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NRSE-4570 Childbearing Families > Exam 2 Study Guide > Flashcards

Exam 2 Study Guide Flashcards

1
Q

What is ‘VEAL’ evaluating in veal chop mine

A

FHR pattern

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2
Q

What is ‘CHOP’ evaluating in veal chop mine?

A

cause

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3
Q

what is ‘MINE’ telling us in veal chop mine?

A

management

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4
Q

VEAL acronym stands for?

A

Variable deceleration
Early deceleration
Acceleration
Late deceleration

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5
Q

What does CHOP acronym stand for?

A

Cord compression
Head compression
Okay!
Placental insufficiency

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6
Q

what does ‘MINE’ acronym stand for

A

Maternal repositioning
Identify labor progress
No interventions
Execute interventions

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7
Q

What are accelerations?

A

increase in fetal HR from baseline by 15 bpm lasting 15 seconds or more

-determinant of fetal well-being

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8
Q

Are accelerations on the FHR reassuring?

A

Yes

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9
Q

What are the types of decelerations seen in FHR monitoring?

A

-variable decelerations
-early decelerations
-late decelerations
-prolonged decelerations

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10
Q

Cause of variable decelerations

A

cord compression

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11
Q

interventions for variable decelerations?

A

-move mom to release pressure on cord

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12
Q

Late decelerations are caused by

A

utero-placental insufficiency

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13
Q

Interventions for late decelerations ?

A
  1. roll mom over to increase perfusion
  2. stop oxytocin
  3. IV fluids and oxygen
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14
Q

Early decelerations are caused by

A

head compression

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15
Q

Interventions for early decelerations?

A

-none
-perform labor checks

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16
Q

Prolonged decelerations last how long?

A

> 2 minutes

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17
Q

Interventions for prolonged decelerations?

A

-same as late
-prepare for c -section

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18
Q
A

-beginning, middle, and end of decelerations exactly matches uterine contractions

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19
Q
A

-beginning of deceleration aligns with the peak of uterine contraction

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20
Q

variable decelerations

A

-significant drop down
-U’s, V’s, W’s

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21
Q

What is FHR variability?

A

normal irregularity of the cardiac rhythm

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21
Q

Absence of variability is a sign of?

A

fetal compromise

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22
Q

FHR variability is a determinant of

A

fetal well-being

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23
Q

What is absent variability?

A

line almost completely flat

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24
Q

What is minimal variability?

A

very slight variability from baseline

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25
Q

Cause of minimal variability and nursing interventions

A

-sedated baby
-monitor more

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26
Q

Moderate variability is

A

a reassuring sign and what we want to see

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27
Q

What is sinusoidal variability?

A

FHR repeating cycle of upward increase in the HR followed by a decrease in the HR

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28
Q

What is cord compression?

A

Baby compressing umbilical cord which leads to decreased perfusion to baby

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29
Q

How is cord compression relieved?

A

repositioning mom

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30
Q

Cord compression will cause

A

variable decelerations

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31
Q

What FHR patterns are reassuring

A

-accelerations
-moderate variability

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32
Q

What FHR patters are non-reassuring?

A

-tachycardia
-bradycardia
-decreased / absent variability
-late decelerations
-persistent variable decelerations

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33
Q

What interventions are performed for absent variability?

A
  1. repositioning mom
  2. administering oxygen
  3. IV fluid bolus
  4. discontinue oxytocin infusion
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34
Q

For absent variability, what can we stimulate in the fetus to promote FHR variability/ acceleration?

A

the fetus’s scalp
-can be done with hands or forceps

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35
Q

What may have to be applied to fetus when we have absent variability on the FHR?

A

fetal scalp electrode

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36
Q

What is a normal FHR?

A

110-160 BPM
- average rate over 10 minutes

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37
Q

What is fetal tachycardia?

A

baseline above 160 BPM

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38
Q

What can cause fetal tachycardia?

A
  • fetal hypoxia
    -maternal fever
    -intrauterine infection
    -drugs
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39
Q

What is fetal bradycardia?

A

baseline below 110 BPM

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40
Q

What are causes of fetal bradycardia?

A

-profound hypoxia, anesthesia, beta blockers

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41
Q

If mom is given sedation, will this cause effects on the baby?

A

yes

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42
Q

What are interventions for late decelerations?

A
  1. reposition mom first
  2. oxygen therapy
  3. IV fluid bolus
  4. discontinue oxytocin infusion
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43
Q

What is intermittent FHR monitoring

A

-low technology method that is performed during labor

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44
Q

What instruments can be used to perform intermittent FHR monitoring?

A
  • doppler, ultrasound stethoscope, fetoscope
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45
Q

What is continuous FHR monitoring

A

continuously monitoring FHR and uterine contractions by placing a transducer on the client’s abdomen and tocotransducer on the client’s fundus

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46
Q

What are advantages to continuous FHR monitoring?

A

-noninvasive and reduces risk of infection
-performed by a nurse
-provides permanent record of FHR and uterine contractions

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47
Q

Does the cervix have to be dilated OR membranes have to be ruptured for continuous FHR monitoring?

A

No (this is considered an advantage)

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48
Q

During the latent phase of labor, how often should the FHR be monitored?

A

q 30-60 min

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49
Q

During the active phase of labor, how often should the FHR be monitored?

A

q 15-30 min

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50
Q

During second stage of labor, how often should the FHR be monitored

A

q 5-15 min

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51
Q

What is an epidural?

A

local anesthetic injected into the epidural space at the 4th-5th vertebrae

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52
Q

Where does an epidural eliminate pain?

A

-umbilicus to thighs
-might not remove pressure sensations

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53
Q

What are complications of the epidural?

A

-maternal hypotension
-fetal bradycardia

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54
Q

When using an epidural, clients may lose the

A
  1. ability to feel the urge to void –> leads to urinary retention
  2. bearing down reflex
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55
Q

Can an epidural cause fever and itching?

A

yes

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56
Q

What must be inserted to help with elimination if a client receives an epidural

A

-Foley catheter

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57
Q

What must be administered to client receiving an epidural to prevent maternal hypotension

A

-a bolus of IV fluids

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58
Q

After insertion of the epidural, what position should the client be in?

A

side-lying
-helps prevent hypotension

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59
Q

Should FHR be assessed for continuously after receiving epidural?

A

yes due to potential for fetal bradycardia

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60
Q

Client’s with an epidural are at risk for ______, so client safety is a priority

A

falls

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61
Q

How can we prevent falls in patients receiving epidurals?

A
  • do not let client get up and walk around
  • assess when she can feel sensation again
  • assist client with standing and walking for the first time
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62
Q

What is the first stage of labor?

A

When cervix is dilating from 0-10 cm

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63
Q

The first stage of labor is broken down into three stages. What are they?

A

-latent phase: 0-3cm
-Active phase: 4-7 cm
-Transition: 8-10 cm

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64
Q

The first stage of labor begins with onset of _____ contractions and ends with ______- _______

A

regular contractions ; complete dilation

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65
Q

What are contractions like during the latent phase of labor?

A

-irregular, mild to moderate
-q 5-30 min
-lasts 30-45 sec

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66
Q

During the latent phase, are mothers often talkative and eager?

A

yes

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67
Q

Some dilation and effacement will occur slowly during the

A

latent phase

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68
Q

contractions during the active phase of labor will be?

A

-regular and moderate to strong
-q 3-5 min
-lasts 40-70 seconds

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69
Q

What phase of labor will mothers begin to feel anxiety, restlessness, and helpless

A

active face

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70
Q

Rapid dilation and effacement with some fetal descent occurs during which phase?

A

active

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71
Q

Contractions during the transition phase will be?

A

-strong to very strong
-q 2-3 min
-45 - 90 sec duration

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72
Q

Which phase of labor will make the mom tired, restless and irritable?

A

transition phase (considered most difficult part of labor)

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73
Q

During the transition phase of labor, birthing mothers will often express that

A

‘they cannot continue’

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74
Q

what phase of labor will have increased rectal pressure, need for bowel movement, and increased bloody show?

A

transition phase

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75
Q

Mothers will not feel the urge to push until which phase of labor

A

transition

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76
Q

Can mothers experience nausea and vomiting during the transition phase?

A

they can

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77
Q

What happens during the second stage of labor?

A

-begins with complete cervical dilation and ends with DELIVERY OF FETUS

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78
Q

During the second stage of labor, will mothers experience contractions q 1-2 min

A

yes

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79
Q

What happens during the third stage of labor?

A

-begins with delivery of the neonate and ends with DELIVERY OF THE PLACENTA
-separates from uterine wall

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80
Q

What is Schultze presentation?

A

shiny fetal surface of placenta emerges first

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81
Q

What is Duncan presentation?

A

-dull maternal surface of placenta emerges first

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82
Q

What is the fourth stage of labor?

A

maternal stabilization of vital signs lasting 1-4 hours

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83
Q

What does locha look like during the fourth stage of labor?

A

scant to moderate rubra

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84
Q

What is VBAC?

A

vaginal birth after cesarean

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85
Q

Selection criteria for VBAC includes?

A

-no other uterine scars or history of previous rupture
-clinically adequate pelvis
-no current contradictions

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86
Q

What kind of incision must the woman have to meet VBAC criteria?

A

-low transverse

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87
Q

Can a woman qualify for VBAC if her birthing center doesn’t have providers immediately available?

A

NO - must be able to go into emergency c-section if it ends up being indicated

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88
Q

Can clients who have had dysfunctional labor, breech presentation, or abnormal FHR pattern quality for VBAC?

A

yes because these are considered nonrecurring events

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89
Q

What is OP position?

A

occiput posterior

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90
Q

What happens during occiput posterior position?

A

baby is head down but facing the mother’s front instead of her back

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91
Q

occiput posterior position can cause

A

-labor to be longer and more painful
-c-section
-use of forceps or vacuum

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92
Q

Why do women with fetuses in OP position have ‘back labor’

A

baby’s head is pressing up against the lower spine

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93
Q

What will help with back labor pain?

A
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94
Q

What is a fetal fibronectin test?

A

-tests the amount of fFN in vaginal fluid to assess the risk of preterm birth
-between weeks 24-34 of pregnancy

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95
Q

A negative test result in a fibronectin test means?

A

the client is not in preterm labor

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96
Q

A positive fibronectin test indicates?

A

pre-term labor may be occurring/ at high risk for one

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97
Q

What is a bishop score?

A

a score used to evaluate maternal readiness for labor and if they will need induction

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98
Q

What does the bishop score evaluate

A

-cervical dilation
-cervical effacement
-cervical consistency
-cervical position
-station of presenting part

-each have a numerical value of 0-3

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99
Q

a score of 5 or less on the bishop scoring indicates

A

unfavorable cervix; induction may be necessary for vaginal delivery

100
Q

A bishop score of 6-7 indicates

A

unclear whether or not induction will be successful

101
Q

a bishop score of 8 or greater indicates

A

spontaneous vaginal delivery likely; induction may not be necessary

102
Q

What are objective indications of pain our patients may expereince

A

-behavioral changes
-increase BP, tachycardia, hyperventilation
-Nausea and vomiting

103
Q

What is the gate-control theory of pain

A

the idea that non-painful stimuli can override and reduce painful stimuli

104
Q

What can our patients do to block painful stimuli (gate - control theory of pain)

A

-rubbing a painful area
-being distracted
-burn incense

105
Q

Child-birth classes, doulas, and hypnosis are examples of?

A

nonpharmacological pain interventions

106
Q

What sensory stimulation strategies can we promote in our patients to reduce pain?

A

-aromatherapy
-breathing techniques
-imagery
-music
-use of focal points
-subdued lighting

107
Q

What are cutaneous stimulation strategies based on the gate-control theory to promote relaxation and reduce pain?

A

-therapeutic touch and massage
-walking
-rocking
-effleurage
-sacral counter pressure

108
Q

What is effleurage?

A

-light, gentle circular stroking of the client’s abdomen with the fingertips in rhythm with breathing during contractions

109
Q

What is sacral counterpressure?

A

consistent pressure is applied by the support person using the heel of the hand or fist against the clients sacral area to counteract pain in the lower back

110
Q

What nonpharmacological pain management strategy increases maternal endorphin levels

A

hydrotherapy (whirlpool or shower)

111
Q

Common positions for our mothers to promote relaxation

A

-semi-sitting
-squatting
-kneeling
-kneeling and rocking back and forth

112
Q

What pharmacological pain management are not commonly used during labor , but MAY be used to induce sleep in the early or latent phase?

A

-sedatives (phenobarbital, pentobarbital)

113
Q

Why are barbiturates not commonly used for pain management?

A

-neonate respiratory depression
-unsteady ambulation by mom
-decreases mom’s ability to cope with pain of labor

114
Q

Should sedatives be prescribed if mom is feeling pains of labor?

A

No - may cause them to become hyperactive and disoriented

115
Q

Nursing strategies when client is prescribed barbiturates?

A

-provide safety for mom
-dim lights and promote rest
-monitor fetal respirations

116
Q

What opioids are commonly used in childbirth?

A

-meperidine, fentanyl, butorphanol, nalbuphine

117
Q

Which opioids provide pain relief without causing significant respiratory depression in the mother or fetus?

A

butorphanol and nalbuphine

118
Q

Adverse effects of opioids ?

A

-respiratory depression in mother or neonate
-reduction of gastric emptying –> nausea and vomiting
-FHR variability decreased

119
Q

What part of labor are opioids given

A

-early part of active labor

120
Q

What routes are opioids given during labor

A

-IM or IV (IV most common route)

121
Q

Nursing actions to monitor during labor

A

-verify well established labor
-monitor VS,FHR,ctx, pain

122
Q

What is administered during epidural and spinal regional analgesia?

A

-fetanyl administered as a motor block into subdural or intrathecal space without anesthesia

123
Q

Epidural and spinal analgesia produce ____ pain belief while still allowing _____ of contractions an _____ to push

A

rapid ; sensation ; ability

124
Q

Adverse effects of epidural and spinal analgesia

A

nausea and vomiting
hypotension

125
Q

Nursing actions for epidural and spinal regional analgesia?

A

-safety precautions
-monitor VS and FHR

126
Q

the epidural eliminates pain at the level from

A

the umbilicus to the thighs (may not remove pressure sensations)

127
Q

When is the epidural administered?

A

when the client is in active labor and at least 4 cm dilated

128
Q

What is patient controlled epidural analgesia

A

using a PCA pump to administer the epidural after initial placement

129
Q

the spinal anesthesia is administered into?

A

the subarachnoid space into the spinal fluid at the 3rd, 4th, and 5th lumbar space

130
Q

the spinal anesthesia eliminates all pain from the ____ down

A

nipple

131
Q

Spinal anesthesia is commonly used in?

A

cesarean births

132
Q

Adverse effects of the spinal anesthesia

A

-maternal hypotension
-fetal bradycardia
-potential headache from leakage of cerebrospinal fluid

133
Q

Nursing actions with spinal anesthesia

A

-IV bolus before
-monitor FHR
-monitor for HA

134
Q

Nursing actions to prevent postpartum HA from spinal anesthesia q

A

-supine position
-bed rest in a dark room
-oral analgesics, caffeine, and fluids
-autologous blood patch is the most beneficial and reliable measure

135
Q

In what scenario would general anesthesia be used?

A

-contraindication to spinal or epidural
-seeing no pain relief
-delivery complications
-severe emergencies

136
Q

If general anesthesia is used, is the support person allowed in the room”

A

No

137
Q

General anesthesia will not be administered to the mom until?

A

everyone is in the room and ready

138
Q

What is priority to monitor after a client is given general anesthesia

A

uterine tone –> general anesthesia can lead to hemorrhage

139
Q

What does the nurse want the uterus to feel/look like after receiving general anesthesia

A

firm, contracting, controlled bleeding

140
Q

Nursing actions for general anesthesia

A

-apply anti-embolic stockings
-administer antacids and H2 receptor antagonists (ranitidine)
-monitor VS and IV site

141
Q

What is chorioamnionitis?

A

an infection of the placenta and amniotic fluid (amniotic sack)

142
Q

How does chorioamnionitis present?

A

-yellow, malodorous discharge
-fever
-tenderness/pain
-sweating
-fetal or maternal tachycardia

143
Q

How is Chorioamnionitis treated?

A

-Ampicillin
-obtain vaginal, urine, and blood cultures before administering antibiotics

144
Q

When is a vacuum delivery indicated?

A

-maternal exhaustion
-ineffective pushing efforts
-fetal distress (during second stage)
-after 34 weeks

145
Q

Can a vacuum assisted birth be used if the mom is not 10 cm dilated and membranes not ruptured?

A

no

146
Q

What presentation must baby be in for provider to use vacuum assisted birth?

A

vertex

147
Q

If mom’s pelvis is disproportionate and baby is not engaging, can vacuum assisted delivery be performed?

A

no

148
Q

What medication is needed in room for birth, medication wise for mom and baby

A

naloxone ?? (thanks Aaron)

149
Q

What happens during uterine rupture?

A

-when the uterus tears open during pregnancy (can be complete or incomplete)

150
Q

A complete uterine rupture involves the uterine wall, peritoneal cavity, and or broad ligament. What does this cause?

A

internal bleeding

151
Q

An incomplete uterine rupture is. caused by dehiscence at the sign of a prior scar. Is internal bleeding always present?

A

no

152
Q

Is uterine rupture a life threatening emergency?

A

yes

153
Q

What symptoms will the client report if experiencing a uterine rupture?

A

-sensation of ripping, tearing, and sharp pain
-abdominal pain and uterine tenderness

154
Q

With uterine rupture, changes in uterine and shape occur. what assessment finding accompanies this

A

-fetal parts palpable

155
Q

Cessation of ____ and loss of fetal _____ occurs during uterine rupture

A

contractions ; station

156
Q

What will FHR look like during uterine rupture?

A

-nonreassuring FHR with indications of distress
-bradycardia, variable/late decelerations, minimal/absent variability

157
Q

Manifestatiosn of hypovolemic shock, which can occur with uterine rupture, are?

A

-tachypnea, hypotension, pallor, cool and clammy skin

158
Q

What is the biggest indicator that our client is in true labor?

A

-cervical changes such as dilation and effacement

159
Q

Contractions in true labor vs false labor?

A

true: start irregular but become regular, strong, last longer, more frequent, felt in lower back and radiates to abdomen, walking increases contraction intensity. comfort measures do not work

False: can be painless, intermittent, and irregular frequency. decrease in pain and intensity with walking. felt in lower back or above umbilicus, relieved by comfort measures

160
Q

The presenting part of the infant will engage in true or false labor?

A

true

161
Q

Will bloody show occur in false labor?

A

no - only true labor

162
Q

where should fetal heart tones be assessed if in vertex presentation?

A

below the umbilicus in the right or left lower quadrant

163
Q

Where should fetal heart tones be assessed if in breeched position?

A

above the clients umbilicus in either the right or left upper quadrant of the abdomen

164
Q

What are tocolytics?

A

medications that are used to delay or stop uterine contractions in pregnancy\
-used mostly in preterm labor (before 36 weeks and 6 days gestation)

165
Q

What medications are tocolytics?

A

magnesium suflate and terbutaline

166
Q

How does magnesium sulfate work?

A

-depresses central nervous system and relaxes smooth muscles

167
Q

Sx of magnesium sulfate toxicity?

A

BURP
Blood pressure decreased
Urine output decreased
Respirations less than 12
Patella reflex absent
-decreased LOC
-cardiac dysrhythmias

168
Q

What is the antidote for magnesium sulfate?

A

calcium gluconate

169
Q

How does terbutaline work?

A

-beta adrenergic agonist that relaxes smooth muscles and inhibits uterine activity

170
Q

If our uterus is relaxed after pregnancy, a side effect of tocolytics, what are we at risk for after delivery

A

hemorrhage

171
Q

When is oxytocin given?

A

-cervical priming to increase readiness for labor
-induction of labor
-dystocia (due to atypical contractions)
(augment labor and strengthen uterine contractions)

172
Q

Prior to the administration of oxytocin for induction of labor, it is important the nurse confirm what?

A

-that the fetus is engaged at a minimum station of 0

173
Q

During induction of labor, it is important to wait for oxytocin infusion until?

A

-the cervix is ready after ripening
-4 h after misoprostol
-6-12 after dinoprostone gel instillation

174
Q

When should oxytocin infusion be stopped?

A

during tachysystole/ hypertonic contractions

175
Q

Sx of tachysystole include?

A

-contractions frequency less than 2 min apart
-duration of contraction > 90 sec
-pressure of contractions ? 90 mmhm
-uterus not relaxing between contractions
-uterine resting tone > 20 mmhg

176
Q

Contraindications for using oxytocin include

A
177
Q

What is GBS screening done for?

A

-culture to screen for group B streptococcus

178
Q

when is the GBS screening done?

A

35-37 weeks

179
Q

why is GBS important to know?

A

-we must administer ABX intravenously to prevent complications to baby

180
Q

What can happen to the neonate if GBS is spread to it

A

-pneumonia, respiratory distress syndrome, sepsis, and meningitis

181
Q

What medications are used to treat GBS?

A

-penicillin and ampicillin

182
Q

What is fetal station?

A

relationship of fetal head to the mothers pelvis

183
Q

How is station measured?

A

-station 0 being at the level of ischial spines
-above 0 is -1,-2,-3
-below 0 is +1,+2,+3

184
Q

How do we facilitate descent of fetus?

A

by using gravity
-peanut ball bouncing
-hands and knees position
-hugging ball on floor
-squatting with chair

185
Q

What isi a precipitous delivery?

A

labor completed in less than 3 hours when starting contractions to birth

186
Q

what do we need to monitor for during precipitous delivery?

A

-cervcial lacerations
-uterine rupture
-pain management

187
Q

What should we monitor in the fetus during precipitous delivery

A

-head trauma (intracranial hemorrhage or nerve damage)
-hypoxia due to rapid progression of labor

188
Q

When is magnesium sulfate given?

A

-during preterm labor to suppress contractions
-in preeclampsia (from last exam to prevent seizures)

189
Q

When is magnesium sulfate no longer safe?

A

When adverse reactions are present:
-hot flashes
-diaphoresis
-burning at IV site
-nausea
-vomiting
-drowsiness
-blurred vision
-headache
-non-reactive non stress test
-reduced FHR variability

190
Q

What are signs of labor?

A

-backache
-weightloss (1-3.5lbs)
-lightening
-contractions (Braxton hicks –> regular)
-expulsion of mucous plug (brown or blood tinged)
-energy changes
-GI changes
-cervical changes
-rupture of membranes

191
Q

What is lightening and what sx will occur (preceding labor)

A

when fetal head descends into relics about 14 days before labor
-feels like baby has ‘dropped’
-easier breathing
-urinary frequency increases again

192
Q

What happens during a cord prolapse

A

-occurs when the umbilical cord is displaced (comes before the fetus, protruding through cervix)

193
Q

What does cord prolapse result in?

A

cord compression and compromised fetal circulation

194
Q

During a cord prolapse, the nurse should call for assistance immediately. What else should they do?

A

-use a sterile gloved hand, insert two fingers into the vagina and apply pressure on the fetal presenting part to elevate it off of the cord (remain until birth of baby)

195
Q

What position should mom be placed in if cord prolapse occurs

A

knee-chest
trendelenburg
side lying with towel under clients hip

196
Q

If the cord is visible outside, what should be applied to it to prevent drying and maintain blood flow?

A

sterile, warm, saline soaked towel

197
Q

Other nursing actions during cord prolapse include?

A

-applying 8-10 L of oxygen via facemark
-administering IV fluid bolus
-continuous FHR monitoring

198
Q

What is betamethasone used for?

A

-promoting lung maturity In fetus (mostly used in preterm labor)

199
Q

What is a doula?

A

provides emotional or practical support to mother or couple before, during, and after childbrith

200
Q

How do doulas assist?

A

-pain relief, reduced need for pain medications and delivery options (prevent vacuums, forceps, and c sections)
-emotional and physical support
-information on birth experience

201
Q

What is effleurage?

A

light, gentle circular stroking of the client’s abdomen with the fingertips in rhythm of breathing during contractions

202
Q

When is effleurage done?

A

during labor

203
Q

What are the 5 P’s of labor?

A

passageway
passenger
powers
position
psyche

204
Q

What does passageway mean?

A

the birth canal –> bony pelvis, pelvic floor, vagina, vaginal opening

205
Q

What is the anatomically perfect pelvis for a baby to pass through

A

‘gynecoid’

206
Q

What is ‘presentation’ in the Passenger P

A

what part of fetus is entering the pelvic inlet first
-occiput
-chin
-shoulder
-breech

207
Q

What is ‘L’ in Passenger P

A

-transverse
-parallel

208
Q

What is ‘attitude’ in Passenger P?

A

relationship between fetal body parts (flexion / extension)

209
Q

What occurs during the Powers P?

A

uterine contractions
-cause effacement and dilation
Involuntary urge to push and bearing down

210
Q
A
210
Q

What position is best for fetal descent (Position P in the five P’s)

A

-those that use gravity as assistance

211
Q

What is important to remember in the Psychological P (five P’s)

A

-relaxed mothers are more tolerant of pain
- anxiety and fear can divert blood flow from the placenta

212
Q

What is the premature rupture of membranes (PROM)

A

-spontaneous rupture of amniotic membranes prior to the onset of true labor

213
Q

IF gestational duration is at term, the premature rupture of membranes indicates

A

the onset of true labor

214
Q

What is preterm premature rupture of membranes

A

-premature spontaneous rupture of membranes

215
Q

What are the laboratory tests that are used to verify rupture of membranes

A

-Nitrazine paper test (blue, pH 6.5-7.5)
-positive ferning test: when amniotic fluid is placed under microscope it looks like ferns

216
Q

After 37 weeks, if there is a premature rupture of membranes, it is important for the nurse to make sure

A

labor starts

217
Q

Afte membrane ruptures, we should limit?

A

the amount of vaginal exams to reduce infection

218
Q

If mom ruptures but contractions haven’t started ,what do we do?

A

send her home

219
Q

With premature preterm rupture of membranes, the mom should remain on what at home? q

A

bedrest with bathroom privileges

220
Q

What should we educate clients to do if they experience premature rupture of membranes

A

-monitor daily fetal kick counts and notify nurse of uterine contractions
-adhere to bed rest with bathroom privileges

221
Q

What is rupture of membranes?

A

spontaneous rupture of members can initiate labor or occur anytime during labor, most commonly during transition phase

222
Q

What should be documented following the rupture of membranes?

A

-assessment of amniotic fluid
-testing for presence of amniotic fluid using nitrazine paper

223
Q

What should normal amniotic fluid look like/ what we should document for rupture of membranes?

A

-amniotic fluid should be watery, clear, and slightly yellow
-no foul odor
-volume between 700-1,000 mL

224
Q

Immediately following the rupture of membranes, a nurse should assess for?

A

FHR decelerations that may indicate fetal distress / umbilical cord prolapse

225
Q

What are leopold maneuvers?

A

abdominal palpation of the fetal presenting part, lie, attitude, descent, and the probable location where FHR can be detected best

226
Q

What are leopold maneuvers supposed to detect?

A

malpresentation

227
Q

C-section indications

A

-breech
-nonassuring FHR
-placentia previa and abruption
-previous c -section
-dystocia
-umbilical cord prolapse

228
Q

What are the 7 cardinal movements?

A

-engagement
-descent
-flexion
-internal rotation
-extension
-external rotation (restitution)
-birth by expulsion

229
Q

The 7 cardinal movements are used for what presentation of the fetus

A

vertex

230
Q

What is engagement (7 cardinal movements)

A

when the presenting part passes into the pelvic inlet and is at the level of the ischial spine
-referred to as station 0

231
Q

What is descent (7 cardinal movements)

A

the progress of presenting part throug h the pelvis
-measured by station during vaginal examination (- , 0 , + station)

232
Q

What is flexion (7 cardinal movements)

A

when the fetal head meets resistance of the cervix, pelvic wall, or pelvic floor
-head flexes and brings chin to chest making it smaller and easier to pass

233
Q

What is internal rotation (7 cardinal movements)

A

-the fetal occiput ideally rotates to a lateral anterior position as it progresses from the asocial spines to the lower pelvis in a corkscrew motion to pass through the pelvis

234
Q

What is extension (7 cardinal movements)

A

the fetal occiput passes under the symphysis pubis and the head is deflected anteriorly and is born by extension of the chin away from the fetal chest

235
Q

What is external rotation/restitution?

A

after the head is born, it rotates to the position it occupied as it enters the pelvic inlet (restitution) in alightment with the fetal bod and completes a quarter turn to face transverse as the anterior shoulder passes under the symphysis

236
Q

What is birth by expulsion (7 cardinal movements)

A

after birth of the head and shoulders, the turn of the neonate is born by flexing it toward the symphysis pubis

237
Q

How do we assess uterine labor contraction characteristics?

A

by palpation or external/internal monitoring

238
Q

What is frequency of contractions?

A

established from the beginning of one contraction to the beginning of the next

239
Q

What is duration of contractions

A

time between the beginning of a contraction to the end of THAT SAME contraction

240
Q

What is contraction intensity/ strength?

A

strength of the contraction at its peak described as mild, moderate, or strong

241
Q

Mild contractions can be compared to?

A

slightly tense (like pressing fingertip to tip of nose)

242
Q

Moderate contraction can be compared to

A

firm, like pressing finger to chin

243
Q

Strong contractions can be compared to

A

rigid, like pressing finger to forehead

244
Q

What is the resting phase of contractions

A

tone of the uterine muscle during contractions

245
Q

A prolonged contraction duration (90 seconds or greater) or too frequent contractions (more than 5 in a ten minute period) without sufficient time to rest in between (30 seconds) can result in

A

reduced blood flow to placenta –> fetal hypoxia and decreased FHR

246
Q
A

NRSE-4570 Childbearing Families (4 decks)

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