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maternity > exam 2 > Flashcards

exam 2 Flashcards

1
Q

5 Ps that could affect L&D

A

Passenger (fetus and placenta)
passageway (birth canal)
powers (contractions)
position of mother
psychological response

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2
Q

what determines how the fetus moves through passageway

A

size of head
fetal presentation
fetal lie
fetal altitude
fetal position

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3
Q

anterior fontanel

A

In front of head
diamond shape

what we want to feel when baby is engaging

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4
Q

posterior fontanel

A

in back of head
triangular shape

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5
Q

fetal presentation

A

how baby is facing

Cephalic/vertex- baby is head down

Breech- baby bottom is towards the canal

Shoulder- baby’s shoulder is towards canal

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6
Q

why can’t you deliver a baby if its face first

A

it can cause nerve damage and facial bruising is likely

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7
Q

fetal lie

A

the relation of the long axis of the fetus to the long axis (spine) of the mother

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8
Q

3 types of lies

A

longitudinal- baby back parallel with moms

oblique- baby is crooked

transverse- baby back is perpendicular to moms

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9
Q

what can be performed if breech or transverse

A

version

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10
Q

fetal attitude

A

the relation of the fetal body parts to one another

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11
Q

flexion fetal attitude

A

fetal head is flexed to chest

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12
Q

military fetal attitude

A

head isn’t really flexed or extended

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13
Q

extension fetal attitude

A

baby head is extended. not good

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14
Q

how to determine the 3 level abbreviation for fetal position

A

First letter will be what side baby is laying on in moms abdomen - R or L

Middle letter will be the presenting part - occiput, sacrum, mentum, sinciput

Last letter will be if its anterior or posterior fontanel. Could also be transverse meaning we don’t really have a position.

Ideally we want to feel the anterior fontanel , baby be in occipital presenting part, and the side doesn’t matter

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15
Q

station

A

measurement of fetal descent

-5 is the highest up in the body. baby is not engaged in birth canal

station 0 is at level with ischial spine

+5 is the lowest point, baby is about to be birthes

We expect to see -2 when mom is at full term, but not in labor process
We expect to see +2 when mom is ready to start pushing and is fully dilated

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16
Q

what is passageway composed with

A

mothers rigid bony pelvis, soft tissues of cervix, pelvic floor, the vagina, and the introitus

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17
Q

external vs internal os

A

External os- outer opening of cervix
Internal os- inner opening of cervix

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18
Q

effacement

A

gradual thinning, shortening, and drawing up of the cervix measured in percentages from 0-100%

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19
Q

primary powers

A

involuntary contractions- frequency, duration, intensity

responsible for effacement and dilation

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20
Q

secondary powers

A

voluntary contractions. mom is pushing

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21
Q

signs preceding labor

A

lighting or dropping
return of urinary frequency
backache
braxton hicks
increased discharge
cervical ripening
possible rupture of membranes
weight loss possible from fluid loss
cervical change!!!!

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22
Q

4 stages of labor

A
  1. cervix dilating and thinning
  2. pushing. Baby born
  3. delivery of placenta
    4.After placenta delivery and thru period of recovery. About 2 hours
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23
Q

7 cardinal movements of labor

A

engagement
descent
flexion
internal rotation
extension
external rotation
birth by expulsion

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24
Q

what happens in internal rotation

A

head is under symphysis pubis

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25
Q

what has head reached in the extension cardinal movement of labor

A

perineum

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26
Q

what 2 cardinal movements occur together

A

restitution and external rotation. baby automatically rotates

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27
Q

what happens in the expulsion movement of labor

A

baby is out

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28
Q

how much does cardiac output decrease by in first hour after delivery

A

50%

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29
Q

factors influencing pain

A

physiologic factors
culture
anxiety
previous experience
comfort/support
enviroment

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30
Q

non pharmacological pain management

A

relaxation and breathing techniques
counter pressure
massage
heat/cold
hydrotherapy
aromatherapy
hypnosis
music

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31
Q

can you give opioids when mom is almost fully dilated

A

No- could cause resp depression in baby

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32
Q

types of anesthesia

A

spinal
epidural
local perineal anesthesia- for repairs
nitrous oxide
general-For emergent cases that cant get a epidural. Could cause resp depression in baby. Mom will wake up in a lot of pain

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33
Q

what is a epidural and what are side effects

A

regional anesthesia that blocks pain in a particular region of the body

hypotension, N/V, itching, increase in body temp
serious: spinal nerve damage, convulsions, breathing difficulties

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34
Q

spinal anesthesia block

A

anesthetic solution inserted into L3, L4 or L5 into the subarachnoid cavity where it mixes with CSF
- most commonly used for C section

takes affect in 1-2 mins, last 1-3 hours

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35
Q

advantages of spinal anesthetic

A

no fetal hypoxia if BP is fine
mom remains conscious
excellent muscle relaxation
minimal blood loss
no feeling from chest down

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36
Q

disadvantages of spinal anesthetic

A

hypotension
decreased RR
leakage of CSF

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37
Q

why would baby develop late decelerations after epidural

A

low BP

fix it with IV vasopressor

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38
Q

what is needed for amnionfusion

A

IUPC

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39
Q

variable deceleration interventions

A

*reposition, notify physician, amnioinfusion, discontinue oxytocin, o2, consider vaginal exam

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40
Q

three phases of labor

A

latent
active
transition

41
Q

true labor

A

contractions are regular and increase in intensity. Walking causes intensified contractions as well. Cervix changes from posterior to anterior. Fetus is descending into pelvis

42
Q

false labor

A

contractions are temporary. Stop when mom starts walking. Cervix may start to soften but it is not thinning out or dilating, baby isn’t engaged

43
Q

early laboring mom comfort measure that can be done at home (water hasn’t broke yet but will within few days)

A

warm shower, repositioning, encourage to walk, distraction methods

44
Q

latent phase

A

not dilates yet to 5 cm

relatively calm phase with passive descent of baby through birth canal

45
Q

active phase

A

6cm dilated and above

active pushing and urges to bear down

46
Q

emergency medical treatment and active labor act (EMTALA)

A

federal regulation that all pregnant woman that come in must be assessed before getting sent home

47
Q

TOLAC

A

trial of labor after c section

47
Q

what is the most important history we want to know about mom

A

previous pregnancies & complications, blood type, medications, GBS status, any discharge

48
Q

VBAC

A

vaginal birth after c section

49
Q

how many nurses must be in laboring room

A

2
1 for baby 1 for mom

50
Q

Contraction assessment

A

frequency, duration, intensity, resting tone, strength

use TOCA
palpate for strength of contraction

51
Q

what needs done in the first stage of labor assessment

A

head to toe with focused OB
vitals- need accurate BP
assessment of fetal HR
assessment of uterine contractions
vaginal exam

52
Q

what does L&D vaginal exam tell us

A

Tells us if ruptured, dilation, how much time we have

53
Q

what labs to look for in a laboring mom

A

hgb, hct, wbc, plt, UA, AST, CMP, GBS

53
Q

what needs documented with a rupture of membranes

A

time
odor
color
amount

54
Q

what test tells us if patient ruptured membranes

A

fern test

54
Q

what to monitor for with amnioninfusion

A

for fluid to come back out

55
Q

ferguson reflex

A

mom has natural urge to push

56
Q

what is needed as soon as baby is born

A

immediate assessment

57
Q

OA position vs OP position of baby

A

Baby looking down - OA position - desired
Baby looking up- OP position

58
Q

1st degree laceration

A

laceration confined to skin. Repair usually isn’t needed

59
Q

2nd degree laceration

A

laceration extends through perineal muscles

60
Q

3rd degree laceration

A

Laceration that involves injury to the external anal sphincter muscle

61
Q

4th degree laceration

A

Laceration that extends completely through the anal sphincter and the rectal mucosa

May need to go to OR after and will cause issues with BM. Usually has significant hemorrhage

62
Q

when is QBL counted

A

after placenta is out

63
Q

what to worry about if placenta didn’t deliver

A

placenta being embedded in uterine wall

64
Q

precipitous labor

A

last less than 3 hours from onset of contraction to birth

65
Q

preterm labor

A

regular labor contractions along with a change in effacement and/or dilation

week 20 to week 36 and 6 days

66
Q

why would a preterm birth be indicated

A

medical issue

67
Q

difference between preterm birth and low birth weight

A

preterm is more dangerous no matter the size of the baby because it had less time in utero

68
Q

risk factors for preterm births

A

previous preterm, multifetal, infection, smoking, drug use, high stress, congenital or medical issues.

69
Q

fetal fibronectin test

A

picks up protein due to separation of amnion and chorion. If detected early on may mean preterm. Has high false positive rate, but if its negative its negative

70
Q

if preterm is suspected what do we do

A

restrict sexual activity
bed rest aside from things such as bathroom
admission if needed

71
Q

what do tocolytics do

A

arrest labor

ex- nifedipine, indocin

72
Q

magnesium sulfate for preterm labor

A

can be given to relax uterus and to onboard steroids

73
Q

antenatal glucocorticoid

A

painful, slow injection given in the buttocks to accelerate fetal lung maturity by stimulating fetal surfactant production

given 24 hours apart

ex- betamethasone

74
Q

PROM

A

premature rupture of membranes- happens after labor starts

75
Q

PPROM

A

Preterm premature rupture of membranes. happens between 20-37 weeks

may be caused by UTI, weekend amniotic membrane

76
Q

chorioamnionitis

A

bacterial infection in the abdominal cavity
most often occurs after membranes rupture or labor begins

risk factors- long labor, PROM, multiple vaginal exams, use of internal monitors

s/s- fever, increased HR

77
Q

post term weeks and risks

A

42 weeks or more

risks: fetal Macrosomia, amniotic fluid decreases- cord compression, placenta function decreases, meconium aspiration

78
Q

dystocia

A

lack of progress in labor

79
Q

dysfunctional labor

A

labor that is long, abnormal, or difficult

80
Q

latent phase disorders of labor

A

ineffective contractions

81
Q

active phase disorders of labor

A

Arrest of dilation, abnormal labor patterns, mom exhausted to keep bearing down

82
Q

induction of labor- cervix ripening

A

medication (cervidil) put in cervix to help thin out

83
Q

amniotomy

A

procedure to break the water to induct labor

84
Q

oxytocin

A

High alert med with a lot of risks. Synthetic form of oxytocin. Can be used for labor process for contractions and after if mom is at risk for hemorrhage.

can be used for labor induction

85
Q

types of operative vaginal delivery

A

forceps assisted
vacuum assisted

86
Q

why may someone get a C section

A

Malpresentation, non reassuring fetal HR, herpes, failure to progress, placental abruption, they want it

87
Q

why is meconium stained amniotic fluid a OB emergency

A

aspiration risk for baby

88
Q

shoulder dystocia

A

baby shoulder gets stuck in vaginal delivery
life threatening injuries may occur- brachial plexus palsy, death, asphyxia, broken clavicle

89
Q

amniotic fluid embolism

A

amniotic fluid gets into maternal circulation causing cardiovascular collapse.
high mortality rate

sudden onset of hypoxia, hypotension and hemorrhage

unsure why it happens and is not preventable

90
Q

OB emergencies

A

meconium stained amniotic fluid
shoulder dystocia
prolapse of umbilical cord
uterine rupture
amniotic fluid embolism

91
Q

risk for developing shoulder dystocia

A

The greatest risk factor is a previous shoulder dystocia, as well as diabetes because of the risk for macrosomia, but we do not always know why a woman develops this problem in delivery. Women have had shoulder dystocia with smaller babies.

92
Q

two maneuvers for shoulder dystocia

A

McRoberts Maneuver (pulling moms legs back as far as you can) and the application of Suprapubic pressure.

93
Q

what can cause a prolapse of umbilical cord and how to fix

A

water breakage before baby is engaged

try to keep baby off cord
C section delivery
keep mom in trendelenburg position
provider try to keep pressure by doing a vaginal exam to physically keep pressure off the cord

94
Q

uterine rupture

A

separation of the layers of the uterus or previous scar

high risk if mom has had many c sections

s/s- abnormal fetal heart patterns, sharp abdominal pain, bright red bleeding, hypovolemic shock

95
Q

late decel intervention

A

Reposition-turn on side, oxygen, stop Pitocin, administer fluid bolus, notify physician, administer terbutaline. We may need to prepare for C section.

96
Q

variable decel interventions

A

Reposition mom, which will hopefully reposition the baby. We may need to oxygenate mom, do a vaginal exam, discontinue oxytocin, or do amnioinfusion. When this happens, we should also notify the provider.

maternity (4 decks)

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