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Family Health Concepts - NUR 113 Exam II > Concept of Reproduction - Intrapartum > Flashcards

Concept of Reproduction - Intrapartum Flashcards

1
Q

what does ROM stand for ?

A

rupture of membranes

PROM = premature rupture of membranes

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2
Q

how is PROM diagnosed?

A
  • by a sterile speculum exam by physician looking for (fluid pooling in vagina, test fluid with nitrazine paper, observes under microscope for fern pattern)
  • Sterile vaginal exam (SVE) is avoided in preterm pregnancies because it increased risk of infection, but can be performed for a term pregnancy.
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3
Q

What nursing assessment is done for a patient with PROM?

A
  • COAT (color, odor, amount, time)
  • signs and symptoms of labor
  • signs of infection
  • if term, SVE for dilation and presence of cord
  • if preterm, SSE looking for the same things
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4
Q

What is the treatment for PROM?

A 
if term; 
move towards delivery
if ruptured longer than 18 hours begin a course of IV antibiotics and consider augmentation of labor 
if preterm;
antibiotics --> IV than oral (short-term)
Betamethasone (fetal lung maturity)
IV magnesium sulfate (neruoprotective)
inpatient monitoring until labor occurs
deliver at 34-37 weeks
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5
Q

what is done if a PROM/prolapsed cord occurs?

A

a sterile vaginal exam will be performed, with the nurse of the physician holding the presenting part of the cord until the baby is delivered.
-prolapsed cord is an emergency and a STAT cesarean section is necessary

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6
Q
  • increases risk of infant mortality, respiratory distress syndrome (RDS)
  • _____ newborns have immature organs and systems, they are not prepared for life outside the uterus
A

Preterm labor

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7
Q

classified as such if labor is prior to 37 weeks gestation.

  • if patient is experiencing contractions tell them to stop what they are doing.
  • hydrate, rest, and continue to monitor
  • call MD if they do not go away
A

Preterm labor

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8
Q

contractions that are regular, get stronger, and closer together, causing cervical dilation/effacement

A

Labor

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9
Q

What are some treatments for pre-term labor ?

A
  • tocolysis: suppression of uterine contractions (IVF hydration, Nifedipine (calcium channel blocker), Terbutaline (used less frequently d/t side effects)
  • Magnesium sulfate (neuroprotective)
  • Betamethasone
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10
Q

placenta typically implants in the upper portion of the uterus. Placenta ____ indicates a placenta that is implanted in the lower portion of the uterus or is actually at the lowest portion, covering the cervical opening.

  • this condition can cause painless uterine bleeding (bright red)
  • confirmed only by an ultrasound
A

Previa

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11
Q

A complete and partial previa has to be delivered by a _______ section. while a marginal and low-lying previa can be delivered vaginally.

A

cesarean section

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12
Q

what are some complications of previa?

A
  • bleeding (loss of blood and vital oxygen)
  • cesarean section
  • preterm labor
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13
Q

How does one assess and treat previa?

A
  • monitor blood loss
  • monitor Vs, fetal heart rate, and contractions
  • Labs
  • no vaginal exams (if ever unsure about the reason for bleeding do not perform vaginal exam)
  • IVF and/or blood transfusions
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14
Q

placenta separates from uterine wall prematurely.
-there are varying degrees but a complete _______ is an EMERGENCY
-confirmed by ultrasound
(marginal separation at edge vaginal bleeding is present) central separation the blood is trapped (complete total separation massive bleeding occurs)

A

abruption

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15
Q

what complications are associated an abruption?

A
  • severe blood loss
  • disseminated intravascular coagulation
  • perinatal mortality (fetal) %
  • fetal anemia, hypoxia
  • preterm delivery and associated risk
  • cesarean section
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16
Q
  • increasing due to fertility treatments
  • fraternal (dizygotic) : occur from 2 separate ova
  • identical (monozygotic): occur from 1 ova
  • increased risk for : miscarriage, preterm labor, cesarean section, preeclampsia, PROM)
  • monitored more closely, more frequent office visits
A

Multiple gestation

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17
Q

both babies share a single placenta and amniotic sac

-high risk: long-term fetal monitoring d/t cord enlargement

A

Monochorionic - monoamniotic

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18
Q

babies share a single placenta but have their own sacs.

  • risk for twin to twin transfusion
  • high risk, long-term fetal monitoring, potential need for surgical procedure in utero.
A

Monochorionic - diamniotic

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19
Q

babies have their own placenta and sac

A

dichorionic - diamniotic

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20
Q

during what half of the pregnancy does the fetus begin to swallow and inspire amniotic fluid and to urinate?

A

second half

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21
Q

characterized by:
excessive amniotic fluid
fetal anomalies can cause this increased fluid
maternal discomfort, prolapsed cord

A

polyhydramnios

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22
Q

characterized by:
less than normal amount of amniotic fluid
fetal anomalies, such as renal conditions, can cause the lack of fluid
skeletal abnormalities, respiratory difficulties, and fetal intolerance of labor can occur

A

Oligohydramnios

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23
Q

thinning of the cervix

A

effacement

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24
Q

opening of the cervix

A

dilatation

25
Q

what are the 5 P’s of labor assessment

A
  1. passageway
  2. passenger
  3. position
  4. physiological forces
  5. psyche
26
Q

what is assessed of the passageway ?

A

THE BIRTH PASSAGE

  • size of pelvis
  • type of pelvis (gynecoid, anthropoid (favorable))
  • ability of the cervix to dilate and efface
27
Q

What is assessed of the passenger (THE FETUS)?

A
  • fetal head (5 plates that allow fetal head to adjust to fit through pelvis)
  • fetal attitude (relation of fetal parts to one another, flexion of head, arms, legs)
  • fetal lie ; relationship of fetal spine to maternal spein
  • fetal presentation; presenting part (cephalic (head), breech, or shoulder)
28
Q

what is assessed of the position of the baby?

A
  • relationship between maternal pelvis and presenting part
  • engagement (presenting part at ischial spines)
  • station (relationship to ischial spines)
  • fetal position (fetal landmark and relation to maternal pelvis)
29
Q

what is the physiological factors involved in labor?

A

-Progesterone relaxes smooth muscle, oxytocin stimulates uterine contractions
CONTRACTIONS
-rhythmic, intermittent
-causing effacement and dilatation
-measured in frequency, duration and intensity
-stronger, longer, and closer together

30
Q

what is to be assessed of the psyche involved in labor?

A
  • planned or unplanned
  • support from family/significant other
  • other children
  • health of mother and/or newborn
  • childbirth preparation; does she fear the unknown
31
Q

What are the signs of labor ?

A
  • lightening (when the baby drops)
  • contractions
  • cervical changes
  • bloody show (burgundy looking)
  • rupture of membrane
  • GI upset (don’t encourage enemas or laxatives)
  • pg. 331 16-4 true vs false signs
32
Q

what are the three different phases involved in stage one of labor ?

A
  1. latent phase
  2. active phase
  3. transition phase
33
Q

Onset of true _____ until completely dilated 10 cm.

  • latent (early labor): entails the beginning of regular contractions that are mild and last 40 seconds, and frequent every 10-30 minutes. Gradually increases 5-7 minutes, duration lasting 45-60 seconds. This phase lasts until 3 cm.
  • active is where the cervix dilates from 4-7 cm and this is where there is increasing anxiety and reliance on support persons. Contractions are now every 3-5 minutes
  • Transition is when the cervix dilates from 8-10 cm and the patient becomes restless and changes positions frequently, and becomes fearful. Contractions are 60-90 seconds in length and occur every 2 minutes. May begin to feel rectal pressure as fetal head descends. increase of blood show, hyperventilation, this is commonly where individuals give up on their birth plan.
A

Labor

34
Q

This stage of labor is where there is complete dilation through delivery of the baby.

  • contractions continue to be 60-90 seconds in length occurring every 2 minutes.
  • laboring down
  • pushing
  • episiotomy or laceration
A

Stage two

35
Q

This stage of labor involves placental separation which typically occurs within 30 minutes of delivering the baby.

A

Stage three

36
Q

This stage of labor is characterized by being one to four hours after birth.

  • physiological readjustments begins
  • blood loss is about 250-500mL (250-300 for a vaginal delivery and 300-500 for a cesarean section)
  • Hypotension, and tachycardia
  • contractions of uterus constrict vessels where placenta was attached, to decrease bleeding
  • oxytocin is administered (helps with uterine contractions)
  • shaking and chills.
A

Stage four

37
Q

how often are fundal and VS checks in stage four of labor?

NOTES TO REMEMBER DURING assessement

  • monitor for bladder distention because this can cause increased bleeding
  • continuous trickle of blood from vagina, with a firm uterus may indicate a tear in the vagina that has not been located/repaired
A

every 15 minutes for the first hour; fundus will likely be halfway between the umbilicus and pubis during stage four

38
Q

surgical instrument used to assist in delivery of fetal head

  • can cause facial bruising/laceration on newborn, cephalohematoma with hyperbilirubinemia may occur
  • maternal lacerations of vaginal sidewalls
A

Forceps

39
Q

application of suction to fetal head to aid in delivery

-cephaloheatomas and brain injuries can occur

A

Vacuum

40
Q

birth through the abdomen

  • in U.S. 2013 32.8% of deliveries were by ______
  • typically a transverse skin and uterine incision
  • vertical incision is done for speed
  • epidural or spinal typically; general in the case of an emergency
A

Cesarean Section

41
Q 
is the artificial rupture of membranes (AROM) or amniotomy that typically happens at 39 weeks unless otherwise medically indicated. 
started by: 
- cervical rippening
-stripping membranes
-mechanical dilatation 
-Oxytocin infusion
A

Induction of labor

42
Q

a method of cervical ripening that can be easily removed, and can be used for vaginal birth after c-section (VBAC)

A

Cervidil

43
Q

a method of cervical ripening that can not be removed, contraindicated for VBAC

A

Cytotec

44
Q

This external monitor that can show the frequency and duration of contractions. (intensity must be assessed by palpation) *(used in conjunction with a Doppler transducer to simulate a non stress test.)

A

Tocotransducer

45
Q

This external fetal monitoring is placed over fetal back.

  • the baseline is 110-160 (average over 10 minutes, rounded to 5 bpm)
  • tachycardia, bradycardia
  • variability (absent, minimal, moderate, marked) indicated oxygenation
  • acceleration (15bpm x 15 seconds)
  • deccelerations (variable, early, late)
A

EFM/US transducer or a doppler transducer

46
Q

interplay between sympathetic and parasympathetic nervous systems.

  • fluctuations around the baseline
  • absent amplitude undetectable (associated with hypoxia)
  • minimal amplitude 5 beats/minute or less (can be indicative of sleep cycle or early gestation. can also be associated with hypoxia and/or tachycardia.
A

Variability

47
Q

increase in fetal heart rate caused by fetal movement.

-sign of fetal well-being and adequate oxygen reserve

A

accelerations

48
Q

umbilical cord compression, reducing blood flow between placenta and fetus

  • U,V,W shaped
  • abrupt descent and return
  • can occur at any time (with or without contraction)
A

Decelerations; Variable

49
Q

What is the treatment for variable decelerations?

A
  • Position change, oxygen administration, discontinue oxytocin, SVE for cord prolapse
  • if it is occurring during pushing, may opt to push with every other contraction
50
Q

signs and symptoms include : head compression, typically considered benign. Indicates descent of fetal head. If this type of decelerations happens during preterm, contact physician immediately and check cervix.

A

Early Decelerations

51
Q

clinical manifestations is uteroplacental insufficiency. This is indicative of decreased blood flow and oxygen to the fetus between contractions. this type of decelerations is always associated with contractions. causes maternal hypotension (d/t epidural placement), tachysystole, vena cava syndrome

A

Late Decelerations

52
Q

what is the treatment for late decelerations?

A
  • change position (will correct if it is due to hypotensoin and/or vena cava syndrome)
  • administer oxygen (O2 is what is missing, increase what mom is getting and you increase what baby is getting)
  • Check VS
  • IVF bolus (to correct hypotension)
  • Discontinue oxytocin (if we stop contractions, we stop labor)
  • **first you turn mom and administer O2. watch the monitor for a minute and allow the interventions a chance to work. If they continue give IVF if BP is low. if the BP is stable discharge the oxytocin.
53
Q

_______ profile assesses fetal well being by measuring with five variables with a score of 2 for each normal finding, and a 0 for each abnormal finding for each variable. Variables include; FHR, fetal breathing movements, gross body movements, fetal tone and qualitative amniotic fluid volume

A

Biophysical Profile

  • 8 to 10 is considered NORMAL, low risk of chronic fetal asphyxia
  • 4 to 6 is considered ABNORMAL, suspect chronic fetal asphyxia
  • less than 4; ABNORMAL, strongly suspect chronic fetal asphyxia
54
Q

The variable associated with FHR is dependent on a non-stress test. A normal finding is indicative of a reactive non-stress test and the abnormal is nonreactive.

A

Fetal Heart Rate variability involved in the Biophysical Profile

55
Q

The variable that is indicated by at least 1 episode of greater than 30 seconds duration in 30 min equals a normal finding. while anything less than 30 seconds or completely absent is a abnormal finding.

A

fetal breathing movements of a biophysical profile

56
Q

the variable that is indicated by at least 3 body or limb extensions with return to flexion in 30 min is a normal (2) score while anything less than 3 episodes is abnormal (0).

A

gross body movements of a biophysical profile

57
Q

the variable that is indicated by at least 1 epsiode of extension with return to flexion is a normal finding (2), or a low extension or flexion, lack of flexion, or absent movement is an abnormal finding (0).

A

fetal tone of a biophysical profile

58
Q

the variable that is indicated by at least 1 pocket of fluid that measures at least 2cm in 2 perpendicular planes is a normal finding (2). while pockets that are absent or less than 2 cm is considered abnormal (0).

A

qualitative amniotic fluid volume of a biophysical profile

59
Q

The aspiration of amniotic fluid for analysis by insertion of a needle transabdominally into a client’s uterus and amniotic sac under direct ultrasound guidance locating the placenta and determining the position of the fetus. It may be performed after 14 weeks of gestation.

A

Amniocentesis

Family Health Concepts - NUR 113 Exam II (5 decks)

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