Exam #2 Flashcards
(65 cards)
1
Q
The 5 p’s
A
- Passenger
- Passageway
- Position
- Powers
- Psychological response
2
Q
Passenger
A
Baby
3
Q
Presentation
A
-part of the fetus entering the pelvis/birth canal
- Cephalic/ vertex ( Head first)
- breach ( butt first)
4
Q
What is the attitude?
A
-Position of the head and spine in relation to one another
-want the body to be flexed
- Are the fetal body parts flexed or extended
5
Q
How does the baby lie?
A
- In relation to the mom ( parallel is ideal)
- What is the relationship of the fetal spine to the maternal spine
6
Q
What position of the newborn will the patient likely push harder?
A
- Posterior ( occiput posterio will likely push harder)
- The head of the baby is pushing on the tailbone
- more back pain during labor
7
Q
What nursing intervention can be done for back pain?
A
Counter pressure
8
Q
What is the ideal position of the head?
A
- occiput anterior
9
Q
Passageway, best pelvis shape?
A
- gynecoid shape
10
Q
How does the pelvis change during labor?
A
- With contractions cervix dilates
- The cervix is normally closed but begins to open
- voluntary pushing
- 0-10 cm
11
Q
Powers indicates?
A
- what is driving the labor ( involuntary uterine contractions)
12
Q
What is effacement ?
A
-shortening or thinning of the cervix
- 0-100%
13
Q
What is the number one sign of true labor?
A
- cervical dilation
14
Q
Positioning
A
- Positional changes are important
- important to keep moving
- movement helps keep labor moving
- preform periods of movement with rest
- transverse is lying across
15
Q
psychological response
A
- PTSD
- Anxiety
- Encourage childbirth education
- support systems
16
Q
What is the initial care in labor?
A
- pt preference
- birth plan
- vitals
- assess for true labor
- monitor contractions and fetal wellbeing
17
Q
Manifestations signifying labor?
A
- contractions increasing
- vaginal discharge, bloody show
- mucus plug
- nesting
- decrease in pressure on the diaphragm
- rupture of membranes
18
Q
Intrauterine pressure cath
A
- can tell actual contractions
19
Q
Normal fetal HR
A
- 110-160 BPM
20
Q
What is variability?
A
beat to beat ( squiggly lines)
21
Q
What does Absent variability indicate?
A
- not good
- risk for major complications
- Caesarean is necessary
- less than 5
22
Q
What position is the fetus in for uncomplicated labor?
A
- cephalic position
23
Q
What does primiparous indicate?
A
-pt experiencing a first preganancy
24
Q
What are the powers of labor?
A
uterine contractions throughout labor and maternal pushing efforts during the second stage of labor
25
What is decreasing pressure on the diaphragm as the fetus settles deeper into the pelvis known as?
-lightening
26
What does minimal variability indicate?
- flatter line
- could indicate the baby is sleeping or in trouble
27
What is moderate variability?
6-25 ( good oxygenation)
- most desired
28
What is marked variability?
- greater than 25
- stressed baby
- seen during labor
29
What is a toco meter used for?
- monitors the moms uterine actiivty
30
What is the PMI ( point of maximum impulse)
- point where the fetal HR can be heard the loudest ( place monitor here)
31
If the baby is breach where does the monitor go?
upper abdomen
32
If the baby is head down or cephalic where does the monitor go?
- lower abdomen
33
Fetal scalp monitor use and when to use it?
- internal fetal monitor
- used in high risk pregnancies
- placed on babys scalp
- high infection risk
- membranes must be ruptured
34
What must be present before the nurse can initiate internal fetal monitoring?
- cervical dilation of at least 2 cm
35
As labor progresses we exspect?
Variability
36
What are accelerations?
temporary increase in the fetal HR
- indicates good oxygenation
37
What are decelerations?
-Dips from the baseline
38
What are Early Dcels?
- bowl-shaped dips that mirror contractions
- head compression
- expect during pushing
39
What are variable Decels?
- very concerning
- very deep, sharp v dips
- cord compression
40
What are late decels?
- very bad
- placenta insufficiency
41
What does VEAL CHOP stand for ?
- Variable
- Early
- Accelerations
-Late
-Cord compression
-Head compression
-Oxygenation
-Placenta insufficiency
42
What is the first nursing intervention for any type of Dcel?
- position change
( left lateral, if on that side switch)
43
Nursing intervention for Dcels?
- position change
- Stop oxytocin
- put on oxygen (non-rebreathe) 8-10L
- IV bolus
- prepare for delivery
44
Why should pregnant women never lie flat?
- Compresses the vena cava
45
What occurs in the first stage of labor ( latent phase)?
- 4-6 hr
- irregular contractions
- can walk and talk through contractions
- feels like menstrual cramps
- cervix dilates from 0-3
- be at home moving around
46
What occurs in the active phase of labor?
- Contractions are regular
- every 3-5 min
- moderate pain with contractions
- may have feelings of helpless
- cervix dilates from 4-7
- membranes can rupture at any time
47
What does TACO stand for?
-T Time
- A Amount
- C Color
-O Odor
48
What occurs in the Transition phase ?
- approx 20-40 min
- stronger contractions
- feeling out of control
- pressure in the butt
- urge to push
- dilates 8-10
49
What does the second stage of labor consist of ?
-Contractions are intense every 1-2 min
- cervix fully dilated 10cm
- begin pushing
50
Premature rupture of membranes ?
at or before 37 weeks
- no contractions
51
Preterm premature rupture of membranes?
After 20 weeks, prior to 37 weeks
52
If the baby is less than 34 weeks what is given?
betamethasone ( promote lung maturity) 2 x 24hr apart
53
What are tocolytics used for?
-prevent and slow uterine contractions and labor
54
What does an aborization test for ?
ferning
55
Who can you not give terbutaline to?
people with a cardia hx
56
What can you not give nifedipine with?
Mag
57
What is nifedipine used for?
suppress contractions
58
Indomethasone paramaters?
shouldn't be given for more than 48 hr
- can cause preterm closure of the ductus arteriosus
59
How to treat chorioamnionitis?
( infection of amion, chorion or both)
- give ampicillin or gentimycin
60
What is dystocia?
dysfunctional labor
61
What is a precipitous birth?
- labor length of 3hr or less
62
What is a prolapsed cord?
- displacement of the umbilical cord in front of the presenting part of the fetus protruding through the cervix
- can result in cord compression
-emergency
63
Process for a prolapsed cord?
- steril gloved hand to relieve pressure
- Reposition patient to the knee-chest position
- maintain moist cord with warm slaine and
- if not protruding out CLOSELY MONITOR
64
What is the bishop scale?
- is the labor favorable to labor
- A score of 8 or more indicates successful induction likelihood
-
65
What would you do if the cervix isnt soft or unfavorable?
- not dilated or soft
- pharmaceutical ripening cervidil( can be removed)
- misoprostal in a pill inserted vaginally
- mechanical ripening:
