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OB Exam > Intrapartum Assessment & Interventions (Ch.8) > Flashcards

Intrapartum Assessment & Interventions (Ch.8) Flashcards

1
Q

What is the intrapartum period?

A

Begins with the onset of regular uterine contractions and lasts until the expulsion of the placenta

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2
Q

How does estrogen stimulate labor?

A

Estrogen increases stimulating uterine response

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3
Q

How does progesterone effect labor?

A

Progesterone is withdrawn allowing estrogen to stimulate contractions

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4
Q

Braxton Hicks

A

-Irregular uterine contractions that don’t effect the cervix
“False labor”

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5
Q

Describe Braxton Hicks contractions?

A
  1. Usually not painful
  2. Don’t have regular intervals
  3. Don’t get closer together
  4. Don’t feel stronger over time
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6
Q

What helps Braxton Hicks contractions?

A

Changing activities or position

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7
Q

What are signs of impending labor?

A
  1. Braxton Hicks
  2. Loss of mucous plug or have a change in discharge
  3. Low backache
  4. “Bloody show” - Brownish or blood-tinged cervical mucus discharge
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8
Q

What are the 5 P’s that effect the outcome of labor and delivery?

A
  1. Powers (Contractions)
  2. Passage (the pelvis and birth canal)
  3. Passenger (fetus)
  4. Psyche (response of women)
  5. Position (maternal postures & physical positions to facilitate labor)
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9
Q

How does uterine contractions effect the cervix?

A

Dilation (opening) and effacement (thinning) in the first stage of labor

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10
Q

How are uterine contractions measured?

A
  1. Frequency (minutes)
  2. Duration (seconds)
  3. Intensity
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11
Q

What is the most common type of pelvis?

A

Gynecoid

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12
Q

What does “station” mean when talking about passage of labor?

A

Fetal station refers to where the presenting part is in your pelvis

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13
Q

What is the largest portion of the fetus to come through the birth canal?

A

Fetal head

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14
Q

What should the posture or attitude of the fetus be during labor?

A

Head flexed so the chin is against chest

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15
Q

What is the least favorable type of pelvis?

A

Android (heart) shaped

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16
Q

What does it mean when the fetus lie is transverse?

A

Baby is perpendicular to the mother
Cannot be delivered vaginally
Associated with shoulder being the presenting part

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17
Q

What is the difference between true labor and false labor?

A

True: Changes in cervical effacement & dilation
False: Irregular contractions with little or no cervical change

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18
Q

When does the rupture of membranes occur?

A

During labor

-Women should deliver within 24 hrs to reduce risk of infection to herself & her fetus

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19
Q

What does the AmniSure test do?

A

Noninvasive way to see if ROM has occurred

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20
Q

What should normal amniotic fluid look like?

A

Clear or cloudy with a normal odor

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21
Q

If the amniotic fluid is meconium-stained, what could that indicate?

A

Fetal compromise in uterus

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22
Q

When should you tell a first-time pregnancy with no risk factors to go to the hospital?

A

When contractions are 5 minutes apart, last 60 seconds, and are regular for at least 1 hour

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23
Q

What is the first stage of labor?

A

Begins with onset of labor and ends with complete cervical dilation

24
Q

What is the second stage of labor?

A

Begins with complete dilation of cervix and ends with delivery of the baby

25
Q

What is the third stage of labor?

A

Begins after delivery of the baby and ends with delivery of the placenta

26
Q

What is the fourth stage of labor?

A

Begins after delivery of the placenta and is completed 4 hours later
Immediate postpartum period

27
Q

What are you assessing first stage of labor?

A
  1. Maternal VS
  2. The women’s response to labor & pain
  3. FHR & UCs
  4. Cervical changes
  5. Fetal position and descent in the pelvis
28
Q

What are the three phases of first stage of labor?

A

Latent, Active, Transition

29
Q

What happens during the active phase of first stage of labor?

A
  • Discomfort increases (go to the hospital if they haven’t already)
  • Medical intervention: Rupture membranes if not perviously ruptured, if indicated
30
Q

What does the nurse monitor during the active phase of first stage of labor?

A
  1. Monitor FHR and contractions every 15-30 minutes
  2. Monitor maternal VS every 2 hrs; every 1 hrs if ROM
  3. Assess pain (location & degree)
31
Q

Characteristics of transition phase of first stage of labor

A
  • Often feel and act out of control
  • Trembling
  • More vocal with primal noises and facial expressions
  • Intense contractions every 1-2 minutes lasting 60-90 seconds
32
Q

Medication interventions during transition phase of first stage of labor

A
  1. Perform amniotomy if not previously done
  2. Assess fetal position and cervix
  3. Prepare for delivery
33
Q

What do you assess during second stage of labor?

A
  1. Monitor fetal response to pushing

2. Check FHR every 5-15 minutes or after each contraction

34
Q

If the third stage of labor lasts more than 30 minutes what interventions are implemented?

A

IV/IM oxytocin may be used to manage the retained placenta

35
Q

What are the two things that happen during the fourth stage of labor?

A
  1. Assess the funds for firmness

2. Repair the episiotomy or laceration

36
Q

What does the nurse monitor/interventions during the 4th stage of labor?

A
  1. Fundal massage
  2. Assess loch for color, amount, and clots
  3. Assess maternal VS every 15 minutes
  4. Apply ice packs to perineum
  5. Assist women to the bathroom & measure void
  6. Assess for return of full motor-sensory function if epidural or spinal anesthesia is used
  7. Explore any request to keep placenta
37
Q

Can you push oxytocin?

A

No

38
Q

What Apgar score indicated severe distress?

A

0-3

39
Q

What is the Apgar used for?

A

Rapid objective status of the newborn and the response of resuscitation immediately after birth

40
Q

When is an Apgar done?

A

1 minute and 5 minutes after birth

41
Q

What does the Apgar look at? (good sign)

A 
Respiratory effort (good cry)
Heart rate(above 100)
Muscle tone (Active motion)
Reflex activity (Vigorous cry)
Color (Completely pink)
42
Q

What do you do to resuscitate a neonate?

A
  • Place under heat source
  • “sniffing” position to open airway
  • Clearing airway with bulb syringe
  • Drying the baby
  • stimulate breathing
43
Q

What three medications can you administer to newborns?

A
  1. Erythromycin ointment
  2. Vitamin K given IM
  3. Hepatitis B virus vaccine
44
Q

Why would you give a baby Erythromycin ointment?

A

Administered to the eyes to prevent gonococcal and Chlamydia infections

45
Q

Why would you give a IM injection of Vitamin K to a baby?

A

Prevent hemorrhagic disease caused by Vitamin K deficiency

46
Q

Symptoms of Respiratory Alkalosis for mother

A
  1. Tingling of the fingers
  2. Lightheadness
  3. Dizziness
    Treat: Breathe into a bag or cupped hands
47
Q

What can cause Respiratory Alkalosis in mother?

A

Labor pains increasing > women to breathe in more rapid and shallow > hyperventilation

48
Q

Effleurage (Non-pharmacological management of labor pain)

A

Cutaneous stimulation by lightly stroking the abd in rhythm with breathing during contractions

49
Q

Thermal Stimulation (Non-pharmacological management of labor pain)

A

Application of warmth or cold to reduce anxiety and promote well-being

50
Q

What is the purpose of Sterile Water Injections?

A

SQ injection of 0.5 mL gives 60-90 minutes of lower back pain relief

51
Q

When would you give a local anesthetic?

A
  1. Second stage of labor, immediately before delivery

2. Anesthetizes local tissue for episiotomy and repair

52
Q

What do you need to check before giving Epidural Block?

A
  • Obtain consent
  • Check lab values esp. bleeding/clot abnormalities
  • IV fluid bolus w/ NS or LR
  • Ensure emergency equipment
53
Q

What is the most common complication from giving Epidural Block?

A

Hypotension

54
Q

Postprocedure for an Epidural Block

A

Monitor mom VS and FHR every 5 min initially then every 15 min
Urinary retention can be common
Assess pain and level of sensation & motor loss
Position women on as needed (on side to prevent inferior vena cava syndrome)
Assess for itching, N/V, and headache, and administer PRN meds

55
Q

What is the nurses role for an epidural anesthesia?

A

Nurse monitor but do not manage the care of women receiving epidural anesthesia
Responsibilities: Monitor Mother VS, mobility, LOC, and perception of pain, as well as fetal status

56
Q

What are you looking for if Intravascular Injection has occurred after Epidural Block?

A

HTN, Dizziness, Tinnitus, Metallic taste in the mouth, LOC

Treated by anesthesia care provider

OB Exam (5 decks)

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