Test 1-Labor, Postpartum, Newborn

Question 1

What are the cardinal movements of labor?

Answer 1

Flexed attitude (chin to chest)
Engagement, descent, flexion
Internal rotation
Extension
External rotation
Expulsion

Question 2

How do you assess what position the fetus is in?

Answer 2

Leopold’s procedure

Question 3

What is/are the most important thing/s to do when a mom comes in with ruptured membranes?

Answer 3

Check for a prolapsed cord if she reported a gush

Put on a FHM and make sure baby is okay

Question 4

What do you do if you discover there is a prolapsed cord?

Answer 4

Stick your fingers in the vagina to raise the baby’s head and get mom in for a c section

Question 5

Describe the types of breech positions

Answer 5

Footling-foot first
Frank-butt first
Complete-legs crossed
Shoulder/transverse-shoulder presents first or baby is laying longways across the uterus

Question 6

What are the stages of labor?

Answer 6

1: cervix is dilating and effacing
2: pushing/delivery of baby
3: delivery of placenta
4: recovery

Question 7

What are the phases of labor and in what stage do they occur?

Answer 7

Occur in stage one
Phases:
Latent: 0-3 cm
Active: 4-7 cm
Transition: 8-10

Question 8

Describe baby’s station

Answer 8

Negative number is high, positive is low. 0 station means baby is engaged in the true pelvis (opening of the pelvis)

Question 9

How often do you monitor a low risk mom in labor?

Answer 9

Latent: hourly
Active: q30 min
Transition: q15 mi

Question 10

How often do you monitor a high risk mom in labor?

Answer 10

Latent: q30 min
Active: q15 min
Transition: q5 min

Question 11

What are the pros and cons of AROM?

Answer 11

Pro: baby’s head becomes a mechanical dilator to progress labor
Con: cord prolapse, placental abruption, infection

Question 12

What do we consider true labor?

Answer 12

Contractions every 5 min (10 for a mom with prior births)
Broken water
Contractions radiating from back to belly

Question 13

What are AROM and SROM?

Answer 13

Spontaneous Rupture of Membranes

Artificial Rupture or Membranes

Question 14

How do you know if her membranes have truly ruptured?

Answer 14

Nitrogen’s strip
Ferning test
Amnisure test

Question 15

What is dystocia?

Answer 15

A stop in labor

Question 16

What is a precipitous labor and why is it bad?

Answer 16

A labor that begins and ends with delivery within 3 hours

Trauma to baby’s head and mom’s vag from being forced out so quickly

Question 17

What is hydrocephalus?

Answer 17

Water on the brain causing a large head

Question 18

What is CPD?

Answer 18

Chephalopelvic disproportion-baby’s year is too big to come through mom’s pelvis

Question 19

What is the position in which a baby can be born vaginally?

Answer 19

Cephalic/vertex

Question 20

What is a precipitous labor and why is it bad?

Answer 20

A labor that begins and ends with delivery within 3 hours

Trauma to baby’s head and mom’s vag from being forced out so quickly

Question 21

What is hydrocephalus?

Answer 21

Water on the brain causing a large head

Question 22

What is CPD?

Answer 22

Chephalopelvic disproportion-baby’s year is too big to come through mom’s pelvis

Question 23

What is the position in which a baby can be born vaginally?

Answer 23

Cephalic/vertex

Question 24

What are reasons for postpartum hemorrhage?

Answer 24

Decreased uterine tone
Trauma
Placental fragments

Question 25

How do you (most accurately) determine blood loss?

Answer 25

Weight anything with blood on/in it

Question 26

What are blood loss parameters for hemorrhage?

Answer 26

Vaginal birth: >500 mL during delivery | C/S: >1,000 mL during delivery

Question 27

What is a cause during labor for possible PPH?

Answer 27

Pitocin use

Question 28

What is the first line drug of choice for PPH and why? Why might you not use pitocin and what are alternatives?

Answer 28

- Pitocin - It causes the uterus to contract down to stop the bleeding - If mom was on pitocin for extended time during labor - cytotec (Misoprostol) or Hemobate (unless cardiac issue or asthmatic)

Question 29

Best IV gauge for L/D? Why? Which do you never use and why?

Answer 29

18(green) or 20(pink)-neither will lyse a cell if blood is needed 22(blue)-will lyse a cell

Question 30

How do you give pitocin?

Answer 30

IVPB (never push) diluted in LR Or IM injection

Question 31

What is Ketoralac

Answer 31

To radio-NSAID lain relief

Question 32

What is Sheehan syndrome?

Answer 32

Pituitary gland damage r/t postpartum hemorrhage

Question 33

What are reproductive complications from birth and why do they happen?

Answer 33

Uterine displacement because of bladder distention Bladder distention/urinate retention because of loss of tone PO Hemorrhage because of tone, trauma, or placental fragments

Question 34

What can cause a precipitous labor?

Answer 34

4+ births prior to the current one | Cocaine use

Question 34

What drug relaxes and softens the uterus?

Answer 34

Terbutaline

Question 35

Describe fetal presentation.

Answer 35

What part of the baby is presenting to you first from the vagina

Question 36

Describe fetal lie.

Answer 36

How is the baby lying in the womb Is the spine on the left or right Is the occipital bone anterior or posterior

Question 37

What causes variable decels?

Answer 37

Cord cord compression

Question 38

What causes early decels?

Answer 38

Head compressions

Question 39

What FHR change is okay?

Answer 39

Accelerations

Question 40

What causes late decels?

Answer 40

Placental perfusion problems

Question 41

What does APGAR stand for?

Answer 41

``` Appearance Pulse Grimace Activity Respiratory Effort ```

Question 42

How is APGAR scored? When is it done?

Answer 42

A: 0 for central cyanosis, 1 for acrocyanosis, 2 for full pink color P: 0 for 0 bpm, 1 for 1-99 bpm, 2 for 100+ bpm G: 0 for floppy, 1 for barely grimacing with stimulation, 2 for full grimace A: 0 for floppy and needing resuscitation, 1 for slightly floppy, 2 for screaming and flailing R: 0 for no effort, 1 for grunting/retractions, 2 for healthy cry 1 min, 5 min and then at 10 if either is <7

Question 43

When do you do compressions on a baby?

Answer 43

HR <60

Question 44

What is a respiratory issue r/t labor?

Answer 44

Wet lung sounds from too much pitocin

Question 45

What medications are given to most (if not all) newborns at birth?

Answer 45

Vitamin K Hep B vaccine Erythromycin eye ointment

Question 46

What helps clear baby’s fluid out of his lungs?

Answer 46

Force from birth canal | CatecholaMines released due to the stress of labor

Question 47

How much fluid is in a baby’s lungs at birth?

Answer 47

30 mL

Question 48

What is special about newborn respirations?

Answer 48

They have periods where they stop breathing (not a normal respiratory rate/rhythm but is normal for newborns)

Question 49

What is vernix?

Answer 49

White substance on a baby-totally normal

Question 50

What is milia?

Answer 50

White dots across the nose

Question 51

What is lanugo?

Answer 51

Fine baby hairs (usually on the shoulders and top of back?)

Question 52

What is erythema toxicum?

Answer 52

Baby acne

Question 53

What are Mongolian spots?

Answer 53

Birthmarks that may look like bruises

Question 54

What are Epstein’s pearls?

Answer 54

Calcium deposits in the mouth-totally normal

Question 55

Describe a postpartum assessment

Answer 55

``` Breasts Uterus Bowels Bladder Lochia Epesiptomy/perineum ``` Homan’s sign Emotional Status Rhogam

Question 56

When is rhogam used?

Answer 56

When mom is Rh - and baby is Rh +