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IM 6 Test 1 > Intrapartum > Flashcards

Intrapartum Flashcards

1
Q

What is effacement

A

Thinning and shortening of the cervix

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2
Q

What are the 4 Ps of the birthing process

A

Power
Passage
Passenger
Psyche

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3
Q

What are the two parts of the power

A

uterine contractions
Maternal pushing efforts

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4
Q

What is the Ferguson reflex

A

The fetus distends on the vaginal and puts pressure on the rectum- women feels the need to push

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5
Q

What is the two parts of the passage

A

The hard tissue- bone (pelvis)
The soft tissue- cervix and vagina

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6
Q

What hormone helps the birthing process with the pelvic

A

Relaxin- softens the joint in the pelvis

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7
Q

Which pelvis is good for labor
Gynecoid
Android
Anthropoid
Platypelliod

A

Yes
NO
yes
NO

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8
Q

What is Fetal Lie

A

The orientation of the long axis of the baby

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9
Q

What are these fetal lie
Longitudinal lie
Transverse lie
Oblique lie

A

cephalic or breech ( head or feet first)
Perpendicular ( back first)
Slanted

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10
Q

What is the fetal attitude

A

The relation of the fetal neck

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11
Q

What are these fetal attitudes
Flexion
Extension

A

Neck is flexed ( most desirable for labor)
Neck is extended

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12
Q

What are the different cephalic presentations?
Vertex
Military
Brow
Face

A

The top of the head is first out
The head is slightly raised from vertex
The brow bone is first out
The face is first out

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13
Q

What are the three different breech presentations?

A

Frank Breech- presentation with head and feet up
Complete Breech- presentation with head and feet down
Footling- foot comes up first with labor

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14
Q

What is the first letter in the positioning indicate

A

Presenting part to mom’s left or right side
Right
Or
Left

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15
Q

What is the second letter in positioning

A

What part is coming out first
Occiput (O)
Sacrum (S)

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16
Q

What is the 3rd letter in the positioning mean?

A

the presenting part pointing towards front of mom
Anterior (A)
Posterior (P)
Transverse (T)

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17
Q

What can anxiety cause to the baby

A

Releases catecholamins- inhibit uterine contractility and placental blood flow-slows labor

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18
Q

What are some signs of true labor

A

Contractions are consistently increasing in frequency, duration, and intensity
Increases with walking
Discomfort increasing and pain
Cervix progresses in effacement and dilation (Most important)

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19
Q

What is some signs of false labor

A

Contractions are inconsistent in frequency, duration, and intensity.
Decreasing with walking
Discomfort in more annoying than painful
Cervix has no significant change

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20
Q

When should a mom go to the hospital
Contractions,
Nullipara-
Multipara-
Membranes
Vaginal bleeding-
Fetal movement
Concerns

A

NP- reg CTXs - 5 mins,
MP- reg CTXs- 10 mins
Ruptured membranes
Bleeding should be evaluated
DFM
Concerns- severe pain, vision changes, HA, epigastric pain

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21
Q

What is the engagement
What is great engagement

A

The descent of the fetal presenting part throught the true pelvis
0 station

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22
Q

What is the movement of the baby through labor (cardinal movement )

A

Flexion
Internal rotation
Extension
External rotation
Expulsion

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23
Q

What is the first stage of labor?

A

Cervial dilation and effacement
Begins with the onset of true labor and ends with complete dilation of the cervix

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24
Q

What is the characteristics of the latent phase on the first stage
Dilation
Contractions

A

1-3 cm
Mild crontractions- 5 min apart

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25
Q

What are some characteristics of the active phase of the first stage of labor
Dilation
Contractions

A

4-7 cms
Moderate CTXs 2-5 mins apart

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26
Q

What are some characteristics of the transition phase of the first stage of labor
Dilation
Contractions

A

8-10
Very strong contractions 1 1/2-2 mins apart

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27
Q

What is the second stage of labor?

A

Begins with complete dilation (10cm) and 100% effacement and ends with birth of baby

28
Q

What is an episiotomy

A

An incision in the perineum made to provide more space for labor

29
Q

What are the two types of episiotomy incisions?

A

Median/midline- at midline
Mediolateral- cut at a 45 degree angle to right or left

30
Q

What are some indications of episiotomy
(5)

A

Shoulder dytocia
Face presentation
Breech delivery
Macrosmic fetus
Vacuum or forceps- assisted birth

31
Q

What are these types of perineal lacerations
1st-
2nd-
3rd-
4th-

A

Tear of perineal skin and vaginal membrane
Tear of skin, vaginal membrane, and fascia of the perineal body
Tear of skin, vaginal membrane, perineal muscle, and rectal sphincter
Tear of vaginal membrane to lumen of rectum

32
Q

What is the 3rd stage of labor

A

Begin with birth of baby and ends with expulsion of placenta

33
Q

What can be done to prevent uterine hemorrhages (2)

A

Massage the fundus
Administer uterotonic medication

34
Q

What are some examples of uterotonic medications

A

Oxytocin
Methylergonovine
Carboprost tromethamine
Misoprostol

35
Q

What is contraindicated for methlergonovine

A

Hypertensive patients

36
Q

What is contraindicated for carboprost tromethamine

A

Asthma patients

37
Q

What is the fourth stage of labor

A

Begins with delivery of placenta - focuses on post partum care

38
Q

What is the initial nursing assessment for the labor admission? (9)

A

GPTALM
Gestational age
FHR and VS
UA
Vaginal exam and membrane
UA (dip stick)
Obtain consent
IV access and labs
Delivery prep

39
Q

What can be assessed with Sterile Vaginal Exams
(4)

A

Assess for ruptured/bulging membranes
Assess for dilation effacement, position
Assess for fetal station, presentation, and position
Determine labor progression

40
Q

What nursing intervention need to be done after a rupture of membranes (3)

A

Assess FHR/UA
Assess amniotic Fluid
Take temperature q2

41
Q

What is polydramnios
What is Oligohydramnios
And
What do this indicate

A

Excessive Amniotic fluid- GI issues
Small quantity of amniotic fluidd- placental insufficiency or urinary tract abnormalities

42
Q

What is normal amniotic fluid look like

A

Clear with white flecks (vernix) with musty odor

43
Q

What does dark stained fluid indicate
What does yellow and could smelling fluid indicate

A

Meconium stained fluid- fetal compromise
Yellow stained fluid- chorioamnionitis

44
Q

When is the rupture of membranes considered PPROM?

A

Between 37 weeks

45
Q

What some amniotic fluid test

A

Nitrazine paper- positive if paper turns deep blue
Fern Test-
Amnisure ROM test

46
Q

What are is a risk of ROM

A

Prolapse of the umbilical cord

47
Q

When do you take FHR during labor
Latent
Active
Transition

A

L- q30 mins
A-q15-30 min
T-q5-15 mins

48
Q

When do you take temps for a laboring patient

A

Q4 hrs
ROM - Q1hrs

49
Q

During the second stage of labor when should you get FHR

A

After each contraction

50
Q

What are some nursing interventions during the 3rd stage of labor (5)

A

Observe the blood loss when the placenta separates
Administer oxytocin as ordered
Palpate the fundus
Clean perineal area, assist provider with episiotomy/ laceration repair
Remove both legs together

51
Q

What are some side effects of analgesics during labor

A

It slow the labor process
It can cause neonatal depression

52
Q

What is a common side effect of epidurals

A

Maternal hypotension

53
Q

What are some nursing interventions to help with the hypotension

A

Left lateral position
Fluid bolus
Medication- ephedrine

54
Q

What does Misoprostol used for

A

It’s used to help induce labor

55
Q

When use Misoprostol to induce labor, when can you give Oxyocin?

A

Until 4 hours after last dose

56
Q

What must be done before giving oxytocin to a patient?

A

Obtain a baseline FHR for 20 minutes

57
Q

What type of route is oxytocin given?

A

IVPB on secondary pump

58
Q

If tachsystole or abnormal FHR pattern what is the nursing intervention?

A

Turn off oxytocin
Bolus fluids
O2 with mask

59
Q

What is version

A

The physician turns the fetus from breech to cephalic

60
Q

Can you do version on patient who have had membranes have ruptured or a previous C section

A

Neither

61
Q

When would you do a C section over a natural birth (5)

A

High risk patient
STI
Prolapsed umbilical cored
Placenta abruption
Previous uterine incisions

62
Q

What is the safest incision for C sections

A

Low transverse

63
Q

What is some nursing interventions post op of a C section

A

Observe for hemorrhage
Post op vitals
Assess bladder/fundus
Postoperative care

64
Q

What type of delivery will a patient who is a failed TOLAC previous

A

A C sections

65
Q

What is a contradiction for Misoprostol >

A

Never use with a mom who has previous uterine scar

IM 6 Test 1 (4 decks)

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