Exam 2 Flashcards
what are the 5 factors that affect the process of labor and birth?
Passageway
Passenger
Passage and passenger relationship
Physiological forces of labor
Psychologic response
what is the favorable shapes of the pevic inlet during birth?
Gynecoid and Anthropoid
what are the unfavorable shapes of the pelvic inlet during birth?
Android and Plataploid
what are fontanelles?
intersections of cranial sutures
what is the posterior fontanelle?
back of head, forms a triangle, and closes in 8-12 weeks
what is the anterior fontanelle?
front of head, forms a diamond, and closes by 18 mon
what can closed sutures with no fontanelle cause?
Skull fractures
what is a fetal lie?
relation of the fetal spine to maternal spine
what is a longitudal fetal lie?
fetus is vertical
what is a transverse fetal lie?
fetus is perpendicular to maternal spine (right angle, laying from side to side)
what is attitude?
relation of fetal parts to one another
-flexion is normal
what is presentation r/t the fetus/passenger?
the part of the fetus that enters the pelvis first and leads through the birth canal
what is a cephalic presentation?
fetal head is presenting
what is a breech presentation?
buttock or feet is presenting
what is a shoulder presentation?
acromium process of scapula is presenting
which presentation is the only one who can result in a natural birth?
Cephalic
- vertex presentation is normal and most common
what is engagement?
when largest transverse diameter of fetus has passed through pelvic inlet
“0 station”
when does engagment occur in a primigravida mother?
before labor
when does engagement occur in a multipara?
not until labor is established
what is the station?
location of the fetus in relation to an imaginary line btwn maternal ischial spines
what are the number ranges of a station?
-5 is high towards belly button
0 is in middle of ishical spines
5 is at bottom of ischial spines ready to be birthed
what is a primary power?
involuntary uterine contractions
what is a secondary power?
mothers bearing down efforts
what is a hypertonic uterus and what can it cause?
uterus does not relax between contractions
- can cause fetal distress
what does progesterone do for the labor process?
relaxes smooth muscle
what does estrogen do for the process of labor?
stimulates uterine contractions
what are the possible causes of labor onset?
Progesterone withdraw hypothesis
Prostoglandin hypothesis
Corticotropic releasing hormone hypothesis
what is the progesterone withdraw hypothesis?
at the end of term progesterone decreases which makes estrogen stimulate contractions
what is the prostoglandin hypothesis?
inducing of labor after vaginal application of prostaglandins (semen)
what is the corticotropin releasing hormone hypothesis?
CRH increases at end of term which stimulates prostaglandins
what is lightning and what does it cause?
baby drops which causes return of urinary frequency
what is a bloody show and what can you expect ?
mucous plug is expelled causing pink secretions
labor in 24-48 hours
if mom has a rupture of membranes, what do you assess?
COAT color odor amount time
what can you use to differentiate amniotic fluid with urine?
Nitrozen paper (amniotic fluid is alkaline and urine is acidic)
what is the most accurate way to differentitate amniotic fluid and urine after a ROM?
microscope test
- fernning pattern is amniotic fluid
if a mom’s membrnaes have been ruptured for 24 hours and the baby hasnt been birthed, what do you give?
prophalactic ATB to prevent infection
when does stage 1 of labor begin and end?
begins at onset of true labor and contractions
ends when cervix is completely dialated and effaced
when does stage 2 of labor begin and end?
begins when cervix is fully dialated/effaced
ends with birth of baby
when does stage 3 of labor begin and end?
begins with birth of baby
ends when placenta is delivered
when does stage 4 of labor begin and end?
begins after placenta delivery
last for 2 hours
immediate recovery period
what is a mother and babys job during stage 1 of labor?
mother dialate baby rotate
what is the cervical dialations for the 3 phases of stage 1 of labor?
Latent: 0-3cm
Active: 4-7cm
Transition: 8-10cm
when does nursing care begin for the 1st stage of labor?
when mom reports:
- progressive, regular contractions that increase in frequency, strength, and duration
- blood tinged mucoid discharge
- fluid discharge
what are the laboring characteristics for the latent/early stage during stage 1 of labor?
last 6-8 hours
contractions can be 5-30min apart lasting 30-40 dec (mild/moderate)
station is -2 to 0
mom is excited and thoughts are centered towards baby
what are the laboring characteristics of the active phase during stage 1 of labor?
last 3-6 hours
contractions can be 2-5 min apart and last for 40-60 seconds (moderate/strong)
station is 1 to 2
mom becomes more seriou, apprehensive, and irritable
what are the laboring characterisics of the transition phase during stage 1 of labor?
last 20-40 min
contractions will be 1-2 min apart and last 60-90 seconds (very strong)
station is 2 to 3
mom is fearfull of loss of control and extremely agitated and may feel like she has to poop
what are the 7 cardinal movements?
- descent
- flexion
- internal rotation
- extension
- resitution
- external rotation
- expulsion
what side of the placenta is grey?
fetal side
what can happen to mom in the 4th stage of labor?
shaking chills or hypotonic bladder (unable to urinate)
what can make a pregancy high risk?
abnormal presentation
multiple gestation
meconium staining
PROM
abruptio placenta
Placenta previa
what is an amniotomy?
artifical rupture of membranes (AROM) to induce labor
what are the characteristics of amnitic fluid?
pale, straw colored
white flecks of vernix, lanugo and hair
no strong odor
alkaline
what can happen when membranes rupture and what do you assess?
umbillical cord could prolaspe
assess FHR and pattern immediatly
what are the 2 types of external monitoring?
Transducers for FHR
Tocodynometer for UC
what are 2 types of internal monitoring?
Spiral Electrode
B.O.W. rupture
what can cause FHR changes?
periodic changes with UC
Episodic (non-periodic) changes are not associated with UC
accelerations
decelerations
what can cause fetal tachycardia?
early fetal hypoxia
maternal fever, dehydration, or hyperthyroidism
fetal anemia
what can cause fetal bradycardia?
late fetal hypoxia
maternal hypotension or hypothermia
umbillical cord compression
fetal arrythmia
uterine hyperstimulation or rupture
abruptio placenta
what is the single best indicator of fetal well being?
FHR variability
what is an absent FHR variability?
undetected
what is a minimal FHR variablity?
greater than undetected but less than or equal to 5bpm
what is a moderate FHR variability?
6-25 bpm
what is a marked FHR varability?
greater than 25 bpm
what is reassuring FHR patterns?
FHR 110-160
moderate variabliity
accelerations with UC
what is an early deceleration r/t FHR?
baby is okay
- head could be compressed during a UC
what is a late deceleration r/t FHR?
baby bad
-decreased blood and o2
-placental insuffencicy
what is a variable deceleration r/t FHR?
baby bad
- decreased blood and 02
-cord compression
what is the nursing care managment for late or variable deceleration FHR patterns?
notify HCP immediatly
stop oxytocin
change maternal position
increase IV fluids
administer 02
prepare for delivery
what are the FHR patterns and their causes?
VEAL and CHOP
Variable to cord compression
Early to head
Acceleration to okay
Late to placental insufficency
when should a pregnant women reprt to a birthing unit?
if her membranes have ruptured
regular frequent contractions
vaginal bleeding
decreased fetal movements
what are considered regular frequent contractions for a nullipara?
5 min apart for 1 hour
what are considered regular frequent contractions for a multipara?
6-8 min apart for 1 hour
why is a urine sample taken on admission and what can it indicate?
to assess for proteinuria
-can indicate preclampsia
if mom is excessivly bleeding, what assessment do you NOT do?
Cervical examination
-notify HCP
what are the nursing actions (Vitals) during the latent phase of stage 1?
Maternal BP and RR every hour
Maternal temp every 4 hour unless over 99.6 or membranes have ruptures then every hour and if contractions have started then every 30 min
FHR every 30-15 min
what are the nursing actions (vitals) during the active phase of stage 1?
Maternal BP, RR, and HR every hour
Palpate contractions every 15-30 min
FHR every 30-15 min
what are the nursing actions (vitals) during the transition phase of stage 1?
Maternal BP, RR, and HR every 30min
Palpate contractions every 15 min
FHR every 30-15 min
what are the nursing actions (vitals) during stage 2?
Maternal BP, RR, and HR every 5-15 min
Maternal temp every 2 hour
Palpate contractions continuously
FHR evert 15-5 min
what are the nursing actions (vitals) during stage 3 of labor?
Maternal BP, RR, and HR every 5 min
Palpate contractions intermittenly to assess for placental seperation
Fetal newborn assessment, gestational age, and neurological assessment within 1st hour
APGAR at 1 and 5 min
Assesss umbillical cord for 3 vessells
what are the nursing actions (vitals) during stage 4 of labor?
Maternal BP, RR, HR, and temp every 15 min for first hour
Maternal assessment of fundus, lochia, perineum, laceration, bladder and rectum every 15 min
Fetal assessment needs to be complete in 1-4 hours post birth
After inital 8 hours, do vitals and assessment every 8 hours
Fetal skin assessed every 4 hours
what are the nursing responsibilities during stage 1 of labor?
determine true/false labor
establish rapport
orient family
position changes
provide ice chips
assist to void every 1-2 hours
rest between contractions
breathing techniques
keep couple informed
what are the nursing responsibilities during stage 2 of labor?
assist with pushing efforts
provide support
patient advocate
what are the nursing responsibilities during stages 3 and 4 of labor?
Inital care of newborn (APGAR, care of umbillical cord, physical assessment, and newborn identification)
Delivery of placenta
Enchancing attatchment
Maternal stabilization
what is a 1st degree laceration?
ectends through skin and structures superficial to muscles
what is a 2nd degree laceration?
extends through muscles of perinuem
what is a 3rd degree laceration?
extends through anal sphincter
what is a 4th degree laceration?
extends through anterior rectal wall
why are episiotomies not often performed?
bc they increase risk for a 4th degree laceration
how can you prevent a laceration?
Use counter pressure
Lubricate periunuem
use warm compress
what are the nonpharmalogical managements of discomfort while in labor?
guided imagery, massage, position changing, and effleurage
what is effleurage?
gently use the tip of funger ti touch or massage abdomen
what pharmalogical management us used for emergency c sections?
general anesthsia
what are the systemic analgesia medications used for discomfort in labor?
Opiod agonist (Demerol, Morphine)
Opiod agonist-antagonist (Nubain) *narcotic
Opiod antagonist (Ultram) *narcotic
Ataractics (Xanax)
what is Nalbuphine Hydrochlorids (Nubian) and its advantages?
It is comparable to Morphine
-works within 5 min
-minimal nausea and fetal effects
What can Nubian cause?
Drowsiness
what is Dutorphanol Tartrate (Stadol) and its advantages?
It is a narcotic and sedative
-works within 5 mun
-minimal nausea and fetal effects
what stage of labor is Stadol given?
first stage
what can Stadol cause?
Maternal hypotension, drowsiness, and dizziness
what can nerve block anesthsias cause?
Maternal hypotension
Ineffective breathing
Medication reactions
Spinal HA
What do you use for a spinal HA?
use a blood patch
what is a pudendal block?
injection into perineum
what is a pudendal block used for and what stages is it given in?
repair episiotomies
-stages 2 and 3
when is an epidural given?
when active labor begins
when is an epidural block used and what is it used for?
all stages of active labor and for the repair of episiotomies
what are the characteristics of an epidural block?
they dont wear off
gravity activated so change maternal positions if it is not effective on one side
administered continuously VIA pump
what can an epidural cause?
Longterm back pain
maternal hypotension
delay of bladder function
what can a hypotonic bladder increase the risk for?
postpartum hemmorage
*so make sure momma is urinating
what are the contradictions of an epidural?
Infection
Blood coagulation *monitor platelets
Increase ICP
Allergies
Hypovolemic shock
what type of anesthsia is used in C-section deliveries?
spinal block
what is a low spinal block?
Used in csection dele=iveries to numb nipple to feet
what can a spinal block cause?
delayed bladder control for 8-12 hours
what do you administer before an epidural and what do you do?
IV fluid blous 500-1000ml
*make sure momma empty bladder before epidural is given
what is given for hypotension during labor?
Ephedrine
how often should blood pressure be checked after administration of an epidural?
every 3-5 min for the 1st 30 min
when is the newborn period?
birth to 28 days
what is the neonatal transition?
1st few hours of life when newborn stabalixes respiratory and circulatory functions
what is surfactant required for and when does it peak?
it is required for lung expansion and peaks at 35 weeks gestation
what is the rate of breaths for a newborn?
shallow and iregular
30-60 BPM
short periods of apnea (no more than 20 seconds)
what type of breathers are newborns and what is the main nursing action?
obligatory nasal breathers
* make sure nasal passages are clear
Is acrocyanosis normal for a newborn?
yes, but only for the 1st 24 hours
what happens to the cardiovascular system of a newborn after birth?
their 1st breath inflates the lungs and decreased pulmonary vascular resistance to the pulmonary blood flow
increased pulmonary blood flow returns to left side of heart and increases pressure in left atrium
3 shunts close and chnage to maternal circulation
what does a newborns blood contain and what happens to it?
fetal hemoglobin
-will decreaase by 55% in 5 weeks
-will reduce to 5% by week 20
what is most critical to a newborns survival?
- respiration
- circulation
- heat regulation
what is convection heat loss?
loss of heat from warm body to cool air currents
what is radiation heat loss?
baby loses heat when heat transfers from warm body surface to cooler objects not in direct contact with body
what is evaporation heat loss?
baby loses heat when water is converted to vapor
- immediatly after birth when wet with amniotic fluid
what is conduction heat loss?
baby loses heat to a a cooler surface by direct contact with body
- chilled hands, cold tables, cold stethascopes
what is physiological jaundice also known as?
hyperbilirubinemia
what is physiological jaundice or hyperbilirubinemia?
inmatture liver is not able to get rid of all billirubin produced by breakdown of RBC
so billirubin seeps out of blood into skin coloring them yellow the 1st three days of life
when do signs of psychological jaundice appear?
24 hour after birth
if signs of psychological jaundice appear before 24 hours what does it mean?
something could be wrong the liver
what can decrease billirubin levels?
frequent feedings, maintain tempreture of 97.8 and monitor stool for excretion of billi
what is the normal fetal billirubin level?
less than 3
what are the nutritional needs of a newborn for the first three months?
110/115 kcal/kg/day
how much nutrition does breastmilk provide?
67 kcal/100ml
what are the changes in output requirements for a newborn that indicate a change in nutritional needs?
less than 6-8 wet diapers per day AND OR less than 3 stools every 24 hours
what is the urine output of a newborn at birth and days 1 and 2?
small quanity (40ml) is present at birth in newborns bladdar
Day 1-2: 2-6 diapers a day
what indicates adequate fluid intake?
6-8 voids a day of pale straw colored urine
what is meconium?
newborns first BM
black, tarry, and sticky
when should a baby show meconium?
within 12 hours of birth
what are the characteristics of a newborns immune system?
for the first 3 mon the baby has some immunity from mom
*if breastfed they will recieve immunity from colostrum and breastmilk
what is mongolian spot?
Bruise like spot /appearance
if a baby has a magolian spot what does the nurse do?
document well due to appearance could be mistaken for abbuse
how long should vernix caseosa be kept on baby?
1st 4-6 hours
what do increased estrogen levels cause on a newborn?
swelling of breast tissue
vaginal discharge (pseudomenstruation)
witchs milk: thin discharge from nipple
what is an ortolani test?
assessment of developmental dysplasia of the hips
* newborn girls