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NRSG 344 > Routine Prenatal Care and Infections: Labor and Delivery > Flashcards

Routine Prenatal Care and Infections: Labor and Delivery Flashcards

1
Q

EDC

A

Estimated Date of Confinement

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2
Q

EDD

A

Estimated Date of Delivery

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3
Q

Prenatal hx inclueds

A

*Obstetric hx
*Due date for this preg
*Month/week/prenatal visits
*Lab values
*Maternal medical hx
*Ultrasound results

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4
Q

TPAL

A

Term births
Preterm Births
Abortions (spontaneous and therapeutic)
Living Child

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5
Q

Gravida (G)

A

of pregnancies

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6
Q

Para (P)

A

of gestationally viable births

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7
Q

Cues for high risk pregnancy

A

*High BP
*Hx of previous postpartum hemorrhage
*Hx of previous shoulder dystocia
*Rh negative
*Gestational diabetes
*More than 5 previous births

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8
Q

Which of the following clients is at highest risk for developing a hypertensive
illness of pregnancy?
1. G1 P0000, age 41 with history of diabetes mellitus.
2. G2 P0101, age 34 with history of rheumatic fever.
3. G3 P1102, age 27 with history of scoliosis.
4. G3 P1011, age 20 with history of celiac disease.

A
  1. G1 P0000, age 41 with history of diabetes mellitus.
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9
Q

A 15-year-old client is being seen for her first prenatal visit. Because of
this client’s special nutritional needs, the nurse evaluates the client’s
intake of:
1. Protein and magnesium.
2. Calcium and iron.
3. Carbohydrates and zinc.
4. Pyroxidine and thiamine.

A
  1. Calcium and iron.
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10
Q

Risk factors w/ STDs

A

*Increased risk of preterm labor and preterm birth
*Premature rupture of membranes w/ risk of infection

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11
Q

Risk factors for group B strep

A

*<37 wks gestation
*Ruptured membrane >/= 18 hrs
*Maternal temp >/+ 100.4 F
*GBS bacteriuria this preg
*Hx of infant w/ GBS disease1

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12
Q

Increased risk for Diabetic Mothers

A

*Pyelonphritis
*Ketoacidosis
*Preeclampsia

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13
Q

Increased risks for infants of diabetic moms

A

*Macrosomia
*Birth trama
*Congenital anomalies
*Resp distress syndrome
*Hypoglycemia
*Hyperbilirubinemia
*Fetal Malformations
*Fetal demise

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14
Q
  1. Before actively trying to become pregnant, the client is strongly encouraged to
    stabilize her blood glucose to reduce the possibility of her baby developing which
    of the following?
    A. Port wine stain.
    B. Cardiac defect.
    C. Hip dysplasia.
    D. Intussusception.
A

B. Cardiac defect.

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15
Q

Which of the following assessments can the nurse anticipate that the
provider will monitor to reduce the risk of the identified. Select 2 answers
complication? Select two.
A. Glycosylated hemoglobin (HgbA1c) level.
B. Blood pressures.
C. Weight.
D. Preprandial blood sugar assessments.

A

A. Glycosylated hemoglobin (HgbA1c) level.
D. Preprandial blood sugar assessments.

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16
Q
  1. Specify two interventions the nurse should recommend to the client
    as a way to reduce the risks of the identified complication. Select two.
    A. Regular blood pressure monitoring.
    B. Carbohydrate counting.
    C. Regular exercise.
    D. Support stockings.
A

B. Carbohydrate counting.
C. Regular exercise.

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17
Q

Cues for maternal substance abuse: Medical Hx

A

◼ Cellulitis
◼ Hepatitis/Cirrhosis
◼ Depression/Suicide attempt
◼ STDs/HIV/AIDS

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18
Q

Cues for maternal substance abuse:

A

◼ Placental abruption
◼ Unexplained fetal death
◼ Spontaneous abortions
◼ Preterm labor/birth
◼ Low birth weight

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19
Q

Cues for intimate partner violence (IPV)

A

◼ Unplanned pregnancy
◼ Delayed or no prenatal care
◼ STD’s
◼ Bleeding, miscarriage
◼ Fetal injury, fetal demise
◼ PTL (Pre term labor), low birth weight
◼ Depression, substance use

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20
Q

Teratogens

A

Substances that cause congenital disorders in developing embryo or fetus

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21
Q

Examples of teratogens

A

*Smoking
*Alcohol
*Drugs
*Occupational hazards
*Viruses
*Nutritional deficiencies

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22
Q

Smoking can cause…

A

cleft lip/palate or both

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23
Q

Alcohol can cause…

A

*Fetal alcohol syndrome
*Mental disabilities
*Dysmorphic facial features

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24
Q

When do teratogens affect fetus

A

*about 10-14 days after conception
*Neural tubes close at 3-5 wks, during this time teratogens can cause neural tube defects (spina bifida)

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25
Q

Which organs are sensitive to teratogens during the whole pregnancies

A

Brain and spinal cord

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26
Q

TORCH Neonatal Viral infections

A

Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes
Syphilis

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27
Q

What might a neonate present with is positive for a viral infection

A

◼ Fever
◼ Sepsis
◼ Disseminated Intravascular Coagulation (DIC)
◼ Respiratory Distress Syndrome (RDS)

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28
Q

Toxoplasmosis

A

infection with a parasite

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29
Q

Mode of transmission of toxoplasmosis

A

*transplacental
*eating or handling raw meat
*exposure to infected cat feces

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30
Q

Prevention of toxoplasmosis

A

Cook meat thoroughly, wash hands and food prep surfaces carefully, avoid scooping cat litters

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31
Q

Hep B: mode of transmission

A

Direct contact w/ infected blood/body fluids

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32
Q

Hep B: practices

A

Infants Hep B positive moms are given HBIG (immune globulin) and hep B vaccines w/i 12 hrs of birth. 2 more doses w/i 1st yr

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33
Q

Hep B: Maternal effects

A

*No specific tx
*Breastfeeding is not contraindicated unless nipples are cracked and bleeding

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34
Q

Rubella antibody

A

Rubella antibody titer of 1:8-1:10 or more indicates immune status – reassuring

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35
Q

Most common cause of congenital deafness

A

Rubella

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36
Q

If woman is not immune to rubella

A

should be immunized before becoming pregnant or prior to hospital discharge postpartum

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37
Q

HSV: when acquired for neonates

A

during delivery or by ascending infection

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38
Q

HSV: Maternal effects

A

◼ Painful cervical, vaginal or genital lesions
◼ Virus sheds until lesions are completely healed

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39
Q

HSV: tx

A

oral antiviral therapy
*C-section if active genital lesions when presenting in labor

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40
Q

Most common cause of neonatal infectious morbidity & mortality in the U.S.

A

Group B strep

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41
Q

GBS: Prevention approach and screening

A

◼ Urine culture at prenatal visit
◼ Vaginal/anal culture at 35 weeks
◼ If positive, treatment with Penicillin starts when in labor
◼ At least 2 doses before the birth can be protective for baby

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42
Q

Four full-term babies were admitted to the neonatal nursery. The mothers of each of the babies had labors of 4 hours or less. The nursery nurse should carefully monitor which of the babies for tachypnea?
1. The baby whose mother cultured positive for group B streptococci during her third trimester.
2. The baby whose mother has cerebral palsy.
3. The baby whose mother was hospitalized for 3 months with complete placenta previa.
4. The baby whose mother previously had a stillbirth.

A
  1. The baby whose mother cultured positive for group B streptococci during her third trimester.
    ➢ Because her labor was so fast, it’s not likely she received a dose of PCN in time to protect the fetus, who may show symptoms of GBS infection after the delivery
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43
Q

Who is the most common demographic for gonorrhea

A

Teenage pregnancies

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44
Q

Gonorrhea: fetal and neonate effects

A

*Premature rupture of membranes
*PTD
*Chorioamnionitis
*Neonatal sepsis

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45
Q

Syphilis: transmission

A

Infection can be transmitted to the fetus at any stage of the disease

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46
Q

Syphilis: pregnancy results

A

◼ Miscarriage
◼ Fetal death
◼ Newborn death

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47
Q

HIV/AIDS: transmission

A

transplacental, intrapartum, or from breastmilk

48
Q

Initial eval in labor

A

◼ Presenting complaint
◼ EDD/EDC
◼ Pregnancy history (Gravida, para, TPAL, complications)
◼ Frequency, duration & intensity of contractions
◼ Membrane status
◼ Presence/absence of bleeding
◼ Cervical status
◼ Thoroughly review prenatal record –blood type, platelets, etc
◼ Any complications of pregnancy

49
Q

Cues that warrant closer focus

A

◼ Bleeding
◼ History of genital herpes and current sx
◼ Ruptured membranes (GBS)
◼ Advanced cervical dilation
◼ FHR minimal variability or decelerations
◼ Large or small for gestational age
◼ Previous Complications i.e. postpartum
hemorrhage, shoulder dystocia, etc.

50
Q

Performing Leopold’s maneuvers

A

*Determine fetal line: Up and down, or across (transverse line)
*Presentation: head/buttocks, shoulder, face, brow coming first
*Position: Engaged in the pelvis or not
*Assists in determining best site for FHR auscultation

51
Q

Performing a vaginal exam with sterile gloves,
assess cervix for:

A

◼ Dilation—how open is the cervix?
◼ Effacement—how thin is the cervix?
◼ Station—how low is the presenting part?

52
Q

Effacement

A

The gradual thinning, shortening, and drawing up of the cervix measured in percentage from 1-100%

53
Q

Dilation

A

The gradual opening of the cervix measured in cm from 0-10 cm

54
Q

Fetal Station

A

Relationship of presenting part to the ischial spines. “Will the baby fit through the pelvis?”

55
Q

“Minus 1” or “Minus 2, 3, 4, 5” means:

A

Presenting part is above zero station and
higher than the ischial spines.

56
Q
  • “Plus 1” or “Plus 2, 3, 4, 5” means:
A

Presenting part has descended lower than
the ischial spines.
*Positive (+) 4 is at the outlet.

57
Q

Stages and Phases of labor

A

◼ 1st Stage
* Pre-Labor
* Phase 1 – Latent Labor
* Phase 2 - Active Labor
* Phase 3 – Transition
◼ 2nd Stage- Pushing
◼ 3rd Stage- Birth

58
Q

Hormonal theories of labor: Progesterone

A

◼ Progesterone inhibits uterine contraction
◼ Labor begins when progesterone’s inhibition is overcome by an increase in the levels of estrogen

59
Q

False labor

A

produces pain at irregular intervals (Braxton Hicks contractions) but there is no cervical dilation

60
Q

True labor

A

begins when contractions occur at regular intervals and there is cervical change

61
Q

Pain of true labor

A

◼ Tight metal belt from back around to below uterus
◼ Heat and tightness with each contraction
◼ Back pain increases with walking

62
Q

5 P’s that influence labor process

A

*power
*passenger
*passageway
*positions
*psychology

63
Q

Bedside nurse’s job during labor

A

◼ Support maternal and family birth plan,
◼ Monitor, assess, intervene, educate
◼ Provide safe environment

64
Q

Nursing assessment during labor includes

A

◼ Duration
◼ Frequency
◼ Intensity – palpation
◼ Resting tone

65
Q

Intensity contraction palpations

A

Mild = nose
Moderate = chin
Strong = forehead

66
Q

Timing of contractions

A

From the beginning of one to the beginning to another

67
Q

Tachysystole

A

Danger: Too many contractions
*More than 5 contractions in 10 min (Closer than 2 min apart) for 30 min

68
Q

Fetal descent through the birth canal is determined by:

A

◼ Size of fetal head
◼ Fetal lie
◼ Fetal presentation
◼ Fetal attitude
◼ Fetal position

69
Q

What assessment monitors fetal descent

A

Leopold’s

70
Q

Fetal lie

A

Relationship of long axis (spine) of the fetus to long axis of mom

71
Q

2 primary lies

A

Longitudinal
Transverse or oblique

72
Q

Attitude of lie

A

Flexion of the head toward the chest

73
Q

Fetal presentations

A

*Cephalic: Head first
*Breach: feet first
*Shoulder
*Compound: hand by head

74
Q

Average first labor is

A

15 hrs from 4 cm dilation

75
Q

Active phase labor

A

*At least 4 cm dilated
*Regular, frequent, usually painful contractions
*Dilate at least 1.2-1.5 cm/hr
*Are not comfortable w/ talking/laugh during their contractions

76
Q

1st stage of labor nursing care

A

*When in bed, side-lying or semi-fowler’s position
*Contractions monitored
*Fetal heart tones: variable, baseline rate, decelerations/accelerations
* Maternal Vital Signs
* Fetal heart rate
* Subsequent Vaginal Examinations

77
Q

SROM

A

Spontaneous rupture of membranes

78
Q

AROM

A

Artificial rupture of membranes

79
Q

SROMs occur when?

A

at the height of the contraction with gush of fluid out of vagina

80
Q

How long to monitor AROMs

A

30 min afterwards to confirm no prolapse

81
Q

Cardinal movements of labor

A

*engagement
*descent
*flexion
*internal rotation
*extension
*external rotation
*expulsion

82
Q

Flexion

A

Fetal head against the chest

83
Q

Internal rrotation

A

fetal head rotates from transverse to anterior

84
Q

Extension

A

Head extends with crowning

85
Q

External rotation (restitution)

A

Head returns to its transverse orientation

86
Q

Expulsion

A

shoulders and torso of the baby are delivered

87
Q

Engagement

A

*Largest diameter of presenting part reaches or passes through the pelvic inlet
*In most instances, the occiput is at the level of the ischial spines at 0 station

88
Q

Posterior presentation

A

Back of the bb’s head is towards the bed (sunny side up)

89
Q

Cue of posterior presentation

A

Severe back pain, slow progress of labor

90
Q

When does mom need help: Early labor

A

◼ Tensing at peak of contraction
◼ Ragged or strained breathing
◼ Expression of dread for contractions

91
Q

When does mom need help: Active labor

A

◼ Activity unfocused, random, lacking rhythm
◼ Writhing, wincing, crying out,
◼ Panic

92
Q

labor pain relief

A

◼ Warm tub
◼ Nitrous oxide
◼ IV medication
◼ Local anesthetic block
◼ Epidural

93
Q

Counterstimulation during labor

A

◼ Counter pressure
◼ Hydrotherapy
◼ Hot or cold packs

94
Q

Nitrous oxide: how, what

A

*How:
◼ Inhaled anesthetic and analgesic gas
◼ Self-administered via a facemask or
mouthpiece
*What:
◼ Increases release of endorphin, dopamine,
and other natural pain relievers in the brain,
◼ Reduces anxiety

95
Q

Fentanyl dose

A

50-100 mcg/q2hr prn
*Start w/ lowest does and repeat in 30 min

96
Q

Local anesthetic block

A

◼ Pudendal, Cervical

97
Q

Regional anesthesia

A

◼ Epidural on continuous infusion

98
Q

Epidural analgesia

A

*Analgesia w/ some motor blockade
*Reduces maternal serum catecholamin concentrations, which in turn improves uteroplacental perfusion

99
Q

Nursing care after Epidural

A

◼ Position patient in semi reclining position with lateral tilt
◼ Frequent vital signs initially (20 min) then hourly
◼ Treat hypotensive episodes
◼ Bladder assessment

100
Q

SE of epidural

A

◼ Hypotension
◼ Itching – Naloxone (Narcan)
◼ Nausea and vomiting
◼ Urinary retention
◼ Shivering
◼ Impaired motor ability

101
Q

Contraindications of epidural

A

◼ Maternal refusal
◼ Local or systemic infection
◼ Coagulation disorders
◼ Low platelet counts : Less than 100,000
◼ Hypovolemia
◼ Allergy to specific agents
◼ Suspicion of neurological disease

102
Q

2nd stage of labor: Nursing care cues

A

◼ FHR variables
◼ Increase in vaginal show
◼ Suprapubic pain if epidural present
◼ Grunting if no epidural
◼ “I’m going to poop!”

103
Q

2nd stage of labor: Nursing care actions

A

◼ SVE to confirm 10 cm and station
◼ Notify Provider
◼ Set up warmer and turn on!: 8 cm for multip, 10 cm for primip
◼ Delivery table in room
◼ Coach pushing
◼ Document time head is delivered
◼ Document time body is delivered

104
Q

After labor: nursing care

A

◼ After the birth, Mother & Baby skin-to-skin
◼ Hat, warm blankets
◼ Assign Apgar scores
◼ Some providers ask for Pitocin IM after head delivered to prevent PPH
◼ Prepare pitocin bag to run after placenta delivered at rate ordered. DO NOT HANG UNTIL AFTER THE BIRTH

105
Q

Nursing care: placenta delivery s/s

A

◼ Patient uncomfortable – crampy
◼ Gush of blood
◼ Umbilical cord protrudes further

106
Q

Nursing care: placenta delivery psych changes

A

◼ Women may feel relief
◼ Usually focused on infant

107
Q

“Assisted Delivery”
“Instrumented Delivery”
“Operative Delivery”

A

◼ Vacuum Extractor
◼ Forceps

108
Q

Recovery time

A

in 1st hr of life, bb can crawl and self-attach to breast

109
Q

Prolapsed cord

A
  • Umbilical cord slips out through the vagina before the baby when the bag of waters (BOW) breaks and head is not engaged
  • Potentially fatal complication
110
Q

Risk factors of prolapsed cord

A

➢ Multiples (twins or triplets)
➢ Preterm labor
➢ Low birth-weight baby
➢ Breech presentation
➢ Transverse lie (across the uterus from left-to-right instead
of up and down)
➢ Ruptured membranes with unengaged fetal head

111
Q

What if the baby is stuck? (Shoulder dystocia)

A

*Lower mom’s head
*McRobert’s maneuver: Have stool at bedside

112
Q

Common reasons for c/s

A

◼ Multiples
◼ Breech presentation
◼ Previous uterine surgery (not c/s)
◼ Vertical uterine incision with prior c/s
◼ Placenta previa
◼ Placental abruption
◼ No progress with pushing after several hours
◼ Fetal intolerance of labor

113
Q

TOLAC

A

Trial of Labor after c-section

114
Q

VBAC

A

Vaginal birth after c-section

115
Q

Vertical incision

A

cannot have TOLAC after due to risk of rupture

116
Q

Horizontal incision

A

TOLC and VBAC are possible

117
Q

C/S recovery

A

*2 hrs
*mom may breastfeed
*fundal checks just as for vaginal births
*may have less lochia initially due to uterus being wiped during surgery

NRSG 344 (11 decks)

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