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NSG 312 OB > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

oxytocics

A

agents that stimulate uterine contractions to promote labor

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2
Q

tocolytics

A

uterine relaxants

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3
Q

agents used for cervical ripening

A

cervadil and cytotec

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4
Q

misoprostol

A
  • most widely used agent for cervical ripening
  • preferred agent for controlling postpartum hemorrhage
  • can cause uterine contractions
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5
Q

what does oxytocin target?

A

the uterus

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6
Q

does oxytocin ripen the cervix?

A

no; don’t give to someone with an unripened cervix

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7
Q

when should we not use pitocin?

A
  • fetal lungs have not matured
  • patient has had previous c-section or uterine surgery
  • patient has active genital herpes
  • cephalo-pelvic disproportion
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8
Q

betamethasone

A

steroids given to accelerate fetal lung maturity

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9
Q

main purpose of magnesium sulfate

A

used to prevent seizures

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10
Q

signs of magnesium toxicity

A
  • respirations < 12 per minute
  • significant drop in maternal pulse/BP
  • hyporeflexia or absent reflexes
  • urine output < 30 mL/hr
  • serum mag levels > 9.6
  • fetal tachycardia or bradycardia
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11
Q

interventions for mag toxicity

A
  • discontinue mag sulfate
  • call provider
  • administer calcium gluconate (antidote)
  • monitor maternal and fetal status
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12
Q

signs of impeding labor

A
  • lightening: fetus settles into pelvis (10-14 days prior to labor for nulliparas and unpredictable for multiparas)
  • braxton hicks contractions
  • cervical changes: softening of cervix
  • bloody show: pink tinged mucus secretion when mucus plug is expelled (occurs when cervix ripens and starts to dilate)
  • nesting: occurs 24-48 hours before labor starts
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13
Q

do braxton hicks contractions cause cervical changes?

A

no

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14
Q

what is important to remind women about nesting?

A

forewarn them not to over-exert ~ trauma can lead to abruption

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15
Q

true labor

A
  • regular contractions, increase in frequency, intensity, and duration
  • cause cervical dilation and effacement
  • does not decrease with walking, showering, etc.
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16
Q

what kind of assessment is cervical dilation?

A

subjective

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17
Q

what are the 5 P’s of labor?

A
  • passageway
  • passenger
  • power
  • position of mother
  • psychological factors
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18
Q

what does the passageway include?

A
  • pelvis
  • cervix
  • vagina
  • external perineum
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19
Q

who is the passenger during labor?

A

the fetus

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20
Q

open suture lines

A
  • membranous space between bones
  • sagittal suture line: between parietal bones on top of head
  • coronal suture line: between frontal bone and two parietal bones on front of head
  • lamdoidal suture line: between parietal bones and occipital bone on the back of head
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21
Q

anterior fontanel

A
  • junction of coronal and sagittal suture line
  • also called “bregma”
  • diamond in shape
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22
Q

posterior fontanel

A
  • junction of sagittal and lamdoidal sutures
  • triangular in shape
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23
Q

landmarks of fetal skull entering the pelvis

A
  • occiput: area over occipital bone
  • sinciput: area over frontal bone
  • mentum: chin
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24
Q

best position for fetal skull to enter pelvis

A

occiput

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25
Q

what part is the widest diameter of the skull?

A

anterior posterior diameter

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26
Q

transverse diameter

A
  • also called biparietal diameter
  • approximately 9.25 cm across
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27
Q

attitude of fetal presentation

A

describes degree of flexion fetus assumes as well as position of body parts in relation to each other

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28
Q

best attitude for fetus to be delivered

A

full flexion

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29
Q

moderate flexion

A
  • military style
  • chin is not flexed forward
  • not usually a problem for delivery
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30
Q

partial extension

A
  • brown presentation
  • head is in partial extension
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31
Q

complete extension

A
  • face presentation
  • back is arched
  • neck is extended
  • not successful vaginal delivery, cervix won’t dilate since not a lot of pressure
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32
Q

three types of fetal presentation

A

cephalic, breech, shoulder

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33
Q

cephalic fetal presentation

A

“vertex” ~ head down first

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34
Q

breech fetal presentation

A

a bunch of parts presenting first

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35
Q

how are breech presentations delivered?

A

via c-section

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36
Q

engagement

A

presenting part is settled into pelvis and is at level of ischial spines (zero station); determined during vaginal exam

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37
Q

what are the 3 numbers obtained during a SVE?

A

cm dilated, % effaced, station

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38
Q

Station

A

relationship of presenting part of fetus to level of ischial spines, when presenting part is at level of ischial spine = 0 station

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39
Q

how do we chart fetal presentation and position?

A
  • maternal pelvis: right or left
  • landmark of fetal presenting part: occiput (O), mentum (M), sacrum (S), scapula (Sc)
  • maternal pelvis: anterior, posterior, transverse
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40
Q

what will we always see O in for the fetal presentation?

A

vaginal deliveries

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41
Q

what does LOA mean?

A

occiput on maternal left, pointing anterior

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42
Q

fastest type of deliveries have what fetal presentation?

A

ROA or LOA

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43
Q

what kind of deliveries are longer and more painful?

A

posterior deliveries ~ ROP or LOP (sunny-side up)

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44
Q

four methods to determine fetal position

A
  • abdominal inspection and palpation (leopold’s)
  • vaginal exam
  • auscultation of FHT (over spine is best way to hear)
  • U/S (most accurate)
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45
Q

labor assessment acronym

A

B - bladder (keep empty)
U - uterine contractions
R - rupture of membranes (causes stronger and harders contractions)
T - temperature (portal of entry from rupture
H - heart tones (fetal)
S - sterile vaginal exam

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46
Q

where does the power come from in uterine contractions?

A

the fundus of the uterus

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47
Q

how long should uterine contractions occur and last?

A
  • every 2-5 minutes
  • should last less than 90 seconds
  • should have at least 30 seconds of rest from end of one to beginning of next
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48
Q

frequency of uterine contractions

A

time between beginning of one contraction to beginning of next

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49
Q

duration of uterine contractions

A

measured from beginning of contraction to completion

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50
Q

intensity of uterine contractions

A

strength of contraction

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51
Q

how is intensity of uterine contractions determined?

A
  • by IUPC or by palpating
  • palpating fundus can show “indentability” (mild are easily indented and strong cannot be indented)
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52
Q

what must occur for IUPC to be placed?

A

membranes must be ruptured ~ risk of infetion

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53
Q

what is the only accurate to determine true intensity of contractions?

A

IUPC

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54
Q

what are uterine contractions responsible for?

A
  • effacement of cervix
  • dilation of cervix
  • descent of fetus
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55
Q

stages of labor and birth

A
  • first stage: from onset of true labor to complete dilation
  • second stage: from complete cervical dilation to birth of baby (pushing stage)
  • third stage: from birth of baby to birth of placenta
  • fourth stage: postpartum
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56
Q

three phases in the first stage of labor

A
  • latent
  • active
  • transitional
57
Q

latent phase

A
  • begins with onset of regular contractions
  • mild and short contractions: last about 30-45 seconds
  • effacement occurs
  • dilation 3-4 cm
  • can still walk and talk
  • avoid giving analgesia at this time because it can slow or stop contractions
58
Q

active phase

A
  • dilation progresses form 4-8 cm
  • stronger and longer contractions lasting 60 seconds
  • frequency of contractions is usually every 3-5 minutes
  • painful
  • cannot talk through
  • good time to give analgesics IV or IM
59
Q

goals of pharmacologic treatment during labor

A
  • relax and relieve discomfort
  • minimal effect on uterine contractions
  • minimal effect on ability to push
  • minimal effect on fetus
60
Q

anesthesia

A

loss of feeling

61
Q

analgesia

A

pain control

62
Q

how far can an epidural be given?

A

through stage 2

63
Q

epidural

A
  • blocks nerve pathways
  • temporary loss of sensation
  • women are not aware of their contractions, or may just feel slight pressure
  • will not alter uterine contractions
  • may effect urge to push
64
Q

most common complication from an epidural

A

maternal hypotension

65
Q

transitional phase

A
  • dilation from 8-10 cm
  • strong and long (60-90 seconds)
  • frequency every 2-3 minutes
  • usually a rapid phase of labor
  • full dilation and complete effacement occur
  • very emotional, very moody
  • may begin to feel urge to push (say they feel like they have to have a BM)
66
Q

what phase of labor is usually not a good time for analgesia?

A

transitional phase

67
Q

assessments once membranes rupture

A
  • color, odor, time, amount, fetal respose
  • fetal HR and temperature every 2 hours
68
Q

how fast should we try to deliver after ROM?

A

within 24 hours ~ if not, she will be induced

69
Q

SROM

A

spontaneous rupture of membranes

70
Q

AROM

A

artificial rupture of membranes

71
Q

PROM

A

premature rupture of membranes ~ may occur before onset of contractions

72
Q

main concerns of ROM

A
  • infection
  • prolapsed cord
73
Q

what do we look for with fetal heart monitoring?

A

fetal well-being

74
Q

what can we use to determine fetal position?

A

leopolds maneuver

75
Q

where is the best place to listen for fetal heart sounds?

A

the back

76
Q

baseline FHR range

A

110-160 BPM

77
Q

causes of fetal tachycardia

A
  • early fetal hypoxia
  • fetal anemia
  • maternal dehydration
  • beta sympathomimetic drugs (terbutaline)
  • intrauterine infection
  • maternal hyperthyroidism
78
Q

causes of fetal bradycardia

A
  • late fetal hypoxia
  • maternal hypothermia
  • maternal hypotension
  • prolonged umbilical cord compression
  • fetal arrhythmia
79
Q

variability

A

irregular waves or fluctuations in baseline FHR

80
Q

no variability

A

amplitude range undetectable

81
Q

minimal variability

A

< 5 BPM

82
Q

moderate variability

A

6 - 25 BPM

83
Q

marked variability

A

> 25 BPM

84
Q

short term variability

A
  • beat to beat
  • only accurately measured with internal electrode
85
Q

long term variability

A

rhythmic fluctuations

86
Q

causes of decreased variability

A
  • hypoxia and acidosis
  • drugs such as demerol, valium, vistaril
  • fetal sleep cycle
  • fetus less than 32 weeks gestation
87
Q

causes of increased variability

A
  • early mild hypoxia (compensation)
  • fetal stimulation
88
Q

VEAL CHOP

A

Variable Decelerations -> Cord Compression
Early Decelerations -> Head Compression
Accelerations -> Okay!
Late Decelerations -> Placental Utero Insufficiency

89
Q

interventions of early decelerations

A
  • does not require intervention
  • benign
  • may indicate CPD if they occur early in labor
  • peak of contraction and deceleration match up
90
Q

are late decelerations concerning?

A

yes! you need to notify HCP

91
Q

interventions for late decelerations

A
  • does not necessarily warrant immediate delivery
  • does warrant close observation
92
Q

TTOIV

A

Turn of Pitocin
Turn patient on her side to increase perfusion to placenta
Oxygen to mom: 10-15 L
IV fluids wide open

93
Q

varibale decelerations

A

sharp drop from baseline and sharp return to baseline

94
Q

interventions for variable decelerations

A
  • continue monitoring (usually benign)
  • change maternal position
  • administer oxygen
  • administer amnioinfusion if ordered (LR or NS)
95
Q

if there are prolonged decelerations, what should you do?

A

TTOIV

96
Q

what do we check for with a SVE?

A

dilation, effacement, station

97
Q

when should we not do SVE?

A

if there is significant vaginal bleeding

98
Q

effacement

A

thinning and shortening of cervix

99
Q

second stage of labor

A

full dilation to birth of baby ~ verified with SVE

100
Q

crowning

A

when you start to see baby’s head with pushes

101
Q

episiotomy

A
  • surgical incision made to prevent a tear
  • incision can be a midline episiotomy (straight up and down) or mediolateral episiotomy (out towards legs)
102
Q

advantages of midline episiotomy

A
  • heals more quickly
  • less blood loss
  • less discomfort
103
Q

mediolateral episiotomy

A
  • if it tears, it won’t tear into rectum
104
Q

modified ritgen maneuver

A

used to control birth of head using hands

105
Q

third stage of labor

A

begins at time baby is born and ends with delivery of placenta

106
Q

how long does placenta take to deliver after birth of baby?

A

about 5 minutes

107
Q

signs of placental separation

A
  • lengthening of umbilical cord
  • slight gush of vaginal blood
  • change in shape of uterus
108
Q

expulsion of placenta

A
  • mom starts to gently push
  • provider tugs gently
109
Q

2nd leading cause of infant mortality

A

preterm labor and birth

110
Q

initial instructions to prevent preterm labor

A
  • empty bladder
  • drink 2-3 glasses of fluid
  • lie down on side for 1 hr
  • if ctxs q10 minutes or less after 1 hr. call Dr.
111
Q

when should you call the doctor in any preterm labor?

A
  • any vaginal bleeding
  • leaking of fluid
  • malodorous discharge
112
Q

tocolytics

A

only fairly effective at preventing PT birth; works directly on uterus

113
Q

why do we prevent birth for 24-48 hours?

A
  • transfer to facility with NICU
  • treat an infection/medical condition
  • administer corticosteroids to stimulate
  • fetal lung maturation
  • betamethasone
114
Q

what does magnesium sulfate do for preterm labor?

A
  • CNS depressant
  • relaxes smooth muscles
  • decreases calcium in cells
115
Q

nifedipine (procardia)

A
  • calcium channel blocker ~ decreases calcium in cells
  • commonly used as antihypertensive agent ~ may cause hypotension
116
Q

terbutaline

A
  • relaxes smooth muscles
  • bronchodilation
117
Q

goal to promote fetal lunch maturity

A

administer at least 24 hours before delivery

118
Q

what cervix dilation shows inevitable preterm birth?

A

> 4 cm ~ transfer to high risk hospital

119
Q

care during inevitable preterm labor and birth

A
  • little or no systemic analgesia
  • left side, continuous monitoring
  • delay AROM until >= 6cm
  • low dose pitocin
  • generous episiotomies or C/S delivery
  • neonatologist/peds present
  • third stage longer ~ small placenta does not readily separate
120
Q

PPROM

A

rupture of membranes before labor starts - at least 1 hours

121
Q

risks of PPROM

A
  • chorioamnionitis
  • cord prolapse
122
Q

induction of labor acronym

A

Cooks balloon
Oxytocin (pitocin)
Misoprostol (cytotec)
Membrance stripping
AROM
Nipple stimulation
Dinoprostone (cervidil)

123
Q

amniotomy

A
  • AROM
  • only used to induce if cervix is ripe and head is engaged
124
Q

greatest risk of AROM

A

infection

125
Q

contraindications to oxytocin administration

A
  • CPD
  • prolapsed cord
  • transverse lie
  • placenta previa
  • prior classic uterine incision
  • active genital herpes
  • invasive caner of cervix
126
Q

if concerned about pitocin, what should we do?

A

stop it and TTOIV

127
Q

when should a forceps delivery never be used?

A

on a fetus that is unengaged

128
Q

dystocia

A

long, difficult, or abnormal labor

129
Q

causes of dystocia

A
  • too much pitocin
  • maternal fatigue, dehydration, fear
  • analgesics/anesthetics
  • uterine abnormalities
130
Q

management of hypertonic dystocia

A
  • reduce anxiety
  • comfort measures
  • analgesics for sedation
  • IV fluids and I/O
  • if pattern continues or fetal distress -> C/S
131
Q

main cause of hypotonic dystocia

A

excessive narcotics, analgesics, anesthetics in early labor, especially before 3-4 cm dilation

132
Q

preciptuous labor

A

labor that lasts < 3 hours

133
Q

if fetal hypoxia is >5 minutes in a prolapsed umbilical cord, what can happen?

A

can cause CNS damage or fetal death

134
Q

if prolapse of umbilical cord an emergency?

A

yest

135
Q

how to manage a prolapsed umbilical cord

A

relieve pressure on cord!
- place fingers on presenting part and push forward
- position mom in knee-chest or extreme trendelenburg position
- if cord is evident, cover with warm, wet sterile towel (if not in hospital)

136
Q

shoulder dystocia

A

head is born, but shoulder cannot pass under pubic arch

137
Q

effects of aging placenta

A
  • 800 mL by 40 weeks
  • 400 mL by 42 weeks
  • can lead to cord compression/fetal hypoxia
  • placental starts to hard/calcify
138
Q

if there is meconium fluid and oligo, what can be done?

A

amnioinfusion

NSG 312 OB (4 decks)

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