Exam Two Flashcards
What are some examples of health promotion that should be provided to patient about childbirth and perinatal education?
Diet Exercise Rest Avoid unsafe practices Fetal growth and development Signs and symptoms of labor options for birth family planning infant nutrition
a psychoprophylactic (“mind prevention”) method of preparing for labor and birth that promotes the use of specific breathing and relaxation techniques…
Lamaze Method
various exercises and slow, controlled abdominal breathing to accomplish relaxation
Bradley (Partner-coached) method
focus on fear reduction via knowledge and abdominal breathing techniques
Dick-Read
List pros and cons of breast feeding
Pros:
bonding between mother and child
free
extra calories are used
oxytocin is released
sucking helps to develop muscles in the infant’s jaw
food allergies are less likely to develop
Cons: breast discomfort sore nipples mastitis engorgement breast abscess milk stasis flat or inverted nipples vaginal dyness decreased libido
Pros and cons for bottle feeding
Pros:
Anyone can feed baby
Cons:
Not free, can become costly
During the last trimester of pregnancy, estrogen levels ____ and progesterone levels ____.
During the last trimester of pregnancy, estrogen levels increase and progesterone levels decrease.
Signs and Symptoms of true labor
Pain in back radiates to front
regular rhythmic contractions that increase with ambulation
Progressive cervical dilation
SIGNS AND SYMPTOMS OF FALSE LABOR
Irregular contractions
No progression/dilation
tightening but not painful
change in position or activity usually slows contractions down
Signs before labor
cervical changes lightening increased energy level nesting Blood show Braxton hicks contractions Spontaneous ROM
The _______ is the route through which the fetus must travel to be born vaginally.
The birth passageway is the route through which the fetus must travel to be born vaginally.
Which type of pelvis is not favorable and male shaped for child birth Gynecoid Android Anthropoid Platypelloid
Android
As contractions increase, what happens to cervix?
cervix grows and thins but then disappears
If a doctor says, “patient is 7/80/+1” what does this mean? Using this statement is patient close to giving birth or has she just begun the labor process?
Patient is 7cm dilated, 80% effaced and has a station of +1. Patient is closer to giving birth
What feature in a baby’s head or skull helps identify the position of the fetal head during vaginal examination?
Sutures
What refers to the posturing (flexion or extension) of the joints and the relationship of fetal parts to one another
Fetal attitude
What refers to the relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother. There are three possible lies: longitudinal (the most common), transverse, and oblique.
Fetal lie
What refers to the body part of the fetus that enters the pelvic inlet first
Fetal presentation
How do you identify fetal lie? if the baby is transverse, what type of delivery will the mother have?
Leopold’s manuever
C-section
What type of position is the baby if they ROA?
Right occiput anterior
What type of position is the baby if they are lOT
Left occiput transverse
What type of position is the baby if they are ROP
Right occiput posterior
The fetus goes through many positional changes as it travels through the passageway. These positional changes are known as
The fetus goes through many positional changes as it travels through the passageway. These positional changes are known as the cardinal movements of labor
What are maternal physiologic responses to labor
Heart rate increases by 10-20 bpm Cardiac output increases Blood pressure increases WBC increases RR increase gastric motility and food absorption decrease Slight temperature elevation decreased glucose levels
Fetal physiologic responses to labor
Periodic FHR accelerations and slight decelerations
decrease in circulation and perfusion
Increase in arterial carbon dioxide pressure (PCO2)
Decrease in fetal breathing movements throughout labor
Decrease in fetal oxygen pressure with a decrease in the partial pressure of oxygen (PO2)
Which stage of labor? Onset of contractions to full dilation 2 phases: latent and active latent--> 0-6cm and 6-8 hours active --> 6-10 cms and 3-6 hours Longest of all stages quicker for multipara than primipara patients Breathing techniques are encouraged
1st stage
What stage of labor?
1-2 hr for multipara, 2-3 hr for primipara
Complete dilation until birth of fetus
maternal pushing
Contractions are every 2-3 minutes and last 60-90 seconds
2nd stage
What stage of labor?
lasts 5-30 minutes
Birth until placental separation
placental separation and placental explusion
3rd stage
What stage of labor?
First 1-4 hours following develiery
Post partum
risk fo post-partum hemorrhage
4th labor
What are active managements a nurse might do for post partum eating?
active management includes administration of a uterotonic agent after the birth, expulsion of the placenta with controlled traction of the cord, and uterine fundal message after placental expulsion
The following signs of separation indicate that the placenta is ready to deliver:
The uterus rises upward.
The umbilical cord lengthens.
A sudden trickle of blood is released from the vaginal opening.
The uterus changes its shape to globular.
The focus during the 4th stage is to monitor the mother closely to prevent…
The focus during this stage is to monitor the mother closely to prevent hemorrhage, bladder distention, and venous thrombosis.
What is the priority in triage?
Assessment is first priority
Place patient on monitor
List nonpharmacologic measures that help with labor and pain management
Continuous labor support Hydrotherapy Ambulation and position changes Acupuncture nd acupressure Attention focusing and imagery Therapeutic touch and massage; effleurage Breathing techniques
T/F Changing position frequently (every 30 minutes or so)—sitting, walking, kneeling, standing, lying down, getting on hands and knees, and using a birthing ball—helps relieve pain
True
_______ is a light, stroking, superficial touch of the abdomen, in rhythm with breathing during contractions. It is used as a relaxation and distraction technique from discomfort. External fetal monitor belts may interfere with the ability to accomplish this.
Effleurage is a light, stroking, superficial touch of the abdomen, in rhythm with breathing during contractions. It is used as a relaxation and distraction technique from discomfort. External fetal monitor belts may interfere with the ability to accomplish this.
_______ involves the use of one or more drugs administered orally, intramuscularly, or intravenously; they become distributed throughout the body via the circulatory system.
Systemic analgesia involves the use of one or more drugs administered orally, intramuscularly, or intravenously; they become distributed throughout the body via the circulatory system.
Why would a patient being given opioids also be given an antiemetic?
For nausea and vomiting
What route is systemic analgesic typically administered through?
Existing IV line, can be oral or IM also but PO is not preferred
_______ provides pain relief without loss of consciousness. It involves the use of local anesthetic agents with or without added opioids to bring about pain relief or numbness through the drug’s effects on the spinal cord and nerve roots.
Regional analgesia provides pain relief without loss of consciousness. It involves the use of local anesthetic agents with or without added opioids to bring about pain relief or numbness through the drug’s effects on the spinal cord and nerve roots.
An epidural is contraindicated for women with a previous history of…
spinal surgery or spinal abnormalities, coagulation defects, cardiac disease, obesity, infections, and hypovolemia. It is also contraindicated for the woman who is receiving anticoagulation therapy.
Complications of epidural include
nausea and vomiting, hypotension, fever, pruritus, intravascular injection, maternal fever, allergic reaction, and respiratory depression.
T/F General anesthesia is common and used similar to an epidural
FALSE, general is used only on emergencies
What is important to indentify during a phone assessment of a patient who believes she is in labor
Identify S/S of true and false labor
What are some things to ask during a phone assessment?
EDD Fetal movement; frequency other signs of labor GP time frame of previous labors characteristics of contractions bloody show and ROM status Presence of supportive adult in household or alone
List nursing care and interventions that are done during the 1st stage of labor
Identifying the estimated date of birth from the client and the prenatal chart
Validating the client’s prenatal history to determine fetal risk status
Determining fundal height to validate dates and fetal growth
Performing Leopold maneuvers to determine fetal position, lie, and presentation
Checking FHR
Performing a vaginal examination as appropriate to evaluate effacement and dilation progress
Instructing the client and her partner about monitoring techniques and equipment
Assessing fetal response and FHR to contractions and recovery time
Interpreting fetal monitoring strips
Checking FHR baseline for accelerations, variability, and decelerations
Repositioning the client to obtain an optimal FHR pattern
Recognizing FHR problems and initiating corrective measures
Checking amniotic fluid for meconium staining, odor, and amount
Comforting the client throughout the testing period and labor
Documenting times of notification for team members if problems arise
Knowing appropriate interventions when abnormal FHR patterns present
Supporting the client’s decisions regarding intervention or avoidance of intervention
Assessing the client’s support system and coping status frequently
What are some things that are assessed throughot 1st stage of labor
VS Vaginal exam uterine contractions pain level coping ability FHR amniotic fluid
An ______ is an incision made in the perineum to enlarge the vaginal outlet and theoretically to shorten the second stage of labor.
Episiotomy
