Exam 9 Flashcards
1
Q
Sinciput
A
fetal brow
2
Q
Vertex
A
area btwn anterior & posterior fontanelles
3
Q
Occiput
A
area beneath posterior fontanelle occupied by occipital bone
4
Q
Mentum
A
fetal chin
5
Q
4 bones of pelvis
A
2 innominate
1 sacrum
1 Coccyx
6
Q
Supports weight of growing & directs presenting part into true pelvis
A
False Pelvis
7
Q
Bregma
A
anterior fontanelle
8
Q
Intersection btwn posterior cranial sutures
A
Posterior Fontanelle
9
Q
relationship of fetal spine to the maternal spine
A
Lie
10
Q
Attitude (Fetal orientation)
A
relationship of fetal parts to one another (flexion/extension)
11
Q
fetal body part entering the pelvis 1st or lying over the inlet
A
Presentation (Fetal orientation)
12
Q
Cephalic Presentation
A
fetal head first
13
Q
Breech Presentation
A
fetal buttocks, feet or knees first
14
Q
3 classifications of Breech Presentation
A
Complete
Frank
Footling
15
Q
Shoulder Presentation
A
transverse lie
16
Q
1+ presenting part
A
Compound presentation
Ex: head, hand and arm.
17
Q
Rapid, slow or irregular FHT
A
Fetal hypoxia
18
Q
Greenish-Brown amniotic fluid in for a check presentation
A
Fetal distress
19
Q
Port-wine colored amniotic fluid/bleeding
A
placenta previa
Separation of the placenta; torn maternal tissue; DIC
20
Q
Unengaged presenting part
A
Disproportion or malpresentation
21
Q
Failure to progress in dilation
A
Prolonged labor w/ increased danger of perinatal loss
22
Q
Failure of presenting part to descend after complete cervical dilation
A
Disproportion or Error in estimate dilation
23
Q
Rising B/P
A
Preeclampsia
24
Q
Low BP (significance)
A
Shock; postural hypotension; reaction to drugs
25
Significance of fever
Amnioitis; extrauterine infection
26
Significance of maternal tachycardia
Impending shock
27
Foul or Purulent vaginal discharge
Amnioitis (Eventual fetal infection)
28
Significance-abnormal abdominal pain/tenderness
Separation of placenta;
Rupture of uterus;
Abnormal condition not r/t pregnancy
29
Uterine tetany (significance)
Interuterine bleeding D/T premature separation of placenta, possible uterine rupture
30
Excessive C/O pain (significance)
Hysteria;
Undetected abnormality;
Reaction to medication;
31
Prolapsed cord (significance)
W/o instant intervention-perinatal death
32
Unconsciousness (significance)
Eclampsia
Shock
Hysteria
Sedation
33
Pallor, cool damp skin, air hunger
Bleeding; shock
34
Cyanosis (significance)
Aspiration of vomitus
Cardiac failure
Pulmonary embolism
35
Stage-->onset of labor to complete cervical dilation
First stage
36
Three phases of the first stage of labor
Latent
Active
Transition
37
Labor on set to 3 cm dilation
Latent phase (first stage)
38
4– 7 cm dilation
Active phase (first stage)
39
8–10 cm dilation
Transition (first stage)
40
Complete dilation to birth of baby
Second stage of labor
41
Birth to placental expulsion
Third stage
42
1–4 h after placental expulsion; uterus contracts to control bleeding
Fourth stage of labor (recovery)
43
Single most important factor influencing fetal well being
euglycemic status of mother
44
S&S of impending labor
Premonitory Signs
45
aka as engagement; fetus descends into pelvic inlet
Lightening
| Subjective sensation
46
Weeks before delivery Lightening occurs in Primigravida
2-4 weeks before delivery
47
Lightening in Multigravida occurs
with onset of labor
48
Support wait a growing uterus and directs presenting part into true promise
False pelvis
| top of V
49
There any limits of birth canal
True pelvis
50
Point where baby interstate true pelvis
Inlet
51
Female pelvis
Inlet is rounded
favorable for delivery
50%
Gynecoid pelvis
52
Normal female pelvis
| Usually OA
Gynecoid pelvis
53
Male pelvis
Android pelvis
54
Inlet heart-shaped
Head decent into pelvis slow
Arrest of labor frequent -> C/S
Android pelvis
55
Android pelvis (head engages)
Head usually engages transverse or OP
56
Favorable influence
labor inlet is oval
Abe like pelvis
Anthropoid pelvis
57
Anterior fontanelle
Bregma
58
Relationship of fetal parts to one another (flexion/extension of fetal head)
attitude
59
Cephalic presentation
Fetal head first
60
Shoulder presentation
Transverse lie
61
You don't hips are flexed, knees are extended; buttocks present. (Legs by ears)
Breech (frank) presentation
62
HTN w/o Proteinuria after 20wks gest.
Gestational HTN
63
HTN + Proteinuria post 20wks gest.
Preeclampsia
64
0.3g+/24h protein excrete
proteinuria
65
Mild pre-eclampsia
140/90+ +proteinuria
66
Severe pre-eclampsia
160/110+
67
160/110+ >15 MIN =
MEDICAL EMERG
68
3+ proteinuria or 5+g/ 24h
Severe Preeclampsia
69
```
Oliguria <500cc/24h
Cerebral visual disturbances
Pulmonary edema/ cyanosis
RUQ/ Epigastric Pain
Impaired Liver Function
Thrombocytopenia
IUGR
```
s/s of severe preeclampsia
70
New-onset grand mal seizures in woman with pre-eclampsia
Eclampsia
71
New onset/ sudden increase of proteinuria in a woman with HTN PRIOR to 20 wks best, sudden increase in HTN or HELLP syndrome
Superimposed preeclampsia
72
Antihypertensive of choice in Pregnancy (Chronic HTN)
Aldomet
| Methyldopa
73
AntiHTN Meds Necessary if BP>
150-160/100-110
74
HELLP
Hemolysis
Elevated Liver enzymes
Low Platelets
75
Danger Signs
Clonus
HA
Vision Changes
RUQ Pain
76
MgSulfate
Monitor BP
I&O
RR (CNS depressant)
Deep tendon reflexes
77
MgSulfate Antidote
Ca+ Gluconate
| Must Keep at Bedside
78
Hour PP Risk for Seizures Continues
48h
| Diuresis -->Decreased Risk
79
Nursing Considerations Pre-eclampsia
```
Close to RN Station
Dark, quite, low stimuli
Private
L side lying
Decrease Na+ Increase Protein
```
80
relative position of fetal presenting part above or below an imaginary line drawn between maternal ischial spines
Station
81
largest diameter of presenting part reaches or passes through pelvic inlet
Engagement
82
Irregular contractions
Pain in fundus, lower abd, or groin (all up front)
Easily Sedated
False Labor
83
Pain felt in back and radiates forward, Contractions become regular, Sedation is not effective
True Labor
84
Only Definitive Way to Dx Labor
Vag Exam
| Reassess 1h after admit
85
During Stage 1 of Labor SBP
increases w/ contractions
86
During Stage 2 of Labor (BP)
SBP& DBP increase w/ contractions, may stay SLIGHTLY elevated btwn
87
During labor- GI motility, gastric emptying, blood glucose, and insulin requirements
decrease--> N/V (esp w/ transition)
88
Increase during labor
O2 demand/ consumption --> increased RR; Immune response --> Increased WBC
89
+GBS
PCN q4 x 2 doses
90
Pattern and intensity directly effect labor length (wavelike)
uterine contractions
91
Amniotic Fluid Characteristics
Clear
Alkaline
May have white flakes/ earthy odor
92
Natrazine Test
pH
want blue/ purple (alkaline)
MUST be before bag. lube
93
Green Natrazine Test
False Reading
94
Negative Natrazine Test
Yellow
95
Ferning
(ROM)Definitive
| Sample placed on slide--> fern pattern
96
Always first intervention after ROM
Immediately assess FHR
97
ROM--> Temp
```
q1-2h
before ROM (q2-4)
```
98
Hours of labor vs cervical dilation
| based on prime vs multi
Labor Curve
99
Uterine Contractions MUST BE
validated by PALPATION
q15-30
note f,d,I, Tone
100
1 stage assess FHR
q15-30 min
| Continuous monitoring best
101
2nd Stage Assess FHR
q5-15 mins
| Continuous monitoring best
102
BP, Pulse, RR
q1h (dictated by status/ meds/ induction)
103
Low platelets
NO EPIDURAL
104
Contraindications for Activity
```
ROM w/o engagement
Faulty presentation/ fetal position
Complications of preg
Vaginal Bleeding
Active Labor
Meds
```
105
Frequent voiding prevents
distended bladder--> slows fetal descent & increases discomfort w/ contractions
106
Effleurage
counterclockwise
straight back
tactile stimulation/distraction
Helps w/ back ache
107
Breathing to prevent pushing
Panting
108
Ritgen's Maneuver
push on rect. area --> lift fetal head (extend)
109
Suction
mouth then nose before body delivered
110
bladder fails to close properly during embryonic development --> fistula between the bladder and umbilicus
patent urachus
111
Clinical Manifestations of patent urachus
Clear odorless fluid draining from base of the cord→ph test
112
Exstrophy of the Bladder:
bladder on the o/s
asc. w/ multiple deformities
No tub baths
113
IgG
Passive acquired immunity:
Transferred to fetus in utero
Fetus does NOT produce
114
Protection of IgG
Active against bacterial toxins
115
Acquisition IgM
Active immunity
Fetus is able to produce by 20wks gestation
Stimulated by infectious agents
116
IgA
Does NOT cross placenta
Not produced by fetus
Protects respiratory, GI, eyes
117
Passive immunity of the NB is gone by
3 mo of age
