Week 3 Flashcards
1
Q
5 P’s
A
Passenger
Passageway
Powers
Position
Psychological
2
Q
closure of A fontanelle
A
18 mo
3
Q
closure of P fontanelle
A
6-8 weeks
4
Q
in the fetus the occipital bone is larger meaning
A
when baby is placed flat it pushes head down
- watch airway
5
Q
sagittal suture can be felt for
A
direction of fetus
6
Q
fetal presentation
A
part of the fetus that lies closest to the internal os of the cervix
7
Q
what do we normally want to present
A
head
- occipital
8
Q
Vertex
A
head down
9
Q
breach
A
butt down
10
Q
shoulder
A
shoulder down
11
Q
proven pelvis
A
had a vaginal birth before
12
Q
CPD
A
cephalopelivc disproortion
- head is not going through pelvis good
13
Q
fetal lie
A
relation of the long axis of the fetus to the long axis of the mother
- spines
14
Q
fetal attitude
A
relation of the fetal body parts to one another
15
Q
normal fetal attitude
A
general flexion with the chin flexes onto chest and the extremities flexed into the abdomen
16
Q
why do we need to know fetal position
A
where to put the monitor
17
Q
Liapolds can determine
A
lie
attitude
presentation
18
Q
fetal station
A
measure of the degree of descent of the presenting part through the birth canal
19
Q
what is 0 station
A
at the ischial spine
20
Q
more engaged
A
more than 0
+
21
Q
less engaged
A
22
Q
+ 4/5 =
A
birth is imminent
23
Q
why is squatting or sitting on a. ball good
A
open hips and push baby down
24
Q
4 types of pelvis
A
gynecoid
android
anthropoid
platypelloid
25
normal female pelvic shape
gynecoid
26
effacement
the thinning and shortening of the cervix
27
dilation
force of contraction and pressure from presenting part make diameter expand from closed <1cm to complete 10 cm
28
primary vs secondary powers
primary: uterus contractions
secondary: maternal bearing down
29
Ferguson reflex
feeling the urge to push
30
why do we like left side lying
takes pressure off main vessels
31
anxiety and fear in birth
stimulates catacholmines release which causes ineffective contractions and dysfunctional labor
32
muslim possible culture requests
female only staff
very modest
33
jewish possible culture requests
kosher diet
34
Asian possible culture requests
fish and rice prepared by mom
35
Hispanic possible culture requests
evil eye
touch while giving compliment
36
TRUE ACTIVE LABOR
DILATION
EFFACEMENT
AND DESCENT OF FETUS
37
preceding labor
-primips
uterus drops 2 weeks before term
38
preceding labor
-multips (dropping)
may not happen until true labor is in process
39
why might we see bloody show
small capillaries on cervix rupture
40
Braxton hicks
practice contractions
41
factors involved with onset of labor
oxytocin
42
pressure on the cervix releases
oxytocin
43
production of prostaglandins do what
soften the cervix and dilate
44
labor
process of moving fetus, placenta, and membranes out of the uterus through birth canal
45
how many stages of labor
4
46
false vs true labor
true
- increase frequency of contractions
- back pain and radiates to front
- contractions continue with sleep
- walking increases contractions
- PROGRESSIVE EFFACTMENT
false
- decrease in frequency
- lower abdomen pain
- disappears with sleep
- NO CHANGE IN CERVIX
47
1st stage of labor
onset of contractions to full dilation
48
1st stage
- latent
0-5 cm
49
1st stage
- active
6 cm and up
50
once you get to 6cm
1 cm every hour
51
2nd stage
cervix is dilated to birth of infant
52
3rd stage
birth of infant to birth of placenta
53
4th stage
birth of placenta to 2 hours PP
54
7 cardinal movements
engagement
descent
flexion
internal rotation
extension
external rotation
expulsion
55
not coping with pain
crying
moving
can't focus
jitters
sweating
56
is coping
eyes closed
rhythmically breathing
rotating hips
57
fatigue does what
decreases woman's ability to cope effectively with contraction pain
58
do we give heat with epidural
no because no sensation
59
opioids do what to maternal vital signs
decrease HR, RR, BP
60
why is fent good
short half life
fewer neonatal effects
61
what do we give 15 to 30 mins before anesthesia
fluid bolus (500cc)
62
what does fluid bolus do
decrease the potential for hypotension caused by sympathetic blockade
63
disadvantages to spinal anesthesia
hypotension
impaired breathing
operatie birth more likely
64
spinal headache caused by
accidentally punctured the dura
"wet tap"
- treatment is blood patch
65
maternal labs for epidural
platelets
- lesss than 100,000 bad and cannot get epidural
66
wedge under hip does what
displaces the uterus and gets it off major vessels
67
cricoid pressure
helps visualize vocal cords for intubation
also helps prevent aspiration
68
more movement is better because
helps change babies position
69
side effects of anesthesia
hypotension
N/V
itchy skin
urinary retention
HA
increase temp
70
fetal wellbeing during labor is measured by
the response of fetal heart rate to the uterine contractions
71
contractions reduce the blood flow through the maternal vessel which
decrease O2 content in the maternal blood
72
does FHR monitoring decrease neonatal morbidity
false
73
abnormal fetal HR
hypoxia
74
Pitocin does that equal high or low risk mom
high risk
75
we use intermittent auscultation in a
low risk pt
76
components of external monitoring
ultrasound transducer
Toco transducer
77
ultrasound transducer measures
fetal HR
78
where is the ultrasound transducer placed
on fetal back
- use leipolds to find that
79
toco transducer measures
contractions
80
where is the toco transducer placed
on fundus
81
components of internal monitoring
spiral electrode
intrauterine pressure catheter
82
spiral electrode
HR
screwed into head
83
intrauterine pressure catheter
amount of pressure in the uterus
monitors contractions
84
why do we want moms pulse ox on
so we know we are picking up baby heart tones and not moms
85
normal fetal HR range
110-160
86
bradycardia (less than 110) causes
hypoxic
drugs
vasovagal
87
tachycardia (greater than 160) causes
maternal fever
infection
fetal anemia
88
variability tells us
if we got good oxygenation during labor
89
4 categories of variability
absent
minimal
moderate
marked
90
absent variability
no range
- m acid
- fetal sleep cycle
91
minimal variability
less than 5 BPM above or below baseline
92
moderate variability
6-25BPM above or below
normal acid base balance
93
what type of varaibilty do we want
moderate
94
marked variability
over 25BPM above or below
- fetal anemia or chorioamnionitis
95
accerlations indicate
fetal well being/adequately oxygenation
- we want accelerations
96
accerlation criteria terms and before 32 weeks
at least 15BPm increase for at least 15 sec
32: at least 10 BPM increase for at least 10 sec
97
decorations
decrease in FHR characterized by their shapes and timing relationship to contractions
98
early decels
response to vital head compression
99
late decels
uteroplacental insufficiency
100
variable decal
umbilical cord compression or prolapse
101
prolonged deceleration
more than 2 min but less than 10 min
102
contractions frequency
time from beginning of one cxn to beginning of next cxn, measured in mintues
- cxn in 10 min window averaged over 30 mins
103
tachysystole
>5 cxn in a 10 min window, averaged over 30 mins
- bad because HR goes down and the fetus is not being perfused = acidosis
104
resting tone
normal intrauterine pressure between cxn or in absence of cxn
- allows the uterine vessels to give blood flow to the placental allowing the fetal exchange of repritory gases which enhanced fetal oxygenation
105
VEAL CHOP
variability
early
accerlated
late
cord
head
okay
perfusion
106
if we have variable what do we do
the cord is not perufsing enough so we want to slow labor down and stop pit
107
Category 1
- HR
- Variability
- decels
normal HR (110-160)
moderate variability
absent decels
108
category 2
- HR
- Variability
- decels
- accelerations
- bradycardia/tachycarida
- minimal or absent variability
- recurrent decels
- no accelerations in response to fetal stimulation
109
category 3
- HR
- Variability
- decels
- nonreasuring FHR pattern associated with hypoxemia (bradycardia)
- absence of baseline variability
- recurrent or late decels
- sinusoidal pattern
110
what happens if you have category 3
emergency delivery
111
where do we draw cord ABG
arterial
112
intrauterine resuscitation acronym
LIONS PIT
113
LIONS PIT
stop pit
left side
IV open
oxygen ?
notify MD
stop
PIT
114
what does stoping pit do
maximize uterine blood flow and placental perfusion
115
amnioinfusion
due to decrease amniotic fluids and we replace it to help cushion baby
116
tocolytic therapy is used for
tachysstole
117
TRUE ACTIVE LABOR
CERVICAL DILATION
EFFACEMENT
DESCENT OF FETUS
118
first stage of labor
begin with regular contractions and ends with full cervical effacement and dilation
latent: 0-5cm
active: >6cm
- 1cm for every hour after 6
119
EMTALA
emergency medical treatment and active labor act
- a woman is considered to be in true labor until a qualified provider determines that she is not
- stablize mom and baby and then transport
120
what do we need to do when membrane is ruptured spontaneously or artificially
time
color: normal is clear
odor: abnormal is foul
FETAL HR if decreased then might be cord issue and have to do C
121
by the time of rupturing and delivery is how long due to infection risk
18 hours
122
leopolds determines
lie
attiutde
presentation
123
3/70%/-2
dilation 3
effacement 70%
staton -2
124
station of what means birth is imminent
+ 4/5
125
we need a station of what before we can rupture the membrane
-3
126
moms should void every
2hours
127
full bladder can
prevent fetal descent in the labor process
and prevent uterine clamping down in the PP
128
APGAR
1, 5, 10
129
nuchal cord
wrapped around neck
130
