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MCN LEC MIDTERMS > INTRAPARTAL CARE ASSESSMENT > Flashcards

INTRAPARTAL CARE ASSESSMENT Flashcards

1
Q

e series of events by which uterine contractions and abdominal pressures expel the fetus and placenta from the woman’s body

A

LABOR

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2
Q

 Uterine muscle stretching which results in prostaglandin release
 Pressure on the cervix, which stimulates the release of oxytocin
 Oxytocin stimulation which works together with prostaglandin
 Change in the ratio of estrogen to progesterone
 Placental age
 Rising fetal cortisol level
 Fetal membrane production of prostaglandin
 Seasonal and time influences

A

Factors that influence labor onset

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3
Q

-Lightening
-Increase level of activity
-Braxton Hicks contraction
-Ripening of the cervix

A

Preliminary Signs of Labor

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4
Q
  1. Uterine contraction
  2. Show – blood and mucus
  3. Rupture of the Membranes
A

Signs of True Labor:

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5
Q

initiation of effective, productive, involuntary uterine contractions

A

Uterine contraction

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6
Q
  1. Increment/ Crescendo – intensity of contraction increases
  2. Acme/ Apex – contraction reaches its height or peak
  3. Decrement/Decrescendo – intensity of contraction decreases
A

Uterine contraction Phases

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7
Q

 Duration
 Intervals
 Frequency
 Intensity

A

Observation of Contraction

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8
Q

from the beginning of one contraction to the end of same contraction.

A

Duration

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9
Q

Duration during EARLY STAGE OF LABOR

A

20 to 30 seconds

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10
Q

Duration during LATE STAGE OF LABOR

A

60 to 70 seconds

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11
Q

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

A

Intervals

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12
Q

Interval during EARLY STAGE OF LABOR

A

40-45 minutes

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13
Q

Interval during LATE STAGE OF LABOR

A

2-3 minutes

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14
Q

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

A

Frequency

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15
Q

– the strength of the contraction
– mild, moderate, strong

A

Intensity

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16
Q
  1. Intrauterine infection
  2. Prolapse of the umbilical cord
A

Two risks associate with Rupture of Membranes (ROM)

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17
Q
  1. Passage – uterus, cervix, vagina, external perineum
  2. Passenger - fetus
  3. Power – uterine factors
  4. Psyche
  5. Placenta
A

Components of Labor (5 Ps)

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18
Q

Are systemic method of observation and palpation to determine fetal presentation and position

A

Leopold’s Maneuver

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19
Q

Determine what fetal part is at uterine fundus

A

First Maneuver (Fundal Grip)

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20
Q

buttocks should feel irregular shape and firm

A

fetus is in the vertex position (head first)

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21
Q

head should feel hard, round and movable

A

fetus is in breech position

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22
Q
  • Identifies and describes the fetal parts contained on each side of the uterus.
  • Locates for the position of the fetal back and auscultate for the fetal heart beat
A

Second Maneuver (Umbilical Grip)

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23
Q

smooth, hard surface on one side

A

fetal back

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24
Q

Identifies the presenting part to determine the presentation and it’s mobility to determine engagement.

A

Third Maneuver (Pawlick’s Grip)

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25
Q

If the fetus is in the vertex and has descended

A

you’ll feel a less distinct mass

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26
Q

If the fetus is in the breech position

A

you’ll also feel a less distinct mass, which could be the feet or knees

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27
Q
  • Determines the fetal attitude.
  • Can determine flexion or extension of the fetal head and neck
A

Fourth Maneuver (Pelvic Grip)

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28
Q
  • the position of the fetal presenting part and its descent into the pelvis — - how far has the fetus descended
  • the ischial spines of the maternal pelvis are used to describe station 0.
A

Fetal station

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29
Q

described by the relationship of the long axis of the fetus to the long axis of the mother

A

Fetal Lie

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30
Q

the most common fetal lie

A

vertical lie

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31
Q

a problem with a term baby and labor approaching

A

Transverse lie

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32
Q

a problem in a term pregnancy

A

Oblique Lie

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33
Q

Denotes the body part that will first contact the cervix or deliver first

A

Fetal Presentation

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34
Q
  1. Cephalic
  2. Breech Presentation
  3. Shoulder (Transverse)
A

Types of Fetal Presentation

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35
Q

a) Vertex
b) Brow
c) Face
d) Mentum

A

Types of CEPHALIC PRESENTATION

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36
Q

parietal bone (full flexion)

A

VERTEX PRESENTATION (CEPHALIC)

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37
Q

head is moderately flexed (military)

A

BROW PRESENTATION (CEPHALIC)

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38
Q

extension of head, face

A

FACE PRESENTATION (CEPHALIC)

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39
Q

hyperextension of the head (chin)

A

MENTUM PRESENTATION (CEPHALIC)

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40
Q

head is the presenting part

A

CEPHALIC PRESENTATION

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41
Q

buttocks of the baby are presenting first at the bottom of the uterus

A

BREECH PRESENTATION

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42
Q
  1. Frank Breech
  2. Complete Breech
  3. Incomplete Breech
A

Types of BREECH PRESENTATION

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43
Q

legs are flexed at the hips and extended at the knees so the feet are up by the head.

A

Frank Breech

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44
Q

one or both of the legs are flexed.

A

Complete breech

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45
Q

one or both hips are not flexed and the feet and knees are
often below the buttocks

A

Incomplete Breech

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46
Q

– fetus is lying horizontally in the pelvis.
- Presenting part can be the shoulder, iliac crest, hand, or elbow

A

SHOULDER (TRANSVERSE) PRESENTATION

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47
Q

 Relaxed abdominal walls from grand multiparity
 Pelvic contraction in which horizontal space is greater than the vertical space
 Placenta previa (placenta located low in the uterus)

A

CAUSES OF SHOULDER (TRANSVERSE) PRESENTATION

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48
Q

the relationship of the presenting part to a specific quadrant of the woman’s pelvis

A

Fetal Position

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49
Q
  1. Right Anterior
  2. Left Anterior
  3. Right Posterior
  4. Left Posterior
A

FOUR QUADRANTS

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50
Q
  1. Occiput
  2. Breech – Sacrum
  3. Face – Chin (Mentum)
  4. Shoulder – Scapula or acromion process
A

FOUR LANDMARKS

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51
Q

whether the landmark is pointing to the mother’s right or left

A

FIRST LETTER

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52
Q

denotes the fetal landmark:
O- occiput
Sa – sacrum,
M – mentum
A- acronium

A

MIDDLE LETTER

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53
Q

whether the landmark points anteriorly (A), posteriorly (P), transverse (T) (w/ regards to mother’s ante and poste)

A

LAST LETTER

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54
Q

 Combined abdominal inspection and palpation
 Vaginal Examination
 Auscultation of FHT
 Sonography

A

FOUR METHODS USED TO DETERMINE FETAL POSITION, PRESENTATION, AND LIE

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55
Q
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal Rotation
  5. Extension
  6. External Rotation (Restitution)
  7. Expulsion

EDFIrEErE

A

Cardinal Movements (Mechanisms) of Labor

56
Q

at 0 station (Ischial Spine)

A

Engagement

57
Q

head within the pelvic inlet

A

Descent

58
Q

fetal head flexed against the chest

A

Flexion

59
Q

fetal head rotates from transverse to anterior

A

Internal Rotation

60
Q

head extends with crowning

A

Extension

61
Q

head returns to its’ transverse orientation

A

External rotation (restitution)

62
Q

shoulders and torso of the baby are delivered

A

Expulsion

63
Q
  1. Dilatation
  2. Effacement
A

Cervical Changes:

64
Q

How far the cervix has opened

A

Dilatation

65
Q

Thinning of the cervix

A

Effacement

66
Q

STAGE 1: CERVICAL DILATITION (LAT)
STAGE 2: DELIVERY STAGE
STAGE 3: PLACENTAL STAGE
STAGE 4: RECOVERY AND BONDING

A

STAGES OF LABOR

67
Q

Begins with true labor contraction and ends w/ full dilatation

A

STAGE 1: CERVICAL DILATITION

68
Q
  1. Ambulation if with intact membranes
  2. If in bed, LIE ON ONE SIDE or the other…NOT flat on her back
  3. Check vital signs Q4 HRS
  4. NPO EXCEPT ice chips or small sips of water for hydration
A

Management of Early Labor

69
Q
  1. Latent Phase
  2. Active Phase
  3. Transition Phase
A

THREE PHASES OF STAGE 1: CERVICAL DILATITION

70
Q

0 to 3 cm dilatation

A

Latent Phase

71
Q

NULLIPARA: 6 hours
MULTIPARA: 4 to 5 hours

A

Latent Phase

72
Q
  1. Backache
  2. Cramping
  3. Bloody show
  4. Mother is talkative, cheerful, anxious
A

SIGNS DURING LATENT Phase

73
Q
  1. Diversional activities
  2. Time the contractions
  3. Assess maternal-fetal status
  4. Promote hydration
  5. Utilize breathing patterns – SLOW, CHEST BREATHING
  6. Evaluate labor progress
A

NURSING CARE DURING LATENT Phase

74
Q

4-7 cm dilatation

A

Active Phase

75
Q

3-5 minutes apart

A

ACTIVE Phase CONTRACTON INTERVAL

76
Q

40-60 seconds long

A

ACTIVE Phase CONTRACTON DURATION

77
Q

Stronger and more intense

A

ACTIVE Phase CONTRACTON INTENSITY

78
Q

NULLIPARA: 3 hours
MULTIPARA: 2 hours

A

Active Phase

79
Q
  1. Assess maternal and fetal status
  2. Instruct the client PANT-BLOW
  3. Backrubs, comfort measures
  4. Provide encouragement
  5. Provide analgesia if requested and if appropriate
  6. Promote hydration and elimination
  7. Keep perineum clean
  8. Promote rest between contractions
  9. Evaluate labor progress
A

NURSING CARE DURING ACTIVE Phase

80
Q

During EARLY labor, for LOW RISK patients, note the fetal heart rate every

A

1-2 HOURS

81
Q

During ACTIVE labor, evaluate the fetal heart every

A

30 MINS

82
Q

Normal FHR

A

120-160 BPM

83
Q

 Continuously records the instantaneous fetal heart rate and uterine contractions
 Patterns are of clinical significance.
 Use in high-risk patients.
 Use in low-risk patients is OPTIONAL

A

Electronic Fetal Monitors

84
Q

2-3 minutes apart

A

TRANSITION Phase CONTRACTON INTERVAL

85
Q

8-10 cm dilatation

A

Transition Phase

86
Q

40-90 seconds long

A

TRANSITION Phase CONTRACTON DURATION

87
Q
  1. Leg cramps
  2. Perspiration on forehead and upper lip
  3. Dark profuse bloody show
  4. Mother is Irritable, anxious and self-oriented.
A

SIGNS DURING TRANSITION Phase

88
Q
  1. Assess maternal-fetal status
  2. Provide comfort measures
  3. Pant-blow w/ PUSHING URGES
  4. Be supportive and help mother maintain control with breathing
  5. Evaluate labor progress
A

NURSING CARE DURING TRANSITION Phase

89
Q
  • From time of full dilatation until the infant is born
  • Mother has urge to push
A

STAGE 2: DELIVERY STAGE

90
Q
  1. Assess maternal-fetal status
  2. COACH pushing
  3. Provide comfort
  4. RECORD time of delivery, episiotomy/ lacerations, medications/ anesthesia
  5. Evaluate labor progress
  6. Promote bonding
A

STAGE 2: DELIVERY STAGE NURING CARE

91
Q
  1. Narcotics
  2. Paracervical
  3. Pudendal
  4. Epidural
  5. Saddle (spinal) anesthesia
A

Anesthesia/ Analgesia for Labor and Delivery

92
Q
  • Meperidine HCl (Demerol), after mixed with Promethazine (Phenergan) to potentiate.
  • Do NOT give if within TWO hours of delivery, infant may be depressed
A

Narcotics

93
Q
  • numbs cervix, good for STAGE 1 of labor; should NOT be given AFTER 8 CM
  • can cause fetal bradycardia
A

Paracervical

94
Q

numbs vagina and perineum; good for STAGE 2 of labor

A

Pudendal

95
Q

numbs from the waist down

A

Epidural

96
Q
  1. BP every 15 minutes until stable
  2. Assess bladder
  3. Assist in turning and pushing
  4. Hydrate client
  5. Assess FHR
A

Nursing Interventions for EPIDURAL

97
Q
  1. Hypotension
  2. Fetal distress
A

EPIDURAL COMPLICATIONS

98
Q

numbs waist down

A

Saddle (spinal)

99
Q

Headache

A

Saddle (spinal) Complications

100
Q
  1. Flat on bed 4-6 hours
A

Nursing Intervention for Saddle (spinal)

101
Q

 Avoids lacerations
 Provides MORE ROOM for obstetrical maneuvers
 SHORTENS the 2nd Stage Labor
 MIDLINE associated with GREATER risk of rectal lacerations, but heals FASTER
 Many women don’t need them.
* If there are lacerations, vaginal episiorrhaphy (repair) is done.

A

Episiotomy

102
Q

Gauze is compacted into the vagina to absorb the blood and apply pressure on the arteries of the uterus and can slow bleeding

A

Vaginal packing

103
Q
  • must be done to MAINTAIN PRESSURE on the suture line
  • Must be REMOVED after 6-8
    hrs.
A

Vaginal Packing

104
Q

Clamp and Cut the Cord when

A

pulsations stop

105
Q

Clamp and Cut the Cord for about

A

an inch from baby’s abdomen

106
Q

Check the Cord for these 3 vessels

A

AVA

107
Q

From time the infant is born until after the delivery of the placenta

A

STAGE 3: PLACENTAL STAGE

108
Q
  1. Separation
  2. Expulsion
A

TWO PHASES OF STAGE 3: PLACENTAL STAGE

109
Q
  1. Lengthening of the umbilical cord
  2. Sudden gush of vaginal blood
  3. Change in the shape of the uterus
A

SIGNS OF PLACENTA SEPARATION

110
Q
  1. Assess maternal status - Palpate the uterus to see if its contracted, may develop uterine atony
  2. Assess blood loss (250 ml), note time (30 mins) of delivery of placenta
  3. Administer medications if ordered
  4. OXYTOCIN (Methergin)– once placenta is delivered, oxytocin is ordered by IM/IV, to increase uterine contraction & minimize uterine bleeding. BP should be monitored as oxytocin causes HPN by vasoconstriction.
  5. Inspect the Placenta
A

NURSING CARE DURING STAGE 3: PLACENTAL STAGE

111
Q
  1. Make sure it is complete
  2. Look for missing pieces
  3. Look for malformations
  4. Look for areas of adherent blood clot
A

how to Inspect the Placenta

112
Q

Begins after delivery of the placenta and continues for 1-4 hours after delivery

A

STAGE 4: RECOVERY AND BONDING

113
Q
  1. Assess VS, fundus and flow every 15 minutes
  2. Encourage hydration and elimination
  3. Promote comfort
  4. Promote bonding
A

NURSING CARE DURING STAGE 4: RECOVERY AND BONDING

114
Q
  • A tool for managing labor, a graphic representation of the events of labor plotted against time in hours
  • Started only when a woman is in labor
A

PARTOGRAPH

115
Q
  1. Fetal Condition
  2. Progress of Labor
  3. Maternal Condition
A

3 COMPONENTS OF PARTOGRAPH

116
Q

Use to monitor the ff parameters:
1. FHR
2. Membranes and Color of Liquor
3. Descent/Molding of fetal skull

A

Fetal condition

117
Q

Use to plot the parameters:
1. Cervical Dilatation
2. Descent of fetal head
3. Uterine contractions (IFD)

A

Progress of labor

118
Q

Use to monitor the parameters:
1. VS
2. Urine
3. IV fluids
4. Drugs and Oxytocin

A

Maternal condition

119
Q
  1. Early detection of deviation from normal progress of labor.
  2. Prevention of prolonged labor.
  3. Reduce the risk of postpartum hemorrhage and sepsis.
  4. Eliminate obstructed labor, uterine rupture.
A

PURPOSES OF PARTOGRAPH

120
Q
  1. Improvement in maternal morbidity, perinatal morbidity and mortality.
  2. Serve as an early warning system and assist in early decision on:
    - Transfer
    - Augmentation
    - Termination of labor
  3. Prevention of asphyxia ,brain damage, infection and death in infant.
A

PURPOSES OF PARTOGRAPH

121
Q
  1. To reduce prolonged labor and sequela of morbidity and mortality for both women and infants.
  2. To improve quality of care for women in labor and to increase the observation and interpretation skills of the on the progress of labor by health personnel.
  3. To encourage timely referral from the periphery
A

OBJECTIVES OF PARTOGRAPH

122
Q
  1. Patient identification
  2. Time
  3. Zero
  4. Fetal heart rate
  5. Membranes and color of liquor
  6. Cervical dilatation
  7. Descent of Head
  8. Uterine contractions
  9. Drugs and Fluids
  10. Blood pressure
  11. Pulse rate
  12. Oxytocin
  13. Urine Analysis
  14. Temperature Record
A

Description of indicators used in Partograph

123
Q

It is recorded at an interval of one hour.

A

Time

124
Q

time for spontaneous labor, is time of admission in the labor ward and, is time of induction

A

Zero Time

125
Q

Is recorded at an interval of 30 minutes

A

FHR

126
Q

“I” designates intact membranes
“C” designates clear liquor
“M” designates meconium stained liquor
“B” designates bloody liquor
“A” designates absence of liquor

A

Membranes and color of liquor

127
Q

measured by the diameter in cm 0-10. (X is designated )

A

Cervical dilatation

128
Q

O is designated

A

Descent of Head

129
Q

Squares in vertical columns are shaded according to duration and
intensity

A

Uterine contractions

130
Q

It is recorded in vertical lines at an interval of 2 hours

A

BP

131
Q

It is also recorded in vertical lines at an interval of 30 minutes.

A

PR

132
Q

Concentration is noted down in upper box; while dose is noted in lower box

A

OXYTOCIN

133
Q

Perform internal examination every

A

4 HOURS or more often if necessary

134
Q

if plotting stays on or to the left of the alert line (green part)

A

Progress of labor is normal

135
Q

Plotting that passes the alert line (yellow part) more so if it reaches or passes the action line (red part) indicates

A

ABNORMAL progress of labor

136
Q
  1. Reassess woman and consider criteria for referral.
  2. Alert transport services
  3. Encourage woman to empty bladder
  4. Encourage upright position and walking if woman wishes.
  5. Monitor intensively.
  6. If referral takes a long time, refer immediately. DO NOT WAIT TO CROSS ACTION LINE
A

IF PLOTTING PASSES ALERT LINE:

137
Q

Refer urgently to hospital unless birth is imminent

A

IF PLOTTING REACHES ACTION LINE:

MCN LEC MIDTERMS (4 decks)

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