MCN 3 Nursing Care of the client with high-risk labor & delivery & her family Flashcards
(97 cards)
1
Q
Abnormal positions of the vertex of the fetal head(with the occiputas the reference point) relative to the maternal pelvis
A
Fetal malposition
2
Q
This is also called as Vertex presentation
A
Cephalic presentation
3
Q
If the posterior aspect of the head of the fetus is called occiput or occiputo what about the anterior aspect
A
Sinciput
4
Q
This fetal position is posterior rather than anterior. Tend to occur in women with android, anthropoid, or contracted pelvises.
A
Occipitoposterior Position
5
Q
The four types of female pelvis
Differentiate
A
Gynecoid o
Android ♡
Platypelloid ◇
Android 0
6
Q
What are the
two normal cephalic presentation.
A
ROA
LOA
7
Q
One of the complications of occiputoposterior position is it increases the risk of umbilical
cord prolapse. What would be your management?
A
Confirm position by vaginal
examination or ultrasound.
8
Q
Because the fetal head rotates against the sacrum, a woman may experience pressure and pain in her lower back because of sacral nerve compression. What would be your nursing management?
A
Applying counter pressure on the sacrum by a backrub.
9
Q
For the nursing consideration of occiputoposterior, why do we advice the mother to void every 2 hours to keep her bladder empty?
A
Full bladder could further impede descent of the fetus.
10
Q
What is effacement?
A
Thinning or shortening of the cervix
11
Q
Occurs when the part of the fetus which is closest to the pelvic inlet is not the fetal head.
A
Fetal malpresentation
or Breech presentation
12
Q
Space in the hip bone that occupies the organs of the reproductive system.
A
Pelvic cavity
13
Q
TRUE or FALSE
Most fetuses are in a breech presentation early in pregnancy. By week 38, however approximately 97% of all pregnancies, a fetus turns to a cephalic presentation.
A
TRUE
14
Q
A type of breech presentation: Knees and thighs are flexed on the abdomen.
A
Complete
15
Q
A type of breech presentation: Knees are extended, hips are flexed.
A
Frank
16
Q
What is a Pendulous abdomen?
A
Uterus may fall so far forward that the fetal head comes to lie outside the pelvic brim, causing a breech presentation.
17
Q
These are factors for breech presentation except which?
a. Gestational age less than 40 weeks
b. Abnormalities such as anencephaly,hydrocephalus,or meningocele
c. Polyhydramnios
d. Congenital anomaly of the uterus, such as a mid septum
A
None
All are factors that might affect breech presentation
18
Q
This is Assessment is for what presentation.
Contour of the mother’s abdomen at term may appear fuller side to side rather than top to bottom.
A
Shoulder Presentation
19
Q
Which of these are factors for breech presentation.
a. Gestational age less than 40 weeks
b. Abnormalities such as anencephaly, hydrocephalus, or meningocele
c. Polyhydramnios
d. Congenital anomaly of the uterus, such as a mid septum, that trapsthefetusinabreech position
e. Prolapse of the umbilical cord
f. Any space-occupying mass in the pelvis (fibroid tumor of uterusorap.previa)
g. Pendulous abdomen (the uterus may fall so far forward that thefetal headcomes to lie outside the pelvic brim, causing a breech presentation)
h. Multiple gestation (the presenting infant cannot turn to a vertexposition)
i. Chorioamnionitis
A
A B C D F G H
Prolapse of the umbilical cord and chorioamnionitis doesn’t directly affect breech presentation
20
Q
A congenital condition where the uterus has a septum or wall of tissue dividing it partially or completely into two separate cavities.
A
Uterine septate/septum
21
Q
All are assessments for breech presentation except?
a. Fetal heart sounds heard low in the abdomen.
b. Leopold maneuvers and a vaginal examination.
c. Ultrasound
d. FHR monitoring and uterine contractions
A
a. Fetal heart sounds are heard high in the abdomen
22
Q
In Breech Presentation
The Birth Technique can be
Vaginally: The mother is allowed to push if dilatation of at least 4-7 is achieved, and the bottom, trunk, and shoulders are born. True or false.
A
False. She is allowed to push if FULL dilatation is achieved, uterine rupture might occur if the uterine is not fully dilated.
23
Q
TRUE or FALSE
These are normal findings of breech presentation
a. Frank breech position tends to keep his or her legs extended and at the level of the face for the first month of life.
b. Footling breech may tend to keep the legs extended
in a footling position for the first 2 weeks
A
False. Persistent positioning consistent with a breech presentation beyond the first few days of life, (at least 2-3 days) it’s essential to consult with a pediatrician or healthcare provider.
24
Q
An abnormal form of cephalic presentation where the presenting part is the mentum/chin.
A
Face presentation
25
True or False
Face Presentation
Birth Technique:
If the chin is in the posterior aspect of the mother and the pelvic diameters are
within normal limits, it may be possible for the infant
to be born without difficulty.
False. The Chin or mentum of the baby must be on the anterior aspect of the pelvic not on the posterior aspect.
26
All are factors of Face Presentation except, which?
a. Contracted pelvis
b. Relaxed uterus of a multipara
c. Prematurity
d. Transverse lie
e. Polyhydramnios
f. Placenta previa
e. Fetal malformation
D. Transverse lie is a different fetal presentation
27
The following are nursing considerations for face presentation except which?
a. Assess for facial edema and ecchymotic bruising
b. Observe the infant closely for a patent airway.
c. Gavage( way to provide breastmilk or formula directly to your baby's stomach) feedings may be necessary to allow them to obtain enough fluid until they can suck effectively.
d. May be transferred to a neonatal intensive care unit for 24 hrs
e. Reassure the parents that the edema is transient and will disappear in a few days with no aftermath.
None. All optoins are nursing considerations
28
A cephalic presentation in which the head is midway between flexion and extension. Rarest of the presentations.
Brow presentation
29
In a Face Presentation, if the mentum is in the posterior aspect of the mother, what would be the birth technique. NSD or CS
Cesarean Section
30
In the management of brow presentation, if the presentation spontaneously corrects itself. What would be the birth technique, NSD or CS?
Normal Spontaneous Delivery
31
In the management of brow presentation, Unless the presentation spontaneously corrects, what would be the birth technique, NSD or CS?
Cesarean Section
32
A fetal presentation in which the fetal longitudinal axis lies perpendicular to the long axis of the uterus.
Transverse Lie
33
All of these are factors for Tranverse Lie except which?
a.Pendulousabdomens
b. Uterinefibroidtumors
c. Congenital abnormalities of the uterus
d. Polyhydramnios
e. Maternal weight or body mass index (BMI)
f. It may occur in infants with hydrocephalus or another abnormality that prevents the head from engaging
g. Prematurity
h. Strenuous Exercise
i. Multiplegestations
j. Shortumbilicalcord
E. Maternal weight can influence factors such as the risk of gestational diabetes, hypertension, or cesarean delivery, but it does not directly impact the baby's position in the womb.
H. Strenuous physical activity is not typically considered a direct factor in influencing fetal presentation, however, strenuous activity during pregnancy may increase the risk of other complications, such as preterm labor or placental abruption
34
Fetal malpresentation:
The presenting part is usually one of the shoulders
(acromionprocess), an iliac crest, a hand, or an elbow. Associated with a transverse lie
Shoulder presentation
35
A loop of the umbilical cord slips down infront of
the presenting fetal part.
An emergency situation: leads to cord compression and decreased oxygenation to the fetus.
Prolapse of the umbilical cord
36
Which of these should be your assessments in an umbilical cord prolapse:
a. Vaginal exam: cord may be felt as the presenting part
b. Transvaginal UTZ
c. FHR: unusually slow or a variable deceleration
d. Can be confirmed by Leopold maneuvers.
A
B
C
Leopold maneuvers are unnecessary in assessing Prolapse of the umbilical cord
37
What would be the birth technique for Shoulder presentation. NSD or CS
Cesarean Section
38
All of these are factors for Prolapse of the umbilical except which?
A. Premature rupture of membranes
b. Fetal presentation other than cephalic
c. Placenta previa
d. Intrauterine tumors preventingthe presenting part from engaging
e. A small fetus
f. CPD preventing firm engagement
g. Polyhydramnios
h. Multiple gestation
None. All are factors of Umbilical cord prolapse
39
Which of these should be the your assessments for Umbilical cord prolapse:
a. Vaginal exam: cord may be felt as the presenting part
b. Transvaginal UTZ
c. FHR: unusually slow or a variable acceleration
A and B
FHR should have a variable deceleration not acceleration
V C
E H
A O
L P
40
Which of these Therapeutic Management for Umbilical cord prolapse are necessary:
a. Knee-chest position or Trendelenburg position
b. Administering oxygen at 10L/min by facemask
c. Tocolytic agent
d. Amnio infusion
e. Push any exposed cord back into the vagina
f. Fetal blood sampling (FBS)
g. Uterotonic agents
A - alleviate pressure on the umbilical cord by shifting the weight of the uterus off the cord, thus improving blood flow to the fetus. Additionally, gravity may help to encourage the fetus to move away from the prolapsed cord, reducing the risk of compression and associated complications.
B -compressed cord decreases the oxygen that goes to the fetus
C- slows or stops uterine contraction
D- Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity.
F-supplies information as to whether a fetus is becoming acidotic.
*Do not attempt to push any exposed cord back into the vagina because this could add to the compression by causing knotting or kinking. Instead, cover any exposed portion with a sterile saline compress to prevent drying.
*Uterotonics induces uterine contractions
41
This is the most common type of pelvis in
females and is generally considered to be the typical
female pelvis. Its overall shape is round, shallow, and open.
Gynecoid
42
TRUE or FALSE
The anthropoid pelvis is thought to be the most favorable pelvis type for a vaginal birth. This is
because the wide, open shape give the baby plenty of room during delivery.
FALSE. It should be gynecoid pelvis not anthropoid, An
anthropoid pelvis is narrow and deep. Its shape is
similar to an upright egg or oval.
43
This type of pelvis bears more resemblance to
the male pelvis. It’s narrower
than the gynecoid pelvis and is shaped more like a heart or a wedge.
Android
44
The elongated shape of this pelvis makes it roomier from front to back than the android pelvis. But it’s still narrower than the gynecoid pelvis. Some pregnant women with this pelvis type may be able to have a vaginal birth, but their labor might last longer.
Anthropoid
45
This pelvis is also called a flat pelvis. This is the least common type. It’s wide but shallow, and it resembles an egg or oval lying on its side.
Platypelloid
46
Narrowing of the anteroposterior diameter of the pelvis to less than 11cm, or of the transverse diameter to 13cm or less. Caused by rickets in early life or by an inherited small pelvis.
Inlet contraction
47
Narrowing of the transverse diameter, the distance between the ischial tuberosities at the outlet, to less than 11 cm
Outlet contraction
48
Occurs at the second stage of labor when the fetal head is born but the shoulders are too broad to enter and be born through the pelvic outlet.
Shoulder dystocia
49
All are complications for shoulder dystocia except, which?
a. Can result in a fractured clavicle or abrachial plexus injury for the fetus (most common)
b.Can result in vaginal or cervical tears.
c. Cord compression
d. Separation of the pubic bone
e. Fetal intracranial hemorrhage
E. Shoulder dystocia: when the head is born but the shoulders are too broad for the pelvic outlet
50
A clinical sign for a shoulder dystocia where the fetal head retraction is manifested by head bobbing, emerging, and then pulling back, conceptualized as similar to a turtle pulling its head into and out of its shell.
Turtle sign
51
Involves asking or assisting a woman to flex her thighs sharply on her abdomen, which widens the pelvic outlet and may allow the anterior shoulder to be born. What maneuver is this?
McRoberts
52
There is a mismatch between the size of the fetal head and the size of the maternal pelvis, resulting in failure to progress in labor for mechanical reasons.
Cephalopelvic Disproportion (CPD)
53
Which of these are factors for CPD:
a. Gestational diabetes
b. Post-term pregnancy
c. Small pelvic outlet
d. Congenital dislocation of the hips
e. Polyhydramnios
f. Braxton Hicks contraction
g. Occipital posterior disproportion
A B C D G
Polyhydramnios and Braxton Hicks contraction doesn't directly affect CPD
54
TRUE or FLASE
More than 95% of women who had been diagnosed with CPD in earlier pregnancies were able to deliver vaginally in subsequent pregnancies (American Journal of Public Health).
FLASE. It should be 65%
55
This refers to difficulty in labor, which is usually due to uterine dysfunction, fetal malpresentation/abnormality, or pelvic abnormality.
Dysfunctional labor (Dystocia)
56
All of these are factors for Dysctocia except which?
a. Advanced maternal age
b. Obesity
c. Overdistention of uterus
d. Cephalopelvic disproportion
e. Maternal fatigue
f. Dehydration
g. Fear or anxiety
h. Lack of analgesic assistance
i. Overstimulation of the uterus
None. All are factors for Dysfunctional labor (Dysctocia)
57
Labor that occurs before the end of week 37 of gestation. Occurs in approximately 9% to 11% of all pregnancies and is responsible for almost two-thirds of all infant deaths in the neonatal period.
Premature labor
58
TRUE or FALSE
A woman is documented as being in actual labor rather than having false labor contractions if contractions have caused cervical effacement over 80% or dilation over 1cm.
TRUE
59
For premature labor, the therapeutic management may include medical attempts to stop labor if:
a. The fetal membranes have not ruptured
b. Fetal distress is present
c. There is no evidence of bleeding occurring
d. The cervix is not dilated more than 4 to 5cm
e. Effacement is not more than 50%.
Which of these are not included.
A C D E
Fetal distress should be absent not present
60
This Drug was used to prevent ARDS in because of it's bronchodilator effect but may be used as a tocolytic agent
Terbutaline
61
Pharmacologic Intervention
given IV, is used primarily to treat preeclampsia and prevent eclamptic seizures.
*It was traditionally given to prevent preterm labor as well.
Magnesium sulfate
62
What pharmacologic intervention can be used in cases of premature labor to reduce the possibility of respiratory distress syndrome or bronchopulmonary dysplasia by promoting the formation of lung surfactant?
Corticosteroids such as Betamethasone
63
Predicted from a labor graph if, during the active phase of dilatation, the rate is greater than 5 cm/hr (1 cm every 12 minutes) in a nullipara or 10 cm/hr (1 cm every 6 minutes) in a multipara.
Precipitate labor and birth
64
Cervical dilatation that occurs at a rate of 5 cm or more per hour in a primipara or 10 cm or more per hour in a multipara.
Precipitate dilatation
65
Uterine contractions are so strong a woman gives birth with only a few, rapidly occurring contractions, often defined as labor that is completed in fewer than 3 hours.
Precipitate birth
66
Complications in a Precipitate labor and birth includes:
a. Contractions can be so forceful they lead to premature separation of the placenta or lacerations of the perineum.
b. Risk for hemorrhage.
c. Risk for edema.
A and B
Edema is not a direct complication of PLB
67
TRUE or FALSE
Caution a multiparous woman by week 28 of pregnancy that because a past labor was so brief, her labor this time also may be brief so that she has time to plan for adequate transportation to the hospital or alternative birthing center.
TRUE
68
The uterus has descended into the vagina due to overstretching of uterine supports and trauma to the levator ani muscle.
Uterine Prolapse
69
A broad muscle group that forms the greater part of the floor of the pelvic cavity.
Levator Ani Muscle
70
TRUE or FALSE
Women with pessaries in place need to return for a pelvic examination every 6 months to have the pessary removed, cleaned, and replaced and the vagina inspected; otherwise, vaginal infection or erosion of the vaginal walls can result. Surgical replacement is also possible.
FALSE. Pelvic examination should be at least 3 months
71
The device fits into the vagina and provides support to vaginal tissues displaced by pelvic organ prolapse.
Pessary
72
Rupture of the uterus during labor, although rare, is always a possibility. It occurs most often in women who have a previous cesarean scar.
Uterine Rupture
73
Uterine rupture can be classified into two types: Which of these is complete and which is incomplete?
a. Going through the endometrium, myometrium, perimetrium, and peritoneal layers. Uterine contractions will immediately stop.
b. Leaving the peritoneum intact.
A. Complete
B. Incomplete
74
Determine which of these assessments are/is Complete or Incomplete Uterine rupture
1. Going through the endometrium, myometrium, perimetrium, and peritoneal layers - Uterine contractions will immediately stop
2. Leaving the peritoneum intact.
1. Complete
2. Incomplete
75
Commonly refered to as the after birth.
Placenta
76
Which of these options are FALSE:
a. A normal placenta weighs approximately 500g and is 15 to 20cm in diameter and 1.5 to 3.0cm thick. Its weight is approximately one-sixth that of the fetus.
b. A placenta may be unusually small in women with diabetes.
c. If the uterus has scars or a septum, the placenta may be wide in diameter because it was forced to spread out to find implantation space.
B. Women with diabetes may supposed to have an enlarged placenta
77
Normal placenta weighs approximately
a. 600 g
b. 450 g
c. 300 g
d. 500 g
D
78
Refers to the implantation of placenta in the lower segment of the uterus.
Placenta previa
79
Premature separation of the placenta
Abrubtio placenta
80
A placenta that has one or more accessory lobes connected to the main placenta by blood vessels is called an accessory placental lobe.
- No fetal abnormality is associated with this type.
- Complication: Small lobes may be retained in the uterus after birth, leading to severe maternal hemorrhage.
- Assessment: On inspection, the placenta appears torn at the edge, or torn blood vessels extend beyond the edge of the placenta.
Placenta Succenturiata
81
Placenta in which the chorion membrane begins at the edge of the placenta and spreads to envelop the fetus; no chorion covers the fetal side of the placenta.
Placenta Circumvallata
82
The placenta is covered to some extent with chorion. The umbilical cord enters the placenta at the usual midpoint, and large vessels spread out from there.
Placenta Circumvallata
83
Placenta in which the cord is inserted marginally rather than centrally. This anomaly is rare and has no known clinical significance either.
Battledore Placenta
84
A situation in which the cord, instead of entering the placenta directly, separates into small vessels that reach the placenta by spreading across a fold of amnion.
Velamentous Insertion of the Cord
85
The umbilical vessels of a velamentous cord insertion cross the cervical os and therefore deliver before the fetus. The vessels may tear with cervical dilatation, just as a placenta previa may tear.
Vasa Previa
86
An unusually deep attachment of the placenta to the uterine myometrium, so deep that the placenta will not loosen and deliver.
Placenta Accreta
87
One medical management for Placenta Accreta: Hysterectomy to remove the uterus or treatment with Betamethasone to destroy the still-attached tissue may be necessary.
Betamethasone is a corticosteroid medication used to help fetal lung maturation in cases of preterm labor, the right drug should be methotrexate.
88
TRUE or FALSE
The umbilical cord is a bundle of blood vessels that develops during the early stages of embryological development. It is enclosed inside a tubular sheath of chorion and consists of two paired umbilical arteries and one umbilical vein. The umbilical cord allows for the transfer of oxygen and nutrients from the maternal circulation into fetal circulation while simultaneously removing waste products from fetal circulation to be eliminated maternally.
FALSE. The correct term is amnion, not chorion. The umbilical cord is enclosed inside a tubular sheath of amnion, not chorion.
89
The umbilical cord
contains only two blood
vessels—one vein and
one artery. Also known as single umbilical artery.
Two-Vessel Cord
90
Which of the following statements regarding the umbilical cord is true?
a. A short umbilical cord can result in premature separation of the placenta or an abnormal fetal lie.
b. A long cord may be easily compromised because of its tendency to twist or knot.
c. It is not unusual for a cord to wrap once around the fetal neck (nuchal cord) without interference to fetal circulation.
d. All of the above.
e. None of the above.
D. All of the above
91
The emotional state of the mother during her labor which can also have an overall effect on progress of labor.
Psyche
92
Which of the following is not a factor for the psyche of the mother during labor and birth?
a. The temperature of the delivery room
b. The progress of labor and birth can be adversely affected by maternal fear and tension.
c. Support system (partner, family, etc.)
d. Welcoming and supportive environment.
e. The color of the hospital walls
f. Levels of stress and underlying anxiety during the process
g. The aroma of flowers in the room
A E and G
93
TRUE or FALSE
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor.
TRUE
94
TRUE or FALSE
Women experiencing increased pain or high levels of anxiety release endorphins, which can have an inhibitory effect on uterine contractility leading to abnormal labor progression.
FALSE. Women experiencing increased pain or high levels of anxiety release catecholamines, not endorphins, which can have an inhibitory effect on uterine contractility leading to abnormal labor progression.
95
What factors for the psyche of the mother contribute to therapeutic management to ensure adequate progress during labor?
a. Adequate analgesia
b. Monitoring fetal heart rate
c. Controlled breathing techniques
d. Emotional support
e. Performing pelvic floor exercises
A and D
96
Although the length of the umbilical cord rarely varies, some abnormal lengths may occur.
Unusual Cord Length
97
A protein produced by trophoblast cells . If this is present in vaginal mucus, it predicts that preterm contractions are ready
to occur; absence of the protein predicts that labor will not
occur for at least 14 days.
Fibronectin
