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Flashcardlet > 1229 Exam 3: Intrapartal Care > Flashcards

1229 Exam 3: Intrapartal Care Flashcards

1
Q

beginning with irregular uterine contractions (Braxton Hicks) that eventually progress in strength and regularity

A

Contractions

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2
Q

2-3 cm long and 1 cm thick all you fill is the rim. Not considered in labor till 4 cm.

A

Effacement (Chapter 15 pg 27)

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3
Q

Measurement of fetal decent in centimeters.

A

Station (with station 0 being at the level an imaginary line at the level of the ischial spines, minus stations superior to ischial spines, and plus stations inferior to the ischial spines.)

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4
Q

The condition of being dilated or stretched beyond normal dimensions. The act of dilating or stretching

A

Dilatation

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5
Q

Occurs when the presenting part, passes the pelvic inlet at the level of the ischial spines. Referred to as station 0.

A

Engagement

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6
Q

Brownish or blood-tinged mucus discharge caused by expulsion of the cervical mucus plug resulting from the onset of cervical dilation and effacement.

A

Bloody Show

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7
Q

Surgical rupture of the membranes to induce labor.

A

Amniotomy

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8
Q

Introduction of solutions into the Amnion.

A

Amnioinfusion

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9
Q

Tests pH of the fluid and will turn deep blue indicating the alkalinity of the amniotic fluid and will remain yellow indicating slight acidity if the fluid is urine.

A

Nitrazine Test

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10
Q

Long, difficult, or abnormal labor caused by various conditions associated with the five factors affecting labor.

A

Dystocia

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11
Q

Dome-shaped top of the uterus and is the site at which the uterine tubes enter the uterus.

A

Fundus

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12
Q

Surgical incision made in the area between the vagina and anus (perineum).

A

Episiotomy

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13
Q

Occurs when the widest part of the head (the biparietal diameter) distends the vulva just before birth.

A

Crowning

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14
Q

An obstetric procedure use to control delivery of the fetal head. It involves applying upward pressure from the coccygeal region to extend the head during actual delivery, thereby protecting the musculature of the perineum.

A

Ritgen Maneuver

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15
Q

Determined at 1 and 5 minutes, provides information that must be considered in the context of data from the total assessment.

A

Apgar Score

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16
Q

Begins after the contraction has started, and the lowest point of the deceleration occurs after the peak of the contraction. Usually doesn’t return to baseline until after contraction is over

A

Late Deceleration

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17
Q

Defined as visually apparent, abrupt increase in FHR above the baseline rate

A

Acceleration

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18
Q

Generally onset, nadir, and recovery of the deceleration correspond to the beginning, peak, and end of the contraction. “Mirror Image” of a contraction

A

Early Deceleration

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19
Q

The degree of divergence or ability of an object to vary from a given standard or average

A

Variability

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20
Q

Factors that Affect Labor

A 
Passenger
Passageway
Powers
Position
Psychological
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21
Q

Consists of the fetus and the placenta. The size of the fetal head, fetal presentation, lie, position, and attitude affect the ability of the fetus to navigate the birth canal. The placenta can be considered a passenger because it must also pass through the canal.

A

Passenger

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22
Q

The relationship of the maternal longitudinal axis (spine) to the fetal longitudinal axis (spine).

A

Lie

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23
Q

Relationship of fetal body parts to one another

A

Attitude

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24
Q

The part of the fetus that is entering the pelvic inlet first. It can be the back of the head (occiput), chin (mentum), shoulder (scapula), or breech (sacrum).

A

Presentation

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25
Q

Relationship of the presenting part of the fetus (sacrum, mentum, or occiput) preferably the occiput, in reference to its directional position as it relates to one of the four maternal pelvic quadrants.

A

Fetopelvic or Fetal Position

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26
Q

Uterine contractions cause effacement and dilation of the cervix and descent of the fetus. Involuntary urge to push and voluntary bearing down in the second stage helps in the expulsion of the fetus.

A

Powers

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27
Q

“The Birth Canal” which is composed of the bony pelvis, cervix, pelvic floor, vagina, and introitus (vaginal opening). The size and shape of the bony pelvis must be adequate to allow the fetus to pass through it. The cervix must dilate and efface in response to contractions and fetal descent.

A

Passageway

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28
Q

The client should engage in frequent position changes during labor to increase comfort, relieve fatigue, and promote circulation. Position during second stage is determined by maternal preference, primary care provider preference, the condition of the mother and the fetus.

A

Position of Laboring Woman

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29
Q

Maternal stress, tension, and anxiety can produce changes that impair the progress of labor.

A

Psychological Response

30
Q

Bony Pelvis

A

Page 380

31
Q

Involuntary uterine contractions that signal the beginning of labor

A

Primary Powers

32
Q

Once the cervix has dilated voluntary bearing-down efforts by the woman that augment the force of the involuntary contractions

A

Secondary Powers

33
Q

Two contractions without returning to the baseline. This is an ominous sign.

A

Coupling

34
Q

Measured from the beginning of one contraction to the beginning of the next or from the peak of one to the peak of the next

A

Frequency

35
Q

The beginning of one contraction to the end of the same contraction

A

Duration

36
Q

Strength of the contraction

A

Intensity

37
Q

The end of one contraction to the beginning of the next

A

Interval

38
Q

Signs of Preceding Labor

A

Lightening (baby dropped)
Bloody show
Maternal weight loss
Surge of Energy

39
Q

May be spontaneous or by amnotomy

A

Rupture of Membranes (ROM)

**Assess FHT immediately after ROM

40
Q

Indications of Imminent Delivery

A

Bulging of perineum
Uncontrollable urge to bear down
Sudden increase in bloody show
- May accompany urge to bear down

41
Q

Phases of Stage 1 of Delivery

A

Latent
Active
Transitional

42
Q

Cervical Dilation 0 to 3-4 cm
Effacement - Beginning to 50%
Contractions - regular, q 15-30 min, mild-moderate intensity lasting 15-30 sec
Presenting part -3 to 0 station
Bloody show may be present
Mother may feel anticipation, excitement and be talkative and able to cope

A

Latent Phase

43
Q

Cervical dilation - 4 to 7-8 cm
Effacement 50 to 100%
Contractions regular q 3-5 min x 30-60 sec with moderate intensity
Presenting part +1 to +3 station
Increased bloody show
Mother becomes serious, concerned about progress of labor, and may ask for pain meds

A

Active Phase

44
Q

Cervical dilation - 8 to 10 cm
Effacement - 100%
Presenting part continues descent
Heavy bloody show
Spontaneous rupture of membranes (SROM) - monitor FHR after ROM***
Mother less able to cope, may become angry, may lose control, thrash about in bed, groan or cry, may develop n/v, leg tremors

A

Transitional Phase

45
Q

From complete cervical dilation through delivery of infant.
Maternal behavior changes to actively pushing but may become exhausted
In order to assist the client with pushing tell the client to take 2 cleansing breaths and push
When the client is crowning the doctor is called and delivery is accomplished
The nurse is responsible for prepping the perineum for the delivery

A

Stage 2

46
Q

From delivery of infant through delivery of placenta.
May experience due to uterine contractions before expulsion of placenta
The doctor will deliver the placenta and examine the client for retained placenta
The sign of release of the placenta
-Lengthening of the umbilical cord in the vagina
-Gush of dark blood
-Globular shaped uterus
Usually within 5-7 minutes after birth of baby

A

Stage 3

47
Q 
1-4 hours following delivery
Uterus should remain firm and positioned at midline, 1-2 finger breadths below umbilicus. 
Mother usually excited and tired, may be hungry or drowsy
Assess
-VS
-Lochia (Bloody discharge after delivery)
-Apply ice to episiotomy
-Massage fundus
-Check bladder
Prevent hemorrhage
-Massage fundus
-Administer oxytocin
-Keep bladder empty
-Monitor VS
A

Stage 4

48
Q

7 Cardinal Movements

A 
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Birth by Expulsion
49
Q

Occurs when the presenting part passes the pelvis inlet at the level of the ischial spines. Referred to as station 0

A

Engagement

50
Q

The progress of the presenting part through the pelvis

A

Descent

51
Q

When the fetal head meets resistance of the cervix, pelvic wall, or pelvic floor, THe head flexes bringing the chin close to the chest, presenting a smaller diameter to pass through the pelvis

A

Flexion

52
Q

The fetal occiput ideally rotates to a lateral anterior position as it progresses from the ischial spines to the lower pelvis in a corkscrew motion to pass through the pelvis

A

Internal Rotation

53
Q

The fetal occiput passes under the symphysis pubis and then the head is deflected anteriorly and is born by extension of the chin away from the fetal chest

A

Extension

54
Q

After the head is born it rotates to the position it occupied as it entered the pelvic inlet in alignment with the fetal body and completes a quarter turn to face transverse as the anterior shoulder passes under the symphysis

A

External Rotation

55
Q

After birth of the head and shoulder the trunk of the infant is born by flexing it toward the symphysis pubis

A

Birth by Expulsion

56
Q

Fetal Adaptation to Labor

A

Heart Rate (Accelerates and Decelerates)
Circulation
Respiration (Pg. 390)

57
Q

Maternal Adaptation to Labor

A

Every system is affected (look at diagram of women)

58
Q

Assessment of the laboring patient

A 
Birth Plan: 
-Childbirth techniques; attended classes?
-Support
-Analgesia; Anesthesia
Prenatal History:
-EDC
-Lab
-Previous Experiences
-Risk Factors
59
Q

Assessment

A 
Urine
VS
Connect to Monitor
Uterine Contractions
FHR-rate, variability, periodic changes
Vaginal Exam (must be done sterile)
Temp q2h if ROM
60
Q

Vital Signs

A

Epidural:
-BP q min x 5 min, then q5min, then q15min until stable as ordered
Active Labor:
- q 15-30 min
-q 15 min during transition
Take the temp q2hr
- if PROM be vigilant in checking the VS and for signs of infections

61
Q

Induction of Labor

A

Pitocin (Oxytocin) - used to induce labor (Protocol when membranes intact):

  • Pitocin 30 units in 500 ml NS for induction
    • IVPB into primary IV
    • Begin at 3 milliunits/minute via infusion pump
    • May increase to 5 milliunits/minute after 15 minutes
  • Never exceed 20 milliunits unless MD orders
  • ALWAYS ON PUMP*
62
Q

From cervical changes, distention of lower uterine segment, and uterine ischemia
Located over the lower portion of abdomen
Referred pain: originates in uterus, radiates to abdominal wall, lumbosacral area of back, iliac crests, gluteal area, and down the thighs

A

Visceral Pain

63
Q

Pain described as intense, sharp, burning, and well localized
Stretching and distention of perineal tissues and pelvic floor to allow passage of fetus, from distention and traction on peritoneum and uterocervical supports during contractions, and from lacerations of soft tissue

A

Somatic Pain

64
Q

Threshold remarkably similar in all, regardless of gender, social, ethnic, or cultural differences
Differences play definite role in person’s perception of and behavioral responses to pain

A

Perception of Pain

65
Q

Pain results in physiologic effects and sensory and emotional (affective) responses
Emotional expressions of suffering often seen

A

Expression of Pain

66
Q

Nonpharmacologic Management of Discomfort

A

Relaxing and breathing techniques:

  • Relaxation
  • Imagery and visualization
  • Music
  • Touch and massage
  • Breathing techniques
  • Effleurage and counter pressure
  • Water therapy (hydrotherapy)
67
Q

Medications for Pain (Analgesia)

A

Demerol/Fentanyl
Stadol/Nubain (IVP)
-Push at the beginning of the contraction***
-May be used because these do not depress respirations or cause fetal depression
-If given to a drug addicted client may cause narcotic withdrawal

68
Q

Epidural Anesthesia

A

Put in at about 4 cm
The nurse is responsible for vital signs
-BP (Monitor drop in BP immediately following epidural), R, FHT’s, etc..
*For Epidural/Spinal Anesthesia the client is given a bolus of IV fluid to offset the fluid volume deficit**

69
Q

If the BP drops…

A

Open plain IV fluid
Turn client to the side
Apply oxygen by tight face mask at 10-12 L/min
Elevate feet (don’t put head down below 35 degrees)
If FHT’s go down may need to turn off Pitocin

70
Q

An abnormal, dysfunctional, or difficult process of labor resulting primarily from ineffective uterine contractions, fetal problems or pelvic inadequacy

A

Dystocia

71
Q

Thin, Watery (light brown)–no treatment
Thick peas soup like–Indicates that the fetus has been stressed or in distress
-Delee suction @ birth before first breath
-Suction through ET tube with meconium aspirator

A

Meconium Stained Amniotic Fluid

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