Exam 2 - OB Flashcards
this test is assessing fetal movement + fetal HR accelerations (no contractions)
NST
what is normal fetal HR
110-160
fetal movement + fetal HR accelerations means what (with NST)?
adequate oxygenation to fetus
+
autonomic nervous system is fxning correctly
how long do we monitor for with NST?
20-40 mins
normal NST =
reactive
reactive NST =
normal
what are components of reactive NST? (for >32 weeks, and <32 weeks)
> 32 weeks: accelerations 15 (bpm) x 15 (secs) 2x in 20 mins
<32 weeks: accelerations 10(bpm) x 10 (secs)
No accelerations in 40 min window = what result?
if you get this result, what happens next?
nonreactive on NST (abnormal)
further assessment (CST)
If fetus doesn’t show variability during a NST, what can we do?
give snack or auditory vibration/stimulation to get some movement + to wake dat baby up
2 ways we can stimulate contractions during Contraction stress test (CST)
- nipple stimulation
2. oxytocin stimulation
negative CST =
normal
positive CST =
abnormal
what are the components of a negative CST?
No late decels in 10 min period w/3 contractions
what are the components of a positive CST?
late decels in 50% of contractions
tell us baby might not be able to handle labor
what could late decels be indicative of?
placental insufficiency
what is major risk of CST? what should we have handy in preparation for this?
preterm labor risk → give tocolytics if they have >5 contractions in 10 mins
L/S ratio is tested via what?
amniocentesis
what is L/S ratio testing? what is ratio that indicates this?
bonus: what is ratio for preggo pt with diabetes?
fetal lung maturity (2:1)
diabetes L/S: 2.5:1 or 3:1
what is variability?
variations in fetal HR - moderate is normal, expected ◡̈
accelerations are what? what do they tell us?
increase in HR - indicates good oxygenation
early decels indicate what?
head compression
type of HR variation:
gradual decrease in FHR; mirrors contraction
early decels
type of HR variation:
abrupt decrease in FHR; resembles a V on monitor; no relation to contractions
variable decels
variable decels indicate what?
cord compression
what is intervention for variable decels?
repositioning 1st (side or knee to chest)
if cord prolapse occurs, what should you do? (5)
- gloved hand into vagina to relieve pressure off cord to perfuse baby
- emergency bell for assistance
- Trendelenburg positioning
- warm saline
- O2
C section if birth is not immediate
type of HR variation:
gradual decrease of FHR; onset after beginning of contraction
late decels :(
late decels are indicative of what?
placental insufficiency :(
what is intervention for late decels?
repositioning 1st
components of VEAL - CHOP
Variable - Cord Compression
Early - Head compression
Accelerations - Ok ◡̈
Late - Placental insufficiency
interventions for decels: (5)
1st: reposition (side, knee to chest)
Then… discontinue oxytocin, IV bolus of LR, O2 via face mask 8-10L/min, notify provider
true labor vs false labor
false labor: braxton hicks, irregular contractions, no cervical changes
true labor: cervical changes (dilation + effacement), regular contractions that increase in frequency and intensity
in simple terms, what happens in each stage of labor?
1: start of TRUE labor w/cervical changes - dilation up to 10cm
2: baby delivered
3: placenta delivered
4: recovery
what are the 3 phases of stage 1 of labor?
latent, active, transition
how long does latent phase last?
4-6 hrs
what is dilation range for latent phase?
0-3cm
what are contractions like in latent phase? (characteristic, frequency, duration)
mild, 5-30 mins apart, last 30-45 seconds
how long does active phase last?
2-3 hrs
what is dilation range for active phase?
4-7cm
what are contractions like in active phase? (characteristic, frequency, duration)
moderate to strong, 3-5 mins apart, last 40-70 seconds
what is important patient care in active phase of labor to keep progressing with fetal descent?
keep bladder empty
in active phase of labor, if pt experiences urge to push before fully dilated, what should we do?
encourage panting/shallow breathing to prevent urge to push until it’s go time
how long does transition phase last?
20-40 mins
what is dilation range for transition phase?
8-10cm
what are contractions like in transtion phase? (characteristic, frequency, duration)
strong!, 2-3 mins apart, lasting 45-90 seconds
what stage of labor is pushing happening in? (intense contractions 1-2 mins apart)
stage 2
when should you expect placenta delivery?
5-30 mins after baby
how long does stage 4 of labor last?
up to 4 hrs (recovery + stabilizing)
in stage 4, how often should position and firmness of uterus be assessed?
q 15 mins
intervention for boggy uterus
fundal massaaaagggeeee
If fundus is firm, but birth person is bleeding, what might be happening?
there might be a laceration - needing sutures
opening of cervical os (+ range)
dilation (0-10cm)
thinning + shortening of cervix (+ range)
effacement (0-100%)
position of presenting part of fetus in pelvic cavity
station
re: station of fetus, what is 0? what do negative numbers mean? what about positive numbers?
0 = ischial spine (narrowest opening baby must pass through)
- numbers = above ischial spine
+ numbers = further down into pelvis (“positively moving towards delivery”)
what station number would you see with crowning of head?
+3 (or +4)
how many seconds is too long for a contraction?
> 90 seconds
what is the number for too frequent of contractions?
> 5 in 10 min period
if contractions are too long or too frequent, what interventions should you implement?
turn off pit, monitor contractions + fetal VS
if these don’t work, terbutaline to relax contractions
term for: relationship of pregnant person’s spine to fetal spine
fetal lie
term for: fetus posture
fetal attitude
term for: part of fetus that will come through birth canal 1st
fetal presentation
what is ideal fetal attitude (posture)
flexion (chin to chest)
what is frank breech?
legs extended to shoulders
what is complete breech?
bum presents + legs crossed
what is footling breech?
one or both feet present 1st
re: fetal position, what do these letters mean?
O
S
A
M
O: occiput (head)
S: sacrum (bum)
A: acromion process (shoulder)
M: mentum (chin/face)
what is amniotomy?
artificial rupture of membranes by provider
after amniotomy, what assessments should happen? (3)
- amniotic fluid - color, odor, volume
- temp q 2hr
- FHR
how quickly after ROM does labor usually begin?
24 hours
> 24 hrs after ROM (prolonged) = risk for what?
infection!
If amniotic fluid is meconium stained, this means potential for what? what intervention do we need?
risk for respiratory distress in newborn - need NICU present @ birth
what should be limited after ROM?
vaginal exams (to reduce infection risk)
reason to use tocolytics
relaxes smooth muscles → reduce strength + frequency of contractions
for preterm labor
reason to give betamethasone
preterm fetus - to stimulate surfactant to mature lungs
reason to give cervidil + cytotec
stimulates powerful contractions
for PPH
this med can be given to both initiate labor + to stop bleeding with PPH
oxytocin (Pitocin)
will an epidural relieve pain + pressure?
only pain, NOT pressure
2 things to do before epidural admin
- monitor FHR for 20-30 mins
2. fluid bolus to manage BP
when should APGAR happen?
1 and 5 mins after birth
components of APGAR
Appearance Pulse Grimace (reflex) Activity (tone) Respiratory
meanings of these APGAR scores:
0-3:
4-6:
7-10:
0-3: need full resuscitation
4-6: mild resuscitation (stimulation, suction, O2)
7-10: all good, normal monitoring
what 3 things make up a fundal assessment?
- location
- consistency
- height
when palpating the uterus, what should you ALWAYS do?
support lower segment
where would you expect fundus to be on day of birth?
umbilicus
where would you expect fundus to be immediately after birth?
-3 (3 fingers/cm below umbilicus)
if fundus is displaced to right or left, what is your intervention?
empty bladder
scant lochia:
<1 inch blood on pad
light lochia:
<4 inch blood on pad
moderate lochia:
blood covering most of pad
heavy lochia:
saturating pad in 1 hr
lochia rubra is what color for how many days?
bright red 1-3 days
lochia serosa is what color for how many days?
pink or brown, serosangineous for 4-10 days
lochia alba is what color for how many days?
yellow, white-ish for 11-21 days (longer if lactating)
clots larger than _________ require further assessment
a nickel
when assessing peri pads and lochia, what should we always do for most accurate assessment?
turn patient on side to check for pooling/dependent bleeding under patient
for comfort after birth, what can we use in first 24 hours? then what after that?
1st 24: ice packs/cool
after that: warm to stimulate circulation + tissue repari
breast engorgement is what? what is the intervention?
overfilled breasts
intervention: frequent feedings (q 2-3hrs) and pump after if needed
what postpartum complication could this be?
unilateral redness, hard, painful, fever, chills, HA, feeling shitty
mastitis
what postpartum complication could this be?
Severe pelvic pain + uterine tenderness, increased temp, dark lochia that has odor
endometritis
what should you NEVER do when person has DVT?
massage the site !
what postpartum complication could this be?
bulging swollen blue-ish area
hematoma
what is uterine atony?
uterus cannot contract normally → boggy
PPH is classified as how much blood loss (w/vaginal delivery + w/CS)?
> 500mL EBL with vaginal delivery
> 1000mL EBL with CS
risk factors for uterine atony (7)
macrosomia (big bebe) multiples prolonged labor polyhydraminos trauma assistance during birth (forceps, vacuum) retained placental fragments
what med should we NOT use with pre-e patients b/c can cause HTN?
Methylergonovine (Methergine)
what med should we NOT use with asthmatic patients b/c of bronchoconstriction?
Carboprost (Hemabate)
name the meds we can use for PPH (5)
- Oxytocin (Pitocin)
- Methylergonovine (Methergine)
- Carboprost (Hemabate)
- Misoprostol (Cytotec)
- Dinoprostone (Prostin)
= stimulate uterine contraction to compress vessels to control bleeding
Up + down with mood (teary, insomnia, feelings of inadequacies)
Resolves in ~10 days
postpartum blues (85% of ppl)
interventions for PP blues
get adequate rest, eat good food, rely on support system
PERSISTENT feelings of sadness + intense mood swings within 6 months of delivery
postpartum depression
hallucinations, delusions, paranoia, disorientation within 1st couple weeks of delivery
postpartum psychosis
intervention for postpartum psychosis
psychiatric care
what is priority nursing care for newborn immediately after delivery? then what happens?
AIRWAYY - suction + clear respiratory tract before anything
then…. dry thoroughly + stimulate, cover with warm blanket, skin to skin + put hat on
normal newborn RR
30-60 w/periods of apnea (<15 seconds)
normal newborn temp
97.7-99.5 (axillary)
if birthing person has hepatitis, infant should get __________________ with ________ of birth
Hep B immune globulin; 12 hrs
what are these reflexes? Rooting Palmar + plantar grasp Moro Tonic neck Babinski Stepping
rooting: stroke cheek and will turn that direction
palmar + plantar grasp: wrapping fingers or toes around finger (“holding your hand”)
moro: startle
tonic neck: bow + arrow position
babinkski: stroke outside of foot from heel towards toes; positive = fan out
stepping: hold vertically + will look like they’re walking
crosses suture line
caput (goes away in a few days)
doesn’t cross suture line; bulging on head
Cephalohematoma (goes away in 3-6 weeks)
circ care with Gomco + Mogen (clamps)
use vaseline
circ care with plastibell
plastic ring will fall off within a week; no vaseline
cold stress for newborns manifests as what?
respiratory distress
risk factors for hypoglycemia in newborns
- mom with diabetes
2. small for gestational age (low glycogen stores)
what are S+S of hypoglycemia in newborn
usual S+S with respiratory distress, flaccid muscle tone, weak cry, cyanosis
interventions for hypoglycemia
breastfeeding ASAP
heel sticks to test blood glucose
what is normal blood glucose for newborn
40-60
physiologic vs pathologic jaundice
physiologic: occurs AFTER 24 hrs post birth (benign, but need tx)
pathologic: occurs within 24 hours post birth (underlying issue)
expected bilirubin at 24 hrs
2-6
expected bilirubin at 48 hrs
6-7
expected bilirubin at 3-5 days
4-6
