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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
impending sigs of labor
- lightening (movement into pelvis) - braxton hicks - cervical changes - blood show/expulsion of mucus plug - ROM - sudden burst of energy (nesting) - wt loss - GI upset
26
facts about true labors
- contractions are regular, gradually shorten, and increase in duration and intensity - cervical dilation and effacement progress - contractions do not get better with warm
27
facts about false labor
- contractions are irregular - discomfort usually in abdomen - no cervical change - warm baths help
28
stages of labor
first: onset until finally dilated second: full dilation until birth third: birth until birth of placenta fourth: 4 hours after birth
29
what are the stages of first stage of labor
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
30
what happens in the second stage of labor
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
what are the mechanisms of labor
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
what are the benefits of kangaroo care
- inc bonding - inc oxytocin release - stimulates milk production - stabilizes HR, temp
33
what is the third stage of labor
birth until delivery of placenta - no longer than 30 mins - pitocin IV bolus to dec blood loss - fundal massage
34
signs of placental separation
- globular uterus rises in abdomen - gush or trickle of blood - inc protrusion of umbilical cord
35
what are the characteristics of placenta
dirty duncan --> uterus, mom shiny schultze --> fetal membrane (chorion, amnion)
36
what is oxytocin given for
induce labor dec postpartum bleeding
37
what happens during the fourth stage of labor
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
common physiological readjustments in the 4th stage
- 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
sve score
dilation/effacement/staging
40
admission assessments for labor
- 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
admission labs
- blood type and screen - CBC - GBS - rubella
42
external fetal monitoring
- toco: monitors contractions, place on fundus - FHR monitor: place on fetal shoulders/back
43
external fetal monitoring advantages (US)
- continuous - established baseline - noninvasive - no ROM - nurse can place
44
external fetal monitoring disadvantage
- susceptible interference from movement - may be weak signal - may be sketchy and difficult to interpret
45
fetal scalp electrode
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
intrauterine contraction monitoring
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
nitrazine tape
tests for amniotic fluid (aka ROM) - negative: yellow color (more acidic) - positive: deep blue color (more alkaline)
48
ferning test
tests for amniotic fluid (aka ROM) - positive: crystalized under microscope
49
amnisure
tests for amniotic fluid (aka ROM) - swab vaginal discharge and then wait for basically covid results to come back - two lines is positive
50
what are episodic FHR with contractions
FHR changes that are not associated with contractions
51
what are periodic FHR with contractions
FHR changes that are associated with contractions
52
FHR baseline range
110-160 bpm for 10 mins
53
what are accelerations
32 wks: + 15 beats for 15+ secs 31 wks: +10 beats for 10+ secs
54
early decels are
head compression
55
late decels are
uteroplacental insufficiency
56
variable decels are
umbilical cord compression
57
early decels
HR dec when contraction happens (mirror) - longer than 30 secs - SVE
58
late decels
caused by a perfusion problem (HTN, HypoTN, bleeding) - HR dec around end of contraction - position change
59
variable decels
caused by cord compression which can happen with out without a contraction - ABRUPT dec in HR - position change
60
veal chop
variable cord compression early head compression acceleration is okay late placental perfusion
61
UNCOIL
Undo what is happening Change position Oxygen on or oxytocin off IV fluid bolus Lower HOB
62
prolonged decel
decel that lasts longer than 2 mins * if it lasts longer than 10 mins it is a change in baseline*
63
sinusoidal pattern
baby is acidotic and needs to be delivered now - HCP alerted immediately
64
what does FHR variability indicate
fetal oxygenation
65
types of variability
absent: baby in distress, no changes flat lines minimal: less than 5 change moderate: 6-25 change marked: 25+
66
goal variability
moderate
67
FHR bradycardia
less than 110 bpm - prolapsed cord - placental abruption - lots of bleeding - occurs for at least 10 mins
68
FHR tachycardia
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
nursing interventions for non reassuring patterns
- change position - slow or turn off pit - inc IV fluid (bolus) - oxygen - notify HCP and document - tocolytics - prepare for delivery
70
coat
assesses amniotic fluid - color - odor - amount - time
71
effleurage
massaging cervix/vagina with circular motion using palms of hands
72
indications of imminent birth
bulging of the perineum uncontrollable urge to bear down inc bloody show
73
BUBBLELE
breasts uterus bowel bladder lochia emotional status laceration
74
immediate dangers post birth
hypotenstion tachycardia uterine atony excessive bleeding hematoma

NUR 332 (3 decks)

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