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Antepartal Nursing > Intrapartal Nursing > Flashcards

Intrapartal Nursing Flashcards

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0
Q

Duration

A

Beginning of contraction (muscle begins to tense), to the end of same contraction (muscle is completely relaxed)

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1
Q

Frequency

A

Beginning of one contraction to the beginning of the next

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2
Q

Uterine resting tone

A

Between uterine contractions when optimum uterine relaxation is achieved

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3
Q

Acme or peak

A

Intensity is evaluated subjectively by estimating firmness (nose, chin, four head= mild, moderate, and strong)

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4
Q

Early or Latent phase of labor

A

0 to 3 cm, relaxed, excited, anxious

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5
Q

Active phase of labor

A

4 to 7 cm, more intense, begins to tire

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6
Q

Transitional phase of labor

A

8 to 10 cm, feel tired, unable to cope, needs frequent coaching to maintain breeding patterns

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7
Q

Electronic monitoring with external toco

A

Can determine frequency and direction, cannot determine intensity, may be used BEFORE and AFTER ROM rupture of membranes, placed over fetal part of fundus on outside of abdomen

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8
Q

Internal uterine pressure catheter (IUPC)

A

Inserted into uterine cavity of cervical os, place in area of fetal small parts, can only be used AFTER ROM ruptured membranes, measures resting tone of uterus between contractions, measure actual pressure during contractions – intensity
Advantage – critical in woman attempting vaginal birth to avoid tachysystole and uterine rupture

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9
Q

Leopold maneuver position

A

Bladder empty
Lie on back with abdomen uncovered, shoulders race lightly on pillow, knees drawn up a little
Completed between contractions
Determines lie – longitudinal or transverse

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10
Q

Fetal scalp electrode – FSE – internal monitoring

A

Most precise method of monitoring EKG of FHR, attached to fetus during vaginal exam
Cervix must be 2 cm dilated, pedal car presenting, are ROM
Avoid in preterm infants because increased risk of ventricular hemorrhage

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11
Q

Baseline fetal heart rate

A

Must be at least two minutes of identical baseline segments and any 10 minute window
Acceleration deceleration or periods of mart fetal heart rate variability are excluded

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12
Q

Fetal tachycardia

A

BL FH are greater than 160 bpm for at least a 10 minute.

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13
Q

Variable deceleration

A

Decrease in fetal heart rate – defined as onset of the deceleration to beginning of fetal heart rate made her a 30 seconds or less
Decrease in fetal heart rate 15 beats a minute, lasting 15 seconds or more, in less than two minutes duration

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14
Q

Prolonged deceleration

A

Decrease in fetal heart rate of 15 beats a minute or more that last more than two minutes and less than 10 minutes

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15
Q

Critical factors in labor

x5

A 
Birth passage
Fetus
Relationship between birth passage of fetus
Physiological forces of labor
Psychosocial considerations
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16
Q

Fetal attitude

A

Posture the fetus assumes as it conforms to the shape of the uterine cavity
-* normal is general flexion: baby ducks head down, presenting the clown

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17
Q

Fetal lie

A

Relationship of access, spinal column, a fetus to access of mother spinal column

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18
Q

Longitudinal lie

A

Cephalocaudal access of the feudal spine is parallel to one months time

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19
Q

Transverse lie

A

Cephalocaudal access of the fetal spine is at a right angle to the woman spine

  • cause shoulder presentation
  • Csection
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20
Q

Fetal presentation

A

Determined by fetal lie, body part a fetus that enters maternal pelvis first, “presenting part” felt through cervix on vag exam
Cephalic (head first), breech (buttocks or feet first), or shoulder (malpresentation)

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21
Q

Vertex presentation

A

Most common
fetal head completely flexed
Smallest diameter presents
*Occiput is landmark

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22
Q

Sinciput presentation

A

Fetal head partially flexed
Top of head is presenting part
Occiptofrontal diameter presents
*Occiput is landmark

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23
Q

Brow presentation

A

Head partially extended
Occipitomental diameter/ LARGEST anterioposterior diameter presented
* Chin is landmark

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24
Q

Face presentation

A

Head is hyper extended
Submentobregmatic diameter
*Chin is landmark

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25
Q

Complete breech

A

Head and knees flexed,thighs on abdomen
Cavs on posterior aspect of thighs
Buttocks and feet present
* sacrum is landmark

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26
Q

Frank breech

A

Hips flexed, knees extended
Buttocks presents
* sacrum is landmark

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27
Q

Footling breach

A

Hips and knees extended
Feet present
Single footling, double footling
* sacrum is landmark

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28
Q

Effacement

A

Drawing up of internal os and cervical canal into uterine sidewalls

29
Q

Shoulder presentation

A

Shoulder is presenting part
Fetus is in transverse lie
*Acromion process of scapula is landmark

30
Q

Cephalon presentation

Engagement

A

Biparietal diameter is largest dimension of fetal skull to pass through pelvic inlet

31
Q

Breech presentation engagement

A

Tetrochanteric diameter (transverse diameter between right and left trochanter) is largest to pass through pelvic inlet

32
Q

Engagement

A

When largest diameter of presenting part reaches or passes through pelvic inlet

33
Q

Station

A

Relationship of presenting part to an imaginary line drawn between Ischial spines of maternal pelvis
Higher is negative
Lower is positive

34
Q

Lightning

A

Fetus begins to settle in pelvic inlet

“the baby dropped”

35
Q

Bloody show

A

mucous plug expel due to softening and effacement of cervix, blood loss from expose cervical capillaries

36
Q

Ripening

A

Softening of cervix

37
Q

Spontaneous rupture of membranes

SROM

A

Risk of prolapsed cord if fetus not engaged, bacteria can enter

38
Q

Premature rupture of membranes

PROM

A

Any spontaneous rupture of membranes before onset of labor

39
Q

Preterm premature rupture of membranes

PPROM

A

Leakage or rupture of amniotic fluid before 37 weeks

40
Q

True labor

A

Dilation and effacement
Back pain that radiates around to abdomen
Pain not relieved by ambulating
Contractions regular and increasing in frequency, duration, intensity

41
Q

First stage

Active phase

A

Onset of regular contractions, mild intensity
Cervix dilate and effaces but a little fetal dissent
Able to cope, smiling, talkative
Should not exceed 20 hours

42
Q

First stage

Active phase

A

Intensification of contractions
Fetal dissent is progressive
anxiety tends to increase, fear loss of control, decreased ability to cope
* Metabolic acidosis compensated by respiratory alkalosis
Cervix dilate from about 4 to 7 cm

43
Q

First stage

Transitional phase

A

Contractions become more frequent and strong Increased rectal pressure, urge to Bear down
Significant anxiety, crying and yelling, hyperventilation and restlessness, “lose her mind”
Cervical dilation slows from 8 to 10 cm and rate of fetal dissent increases
Generalized discomfort, sensitivity to touch
Needs partner support or nurses
Hiccuping, belching, nausea or vomiting, perspiration on upper lip

44
Q

Positional changes a fetus

Flexion

A

As fetal head to sense, result of resistance, fetal chin flexes downward onto chest

45
Q

Positional changes a fetus

Internal rotation

A

Fetal HEAD must rotate to fit diameter of pelvic cavity, occiput rotates from LEFT to RIGHT (side to front) and sagittal suture aligns in anterioposterior pelvic diameter

46
Q

Positional changes a fetus

Restitution

A

Shoulders of infant enter pelvis obliquely, neck becomes twisted. Once head emerges, neck untwist turning head to one side and aligns (restitution) with position of back in birth canal

47
Q

Positional changes a fetus

External rotation

A

Shoulders rotate to the anterior posterior position and pelvis head is turned farther to the side

48
Q

Positional changes a fetus

Expulsion

A

After external rotation, anterior shoulder is born before posterior shoulder, body follows quickly

49
Q

Third stage

Placental separation signs

A
  1. globe shaped uterus
  2. Rise a fundus in abdomen
  3. Sudden gush or trickle of blood
  4. further protrusion of umbilical cord out of vagina
50
Q

Third stage

Placental delivery

A

Retained placenta – more than 30 minutes elapsed

  • Shultze Mechanism: expelled with fetal shiny side presenting,” shiny shultze”
  • Duncan Mechanism: expelled with maternal surface delivering first, surface is rough, “dirty Duncan”
51
Q

Fourth stage

A

One to four hours after birth
Physiologic readjustment of mothers body begins
VS: drop in blood pressure, increased polls, moderate tachycardia
May experience shaking chill
Hemodynamic changes
Acid/base is more balanced

52
Q

Secobarbital

Second choice

A

Oral
Treat false labor and produce sedation affect
Long half-life, remain in maternal and fetal blood for up to 40 hours

53
Q

Zolpidem (Ambien)

First choice Barbituate

A

Oral
False labor and produce sedation effect
Half-life of 4.5 hours
For sleep to encourage rest

54
Q

Diazepam (Valium)
Midazolam (Versed)
Benzodiazepine

A

Treat anxiety, anticonvulsant action
Fetal side effects: increase in variability of FHR, hypotonicity, hyperactivity, impaired temperature regulation, impaired metabolic response to cold stress
Not recommended before baby is born
Associated with low Apgar scores when administered five minutes or less before birth

55
Q

Promethazine (Phenergan)

A

Sedative, antiemetic

Crosses placenta barrier and result in decreased FHR variability

56
Q

Hydroxyzine (Vistaril)

A

IM

Given in early labor to decrease anxiety and nausea

57
Q

Diphenhydramine ( Benadryl)

A

Treat allergic rhinitis and hives
Sedative and antiemetic
Half-life last up to 6 to 8 hours

58
Q

Butorphanol (Stadol)

Narcotic

A

Precipitate withdraw and drug dependent individuals
(Know patients drug history)
Given in labor

59
Q

Fentanyl (Sublimaze)

Narcotic

A

Moderate analgesia and mild sedation
Rapid onset, short half-life
*Limited placental transfer

60
Q

Nubain

Narcotic

A

May precipitate drug withdrawal of woman is physically dependent on narcotics
* crosses placental to fetus, respiratory depression

61
Q

Meperidine (demerol)

Narcotic

A

Used to relieve shaking
Crosses placenta within 90 seconds

Maternal side affects: urinary retention, respiratory depression, sedation, conversions, dizziness, N/V

Fetal side effects: decreased/absent respiratory movement, decreased fetal movement, decrease in variability, low Apgar scale, low O2 sat, alteration in fetal ECG

62
Q 
Local anesthetics
Esters
-Novacaine
-Nesacaine
-Pontocaine
A

Rapidly metabolized

Toxic maternal levels not as likely, placenta transferred to fetus is present prevented

63
Q 
Local anesthetic
Amides
-Bupivicaine (Marcaine)*
-Ropivacaine*
-Levobupivicaine*
A

Powerful and long-acting

Cross placenta, affect fetus for prolonged period

64
Q

Lumbar epidural block

A

Epidural space is between dura mater and ligamentum flavum
Disadvantage:* most common complication is maternal hypotension
Onset of analgesia may not occur for up to 30 minutes
Avoid perforating Dura mater
Close observation of mother and fetus required
Decreased FHR variability, late the cells if maternal hypotension occur

65
Q

Lumbar epidural block

Relative contraindication

A 
Platelet count less than 100,000
Sepsis
Hypertension
Uncooperative patient
Severe anatomic abnormalities of the spine
66
Q

Lumbar epidural block

Technique

A

IV infusion begun, preload of 500 to 2000 ml of IVF given over 15 to 30 minutes (prevents) hypotension
Positioned on the right or left side, or sitting on edge of bed with back
Woman is attained by nurse for first 20 minutes
Blood pressure monitor every 1 to 2 minutes for first 10 minutes, then every 5 to 15 minutes until block wears off
Hypotension: left lateral displacement of uterus, Trendelenburg, epinephrine

67
Q

Spinal block

A

Local Anesthetic injected into spinal fluid and subarachnoid space
Does not cross fetal circulation
Contraindication: CNS disease
Position: placed on back with pillow under head positions alter the level of those within 3 to 5 minutes

68
Q

Pudenal Block

A

Perineal anesthesia for second stage of labor, birth, episiotomy
Injected below pudendal plexus
Relief of pain from perineal distention, does not relieve contraction pain
disadvantage: decreased urged to bear down, burning
complications: perforation of rectum, trauma to sciatic nerve, potential broad ligament hematoma

69
Q

Ketamine

IV Gen. Anasthesia

A

Last 20 to 60 minutes
Hyper salivation can occur, hallucinations
Contraindication: preeclampsia or chronic hypertension

70
Q

Inhaled anesthesia agent

Nitrous oxide

A

Crosses placenta immediately, less neonatal depression

71
Q

Inhaled anesthesia

Isofurane, Sevofurane, Halothane, Desflurane,Enflurane

A

Maybe use for woman with aortic stenosis

Used if spinal or epidural anesthesia ineffective

Antepartal Nursing (8 decks)

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