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Obstetrics > Assessment and Care in Labour > Flashcards

Assessment and Care in Labour Flashcards

1
Q

What 3 things should a pregnant patient come to hospital for no matter what?

A

o Vaginal bleeding
o Decrease or change in movement
o Membranes have ruptured

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2
Q

Compare the timing of the assessment of the fetus vs client when they are determined to be in active labor

A
  • Mother can be assessed at any time with general inspection
  • Should assess fetus first/as you complete fetal assessment
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3
Q

What does glucose in the urine of the laboring client indicate?

A

Gestational Diabetes

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4
Q

What do ketones in the urine of the laboring client indicate?

A

produced when using alternate fuel sources other than glucose; indicates gestational diabetes but most likely indicating hypoglycemia

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5
Q

What does protein in the urine of the laboring client indicate?

A

gestational diabetes

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6
Q

Describe the frequency of normal labor contractions

A

no more than 1 every 2 minutes (max. 5 in 10 minutes)

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7
Q

Describe the duration of normal labor contractions

A

Less than 90 seconds (60-90 seconds in active labour)

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8
Q

Describe the intensity of normal labour contractions

A

Subjective w palpation (mild, moderate or strong)

Objective w IUPC (intrauterine pressure catheter) 25 mmHg to 75 - 80 mmHg above baseline.

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9
Q

Describe the frequency of a tachysystolic uterine contraction

A

6 or more in 10 min

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10
Q

Describe the duration of a tachysystolic uterine contraction

A

Longer than 90 seconds

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11
Q

Describe the resting tone of tachysystolic uterine contractions

A

resting period of < 30 seconds or remains firm to palpation between contractions (> 25mmHg w IUPC)

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12
Q

How do you non-electronically assess contractions

A

Using a clock and placing warm hand on fundus to assess f/d/i

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13
Q

What 2 ways can you electronically assess contractions?

A

Tocometer
IUPC

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14
Q

What is important to remember when using a tocometer to assess contractions?

A

It picks up timing and intrauterine pressure as its reflected through tissues/picks up abdominal pressure
> Must palpate no matter what unless you have IUPC

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15
Q

What 6 things does a sterile vaginal examination provide information on?

A
  1. dilation
  2. effacement
  3. membrane status
  4. amniotic fluid
  5. fetal position
  6. station
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16
Q

Describe the thickness of the cervix effaced vs not

A

0 - 100% or 4cm - >1mm

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17
Q

Describe the cervix of a woman in labour

A

moves anteriorly, thin, and shorten

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18
Q

Describe the cervix that indicates no labour

A

Firm, posterior, long cervix

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19
Q

If a patient experiences SPOM, when and why should they come in?

A

As soon as it occurs
- risk of infection > 18 hr
- cord compression/prolapse

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20
Q

AROM

A

amniotomy

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21
Q

PROM

A

Premature
When labour does not occur 12-24 hours following rupture

22
Q

PPROM

A

Premature Preterm
When labour does not occur 12-24 hours following rupture and the mother is less than 37 weeks

23
Q

What is the normal amount of amniotic fluid at term?

A

800-1000ml

24
Q

What is ferning?

A

A way to confirm amniotic fluid presence; pattern on the microscope

25
Q

What is a nitrazine swab used for?

A

A way to confirm amniotic fluid presence; yellow - negative and blue - positive

26
Q

How often is the fetus assessed in labor?

A

q15min

27
Q

Why is electronic fetal monitoring useful?

A

Provides continuous data correlated with other activities i.e. contractions
* Therefore can see effects of contractions on fetal heart rate

28
Q

What is a con of electronic fetal monitoring?

A

Reduces/restricts patient in mobility

29
Q

How is the FHR baseline found and what is the normal range?

A

Approximate mean rounded to 5 bpm in 10 min, excluding accelerations and decelerations
110-160

30
Q

How is FHR variability quantified?

A

Fluctuations in baseline per minute, excluding accelerations and decelerations
Visually quantified as peak to trough

31
Q

Describe absent, minimal, moderate, and marked variability

A

Absent = undetectable
Minimal = less than or equal to 5bpm
Moderate = 6-25bpm
Marked = more than 25

32
Q

What common occurrence might reduce FHR variability short term and how do you correct it?

A

If fetus rests for 15-30 min
Reposition client if prolonged

33
Q

Describe a sinusoidal FHR pattern

A

smooth and repetitive sine pattern persisting for longer than 20 minutes with an amplitude of 5-15 and a frequency of 3-5 cycles/min

34
Q

When and why is a sinusoidal FHR pattern concerning?

A

Concerning if persisting for longer than 20 minutes; indicates neural perfusion issues

35
Q

Define acceleration

A

Abrupt (onset > peak less than 30 seconds) increase in FHR of at least 15bpm for at least 15 seconds and less than 2 minutes

36
Q

True or false: for it to be deemed an accelerate, it must get to and remain at 15bpm above baseline for at least 15 seconds and less than 2 minutes

A

False: Doesn’t have to remain at 15bpm above, just get there and then return to baseline around 15s - 2 min

37
Q

How are decelerations categorized?

A
  • Categorized by:
    § abruptness
    § relationship with contractions
38
Q

What is a variable deceleration and what does it indicate?

A

Abrupt (onset to lowest point less than 30 seconds) decrease in FHR greater than on equal to 15 bpm for longer than 15 seconds

39
Q

Describe a periodic variable deceleration

A

regular, recur, happen with every contraction as it squishes cord

40
Q

Describe a episodic variable deceleration

A

irregular, sporadic, baby accidentally happened to squish cord; not associated with contraction

41
Q

What are early decelerations and what do they indicate?

A

A gradual (onset to lowest point greater than or equal to 30 sec) decrease in fetal heart rate associated with uterine contraction/no depth criteria

Contraction squishing head

42
Q

What is a late deceleration and what does it indicate?

A

A gradual (onset to lowest point greater than or equal to 30 sec) associated with uterine contraction/no depth criteria

  • Onset, nadir, and recovery occur after the beginning, peak and end of contraction
  • May be associated with fetal acidemia
  • OMINOUS
  • Always ATYPICAL (if intermittent) or ABNORMAL (if recurrent)
43
Q

What is a prolonged deceleration and what does it indicate?

A

Visually apparent decrease in FHR below baseline lasting longer than 2 minutes but less than 10

Indicate profound change in fetal environment/increased likelihood for hypoxia

44
Q

Describe features of normal EFM

A

§ Normal contraction pattern
§ Rate: 110 - 160
§ Moderate variability (<5 for < 40 mins)
§ Accelerations present (but not required)
§ Decelerations
* Absent
* Early
* Variable - if non-repetitive and uncomplicated

45
Q

Describe atypical/abnormal features of EFM

A

§ Bradycardia < 110
§ Tachycardia > 160
§ Absent, minimal or marked variability*
§ Recurrent late decelerations
§ Complicated or Repetitive variable decelerations
§ *Depends on how long the feature lasts

46
Q

What 4 things do you assess amniotic fluid for?

A

time, amount, colour, odour

47
Q

What are the possibilities of colour of amniotic fluid and meaning

A
  • Clear, Whitish, White flecks (vernix dissipating)
  • Green - meconium - thick, thin, particulate
  • Bloody – streaks/brownish/pinkish normal (mixed with bloody show), fresh bright red is not!
48
Q

Describe the fetal response to altered blood flow during each contraction

A
  • Decrease to fetus at peak of each contraction leading to decrease pH
  • Further decrease of pH occurs during pushing due to woman holding her breath
49
Q

What are the nursing interventions for intrauterine resuscitation? (10)

A
  1. reposition repeatedly
  2. decrease d/c oxytocin or any medications for augmentation/induction
  3. differentiate MHR (slower) from FHR
  4. correct hypotension (IV flluids)
  5. modify pushing efforts if pushing efforts are causing decreased oxygenation
  6. vaginal exam to rule out prolapse
  7. Consider tocolysis (relaxation of uterus - nitroglycerine)
  8. Continuous EFM
  9. Assure mother is oxygenated
  10. Support, explain, notify, document
50
Q

How often should a mother be voiding in first stage of labour

A

q2h

51
Q

How often should you be assessing FHR while pushing

A

q5min

Obstetrics (12 decks)

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