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[Crash Course] NCLEX-RN (7) Maternity > Labor & Delivery > Flashcards

Labor & Delivery Flashcards

Review fetal presentation, stages of labor, procedures during labor, pain control, and complications. (77 cards)

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1
Q

What is fetal presentation?

A

The position of the fetus in the uterus.

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2
Q

What is breech presentation?

A

The buttox or feet are the presenting part in the client’s pelvis.

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3
Q

What is vertex presentation?

A

The back of the head (occipital) is the presenting part in the client’s pelvis.

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4
Q

What is face presentation?

A

The front of the head (mento) is the presenting part in the client’s pelvis.

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5
Q

What is shoulder presentation?

A

The shoulder is the presenting part in the client’s pelvis.

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6
Q

Fetal presentation has 3 letters in it.

Q: What does the first letter indicate?

A

The first letter of a fetal presentation can be L or R.

  • This means that the presenting part in the mom’s pelvis can be facing the left or right.
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7
Q

Fetal presentation has 3 letters in it.

Q: What does the second letter indicate?

A

The second letter of a fetal presentation can be O, M, or S.

This means that the presenting part in the mom’s pelvis can be the:

  • O: occipital - the back of the baby’s head
  • M: mento - the face
  • S: sacrum - the buttox
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8
Q

Fetal presentation has 3 letters in it.

Q: What does the third letter indicate?

A

The third letter of a fetal presentation can be A, P or T.

This means that the presenting part in the mom’s pelvis can be:

  • anterior: facing the front of the mom’s body
  • posterior: facing the back of the mom’s body
  • transverse: facing either side of the mom’s body
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9
Q

What fetal presentation is this?

A

Right occipitoposterior or ROP

The back of the head (occipito) is in the right side of the mom’s pelvis and is facing the back of the mom’s body (posterior).

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10
Q

What fetal presentation is this?

A

Left occipitoposterior or LOP

The back of the head (occipito) is in the left side of the mom’s pelvis and is facing the back of the mom’s body (posterior).

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11
Q

What fetal presentation is this?

A

Right occipitoanterior or ROA

The back of the head (occipito) is in the right side of the mom’s pelvis and is facing the front of the mom’s body (anterior).

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12
Q

What fetal presentation is this?

A

Left occipitoanterior or LOA

The back of the head (occipito) is in the left side of the mom’s pelvis and is facing the front of the mom’s body (anterior).

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13
Q

What fetal presentation is this?

A

Left mentoanterior or LMA

The face (mento) is in the left side of the mom’s pelvis and is facing the front of the mom’s body (anterior).

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14
Q

What fetal presentation is this?

A

Right mentoposterior or RMP

The face (mento) is in the right side of the mom’s pelvis and is facing the back of the mom’s body (posterior).

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15
Q

What fetal presentation is this?

A

Left sacrum anterior or LSA

The sacrum is in the left side of the mom’s pelvis and is facing the front of the mom’s body (anterior).

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16
Q

What fetal presentation is this?

A

Left sacrum posterior or LSP

The sacrum is in the left side of the mom’s pelvis and is facing the back of the mom’s body (posterior).

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17
Q

What is the most common and desirable fetal presentation for delivery?

A

LOA = left occipital anterior

This is the easiest position for delivery of baby.

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18
Q

Where should the fetoscope be placed to hear fetal heart tones best?

A

On the upper back of the baby.

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19
Q

What is fetal station?

A

Fetal station is how many centimeters the fetus is above or below the ischial spines.

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20
Q

What is true labor?

A
  • contractions are regular
  • contractions are getting more frequent and closer together
  • cervical dilation is progressing
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21
Q

What is false labor?

A
  • contractions are irregular
  • contractions go away when walking or drinking water

False labor contractions are also called Braxton-Hick contractions.

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22
Q

What is a normal fetal heart rate?

A

110 - 160 beats/minute

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23
Q

What is fetal bradycardia?

A

< 110 beats/minute for at least 10 minutes.

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24
Q

What is fetal tachycardia?

A

> 160 beats/minute for at least 10 minutes or longer.

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25
# Interventions: **Fetal bradycardia or tachycardia**
* position mom on left side * give 7 - 10 liters of oxygen by face mask * get vital signs * call HCP
26
What are the **4 stages of labor**?
1. labor 2. pushing and birth of baby 3. delivery of placenta 4. recovery
27
What are the **3 parts** of the first stage of labor?
1. Latent stage 2. Active stage 3. Transition stage
28
What is the **latent stage** of labor?
* mild intensity * cervical dilation of 1 - 4 cm * contractions are every 15 - 30 minutes and last 15 - 30 seconds
29
What is the **active stage** of labor?
* moderate intensity * cervical dilation of 4 - 7 cm * contraction are every 3 - 5 minutes * contractions last for 30 - 60 seconds
30
What is the **transition stage** of labor?
* severe intensity * cervical dilation of 8 - 10 cm * contractions are every 2 - 3 minutes * contractions last for 45 - 90 seconds
31
How long does the **recovery stage** last for?
Recovery stage lasts for **1 - 4 hours.**
32
What are the **general interventions** for all the stages of labor?
* maternal and fetal vital signs * IV fluids * contraction monitoring * basic comfort and pain control
33
Why would **local anesthesia** be used during labor?
Local anesthesia would be used in the perineal area if the laboring client has to get an **episiotomy**.
34
What is an **episiotomy?**
An episiotomy is a **surgical cut of the perineum** to quickly enlarge the opening for the baby to pass through.
35
What are the **interventions** after an episiotomy?
1. **decrease swelling and discomfort** * ​apply ice packs​ * sitz baths * analgesic spray or ointment 2. **prevent constipation** 3. **take showers instead of baths** * baths increase the risk of infection
36
What is a **lumbar** **epidural block?**
When a **catheter is placed in the lumbar region to deliver pain meds** continuously during labor.
37
# Interventions: Lumbar epidural block
* monitor for hypotension * increase IVF for hypotension * monitor for bladder distention *The nerve that controls blood pressure and bladder control may get blocked.*
38
What is a **subarachnoid spinal block?**
**Pain medication is administered once** in the spine with a needle right before birth.
39
# Interventions: Subarachnoid spinal block
1. **lie flat 8 - 12 hours after injection** * to prevent leakage of fluid and headache 2. **monitor for hypotension** * increase IVF for hypotension *The nerve that controls blood pressure may get blocked.*
40
What **opioid pain medicines** can be given to a laboring woman?
* hydromorphone * meperidine * fentanyl
41
# Side effects and nursing considerations: Opioid pain meds during labor
* assess for decreased respirations and hypotension * don't give to client with history of opioid dependence * antidote is naloxone
42
What is **induction**?
**Induction** is medications that are given to **quicken the laboring process**.
43
What classifications of meds would be given for **induction**?
* **Prostaglandins** - misoprostol * **Uterine stimulants** - oxytocin
44
What is an **amniotomy**?
An amniotomy is when the **amniotic membranes are ruptured** using a hook to quicken the labor process.
45
What are the **assessments** after an amniotomy?
1. assess for prolapsed cord 2. assess for meconium-stained fluid 3. assess for bloody fluid * may indicate abruptio placenta or fetal trauma 4. assess for bad odor * may indicate infection
46
What is **external rotation**?
External rotation is **manipulating the fetal position** by pressing on the mom's abdomen. ## Footnote *It is done to get the baby in a more favorable position for labor.*
47
What is a **cesarean delivery**?
Cesarean delivery is an **abdominal incision is made through the uterus** to deliver the baby.
48
What are the **interventions** before a Cesarean delivery?
* informed consent is signed * maternal and fetal vital sign monitoring * start IV fluids * insert foley
49
What are the **interventions** after a Cesarean delivery?
* assess for bleeding and infection * encourage ambulation to prevent DVT * encourage turning, coughing and deep breathing to prevent pneumonia * pain control * promote bonding
50
What is **PROM**?
PROM is **premature rupture of the membranes before 37 weeks' gestation.** ## Footnote *Client will report continuous vaginal wetness. Have her report to hospital as soon as possible for delivery.*
51
# Interventions: **PROM**
* check nitrazine test to see if it's positive for amniotic fluid * no vaginal exams - increases the risk of infection
52
# Immediate complication What is a **prolapsed umbilical cord**?
A prolapsed umbilical cord is when the **umbilical cord drops through the open cervix** into the vagina ahead of the baby. ## Footnote *The cord can then become trapped against the baby's body during delivery.*
53
# Interventions: Prolapsed umbilical cord
* elevate any parts that are lying on the cord with a gloved hand * put mom in extreme Trendelenburg position * give oxygen 8 - 10 L/minute by mask * prepare for immediate birth
54
What is **placenta previa**?
Placenta previa is when the **placenta has grown over the cervix.**
55
What are the **characteristic signs** of placenta previa?
painless, bright red bleeding
56
# Interventions: Placenta previa
* maternal vital signs and fetal monitoring if there is excessive bleeding * no vaginal exams * bed rest
57
# Immediate complication What is **abruptio placenta**?
Abruptio placenta is when the **placenta has separated off the uterine wall.**
58
What are the **characteristic signs and symptoms** of abruptio placenta?
* severe pain and dark red blood * rigid and tender uterus that doesn't fully relax between contractions
59
# Interventions: Abruptio placenta
* cesarean delivery if baby is not coming out immediately * blood transfusion to mom
60
# Describe: Vena cava syndrome
Vena cava syndrome is is another word for **supine hypotension syndrome.** ## Footnote *It is not a medical emergency, but interventions are required. It is when the mom is laying on the vena cava and cutting off circulation to the baby.*
61
What are the **characteristic signs and symptoms** of vena cava syndrome?
* hypotension * lightheadedness
62
# Interventions: Vena cava syndrome
* put mom on left side * or put mom with a pillow under one side of the hips ## Footnote *This position gets pressure off the vena cava.*
63
What is the gestational **age** of preterm labor?
Between **20 - 37 weeks of gestation**
64
# Medications: Preterm labor
1. **give tocolytics to prevent labor** * magnesium sulfate 2. **give steroids** to increase production of surfactant to fetal lungs * betametha**_sone_** or dexametha**_sone_**
65
# Describe: Dystocia
Dystocia is a **difficult labor that is prolonged or painful.** ## Footnote *It is caused by a large fetus, position of fetus or the mom's pelvis shape.*
66
# Describe: Amniotic fluid embolism ## Footnote *Immediate complication*
Amniotic fluid embolism is when an **embolism can lead to respiratory failure and bleeding**.
67
# Interventions: Amniotic fluid embolism
* give oxygen, possible intubation, and ventilator * cesarean delivery once the mom is stabilized
68
# Signs and symptoms: Fetal distress ## Footnote *Immediate complication*
* fetal heart rate is \< 110 or \> 160 beats/minute * meconium-stained amniotic fluids * fetal hypo or hyperactivity * severe variable or late decelerations
69
# Describe: Intrauterine fetal demise
Intrauterine fetal demise is when the **baby dies in utero**.
70
# Interventions: Intrauterine fetal demise
* assess mom for DIC (bleeding and clotting disorder) * emotional support
71
What is "**VEAL CHOP**"?
VEAL CHOP is an **acronym to remember fetal heart rate pattern changes.** ## Footnote *The order of the letters in VEAL correlates to accelerations or decelerations and the letters in CHOP help you remember the cause of each fetal heart rate change.*
72
What do the **letters "VEAL CHOP"** stand for?
1. **V**ariable decelerations in baseline fetal heart rate * **C**ord is compressed 2. **E**arly decelerations of fetal heart rate * **H**ead is compressed​ 3. **A**ccelerations of fetal heart rate * **O:** everything is OK​ 4. **L**ate decelerations: * **P**lacenta is compressed
73
What type of **fetal heart rate decelerations** are these?
**Variable decelerations caused by cord compression.** ## Footnote *There is an abrupt decrease in fetal heart rate. T**hey have a U, V or W shape.** Can occur at any time during contraction cycle.* *Can be an emergency if fetal heart rate declines to less than 70 beats/minute.*
74
What type of **fetal heart rate decelerations** are these?
**Early decelerations caused by head compression.** *There is a gradual decrease in fetal heart rate and a return to baseline associated with contraction. This is a normal finding.*
75
# Immediate complication What type of **fetal heart rate decelerations** are these?
**Late decelerations caused by placenta compression.** *There is a gradual decrease in fetal heart rate. The lowest heart rate occurs after the contraction peak.*
76
# Immediate complication What are the **general interventions** if the mom or baby is having life-threatening distress during labor?
* put mom in Trendelenburg position * give oxygen 8-10 liters by mask * give IV fluids * blood transfusion if needed * prepare for cesarean delivery
77
What is a **fetal scalp electrode**?
A fetal scalp electrode is a spiral wire placed directly on the fetal scalp or presenting part used to **measure and record a very accurate fetal heart rate.** ## Footnote *They are placed when there is a non-reassuring fetal heart rate.*

[Crash Course] NCLEX-RN (7) Maternity (5 decks)

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