Test 2 -Labor and Delivery Flashcards by Makieah Mack

Which pelvis shape is the most favorable for delivery ?

Gynecoid Pelvis

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Gynecoid - well ________ most favorable for delivery
Platypoid - Broad, but flat and short; favors ________ fetal presentation (requires _________)
Anthropoid - oval but long and narrow; __________ for vaginal delivery
Android - “________ pelvis” narrow/heart shaped (requires CS or _______)

rounded
transverse, CS
adequate
male, forceps

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What are the 5 P’s of Labor?

Passage (pelvis)
Passenger (fetus)
Powers (CTX/pushing)
Position (how the baby is inside/ mother position)
Psyche (how the mother is coping)

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How can you tell the baby is in the correct position for delivery?

Sutures in the head palpated

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Fetal attitude is the relation of the fetal parts to one another (refers to ________ of fetus during labor)

posture

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What is the leopold’s maneuver?

Palpates around the fetus to determine how they are positioned in the uterus

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What does a contraction feel like?

firm and globular

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What is effacement of the cervix?

Thinning (0-100%)

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What factors contribute to the woman’s attitude in labor?

her perception
those around her
Prior experience/ expectations

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What factors prepare and support are available to enhance coping effects?

relaxation of voluntary muscles
support person/ coach/ doula/ positioning
distraction
breathing techniques with each ctx

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Nursing should AVOID _______ exams whenever possible on women with PROM/ SPROM
*** never if she had vaginal bleeding

vaginal

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What should you document for rupture of membranes
- _______ of fluid
- _______ of fluid
- ______ rupture occurred
*** assess immediately for _________ cord

color
odor
time
prolapsed

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What is your primary concern if a woman presents and she is leaking fluid for 4 days? Why?

Infection
Because membrane is open and baby is now exposed

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First stage of labor : beginning to complete of ___________ ________ (0-10cm)

cervical dilation

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Second Stage of labor : complete dilation to ______ of baby

birth

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Third stage of labor : Birth to delivery of _________

placenta

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Fourth stage of stage : first ___ hours after delivery of ______

4
placenta

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First stage “dilating stage”
Latent (__-__cm) ctx become increasingly stronger and more frequent
Active (__-__cm) more rapid dilation/effacement and descent of fetus
Transition (__-__cm) ctx every 2-3 min and last 60-90 seconds
** maternal symptoms: irritability, restlessness, hyperventilation, N/V, rectal pressure

0-3
4-7
8-10

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Braxton Hicks Contractions
_____ labor pains
Feel strong at times
Do _____ change or dilate the cervix
____ pattern
Stop with change in _________
“________” for the marathon

false
NOT
NO
activity
Practice

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What is fetal station?

How far down the baby’s head has decreased into the mother’s pelvis

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What is the purpose of fetal station?

To tell how far through (or above) the pelvis baby is

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What are the risks of pushing before its time?

Retard labor
Failure to progress
Cervical edema

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NURSING CARE : FIRST STAGE
- VS, fluid/electrolyte balance
- Contraction monitoring (_________, __________, _________)
- Voiding/bladder: how often pt is voiding, not any ________/________
- Comfort measures : ________, ______ massage, ice chips, relaxation, focal point
- Provide reassurance, explain process/procedures, reinforce teaching
- Assist support person

frequency, duration, intensity
protein/glucose
positioning, back

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TOCO is a device for monitoring and recording __________ _________ before and during labor

uterine contractions

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Doppler monitor measures :

Fetal HR

SECOND STAGE OF LABOR - avg __ hrs nulliparous. ___min multiparous - Complete _________ dilation to delivery of _____

2,20 cervical , fetus

NURSING CARE : 2ND STAGE OF LABOR - Monitor physical status, progress of labor - Assist with techniques that foster _________ of fetus - encourage _________ down - Discourage ________ _________ for more than 5 seconds - Positioning: __________ _______, ______ ______, ______ _______ - Comfort measures - Assist support person - Monitor FHR and regularity - Remove foley cath and internal monitors as needed

expulsion bearing holding breath side lying, semi fowler, squatting position

INSTRUMENT ASSISTED VAGINAL DELIVERIES - Forceps : curved blades to extract the ______ ______ Indicated if mom : can’t _____, fetus is ____________ - Vacuum: delivery with suction device applied to the fetal ______ for traction Contraindicated: ____/breech presentation Can be used if mom is ____________ or unable to push ___________

fetal head push/ compromised head face Exhausted, effectively

Delivery of the placenta should be done within ____ minutes

Blood loss of ____-_____ mL occurs as a normal consequence of placental separation

300-500

Contractions of the uterus prevents maternal _________

hemorrhage

_________ __________ occurs when the placental fails to detach from the uterus as it exits, pulls on the inside surface, and turns the uterus inside out

uterine inversion

NURSING CARE STAGE THREE - Observe for s/s of _____ separation - Assess _____ loss - Monitor VS - Assist with delivery of ______ - Bulb ______ baby ALWAYS ______ then ______ to avoid aspiration - Cord is clamped _____ and cut between clamps - Record time of birth - ________ infant to mom’s chest first hour

placental blood placenta suction mouth, nose twice stable

What are some benefits of skin-to-skin care?

Regulates: BS RR Temp Infection HR Decreases crying Better sleep Better breast feeding

Forth stage of labor is the most critical period for the mother. Why?

To prevent the mother from infection and hemorrhage

It is important to teach the patient the importance of breastfeeding, ambulation, and newborn care during the forth stage of labor (TRUE OR FALSE)

True

Labor induction is the stimulation of uterine contraction during pregnancy ______ labor begins on its own to achieve ______ birth

before vaginal

HOW IS INDUCTION PERFORMED? - ________ ripening ( medications or foley bulb) - ________ _________ of membranes - ____ medications ( Pitocin, Cervidil, Cytotec) - Complimentary methods (Resting, prostaglandins)

cervical Artificial rupture IV

What are some reasons a woman may be induced?

high BP Slight abruption Chronic condition ROM Something wrong with baby

Labor dystocia is an abnormal ________ pattern Can be due to a problem with - - -

labor the powers passage passenger

Labor dystocia is defined as less than ____cm of cervical dilation per hr over a ___ hour period

0.5 4

Labor augmentation refers to the artificial stimulation of ______ ___________ when spontaneous contractions have failed to result in progressive cervical dilation or the descent of the fetus

uterine contractions

Why would you perform labor augmentation?

To speed labor up/ help it progress

What natural ways can you augment a labor?

- walking - nipple stimulation - sex

INDUCTION - Stimulate labor _______ it starts AGUMENTATION - labor has ______ but has not lead to cervical _______ so we are going to help it along

BEFORE started, dilation

An amniotomy is an __________ ________ of membranes

artificial rupture

Amniotomy is used in the _____ stage of labor to shorten the length of labor

first

What are some nursing interventions for an amniotomy? - FHR _______ and immediately _______ - Assess amniotic fluid _____/_____ - Assess pt’s temp every ___ hrs

BEFORE/AFTER color/odor 2

An amino infusion is done by having warm sterile NS or LR introduced into the uterus through a _________

IUPC

When is an aminoinfusion used? - Low fluid (__________________) - ________ decels, (cord ___________) - __________ stained fluid

- oligohydraminos - Variable , compression - Meconium

Opioid analgesics are use in _____ labor - They induce _______

early sedation

What is the number he narcotic used in L&D?

Fentanyl

Morphine lasts a long time and is given during the _____ stage of labor

1st

MORPHINE - rapidly crossed the _______ - do NOT admin. within __ hours of delivery - Have ________ available for newborn if overly sedated

placenta 2 Narcan

FENTANYL - Causes less n/v and __________ depression than other options - Minimal ________ - Minimal _______ side effects - Works quickly and ______ off quickly

respiratory sedation fetal wears

HYDROXYZINE - May increase effectiveness of ______ - May _______ anxiety - Cannot be given ____

opioids decrease IV

PROMETHAZINE - Can cause ______ - Can contribute to _________ ___________

sedation maternal hypotension

Prodromal labor is _____ labor with regular ctx but they start and stop and do ______ cause significant cervical change

early NOT

The cause of prodromal labor is unknown but is thought to prepare the uterus for true labor (TRUE or FALSE)

TRUE

Prodromal labor is different from Braxton Hicks because prodromal labor can be ________ contractions whereas Braxton hicks are ______

regular irregular

What is the treatment of Prodromal labor? - Provider may administer a _________ or ____ medication to allow mom to rest and encourage hydration - ______ labor will usually begin soon

sedative,pain True

What are the common meds included in a “party pack”?

Phenergan Vistaril Oxycodone Used to give Butisol but no longer in the US

PUDENDAL BLOCK “SADDLE BLOCK” - local anesthetic injected into __________ nerves - Provides relief to lower ______, ______, _______ - May diminish ______ ___ _____

pudendal vagina, vulva, perineum urge to push

EPIDURAL OPIOID ANALGESIA - affects T12-S5 - Continuous infusion of anesthetic into the _______ space - Provides analgesia for approx ___ hours after delivery

epidural 24

What are the HIGH risks that come with epidurals?

Maternal Hypotension (tx with Fluid Bolus 1000mL)

CESAREAN BIRTH - Birth of an infant through an __________ and _______ incision

abdominal , uterine

Can a woman have a vaginal birth after C-section? (VBAC) If so, who?

YES! Pts who had previous low transverse incision

What uterine incision is most used and most favorable and allows for a later vaginal birth ?

Low transverse

Success rate of VBAC ?

70-75%

C-section patients are at the highest risks for …

Hemorrhage Shock Infection

Patients who received a c-section have what kind of diet?

Ice chips, clears to full

Catheter is removed ___-____ hours after c-section

6-8

Count fetal movements daily (same time) every day beginning at ____ weeks gestation

NON-STRESS TEST (NST) - measure of the FHR in response to its own _________ - Indications: ____ risk pregnancy, _______ fetal movement in norm. pregnancy - Purpose: Adequate ________ is required for fetal activity ad HR to be within normal ranges - Results: __________ (Normal) ,____________(Abnormal) ,_____________

movements high/decreased oxygen reactive, non-reactive, unsatisfactory

Healthy babies will respond with an __________ HR during times of movement, and the HR will __________ at rest

increased decreased

Reactive NST “___________” - 2 ____________ of at least __bpm above fetal HR baseline that lasts __ seconds - Monitoring for minimum of ___ minutes, max __ minutes

reassuring accelerations 15 15 20 40

Non-reactive = “____-___________” - Criteria for reactive are not met

non-reassuring

_____________ stimulator is applied to the maternal abdomen over the area of the fetal head

Vibroacoustic

If you have a non-reactive NST, there are no further actions (TRUE OR FALSE)

False

Biophysical Profile combines the ____ and fetal ____________ and evaluates the well being of the _____

NST ultrasound fetus

Results of a Biophysical profile - Scores of 8-10 are considered _______ - Scores of 7-5 are neither _________ nor __________ Needs further _________ - Repeat BPP in __-__ hours - Consider __________ - Scores <4 Immediate __________ plan

normal reassuring/ nonreassuring monitoring 12/24 delivery delivery

CONTRACTION STRESS TEST - Determines how well the baby will cope with the ___________ of vaginal delivery by stimulating synthetic contractions

contractions

CST RESULTS - NORMAL result = ________ CST - fetus’ HR did NOT slow during contractions - ABNORMAL result = _________ CST - fetus’ heart DID decrease during ctx, can determine a more serious problem

negative positive

BENEFITS OF DELAYED CORD CLAMPING TO THE BABY INCLUDES - _____ frequency of iron deficiency anemia - ________ need for blood transfusion - ______ blood volume - Neurodevelopment may be _________ ** This is currently the standard of practice

lower reduced higher enhanced

An amniotic fluid embolism occurs when ___________ fluid is forced into an open maternal uterine blood sinus. This condition may occur during labor or in the post-partial period

amniotic

UTERINE RUPTURE S/S: Sudden sharp _______ pain , ______ of ctx, Sudden fetal brady to absence of fetal _____ tone, shock INTERVENTIONS: deliver the baby via _________ ASAP

abdominal, cessation, heart c-section

Uterine rupture is a catastrophic tearing open of the ______ into the ________ cavity

uterus abdominal

ETIOLOGY OF UTERINE RUPTURE - Rupture of previous _________ - __________ labor - Injudicious use of Pitocin ( _____________) - Excessive ________ pressure applied to the __________ during delivery

C-section scar Prolonged overstimulation manual, fundus

A retained placenta is the retention of the placenta beyond ___ minutes after birth CAN LEAD TO : __________, ___________ *** may require manual removal or placenta via D&C

30 hemorrhage, infection

Pulling on the cord carries a risk of tearing the cord and of causing a rare but life-threatening condition — ______ ___________, in which the organ is pulled indie out or even of the body

uterine inversion

Signs and Symptoms of retained placenta :

Fever Foul Smelling discharge Persistent pelvic/ Abdominal pain Excessive vaginal bleeding

POST-TERM PREGNANCY - Birth beyond ____ completed weeks of pregnancy MOST COMMON CAUSES - poor pregnancy ______ - desire for _______ labor - no _________ care

42 dating natural prenatal

PERINATAL COMPLICATIONS OF POST-TERM PREGNANCY - ___________ staining - Asphyxia - _______ complications - Fractures - ________ injury - ____________ hemorrhage

meconium cord nerve intracranial

Macrosomia is when the baby weighs more than ______ grams at birth DELIVERY RECOMMEND. = ________ if weight estimated > 4500grams (11lbs)— otherwise vaginal delivery

4000 c-section

Persistent occipital posterior position (POP) is when the baby’s ______ is lying against the maternal ________. (back to back) RISK of : __/__ degree perineal laceration *** attempt to reposition the baby LABOR IS : - ______ labor - longer - ______ painful - needs forceps/vacuum

Spine Spine 3/4 back more

Shoulder dystocia is an obstructed labor, after the delivery of the head, the anterior _______ of the infant cannot pass below the pubic symphysis ** Most experts agree that this _________ be predicted

shoulder CANNOT

SHOULDER DYSTOCIA COMMON SIGN IN LABOR: - Turtling : occurs when the ______ emerges and then ________ (pulls back) against the perineum, like a turtle in its shell. This causes the baby’s checks to bulge

head retracts

Cephalopevlvic disproportion is when the fetus is ______- than the mother’s passageway

larger

SHOULDER PRESENTATION “TRANSVERSE LIE” - _________ for vaginal delivery - if discovered before term, _____________ is expectant (watchful) - External cephalon version (ECV) attempt, followed by __________ of labor if successful

impossible management induction

Test 2 -Labor and Delivery Flashcards

(99 cards)