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Antepartal Nursing > Intrapartal Nursing > Flashcards

Intrapartal Nursing Flashcards

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0
Q

Duration

A

Beginning of contraction (muscle begins to tense), to the end of same contraction (muscle is completely relaxed)

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1
Q

Frequency

A

Beginning of one contraction to the beginning of the next

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2
Q

Uterine resting tone

A

Between uterine contractions when optimum uterine relaxation is achieved

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3
Q

Acme or peak

A

Intensity is evaluated subjectively by estimating firmness (nose, chin, four head= mild, moderate, and strong)

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4
Q

Early or Latent phase of labor

A

0 to 3 cm, relaxed, excited, anxious

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5
Q

Active phase of labor

A

4 to 7 cm, more intense, begins to tire

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6
Q

Transitional phase of labor

A

8 to 10 cm, feel tired, unable to cope, needs frequent coaching to maintain breeding patterns

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7
Q

Electronic monitoring with external toco

A

Can determine frequency and direction, cannot determine intensity, may be used BEFORE and AFTER ROM rupture of membranes, placed over fetal part of fundus on outside of abdomen

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8
Q

Internal uterine pressure catheter (IUPC)

A

Inserted into uterine cavity of cervical os, place in area of fetal small parts, can only be used AFTER ROM ruptured membranes, measures resting tone of uterus between contractions, measure actual pressure during contractions – intensity
Advantage – critical in woman attempting vaginal birth to avoid tachysystole and uterine rupture

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9
Q

Leopold maneuver position

A

Bladder empty
Lie on back with abdomen uncovered, shoulders race lightly on pillow, knees drawn up a little
Completed between contractions
Determines lie – longitudinal or transverse

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10
Q

Fetal scalp electrode – FSE – internal monitoring

A

Most precise method of monitoring EKG of FHR, attached to fetus during vaginal exam
Cervix must be 2 cm dilated, pedal car presenting, are ROM
Avoid in preterm infants because increased risk of ventricular hemorrhage

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11
Q

Baseline fetal heart rate

A

Must be at least two minutes of identical baseline segments and any 10 minute window
Acceleration deceleration or periods of mart fetal heart rate variability are excluded

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12
Q

Fetal tachycardia

A

BL FH are greater than 160 bpm for at least a 10 minute.

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13
Q

Variable deceleration

A

Decrease in fetal heart rate – defined as onset of the deceleration to beginning of fetal heart rate made her a 30 seconds or less
Decrease in fetal heart rate 15 beats a minute, lasting 15 seconds or more, in less than two minutes duration

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14
Q

Prolonged deceleration

A

Decrease in fetal heart rate of 15 beats a minute or more that last more than two minutes and less than 10 minutes

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15
Q

Critical factors in labor

x5

A 
Birth passage
Fetus
Relationship between birth passage of fetus
Physiological forces of labor
Psychosocial considerations
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16
Q

Fetal attitude

A

Posture the fetus assumes as it conforms to the shape of the uterine cavity
-* normal is general flexion: baby ducks head down, presenting the clown

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17
Q

Fetal lie

A

Relationship of access, spinal column, a fetus to access of mother spinal column

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18
Q

Longitudinal lie

A

Cephalocaudal access of the feudal spine is parallel to one months time

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19
Q

Transverse lie

A

Cephalocaudal access of the fetal spine is at a right angle to the woman spine

  • cause shoulder presentation
  • Csection
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20
Q

Fetal presentation

A

Determined by fetal lie, body part a fetus that enters maternal pelvis first, “presenting part” felt through cervix on vag exam
Cephalic (head first), breech (buttocks or feet first), or shoulder (malpresentation)

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21
Q

Vertex presentation

A

Most common
fetal head completely flexed
Smallest diameter presents
*Occiput is landmark

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22
Q

Sinciput presentation

A

Fetal head partially flexed
Top of head is presenting part
Occiptofrontal diameter presents
*Occiput is landmark

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23
Q

Brow presentation

A

Head partially extended
Occipitomental diameter/ LARGEST anterioposterior diameter presented
* Chin is landmark

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24
Face presentation
Head is hyper extended Submentobregmatic diameter *Chin is landmark
25
Complete breech
Head and knees flexed,thighs on abdomen Cavs on posterior aspect of thighs Buttocks and feet present * sacrum is landmark
26
Frank breech
Hips flexed, knees extended Buttocks presents * sacrum is landmark
27
Footling breach
Hips and knees extended Feet present Single footling, double footling * sacrum is landmark
28
Effacement
Drawing up of internal os and cervical canal into uterine sidewalls
29
Shoulder presentation
Shoulder is presenting part Fetus is in transverse lie *Acromion process of scapula is landmark
30
Cephalon presentation | Engagement
Biparietal diameter is largest dimension of fetal skull to pass through pelvic inlet
31
Breech presentation engagement
Tetrochanteric diameter (transverse diameter between right and left trochanter) is largest to pass through pelvic inlet
32
Engagement
When largest diameter of presenting part reaches or passes through pelvic inlet
33
Station
Relationship of presenting part to an imaginary line drawn between Ischial spines of maternal pelvis Higher is negative Lower is positive
34
Lightning
Fetus begins to settle in pelvic inlet | "the baby dropped"
35
Bloody show
mucous plug expel due to softening and effacement of cervix, blood loss from expose cervical capillaries
36
Ripening
Softening of cervix
37
Spontaneous rupture of membranes | SROM
Risk of prolapsed cord if fetus not engaged, bacteria can enter
38
Premature rupture of membranes | PROM
Any spontaneous rupture of membranes before onset of labor
39
Preterm premature rupture of membranes | PPROM
Leakage or rupture of amniotic fluid before 37 weeks
40
True labor
Dilation and effacement Back pain that radiates around to abdomen Pain not relieved by ambulating Contractions regular and increasing in frequency, duration, intensity
41
First stage | Active phase
Onset of regular contractions, mild intensity Cervix dilate and effaces but a little fetal dissent Able to cope, smiling, talkative Should not exceed 20 hours
42
First stage | Active phase
Intensification of contractions Fetal dissent is progressive anxiety tends to increase, fear loss of control, decreased ability to cope * Metabolic acidosis compensated by respiratory alkalosis Cervix dilate from about 4 to 7 cm
43
First stage | Transitional phase
Contractions become more frequent and strong Increased rectal pressure, urge to Bear down Significant anxiety, crying and yelling, hyperventilation and restlessness, "lose her mind" Cervical dilation slows from 8 to 10 cm and rate of fetal dissent increases Generalized discomfort, sensitivity to touch Needs partner support or nurses Hiccuping, belching, nausea or vomiting, perspiration on upper lip
44
Positional changes a fetus | Flexion
As fetal head to sense, result of resistance, fetal chin flexes downward onto chest
45
Positional changes a fetus | Internal rotation
Fetal HEAD must rotate to fit diameter of pelvic cavity, occiput rotates from LEFT to RIGHT (side to front) and sagittal suture aligns in anterioposterior pelvic diameter
46
Positional changes a fetus | Restitution
Shoulders of infant enter pelvis obliquely, neck becomes twisted. Once head emerges, neck untwist turning head to one side and aligns (restitution) with position of back in birth canal
47
Positional changes a fetus | External rotation
Shoulders rotate to the anterior posterior position and pelvis head is turned farther to the side
48
Positional changes a fetus | Expulsion
After external rotation, anterior shoulder is born before posterior shoulder, body follows quickly
49
Third stage | Placental separation signs
1. globe shaped uterus 2. Rise a fundus in abdomen 3. Sudden gush or trickle of blood 4. further protrusion of umbilical cord out of vagina
50
Third stage | Placental delivery
Retained placenta – more than 30 minutes elapsed * Shultze Mechanism: expelled with fetal shiny side presenting," shiny shultze" * Duncan Mechanism: expelled with maternal surface delivering first, surface is rough, "dirty Duncan"
51
Fourth stage
One to four hours after birth Physiologic readjustment of mothers body begins VS: drop in blood pressure, increased polls, moderate tachycardia May experience shaking chill Hemodynamic changes Acid/base is more balanced
52
Secobarbital | Second choice
Oral Treat false labor and produce sedation affect Long half-life, remain in maternal and fetal blood for up to 40 hours
53
Zolpidem (Ambien) | First choice Barbituate
Oral False labor and produce sedation effect Half-life of 4.5 hours For sleep to encourage rest
54
Diazepam (Valium) Midazolam (Versed) Benzodiazepine
Treat anxiety, anticonvulsant action Fetal side effects: increase in variability of FHR, hypotonicity, hyperactivity, impaired temperature regulation, impaired metabolic response to cold stress Not recommended before baby is born Associated with low Apgar scores when administered five minutes or less before birth
55
Promethazine (Phenergan)
Sedative, antiemetic | Crosses placenta barrier and result in decreased FHR variability
56
Hydroxyzine (Vistaril)
IM | Given in early labor to decrease anxiety and nausea
57
Diphenhydramine ( Benadryl)
Treat allergic rhinitis and hives Sedative and antiemetic Half-life last up to 6 to 8 hours
58
Butorphanol (Stadol) | Narcotic
Precipitate withdraw and drug dependent individuals (Know patients drug history) Given in labor
59
Fentanyl (Sublimaze) | Narcotic
Moderate analgesia and mild sedation Rapid onset, short half-life *Limited placental transfer
60
Nubain | Narcotic
May precipitate drug withdrawal of woman is physically dependent on narcotics * crosses placental to fetus, respiratory depression
61
Meperidine (demerol) | Narcotic
Used to relieve shaking Crosses placenta within 90 seconds Maternal side affects: urinary retention, respiratory depression, sedation, conversions, dizziness, N/V Fetal side effects: decreased/absent respiratory movement, decreased fetal movement, decrease in variability, low Apgar scale, low O2 sat, alteration in fetal ECG
62
``` Local anesthetics Esters -Novacaine -Nesacaine -Pontocaine ```
Rapidly metabolized | Toxic maternal levels not as likely, placenta transferred to fetus is present prevented
63
``` Local anesthetic Amides -Bupivicaine (Marcaine)* -Ropivacaine* -Levobupivicaine* ```
Powerful and long-acting | Cross placenta, affect fetus for prolonged period
64
Lumbar epidural block
Epidural space is between dura mater and ligamentum flavum Disadvantage:* most common complication is maternal hypotension Onset of analgesia may not occur for up to 30 minutes Avoid perforating Dura mater Close observation of mother and fetus required Decreased FHR variability, late the cells if maternal hypotension occur
65
Lumbar epidural block | Relative contraindication
``` Platelet count less than 100,000 Sepsis Hypertension Uncooperative patient Severe anatomic abnormalities of the spine ```
66
Lumbar epidural block | Technique
IV infusion begun, preload of 500 to 2000 ml of IVF given over 15 to 30 minutes (prevents) hypotension Positioned on the right or left side, or sitting on edge of bed with back Woman is attained by nurse for first 20 minutes Blood pressure monitor every 1 to 2 minutes for first 10 minutes, then every 5 to 15 minutes until block wears off Hypotension: left lateral displacement of uterus, Trendelenburg, epinephrine
67
Spinal block
Local Anesthetic injected into spinal fluid and subarachnoid space Does not cross fetal circulation Contraindication: CNS disease Position: placed on back with pillow under head positions alter the level of those within 3 to 5 minutes
68
Pudenal Block
Perineal anesthesia for second stage of labor, birth, episiotomy Injected below pudendal plexus Relief of pain from perineal distention, does not relieve contraction pain disadvantage: decreased urged to bear down, burning complications: perforation of rectum, trauma to sciatic nerve, potential broad ligament hematoma
69
Ketamine | IV Gen. Anasthesia
Last 20 to 60 minutes Hyper salivation can occur, hallucinations Contraindication: preeclampsia or chronic hypertension
70
Inhaled anesthesia agent | Nitrous oxide
Crosses placenta immediately, less neonatal depression
71
Inhaled anesthesia | Isofurane, Sevofurane, Halothane, Desflurane,Enflurane
Maybe use for woman with aortic stenosis | Used if spinal or epidural anesthesia ineffective

Antepartal Nursing (8 decks)

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