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NUR 220 > Intrapartum > Flashcards

Intrapartum Flashcards

1
Q

maternal factors labor

A
  • Uterine muscles stretched
  • Pressure on the cervix
  • Oxytocin stimulation
  • Estrogen: Progesterone ratio change
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2
Q

fetal factors labor

A
  • Placental aging
  • Fetal cortisol concentration
  • Prostaglandin
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3
Q

s/s of approaching labor

A

Lightening
* Increased energy level “nesting”
* Loss of mucus plug
* Flu like symptoms
* Weight Loss
* Rupture of Membranes

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4
Q

powers

A

uterine contraction
lower uterine segment lengthens and becomes thinner
during contractions the uterine fundus becomes thicker which allows the uterus to aid in fetal decent
produce cervical changes

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5
Q

what to know with uterine contractions

A

frequency
duration
intensity
resting tone

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6
Q

what promotes felxibility of pelvic joints

A

relaxin

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7
Q

mucus plug

A

Plugs” the passageway from the
vagina to the uterus
* Similar to Bloody Show
* Tiny blood vessels + mucus

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8
Q

what is biparietal diameter

A

largest transverse
measurement of the fetal head

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9
Q

what is breech

A

buttock/feet

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10
Q

what is transverse

A

shoulder first

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11
Q

passageway and passager

A

Engagement
* Biparietal Diameter
* Station
* Ischial Spines
* -5 to + 5
* Position
* 3 Letters

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12
Q

true labor causes…..

A

cervical changes

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13
Q

1st stage of labor

A

1st Stage: Onset of regular
uterine contractions-
Full dilation
* Latent
* Active

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14
Q

2nd stage of labor

A

Full dilation- Birth of the baby

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15
Q

3rd stage of labor

A

Birth of the baby- Delivery
of the Placenta

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16
Q

4th stage of labor

A

Delivery of the placenta-
Two hours after delivery

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17
Q

latent phase contractions

A

Frequency: 5-10 minutes
* Duration: 30-45 seconds
* Intensity:
* Feels like menstrual
cramps , low dull
backache
* Mild by palpation

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18
Q

latent phase cervical exam

A

0-6 cm

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19
Q

maternal reactions latent phase

A

Chatty/Talkative
* Sociable
* Laughing
* Excited

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20
Q

anticipatory guidance latent phase

A

14-20 hours
* Can be completed at home

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21
Q

active phase contractions

A

Frequency: 2-5 minutes
* Duration: 45-60 seconds
* Intensity:
Moderate-strong by
palpation

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22
Q

anticipatory guidance active phase

A

4-6 hrs

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23
Q

cervical exam active phase

A

6-10 cm

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24
Q

maternal reactions active phase

A

Quieter
* More inwardly focused
* Need to remain focused on staying
in control and managing pain
* May have new symptoms: shakes,
nausea, hiccups and belching

25
nsg considerations active phase
Encourage and praise patient * Bulging perineum * Increased bloody show
26
second stage contractions
Frequency: 2-3 minutes * Duration: 60-90 seconds * Intensity: * Strong by palpation
27
maternal reactions 2nd stage
Burst of renewed energy * Feels more in control and less irritable * Excited to be able to push * May want a mirror to watch progress
28
anticipatory guidance 2nd stage
Up to 3 hours from complete dilation to birth
29
nsg considerations 2nd stage
If patient has an epidural, she may not feel the urge to push and may need to be told - “directed pushing” * Infant's head should rotate as it descends to pelvic floor * Episiotomy may be necessary
30
3rd stage of labor
Delivery of the Placenta: * Mild uterine contractions * Fullness in vagina felt *Gush of blood as placenta detaches from the uterus * Takes approximately 5- 30 minutes
31
3rd stage active management
Fundal massage * Administration of oxytocin
32
nsg considerations 3rd stage
Assess placenta for any missing parts * Maternal plan for placenta
33
4th stage
Maternal Reactions: * Relief, joy, crying Infant Bonding: * Skin to skin, BF Active Management: * Fundal massage * Administration of oxytocin * Monitor for signs of PPH Nursing Considerations: *Vital Signs *Fundus *Bleeding *Breastfeeding *Comfort Anticipatory Guidance: * First 1-4 hours after birth
34
external monitoring
Transducers: Where to place Toco: Over the fundus where the greatest traceable activity is Where to place Ultrasound: Over the fetal back
35
external mnoitoring advantages
Provides a visual record of FHR & uterine activity ◦ Noninvasive: Monitor without risk of infection ◦ Can be done by RN ◦ Easily accessible ◦ Increased freedom of movement ◦ ROM or cervical dilation not required
36
external monitoring disadvantages
Increase BMI may have poor readings o Artifact o Take care of monitor not patient o Client/family can remove
37
continuous fetal monitoring
Applied from admission through birth of the baby ◦ Allows detection of FHR baseline, accelerations, decelerations, and variability ◦ Creates a permanent record
38
intermitten fetal monitoring
Use a Doppler or EFM ◦ Non-invasive, freedom to move around ◦ Done at prescribed intervals for 60 seconds ◦ During and immediately after contractions
39
internal monitoring
FSE ◦ Fetal spiral electrode detects FHR IUPC ◦ Intrauterine pressure catheter records contraction frequency, duration, intensity/resting tone in mmHg
40
advantages of internal monitoring
Greater accuracy and early detection of issues ◦Continuous monitoring ◦Better option for increased BMI
41
disadvantages to internal monitoring
Must have ROM *Cervix must be dilated *Increased risk of infection *Must be qualified to place
42
fetal monitoring is looking at....
CNS of baby
43
cns
Responsible for variations in the FHR and baseline variability related to fetal activity Begins and maintains FHR by week 10 Parasympathetic and Sympathetic Components
44
pns
influences heart rate through vagus nerve * Decreases the FHR * Helps to maintain variability
45
sns
Increases the FHR * Responsible for establishing and sustaining FHR * SNS may be stimulated during periods of hypoxemia * Action occurs through the release of norepinephrine
46
baseline fhr
Average FHR observed between contractions over a ten-minute period Excludes periodic FHR changes 110-160 bpm 2 abnormal variations: ◦ Tachycardia or Bradycardia
47
tachycardia
Persistent FHR above 160 bpm for at least 10 minutes ◦ Sympathetic response Potential Causes: Maternal fever Bronchodilator usage Terbutaline Caffeine Cigarette smoking Maternal dehydration Hyperthyroid Infection Fetal anemia
48
bradycardia
Persistent FHR below 110 bpm for at least 10 minutes ◦ Parasympathetic response Potential Causes: EPIDURAL Maternal supine positioning Maternal hypotension Maternal hypoglycemia Analgesics Fetal hypoxia Umbilical cord compression
49
after epidural how should we position mom
left side
50
variability
The fluctuations in FHR during a steady state ◦ Created by push-pull effect from the parasympathetic and sympathetic nervous system Most important FHR characteristic Indicator of normal fetal pH Reflects a healthy nervous system
51
mderate variability
6-25 bpm
52
marked variability
>25 bpm Baby moves, heart rate goes crazy Causes: Stimulant drugs (Cocaine), Sympathetic drugs (Terbutaline), Sudden hypoxia
53
absent and minimal variability
<5 The baby’s heart rate is not increasing when the baby moves. Three S’s: Sleep, Sickness, Sedation
54
variable deceleration....cord compression
FHR falls abruptly and rises abruptly No relationship to the beginning or end of a contraction CHANGE POSITION
55
early deceleration....head compression
fHR decreases at the beginning of the contraction baby is pissed no interventions
56
accelerations
ok Abrupt increase in FHR well oxygenated fetus Healthy CNS response
57
late decelerations....placental insufficiency
Decrease in FHR at the end of a contraction cns is compromised arriving late to the party....contraction already happened Placental issue expedite delivery-emergency c section
58
nsg interventions for intrauterine resuscitation measures
Maternal Position Oxygen- 10 L in nonrebreather mask IVF Oxytocin- turn off Notify Provider Prepare for c-section

NUR 220 (6 decks)

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