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Dressler > Dressler Module 3 > Flashcards

Dressler Module 3 Flashcards

1
Q

What are some alternative pain controls

A

Positioning, Relaxation Techniques, Control breathing with EFFLEURAGE (light massage on abdomen), Positive imagery, Distractions, Acupressure, Massage, Cultural Implications

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2
Q

What does Analgesic Pain Control provide

A

Provides emotional & physiological benefits but can interfere with respiratory system of newborn. NOT GIVEN IF BIRTH IS WITHIN ONE HOUR

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3
Q

What are opiates

A

Decreases perception of pain (Narcan, Demerol)

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4
Q

These are used in latent phase and allows mom to rest to conserve energy

A

Sedative

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5
Q

What do tranquilizers do

A

relaxes mom and baby (NOT RECOMMENDED)

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6
Q

When can narcotics be given

A

Active phase

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7
Q

Used during emergencies when quick intervention is necessary (For c-section)

A

Anesthesia (Drug like novacane or lidocaine placed in vaginal wall)

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8
Q

Pudendal Block

A

Local in the perineum

Good for EPISIOTOMY

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9
Q

This drug blocks pain sensation from waist down, patient must have an IV to receive. used for POST-OP pain control.

A

Epidural

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10
Q

Major side effect of an Epidural

A

Hypotension

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11
Q

This is an injection into 3,4,5 spinal column, Patient must lie flat.

A

Spinal anesthesia

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12
Q

Norms during Continuous Fetal Monitoring

A 
FHR decreases during contraction
Temporary lack of oxygen 
HR should return to 120 between contractions 
Monitoring gives ongoing fetal status 
Fetal Heart Rate should be 120-180
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13
Q

Subjects of Internal Fetal Monitoring

A 
Saline filled catheter in place 
Ruptured membranes
Accurate assessment 
Monitors FHR
Intensity of contractions 
Risk of infection 
Permanent record
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14
Q

Early FHR Deceleration

A

Deceleration starts & ends with each contraction

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15
Q

Variable FHR Decelerations

A

Deceleration begins & end abruptly, not consistent

Umbilical cord compression

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16
Q

Late FHR Deceleration

A

Delay in decrease, does not go back to baseline
Uteroplacental insufficiency

Lack of BLOOD FLOW TO PLACENTA

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17
Q

During labor Blood pressure and Heart Rate

A

Increase during 1st and 2nd stage, returns to pre-labor during 3rd and 4th stage

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18
Q

During labor respirations

A

Increase and become prone to blood gas disturbances

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19
Q

Some changes to kidney during Labor

A

They become stressed
Trace of protein as a result of muscle breakdown during labor
Potential for decreased urinary flow due to position

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20
Q

During labor Myometrium

A

Works very hard

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21
Q

Because baby is pushing on bladder this can occur

A

Urinary retention can occur

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22
Q

During labor Peristalsis and absorption

A

slows down and patient is NPO except ice chips

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23
Q

During labor Muscle activity _____ sweating and fluid _____ and patient is at risk for

A

Increase
Increase
Dehydration

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24
Q

Signs and Symptoms of Impending Labor

A 
Lightening 
Braxton Hicks Contractions 
Cervical changes (mucous plug comes out)
Increased energy (Nesting syndrome) 
Weight loss (Polyuria)
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25
Q

When moms mucous plug comes out mom is at risk for

A

infection

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26
Q

During true labor Contractions ______ in frequency, duration, and intensity.

A

increases

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27
Q

During ____ labor there is no increase in frequency, duration, and intensity

A

False

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28
Q

Sequence of Mechanism of Labor / Cardinal Movements

A 
Engagement 
Descent 
Flexion
Internal rotation
Extension
External rotation 
Expulsion
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29
Q

The soft spot on the babys head is called the

A

Fentanyl

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30
Q

Squiggly lines on babys head are called

A

Sutures

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31
Q

What are the 3 phases in stage 1 of Labor

A

Latent –> Active –> Transition

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32
Q

Phase where early labor, feels like bad menstrual cramps (4cm dilated)

A

Latent phase

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33
Q

Phase where mom starts to feel labor, need for pain medication, goes through TRANSITION, mood swings (4cm-7cm)

A

Active phase

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34
Q

Phase where cant give no more pain medication (7cm - 10cm)

A

Transition

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35
Q

Stage where dilated cervix to birth of the baby (baby comes out)

A

Stage 2

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36
Q

Stage where birth of baby to delivery of placenta (Placenta needs to be pushed out

A

Stage 3

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37
Q

Stage where 1-4 hours after delivery

A

Stage 4

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38
Q

The 5 p’s of labor are

A 
Passageway
Passenger
Power
Position
Psyche
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39
Q

The structure the fetus passes through

A

Passageway

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40
Q

Size and position of fetus

A

Passenger

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41
Q

Another word for contractions

A

Power

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42
Q

Maternal position and gravity

A

Position

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43
Q

Moms emotional status

A

Psyche

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44
Q

When 10cm dilated the _____ falls out

A

Mucous plug

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45
Q

_____ help pull cervix open

A

Contractions

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46
Q

Flattening of cervix that we measure and want to be 100% this

A

Effacement

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47
Q

Top of pelvis is also called

A

Inlet

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48
Q

Bottom of pelvis is called

A

Outlet

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49
Q

Comparison of babys head to opening

A

Cephalo Pelvic Relationship

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50
Q

Fetal heads will ____ to moms opening

A

adjust

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51
Q

Position of fetus long axis in relationship to moms long axis

A

Fetal Lie

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52
Q

What are the three Fetal Lies

A

Longitudinal, Transverse, Oblique

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53
Q

Foremost part of the fetus entering the pelvic inlet

A

Presentation

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54
Q

Cephalic presentation

A

Head first

55
Q

Vertex presentation

A

IDEAL tip top of head

56
Q

Military presentation

A

flat part of head toward tapur

57
Q

Brow presentation

A

Forehead / Eyebrows

58
Q

Face presentation

A

Can see face

59
Q

Breech presentation

A

Painful for mom Feet / Buttocks / Shoulder

60
Q

What do we do when fetus is in Breech Buttocks

A

push baby back in and try again

61
Q

Relationship of fetal parts to one another

A

Fetal attitude

62
Q

Ideal Fetal attitude

A

Flexion - head down arms and legs up smallest part of head entering first

63
Q

Relationship of the presenting parts to moms pelvic 4 quadrants

A

Position

64
Q

Relationship of presenting part to ischial spine

A

Station

65
Q

At station 0 the ischial spine is

A

Engaged

66
Q

Station is measured in

A

centimeters negative to positive

67
Q

Where can the nurse put her hand on to feel contractions

A

Fundus

68
Q

Contractions should not last longer than ____

A

90 seconds (Fetal heart rate would be too low for too long

69
Q

Upper portion of the uterus that detaches from wall with CONTRACTIONS

A

Placenta

70
Q

The Traditional / Lithotomy position the mom is

A

Supine Knees are up

71
Q

When fetal pulse is low we can place mom on her

A

Left side

72
Q

When moms cord drops out before fetus ____ must occur and patient should be in ____ position

A

C-section

Knee Chest

73
Q

Stage that starts with onset of contractions and ends at 10cm dilation

A

First stage

74
Q

Which phase follows? 0-3cm, Effacement, Contractions q20-q5 and last 15-40 seconds

A

Latent phase

75
Q

4-7cm, Amniotic rupture, ok to give pain meds, Contractions q2-q5 min last 40-60 seconds

A

Active phase

76
Q

8-10cm, fully effaced, difficult for mom, contractions q2min, lasting 60-90 seconds

A

Transition phase

77
Q

When membranes are ruptured and contractions are less than 5 min apart what should mom do

A

come to hospital

78
Q

What can LPNs do and what cant they

A

LPNs can do vaginal exams however anything that involves going inside the vagina is disobeyed LPNs can check perineum to assess bulging/crowning

79
Q

During first stage of labor what nursing implications are most important

A

Monitor FHR
Intake and Output
IV fluids for electrolyte imbalance

80
Q

When changing moms position what position is best

A

Whichever mom is most comfortable

81
Q

When moms feels bowel movements what should we do

A

Check perineum because bowel movements can be mistaken for the baby coming

82
Q

Ends with birth of baby (10cm dilated) and where EPISIOTOMY may be done

A

Second stage

83
Q

Surgical incision

A

Episiotomy

84
Q

Nursing care for Second stage of labor

A

Check VS between contractions
Suction baby
Push shoulder up to help increase gravity
Encourage mom the INHALE DURING CONTRACTION.

85
Q

Begins with Birth of the baby Ends with Placental Expulsion

A

3rd stage

86
Q

Smooth and dry side of placenta attached to baby

A

Shultz

87
Q

Red Gushy side attached to mom

A

Duncan

88
Q

During 3rd stage of labor mom has a potential for

A

hemorrhage

89
Q

Nursing Care for 3rd stage of labor

A 
Skin pale cold and clammy IS NORMAL
Massage uterus 
Uterus should look like 20 week stage
Check for necessity of PITOCIN 
Obtain CORD BLOOD IF NEEDED
90
Q

During 3rd stage of labor what should we do for baby

A

Dry off and assess VS
Apgar scoring
Apply ID bands IMMEDIATELY

91
Q

Higher the APGAR score the higher the babys

A

Adaptability to the world (rub their feet if low)

92
Q

Begins with delivery of placenta, and where involution takes place

A

4th stage

93
Q

Where organs start to return to pre-pregnancy stage

A

Involution

94
Q

Nursing care for 4th stage of labor

A

Monitor moms vital signs

Assess fundus

95
Q

What is the ideal palpation for fundus

A

Firm(Like a ripe plum)

96
Q

If Fundus is Boggy

A

Massage

97
Q

If Fundus is Rigid

A

Call MD

98
Q

What is the average loss of blood during 4th stage of labor

A

400-500ml

99
Q

Stages of Lochia after birth

A

Rubra(Bright red) –> Serosa(Pinkish) –> Alba(Whitish)

100
Q

Women should be able to wear OB pad for more than

A

2hours

101
Q

If mother is experiencing pain after 4th stage of labor it important to tell her

A

Uterus is going back into place

102
Q

Nursing care of Neonate(Newborn)

A

Suction
Clean secretions
Vernix (Wrap baby)
Instillation of neomycin drops for ophthalmia

103
Q

Wrapping baby and swabbing everything else away is called

A

Vernix

104
Q

Given for eye infections that may cause blindness

A

Neonatorum

105
Q

Observations we can make for newborn

A

Skin milia (Acne)
Acrocyanosis
Caput succedaneum
Cephalohematoma

106
Q

Pointed shape of head due to edema

A

Caput succedaneum

107
Q

Accumulation of blood between skull and periosteum

A

Cephalohematoma

108
Q

Labor

A

Process that begins with uterine contractions and ends one hour after delivery of the baby

109
Q

Effacement

A

Thinning and shortening of the cervix

110
Q

Dilation

A

Opening of the cervix

111
Q

Cephalo

A

Pelvic relationship Size of fetal head in relation to moms pelvis

112
Q

Lie

A

Relation of fetus long axis to moms long axis

113
Q

Attitude

A

Degree of flexion of Fetus, Relationship of fetal body parts to each other

114
Q

Presentation

A

The part of the fetus that enters the pelvis first

115
Q

Position

A

Relation of the fetus presenting part to the Mothers 4 quadrants of the pelvis

116
Q

Station

A

The relationship log the presenting part to moms ischial spine

117
Q

Contraction

A

Uterine activity that is a part of the labor process

118
Q

Increment

A

The beginning of a contraction

119
Q

Acme

A

The height of a contraction

120
Q

Decrement

A

The contraction starts to subside

121
Q

Intensity

A

The strength of contraction Mild moderate firm

122
Q

Frequency

A

His often a contraction occurs Measured from the beginning if one to the beginning of the other

123
Q

Duration

A

How long a contraction lasts measured from increment to decrement

124
Q

Lightening

A

The descent of the fetus into the pelvis

125
Q

Braxton hicks contractions

A

Random mild abdominal contractions “false labor”

126
Q

Mechanism of labor

A

The rotation the fetus goes through while descending out of the body

127
Q

Apgar score

A

Assessment took of the neonateDone 1 and 5 minutes after birth

128
Q

Crowning

A

The appearance of the the fetal head in the vagina during contraction

129
Q

Lochia

A

The bleeding that occurs after delivery

130
Q

Lochia rubra

A

Bright red with small clots

131
Q

Lochia Serosa

A

ThinPinkish Brown discharge

132
Q

Lochia Alba

A

White creamy discharge

133
Q

After pains

A

Contractions of the uterus after delivery may last 48-72 hours

134
Q

Involution

A

The retuning of the reproductive organs to the prepregnant state

Dressler (6 decks)

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