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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
Q

nsg considerations active phase

A

Encourage and praise patient
* Bulging perineum
* Increased bloody show

26
Q

second stage contractions

A

Frequency: 2-3 minutes
* Duration: 60-90 seconds
* Intensity:
* Strong by palpation

27
Q

maternal reactions 2nd stage

A

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
Q

anticipatory guidance 2nd stage

A

Up to 3 hours from complete dilation
to birth

29
Q

nsg considerations 2nd stage

A

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
Q

3rd stage of labor

A

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
Q

3rd stage active management

A

Fundal massage
* Administration of oxytocin

32
Q

nsg considerations 3rd stage

A

Assess placenta for any missing
parts
* Maternal plan for placenta

33
Q

4th stage

A

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
Q

external monitoring

A

Transducers:
Where to place Toco:
Over the fundus where
the greatest traceable
activity is
Where to place
Ultrasound:
Over the fetal back

35
Q

external mnoitoring advantages

A

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
Q

external monitoring disadvantages

A

Increase BMI may have poor
readings
o Artifact
o Take care of monitor not patient
o Client/family can remove

37
Q

continuous fetal monitoring

A

Applied from admission through
birth of the baby
◦ Allows detection of FHR baseline,
accelerations, decelerations, and
variability
◦ Creates a permanent record

38
Q

intermitten fetal monitoring

A

Use a Doppler or EFM
◦ Non-invasive, freedom to move
around
◦ Done at prescribed intervals for 60
seconds
◦ During and immediately after
contractions

39
Q

internal monitoring

A

FSE
◦ Fetal spiral electrode
detects FHR
IUPC
◦ Intrauterine pressure
catheter records
contraction frequency,
duration, intensity/resting
tone in mmHg

40
Q

advantages of internal monitoring

A

Greater accuracy and
early detection of
issues
◦Continuous
monitoring
◦Better option for
increased BMI

41
Q

disadvantages to internal monitoring

A

Must have ROM
*Cervix must be
dilated
*Increased risk of
infection
*Must be qualified
to place

42
Q

fetal monitoring is looking at….

A

CNS of baby

43
Q

cns

A

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
Q

pns

A

influences heart rate through vagus nerve
* Decreases the FHR
* Helps to maintain variability

45
Q

sns

A

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
Q

baseline fhr

A

Average FHR observed between
contractions over a ten-minute
period
Excludes periodic FHR changes
110-160 bpm
2 abnormal variations:
◦ Tachycardia or Bradycardia

47
Q

tachycardia

A

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
Q

bradycardia

A

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
Q

after epidural how should we position mom

A

left side

50
Q

variability

A

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
Q

mderate variability

A

6-25 bpm

52
Q

marked variability

A

> 25 bpm
Baby moves, heart rate goes crazy
Causes: Stimulant drugs (Cocaine),
Sympathetic drugs (Terbutaline), Sudden
hypoxia

53
Q

absent and minimal variability

A

<5
The baby’s heart rate is not increasing
when the baby moves.
Three S’s: Sleep, Sickness, Sedation

54
Q

variable deceleration….cord compression

A

FHR falls abruptly and rises abruptly
No relationship to the beginning or end of a contraction
CHANGE POSITION

55
Q

early deceleration….head compression

A

fHR decreases at the beginning of the contraction
baby is pissed
no interventions

56
Q

accelerations

A

ok
Abrupt increase in FHR
well oxygenated fetus
Healthy CNS response

57
Q

late decelerations….placental insufficiency

A

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
Q

nsg interventions for intrauterine resuscitation measures

A

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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