OB exam 2 - Intrapartum 2

Question 1

what can a birth plan include

Answer 1

-environment
-pain mgt
-in case of emergency
-newborn care

Question 2

where does the toco go

Answer 2

fundus of the uterus

Question 3

where should ultrasound be put

Answer 3

in the area where the fetal shoulders are bc it will be the loudest area to hear the heart beat

Question 4

fetal scalp electrode

Answer 4

-placed on a firm part of the baby’s head (avoid sutures & fontanels)
-gives a continuous trace of HR even if mom is moving
-gives better information about variability
-nurse can place
-requires rupture of membranes & dilation so increase risk for infection & injury

Question 5

Intrauterine pressure catheter

Answer 5

used if the toco is not providing good readings but is invasive so only use when necessary
they tell intensity which a toco is unable to do

Question 6

montevideo units (MVUs)

Answer 6

measures the intensity of contractions & helps dx if you have adequate labor
subtract the baseline of uterine pressure from peak of each contraction in a 10 minute time period then add all answers together -> greater than 200 indicates adequate labor & you do not want it to exceed 300

Question 7

what should resting tone be

Answer 7

less than 25

Question 8

what is the longest a contraction should last & max frequency

Answer 8

120 seconds & do not want more than 5 contractions in 10 minutes

Question 9

what do you want to note of ROM

Answer 9

-spontaneous or artificial
-time, color of fluid, amount & odor (coat)

Question 10

what to note during a vaginal exam

Answer 10

-cervix: posterior, mid position, anterior
-cervical dilation
-cervical effacement
-fetal presentation
-station

Question 10

what does nitrazine tape test for

Answer 10

to see if someone’s water is broken
negative = yellow
positive = blue
noninvasive

Question 11

ferning test

Answer 11

provider takes a sample of vaginal discharge and looks at it under a scope -> if crystallized “ferning” structure appears then it is positive and pt’s water is broken

Question 12

amnisure test

Answer 12

swabs vaginal discharge -> puts into solvent for 1 min -> insert test strip & two lines equals positive test and pt water is broken

Question 13

leopold’s maneuver

Answer 13

nurse manually tries to determine fetal positioning and presentation
1st: try to determine between butt (soft) and head (hard) @ fundus
2nd: feel for arms & legs (bumpy) or back (smooth)
3rd: feel for presenting part by palpating the synthesis pubis for head (hard) or butt (soft)
4th: feel outline of fetus w/ palms, higher head = feel more

Question 14

episodic means

Answer 14

not associated with a contraction

Question 15

periodic means

Answer 15

associated with a contraction

Question 16

to determine fetal baseline, how long does FHR need to be monitored

Answer 16

10 minutes (normal is 110-160 bpm)

Question 17

veal chop

Answer 17

variable = cord compression
early = head compression
acceleration = oxygenation / okay!
late = placenta insufficiency

Question 18

how long will an early & late decel be

Answer 18

greater than 30 seconds to nadir

Question 19

in a late decel, what will cause decrease blood flow to placenta

Answer 19

-if pt has high or low BP
-if pt is bleeding bc it creates a volume problem

Question 20

how long is a variable decel

Answer 20

less than 30 seconds to nadir but can last up to 2 minutes

Question 21

uncoil (for decels)

Answer 21

UNdo what is occurring
Change position
Oxygen on or Oxytocin off
Ivf bolus
Lower head of the bed

Question 22

timing of prolonged deceleration

Answer 22

> / 2min but <10 minutes
if >10 than that is considered a baseline change

Question 23

what is a main reason for a prolonged decel / bradycarida

Answer 23

umbilical cord prolapse (a compressed cord stays compressed)

Question 24

sinusodial pattern

Answer 24

a perfect small wave pattern that would have an exact baseline -> means that baby could be acidodic and it is extremely important to deliver the baby **1st action is call provider**

Question 25

what is the best indicator of fetal oxygenation

Answer 25

FHR variability

Question 26

FHR variability

Answer 26

absent: amp range is undetectable (acidotic, distress) min: <5 bpm (sleep cycle, meds, mag sulf) mod: 6-25 bpm (goal) marked: >25 bpm

Question 27

tachy and brady time

Answer 27

below or above normal range for 10 minutes

Question 28

main causes of brady

Answer 28

prolapsed cord or maternal bleeding

Question 29

if your pt is tachy, what do you do first

Answer 29

check temp

Question 30

non reassuring fetal heart rate patterns

Answer 30

-decels persistent & severe -late decels of any magnitude -prolonged decels -absence of variability -sinusoidal pattern -severe (marked) brady or prolonged tachy

Question 31

category 1 - normal

Answer 31

-normal FHR -moderate variability -no variable or late decels (early are ok)

Question 32

category 2 - intermediate

Answer 32

-minimal or marked variability -no accels -prolonged decels -recurrent variable or late decels

Question 33

category 3 - abnormal

Answer 33

-sinusoidal pattern -absent variability -recurrent late or brady **needs to be delivered asap**

Question 34

if you have late decels w/ oxytocin running, what is your first nursing action

Answer 34

turn off the oxytocin

Question 35

if contractions are lasting too long or happening too often, what can be done

Answer 35

administer a tocolytic

Question 36

if monitoring has non reassuring patterns and interventions are not working, what is the next step

Answer 36

prepare for immediate delivery **if vaginal delivery is near then can use forceps or vacuum to progress the birth & get the baby out quickly but if not then C section**

Question 37

latent stage nursing interventions

Answer 37

-education & support -encourage ambulation -offer ice chips -VS every hour -temp every 4 hours **every 2 if ROM** -intermittent FHR every 30-60 min (based on risk status and findings)

Question 38

active phase nursing interventions

Answer 38

-palpate contractions every 15-30 min or continuous monitoring -vaginal exams -encourage voiding every 1-2 hrs -start IV fluids -auscultate FHR every 15-30 mins -assess VS every 15-30 mins -assess amniotic fluids & FHR when ruptured -change positions & pads

Question 39

transition phase nursing interventions

Answer 39

-palpate contractions every 15 mins or continuous monitoring -sterile vaginal exams -assess FHR every 15-30mins -assist w/ breathing -keep women from pushing until fully dilated

Question 40

who is the peanut ball good for and why

Answer 40

pt with an epidural bc it helps them open up their pelvis to promote fetal optimal rotation & it is really good if baby is in the OP position to hopefully get the baby to move to the OA position

Question 41

second stage nursing interventions

Answer 41

-sterile vaginal exams to assess fetal descent -assess FHR every 5-15mins -assess maternal VS every 30 min -provide support and information about labor -assist w/ pushing -assist the physician w/ birth

Question 42

indications of imminent birth

Answer 42

-bulging of the perineum -uncontrollable urge to bear down -increased bloody show

Question 43

third stage nursing interventions

Answer 43

**newborn care** -provide simulation & maintain warmth -VS -APGAR - ID -assessment -give to mom & skin to skin **maternal care** -monitor for delivery of placenta

Question 44

fourth stage nursing interventions

Answer 44

-VS every 15 mins for the first hour -assess temp hourly -IV fluids w/ pitocin 20 U -palpate fundus every 15 min for 1 hr -assess vaginal bleeding & perineum -encourage bonding -assist w/ feeding -count instruments & sponge used in delivery

Question 45

boggy fundus indicates what

Answer 45

increased bleeding

Question 46

palpation of fundus

Answer 46

put a hand to support the lower base of the uterus around the symphysis pubis & the other hand cuffs and feels the fundus of the uterus **should feel firm @ midline, if to side then possible full bladder that needs to be emptied**