OB - Module 4

Question 1

5 P’s

Answer 1

Passage, Power, Passenger, Position, Psyche

Question 2

Passage

Answer 2

Bony and Soft (vaginal canal)

Question 3

Power

Answer 3

Passive - Stage 1 labor (uterine contractions)

Active - Stage 2 labor (mother pushing)

Question 4

Passenger

Answer 4

Fetal lie (position): Longitidunal , transverse, or horizontal.
Fetal attitude: Cephalic, Breech (butt), Shoulder

Question 5

Position

Answer 5

R,L
M - Cephalic, O - Head flexed chin to chest, S- Sacral
ex. RM Right Cephalic presenting

Question 6

Psyche

Answer 6

Individual/Cultural values

Question 7

Common cardiovascular changes

Answer 7

Increased BP (check vitals between contractions) and side-lying hypotension

Question 8

Urinary system

Answer 8

Decreased bladder sensations. must encourage woman to empty bladder.

Question 9

Fetal Protective mechanisms during contractions

Answer 9

Hemoglobin carries 20-50% more oxygen than adult, Releases CO2 more easily, and has high cardiac output

Question 10

Nesting syndrome

Answer 10

Sudden urge to set things up and get ready for the baby

Question 11

Premonitory Signs of normal labor

Answer 11

Braxton hicks (irregular contractions), lightening, increased vaginal mucous secretions, bloody show, energy spurt (nesting syndrome), weight loss.

Question 12

Descent

Answer 12

?

Question 13

Engagement

Answer 13

?

Question 14

Flexion

Answer 14

?

Question 15

Internal rotation

Answer 15

?

Question 16

Extension

Answer 16

?

Question 17

External rotation

Answer 17

?

Question 18

Expulsion

Answer 18

?

Question 19

First Stage

Answer 19

Latent (contactions)
Active (cervix dilation)
Transition (strongest contractions and woman may lose control)

Question 20

Second Stage

Answer 20

Woman is pushing and regains control.

Question 21

Third stage

Answer 21

Delivery of infant to delivery of placenta.

Question 22

Fourth stage

Answer 22

Recovery. Goal is to ensure uterus is firmly contracted and encourage infant contact and breastfeeding.

Question 23

Evaluating Amniotic Fluid

Answer 23

TACO - Time, amount, color, and odor

Question 24

Assessment for artificial rupture

Answer 24

vitals q 2 hours.

Question 25

How is labor induced?

Answer 25

Pitocin (Oxytocin) drip diluted in electrolyte fluid as a secondary infusion plug into lowest port near the venipuncture site. Start slowly and increase gradually.

Question 26

What happens when the baby has a non-reasuuring heart pattern?

Answer 26

Stop the infusion Turn on side Give O2-tight fitting mask

Question 27

What happens if Mom-hypertonus occurs?

Answer 27

``` Stop infusion Turn on side Give O2 Assess BP/pulse Record I/O Watch for water intoxication ```

Question 28

Version

Answer 28

Changing fetal position

Question 29

Steps before Version can be attempted

Answer 29

Determine gestation age > 37 weeks, give tocolytic, ultrasound, and explain procedure and obtain written consent.

Question 30

When to use Outlet forceps

Answer 30

Fetal head is on perineum

Question 31

When to use Low forceps

Answer 31

Leading edge of skull is at 2+

Question 32

When to use Mid-pelvis forceps

Answer 32

Leading edge of skull between 0 and 2+

Question 33

Types of episiotomies

Answer 33

Midline (straight down) and Medial-lateral (to side)

Question 34

What is the procedure for Cesarean?

Answer 34

Give famotidin and sodium citrate, perform CBC and PT/PTT, skin prep, indwelling foley catheter, and possible prophylactic antibiotics.

Question 35

Uterine incisions

Answer 35

Low transverse (sideways near vagina), low vertical (up/down near vagina), and classic (straight in the middle of the belly)

Question 36

VBAC

Answer 36

vaginal birth after cesarean

Question 37

TOLAC

Answer 37

trial of labor after C-section

Question 38

PAIN

Answer 38

Purposeful Anticipated Intermittent (not constant) Normal

Question 39

Somatic Pain

Answer 39

Quick, sharp, localized pain

Question 40

Visceral

Answer 40

Slow, deep, poorly localized. Generally in the first stage

Question 41

Four sources of labor pain

Answer 41

Tissue ischemia Cervical dilation Pressure (pulling on cervical structures Distention of vagina/perineum

Question 42

Systemic Opioid Drugs

Answer 42

Nubain, Stadol, Demerol

Question 43

Systemic Opioid Drugs Indications

Answer 43

Given IV, alters perception of pain, and can cause respiratory depression.

Question 44

Opioid antagonists

Answer 44

Naloxone and Naltrexone (used when patient has history of opioid dependence)

Question 45

Opioid antagonists Indications

Answer 45

Given to reverse effects of pain medication such as respiratory depression. May have to repeat a dose as it has a shorter half life.

Question 46

Adjunctive drugs

Answer 46

Phenergan, Vistaril (never IV)

Question 47

Adjunctive drugs Indications

Answer 47

Antiemetic and tranquilizing effects but can cause respiratory depression

Question 48

Intrathecal opioids

Answer 48

Fentanyl, Sufentanyl, Morphine

Question 49

Intrathecal opioids indications

Answer 49

Allows woman to feel contractions, but no pain and is used in low-risk settings. Only last a short amount of times and may not give enough relief.

Question 50

Pudendal block

Answer 50

Numbs lower vagina and perineum

Question 51

Spinal block

Answer 51

Used ONLY for cesarean. Anesthetic is injected into subarachnoid space that removes sensory and motor functions below the level of insertion.

Question 52

General Anesthesia

Answer 52

Used for emergency c-sections. Rarely used for birth and results in a loss of consciousness.