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Maternity > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are the factors that influence the onset of labor?

A

Uterine Stretch

Progesterone withdrawal

Increased oxytocin sensitivity

Increased release of prostaglandins

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2
Q

What are the signs of labor?

A

Cervical changes (cervical softening, possible cervical dilation)

Lightening

increased energy levels (nesting)

bloody show: sign of effacement/dilation

Braxton Hicks contractions

spontaneous rupture of membranes

weight loss

backache

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3
Q

What is true labor?

A

Contractions: regular, closer together, q4-6 min, 30-60 secs

Contractions: stronger with time, feel vaginal pressure

Discomfort start in back and radiates around to the front of the abdomen

contractions continue despite position changes

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4
Q

What is false labor?

A

Contraction: irregular, not close together

frequently weak, not stronger with time, felt in the front of the abdomen

contractions may stop or slow with movement or position change

drinking fluids and position change may change intensity or diminish contractions

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5
Q

What are the 5 Ps of birth?

A

Passageway (birth canal: pelvis & soft tissue)

Passenger (fetus & placenta)

powers (contraction)

Position (maternal)

Psychological response

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6
Q

Group B Streptococcus (GBS)

A

GBS colonization is often asymptomatic for women but can be devastating for infants

s/s in neonates: sepsis, pneumonia, meningitis (treatment with IV antibiotics)

women should be screened for GBS at 35-37 weeks of gestation

GBS positive women are treated in labor with antibiotics that must be started at least 4 hrs. before delivery

women with preterm labor are treated for GBS without screening: prophylaxis

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7
Q

What are the physiologic response to labor for the mother?

A

Increased heart rate, cardiac output, blood pressure (during contraction)

increased white blood cell count

increased respiratory rate and oxygen consumption

decreased motility and food absorption

decreased gastric emptying and gastric pH

slight temperature elevation

muscle aches/cramps

increased BMR

decreased blood glucose

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8
Q

What are the physiologic response to labor for the infant?

A

periodic FHR acceleration and slight decelerations

decrease in circulation and perfusion

increase in arterial carbon dioxide pressure

decrease in fetal breathing movement

decrease in fetal oxygen pressure: decrease partial pressure of oxygen

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9
Q

What is the nursing management for laboring women?

A

Assessment

comfort measure

emotional support

information and instructions

advocacy

support for the partner

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10
Q

What would the nurse assess for the mother during labor?

A

Maternal status (vital signs, pain, prenatal record review)

Vaginal exam (cervical dilation, effacement, membrane status, fetal descent)

Rupture of membranes

Uterine contractions

leopolds Maneuvers

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11
Q

What are some nonpharmacological measures for pain management?

A

Continuous labor support

hydrotherapy

ambulation and position changes

acupuncture and acupressure

attention focusing and imagery

therapeutic touch and massage: effleurage

breathing techniques (e.g. patterned paced breathing)

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12
Q

What should the nurse assess for the infant during labor?

A

Amniotic fluid analysis

fetal heart rate monitoring
> handheld vs electronic: intermittent vs continuous; external vs internal

Fetal heart rate patterns:
baseline, baseline variability, periodic changes, other assessment methods

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13
Q

Rupture of Membranes:

A

Monitor fetal heart rate tracing for signs of distress following ROM (immediately)

ROM can cause cord to prolapse, leading to fetal distress

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14
Q

What is dilation?

A

the process of the cervix opening in preparation for childbirth: cervix will dilate from 0-10cm to allow the baby through the birth canal

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15
Q

What is effacement?

A

the thinning and shortening of the cervix in preparation for childbirth

0-100%

hormonal changes causes the cervix to soften and stretch

Sign: increased pressure, changes in discharge (bloody show)

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16
Q

What is fetal station?

A

position of the baby’s head in relation to the ischial spine of the mother pelvis during labor

helps the healthcare provider assess how far the baby has descended into the birth canal

Negative number: baby is above ischial spine (-1.-2)

Zero station: baby’s head is level with ischial spine

Positive: baby is below ischial spine (+1,+2) moving closer to delivery

helps determine labor progress and can indicate whether the baby is in optimal position for delivery

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17
Q

What is fetal attitude?

A

position of the fetus in the womb, how the baby body is flexed or extended

Flexed (flexion): most favorable for delivery. Baby chin is tucked to chest, arms are flexed, legs curled up toward abdomen

Extension: head is tiled back and limbs may be extended

Combination: flexion and extension

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18
Q

What is fetal lie?

A

orientation of the fetus in relation to the mother’s body

Longitudinal Lie: baby is vertical with head or butt pointing toward birth canal
> Cephalic presentation: head is down, ideal for vaginal delivery
> Breech: butt or feet are down: complications delivery

Transverse: position horizontally across the uterus: may require c-section

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19
Q

What is fetal presentation?

A

part of the fetus that is position to enter the birth canal

Cephalic: head is presenting

Breech: butt or feet are presenting

Shoulder: shoulder is presenting (transverse lie)

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20
Q

What is fetal position?

A

Occipital bone (0): vertex presentation

Chin (mentum (M): face presentation

Buttocks (sacrum (S):breech presentation

Scapula (acromion process(A): shoulder presentation

Three-letter abbreviation for Identification

21
Q

What is fetal engagement?

A

Presenting part reaching 0 station

Floating: no engagement; presenting part freely movable about pelvic inlet

baby’s head descends into the pelvis and settles into the position in which it will be delivered.

22
Q

What are the cardinal movements of labor?

A

refer to the series of movements that a fetus undergoes as it navigates through the birth canal during delivery.

Engagement : baby’s head enter the pelvic inlet and aligns with the pelvis (station 0)

Descent : babys head move down through the pelvic canal

Flexion: baby chin tuck into its chest, reduces diameter of the head, easier passage through pelvis

Internal rotation: usually turned to mothers back: head rotates

Extension: head extends allows the face, chin to emerge

Restitution and external rotation: after head is born, it rotates back to the position it was in before birth, allowing shoulder to come out

Expulsion (birth) : shoulder and rest of the body are born

23
Q

What are the stages of labor?

A

First stage:
True labor to complete cervical dilation (10 cm)
Longest of all stages
> Three stages:
Latent phase (0-3cm, 0-40%, contraction q5-10 min, 30-45 seconds)
Active Phase: (4-7cm, 40-80%, q2-5 min, 45-60 seconds
Transition phase: (7-10cm, 80-100%, q1-2 min, 60-90 sec)

Second stage: cervix dilated to birth of baby- pushing

Third Stage: birth of infant to placental separation
Placental separation
Placental expulsion

4th stage: 1-4 hrs. following delivery

24
Q

What is labor pain?

A

Pain is what the patient say its is

Many factors play a role in pain tolerance, including:

Fear

Previous experience with labor pain

Support system

Fatigue

Manifestations of pain include:
>Pain in abdomen, low back or thigh with contraction
>Continuous pain in low back may occur if fetus is in an occiput-posterior position
> Continuous abdominal pain may indicate a placental abruption

25
Q

Baseline fetal heart rate:

A

baseline rate is average during 10-20 min excluding: acceleration, deceleration, periods of marked variability, normal range at term 110-160 beat/min

average heart rate of the fetus

Normal 110-160 bpm

26
Q

Baseline Variability:

A

FHR variability is described as fluncuations in the FHR baseline that are irregular in frequency & amplitude

Expected variability is moderate

Tachycardia: baseline more than 160 beat/min for 10 minute or longer
Bradycardia: baseline less than 110 beats/min for duration of 10 minutes or longer

Absent: non-reassuring
Minimal: deteactable but less than 5/min
Moderate: 6-25 minute
Marked: more than 25 minute

27
Q

Acceleration:

A

temporary increases in the fetal heart rate of atleast 15 beat/min above the baseline: lasting 15 seconds

shows fetal well-being and are often associated with fetal movement

28
Q

Deceleration: early, late, variability

A

Deceleration: temporary decrease in FHR

Early: response to fetal head compression: happening with contraction: mirror contraction pattern

Late: uteroplacental insuffiency/ fetal distress: DO NOT WANT THIS: after peak of contraction

Variable: umbilical cord compression: abrupt decrease in FHR that can occur anytime: short duration

29
Q

Late Deceleration: causes + Intervention

A

Causes:
inadequate fetal oxygenation
maternal hypotension, placenta previa, abruptio, uterine hyperstimulatin with pitocin
preeclampsia
post term pregnancy
Diabetes

Intervention:
Place client on left side
IV, increase fluid
discontinue pitocin
elevate legs
notify provider
prepare of assisted vag del or c/s

30
Q

Electronic fetal monitor

A

useful tool for visualizing fetal heart rate (FHR) patterns on monitor screen or printed tracing

External:
> FHR: ultrasound transducer
>UCs: tocotransducer

Internal: (invasive)
- fetal spiral/scalp electrode
IUPC (intrauterine pressure cath)

31
Q

Periodic baseline change:

A

consistent changes in the fetal heart rate pattern that are associated with contraction

include accelerations and deceleration that correlate with uterine activity

32
Q

Nursing care during first stage of labor:

A

General measures:

Obtain admission history

Check results of routine lab test and any special test

Ask about childbirth plan

Complete a physical assessment

Initial contact either by phone or person

33
Q

Internal Fetal Heart Rate Monitoring (criteria)

A

Uses a machine to produce a continuous tracing of the FHR

Produce a graphic record of the FHR pattern

Primary objective:
>To provide information about fetal oxygenation and prevent fetal injury from impaired oxygenation
> To detect fetal heart rate changes early before they are prolonged and profound

Criteria:
Ruptured membranes
Cervical dilation of at least 2 cm
Present fetal part low enough to allow placement of the scalp electrodes
Skilled practitioner available to insert spiral electrode

34
Q

Systematic analgesia/anesthesia:

A

Route: typically, administered parenterally through existing IV line

Drugs:
>Opioids (butorphanol, nalbuphine, meperidine, fentanyl)
>Ataractics (hydroxyzine, promethazine)
>Benzodiazepines (diazepam, midazolam)

35
Q

Regional anesthesia:

A

Epidural block: continous infusion or intermittent injection usually started when dilated more than 5 cm

Combined spinal-epidural block (“walking epidural”)

Patient controlled epidural

Local infiltration (usually for episiotomy or laceration repair)

Pundenal block (usually for 2nd stage, episiotomy, or operative vaginal birth)

Intrathecal (spinal) analgesia/anesthesia (during labor and cesarean birth)

36
Q

General anesthesia:

A

Emergency cesarean birth or women with contraindication to use of reginal anesthesia

IV injection, inhalation, or both

Commonly, first thiopental IV to produce unconsciousness

Next, muscle relaxant

Then intubation, followed by administration of nitrous oxide and oxygen; volatile halogenated agent also possible to produce amnesia

37
Q

Hypotonic Uterine Dysfunction: risk factors, assessment finding, management

A

The pressure of the uterine contraction is insufficent (less than 25 mm Hg) to promote cervical dilation and effacement

Risk factors: multiples, in active phase, fear

Assessment finding: decrease in frequency, strength, duration of the Uterine contraction, no cervical change, fear/anxiety

Management: evaluate labor progress, determine cause, pitocin, amniotomy, possible c-section

Causes: exhaustion, full bladder, uterine overdistention

38
Q

Hypertonic Uterine dysfuntion: (risk factors, assessment finding, management, nursing action)

A

defined as uncoordinated uterine activity: contractions are excessively frequent, or intense in contraction that lead to inadequate relaxation of the uterus between contraction

Risk: nulliparous women

Assessment finding: painful, frequent, ineffective

Management: evaluation, hydrate, pain management, lateral position, O2 by facemask as needed

Nursing: promote relaxation ,treat pain, hydrate

39
Q

Shoulder dystocia: Medical management:

A

downward traction may be applies to fetal head with suprapubic pressure

extended midline episiotomy

McRoberts Maneuver, wood corkscrew manuever

deliver posterior shoulder by sweeping post, arm across fetal chest followed by delivery of arm

most resolved by manuevers

Zancanelli manuever: cephalic replacement into the pelvis and then c/s

40
Q

Shoulder dystocia: RF, Associated Risk for infant, assessment

A

refers to the difficulty encountered during delivery of the shoulders after the birth of the head

Risk factors: fetal macrosomia, maternal diabetes, hx of shoulder dystocia, prolonged second stage, exessive weight gain

associated risk: fetal injury/death, brachial plexus injury, fractured clavicle, maternal complication: laceration, infection, hemorrhage

Assessment finding: delay in delivery of shoulder, retraction of the head against maternal perineum after delivery of head “turtle sign”

MEDICAL EMERGENCY

41
Q

Prolapsed Cord: risk factors, assessment finding, medical management, nursing action)

A

MEDICAL EMERGENCY

the cord lies below the presenting part of the fetus

Risk factor: Malpresentation (breech) unengaged presenting part, polyhydramniosis, small/preterm fetus, multiple gestation, high parity

Assessment: sudden fetal bradycardia, prolapsed cord on the vaginal exam, protruding from the vagina

Medical Management: STAT C/S

Nursing action: Lift presenting part off the cord with vaginal exam, knee chest position or Trandeleburg to relieve pressure on an occluded cord

42
Q

Uterine Rupture: Assessment, management, risk

A

obsteteric emergency: onset marked by sudden fetal bradycardia, PAIN

Nursing assessment: onset of sudden fetal distress, irregular abdominal wall contour, hypotension, tachycardia, pallor, fetal presenting part in pelvis, loss of station
> severe tearing, burning, stabbing pain, vaginal bleeding

Management: urgent C/S, continous maternal and fetal monitor, control bleeding, hysterectomy

Risk: previous c/section, VBAC, previous uterine surgery, tachysystole

43
Q

Amniotic Fluid Embolism:nursing assessment, management

A

EMERGENCY

sudden onset of hypotension, hypoxia, coagulopathy, due to breakage in barrier between maternal circulation and amniotic fluid

Nursing assessment: difficulty breathing, hypotension, cyanosis, seizures, tachycardia, coagulation failure, DIC, pulmonary edema, uterine atony with subsequent hemorrhage, ARDS, cardiac arrest

Management: supportive measures to maintain oxygenation and hemodynamic function and to correct coagulopathy; critical care monitoring

43
Q

Labor induction and augmentation:

A

Induction: stimulating contraction via medical or surgical means

Augmentation: enhancing ineffective contractions after labor has begun

Indications: prolonged gestation, prolonged premature rupture of the membranes, gestational hypertension, cardiac disease, renal disease, chorioamnionitis, dystocia, intrauterine fetal demise, isoimmunization, and diabetes

Assesment: Relative indications; gestational age determination
Fetal status; maternal status; Bishop’s score

Management: Explanations (Patient teaching)
Oxytocin administration
Pain relief and support

43
Q

Preterm labor: management, nursing assessment

A

Regular uterine contractions with cervical effacement and dilation between 20 and 37 weeks’ gestation

One of most common obstetric complications

Therapeutic Management:
Risk prediction
Tocolytic drugs: there are no clear first-line drugs to manage preterm labor; may prolong pregnancy for 2 to 7 days while steroids can be given for fetal lung maturity
Antibiotic prophylaxis for women with group B streptococcus

Nursing assessment:
Risk factors Subtle signs
Contraction pattern (4 contractions every 20 minutes or 8 contractions in 1 hour)
Laboratory and diagnostic testing: CBC, urinalysis, amniotic fluid analysis, fetal fibronectin, cervical length via transvaginal ultrasound, salivary estriol, home uterine activity monitoring

Expected finding: uterine contraction, pressure in pelvis, GI cramping/diarrhea, urinary freq, vaginal discharge

44
Q

Medications for Preterm Labor:

A

Nifedipine:
Ca channel blocker
Monitor for headache, flushing, dizziness & nausea

Magnesium Sulfate:
>Tocolytic, relaxes smooth muscle of uterus, suppresses contractions
>Instruct client to notify RN of distress (blurred vision, headache, nausea, vomiting, difficulty breathing)
>Monitor for s/s of Mag. Tox. (loss of DTRs, urinary output < 30 cc/hr, respiratory depression, pulmonary edema, chest pain)
>Administer Calcium Gluconate as an antidote as needed

Indomethacin:
>NSAID that suppresses PTL by blocking the production of prostiglandins (this suppresses contractions)
>Rx for no more than 48 hours, only with gestational age <32 weeks, monitor for PPH r/t reduced platelet aggregation

Betamethasone:
>Glucocorticoid, IM x 2, q 24 hrs, to enhance fetal lung maturity & surfactant production, 24-34 wks gest.
> Monitor for fetal & neonatal: pulmonary edema (chest pain, SOB, crackles), hyperglycemia, heart rate changes

Psychological support is essential

45
Q

Operative Vaginal Delivery

A

Vacuum- assisted delivery/ Forceps
> application of traction to fetal head

Indications: Prolonged second stage of labor, nonreassuring FHR pattern, failure of presenting part to fully rotate and descend, limited sensation or inability to push effectively, presumed fetal jeopardy or fetal distress, maternal heart disease, acute pulmonary edema, intrapartum infection, maternal fatigue, infection

Risk of tissue trauma to mother and newborn
> caput common with vacuum assist, facial abraision common with forceps

prevetion is key

46
Q

Cesarian Section

A

The cesarean section rate in the United States remains 32%

Complications of cesarean delivery for mothers include bowel and bladder injury during surgery, hemorrhage, amniotic fluid embolism, and infection. A major neonatal complication is respiratory distress

Indications for cesarean delivery include:

Failure to progress

No reassuring fetal heart rate

Fetal malpresentation

Umbilical cord prolapses

Fetal macrosomia

Unplanned cesarean delivery may cause women a sense of frustration, disappointment, even failure

Types of uterine incisions include classical (vertical), low vertical, or low transverse it is the safest to attempt a vaginal delivery after cesarean if a low transverse incision was used

Maternity (3 decks)

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