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Women and Families > Exam 3 (module 9-11) > Flashcards

Exam 3 (module 9-11) Flashcards

1
Q

Forces of labor: 5 P’s

A

powers, passageway, passenger, position, psyche

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2
Q

powers (contractions)

A

purpose is to dilate cervix and aid in expulsion; measured by frequency, duration, and intensity; mild = nose, moderate = chin, strong = forehead

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3
Q

IUPC

A

intrauterine pressure catheter to assess intensity of contractions; mild <40 mmHg, moderate40-70 mmHg, strong >70 mmHg

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4
Q

passageway

A

route the fetus must travel; maternal pelvis, maternal soft tissue (cervix), gynecoid it true female pelvis (~50% of women)

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5
Q

dilation and effacement

A

effacement happens first by thinning of cervix then cervix dilates

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6
Q

passenger

A

fetal attitude: relationship of fetal body parts to others (flexion or extension, you want flexion); fetal lie: relationship of infant spine to mothers spine (horizontal or longitudinal, you want longitudinal

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7
Q

types of cephalic presentations

A

~95% of the time; mentum (head extended back), brow (head extended slightly back), sinciput (head neutral, vertex/occiput (fully flexed, chin tucked)

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8
Q

types of breech presentations

A

~3-4% of the time; frank (feet by face and legs crossed, full (feet crossed low; criss-cross apple sauce), footling (one foot extended)

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9
Q

shoulder presentation (transverse)

A

~1%; not favorable for vaginal delivery; requires C-section

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10
Q

station

A

relation of presenting part of head to maternal pelvis; zero station is when presenting part engaged in pelvis at level of ischial spines; - is floating

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11
Q

fetal position

A

relation of presenting part to maternal pelvis; 3 letters; direction the presenting part faces (either mother L or R)

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12
Q

presenting parts of fetus

A

o = occiput (most common), m = mentum (chin, fetal head extended),
Sa = sacrum (breech presentation),
A = acromion process (transverse presentation)

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13
Q

relationship to pelvis

A

a = anterior, p = posterior, t = transverse

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14
Q

leopold maneuvers

A

done to determine fetal presentation and position

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15
Q

4 maneuvers of leopold

A

1st maneuver: superior side of fundus; 2nd maneuver: each side of uterus; 3rd maneuver: suprapubic area; 4th maneuver: fetal attitude and extension (only in cephalic position)

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16
Q

maternal assessment (antepartum)

A

focused assessment to determine condition of mother/baby, maternal history, maternal testing/prenatal labs

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17
Q

maternal history consists of

A

allergies, current/recent meds, pregnancy history (previous pregnancies, type of delivery, complications)

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18
Q

maternal testing/prenatal labs consists of

A

blood type/Rh, hematocrit/hemoglobin, GBS, Hep B, HIV, ultrasonography, NST

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19
Q

maternal physical assessment

A

vital signs, uterine activity, bladder status/I&O, bloody show/bleeding, membrane status, response to labor, maternal discomfort, cultural needs

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20
Q

fetal physical assessment

A

fetal presentation and station, FHR, fetal gestation and growth

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21
Q

external fetal heart rate monitor

A

toco

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22
Q

internal fetal heart rate monitor

A

requires rupture of membrane; fetal scalp electrode to measure HR and IUPC to measure contractions

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23
Q

Fetal heart trace

A

each box = 10 seconds; dark line to dark line = 1 minute

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24
Q

what to look for in FHR tracing

A

baseline FHR, variability, accelerations, periodic changes/decelerations

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25
Q

types of periodic changes or decelrations

A

early = head compression, late = placental insufficiency, variable = cord compression

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26
Q

FHR baseline normal

A

110-160

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27
Q

FHR tachycardia

A

mild: 161-180; severe: >180

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28
Q

FHR bradycardia

A

below 110bpm for >10 minutes; mild: 100-109; moderate: 70-99; severe <70

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29
Q

minimal variability

A

less than or equal to 5 bpm change

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30
Q

4 responses to periodic changes

A

accelerations, early decelerations, late decelerations, variable decelerations

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30
Q

marked variability

A

> 25 bpm

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30
Q

Periodic changes in FHR d/t

A

response to contractions and fetal movement, short term changes in rate rather than baseline, last few seconds to 1-2 minutes

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31
Q

FHR accelerations

A

increase of 15bpm and lasts 15 seconds x2; used for stress test (want accelerations), typically good reaction between SNS and PNS

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32
Q

Early decelerations FHR

A

mirror image; d/t contractions causing pressure on skull;nursing interventions do not want this to happen

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33
Q

late decelerations FHR

A

occur late in contraction, indicative of fetal hypoxia; nursing interventions: need to stop oxytocin and change pt to left lateral in order to promote perfusion

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34
Q

variable decelerations FHR

A

occur anytime during contraction, secondary to cord compression; nursing interventions: relieve compression of cord, change position, fix cord prolapse, give O2, stop pitosin

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35
Q

VEAL CHOP

A

variable = cord
early = head compression
acceleration = oxygenated fetus
late = placental problems

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36
Q

FHT categories

A

category I - normal and no intervention is required; category II - requires evaluation and continued monitoring; category III - predictive of abnormal fetus acid base status and require prompt evaluation and interventions

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37
Q

respiratory acidosis result of

A

fetal stress

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38
Q

initiation of labor factors

A

uterine stretching, oxytocin release, decreased progesterone, increased prostaglandin secretion, cortisol release, placental aging

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39
Q

true definition of labor

A
  1. presence of regular phasic uterine contractions increasing in frequency and intensity 2. progressive cervical effacement and dilation (blood show may or may not be present)
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40
Q

signs of impending labor

A

lightening, increased vag. d/c, increased energy (nesting), GI symptoms (N/V, diarrhea), cervical change, bloody show, ROM, lower back pain, weight loss, uterine contractions

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41
Q

false labor

A

irregular contractions, no regular pattern, discomfort in lower abd. and groin, show not present, no cervical change, contractions might stop with walking or rest; sedation will stop or decrease contractions

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42
Q

active labor starts at

A

4cm dilation; doctors want contractions 5 min apart and regular

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43
Q

1st stage of labor

A

from initiation of labor until full effacement and dilation

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44
Q

first stage of labor consists of

A

early labor, active phase, transition phase

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45
Q

early labor (latent phase)

A

0-3cm, mildly uncomfortable, every 10-30 minutes for 20-40 seconds, then every 3-7 minutes for 30-40 seconds, excited and sociable; signs of progress when contractions are longer, stronger, and closer together

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46
Q

active phase labor

A

dilation 4 to 7cm, fetal descent, contractions are stronger, last longer, closer together, every 2-5 minutes x 40-60 seconds, increase in anxiety and discomfort is normal, instinctual behavior

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47
Q

transition phase labor

A

short but intense, dilation 8 to 10cm, painful intense contractions every 1.5-2 minutes for 60-90 seconds, very irritable and may lose control, N/V is common

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48
Q

second stage of labor

A

descent and expulsion of fetus; from full dilation to birth of baby; overwhelming urge to push; increased feeling of control; pressure feeling

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49
Q

third stage of labor

A

expulsion of placenta: detaches about 5-10 minutes after birth (up to 30); signs of occurring are uterus becomes smaller, blood gushes, and cord lengthens

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50
Q

fourth stage of labor

A

immediate postpartum: first 4 hours following birth, may experience chills, afterpains, tiredness; assess for hemorrhage

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51
Q

psyche (emotional response)

A

influenced by pain, parity, age, culture, coping mech., relaxation methods, emotional factors, other discomforts, length of labor, intensity of labor, maternal positions, fetal position

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52
Q

pain during birth d/t

A

tissue anoxia, stretching of cervix (dilation), pressure on pelvic floor

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53
Q

non-pharmacological pain management

A

cutaneous stimulation strategies, sensory stimulation strategies, cognitive strategies

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54
Q

cutaneous stimulation strategies

A

counterpressure, effleurage (light massage), therapeutic touch and massage, walking, rocking, changing positions, application of heat/cold, transcutaneous electrical nerve stimulation, acupressure, hydrotherapy

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55
Q

sensory stimulation strategeis

A

aromatherapy, breathing techniques, music, imagery, use of focal points

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56
Q

cognitive strategies

A

childbirth education, hypnosis, biofeedback

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57
Q

pharmacological pain management

A

analgesia-partial or full relief of painful sensations using medication that decreases or alters pain perception; anesthesia-partial or complete loss of sensation with or without loss of consciousness

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58
Q

systemic analgesics

A

can slow down labor, can affect fetus; opioids- morphine, meperidine, fentanyl, stadol, nubain; inhaled analgesia- nitrous oxide; tranquilizers- vistaril, phenergan

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59
Q

regional anesthesia/analgesia

A

epidural- need to watch for hypotension; spinal- risk of spinal headache; general anesthesia- potential fetal distress

60
Q

pre-term labor

A

diagnosis defined as regular contractions occurring between 20-37 weeks gestation followed by one of the following: progressive cervical change, cervical effacement >80%, dilation >1cm

61
Q

risk factors for preterm labor

A

intrauterine infection/inflammation, decidual hemorrhage, excessive uterine stretch a9d/t multiples or polyhydramnios), maternal or fetal stress, demographic risks, medical risks in current pregnancy/predating pregnancy, environment/behavioral/psychosocial risks

62
Q

biochemical marker predicting preterm labor

A

fetal fibronectin produced during pregnancy and acts as biological glue attaching fetal sac to uterine lining; cannot be detected between 24 and 34 weeks of pregnancy

63
Q

warning signs of pre-term labor

A

uterine cramping, backache, pressure in pelvis, increase or change in vaginal discharge, abd. cramping, change in fetal movement

64
Q

tocolytic therapy

A

process of administering drug for purpose of inhibiting uterine contractions; no drugs for pre-term labor but main goal is to prolong birth enough to administer corticosteroids for fetal lung maturity

65
Q

tocolytic contraindications

A

severe HTN or preeclampsia, evidence of fetal compromise, fetal death, fetal anomaly incompatible with life, mature fetal lungs

66
Q

tocolytics

A

magnesium sulfate, beta-adrenergic agonist, Ca channel blockers (nifedipine/procardia), prostaglandin inhibitors

67
Q

Terbutaline MOA

A

Beta-agonist, promotes smooth muscle relaxation, my be given IV or SQ, rapid onset of action, no better than mag. for PTL but higher incidence of maternal side effects

68
Q

side-effects of terbutaline

A

maternal tachycardia, pulmonary edema, fetal tachycardia, hyperglycemia, hypokalemia, hypotension, cardiac insufficiency, arrhythmias, myocardial ischemia, maternal death

69
Q

Magnesium sulfate MOA

A

prevents reflux of calcium into myometrial cells causing uterine relaxation (CNS depressant); used primarily for fetal neuroprotection instead of tocolytic (still used as tocolytic but not primarily)

70
Q

side effects of mag sulfate

A

maternal “flushing” or warmth, headache, nausea, blurry vision

71
Q

mag. sulfate toxicity

A

loss of deep tendon reflexes (serum~8mg/dl), mental status change/change in LOC, respiratory depression, pulmonary edema, profound hypotension, cardiac arrhythmias

72
Q

magnesium sulfate antidote

A

calcium gluconate 1 gram IV over 3 minutes

73
Q

indomethacin

A

powerful anti-inflammatory that inhibits prostaglandin synthesis and readily crosses placenta; used in conjunction with other tocolytic therapy; effective in prolonging pregnancy 48-72 hours

74
Q

indomethacin risk

A

risk of premature closure of fetal ductus arteriosus if administered after 32nd week

75
Q

nifedipine

A

calcium channel blocker, smooth muscle relaxer, potent vasodilator (monitor for hypotension)

76
Q

nifedipine side effects

A

hypotension, flushing, headache, tachycardia, nausea, dizziness, palpitations

77
Q

promotion of fetal lung maturity in pre term labor

A

betamethasone or dexamethasone are both corticosteroids that stimulate lung maturity

78
Q

Pre-term labor risk factors

A

infection of urinary tract/vagina/chorioamnionitis, previous PTB, multifetal pregnancy, hydramnios, <17 or >35, low socieconomic status, smoking, substance abuse, domestic violence, hx of multiple miscarriages/abortions, DM, HTN, lack of prenatal care, recurrent premature cervical dilation, placenta previa/abruptio placentae, preterm PROM, short interval between pregnancies, uterine abnormalities

79
Q

dystocia

A

abnormal, long, or difficult labor or delivery

80
Q

dysfunctional labor

A

uterine contractions do not dilate cervix, efface cervix, or descend presenting part

81
Q

hypotonic contractions

A

coordinated, infrequent, weak, brief, mildly painful contractions that do not efface, dilate, or cause descent

82
Q

tachysystole

A

> 5 uterine contractions in 10 minutes averaged over 30 minutes with less than 60 seconds of relaxation

83
Q

tachysystole potential complications

A

fetal deoxygenation, uterine rupture

84
Q

cephalopelvic disproportion

A

fetal head larger than maternal pelvic diameter, lack of fetal descent in presence of strong contractions, labor usually prolonged

85
Q

dystocia assistance devices

A

forceps, vacuum extraction

85
Q

vacuum extraction risks

A

caput seccedaneum, cephalohematoma, intracranial hemorrhage

86
Q

forceps risks to infant

A

soft tissue injury, facial palsy, skull fracture

87
Q

forceps risk to mom

A

injury to cervix, vagina, bladder, rectum, increase in pain

88
Q

labor enhancer

A

pitocin (oxytocin)- stimulates/increases contractions but does not efface or dilate

89
Q

pitocin cautions

A

fetal distress, prematurity, over-distension of uterus

90
Q

pitocin side effects

A

increased contractions, increased resting tone, increased HR, decreased BP, water intoxication, fetal tachycardia

91
Q

pitocin side effects

A

fetal hypoxia, uterine rupture, placental abruption, pph, fetal hypotension

92
Q

cesarean section

A

32% of all births

93
Q

pfannenstiel incision

A

most common; horizontal

94
Q

classic incision

A

increased risk of uterine rupture in subsequent pregnancies and labor

95
Q

cesarean section post-op surgical care

A

monitor: pain, respiratory function, I&O, incision, bowel function, circulation, psychological response

96
Q

intrapartum emergencies

A

shoulder dystocia, cord prolapse, amniotic embolism

97
Q

shoulder dystocia

A

impaction of anterior fetal shoulder behind maternal symphysis pubis

98
Q

shoulder dystocia risk factors (what makes you more at risk)

A

fetal macrosomia (>4000g or 9lbs), maternal diabetes, maternal obesity, previous shoulder dystocia

99
Q

cord prolapse

A

obstetrical emergency when umbilical cord drops down alongside or in front of presenting part of fetus; circulation can be reduce or stopped causing physiologic effects of fetus

100
Q

nursing care of prolapsed cord

A

get pressure off cord by placing in tredelenberg, knee to chest, or elevate part of fetus on cord with sterile glove

101
Q

if cord is visible…

A

avoid handling and cover with warm, sterile, saline-soaked gauze; assess FHR continuously

102
Q

amniotic fluid embolism

A

escape of amniotic fluid into maternal circulation; usually enters through open sinus at placental site; usually fatal to mother

103
Q

signs and symptoms of amniotic fluid embolism

A

dyspnea, chest pain, cyanosis, shock

104
Q

therapeutic interventions of amniotic fluid embolism

A

deliver the baby, provide cardiovascular and respiratory support of mother

105
Q

postpartum complications

A

pph, breast feeding complications, postpartum infections: UTI/endometritis/mastitis/wound infection, thrombophlebitis, pulmonary embolism, postpartum psychiatric disorders

106
Q

postpartum hemorrhage

A

more than 500mL after vaginal and more than 1000mL after cesarean; any amount of bleeding that places mother in hemodynamic jeopardy

107
Q

early pph

A

first 24 hours after delivery; usually caused by uterine atony

108
Q

late/delayed pph

A

24 hours to 6 weeks postpartum; usually caused by retained placental tissue

109
Q

4 T’s associated with PPH

A

tone, tissue, trauma, thrombin

110
Q

Tone PPH

A

altered muscle tone d/t overdistention, prolonged or rapid labor, infection, anesthesia/medications that inhibit contractions like nifedipine

111
Q

Trauma PPH

A

cervical lacerations, vaginal lacerations, hematomas of vulva, vagina, or peritoneal areas

112
Q

Tissue PPH

A

retained placental fragments, uterine inversion, subinvolution

113
Q

Thrombin PPH

A

disorders of clotting mechanism

114
Q

Risk factors for PPH

A

Uterine overdistention (large infant, polyhydramnios), grand multiparity, anesthesia/MgSO4, trauma, hypo/hypertonia, oxytocin admin., prolonged labor, maternal anemia, maternal hemorrhage

115
Q

signs of impending hemorrhage

A

excessive bleeding (>2 pads in 30min-1hr); lightheadedness, nausea, visual disturbances, anxiety, pale, clammy skin, hematomas, increasing P and R but same or lower BP, peripheral cyanosis

116
Q

MAP to perfuse kidneys, brain, coronary arteries

A

atleast 60

117
Q

interventions for PPH

A

inspect placenta, avoid over-manipulation of uterus, fundal massage, empty bladder, oxytocin/cytotec/methergine/hemabate, monitor blood loss (weigh pads), frequent VS, cross-match blood, start IV

118
Q

postpartum infections

A

pueperal sepsis, pathogens,

119
Q

puerperal sepsis

A

any infection of genital canal withing 28 days after abortion or birth; >100.4 temp on atleast 2 of 10 day following first not including first 24 hours OR 101 and higher within first 24 hours

120
Q

common infections following birth

A

endometritis, wound infections, UTI, mastitis

121
Q

preconception infection risk factors

A

HX of venous thrombosis/UTI/mastitis/pneumonia, DM, alcoholism, drug abuse, immunosuppression, anemia, malnutrition

122
Q

endometritis

A

involves endometrium, decidua, adjacent myometrium of uterus; causes lower ABD tenderness/pain, temp., chills, foul-smelling lochia, tachycardia, subinvolution

123
Q

endometritis interventions

A

broad spectrum antibiotic, analgesia, emotional support, watch for septic shock, increase fluid intake, monitor vitals/lab values/ proper positioning to drain urine

124
Q

wound infections

A

surgical incision is most common site, episiotomy/laceration occur less commonly

125
Q

wound infection interventions

A

aseptic wound management, frequent perineal pad changes, good hand washing, administer antibiotics, analgesics

126
Q

breast complications following birth

A

engorgement, sore/cracked nipples, blocked ducts, mastitis

127
Q

mastitis

A

caused by S. aureus (often from hands of mother/caregivers entering through crack in nipple); infected fissure causes edema and obstructs milk flow in lobe; engorgement and stasis frequently precede

128
Q
A
129
Q

therapeutic management of mastitis

A

antibiotics and decompression by breastfeeding/pumping; bedrest during acute phase; fluids and analgesics for discomfort

130
Q

risk factors for developing UTI

A

urinary catheterization (straight cath recommended over indwelling to prevent CAUTI), frequent cervical exam in labor, epidural anesthesia, genital tract injury during delivery, cesarean birth, atonic bladder and urethra post delivery

131
Q

symptoms of lower UTI

A

dysuria, frequency, urgency, suprapubic pain, low-grade fever, hematuria, cloudy urine, foul smell

132
Q

symptoms of upper UTI

A

pyelonephritis, develops day 3-4, chills, fever, costovertebral angle tenderness, N/V

133
Q

treatment of UTI

A

vital signs every 4 hours, encourage fluid intake, monitor I&O, antibiotics, antipyretics, antispasmodics, antiemetics, encourage rest

134
Q

thromboembolic disease

A

superficial thrombosis, deep thrombosis, pulmonary embolism

135
Q

superficial thrombosis

A

involves veins of superficial saphenous system

136
Q

deep thrombosis

A

occurs most often in lower extremities; involvement varies but can extend from foot to iliofemoral region

137
Q

pulmonary embolism

A

complication of DVT; clot travels to lung

138
Q

risk factors for thrombosis

A

normal changes in coagulation during pregnancy, hx of thromboembolic disease/varicosities, increased parity, obesity, advanced maternal age, immobility, c-section, tissue trauma, blood type other than O, dehydration

139
Q

postpartum thrombophlebitis assessment

A

hot, red, edematous areas of lower extremities or groin area, homans signst

140
Q

postpartum thrombophlebitis treatment

A

superficial- analgesics, bedrest, elevation; deep- anticoagulants

141
Q

pulmonary embolism symptoms

A

sudden onset dyspnea, sweating, pallor, chest pain, cyanosis, confusion, tachypnea, cough, hemoptysis, increased temp., increased jugular pressure, sense of impending death

142
Q

postpartum psychological compications

A

postpartum depression and postpartum psychosis

143
Q

postpartum depression

A

occurs in 10-20% of all postpartum patients

144
Q

postpartum depression symptoms

A

intense pervasive sadness, mood swings, intense fear. anxiety, anger, unable to care for self or infant, irritability that may lead to violence, rejection of infant, obsessive thoughts

145
Q

treatment of PPD

A

guided by severity; psychotherapy, medication, electroconvulsive therapy (ECT), combination therapy

146
Q

postpartum psychosis

A

syndrome characterized by depression, delusions, bizarre/irrational behavior, thoughts of harming infant or self; may require psychiatric hospitalization; antipsychotics/mood stabilizers like lithium re good choice

147
Q

treatment of pulmonary embolism

A

elevate head of bed, give O2 (8-10L), narcotics, clot busters

148
Q

prevention of postpartum thrombophlebitis

A

inflatable compression devices, encourage early ambulation, antiembolism stockings for c-section mothers, assess for thrombus formation

Women and Families (4 decks)

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