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NUR 332 > Intrapartum > Flashcards

Intrapartum Flashcards

1
Q

what are the 5 P’s for labor and birth

A

passage
passenger
position
power
psyche

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2
Q

what is passage

A
  • size and type of maternal pelvis
  • ability of cervix to dilate and efface
  • ability of vaginal canal and external opening of vagina to distend
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3
Q

what are the various shapes of pelvic canal

A
  • gynecoid: most common
  • android: larger sacrum
  • anthropoid: narrow and longer
  • platypelloid: flat like a pancake, want baby in transverse lye
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4
Q

what is the passenger

A

the fetus characteristics
- head
- attitude
- lie
- presentation

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5
Q

what characteristics does a fetal head have

A

6 bones connected by membraneous sutures, where sutures intersect we call fontanelles
- helps skull to be flexible during birth
- allows for brain development and growth

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6
Q

what is fetal attitude

A

how the baby is positioning itself (relation of fetal parts to one another)
- rounded back, chin tucked to chest, legs pulled into chest, arms crossed over chest

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7
Q

what is fetal lie

A

fetus relation to how its lying in mother
- longitudinal: cephalic, breech
- transverse: horizontal (shoulder position)

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8
Q

types of cephalic presentation

A

suboccipitobregmatic: want
occipitofrontal diameter: chin not flexed
occipitomental diameter: brow delivered frist
submentobregmtaic: face first (bruised and edema)

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9
Q

types of breech presentation

A
  • frank: butt presents, knees extended
  • complete: butt presents, hips and knees flexed
  • footling: feet present, hips and legs extended
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10
Q

what is position

A
  • station (+/-)
  • engagement (ischial spine)
  • fetal position (presenting part)
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11
Q

what is station

A

relation of presenting part to the ischial spines
- above are negative, below are positive

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12
Q

what is ballotable

A

floating or not engaged

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13
Q

what is engagement

A

when presenting fetal part reaches zero station

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14
Q

what is fetal position

A

in relation to mother’s pelvis
- right, left
- anterior, posterior, transverse
- occiput, mentum, sacrum, acromion process
- head, chin, butt, scapula

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15
Q

what is powers

A
  • primary: uterine muscular contractions until complete dilation (body controls)
  • secondary: abdominal muscles used when pushing down (patient controls)
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16
Q

what is in/decrement of contraction

A
  • the build up and decline of contraction
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17
Q

what is acme

A

the strongest point of contraction

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18
Q

what is resting

A

the time between the contractions where the resting tone is relaxed

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19
Q

what is intensity

A

how strong the contraction is
- mild, moderate, intense

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20
Q

what is duration

A

start of contraction to end of contraction

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21
Q

what is the frequency

A

on contraction until the start of contraction and next

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22
Q

what happens during the valsalva maneuver

A

occurs with secondary forces when you are pushing
- reduces blood flow to baby and mom

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23
Q

what is psyche

A
  • fear and anxiety of labor
  • excitement
  • exhaustion
  • level of social support
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24
Q

abnormalities of the five P’s that cause problems in labor

A
  • passageway to small
  • fetus is in malpresentation
  • position is posterior
  • powers are inadequate
  • psychological factors like fear, anxiety, poor support system, exhaustion
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25
Q

impending sigs of labor

A
  • lightening (movement into pelvis)
  • braxton hicks
  • cervical changes
  • blood show/expulsion of mucus plug
  • ROM
  • sudden burst of energy (nesting)
  • wt loss
  • GI upset
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26
Q

facts about true labors

A
  • contractions are regular, gradually shorten, and increase in duration and intensity
  • cervical dilation and effacement progress
  • contractions do not get better with warm
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27
Q

facts about false labor

A
  • contractions are irregular
  • discomfort usually in abdomen
  • no cervical change
  • warm baths help
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28
Q

stages of labor

A

first: onset until finally dilated
second: full dilation until birth
third: birth until birth of placenta
fourth: 4 hours after birth

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29
Q

what are the stages of first stage of labor

A

latent: 0-3 cm, contractions q 10-30 mins for 30 secs, mild to moderate
active: 4-7 cm, contractions q 2-5 mins lasting 4-60 secs, moderate to strong
transition: 8-10 cm, contractions q 1.5-2 mins lasting for 60-90 secs

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30
Q

what happens in the second stage of labor

A

the pushing stage that ends with birth
- urge to push, crowning
- contractions q 1.5 mins to 2 mins, lasting 60-90 sec, strong by palpation
woman has inc sense of control bc she can be actively involved now

31
Q

what are the mechanisms of labor

A

engagement
descent
flexion
internal rotation
extension
external rotation
expulsion
descend down the hill, flex on them with your time, internally rotate to slow down, extend your hands in the air, externally rotate ur hands and wave to your fans

32
Q

what are the benefits of kangaroo care

A
  • inc bonding
  • inc oxytocin release
  • stimulates milk production
  • stabilizes HR, temp
33
Q

what is the third stage of labor

A

birth until delivery of placenta
- no longer than 30 mins
- pitocin IV bolus to dec blood loss
- fundal massage

34
Q

signs of placental separation

A
  • globular uterus rises in abdomen
  • gush or trickle of blood
  • inc protrusion of umbilical cord
35
Q

what are the characteristics of placenta

A

dirty duncan –> uterus, mom
shiny schultze –> fetal membrane (chorion, amnion)

36
Q

what is oxytocin given for

A

induce labor
dec postpartum bleeding

37
Q

what happens during the fourth stage of labor

A

4 hours after birth
- ensure blood loss of 250-500 mls (vaginal) or > 1000 ml (c/s)
ensuring hemodynamic stability
- returning sensation
- O2 sat
- fundus, perineum
- temp
- bladder fullness

38
Q

common physiological readjustments in the 4th stage

A
  • thirst and hunger
  • shaking (CNS response)
  • bladder is often hypotonic
  • uterus should remain hard and in midline of abdomen and between symphysis pubis and umbilicus
39
Q

sve score

A

dilation/effacement/staging

40
Q

admission assessments for labor

A
  • term or preterm
  • HTN?, bleeding disorders?
  • DOPE (DM, obese, previously large infant, excessive wt gain)
  • ambulation or bed rest?
  • continuous or intermittent?
  • birth plan?
41
Q

admission labs

A
  • blood type and screen
  • CBC
  • GBS
  • rubella
42
Q

external fetal monitoring

A
  • toco: monitors contractions, place on fundus
  • FHR monitor: place on fetal shoulders/back
43
Q

external fetal monitoring advantages (US)

A
  • continuous
  • established baseline
  • noninvasive
  • no ROM
  • nurse can place
44
Q

external fetal monitoring disadvantage

A
  • susceptible interference from movement
  • may be weak signal
  • may be sketchy and difficult to interpret
45
Q

fetal scalp electrode

A

continuous HR monitor without adjustment by placing electrode on baby head (not fontanelles)
- better tracings but inc risk of infection and requires ruptured membrane and cervical dilatation

46
Q

intrauterine contraction monitoring

A

inserted by the HCP when the toco monitor is not doing the job
- monitors frequency, duration, intensity, resting tone to determine if you have adequate labor
- add up values (want greater than 200 in 10 mins but dont want greater than 300)
- needs membrane ruptured, inc risk of uterine infection or ruptured, no low lying placenta

47
Q

nitrazine tape

A

tests for amniotic fluid (aka ROM)
- negative: yellow color (more acidic)
- positive: deep blue color (more alkaline)

48
Q

ferning test

A

tests for amniotic fluid (aka ROM)
- positive: crystalized under microscope

49
Q

amnisure

A

tests for amniotic fluid (aka ROM)
- swab vaginal discharge and then wait for basically covid results to come back
- two lines is positive

50
Q

what are episodic FHR with contractions

A

FHR changes that are not associated with contractions

51
Q

what are periodic FHR with contractions

A

FHR changes that are associated with contractions

52
Q

FHR baseline range

A

110-160 bpm for 10 mins

53
Q

what are accelerations

A

32 wks: + 15 beats for 15+ secs
31 wks: +10 beats for 10+ secs

54
Q

early decels are

A

head compression

55
Q

late decels are

A

uteroplacental insufficiency

56
Q

variable decels are

A

umbilical cord compression

57
Q

early decels

A

HR dec when contraction happens (mirror)
- longer than 30 secs
- SVE

58
Q

late decels

A

caused by a perfusion problem (HTN, HypoTN, bleeding)
- HR dec around end of contraction
- position change

59
Q

variable decels

A

caused by cord compression which can happen with out without a contraction
- ABRUPT dec in HR
- position change

60
Q

veal chop

A

variable cord compression
early head compression
acceleration is okay
late placental perfusion

61
Q

UNCOIL

A

Undo what is happening
Change position
Oxygen on or oxytocin off
IV fluid bolus
Lower HOB

62
Q

prolonged decel

A

decel that lasts longer than 2 mins
* if it lasts longer than 10 mins it is a change in baseline*

63
Q

sinusoidal pattern

A

baby is acidotic and needs to be delivered now
- HCP alerted immediately

64
Q

what does FHR variability indicate

A

fetal oxygenation

65
Q

types of variability

A

absent: baby in distress, no changes flat lines
minimal: less than 5 change
moderate: 6-25 change
marked: 25+

66
Q

goal variability

A

moderate

67
Q

FHR bradycardia

A

less than 110 bpm
- prolapsed cord
- placental abruption
- lots of bleeding
- occurs for at least 10 mins

68
Q

FHR tachycardia

A

greater than 160 bpm
- check mom’s temp bc could be infection so that needs to be ruled out
- could be caused by medications

69
Q

nursing interventions for non reassuring patterns

A
  • change position
  • slow or turn off pit
  • inc IV fluid (bolus)
  • oxygen
  • notify HCP and document
  • tocolytics
  • prepare for delivery
70
Q

coat

A

assesses amniotic fluid
- color
- odor
- amount
- time

71
Q

effleurage

A

massaging cervix/vagina with circular motion using palms of hands

72
Q

indications of imminent birth

A

bulging of the perineum
uncontrollable urge to bear down
inc bloody show

73
Q

BUBBLELE

A

breasts
uterus
bowel
bladder
lochia
emotional status
laceration

74
Q

immediate dangers post birth

A

hypotenstion
tachycardia
uterine atony
excessive bleeding
hematoma

NUR 332 (3 decks)

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