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OB/PEDS TEST 3 > OB T3 > Flashcards

OB T3 Flashcards

1
Q

True Pelvis

A

Represents the bony limits of the brith canal; most important in chidlbirth has three sudivisions.

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2
Q

Best pelvis

A

Gynecoid

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3
Q

Female Bony Pelvis

A

Four bones-
2 innominate two side bones/hip bones
The ilium,
the ishium the pubis and the Sacrum.

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4
Q

Pelivic diaphram

A
  • Dilation during birth
  • Returns to pregnancy condition after birth
  • Deep facscia of levater coccygeal muscles form the pelvis.
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5
Q

Premonitory signs of Labor

A
  1. Braxton Hicks
  2. Lightening
  3. Increased vaginal secretions
  4. Bloody show/mucous plug
  5. Energy spurt
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6
Q

True Labor

A

Progressive dilation and effacement

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7
Q

Regular contractions

A
  • ubcreasubg ub frequency, duration, intensity

- Intensity increases with ambulation

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8
Q

False Labor

A

Ambulation, changes of position, resting, or hot bath or shower.

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9
Q

A women with Gynecoid pelvis has

A

LESS COMPLICATIONS

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10
Q

Anthropoid Pelvis

A

Is also good for labor.

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11
Q

Measuring a womens pelvis

A

Is just an estimation

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12
Q

Pelvic floor is made of:

A

Musculature to overcome force of gravity.

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13
Q

Pelvic Diaphragm

A
  • Dilation during birth
  • Returns to prepregancy condition after birth
  • Deep fascia of levator ani, cocygeal muscles form this part of the pelvis.
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14
Q

Questions to ask patient if she calls and says she is experiencing LABOR

A
  1. If she had a contraction and how often
  2. Did your water break.
  3. Pain location, stay or does it change or not
  4. Where is pain located, does it stay the same or does it get worse.
  5. Is baby moving normally.
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15
Q

WHEN WOMEN HAS FALSE LABOR IT can be RELIEVED by:

A
  1. Change in position
  2. Hot bath or showers.
  3. Rest
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16
Q

True Labor

A
  1. Regular contractions
  2. Pain usually starts in back, radiates to abdomen
  3. Pain not relieved by ambulation or by resting.
  4. Contractions do not decrease
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17
Q

We need to assess

A

Fetal and maternal status

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18
Q

False Labor

A
  • Lack of cervical effacement and dilation
  • Irregular contractions do not increase in frequency, duration, and intensity
  • Contractions mainly in lower abdomen and groin
  • Pain may be reduced by amubulation, changes of position, resting, or hot bath or shower.
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19
Q

Nursing responsibiities after admission to the Birth Center

A
  1. Therapeutic Relationship
  2. Imminence of Birth
  3. Fetal and Maternal status
  4. Admission Assessments
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20
Q

Admissiion Assessment

A
  1. Status of Membranes
  2. Leopolds Manuever
  3. Pregnancy History
  4. Cervical dilation
  5. Pain
  6. Labs
  7. Intrapartum high risk screeing
  8. Heart, Lungs, etc.
  9. Ultrasound
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21
Q

Ask women to cough….

A

and FLUID DROPS…Then YES she has ruptured….

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22
Q

Please keep in mind you want to get as much information as possible because women can develop

A

INFECTION

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23
Q

If a women has GIVEN BIRTH MANY TIMES

A

She will go faster…than a women that is more dilated but on her first birth.

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24
Q

Physiological changes during the birth process

A

Cervical changes

  • Effacement-thinning and shortening
  • Dilation-Opening
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25
Q

Physiologic changes

Cardiovascular system

A

Check vitals between contractions

-Remember about Positioning- Vena Cava Syndrome.

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26
Q

Physiologic changes

Respiratory system

A

-Hyperventilation

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27
Q

Physiologic changes

GI system

A
  • Mostly decreased

- Thirst

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28
Q

Urinary System

A

-Reduced sensation of FULL BLADDER.

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29
Q

Physiologic changes during the birth process

A
  • Hematopietic System
  • SVD 500 ml, C/S 1000 ml
  • H/H- we want it good in labor
  • WBC- UP tp 25,000/mm3
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30
Q

Advantages and disadvantages of incrase clotting factors and decrease in Fibrinolysis.

A

Adv:ally naturally prevents Post Partum Hemorage

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31
Q

Psychosocial consideration

A

Readineess

  • Fear, anxieties, fantasies, Hx of rape
  • molestiation
  • Preconceived ideas about birth
  • Birth Plan
  • Factors associated with postive birth
  • Support system
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32
Q

Make sure you include the support person in the

A

PLAN OF CARE

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33
Q

Nurses can’t delegate anything to the

A

Doula

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34
Q

BIRTH PLAN

A

What the patients expectations of the birth.

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35
Q

Compoents of the Birth Process

A

Powers, Passage Passenger, Psyche.

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36
Q

Powers

A

Can be mild, moderate and strong
Mild-Nose
Moderate-Chin
Strong Forehead.

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37
Q

Measure of a contractions

A

Start measuring at the beginning of the contraction.
Duration-From the beginning of one contraction to the end of another contraction.
-Frequency from the beginning of one contraction to the beginning of the next contraction.

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38
Q

Passage

A
  • Size of maternal pelvis
  • Type of maternal pelvis
  • Ability of cervix to dilate, efface
  • Ability of vaginal canal, introitus to distend
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39
Q

Components of the Birth Process

A
  1. Gynecoid-Round 50% of women

2. Android-Heart Shaped 30% of women

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40
Q

Passenger

A
  1. Fetal Head
  2. Fetal Lie
  3. Fetal Attitude
  4. Fetal Presenation
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41
Q

Fetal Lie

A

Relationship of fetal spiral column to that of mother’s- Cephalocaudal axis
-Longitudianal-Vertical
Tranverse-Horizontal
-Shoulder Presentation

42
Q

Fetal Attitude

A

-Relations of fetal body parts one to another
-Posture of fetus to conform to uterine cavity
Normal attide-General Flexion
+Head flexed, chin on chest
+Arms crossed over chest
+Legs flexed at knee, thights on abdomen

43
Q

Fetal Presentation

A
  • Vortex
  • Sinciput
  • Brow C
  • Face D
44
Q

Malpresentation

A

Breech (Frank, footling, complete)

45
Q

Malpresentation

A

Transverse, Lie, Shoulder, Presentation

46
Q

Fetal Position

A

Maternal Pelvis

  • Right (R) or (L) side
  • Occidput (O)
  • Mentum (M)
  • Sacrum (S)
  • Acromion (scapula)
  • Anterior (A), posterior (P), Transverse (T)
47
Q

Station

A

-Station
-Ischial spines are zero station are zero
station
-Presening part moves from negative to positive.

48
Q

First Stage
1st Phase
“Cervical Dilation”

A

Cervical Dilation: 0-10 cm

49
Q

2 nd

A

Birth of Baby “pushing”

50
Q

3 rd

A

Placental delivery

51
Q

4th

A

Recovery

52
Q

Cervical Dilation-Latent Phase

A
  • Beginning cervical dilation and effacement
  • No evident fetal descent
  • No evident fetal descent
  • Uterine contractions increase in frequency
  • duration and intensity
  • Contractions usually mild, regular
  • Excited talkative smiling.
53
Q

Cervical Dilation-Active Phase

A
  • Cervical dilation from 4 to 7
  • progressive fetal descent
  • Contraction more frequent and intense
  • Maternal responses-Increase anxiety
54
Q

Cervical Dilation -Tranverse Phase

A 
-Cervical dilation from 7 to 10 cm
Progressive fetal descent
-Contractions more frequenct and intense
-Maternal responses
-Women likely to withhold into self.
55
Q

Second Pushing

A

Begins with complete dilations (10 cm)

Ends with birth of a baby

56
Q

Open Glottis Pushing

A

-Grunts without holding breath and bears down spontaneously is bad.

57
Q

Pushing for no more than 6-8 seconds, no more than 3 times per contraction

A
  • Decreased risk of episitomy/laceration
  • Decreased risk of operative vaginal birth
  • Decreased maternal fatigue
58
Q

AGOC recommendations for second stage of labor is?

A

2 hours for a multiparous women with anetheisia and 3 hours for a nulliparous women with anethesia.

59
Q

After she been pushing for two hours or what ever she has been doing…

A

Then they are going to consider C section.

60
Q

We should not do…

A

Valsalva Maneuver…..Not the norm…

61
Q

Mechansisms of Labor

A
  1. Desent
  2. Engagement
  3. Flexion
  4. Internal Rotation
  5. Extension
  6. External Rotation
  7. Expulsion.
62
Q

Third Stage “Placental”

A

Begins with birth of baby, ends with explusion of planenta.

63
Q

Placental seperation Signs

A
  1. GUSH OF BLOOD
  2. She feels a need to push again.
  3. Unbilicals lengthens so you see more of it.
  4. Fondus changes to Globular
  5. Practionar delivers the plancenta.
64
Q

Uterine Inversion

A

Is an emergency of when the placenta does not detach.

-Or provider trying to expadite process and pulls earlier.

65
Q

If it happens we

A

Manually have to put it back…..risk for hemorage and infection.
- ALSO possible a piece will stay inside.
Lack of oxygenaises.

66
Q

Stage 4 Recovery.

A
  • Begins with delivery of placenta, ends when mother is stable
  • 1 to 4 hours after birth
  • Phsiolgoic readjustment
  • Thirsty and hungry
  • Shaking
  • Bladder is often hyponic
  • Uterus remains contracted
67
Q

Assessments during labor…

A

Fetal Assessment
Maternal Assessments
Amnionic fluid
Membrain assessment.

68
Q

Amniotomy and vaginal examination are both

A

Sterile procedure done by providers or if doctor oks it the nurse can do it.

69
Q

Why would we want to rupture membraine.

A

Labor Induction and it is uncomfortable because she is dry now.

70
Q

RUPTURE OF MEMBRAINE

A

Make sure it is done at the right time and we want to prevent cord prolapse. If CORD COMES OUT….WE HAVE AN EMERGENCY C SECTION.

71
Q

WHY WOULD we do this….

A

IF baby is high or if there is a breach presentation.

72
Q

TOO MUCH WATER

A

THE CORD WILL FLUSH OUT TOO

73
Q

SIGNS we can visualized…

A

Can be stuck on babies head……and we will see fetal heart rate abnormalities.

74
Q

What equipment should be available for an amniotomy.

A

Amnio-hook

  • Sterile glove and lubricant
  • Clean chux, blankets, washcloths
  • Patient positioned in a semireclingin position
  • Strict sterile technique.
75
Q

Cord Compression what is baby experiencing

A

Hypoxia and deceal heart rate.

76
Q

Which nrusing assessment are to and after the procedure.

A

Assure that the presenting part is engaged prior to amniotomy to prevent cord prolapse.

  • Monitor FHR prior to and after amniotomy for cord prlapse or compression as evidnce by variable decelerations
  • Monitor the color and amount, and smell of fluid.
77
Q

When a cord come through the crevix before th bayb does

A

Causes when there is a poor fit betwen the fetal presenting part and the maternal pelvis.

78
Q

Signs of a prolapse

A

Cord may or may not be visible, may be felt with VagExam Servere variable decelerations or bradycardia seen in FHR.

79
Q

Priority is to releive pressure off the cord.

A
  • Birth by stat C/S unless vaginal birth is imminent
  • Position hips higher than the head (knee-chest, Trendelenburg.
  • With a gloved hand, push the fetal presenting part upward.
  • Give O2 FACE MASK.
80
Q

Nursing Care During Labor

A
  1. Promote placental fuciton

2. Provide Comfor measures.

81
Q

Pain During Labor

A

Normal physiologic process

  • First stage pain, Cervical dilation
  • Second stage pain, uterine muscle cell hypoxia.
  • Third stage pain, Uterine contractions
82
Q

Adverse effects of excessive pain

A

Physiologice-Fear and anxiety release epinephrine whcih causes uterine vasoconstriction and increase uterine musle tone.
Pyscholgoical- Unreolved pain will affect her memory.

83
Q

Non-pharmacolgoic pain releif.

A 
Relaxation techniques
Visualization
Thermal stimulation
Focal Point
Massage
Music
84
Q

Breathing Techniques

A

Eary Labor- Slow Paced breathing
Middle Labor- Modified paced breathing
Late Labor-Patterned pace breathing

85
Q

Pharmacolgoic Pain Management

A

Any drug taken by the women is also taken by the fetus.

  • Drusgs can affect the course and length of labor.
  • Complication may limit the choic of pain management
  • Women who practice substance abuse may have fewer safe choices.
86
Q

Example of a time that we should induce

A
  • Post term
  • Preclampsia
  • Trauma or chrnoic condition
  • BP on high side
  • Gestational diabetes and stress test does not look good.
87
Q

Labor Induction

A

We are starting the process of labor with chemical or mechanical initiation of uterine contractions.

88
Q

Labor Augmentation

A

Helping the process of labor by improving the quality of uterine contractions once labor has started.

89
Q

Bishop Score

A

Used to assess readiness and predict sucess of induction augmenation. Max score is 13.

90
Q

Cervical Repening

A

Need to first RIPEN the CERVIX.

91
Q

Contarindications to Labor Induction or Augementation

A
  1. Vasa previa or complete placenta previa
  2. Transverse fetal lie
  3. Umbilical cord prolapse
  4. Previous classical cesarian delivery
  5. Active genital herpes infection
  6. Previous myomectomy entering endometrial cavity.
92
Q

Some Indications for induction

A

-Nonreassuring fetal testing
-Nonreassuring fetal testing
-Olygohydramnios
-Worsening preclampsia at terms
IUGR at Term
Hx of previous term stillbirths.

93
Q

Cervical Ripening

A
  • Postglandin E2
  • Intravaginal insert
  • Left in prsterior vagina
  • Easily removed
94
Q

Advantage of Cervical Ripening Contraindications

A
  • Nonreassuring FHR tracing
  • Frequenct moderate uterine contractions
  • Prior cesarean section or uterine scar
  • Placenta Previa
  • Undeagnosed vaginal bleeding.
95
Q

Disadvanatge of Porostaglandin Administraion

A
  • Uterine hyperstimulation
  • Nonreassring fetal status
  • Higher incidence of postpartum hemorhage
  • Uterine rupture
96
Q

Stripping amniotic membranes

A

Use your fingers.

97
Q

A natural postglandins releaser is

A

Intercourse

98
Q

Sythentic form of Oxytocin

A

Pitocin

99
Q

Before starting infusion of pictocin the nurse should first.

A
  • Assess Maternal pelvis

- Fetal station, fetal position

100
Q

Adverse reactions to pitocin

A
  • Hypertonic uterine contractions
  • Uterine rupture
  • Water intoxation.

OB/PEDS TEST 3 (3 decks)

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