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NU 330 > Chapter 8 > Flashcards

Chapter 8 Flashcards

1
Q

how many stages of labor are there?

A

4

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2
Q

stage 1 of labor is subdivided into:

A
  • latent: up to 5 cm dilated
  • active: 6-7 cm dilated
  • transition: 8-10 cm dilated
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3
Q

what happens during stage 1 of labor?

A
  • ROM
  • cervix dilates and causes pain
  • assess vitals
  • assess pain
  • FHR & contractions
  • cervical changes
  • fetal decent & position
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4
Q

which stage of labor is the longest?

A

stage 1

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5
Q

nursing actions: stage 1

A
  • limit PO fluids
  • assist with comfort measures
  • encourage frequent position changes
  • help with bowel movements
  • educate
  • peri care
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6
Q

ROM means

A

rupture of membranes

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7
Q

SROM means

A

spontaneous rupture of membranes

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8
Q

how to assess ROM

A
  • ferning: sample fluid from upper vaginal area is placed on a glass slide and assessed for a ferning pattern-ROM occurred
  • nitrazine paper: turns blue when in contact with amniotic fluid-ROM occurred
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9
Q

nursing actions: ROM

A
  • check for umbilical cord prolapse
  • assess color of fluid: should be clear/cloudy without odor; report other colors
  • educate regarding when to seek medical attention
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10
Q

ROM: non-risk patient education *when to go to hospital

A
  • go to hospital when contractions are consistent for 1 hour, and are 5 minutes apart, lasting 60 seconds
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11
Q

ROM: immediate risk patient education

A
  • SROM
  • intense pain
  • bloody show increases
    (needs to go to hospital asap)
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12
Q

stage 2 of labor is

A

10 cm dilated to birth

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13
Q

how does the nurse assist with pushing?

A
  • push for 6-8 seconds
  • slight exhale
  • repeat 3-4 times
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14
Q

what happens during stage 2 of labor?

A
  • baby actively moves down the birth canal
  • lasts about 50 minutes
  • contractions intensify
  • perineal stretching can help decrease tears
  • mom feels urge to push
  • perineum flattens
  • rectum and vagina bulge
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15
Q

episiotomy

A
  • surgical incision made to perineum to aid in delivery
  • done by HCP
  • can be midline (straight down)
  • can be mediolateral (diagonal)
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16
Q

nursing actions: episiotomy

A
  • inspection approximated
  • free of foul smell drainage
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17
Q

laceration

A
  • tear of perineum
  • not done by HCP, happens naturally
  • graded: 1st, 2nd, 3rd, 4th
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18
Q

nursing actions: laceration

A
  • assess for slow, steady trickle of blood
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19
Q

stage 3 of labor

A

begins after birth and ends with the expulsion of the placenta

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20
Q

nursing interventions: stage 3 of labor

A
  • watch for signs of placental separation:
    -increase in cord length
    -upward rising of uterus into a ball shape
    -sudden gush of blood from the vagina
  • assist w/ delivery of placenta:
    -encourage breathing and abdominal relaxation during delivery of the placenta
  • assess fundus continuously; palpate fundus
  • possible need for admin of Pitocin if excess bleeding is noted * have med & IV fluids in room if hemorrhage occurs
  • placenta out: assess for hemorrhage
  • provide newborn care
  • skin to skin
  • monitor delivery of placenta
  • admin oxytocin IM or IV if placenta takes > 30 min to deliver
  • inspect placenta to make sure it is 100% (don’t want to leave any behind)
  • obtain order for pain meds or uterotonics PRN
  • assess vitals q15 min
  • encourage bonding
  • admin pain meds
  • document
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21
Q

nursing interventions: stage 4 of labor

A
  • palpate fundus q15 min x 1 hour: assessing for uterine involution and/or uterine atony
  • assess vaginal bleeding
  • encourage bonding & breastfeeding
  • have Pitocin IV available, if needed, for hemorrhage
  • assess perineum & provide perineal care: tears and lacerations
  • heated blanket
  • provide food
  • encourage rest
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21
Q

stage 4 of labor

A

delivery of placenta to maternal recovery

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22
Q

pain management in labor: nonpharmacologic

A
  • childbirth classes
  • relaxation and breathing
  • cutaneous stimulation- effleurage
  • thermal stimulation
  • mental stimulation
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23
Q

pain management in labor: pharmacologic

A
  • local
  • pudendal block
  • epidural block
  • spinal
  • general
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24
Q

labor triggers: maternal factors

A
  • stretching of uterine muscles
  • estrogen/progesterone changes
  • oxytocin release
  • release of prostaglandins
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25
Q

labor triggers: fetal factors

A
  • fetal cortisol changes
  • placenta ages
  • prostaglandins increase causing contractions
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26
Q

5 P’s: factors affecting labor

A
  • Powers: contractions
  • Passage: pelvis and birth canal
  • Passenger: the fetus
  • Psyche: the response of woman
  • Position: maternal posture and the physical positions to facilitate birth
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27
Q

powers

A

uterine contractions
- rhythmic
- synchronized
- intermittent (not constant, come and go)
upper 2/3 contracts and pushes down
lower segment less active - becomes thin and pulls up

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28
Q

DIF of contractions

A

Duration: how long
Intensity: how strong
Frequent: how often

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29
Q

passage

A

includes pelvis and birth canal

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30
Q

pelvis types

A
  • gynecoid: fat heart
  • android: skinny heart
  • anthropoid: narrow but tall (oval)
  • platypelloid: wide but short (narrow)
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31
Q

parts of the pelvis

A
  • ileum
  • ischium
  • pubis
  • sacrum and coccyx
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32
Q

what plays the biggest role in determining a successful vaginal delivery?

A

the maternal pelvis

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33
Q

effacement

A
  • shortening and thinning of the cervix
  • expressed in percentages 0-100%
  • starts out 2-3 cm long and 1 cm thick
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34
Q

female pelvis: ischial spines- station

A
  • stations are measured as cm up or down the ischial spine
  • -3 to 0 = above the ischial spine
  • 0 = narrowest point & is at the ischial spine
  • +1 to +3 = below the ischial spine
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35
Q

passenger vs passageway relationship

A
  • relationship of fetus to passageway is a major factor in the birthing process
    relationship includes:
  • size of fetal head/skull
  • fetal lie
  • fetal attitude
  • fetal presentation
  • fetal position
  • fetal size
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36
Q

fetal skull

A
  • head is biggest part of fetus
  • head molds to allow the skull to fit through the birth canal
  • sutures (listed anterior - posterior) : frontal |, coronal - , sagittal |, lambdoid -
  • fontanels (squishy, soft patches): anterior, posterior
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37
Q

fetal attitude

A

relationship of the fetal parts to one another

  • vertex presentation
  • brow presentation
  • face presentation
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38
Q

fetal attitude: general flexion

A

back of the fetus is rounded, chin to chest, thighs are flexed on abdomen, legs flexed at the knees

*deviations from normal/gen flex can cause difficulties with labor and birth (i.e. extended head)

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39
Q

vertex presentation

A

head is completely flexed onto the chest
occiput is the presenting part

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40
Q

brow presentation

A

forehead down

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41
Q

face presentation

A

face down
- bruising on baby’s face

42
Q

fetal lie

A
  • refers to the relation of the long axis of the fetus to the mom’s long axis
  • longitudinal: vertical
  • transverse: horizontal
43
Q

frank breech

A

butt down, legs extended up by head

44
Q

complete breech

A

butt down, legs crossed, head tucked chin to chest

45
Q

footling breech

A

1 foot down, 1 foot out, head up

46
Q

fetal position

A
  • relationship of the reference point of the fetus to the mom’s pelvis
  • examiner during internal vaginal exam feels for the presenting part and figure out what it is
  • cephalic: occipital bone
  • breech: sacrum
47
Q

positions: right occiput

A
  • ROA: occiput is on the right side of the maternal pelvis: anterior meaning closer to the front of the pelvis
  • ROT: occiput is on the right side of the maternal pelvis: transverse meaning across the maternal pelvis
  • ROP: occiput is on the right side of the maternal pelvis: posterior meaning to the back part of the pelvis
48
Q

positions: left occiput

A
  • LOA: occiput is on the left side of the maternal pelvis: anterior meaning closer to the front of the pelvis
  • LOT: occiput is on the left side of the maternal pelvis: transverse meaning across the maternal pelvis
  • LOP: occiput is on the left side of the maternal pelvis: posterior meaning to the back part of the pelvis
49
Q

positions: breech

A
  • LSA: sacrum is on the left side of the maternal pelvis with the sacrum sitting anterior (in the front) of the maternal pelvis
  • LSL: sacrum is on the left side of the maternal pelvis with the sacrum sitting lateral of the maternal pelvis
  • LSP: sacrum is on the left side of the maternal pelvis with the sacrum sitting posterior (behind) of the maternal pelvis
  • RSP: sacrum is on the right side of the maternal pelvis with the sacrum sitting posterior (behind) of the maternal pelvis
  • RSL: sacrum is on the right side of the maternal pelvis with the sacrum sitting lateral of the maternal pelvis
  • RSA: sacrum is on the right side of the maternal pelvis with the sacrum sitting anterior (in the front) of the maternal pelvis
50
Q

maternal psyche

A

refers to mother’s disposition during each stage of labor

51
Q

psyche: coping mechanisms

A
  • culture
  • expectations
  • support systems
  • type of support during labor
52
Q

maternal positions

A
  • upright
  • all fours
  • lateral
53
Q

maternal position: upright

A
  • walking
  • standing
  • kneeling
  • squatting
  • sitting: improve abdominal muscles working in greater synchrony with contractions and bearing down effort
54
Q

maternal position: all fours- purpose

A

relieves backache if fetus is occiput/posterior

55
Q

the lateral maternal position is used to ____

A

help rotate fetus that is in a posterior position

56
Q

intrapartum

A

onset of labor through the delivery of the placenta

57
Q

lightening

A

fetus decsends into the pelvis

58
Q

braxton hicks

A

practice contractions
does not change the cervix
prepares the body for labor

59
Q

how does labor influence the cervix/what changes happen to the cervix?

A

soften and thin

60
Q

nesting

A

moms organize, clean and prepare for baby

61
Q

involuntary uterine contractions

A

effacement: thin out the cervix

62
Q

voluntary expulsion of the infant

A

pushing

63
Q

what are the two types of powers?

A
  • involuntary uterine contractions
  • voluntary expulsion of the infant
64
Q

what is the most common pelvis shape?

A

gynecoid
- 50% of women have this shape

65
Q

what is the optimal pelvis shape?

A

gynecoid

66
Q

which pelvis type would have molding of the head?

A

android pelvis

67
Q

which pelvis type is the least common?

A

platypelloid

68
Q

which pelvis type typically has the longest labor?

A

anthropoid

69
Q

dilation

A

the widening of the cervical opening from less than 1 cm to 10 cm (full dilation)
- fully dilated = 10 cm

70
Q

do effacement and dilation both need to happen for delivery?

A

for vaginal- yes

71
Q

do effacement and dilation happen at the same time or one before the other?

A

a nulligravida mom will have effacement before dilation; a multigravida mom may have effacement and dilation occur simultaneously

72
Q

most common presentation

A

cephalic (head)
- vertex
- occiput is presenting part
- 95% of all deliveries

73
Q

what are the ideal positions for a vaginal delivery?

A

ROA or LOA

74
Q

what is the presenting part of a frank breech infant?

A

buttocks

75
Q

shoulder presentation

A
  • usually represents a transverse lie
  • c section
76
Q

false labor

A
  • contractions but no change in cervix
  • activity doesn’t change pattern
  • hydration or sedation slows/stops ctxs
77
Q

true labor

A
  • regular contractions increase in frequency and intensity
  • change in cervix
  • causing effacement and dilation
78
Q

active labor is defined as ___

A

6 cm

79
Q

why is prolonged pushing (2 hr) good for baby?

A
  • pushes all the mucous and fluids out of fetal chest/lungs
  • baby comes out dry, ready to eat
80
Q

1st degree laceration

A

involves the perineal skin and vaginal mucous membrane

81
Q

2nd degree laceration

A

involves skin, mucous membrane, and fascia of the perineal body

82
Q

3rd degree laceration

A

involves skin, mucous membrane, and muscle of the perineal body

83
Q

4th degree laceration

A

extends into the rectal mucosa and exposes the lumen of the rectum

84
Q

oxytocin (pitocin)

A

hormone -IV or IM

  • stimulates uterine muscle that produces intermittent contractions
  • has vasopressor and antidiuretic properties
85
Q

methergine

A

oxytocic or ergot alkaloids

  • increases the tone, rate and amplitude of contractions on the smooth muscles of the uterus, producing sustained contractions and reducing blood loss
86
Q

hemabate/carboprost

A

prostaglandin F2a analog

increases contractions of the uterine smooth muscles

87
Q

misoprostol (cytotec)

A

synthetic analog of prostaglandin E

  • acts as a prostaglandin analogue causing uterine contractions
88
Q

tranexamic acid/TXA

A

antifibronolytic

  • inhibits fibrinolysis (stops the breakdown of clots)
89
Q

1 g blood loss = __ mL blood loss

A

1 mL

90
Q

retained placenta causes what ?

A

PPH (post partum hemorrhage)

91
Q

oxytocin/pitocin: side effects

A
  • hypotension
  • tachycardia
  • water retention
92
Q

oxytocin/pitocin: indications

A
  • control of postpartum bleeding after placental expulsion
93
Q

methergine: indications

A
  • prevent or treat PPH, uterine atony, or subinvoliution
  • used as a second-line medication
94
Q

what do we monitor with methergine use?

A
  • BP
  • CNS status
  • vaginal bleeding
  • may cause nausea
    (patient may require antiemetic)
95
Q

methergine is contraindicated in patients with __

A
  • hypertension
  • preeclampsia
  • may cause severe vasoconstriction
96
Q

hemabate/carboprost: indications

A
  • uterine atony
  • second-line medication
  • carboprost is a treatment alternative to methylergonovine for patients with HTN disorders
  • may be used in hemorrhage situations retractory to methylergonovine and oxytocin
97
Q

hemabate/carboprost: side effects

A
  • nasuea
  • vomitting
  • diarrhea
98
Q

hemabate/carboprost is used with caution with patients with ___

A

asthma
- carboprost can stimulate vasospasm

99
Q

misoprostol: side effects

A
  • abdominal pain
  • diarrhea
  • fever
  • chills
100
Q

misoprostol: indications of use

A
  • used to control PPH
  • 1st line medication in low-resource areas where oxytocin is not available
101
Q

tranexamic acid/TXA: side effects

A
  • abdominal pain
  • headache
  • nausea
  • vomiting
  • diarrhea
102
Q

tranexamic acid/TXA: route/dosage

A

1g IV over 10-20 minutes

103
Q

what are the most common uterotonic medications?

A
  • oxytocin/pitocin
  • methergine
  • hemabate/carboprost
  • misoprostol (cytotec)
  • tranexamic acid/TXA

NU 330 (18 decks)

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