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Maternity Flashcards

1
Q

Stages of Labour

A

Full term = 37-42 weeks
Preterm = before 37 weeks

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2
Q

Stage 1 Labour

A

3 phases:
Latent Phase
Active phase
Transitional phase

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3
Q

Early/latent phase

A

longest phase client is relaxed and contractions are mild
education and encouragement
0-3cm cervix dilation
0-30% effaced

As cervix begins to stretch it trigger oxytocin release Duration 30 seconds

Closely monitor Monitor fetal heart rate
Assess for late decelerations (not enough oxygen getting to the baby)

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4
Q

Active Phase of Labor

A

Go to hospital
Breathing techniques and pain management is the focus
4-7cm dilation
100% effaced
Contractions will be stronger and longer
3-5 min
Water may break - mom all feel restless and anxious
Can provide medications:
Epidural
IV narcotics: given slowly during the peak of the contractions

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5
Q

A client in latent labour receiving an oxytocin infusion for labor augmentation is requesting IV pain medication.
Which nursing action is appropriate

A

Give the medication slowly during the peak of the next contraction?

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6
Q

Transitional Phase

A

Mom should focus and stay in control
8-10cm cervix dilation
100% effaced
Contractions are strongest and closer together

Anxiety and vomiting
Urge to have bowel movement
Strong urge to push with each contraction
Do not push until 10cm dilated (risk for cervical swelling and lacerations)
Amniotic sac ruptures “bloody show”
Assess colour of amniotic fluid (water break)
Meconium-stained fluid (dark fluid) sign of fetal distress or hypoxia

Interventions:
Emotional support and encouragement
Breathing techniques
10cm dilated - document fetal HR every 15 minutes
Avoid pushing until 10cm

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7
Q

What is expected during the transition phase of the first stage of labour

A

Vomiting
Bloody mucus
urge to have a bowel movement

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8
Q

A labouring client reports anxiety, vomiting and the need to have a bowel movement. What is the expected cervical examination finding?

A

8cm dilated, 100% effaced

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9
Q

Stage 2 Labor

A

Decent phase/pushing phase
Delivery of Baby
Cervix must be 100% effaced and 10cm dilated

Signs:
Increase in contractions and urge to push/poop
Ferguson reflex: spontaneous urge to push/bare down during labor
It occurs when the presenting part of the fetus reaches the pelvic floor

Interventions:
Position of the mother is priority
High fowlers, lithotomy, side lying
Push properly
Avoid holding breath or tightening the abdomen
Push when feeling the urge
Breathe IN deep
Breathe out slowly through the mouth and keep mouth open while pushing down

Assessments:
Fetal heart rate before, during and after the contraction
Frequency of contractions
Duration of contractions
Uterine tone between contractions

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10
Q

A client presents to the meergcy department wafter he water broke. She appears anxious and in pain, bearing down with each contraction. What assessment questions should the nurse ask immediately to prepare for birth? potential newborn resuscitation?

A

When your water broke, what was the colour of the fluid?
Dark fluid = bad sign
What is your expected due date (EDD)
How many babies are yay expecting?
Do you have any active sexually transmitted diseases?
Recently have you taken any medications, opioids or illicit drugs?

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11
Q

Stage 3 Labour

A

Placenta delivery
Uterus contracts and placenta slowly detaches from uterine wall
Must be carefully delivered
Never pull on placenta

High risk fir infection if placenta parts are not fully removed
Uterine inversion (pulling on the cord)
severe hemorrhaging (bleeding): decreased blood pressure, increased heart rate
Pitocin (oxytocin) to prevent haemorrhage

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12
Q

Stage 4

A

Post partum recovery
Goal: don’t let client bleed to death
2-4 hours after birth
Skin too skin and breast feeding
breast feeding: stimulates maternal oxytocin release helps contract uterus, provides nourishment and supports blood sugar of new born

Assessments:
Infection: temperature over 100.4
Hemorrhage: priority assessment = monitor peri pads
Fully saturated in less than 1 hour
Decreasing blood pressure, increases heart rate

Interventions:
Fundus First: soft and boggy = massage until firm (contract and stop bleeding)
Assess 3 times every 5mins then every 15min for 1 hour

Void or use catheter (in and out) full bladder can displace fundus and prevent from gully contracting to stop bleeding

Pitocin (oxytocin): IV or IM to control bleeding after childbirth
Breastfeeding: stimulate release of natural oxytocin

Uterine involution occurs: uterus returns to pre pregnancy size and location
15-21 days after delivery

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13
Q

Fundus Assessment

A

Normal:
Firm
midline
Level with umbilicus

12hours after should be 1cm above umbilicus
will resend 1-2cm every 24 hours

Not formal: displaced fundus above umbilicus or to one side = bladder distention
Intervention: void every 2-3 hours (bed pan preferred if patient has been given pain meds)
In and out catheter used if patient is unable to void or walk

Soft or soggy funds (uterine atony) = increase risk for hemorrhaging
Intervention = oxytocin infusion
Fundal massage

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14
Q

A client who gave birth vaginally with epidural anesthesia reports no urge to urinate 3 hours after birth. The clients fundus is above the umbilicus, but 3cm to the right. What should the nurse do?

A

Preform in and out catheterization
Least invasive to most invasive

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15
Q

A client who had a vaginal birth 1 hour ago has a boggy fundus that is deviated to the left and above the umbilicus. Which intervention should the nurse preform first?

A

assist the client to use the bedpan to void

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16
Q

The client delivered a baby 8 hours ago, the fundus is boggy and soft. Which interventions are most appropriate

A

Firmly massage fundus
Encourage the client to void
Administer methergine per orders
Methergin: analgesic used to treat severe bleeding after child birth
increases blood pressure

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17
Q

Six hours after a vaginal delivery the nurse notes the perineal pad is soaked and there is blood underneath the client buttocks. Which action does the nurse take first ?

A

assess the fundus

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18
Q

After delivery the nurse administers oxytocin this medication is used for which purpose

A

Stimulate firm contractions of the uterus

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19
Q

Profuse bleeding in a postpartum client, priority intervention?

A

Palpate uterus and massage if it is boggy

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20
Q

Which drug is used for treating a client with severe postpartum bleeding?

A

Oxytocin

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21
Q

Fourth stage of labor, early sign of excessive blood loss?

A

An increase pulse rate of 88-102

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22
Q

Fourth stage of labor, clients perineal pad saturated with blood and blood soaked into the bed linen. Which is the nurses initial action?

A

gently massage uterine fundus

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23
Q

Top tested key points of true labour

A

all about cervical changes
1. Bloody show “mucus and blood”
2. Water breaking - atomic sac ruptures
3. True labour contractions: increased frequency (regular and rhythmic) and increased intensity and duration cause progressive cervical changes
4. cervix
Dilation: how wide cervix is opening (goal = 10cm)
Effacement: cervix gets thinner and shorter measured in percentages 0-100%

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24
Q

4cm dilated and 60% effaced explain the meaning of this information

A

The opening of the cervix is 4cm wide and the cervical canal is 607 shorter than normal

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25
Braxton hicks contractions
False labor contractions Diapear with walking or position change No dilation of cervix
26
False labor contractions
Decrease in intensity with ambulation irregular contractions Pain alleviated with rest or changing position Cervix = no change
27
True labour
Regular increasing frequency duration and intensity Pain Does not decrease with rest cervix = Progressive change dilation and effacement
28
Which signs are most indicative of true labour
Pain in the lower back that moves to lower abdomen progressive cervical effacement and dilation Regular and rhythmic contractions that increase in frequency Contractions become more intense with walking
29
Which questions would help determine if the client is in true labour
Do you feel like the contractions are getting stronger Does anything you do make the pain eel better Do the contractions feel the same when lying down How frequent are the contractions Where do you feel the contraction pain most
30
Back labor
Black pain “back labour” fetus in occiput posterior position (OP) Back of baby head is against the mothers spine = slow p progression, long labor and back pain Can lead to labor constipation Interventions: Apply counter pressure to the sacrum during contractions Reposition the mother on her hands and knees with birth ball and encourage to change position every 30-60 minutes *no position changes and remaining in bed during early labour left lateral position with not alleviate back pain
31
Client reports intense back pain, fetal position is right occiput posterior. Which intervention would help alleviate the back pain during early labor?
Applying counter pressure to the sacrum during contractions
32
Appropriate task to delegate to the unlicensed assistive personal UAP?
Reposition an uneducated client who is in active labor onto a birthing ball UAP can help with position changes but cannot to assessment to re-evlaution
33
Lochia assessment
Discharge after birth Should become lighter in colour and amount each day Red (rubra) bright red flow 3-4 days, small clots are expected pink/brown (serosa) 4-10 days White/clear (alba) 10-28 days When to notify provider Large clots Foul odor Excessive bleeding (1 pad in 15min) Check under the client for pooled lochia
34
Client gave birth three hours ago a sudden gush of blood from the vagina while ambulating. Which is the most likely cause of the bleeding?
Lochia has pooled in the clients vagina
35
The nurse is assessing a client whoo delivered a baby 3 days ago. When assessing for lochia the nurse notes pink discharge with a serosanguinous consistency. This best described as?
Lochia serosa
36
A client 6 weeks postpartum which of the following findings is normal for the client?
Creamly coloured discharge with fleshy odor
37
Peri Care Postpartum
Cleaning: squeeze bottle with warm water Wipe front to back Blot perineum dry Pain: sitz baths Ice packs PharmL: opioids and NSAIDS topical witch hazel Laxatives and stool softeners (prevent constipation)
38
A client who has an episiotomy, proper perineal care?
Use a squeeze bottle with warm water to keep the sit clean episiotmy is a cut (incision) through the area between your vaginal opening and your anus.
39
Which medication is appropriate for a postpartum client with perineal lacerations now experiencing constipations?
Laxatives
40
5ps of labor
Passenger (baby) Baby delivery: fetal head and body size Fetal attitude: flexed = good Chin to chest Rounded beck Flexed arms and legs Extended = bad Flaccid is indicative of CNS problems Fetal lie: position of babes back in relation to moms back Best for vaginal delivery: longitudinal lie: both baby and mothers body are parallel - spine lies along spine High risk for breech: c- section delivery Transverse: sideways baby Oblique: baby is at an angle Presentation: “presenting part” Cephalic presentation: head first Dimond-shaped and soft in the middle Position of the baby Best position: ROA - right occiput anterior LOA: left occiput anterior Bad position: Sunny side up OP: occiput posterior (left or right) OT: occiput transverse (left or right)
41
5Ps
Passenger Passageway Power Position Psychological response of mother
42
Breech Presentation
Complete breech: buttocks first with legs tucked in Frank breech: buttocks first with legs stretched up Footling breech: foot first Interventions: External cephalic version (EVC) Method of turning baby from breech too head first if that doesn’t work a C-section used
43
Fetal station
Degree of fetal descent into the pelvis -1 to - 5 pelvic inlet: baby's head is above mom’s ischial spine. (baby is deeper inside the pelvis) Station 0 ischial spine and engagement: baby head is level with moms ischial spine Head is engaged and ready for labor Station +1 - +5: Corning and emerging from vagina Baby head is coming out “crowning” start pushing!
44
Vaginal examination, the nurse records: 50%, 6cm, -1. Which is a correct interpretation of the data?
The fetal presenting part is 1cm above the ischial spines
45
Placenta previa
Placenta blocks the cervix preventing the baby from coming out Sudden onset of painless bleeding Fundal height is more than expected Bright red blood Complete plan entails previa = c section
46
Abruptio Placentate
Separation. of placenta from uterine wall after 20 weeks gestation before fetus is delivered Dark red vaginal bleeding Uterine ridgity abdominal pian Signs of fetal distress Trendelenburg to decrease pressure of fetus on placenta Delivery of fetus as quickly as possibe Vaginal if fetus is healthy, C-section if showing signs of fetal distress
47
Placenta Previa vs Abrupto placentae
Previa: painless, bright red blood, uterus soft and relaxed Abrupto: Dark red vaginal bleeding uterine pain and uterine rigidity
48
Second P = Passageway
Birth canal depends on the maternal pelvis and soft tissues If the baby is too large for thise birth canal or the pelvis is not wide enough the baby might need to be delivered a different way such as a C-section
49
3rd P = Power
contractions to open the cervix 3 contractions assessment: 1. Frequency (how often - minutes) 2. Duration (how long - seconds) 3. Intensity (how strong) Dilation: 10cm (fully open) Avoid pushing until 10cm dilated Effacement: 100% thin
50
Which are factors that accelerate dilation of the cervix
Strong uterine contractions Pressure by amniotic fluid Force by fetal presenting part
51
4th P Position
Mother should be in squat position makes labor easy: Promotes fetal descent
52
5th P = Psychological response of mother
cultural considerations Be considerate of social norms Coping mechanisms
53
Fetal Heart Rate
Identify fetal well being and oxygenation during labor abnormal reading may indicate baby is not getting enough oxygen Normal fetal HR: 110 - 160 Bradycardia: Less than 110 for 10min or longer Tachycardia: More than 160 for 10min or longer
54
External fetal monitoring
Mothers abdomen is palpated to find the point of maximal impulse - located between baby's shoulder blades and this is the point where the baby heart rate can be heard the loudest best place to but the heart rate sensor Cephalic will be placed lower abdomen Breech: will be places upper abdomen
55
Contraction monitor sensor
Places higher up on the abdomen Too monitor the contractions
56
Internal fetal monitor: fetal scalp electrode - FSE
Used for high risk pregnancy's Placed on baby scalp through the cervix Can only be used after the amitotic sac has ruptured and cervix is dilated 2cm High risk of infection
57
Which of the following must be present before the nurse initiates internal fetal monitoring
Cervical dilation of at least 2 cm
58
Fetal Heart Rate monitoring strips
Fetal heart rate on top which we always assess first Red lines represent 1 minute Mothers contractions on bottom
59
Key terms for FHR
Baseline: normaal FHR 110-160 Variability: how jiggly or wiggly is the line? as labor progresses we expect the fetal heart rate to have wiggly lines = happy baby and neuro system is intact Delerations: Dips form the baseline
60
Types of variability
Absent variability: Not jiggly = NOT good baby needs to come out asap via c-section Minimal or decreased variability: flatter line, that looks sleepy and sad = baby is in trouble, very concerning Moderate variability: Normal and desired finding Marked variability: jagged jiggles = stressed baby = okay
61
Accelerations
Temporary increases in FHR Indicates gerat oxygenation for the baby Happy little mountains
62
Early Decelerations
Early decals = excellent Shallow bowl shaped dips that mirror mothers contractions, indicates head compression
63
Variable decelerations
very concerning Very deep “sharp V dips” indicates cord compression cuts of oxygen to the fetus Change mothers position Amitotic infusion if doesn’t improve
64
Late deceleration
Very bad indicates lack of oxygen to the baby
65
Key terms for uterine contractions
During contractions babys will hold their breath and fetal oxygenation is impaired 4 components frequency: measure how far apart the contractions are 2. Duration of contractions, how long the contractions last (boxes under the hill measured in seconds) 3. Intensity: rates how strong the contractions 4. Rest (tone and time): the uterus should be soft to palpation between contractions for at least 60 seconds
66
Normal Contractions
Rule of 60 Frequency: 2-3min apart in active labor Duration 60 seconds Intensity 60mmHg Rest: 60 seconds of rest in between contractions
67
Tachysystole complication
Over 5 contractions in 10 minutes Too many contractions: fetal distress, including hypoxia and reduced placental blood flow
68
VEAL CHOP
Variable decelerations = Cord compression Early decelerations = Head compression Accelerations = Okay Late decelerations = Placental insufficiency
69
Interventions for late decelerations
ROADI Reposition mom Oxygen via facemask Aleter HCP Discontinue oxytocin and give tocolytics Increase IV fluids
70
What happens when oxytocin levels are elevated?
Uterine contractions will increase
71
The nurses assesses fetal well being during labor by monitoring which factor
Response of the fetal heart rat to uterine contractions
72
Normal Fetal Heart rate findings
Normal baseline rate 110-160 bpm Accelerations Early decelerations
73
Not normal - indicates fetal distress
Tachycardia/bradycardia Late decelerations Variable decelerations Sinusodial tracing
74
Normal FHR
110-160bpm Baseline between contractions
75
Accelerations
Temporary increase in FHR (this is okay) indicates good oxygenation
76
Early Decelerations
Mirror contractions with decreased FHR during contractions = okay and expected cause: head compression during the contractions Interventions: prepare for delivery of the baby
77
Which fetal heart rate tracking characteristics are considered reassuring or normal?
Early decelerations either present or absent
78
Fetal tachycardia
Increase in FHR over 160/min for over 10 minutes Early sign of fetal distress Causes: trauma to the mother Maternal infection or fever Fetal anemia Dehydration Stimulants (cocaine) Interventions: Oxygen IV fluids Antipyretics
79
Client with a fractured wrist who is 36 weeks pregnant. Which of the following assessment items should the nurse prioritize
The fetal heart rate ice 210/min
80
While monitoring the FHR the nurse notes tachycardia. Which is a probable cause for this condition?
Early signs of fetal distress
81
A FHR baseline of 175bpm the nurse know that this can be caused by which factor
Fetal tachycardia
82
Fetal bradycardia
Decrease FHR less than 110/min for over 10 minutes Causes Uteroplacental insufficiency Umbilical prolapse Maternal hypotension Analgesic medication
83
Interventions for fetal bradycardia
Reposition mom: side lying Oxygen via facemask Alert the HCP Discontinue oxytocin Increase IV fluids
84
Slowing of the fetal heart rate and a loss fo variability
Turn the client onto her side and give oxygen by face mask at 8-10L/min
85
Maternal cardiac output can be increased by factor
Change in position
86
Sudden drop in fetal heart rate from its baseline of 125 to 80.The nurse repositions the client, provides oxygen, increase IV... five minutes have passed and the FHR remains in the 80s. Which additional measure would the nurse take?
Notify the health care provider immediately
87
Abrupt and rapid fluctuation in the fetal heart rate from baseline to 90 beats per minute and back to baseline. The fluctuations in fetal heart rate occur with no relationship to the contraction pattern. Which response by the nurse is best
This is a potential problem that requires a position change first
88
Variable decelerations
Abrupt decreases in FHR less than 30seconds from onset to baseline and 15bpm/min below baseline for 15 seconds - 2 min Causes: cord compression Critical since oxygen tube is compressed Decreased amniotic fluid
89
Variable decelerations Interventions
Reposition mom: side lying Oxygen Alert HCP Discontinue oxytocin Increase IV fluids
90
Amnioinfusion
The installation of sterile saline into the amniotic cavity to refill the lost fluid Done if multiple position changes have not relived the cord compression Report immediately: indication of overfilling Uterine resting tone that increases to 45mmHG Can lead too uterine rupture
91
Late decelerations
Decreased FHR after contractions with prolonged time before retiring to baseline Indicates oxygenation is compromised Causes: Placenta insufficiency uterine tachysystolefluid Side effects of oxytocin causing severe contractions = reduced placental blood flow and impaired fetal oxygenation Stop oxytocin: Over 5 contractions in 10min Late decals Hypotension iei also a cause
92
Late decelerations Interventions
Reposition mom: side lying never supine Oxygen Alert HCP Discontinue oxytocin Increase IV fluids Prepare for C-Section
93
A new nurse is evaluating a fetal monitoring strip of a client in labor who is receiving an oxytocin infusion. Which of the following action should the nurse take next?
Reposition the client to left/right side Oxygen by face mask Initiate an IV bolus of 0.9& saline Notify the provider and prepare terbutaline
94
Oxytocin induction the last five contractions the fetal heart rate has fallen below the baseline and returns to baseline in 20 to 30 seconds after the end of the contraction What actions must the nurse take Select all that apply
Contact the health care provider Stop the infusion of oxytocin Apply oxygen by facemask Reposition the client
95
Fetus is experiencing distress if which heart rate pattern is observed
Late decelerations
96
Sinusoidal FHR
Repetitive wave-like fluctuations (hills) with no variability and no response to contractions Requires immediate intervention Cause: Mother abdominal trauma (fall, motor accident) Leading to fetal blood loss for anemia Intervention: emergency C-section
97
The nurse is observing the fetal heart rate tracing for 4 clients which pattern is most concerning
Sinusoidal FHR
98
Gestation
Time of fertilization until date of delivery about 280 days
99
Neageles Rule
subtract 3 months and add 7 days to the first day of last mensural period
100
Gravidity
Gravida Refers to pregnant person Gravidity refers to the number of pregnancies Nulligravida = person who’s never been pregnant Primigravida = person pregnant for the first time Multigravida = at least second pregnancy
101
Parity
Parity is the number of births (not number of fetuses) carried past 20 weeks of gestation whether or not the fetus was born alive Nullipara = not has a birth at more than 20 weeks gestation Primipara = had one birth that occurred after 20 weeks multipara = person had two or more pregnancies to the stage of fetal viability
102
GTPAL
G: number of pregnancies including the present one T: term births the number born at term (longer than 37 weeks) P: Pre term births before 37 weeks A: is abortions or miscarriage L: number of current living children
103
Fundal Height
measured to evaluate the gestational age of the fetus Weeks 18-30: fundal height iim cm = fetal age in weeks + 2cm

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