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OB > Birth > Flashcards

Birth Flashcards

1
Q

Describe the first 1st stage of labor

A

Onset of regular uterine contractions to full effacement and dilatation of cervic

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2
Q

Describe Latent phase of 1st stage of labor

A

Starts w/ beginning of regular contractions(mild). Women is talkative, excitement is high. Mild contraction may be mild and lasts 30sec w/ a frequency of 10 to 30min and progress to 30-40sec every 5-7min.

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3
Q

Describe the Active phase of 1st stage of labor

A

Anxiety tends to increase as contraction/pain tensify. Cervix dilates from 4cm to 7cm. Fetal descent is progressive. Cervical dilation averages 1.2cm/hr in nulliparas and 1.5cm/hr in multiparas.

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4
Q

Describe Transition phase of 1st stage of labor

A

Contraction of a frequency of about every 1.5 to 2 mins; duration of 60-90 sec; strongly intensify. Hyperventilation, increased irritability, frustration, bloody show, shaking/cramps in legs, sensitivity to touch, n/v, increase rectal pressure/ urge to bear down, and requests for medication

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5
Q

When does the Second stage of labor begin and end?

A

Begins with complete cervical dilation and ends with birth of the baby

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6
Q

Describe the Latent/passive phase of 2nd stage of labor

A

Iniatially experience urge to push. Passive fetal decent occurs d/t uterine contractions

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7
Q

What are some Nursing interventions for latent phase of stage 2

A

Assessing the effectiveness of pushing efforts, provide encouragement, obtain adequate pushing effort, asses fetal response to pushing, continue fetal assessment measures

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8
Q

Describe the Active pushing phase of second stage of labor

A

Occurs once the urge to push has been established and women begins to actively push with her contractions

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9
Q

Nursing intervention of active pushing stage

A

Assess position, ability to push, FHR how their partner is doing.

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10
Q

When is the 3rd stage of labor?

A

Placental delivery, Bp, pulse, and respirations every 5 min. Palpate uterine contractions intermittently to assess signs of placenta separation

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11
Q

When is the 4th stage of labor and what should the nurse do during this stage ?

A

Time, 1-4hrs after birth, which readjustment of mothers body begins. Asses vital signs: BP, temp, pulse and respirations every 5-15mins for 1st hour. Assess fundus, lochia, perineum, laceration/episiotomy site, bladder distention, and rectum every 15min.

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12
Q

Nursing care during 1st stage of labor

A

Emotional support, comfort measures, info and advice, advocacy, support of the partner

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13
Q

Nursing care during latent phase of 1st stage of labor

A

Monitor maternal temp every 4hrs unless temp is over 99.6 (every hr). Monitor Bp, pulse & respirations every hr. If BP is over 120/80 and pulse more than 100 notify physician and check frequently

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14
Q

Nursing care during active phase of 1st stage of labor

A

Palpate contractions every 15-30min. As contractions intensify, vaginal exams are done only when needed to asses cervical dilation, effacement, & fetal station/position.

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15
Q

Nursing care during transition phase of 1st stage of labor

A

Encourage women to rest between contractions. If analgesics have been administered, quiet environment enhances quality of rest

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16
Q

Nursing care during 2nd stage of labor

A

When time to bear down and push, nurse should encourage women and help w/ positioning. Massage, cool clothes to face/forehead with help cool pt down

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17
Q

Pharamachological pain: EPIDURAL BLOCK
Where does the epidural act?

A

Eliminates pain from umbilicus to the thighs, relieving discomfort from contractions, fetal decent and stretching of perinuem.

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18
Q

What are nurse intervention for epidural block?

A

Assess for orthostatic hypotension, assess fhr continuously, assess bladder for distention, help position into sitting or side lying sims

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19
Q

Non-pharmacological pain

A

Reduces anxiety, fear, tension (factors that contribute to pain) by walking, rocking, sacral counterpressures, apply heat or cold, acupressure, position changes

20
Q

What are the principles of fetal heart monitoring?

A

Normal FHR is 110-160/min w/ increases and decreases from baseline. Tachycardia is > 160/min for 10 mins or longer. Bradycardia <110/min for 10 mins or longer

21
Q

What are some advantages of electronic fetal monitoring (EFM)?

A

Non invasive, reduces risk of infection, membranes do not have to ruptured, Cervix does not have to be dilated, placement of transducer, provides permanent record of FHR and uterine contractions

22
Q

List disadvantages of EFM

A

Contraction intensity not measurable, movement of client= repositioning transducers, quality of recording is affected by obesity and fetal position

23
Q

Describe FHR variability and their classifications

A

Fluctuations in baseline that are irregular in frequency and amplitude. Classifcations:
Absent or undetectable variability
Minimal (detectable but =/< 5min
Moderate (6-25min)
Marked (>25min)

24
Q

Included in category I of Three-tier system of FHR

A

baseline 110- 160/min, variability: moderate, acceleration: present or absent, early decelerations: present or absent, variable or late decelerations: absent

25
Q

Category II FHR tracings (baseline/ variability)

A

Baseline rate: tachycardia, bradycardia not accompanied by absent baseline variability
Baseline FHR variability: minimal, absent variability not accompanied by recurrent decelerations, marked baseline variability

26
Q

Category II FHR tracing (decelerations)

A

Prolonged decelerations =/> 2min but < 10min
Recurrent late decelerations w/ moderate variabity
Recurrent variable decelerations w/ minimal/ moderate variability
Variable deceleration w/ overshoots, shoulders, or slow return

27
Q

Category II FHR tracings (accelerations)

A

Absence of inducted accelerations after fetal stimulation

28
Q

Describe category III FHR tracings

A

Sinusoidal pattern
Absent baseline, variability and recurrent variable decelerations recurrent late decelerations and bradycardia

29
Q

What is uterine contraction compromised by?

A

Increment, acme and decrement

30
Q

What is increment?

A

The beginning of the contraction as intensity increases

31
Q

What is acme?

A

The peak of contraction

32
Q

What is decrement?

A

The decline of the contraction intensity as contraction is ending

33
Q

Non reassuring patterns are associated w/ fetal hypoxia and include the following

A

Bradycardia, tachycardia, absence of FHR variability, late decelerations, variable decelerations

34
Q

What is early deceleration of FHR?

A

Slowing of FHR at the start of contraction w/ return of FHR to baseline at the end of contraction

35
Q

What are causes/implications of EARLY deceleration?

A

Compression of the fetal head from uterine contraction, vaginal exam, fundal pressure

36
Q

What is late deceleration?

A

Slowing of the FHR after contraction has started w/ return of FHR to baseline well after contraction has ended

37
Q

What are causes/ implications of LATE decelerations

A

Uteroplacental insufficiency causing inadequate oxygenation, maternal hypotension, placenta Previn, abrupt placentae, uterine tachysystole w/ oxytocin, preeclampsia, late/post term pregnancy, maternal DM

38
Q

List intervention of late decelerations

A

Place pt on side, increase rate of IV fluid, discontinue oxytocin, administer O2 at 8-10L/min (non breather), elevate pt legs, notify provider, prepare for assisted vaginal birth or c- section

39
Q

What are variable decelerations?

A

Transitory, abrupt slowing of FHR 15/min or more below baseline for at least 15 sec, variable in duration, intensity and timing related to contraction.

40
Q

Causes/ complications of variable decelerations

A

Umbilical cord compression, short cord, prolapsed cord, nuhcal cord

41
Q

What are interventions of variable decelerations?

A

Reposition from side to side or into knee-chest, discontinue oxytocin, administer O2 8-10l/min (non breather), vaginal exam, assist with amnioinfusion if prescribed

42
Q

Where can FHR tones be heard in vertex presentation (fetal position)

A

FHR tones should be assessed below umbilicus in RLQ or LLQ of abdomen

43
Q

Where can FHR tones be heard in breech presentation

A

Assessed above umbilicus in RUQ or LUQ of abdomen

44
Q

What must you have the pt do before asses FHR tones?

A

Have pt empty her bladder and lie on her back w/ feet on the bed and knees bent

45
Q

Which of the 5 P’s of labor is hindering labor? Why?

A

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

OB (4 decks)

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