexed

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11
Q

Engagement:

A

When the widest part of the fetal presenting part had passed through the pelvic inlet

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12
Q

Station:

A

The level of the presenting part in relation to the ischial spine.
Station zero
Will usually start pushing at +1

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13
Q

Position:

A

*Right or left of the patient
*Occiput: Position of head coming into the uterus
*Sacrum: Breeched
*mentum: chin
* Acromian process: shoulder
*Anterior,posterior or transverse

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14
Q

Characteristics of false labor:

A

-Contractions are irregular
-Pain is abdominal
-No change in cervix
-Walking lessens pain

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15
Q

Characteristics of true labor:

A

-Contractions are at irregular intervals
-Pain is in lower back and radiates to the abdomen
-Cervical changes occur
-Walking increases labor pain

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16
Q

Signs and symptoms of impending labor:

A

-Lightening: Baby’s head settles in pelvis at 38W
-Braxton Hicks
-Cervial effacement: thinning and softening
-ROM
-Bloody show: bloody mucus plug
-Energy Spurt
-Weight loss
-GI disturbances

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17
Q

What to assess on a mother in impending labor:

A

-Interview
-Fetal & Maternal assessment
-Psychosocial & cultural assessment
-Lab tests (Blood type, Rh factor, CBC, Hemoglobin, Hematocrit, glucose, STIs; UA: WBC, protein, glucose and ketones)
-IV start

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18
Q

What is Leopold maneuvers?

A

Abdominal Palpation of the fetal position.

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19
Q

What is baseline fetal heart rate?

A

The average FHR that observed between contractions over a ten minute period
-110 to 160bpm

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20
Q

What can cause tachycardia in a fetus?

A

-Fetal anemia & hypoxia
-Maternal fever & dehydration
-Medications & substances
-Infection

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21
Q

What can cause bradycardia in a fetus?

A

-Medications
-Maternal hypotension
-Maternal or fetal hypoglycemia, hypothermia and dehydration
-Prolonged cord compression or prolapse

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22
Q

Variability predicts…

A

fetal oxygenation during labor

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23
Q

Absent variability

A

Undetectable, may represent fetal cerebral asphyxia

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24
Q

Minimal variability

A

2-5bpm
May be related to narcotics, mag sulfate, anesthetic agents, supine hypotension, cord compression, unterine tachysystole, or fetal sleep (30min)

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25
Q

Moderate variability

A

6-25bpm
Fetal well-being

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26
Q

Marked variability

A

over 25bpm
Fetal hypoxia

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27
Q

Periodic changes:

A

Accelerations and decelerations in relation to UC

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28
Q

Episodic changes:

A

Accelerations and decelerations that are not associated with UC

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29
Q

Accelerations

A

An increase in FHR of 15bpm over the baseline that lasts 15 seconds to 2 minutes

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30
Q

Decelerations

A

Any decrease in FHR below the baseline.

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31
Q

What is an Early deceleration?

A

Gradual decrease in and return of the FHR associated with UC.

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32
Q

When does the lowest part of the early deceleration occur with the peak of the contraction?

A

At the same time. Mirrored image

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33
Q

What do we do for an early deceleration?

A

Nothing

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34
Q

What is a variable deceleration?

A

Abrupt decrease in FHR below the baseline is 15+ bpm that lasts for at lease 15 seconds to 2 minutes.
-Occurs at any time of the UC and looks like a W or V
-Repetitive ones are a concern

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35
Q

What do we do for variable decelerations?

A

Help patient with anxiety and decrease pain and enhance uterine blood flow.
-Change position (side to side or knee chest)
-Decrease or stop pitocin (give terb for tachysytole)
-Give oxygen
-Vaginal exam
-Give amnioinfusion
-Change pushing technique
-IF NOT CORRECTED: prepare for birth

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36
Q

What is a late deceleration?

A

A gradual decrease in and return to baseline FHR associated with UC.
-Begins around the peak of the contraction
-Indicates uteroplacental insufficiency (decline in placental function)

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37
Q

What do we do for late decelerations?

A

-Position patient on their side
-Give bolus if theres hypotension
-Assess for tachysystole & labor progression
-Stop oxytocin
-Give oxygen
-IF NOT CORRECTED: prepare for birth

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38
Q

What is a prolonged deceleration?

A

Abrupt decrease in the FHR below the baseline that is greater than or equal to 15 bpm and lasts 2 to 10 minutes.

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39
Q

What do we do for prolonged decelerations?

A

-Assess baseline variability
-Reposition
-Stop oxytocin
-Give oxygen
-Give bolus
-Give amnioinfusion
-IF NOT CORRECTED: prepare for birth

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40
Q

What can cause a prolonged deceleration?

A

tachysystole, cord compression/prolapse, profound head compression or rapid fetal descent.

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41
Q

What is considered tachysystole?

A

Greater than 5 contractions in 10 minutes averaged over a 30 minutes period

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42
Q

What occurs in the latent phase of labor?

A

-Onset of regular contractions that are mild in intensity
-5 minutes apart and lasts 30-45 seconds
-0-3 cm dilated
-Excited, talkative, confident, anxious, withdrawn

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43
Q

What occurs in the active phase of labor?

A

-More active contractions that are moderate in intensity
-3-5 minutes apart, lasts about 60 seconds
-4-7 cm dilated
-Focused inwardly & quieter

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44
Q

What occurs in the transition phase of labor?

A

-Most intense part with strong contractions
-2-3 minutes apart and lasts 60 to 90 seconds
-8-10cm dilated
-Difficult to cope, irritable, agitated, hopeless, tired

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45
Q

What is the Friedman curve?

A

A graph used to help identify whether a patient’s labor is progressing in a normal pattern
-Cervical changes over time

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46
Q

How often should each stage of labor be monitored using intermittent ausculation without any complications?

A

-Latent: Q1hr
-Active: Q 5-15 minutes
-Transition: Q 5-15 minutes

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47
Q

How often should each stage of labor be evaluated using continous monitoring without any complications?

A

-Latent: Q 30 minutes
-Active: Q 15 minutes
Q 5 minutes whild pushing

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48
Q

What factors can change electronic fetal monitoring?

A

-ANS (blood pressure, RR, temp.)
-Medications: Increase or decrease variability and baseline
-Anesthetics: decreased bp
-Uterine & maternal condition

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49
Q

What do we give before giving an epidural?

A

Give fluid bolus to increase blood pressure. If that fails give ephedrine.

50
Q

When the uterus is contracting too often, what should we do?

A

Give Terb and fluids with sugar.

51
Q

What is VEAL CHOP?

A

Variable deceleration Cord Compression
Early decelerations Head compression
Accelerations Okay
Late deceleration Placental insufficiency

52
Q

What occurs during the second stage of labor ?

A

Starts with full effacement and dilation.
Ends with the birth of the baby
Woman feels the urge to bear down

53
Q

What is laboring down?

A

Allowing the mother to rest with the use of an epidural as the fetus descends.

54
Q

Open glottis pushing

A

-Involuntary pushing, usually in unsedated patients
-When the mother pushes when she feels the urge to push

55
Q

Closed glottis pushing

A

-Directed/coached pushing, usually with an epidural
-Pushes when fully dilated and effaced regardless of the urge to push

56
Q

Define 1st degree laceration:

A

Involves the perineal skin and vaginal mucous membrane

57
Q

Define 2nd degree laceration:

A

Involves the skin, mucous membrane, and the fascia of the perineal body

58
Q

Define 3rd degree laceration:

A

Involves the skin, mucous membrane, and muscle of the perineal body and extends to the rectal sphincter

59
Q

Define 4th degree laceration:

A

Extends into the rectal mucosa and exposes the lumen of the rectum

60
Q

What is an episiotomy?

A

A surgical incision of the perineum performed to enlarge the vaginal orfice during th second stage of labor.

61
Q

What are the cardinal movements of the second stage of labor?

A

Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion.
Remember: every darn fool in egypt eat raw eggs.

62
Q

What occurs during descent?

A

The progression of the fetal head into the pelvis
4 forces:
-Pressure of the amniotic fluid
-Direct pressure of the uterine fundus on the fetal breech
-Contraction of the muscles
-Extension and straightening of the fetal body

63
Q

What occurs during flexion?

A

Occurs as the fetal head descends and comes into soft tissues of the pelvic floor & cervix.

64
Q

What occurs during internal rotation?

A

The head will rotate to fit into the pelvic cavity

65
Q

What occurs during extension?

A

The head is born as it slides under the pubic symphysis.

66
Q

What occurs during external rotation?

A

The shoulders align causing the head to continue to turn farther to one side

67
Q

What occurs during expulsion?

A

Pushing efforts push the fetal shoulder under the pubic symphysis. once the shoulders are born the rest of the body quickly follows.

68
Q

When should the cord be clamped in a term infant?

A

Delay for 60 seconds

69
Q

When should the cord be clamped in a pre-term infant?

A

Delay for 60 to 120 seconds if the baby does not need resuscitation in the first minute of life.

70
Q

What occurs during the third stage of labor?

A

-Begins with the birth of the infant
-Ends with the delivery of the placenta (5-30min)
-Uterus becomes spherical in shape & rises upward
-Umbilical cord descends further through the vagina
-Gush of blood occurs once the placenta detaches from the uterus.

71
Q

What should the nurse do during the third stage of labor?

A

-Give a high dose of oxytocin (IM or IV)
-Observe and palpate the uterus
-Assess for retained placenta and vulvar injuries
-Monitor V/S
-Emotional support
-Initiate infant attachment

72
Q

What occurs during the fourth stage of labor?

A

-Period of maternal physiological adjustment
Begins with delivery of the placenta and continues through the first two hours after birth.

73
Q

What should the nurse do during the fourth stage of labor?

A

-V/S Q 15 min
-Fundal assessment
-Perineal assessment
-Comfort measures

74
Q

What are non-phamacological methods of pain relief during labor?

A

-Music
-Relaxation techniques
-Focusing strategies
-Massage & touch
-Effleurage: stroke the abdomen to distract.
-Sacral pressure & counter pressure
-Breathing techniques
-Hydrotherapy & aromatherapy
-Acupressure

75
Q

Pain relief meds for the latent stage of labor:

A

Sedatives: Secobarbital. kicks in in 15 min, lasts for 3-4hrs
Anxiolytics: Benzo to decrease anxiety
H1 receptor antagonist: Produces sedative and antiemetic effects (Phenergan)

76
Q

Pain relief meds for the active phase of labor:

A

Opioids: Demerol, stadol
Nerve block analgesia: Epidural and spinal

77
Q

What should the nurse assess before giving opioids?

A

The cervix, RR of mom and baby (at delivery)

78
Q

Other meds that affect the uterus to give during labor:

A

Tocolytics: Terbutaline. Slows contractions
Uterotonics: gives uterus tone in case of hemorrhage. Oxygen, Cytotec, Methergine, and Hemabate

79
Q

What are containdications for hemAbate & metHergine?

A

hemAbate: Asthma
metHergine: Hypertension

80
Q

what phase of the first stage of labor should we avoid opioids?

A

Transition phase, have narcan at bedside

81
Q

Epidural:

A

Baseline VS, bolus of IV fluid 500 to 1000ml
-Test dose
-Left in place until after delivery
-PCEA

82
Q

Spinal:

A

One time injection
-Smaller dose
-Patient should remain flat for several hours and administration to avoid spinal HA

83
Q

Assessment for Epidual and spinal:

A

-place foley and monitor output
-RR & BP
-Sensation and movement: reposition

84
Q

What is dystocia?

A

Long, difficult or abnormal labor
-Hyper or hypotonic

85
Q

What is hypertonic labor?

A

Strong, painful contractions that do not effecively produce effacement and dilation.
Contractions are happening often and can lead to fetal hypoxia

86
Q

Nursing interventions for hypertonic labor:

A

-Rest, hydration, and sedation
-rotate the fetus
-promote walking
-decrease anxiety

87
Q

medications for hypertonic labor:

A

acetaminophen, Benadryl, demerol, dilaudid and morphine

88
Q

What is hypotonic labor?

A

UC that decrease in frequency and intensity.
Fewer than 2 to 3 contractions in 10 minutes
The uterus can easily be indented at the peak of a UC

89
Q

Nursing interventions for hypotic labor:

A

-Walking
-Massage
-Relaxation
-regular v/s and cervical checks
-nipple stimulation

90
Q

Medication for hypotonic labor

A

Oxytocin infusion

91
Q

What is chorioamnionitis?

A

Infection of the amnionic sac that can infect the baby and the uterus.
-characterized by: fever of 104, fetal tachycardia, uterine tenderness, and foul emniotic fluid
-DX: cultures on the placenta

92
Q

Interventions for chorioamnionitis:

A

Delivery and antibiotics (ampicillin) throughout labor and postpartum

93
Q

Shoulder dystocia definition, signs and resolution:

A

When the baby’s shoulder is caught on the pubic bone.
-Emergency
-Slowed labor progression
-Turtle sign: retraction instead of protuding with UC
-Perform suprapubic pressure and McRoberts maneuver

94
Q

What is the Bishop score tool?

A

The method to assess if induction will be more successful.
-Looks at: Dilation, effacement, station, cervical consistency and position.
-The higher score is deemed more successful

95
Q

What is Prostaglandin E1 (cytotec) and Prostaglandin E2 (Cervidil) used for?

A

Cervical ripening, stimulates UC.

96
Q

What mechanical methods can help cervical ripening?

A

Baloon Cath & Laminaria tents (seaweed)

97
Q

When is vacuum assisted birth needed?

A

When labor has stalled, can’t push effectively, or emergency delivery due to fetal distress.

98
Q

What requrements are there for vacuum assisted birth and forceps?

A

vertex presentation, ruptured membranes, and absence of CPD

99
Q

When are forceps needed?

A

Dystocia, inability to push with contractions, and prevent worsening of complications

100
Q

Cephalopelvic Disproportion (CPD):

A

Occurs when the baby is too large.
Most likely needs a C-section.

101
Q

Nursing interventions for CPD:

A

-Change to upright position or squatting
-Relaxation
-Water therapy
-Pain Management

102
Q

What is a nuchal cord?

A

A cord that is wrapped around the baby’s neck and a cord with knots.
Can be fixed when the head is born. The cord is either loosened and slipped over the head or it is double clamped and then cut.

103
Q

How is a nuchal cord dx?

A

US & doppler

104
Q

What is oligohydramnios?

A

Less than 300ml of amniotic fluid. Caused by fetal renal abnormalities, poor placental fusion or PROM.

105
Q

Intervention for oligohydramnios and meconium-stained fluid:

A

Amnioinfusion

106
Q

What is hydramnios (polyhydamnios)?

A

Greater than 2L of amniotic fluid.
Caused by: multiple gestations, anomalies, diabetes.

107
Q

What is meconium-stained amniotic fluid?

A

The baby passes meconium in utero
Caused by: hypoxia, breech, cord compression

108
Q

Placenta previa:

A

Bleeding when the lower uterine segment begins to differentiate from the upper segment in late pregnancy and the cervix begins to dilate.

109
Q

Medical management for placenta previa:

A

-If the FHR is good and the mother is stable at less than 36 weeks the mother is monitored.
-Little to no bleeding, the mother may attempt vaginal birth
-If the fetus is 37+Wks, in labor and persistently bleeding, theres a need for a c-section.

110
Q

Placental abruption:

A

Occurs when the placenta partly or completely separates from the inner wall of the uterus before delivery.
Caused by HTN, cocaine use, trauma, or previous hx.

111
Q

Medical management for placental abruption:

A

With moderate to severe blood loss and the fetus being near term, delivery is facilitated.
-Artificial membrane rupture and augment with oxytocin
-If birth is not imminent, a c-section will occur

112
Q

Nursing interventions for placental abruption:

A

-Lay patient on lateral side
-No vaginal exams or enemas
-Assess urine output

113
Q

What are two complications of placental abruption?

A

-Couvelaire uterus (accumulation of blood between separation of the uterus and placenta)
-DIC

114
Q

What meds/products to give when DIC develops?

A

IV fibrinogen, cryoprecipitate, packed RBCs and platelets

115
Q

Disseminated intravascular coagulation (DIC) definition and s/s:

A

Release of large amount of thromboplastin.
-Bleeding from multiple sites
-Widespread petechiae and bruising
-Tachycardia
-Diaphoresis

116
Q

Uterine inversion:

A

uterus is turned inside out

117
Q

Uterine inversion medical management:

A

manual replacement of the fundus under general anesthesia

118
Q

Medications for Uterine inversion:

A

Oxytocin and antibiotics with possible blood transfusions and fluid resuscitation.

119
Q

Velamentous cord insertion/vasa previa

A

Occurs when the fetal vessels separate at the distal end of the cord and insert into the placenta at a distance away from the margin

120
Q

Succuriate lobe:

A

Contains one or two separate lobes with their own circulation. After birth, one lobe may be retained and impede contractions, causing hemorrhage. Must be removed.

Maternal Health (4 decks)

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