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Flashcards in T2- Advance Organizer (Josh) Deck (72):
1

APGAR:

What Activity gets a 1?

arms and legs flexed w/ little movement

2

The part of the fetus that lies closest to the internal os of the cervix?

Presenting Part

3

When would we see Lochia Alba?

10-14 days after birth

***yellow to whight

***leukocytes, decidua, epithelial cells, mucus, serum, and bacteria

4

How long can lochia be seen post birth?

4-8 wks

5

Nursing actions for Variable Decel?

Change mom position

Elevate legs

Increase IV fluids

Palpate uterus to check for tachysystole

Stop oxytocin

Administer O2

Call MD

6

How long does Phase 1 of Stage 1 last?

Primagravia = 6-8 hrs

Multigravida = 4-5 hrs

7

How long does the Active Phase of Stage 1 last?

3-6 hrs

8

Should the bladder be palpable after delivery?

NO

they need to void to empty it to allow fundus to contract

9

--- are expected irregular fluctuations of the baseline FHR that are an indicator of fetal well being.

Variability

10

Usual duration of UC during Phase 3?

45-90 secs

11

Before AROM, what must first happen?

presenting part needs to be engaged to prevent cord prolapse

woman needs to be free from infection

12

Which Decel is caused by impairment of placental/oxygen exchange?

Late

13

At station -3 is said to be at which Station?

3 cm ABOVE the ischial spines

14

What is the usual length of Stage 2?

Nulliparas: 50 mins

Multiparas: 20 mins - 3 hrs (depending on anasthesia)

15

What would Marked Variability be a sign of?

D-fib

16

APGAR:

What appearance gets a 1?

pink centrally

bluish extremities

17

Uteroplacental Insufficiency causes which type of Decel?

Late Decel

18

What color of AF could indicate an infection?

Yellow (thick cloudy color)

19

What APGAR scores are we looking for?

10 is best, 8 or 9 is good

20

When would we see Lochia Serosa?

3-4 days after birth

***pal pink or brown

***old blood, serum, leukocytes and tissue debris

21

Which Opioids did we talk about?

Dilaudid (Hydromorphine)

Meperidine

Normeperidine

Fentanyl

Sufenta - more potent than Fentanyl

22

Which class of meds should we NEVER give?

Benzos

***will affect thermoregulation of infant

23

APGAR stands for ...

Appearance
Pulse
Grimace
Activity
Respiratory

24

How do opioids affect mom and baby?

decrease maternal HR and BP

affects fetal oxygenation

25

Before epidural, what do we give?

IV bolus (1000mL in less than 30 mins)

***increase epidural space

***protects from hypotensive episode

26

Opioid Agonist Antagonists:

Butorphanol Tartrate (Stadol)

Nalbuphine HCl (Nubain)

***may precipitate withdrawal symptoms in opioid dependent moms and newborns

27

For the first 2 hours after birth, what amount of discharge should we see?

like that of a heavy menstrual period

28

Should we give Naloxone (Narcan) if mother or infant is opioid dependent?

NO

causes abrupt withdrawal

29

If the fundus has deviated to the RIGHT of the mom's umbilicus, what should we do?

encourage to void to decrease size of bladder

***catheter if necessary

30

What can result from ataractic drugs like Promethazine?

mom gets sleepy,

baby gets sleepy,

moderate variablity becomes minimal b/c baby is asleep

31

APGAR:

What Respiratory effort gets a 1?

slow, irregular breathing

weak cry

32

At the Ischial Spines is said to be at which Station?

0

33

What color of AF could indicate meconium?

Greenish Brown

34

APGAR:

What Grimace (reflex irritability) gets a 1?

facial movement only

35

What do we give if baby has respiratory depression?

Stimulation

Fluids

***stadol can cause some resp depression and will not be reversed by Narcan

36

Which type of Decels must be periodic?

Early and Late

***Variable can be either Episodic or Periodic

37

After an epidural, how often are vitals charted?

q 5 mins for fist 20 mins

q 30 mins after 20 mins

38

APGAR:

What pulse gets a 1?

39

Usual duration of UC during Phase 1?

30-45 secs

NOT regular

40

When the bladder is distended, what does this indicate?

uterus will be boggy and above and to the right of the woman's umbilicus

41

Intervention for Variable Decel?

Caused by cord compression

- Turn mom
- Stop oxytocin
- Administer O2
- Call MD

42

Which Decel is a 'mirror image' of the contraction?

Early Decel

***don't chart!

***needs no intervention

43

What do we consider a an acceleration of FHR longer than 10 mins?

considered a change in baseline

44

What is the usual length of Stage 3?

5-30 mins

***if more than 30 mins, it's a problem

45

What causes Early Decels and when would we see them?

Fetal Head Compression

Phase 2 of Stage 1

Stage 2 (when mom is pushing)

46

When would we see Lochia Rubra?

post birth

***bright red and may contain small clots

47

If mom gets a hypotensive episode, what is nursing action?

Turn mom

Increase fluids

Administer O2

Elevate legs (10-20 degrees)

Call MD (order for ephedrine)

48

What would happen if we fail to give IV Bolus before Epidural?

Hypotensive episode (systolic falls below 100)

No accels or moderate variability for baby (nonreassuring FHR)

49

Where the the PMI usually located?

fetal back

***below umbilicus if cephalic presentation

***above umbilicus if breech

50

Which Decel is likely caused by a cord compression?

Variable Decel

***V looks like a Vice

51

Where should the fundus be in the 4th stage?

firm, midline, and halfway b/t umbilicus and symphysis pubis

52

After ROM, check temp ---- and call Doc if it is higher than ---

q 2 hr

38c (100.4)

53

Usual frequency of UC during Phase 2?

3-5 mins

54

Usual frequency of UC during Phase 3?

2-3 mins apart

55

Usual duration of UC during Phase 2?

40-70 secs

56

Variability levels:

Absent =
Minimal =
Moderate =
Marked =

Absent = 0 or undetectable

Minimal 0-5 bpm

Moderate = 6-25 bpm

Marked = > 25 bpm

57

What accels are we looking for at 32 wks?

What about 33 wks or more?

10 x 10

15 x 15

58

S/S of Uterine Infectoin

Pain in lower abdomen

Fever

Foul-smelling discharge

Rapid HR

Swollen, tender uterus

59

Usual frequency of UC during Phase 1?

5-30 mins

60

What do Barbituates do to the neonate?

CNS depression

***avoid if birth is within 12-24 hrs

61

What will a Variable Decel look like on the strip?

abrupt drop (30 secs)

periodic or non-periodic

62

What could cause tachycardia (FHR > 160)?

mom having a fever

prolonged rupture of membranes

Drugs:
- atropine
- hydroxyzine
- terbutaline
- cocaine or meth

63

--- are visually apparent, abrupt increase in FHR above the baseline.

Accelerations

***onset to peak

64

During Stage 3, when would we give Pitocin?

we don't give Pitocin during stage 3

***we give high dose of Pitocin AFTER delivery of placenta

65

What is the minimal amount of time we want b/t contractions?

at least 2 minutes to allow for perfusion to fetus

66

What is the maximum length that Stage 3 should be?

30 mins

***Call nurse if it lasts longer

67

Nursing intervention for Occiputposterior position?

Change mother's position often to facilitate baby to move to OA position

Counter pressure on mom's back (sacrum)

Hip squeeze to push the pelvis back into a relaxed position to relive pressure of stretch

68

What is Fetal Bradycardia and what could cause it?

FHR

69

What can cause fetal head compression and which Decel would it lead to?

Early Decel

- UC
- Vag exam
- Fundal pressure
- Placement of internal monitoring node

70

Relationship b/t the long axis (spine) of fetus with long axis (spine) of mom?

Fetal Lie

71

In order to apply an IUPC or an ISE, what must first happen?

rupture of membranes

72

How long does the Transition Phase of Stage 1 last?

20-40 mins