Exam 2 Flashcards
What is the theory that occurs as the uterine muscles stretch preparing for labor?
results in release of prostaglandins.
The fetus presses on the cervix, which stimulates the release of oxytocin from the posterior pituitary.
Oxytocin stimulation works together with prostaglandins to initiate contractions.
The placenta reaches a set age, which triggers contractions.
The fetal membrane begins to produce prostaglandins, which stimulate contractions.
What are the 4 components of fetal presentation/position?
Attitude: position of baby in relation to itself
Fetal lie: position in relation to the mother
Engagement: lightening, dropped
Station: head in relation to bones in the pelvis
What are is the ideal fetal attitude?
vertext with full flexion (tucked like a football)
How is the station of the baby’s position measured?
The station is measured by the level of engagement with the ischial spine.
0 = engaged right at the spine
negative numbers are further away
positive numbers are beyond the spine and closer to delivery
+4 crowning
What are the different types of presentations?
cephalic: vertex
breech: bum down
shoulder: transverse
How is the position determined in the pelvis? What is the most favorable position for delivery?
It is in relation to the specific quadrant of the woman’s pelvis and the back of the head (occiput)
Examples:
R anterior
L anterior
R posterior
left posterior
occiput anterior is preferred
What is the order of cardinal movements of labor?
descent (engagement)
flexion (tucked)
internal rotation (corkscrew motion, rotates in the pelvis)
extension (head is out, coming from a tucked position to an extended position)
external rotation (continues to twist and rotate)
expulsion (body follows)
What are the 3 powers of labor (uterine contractions)?
origins (starts at the fundus)
phases
contour changes (top of the uterus being thicker and stronger)
What is the duration? What is the frequency of the contractions?
The length of the contraction
The beginning of one to the beginning of the next one (contraction and period of relaxation?
What are the cervical changes?
effacement (thinning), decribed in percentages
dilation
What are the 3 phases of the 1st stage of labor and dilation?
latent: 0-5 cm
active: 6-7 cm
transition: 8-10
What occurs in stages 2-4 lof labor?
2nd: period from full dilation and cervical effacement to crowning and birth
3rd: placental separation, placental expulsion
4th: first 1-4 hours after delivery of the placenta
Signs of the 3rd stage of labor?
gush of blood
cord lengthening
globular and firm uterus
uterus rises anteriorly
should happen within 30 minutes of infant delivery
Why is iron so important in pregnancy? Why? What is needed to help iron to be absorbed in the body?
red blood cell production
for baby, cardiac output increases, blood volume increases, transport of oxygen
vitamin C
What should be avoided with meat when pregnant?
raw fish or meat
deli meat
raw milk
unpasteurized cheese
alcohol
saccharin
fish (mercury)
caffeine
diets
What is the increase in calories for pregnancy? What is normal weight gain during the duration of the pregnancy?
300 cal
25-35 lbs
What is pica? What could be lacking in the diet?
craving of non-food substances
iron and zinc
Whaytis pyrosis? What can help reduce heartburn?
heartburn
smaller portions
avoid spicy, acidic, citrus foods
don’t lay down after eating
sleep on left side, elevate upper torso
antacids
metoclopramide (increases motility)
What are some interventions for hyperemesis graviderum?
feeding tube
metoclopramide
ondansetron
longesta (vit B and antihistamine)
IV line
TPN in central line
frequent weight checks
What are the 5 Ps of labor
Powers: contractions
Passendes: baby and placents
Passage: vagina, cervix,
Psyche: coping and preparation
Position: position of the mother
What are the 3 criteria of the powers of labor?
frequency
duration
intensity
Where is the origin of contractions?
they start at the fundus
What are the 3 measurements of labor?
dilation (cm)
effacement (%)
station (fetal placement)
What are the 3 phases of stage 1 labor? What is stage 2? stage 3? Stage 4?
latent: early contractions to 5 cm
active: 6 cm to 8 cm
transistion:
delivery of baby
delivery of placenta (2 stages)
recovery
What is a normal maternal temperature in labor?
100.4
What is the fetal attitude?
degree of flexion in relation to fetal parts
relation of fetal body parts to one another (how flexed are they? Are they noce and crouched or extended?)
What is fetal lie?
transverse lie
What is the Hawthorn effect in regards to nutrition?
positive change in behavior by just bringing attention to documenting food choices to present to someone else
What nutrients are vital during pregnancy to build baby’s body framework? What can protein help to prevent?
protein
iron
gestational hypertension and preterm birth
What occurs to cells during preganncy and fetal growth?
hyperplasia in early pregnancy (increase in cells)
hypertrophy in late pregnancy (enlargement of existing cells)
How should you calculate the amount of weight that should be gained during pregnancy? Weight gain for normal? Underweight? Overweight? Obese?
calculate BMI
25-35 lb
BMI less than 18.5: 28-40 lb
BMI 25-29.9: 15-25 lb
BMI 30+: 11-20 lb
What is an indirect way to mearue a client’s adequate nurtritional intake?
measuring fundal height and weight gain
What are some possible causes of nausea during pregnancy?
sensitivity to CgH
high estrogen and progesterone
low maternal blood sugar caused by embryo’s needs
lack of pyridoxine (B6)
diminished gastric motility
With hypercholesterolemia what is a pregnant woman more at risk for? Why?
gallstones
elevated levels of progesterone and the cholesterol
How long after bariatric surgery are clients advised to not get pregnant?
18 months
How might the head present in full flexion? moderate flexion? poor flexion?
In full flexion, the fetal head flexes so sharply that the chin rests on the chest, and the smallest anteroposterior diameter, the suboccipitobregmatic, presents to the birth canal.
If the head is held in moderate flexion, the occipitofrontal diameter presents.
In poor flexion (the head is hyperextended), the largest diameter (the occipitomental) will present.
What measurement of the baby’s skull is typically the smallest in diameter? What is the smallest anterioposterior measurement? what is the occipitofrontal measurement? occipitalmental?
biparietal diameter or the transverse diameter, which measures about 9.25 cm.
suboccipitobregmatic measurement (approximately 9.5 cm) and is measured from the inferior aspect of the occiput to the center of the anterior fontanelle.
The occipitofrontal diameter, measured from the occipital prominence to the bridge of the nose, is approximately 12 cm.
The occipitomental diameter, which is the widest anteroposterior diameter (approximately 13.5 cm), is measured from the posterior fontanelle to the chin.
What is the changing of shape of the fetal skull?
molding
overlapping of bones
What is vertex? sinciput? Brow? Face and mentu flexions?
vertex: full flexion
sinciput: moderate flexion/aler or military attitude
brow: partial extension
face: poor flexion/poor extension
mentum: very poor attitude/chin presenting/occipitomental
What is cephalic presentation? What is the ideal cephalic presentation?
head first
vertex
What are the 2 breech presentations? In this circumstance, which one is good fetal attitude, which one is poor? Moderate attitude position?
buttocks or feet
buttocks with fetal knees up against the abdomen
feet with legs and knees extended
Frank: hips flexed but knees extended with legs reaching up to the head
What letters represent the 4 landmark presentations?
occiput/vertex (O)
face/mentum (M)
breech/sacrum (Sa)
shoulder/scapula/acromion process (A)
What does the first letter represent in the fetal position? second letter? 3rd?
whether the landmark is pointing to the mother’s right or left
which landmark is presenting
whether the landmark presents anteriorly posteriorly or transversely
Typically in what posistions influences a faster delivery? What positions can extend labor? What can encourage a rotation from occipitoposterior to occipitoanterior?
ROA, LOA
ROP, LOP
Rest in sims position on same side as fetal spine
hands and knees position
Where are the ischial spines? How is engagement measured? What is the term of this measurement of the degree of engagement? What is the measurement when the head meets the ischial spine? Above the spines? Below ischial spines? When is crowning?
midpoint of pelvis
relation of head to ischeal spine
station
0 station (synonymous with engagement).
If the presenting part is above the spines, the distance is measured and described as minus stations, which range from −1 to −4 cm.
If the presenting part is below the ischial spines, the distance is stated as plus stations (+1 to +4 cm).
At a +3 or +4 station
What are the cardinal movements? What are the cardinal movements?
position changes during the engagement that keeps the smallest part of baby’s head presenting toward the smallest diameter of the pelvis
descent
flexion
internal rotation
extension
external rotation
expulsion
What is the “power” of labor? what is the difference between true contractions and false?
intensity of contractions
true begin irregular, often felt in lower back first, continue no matter activity level, increase in duration and frequency, dilate the cervix
False stay irregular, felt in abdomen and groin, do not increase do not achieve dilation
What are the phases of the contractions?
increment: initiation of increase of intensity at the beginning
acme: contraction at its peak strength
decrement: relaxation of intensity
What are the 4 stages of labor?
The first stage of dilatation, which begins with the initiation of true labor contractions and ends when the cervix is fully dilated
The second stage, extending from the time of full dilatation until the infant is born
The third or placental stage, lasting from the time the infant is born until after the delivery of the placenta
The first 1 to 4 hours after birth of the placenta is sometimes termed the “fourth stage” to emphasize the importance of close maternal observation needed at this time.
What happens to the FHR during contractions? What HRs may indicate fetal distress?
can decrease as much as 5 beats per minute
160< BPM: fetal tachycardia
<110 BPM: fetal bradycardia
What is a normal fetal HR range? How long is fetal HR analyzed? What is variability?
110-160
at least 2 minutes
difference between highest and lowest rates shown on the strip indicates well-being
How is variability recorded?
Absent: No amplitude range is detectable.
Minimal: Amplitude range is detectable but is 5 beats per minute or fewer.
Moderate (normal): Amplitude range is 6 to 25 beats per minute.
Marked: Amplitude range is greater than 25 beats per minute.
What are accelerations and decelerations in terms of fetal HR?
response to fetal movement, contractions, position, analgesic, etc.
When do early decelerations occur?
late in labor when the head is fully descended
what can late and prolonged decelerations indicate?
fetus is not getting enough oxygen
What are variable decelerations? What can they indicate? What is the first intervention? then?
occur at unpredictable times during the contractions
compression of the cord
change position from supine to lateral
perhaps oxygen
knees to chest to relieve pressure off prolapsed cord
What happens in the placental separation of the thrid stage of labor? is the second part of the 3rd stage
There is lengthening of the umbilical cord.
A sudden gush of vaginal blood occurs.
The placenta is visible at the vaginal opening.
The uterus contracts and feels firm again.
placental separation
What are nursing interventions when there are abnormal FHR tracings?
Prompt evaluation is required.
Expedite action to determine the cause and resolve the situation
provision of oxygen
change in position,
discontinuation of labor stimulation
treatment of hypotension
treatment of tachysystole with FHR changes.
birth/cessarian
Why is emptying bladder and bowel encouraged?
Can impede fetal desent
What is analgesia? Anesthesia?
reduces or decreases the awareness of pain
loss of pain sensation
Where is a spinal injection/spinal anesthesia injected? Epidural anesthesia?
into the CSF in the subarachnoid space
just inside the ligamentum flavum in the epidural space
Why would psinal anethesia be used instead of an epidural?
in an emergency situation, it’s faster to administer
What are complications with epidurals?
hypotension which will cause less perfusion to the placenta and fetus
Why would turning on the left side help with hypotension?
take pressure off the vena cave from the uterus. Can increase blood return
What are preliminary signs of labor?
Lightening
Increase in level of activity
Braxton Hicks’s contractions
Ripening of cervix
What are the stages of labor?
latent: 0-3 cm
active: 4-7 cm
transition: 8-10 cm
What is involved in the nursing assessment of the first stage of labor?
History
Physical exam
Leopold maneuvers
Rupture of membranes
Vaginal exam
Sonography
Pelvic adequacy
Vital signs
Laboratory analysis
Blood
Urine
Uterine contractions
Length
Intensity
Frequency
Fetal exam
External and internal electronic monitoring
Telemetry
FHR and uterine contractions
FHR patterns
Baseline FHR
Variability
Periodic changes
Scalp stimulation
Fetal blood sampling
Acoustic stimulation
Change positions
Voiding and bladder care
Support
Pain management
Amniotomy
What is nursing care during the second stage of labor?
Second stage of labor
Preparing for birth
Positioning for birth
Pushing
Perineal cleaning
Episiotomy
Birth
Cutting and clamping cord
What is nursing care during thrid and fourth stages of labor?
Third and fourth stages of labor
Oxytocin
Placental delivery
Perineal repair
Assessment
Immediate postpartum
What are the VEAL FHR patterns? What are the causes (CHOP)? What is the intervention (MINE)?
Variable decelerations: cord compression: move mother
early decelerations: head compression: no Intervention
accelerations: OK: no interventions
late decelerations: placental insufficiency: evaluate why, stop pitocin, give oxygen, give fluid, reposition, possible cessarian
What are some CAT for labor?
Relaxation
Focusing and imagery
Spirituality
Breathing techniques
Herbal preparations
Aromatherapy and essential oils
Heat or cold application
Bathing or hydrotherapy
Therapeutic touch and massage
Yoga and meditation
Reflexology
Hypnosis
Biofeedback
Transcutaneous
What is the intervention for epidural anesthesia? Spinal anesthesia?
Delayed until cervix dilated 3 to 5 cm
Begin IV Ringer’s lactate.
Check that equipment for blood pressure monitoring in place and functioning.
Help position woman on her side.
Aftercare
Be in continuous attendance, recording vital signs and monitoring for complications.
Begin IV fluid such Ringer’s lactate.
Position and steady woman.
Monitor for complications
