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OB > Chapter 19: Nursing Care of the Family During Labor and Birth > Flashcards

Chapter 19: Nursing Care of the Family During Labor and Birth Flashcards

1
Q

the first stage of labor is often called the stage of ________

A

dilation

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2
Q

the first stage of labor begins with ______ and ends with _______

A

onset of regular uterine contractions; complete dilation of the cervix

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3
Q

what stage of labor is most often the longest?

A

the first stage

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4
Q

three distinct phases of the first stage of labor

A
  1. latent
  2. active
  3. transition
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5
Q

the ______ phase of labor begins with the establishment of regular contractions

A

latent

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6
Q

during the latent phase contractions are usually about ______ minutes apart and last ______ seconds

A

5 minutes apart; 30-45 seconds

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7
Q

during the latent phase the cervix dilates_______

A

0-3 cm

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8
Q

the latent phase can last up to _______

A

10-14 hours

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9
Q

contractions in the active phase occur every _______ minutes and last _______ seconds

A

3-5 minutes; 45- 60 seconds

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10
Q

active phase of labor the cervix dilates to ________

A

4-7 cm

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11
Q

_______is the most intense phase of labor

A

transition

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12
Q

transition is characterized by frequent, strong contractions that occur every _______ minutes and last ________ seconds

A

2-3 minutes; 60-90 seconds

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13
Q

stage 1 usually lasts ________ hours for primipara and ______ hours for multiparas

A

10; 8

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14
Q

the second stage of labor begins with _______ and ends with __________

A

full dilation of the cervix; birth of the infant

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15
Q

the nurse may suspect the second stage of labor has begun when:

A

the mother feels an urge to push or involuntarily bear down

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16
Q

What is crowning

A

just before external rotation and the fetal and expulsion, the fetal head is in OA position

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17
Q 
these things increase during labor: 
1.
2.
3.
4.
5.
A
  1. WBC
  2. CO
  3. HR/RR
  4. temp
  5. BP during contractions (goes back to baseline during relaxation)
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18
Q

new phases of stage 1 of labor: (only 2)

A
  1. Latent

2. Active (6-10 cm)

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19
Q

these things decrease during labor:
1.
2.

A
  1. Maternal blood glucose

2. GI motility

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20
Q

______ provides predictive and reliable information about fetal oxygenation

A

Fetal heart rate

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21
Q

fetal heart sounds are best heard over ________ when the fetus is in ______ position

A

the fetal back; flexed position

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22
Q

typically with a cephalic presentation, the fetal heart sounds are best auscultated_____________

A

below the level of the maternal umbilicus

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23
Q

in a ROA presentation, the fetal heart sounds are best heard when auscultated ________

A

right lower quadrant

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24
Q

in a breech presentation the fetal heart sounds are best heard when auscultated ___________

A

above the level of the umbilicus

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25
Q

in LSA position, the fetal heart sounds are best heard when auscultated _________

A

upper left quadrant

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26
Q

________ decreases fetal circulation

A

uterine contractions

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27
Q

during a low risk pregnancy, how often are maternal vital signs taken?

A
  • V/S every hour
  • temp every 4 hours while membranes are in tact
  • temp every two hours after ROM
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28
Q

during a high risk pregnancy, how often are maternal vital signs taken?

A
  • monitor every 15-30 minutes

- temp every 2-4 hours based on membrane status

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29
Q

during the active phase of labor how much effacement occurs?

A

40-80% (usually 100 % in primiparas)

30
Q

after an epidural or Foley insertion the mother’s vital signs should be monitored __________

A

every 1-2 minutes

31
Q

___________ reveals whether a woman is in true labor and if the membranes have ruptures

A

vaginal examination

32
Q

what laboratory tests and assessments are done when the pt arrives in suspected labor? (six major tests)

A
  1. CBC
  2. Urinalysis
  3. HIV
  4. Type and screen
  5. GBS if status is unknown
  6. assessment of amniotic fluids
33
Q

Mechanism of Labor in order (7 steps)

A
  1. engagement
  2. descent
  3. flexion
  4. internal rotation
  5. extension
  6. external rotation
  7. expulsion
34
Q

______ describes the fetal head passing through the pelvic inlet

A

engagement

35
Q

__________ refers to the fetus moving into the birth canal

A

descent

36
Q

_______ refers to the fetus moving its chin toward its chest

A

flexion

37
Q

________ refers to the fetal head aligning with the long axis of the maternal pelvis

A

internal rotation

38
Q

________ refers to the fetus head position when the head is delivered

A

extension

39
Q

_______ describes when the fetal shoulders align along the anteroposterior diameter

A

external rotation

40
Q

________ refers to when the fetal shoulders and body are delivered

A

expulsion

41
Q

first degree perineal tear

A

injury to the perineal skin and vaginal epithelium only

42
Q

second degree perineal tear

A

extends to fascia and muscles of perineal area

43
Q

third degree perineal tear

A

injury through fascia and muscles of perineal area and also extends to the anal sphincter complex

44
Q

fourth degree perineal tear

A

perineal fascia & muscles, anal sphincter, and anal epithelium

45
Q

_______ is when the woman begins pushing at full cervical dilation regardless of the urge to bear down

A

closed-glottis pushing (aka directed pushing)

46
Q

________ is the recommended method of pushing and occurs only when the mother feels the urge to bear down

A

open glottis pushing (aka involuntary pushing)

47
Q

as the fetal head progresses downward the the perineum begins to stretch, thin out, and move ________

A

anteriorly

48
Q

cord clamping should be delayed _______

A

60 -120 seconds, or when cord stops pulsating

49
Q

third stage of labor begins with ______ and ends with ______

A

birth of the infant; delivery of the placenta

50
Q

during the third stage of labor it is common to see_____ and _____

A

cord lengthen; trickle of blood from the vagina

51
Q 
the following indicate separation of the placenta from the uterus:
1.
2.
3. 
4.
A
  1. uterus becomes spherical in shape
  2. uterus rises upward in the abdomen
  3. umbilical cord descends further through the vagina
  4. a gush of blood occurs once the placenta detaches from the uterus
52
Q

if a peripheral IV infusion is established then ______ units of Pitocin is administered after the delivery of the placenta

A

10-20 units

53
Q

if no peripheral IV infusion is established then ______ units of Pitocin is given _______ after the delivery of the placenta

A

10; intramuscularly

54
Q

after the delivery of the placenta vital signs of mother should be closely monitored, focusing on ______ and _____

A

BP; HR

55
Q

the fourth stage of labor begins with _____ and ends with ________

A

after the delivery of the placenta; within 1-2 hours after delivery

56
Q 
key characteristics of the fourth stage of labor include:
1.
2.
3.
4.
A
  1. Newborn is assessed
  2. medications are given- mother and baby
  3. mother may breastfeed for the first time
  4. maternal/infant bonding is encouraged (skin to skin)
57
Q

_______ is used to assess the transition stage from fetus to neonate

A

Apgar scoring

58
Q

The Apgar Scoring system evaluates five signs of newborn cardiopulmonary adaptation and neuromuscular function:

A
  1. heart rate
  2. respiratory effort
  3. muscle tone
  4. reflex irritability
  5. color
59
Q

slow heart rate in a newborn would be ________

A

below 100 BPM

60
Q

sign of adequate respiratory effort in neonate

A

vigorous cry

61
Q

sign of good muscle tone in a neonate

A

the babies extremities return to a flexed position after the nurse extends them

62
Q

how is reflex irritability tested in neonates

A

after gently stroking the spine or flicking the foot the baby should cry (2 points) or at least grimace (1 point)

63
Q

acrocyanosis

A

most newborns exhibit cyanosis in the extremities during the 1 minute APGAR score and it is known as acrocyanosis

64
Q

during the fourth stage of labor the nurse assesses the mother’s uterus for _______, ________, and _______

A

firmness; height; position

65
Q

where should the fundus be palpable following birth of the fetus and placenta

A

midline at or just below the umbilicus

66
Q

a soft, or “boggy” uterus on palpation indicates:

A

excessive blood and/or blood clots have pooled in the uterus

67
Q

what should the nurse do if the uterus feels boggy

A

massage the fundus until it feels firm

68
Q

________ soaked pad(s) within the first postpartum hour is considered the normal maximum flow

A

1

69
Q

a rising pulse and lower blood pressure of the mother following delivery is a sign of

A

hemorrhaging

70
Q

_______ must be well contracted following delivery of baby and placenta

A

myometrium

71
Q 
a woman who had a C-section will go to the PAR (post-anesthesia recovery) unit where they will assess: 
1.
2.
3.
4.
5.
A
  1. activity
  2. respirations
  3. BP
  4. level of consciousness
  5. color

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