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Nursing 132 Final Exam > OB Test # 3 Intrapartum > Flashcards

OB Test # 3 Intrapartum Flashcards

1
Q

If a woman has vaginal bleeding, why should you never perform a vaginal exam of the cervix before an ultrasound can be done?

A

Because your fingers could stimulate contractions

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2
Q

Differentiate the False Pelvis from the True Pelvis. What are the 3 subdivisions of the True Pelvis?

A

1) False Pelvis - Above the pelvic brim
2) True Pelvis - Represents the bony limits of the birth canal. Has 3 subdivisions:
A) Pelvic Inlet - The upper border
B) Mid Pelvis - Pelvic cavity
C) Pelvic Outlet - Lower border

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3
Q

What are the 4 different pelvic types based on the Caldwell-Moloy Classification?

A

1) Gynecoid - Round: Most common and normal
2) Android - Heart shaped: Good prognosis
3) Anthropoid - Oval: Poor prognosis
4) Platyploid - Flat: Poorest prognosis

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4
Q

What are the 5 premonitory signs of labor?

A

1) Braxton Hicks
2) Ligthening
3) ⬆ Vaginal secretions
4) Blood show/mucous plug
5) Energy spurt

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5
Q

What are the ONLY 2 true signs of True Labor?

A

Progressive dilation and effacement

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6
Q

What are the 5 signs of True labor?

A

1) Progressive dilation and effacement
2) Regular contractions - ⬆ frequency, duration and intensity and intensity ⬆ with ambulation.
3) Pain starts in the back and radiates to abdomen
4) Pain not relieved by ambulation or resting
5) Contractions do not decrease with rest nor warm bath

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7
Q

What are the the most significant sign of False labor?

A

Pain is relieved by ambulation, changes of position, resting or hot bath or shower.

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8
Q

(T/F) women who have given birth before usually have a wicker birth the next times around.

A

True

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9
Q

What 9 things are assessed during the Admission assessment?

A

1) Status of membranes
2) Leopold’s Maneuver
3) Pregnancy Hx
4) Cervical dilation
5) Pain
6) Labs
7) High risk screening for HTN/DTRs
8) Heart, lungs, etc.
9) Ultrasound

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10
Q

Define Ferning

A

Ferning - The appearance of a fern-like pattern of dried cervical mucus. An indication of of the presence of estrogen.

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11
Q

In what 3 instances will the Nitrazine paper turn blue (alkaline)?

A

1) When amniotic fluid pH is 7 to 7.5

2) When vaginal pH is > 4.5

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12
Q

In what instances do the Nitrazine paper give false positive and false negative results?

A

1) False Positive - Occur from specimen contamination due to heavy vaginal discharge, blood, cervical mucous, semen, alkaline urine, and soap.
2) False Negative - May be produced by prolonged rupture of membranes (longer than 24 hrs), or when a small volume of fl,IUD has leaked.

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13
Q

What significant respiratory physiological change takes place during the birth process?

A

Hyperventilation

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14
Q

What 2 significant GI physiological changes takes place during the birth process?

A

1) ⬇ Motility

2) Thirst

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15
Q

What significant GU physiological change takes place during the birth process?

A

Reduced sensation of a full bladder

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16
Q

What 3 significant Hemopoietic changes takes place during the birth process?

A

1) EBL of 500mL for vaginal and 1000mL for Caesarian
2) ⬆ clotting factors (even though this can cause DVTs)
3) ⬇ Fibrinolysis

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17
Q

Describe the 4 P’s of the birthing process.

A

1) Powers - Contractions and maternal pushing efforts.
2) Passage - Maternal pelvis size and type.
3) Passenger - Baby (fetal head, fetal lie, fetal attitude and fetal presentation.
4) Psyche - Maternal emotions (i.e., fear and anxiety).

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18
Q

Which hormone is responsible for the molding of the fetal head during birth?

A

Relaxin

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19
Q

Fetal Lie Vs. Fetal Attitude Vs. Fetal Presentation

A

1) Fetal Lie - relationship of the fetal spinal column to that of the mother’s. (Can be longitudinal, transverse or oblique).
2) Fetal Attitude - Relationship of the fetal body parts to one another. (Should be general flexion).
3) Fetal Presentation - Which part is coming out the Vajay first (should be head with face towards the mother’s abdomen).

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20
Q

(T/F) A C-section (not vaginal birth) should be used for malpresentation.

A

True

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21
Q

Define Station as it relates to the birthing process.

A

Station - The presenting part of the fetus Vs. the line between the ischial spines (above the line is negative and below it is positive).

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22
Q

Define the stages of labor

A

1) Stage 1 - Cervical dilation from 0-10 cm
2) Stage 2 - Birth of baby (pushing)
3) Stage 3 - Placental delivery
4) Stage 4 - Recovery (1 to 4 hrs after birth).

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23
Q

Describe the 3 phases of Stage 1 of Labor.

A

1) Latent Phase - Cervical dilation of 3 to 5 cm.
2) Active Phase - Cervical dilation of 4 to 6 cm.
3) Transition Phase - Cervical dilation of 7 to 10 cm.

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24
Q

What is open glottis pushing? What are the 3 advantages of it?

A
  • Grunting without holding breath and bearing down spontaneously while pushing for no more than 6-8 secs, no more than 3x per contraction. The advantages are:
    1) ⬇ Risk of episiotomy/laceration
    2) ⬇ Risk of operative vaginal birth
    3) ⬇ Maternal fatigue
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25
What is closed glottis pushing (Valsalva Maneuver)? What are the 5 disadvantages of it?
- Inhaling a deep breath, holding it, and pushing as hard as possible for as long as possible, pushing 3 times per contraction. The 5 disadvantages are: 1) ⬆ Intrathoracic pressure 2) ⬆ risk for perineal trauma, maternal exhaustion, cystocele and urinary stress incontinence. 3) Impaired blood return from the lower extremities 4) Initially ⬆ then ⬇ blood flow to the placenta 5) Intermittent fetal hypoxia and anaerobic metabolism
26
(T/F) The bladder is often hypotonic during the 4th stage of labor (recovery)?
True
27
What equipment should be available for a sterile Amniotomy?
1) Amnio-hook 2) Sterile glove Nd lubricant 3) Clean crux, blankets and washcloths
28
In what position is a patient placed for a sterile Amniotomy procedure?
Semi reclining
29
What 3 nursing assessments are needed prior to and after a sterile Amniotomy procedure?
1) Assure that the presenting part is engaged prior to Amniotomy to prevent cord prolapse. 2) Monitor FHR prior to and after Amniotomy for cord prolapse or compression AEB by variable decelerations. 3) Monitor the color, amount, and smell of the fluid.
30
Define Amniotomy
Artificial rupture of the membranes
31
Name 4 things that can cause a prolapsed cord.
1) A fetus that remains at a high station 2) A very small fetus 3) A transverse lie 4) Polyhydraminos
32
What 4 interventions are used to manage a prolapsed cord?
1) Birth by stat c/s unless vaginal birth is imminent 2) Position hips higher than the head (i.e., knee-Chet or trendelenburg positions). 3) Push fetal presenting part upward with a gloved hand 4) Give O2 per face mask
33
Describe the cause of 1st, 2nd and 3rd stage pain during labor.
1) First Stage Pain - Cervical dilation 2) Second Stage Pain - Uterine muscle cell hypoxia 3) Third Stage Pain - Uterine contractions
34
What are the physiological and psychological effect of pain during labor?
1) Physiological - Fear and anxiety release epinephrine which causes uterine vasoconstriction and increased uterine muscle tone. 2) Psychological - Unresolved pain will affect her memory of this life event in a negative way and may inhibit bonding after birth.
35
What is the major advantage of non-pharmacological pain relief during labor?
They don't slow progress of labor
36
What are the 6 non-pharmacological methods of pain relief for labor?
1) Relaxation 2) Visualization 3) Thermal stimulation 4) Focal point 5) Massage 6) Music
37
When is it safe to administer pharmacological pain relief during labor.
When she is at least 4cm dilated
38
Labor Induction Vs. Labor Augmentation
1) Labor Induction - The chemical or mechanical initiation of uterine contractions 2) Labor Augmentation - Improving the quality of uterine contractions once labor has started.
39
What is the significance of the Bishop Score?
Bishop Score - Used to assess readiness and predict success of induction augmentation.
40
What are the 6 contraindications to labor Induction/Augmentation?
1) Vasa Previa or Placenta Previa 2) Transverse fetal lie 3) Umbilical cord prolapse 4) Previous c/s 5) Active genital herpes infection 6) Previous fibroidectomy entering endometrial cavity
41
What are 5 indications for induction of labor?
1) Non-reassuring fetal testing 2) Olygohydraminos 3) Worsening preeclampsia at term 4) IUGR at term 5) Hx of previous term stillbirths
42
Which hormone is responsible for Cervical Ripening?
Prostaglandins
43
What are the 5 contraindications to Cervical Ripening?
1) Non-reassuring FHR tracing 2) Frequent moderate uterine contractions 3) Prior c/s or uterine scar 4) Placenta Previa 5) Undiagnosed vaginal bleeding
44
What are the 4 disadvantages of ⬆ Prostaglandins during cervical ripening?
1) Uterine hyper stimulation 2) Non-reassuring fetal status 3) ⬆ Incidence of postpartum hemorrhage 4) Uterine rupture
45
Explain what Stripping the Amniotic Membrane means and why it's done
Stripping the Amniotic Membrane is done by a during a vaginal exam in order to initiate labor. A gloved finger is inserted into the cervical opening and used to separate the amniotic membranes from the cervix. This triggers the release of Prostoglandins.
46
What are then 3 adverse Rxs of Pitocin administration?
1) Hypertonic uterine contractions 2) Uterine rupture 3) Water intoxication
47
What are the 4 Nursing Responsibilities during Induction or Augmentation of labor?
1) Observe the uterine response for hyper stimulation 2) Observe the fetal response 3) Pain assessment 4) Documentation
48
What are the 3 methods used to monitor uterine contractions?
1) Palpation 2) Tocodynamometer 3) Intrauterine pressure catheter
49
What are the 4 advantages of Palpation used to monitor Uterine Contractions and what are the 3 disadvantages?
> ADVATAGES 1) Noninvsive 2) Readily accessible and requires no equipment 3) ⬆ Hands on care of patient 4) Allows mother freedom of movement > DISADVANTAGES 1) No actual quantitate measurement of uterine pressure 2) No permanent record 3) Maternal size and positioning may prevent direct palpation
50
What are the 6 advantages of Tocodynamometer used to monitor Uterine Contractions and what are the 4 disadvantages?
> ADVANTAGES 1) Assess uterine contraction for frequency and duration 2) Noninvasive 3) Easy to place 4) May be used before and following rupture of membranes 5) Can be used intermittently 6) Provides a permanent and continuous recording > DISADVANTAGES 1) Nurse must compare subjective findings with monitor 2) Cannot determine UC intensity 3) Belt may be uncomfortable and may require frequent adjusting 4) Mother may feel inhibited to move
51
What are the 3 advantages of Intrauterine Pressure Catheter used to monitor Uterine Contractions and what are the 6 disadvantages?
> ADVANTAGES 1) Provides pressure measurements, including contraction intensity and uterine resting tone. 2) Accurate timing on UCs 3) Permanent reord of UCs > DISADVANTAGES 1) Membranes must be ruptured 2) Adequate cervical dilation must be achieved 3) It's invasive 4) ⬆ Risk of uterine infection or perforation 5) Contraindicated in cases with active infection 6) Contraindicated with low-lying placenta because the placenta might get punctured.
52
What is Electronic Fetal Monitoring?
EFM - Continuous tracing of FHR
53
What are the 6 indications for Electronic Fetal Monitoring (EFM)?
1) Fetal factors 2) Maternal factors 3) Uterine factors 4) Complications of pregnancy 5) Regional anesthesia 6) Elective monitoring
54
Where is the External EFM placed to monitor the FHR and what is one major disadvantage of it?
External EFM is placed on the mother's abdomen over the fetal back and a major disadvantage is that it is susceptible to interference from maternal and fetal movements.
55
Where is the Internal EFM placed to monitor the FHR and what are 3 major disadvantages of it?
Internal EFM is a fetal scalp electrode attached the the presenting part of the fetus. The 3 disadvantages are : 1) Cervix must be dilated. Least 2 cm 2) Membranes must be ruptured 3) ⬆ Risk of infection
56
(T/F) FHR decreases with gestational age.
True
57
(T/F) Variability show level of oxygenation and evaluates the function of the fetal autonomic nervous system.
True
58
Explain Episodic changes Vs. Periodic changes when referring to variability of contractions.
1) Episodic Changes - Not associated with UC | 2) Periodic Changes - Associated with UC
59
In what 3 instances are variable decelerations concerning?
1) Less than 70 bpm 2) Lasts more than 60 secs 3) Slow to return to baseline
60
What are 5 interventions that can be implemented immediately in the case of late decelerations (uteroplacental insufficiency)?
1) Position change 2) ⬆ IV fluids (except Pitocin) 3) O2 via face mask 4) Stop Pitocin if infusing 5) Notify MD
61
Lost the 5 Non-reassuring fetal heart patterns.
1) Tachycardia or Bradycardia 2) ⬇ or absent variability 3) Late decelerations 4) Severe variable decelerations 5) Any prolonged decelerations
62
What 5 methods are used to manage prolonged decelerations?
1) Perform vaginal exam to R/O prolapsed cord 2) Maintain maternal position on the left side 3) D/C oxytocin if infusing 4) ⬆ IV fluids 5) Administer tocolytic as ordered
63
What are the 5 factors that influence fetal oxygenation and circulation?
1) Maternal cardiopulmonary alterations (i.e., changes in BP) 2) Uterine Activity (i.e., UC that Re too long or too frequent) 3) Placental disruption (i.e., Abruptio Placenta) 4) Interruptions in umbilical flow (i.e., cord compression) 5) Fetal alterations (i.e., anemia, hypoxia, hypotension)
64
What are the 4 factors that might cause minimal variability and lack of accelerations on FHR tracing?
1) Hypoxia 2) Maternal drug administration 3) Magnesium sulfate 4) CNS abnormalities
65
List the 4 other testing available to help determine the significance of abnormal FHR findings?
1) Fetal Scalp stimulation 2) Vibroacoustic stimulation 3) Fetal oxygen saturation monitor 4) Fetal scalp blood sampling (evaluates pH, O2 level, etc.,)
66
(T/F) the transverse (aka Pfannenstiel or bikini cut) c-section is ok because the lower uterine segment does not contract.
True
67
What are the 8 adverse effects of an Epidural Block?
1) Maternal hypotension 2) Bladder distention 3) Prolonged 2nd stage 4) Catheter migration 5) Itching 6) N & V 7) Respiratory depression 8) Shivering
68
What are the 4 most significant adverse effects of a Spinal Block?
1) Maternal hypotension 2) Headache 3) Fetal hypoxia 4) Respiratory depression
69
What is Pudenal Block?
It is perineal anesthesia given during the 2nd stage of labor, birth, episiotomy repair or forceps-assisted or vacuum extraction deliveries. It is injected into the vaginal wall.
70
What are the advantages and disadvantages of a Pudenal Block?
1) Advantages - Ease of administration and absence of maternal hypotension. 2) Disadvantages - Urge to bear down may be decreased
71
What are the 4 complications that can arise from a Pudenal Block?
1) Systemic toxic Rx 2) Broad ligament hematoma 3) Perforation of the rectum 4) Trauma to the sciatic nerve
72
What is Amnioinfusion and what is its purpose?
1) Amnioinfusion - A technique by which warmed, sterile NS or LR solution is introduced into the uterus via a IUPC. 2) Purpose - To ⬆ the volume of fluid in the uterus in case of olygohydraminos, severe variable decelerations, or meconium passage in utero.
73
What are the 2 most common types of Episiotomies?
1) Midline | 2) Mediolateral
74
What are the 8 prerequisites for the use of forceps during delivery?
1) Cervix completely dilated 2) Fetal head engaged 3) Station, presentation, and exact position of head is known 4) Amniotic membranes must be ruptured 5) Type of pelvis identified 6) Maternal ladder empty 7) Adequate anesthesia 8) No cephalopelvic disproportion
75
During vacuum extraction delivery, what 2 circumstances are cause for immediate termination of the procedure?
1) Decent does not occur | 2) The vacuum device pops of the head 3 times
76
Define Labor Dystocia
A difficult labor or a labor that does not progress at the expected rate
77
What are the 3 complications of shoulder Dystocia?
1) Hyperbillirubinemia 2) Herbs Palsy 3) Broken shoulder
78
Explain McRobert's Maneuver?
Maneuver employed in the case of shoulder Dystocia: hyperflexingthe mother's legs tightly to her abdomen allows ⬆ mobility at the sacroiliac joint during labor.
79
What are the 3 nursing interventions to implement when observing a patient for hemorrhage during the 4th stage of delivery?
1) Check fundus for firmness and location every 15 mins during recovery period 2) Check amount of lochia (usually moderate immediately after birth, sometimes with clots) 3) give appropriate meds (Pitocin or methergine) to keep fundus firm * DO NOT give methergine if BP is high
80
When should you absolutely not administer Methergine to a patient?
When the patients BP is high
81
(T/F) Apgars do not guide neonatal resuscitation?
True
82
What is the appropriate neonatal resuscitation intervention in the following cases: 1) HR < 100 2) HR < 60
1) HR < 100 - Start PPV | 2) HR < 60 - Start compressions
83
(T/F) Dehydration can cause preterm labor
True
84
(T/F) Corticosteriods can increase blood sugar levels
True
85
What are the 6 SxS of Preterm Labor?
1) UC (may or may not be painful) 2) Cramps similar to menstrual cramps with or without diarrhea 3) Constant low backache 4) Pelvic pressure not relieved by rest 5) change or increase in vaginal discharge 6) Frequent urination
86
What are the 5 risk factors associated with preterm labor?
1) Dehydration 2) UTIs 3 STDs 4) Incompetent cervix 5) Multiple gestation
87
What are the 5 methods used in the management of Preterm Labor with no evidence of infection?
1) Bedrest in hospital 2) Administer corticosteroids to mature fetal lungs, and ⬇ likelihood of RDS. 3) Get lab work 4) NSTs every shift 5) BPP every 24 hours
88
Why is Indomethacin not administered after 34 weeks gestation?
Because it can cause Patent Ductus Arteriosus (PDA). a congenital disorder in the heart wherein a neonate's ductus Arteriosus fails to close after birth.
89
What is Amniotic Fluid Embolism
When amniotic fluid is drawn into maternal circulation
90
What are the 5 complications of Amniotic Fluid Embolism?
1) Anaphylactoid syndrome/reaction 2) Pulmonary vasospasm 3) Left ventricular failure 4) Neuro responses: Siezures, confusion and coma 5) Severe Coagulopathy: DIC
91
What are the 4 SxS of Amniotic Fluid Embolism?
1) Respiratory distress 2) Seizures 3) Heart failure 4) Circulatory collapse
92
What are the 5 methods used to manage Amniotic Fluid Embolism?
1) CPR 2) Ventilation 3) Blood transfusion 4) Dopamine 5) Delivery of fetus

Nursing 132 Final Exam (7 decks)

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