Intrapartum Nursing Flashcards
1
Q
increment
A
beginning slope of contraction
2
Q
acme
A
peak of contraction
3
Q
decrement
A
ending slope of contraction
4
Q
effacement
A
thinning and shortening
5
Q
dilation
A
cervix is pulled upward and opens as fetus is pushed downward
6
Q
how much blood is shunted back to the maternal system when the placenta detaches
A
300-500 mL
7
Q
signs of hyperventilation X3
A
tingling of hands and feet, numbness and dizziness
8
Q
nursing interventions for hyperventilation
A
breathing techniques like breathing into paper bag or cupped hands
9
Q
what happens to gastric motility during labor and what can it lead to
A
it decreases leading to nausea and vomiting
10
Q
what can a full bladder prevent
A
fetal descent - check bladder distention throughout pregnancy
11
Q
normal blood loss during vaginal birth
A
500 mL
12
Q
normal blood loss during c-section
A
1000 mL
13
Q
what elevates during pregnancy to prevent hemorrhage
A
clotting factors
14
Q
what risks come from increased clotting factors
A
DVT in pregnancy/postpartum
15
Q
what crosses the placenta X4
A
O2, nutrients, waste, sugar
16
Q
what doesnt cross the placenta X2
A
maternal/fetal blood and insulin
17
Q
what moves the fetus through the pelvis in the 1st stage of labor
A
uterine contraction
18
Q
what moves the fetus during the 2nd stage of labor
A
maternal pushing efforts
19
Q
ferguson reflex
A
the pushing urge
20
Q
inlet
A
upper pelvic opening
21
Q
midpelvis
A
pelvic cavity
22
Q
outlet
A
lower pelvic opening
23
Q
gynecoid pelvis
A
most common, round shape. ideal for birthing
24
Q
android pelvis
A
resembles the male pelvis, heart shaped, not good for birthing
25
anthropoid pelvis
resembles the pelvis of anthropoid apes - oval shaped - good for birthing
26
platypelloid pelvis
flat pelvis - c section almost always
27
what does relaxin do
softens cartilage linking pelvic bones near term
28
ideal cephalic position
vertex
29
what does a face presentation require
c-section
30
what does a transverse position requrie
c section
31
what is the position
which way the fetus is pointing in relation to the mother
32
cardinal movements of labor
the way the fetus turns during labor to adapt to pelvic contours
33
how often should you turn mom if she has an epidural
30 mins-1 hr
34
what indicates true labor
gradual cervical changes
35
what are the premonitory signs of labor X7
braxton hicks, lightening, increased vaginal secretions, cervical ripening, nesting, slight weight loss, diarrhea
36
false labor contractions
inconsistent in frequency, duration and intensity and do not change or decrease with activity
37
false labor discomfort
felt in abdomen/groin and may be more annoying than truly painful
38
false labor cervix
does not significantly change in effacement or dilation
39
true labor contractions
consistent, increase with activity and begin in lower back but move forward to lower abdomen
40
true labor discomfort
may be backpain and resembles menstrual cramps in early labor
41
true labor cervix
PROGRESSIVE EFFACEMENT AND DILATION
42
station
measurement of the descent of the fetal presenting part r/t level of the ischial spines of maternal spines
43
-3 position
way up in uterus
44
0 position
even at ischial spine
45
failure to descent
baby head is too big to go through pelvis - c section required
46
when is artificial membrane breaking discouraged and why
-3 and above d/t cord coming out with fluid and baby compressing cord with head
47
which stage of labor has phases
1
48
what occurs in the first stage of labor
cervical dilation and effacement occur
49
what does it mean when the patient is complete
pt is completely dilated (10 cm)
50
first phase of labor
latent phase
51
what is the latent phase:
dilation
maternal attitude
contractions
dilation 1-3 cm
could go unnoticed by the pregnant woman
mild contractions ~ 5minutes apart, gradually intensifying
sociable excited
52
second phase of labor
active phase
53
what is the active phase
dilation
contractions
maternal attitude
4-7 cm, rate of cervical changes accelerates
contractions are 2-5 mins apart for 40-60 seconds w/ moderate-strong intensity
discomfort increases - women begin to ask for epidurals
54
average dilation rate in a multiparous woman
1.5 cm/hr
55
average dilation rate in a nulliparous woman
1.2 cm/hr
56
3rd phase of labor
transition phase
57
transition phase
dilation
vaginal/reflex changes
contractions
common maternal responses
cervix dilates from 8-10 cm
bloody show increases/water breaks
contractions stron - 1.5-2 mins apart for 60-90 seconds
ferguson reflex kidcks in
leg tremors, nausea, vomiting common
epidurals probably can't be done here
58
second stage of labor
duration
maternal behavior
what else happens here to prevent maternal exhaustion
begins with complete dilation and ends with birth
woman allowed to push
laboring down happens here
59
episiotomy
incision in perineum during second stage to provide more space for presenting part
60
risk of median/midline episiotomies
infection
61
risk of mediolateral episiotomies
hurt more
62
1st degree laceration
involves perineal skin and vaginal mucous membrane
63
2nd degree laceration
involves skin, mucous membrane, and fascia of perineal body
64
3rd degree laceration
involves skin, mucous membrane and muscle of perineal body and extends to rectal sphincter
65
4th degree
extends into rectal mucose and exposes the lumen of the rectum
66
third stage of labor
duration
what happens
begins with birth of baby and ends with explusion of placenta
shortest stage
placenta delivers and uterus compresses
67
drugs to help uterus contract X4
oxytocin, methylergonovine, carbohost tromethamine, misoprostol,
68
exsanguinate
bleed out
69
fourth stage of labor
what?
duration
ideal for what
common symptom
stage of physical recovery for mother and infant
lasts from placental delivery to 1-4 hours postpartum
ideal for skin to skin bonding
afterpain common
70
how often should you massage the fundus in the 4th stage of labor
every 15 minutes
71
lochia
vaginal drainage in the 4th stage of birth
72
what do ice packs applied to the perineum do
limits edema and hematoma formation
73
what contractions indicate a need to go to the hospital
nullipara - regular contractions 5 minutes apart lasting 1 minute for 1 hour
multipara - regular contractions 10 minutes apart lasting 1 minute for 1 hour
74
when should a person go to the hospital following ruptured membranes
immediately - certain or suspected, contractions or not
75
what should you do if bright red vaginal bleeding is seen
go to the ER
76
what does proteinuria indicate
pregnancy induced HTN
77
SVE Process
sterile glove, apply water soluble lubricant, insert fingers and assess for dilation, effacement, position, station, and presentation
78
when should you not use lubricant in a SVE
when assessing ROM
79
when should a low risk - no oxytocin pregnancy be monitored
every 30 minutes with intermittent
80
when should a high risk with oxytocin pregnancy be monitored
every 15 minutes continuously
81
SROM
spontaneous rupture of membranes
82
how soon after ROM should a mom deliver
within 24 hours to reduce infection risk
83
how frequently should temp be assessed after ROM and why
q 2 hours to show infection
84
AROM
artificial rupture of membranes
85
who performs an AROM
CNM or MD
86
why is AROM done
induction or augmentation of labor or to allow for a FSE and IUPC
87
PROM
any SROM before onset of labor
88
PPROM
leakage/rupture of amniotic fluid before 37 weeks
89
what does foul smelling/yellow amniotic fluid indicate
chorioamnionitis
90
what 2 disorders are associated with polyhydraminos
TE Fistula and GI Obstruction
91
what is oligohydraminos associated with X2
placental insufficiency or fetal urinary tract abnormalities
92
risks associated with ROM include X3
prolapse of umbilical cord, infection, placental abruption
93
what is the priority assessment following ROM
evaluation of fetal heart beat
94
how do we determine if membranes have ruptured X4
speculum, nitrazine, fern test, amnisure
95
nitrazine paper
turns blue-green to deep blue if positive since amniotic fluid is alkaline
96
fern test
fluid from vagina is placed on a glass slide and allowed to dry.
97
amnisure ROM test
rapid, non-invasive immunoassay test lab test taht is 99% accurate
98
epidural block
started and maintained by anesthesiologist. contains a local anesthetic often combined with opioid
99
what else can go in the epidural catheter
nothing
100
CI for epidural X4
women with coag defects, allergy, infection and hypovolemia
101
how do you prevent hypotension with epidural insertion
preload with 500-1000 mL of warmed LR or NS
102
what drug helps with epidural related hypotension (name and dose)
ephedrine 5-10 mg
103
what happens if maternal SBP drops below 100
baby will nto be perfused
104
spinal block is done primarily before
just before c sections
105
contraindications to inducting/augmenting labor
anything that would CI a vagina delivery
106
bishop score
score of cervical ripening
107
what is a bad bishop score
score of 6 or less indicates that vaginal delivery is unfaborable
108
what is a dinoprostone vagina insert
a time release insert left up to 12 hours to stimulate cervical ripening
109
how do you insert dinoprostone
attached to a string in posterior fornix and removed by a nurse. the woman should be recumbent with a wedge under her hip for 2 hours after insert
110
when can oxytocin be started after dinoprostone removal
30-60 minutes
111
CI for dinoprostone
women with previous uterine scar
112
when can oxytocin be used after misoprostol
4 hours
113
CI for misoprostol
should NEVER be used with a woman who has a previous uterine scar
114
how do you admin oxytocin
always via infusion pum[
115
external cephalic version
attempt to change fetal position to achieve vaginal delivery
116
when is an external cepahlic version done
37+ weeks
117
amnio infusion
instillation of isotonic fluid throuhg an IUPC into uterus to restore amniotic fluid volume
118
what temperature fluid is used during an amnioinfusion
warmed
119
what do you monitor for during an amnioinfusion
weigh under pads to ensure fluid leakage and monitor for increased uterine resting tone or no relaxation
