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IM 6 Test 1 > Intrapartum Nursing > Flashcards

Intrapartum Nursing Flashcards

1
Q

increment

A

beginning slope of contraction

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2
Q

acme

A

peak of contraction

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3
Q

decrement

A

ending slope of contraction

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4
Q

effacement

A

thinning and shortening

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5
Q

dilation

A

cervix is pulled upward and opens as fetus is pushed downward

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6
Q

how much blood is shunted back to the maternal system when the placenta detaches

A

300-500 mL

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7
Q

signs of hyperventilation X3

A

tingling of hands and feet, numbness and dizziness

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8
Q

nursing interventions for hyperventilation

A

breathing techniques like breathing into paper bag or cupped hands

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9
Q

what happens to gastric motility during labor and what can it lead to

A

it decreases leading to nausea and vomiting

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10
Q

what can a full bladder prevent

A

fetal descent - check bladder distention throughout pregnancy

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11
Q

normal blood loss during vaginal birth

A

500 mL

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12
Q

normal blood loss during c-section

A

1000 mL

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13
Q

what elevates during pregnancy to prevent hemorrhage

A

clotting factors

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14
Q

what risks come from increased clotting factors

A

DVT in pregnancy/postpartum

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15
Q

what crosses the placenta X4

A

O2, nutrients, waste, sugar

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16
Q

what doesnt cross the placenta X2

A

maternal/fetal blood and insulin

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17
Q

what moves the fetus through the pelvis in the 1st stage of labor

A

uterine contraction

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18
Q

what moves the fetus during the 2nd stage of labor

A

maternal pushing efforts

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19
Q

ferguson reflex

A

the pushing urge

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20
Q

inlet

A

upper pelvic opening

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21
Q

midpelvis

A

pelvic cavity

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22
Q

outlet

A

lower pelvic opening

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23
Q

gynecoid pelvis

A

most common, round shape. ideal for birthing

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24
Q

android pelvis

A

resembles the male pelvis, heart shaped, not good for birthing

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25
Q

anthropoid pelvis

A

resembles the pelvis of anthropoid apes - oval shaped - good for birthing

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26
Q

platypelloid pelvis

A

flat pelvis - c section almost always

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27
Q

what does relaxin do

A

softens cartilage linking pelvic bones near term

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28
Q

ideal cephalic position

A

vertex

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29
Q

what does a face presentation require

A

c-section

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30
Q

what does a transverse position requrie

A

c section

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31
Q

what is the position

A

which way the fetus is pointing in relation to the mother

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32
Q

cardinal movements of labor

A

the way the fetus turns during labor to adapt to pelvic contours

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33
Q

how often should you turn mom if she has an epidural

A

30 mins-1 hr

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34
Q

what indicates true labor

A

gradual cervical changes

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35
Q

what are the premonitory signs of labor X7

A

braxton hicks, lightening, increased vaginal secretions, cervical ripening, nesting, slight weight loss, diarrhea

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36
Q

false labor contractions

A

inconsistent in frequency, duration and intensity and do not change or decrease with activity

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37
Q

false labor discomfort

A

felt in abdomen/groin and may be more annoying than truly painful

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38
Q

false labor cervix

A

does not significantly change in effacement or dilation

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39
Q

true labor contractions

A

consistent, increase with activity and begin in lower back but move forward to lower abdomen

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40
Q

true labor discomfort

A

may be backpain and resembles menstrual cramps in early labor

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41
Q

true labor cervix

A

PROGRESSIVE EFFACEMENT AND DILATION

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42
Q

station

A

measurement of the descent of the fetal presenting part r/t level of the ischial spines of maternal spines

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43
Q

-3 position

A

way up in uterus

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44
Q

0 position

A

even at ischial spine

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45
Q

failure to descent

A

baby head is too big to go through pelvis - c section required

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46
Q

when is artificial membrane breaking discouraged and why

A

-3 and above d/t cord coming out with fluid and baby compressing cord with head

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47
Q

which stage of labor has phases

A

1

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48
Q

what occurs in the first stage of labor

A

cervical dilation and effacement occur

49
Q

what does it mean when the patient is complete

A

pt is completely dilated (10 cm)

50
Q

first phase of labor

A

latent phase

51
Q

what is the latent phase:

dilation
maternal attitude
contractions

A

dilation 1-3 cm

could go unnoticed by the pregnant woman

mild contractions ~ 5minutes apart, gradually intensifying

sociable excited

52
Q

second phase of labor

A

active phase

53
Q

what is the active phase

dilation
contractions
maternal attitude

A

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
Q

average dilation rate in a multiparous woman

A

1.5 cm/hr

55
Q

average dilation rate in a nulliparous woman

A

1.2 cm/hr

56
Q

3rd phase of labor

A

transition phase

57
Q

transition phase

dilation
vaginal/reflex changes
contractions
common maternal responses

A

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
Q

second stage of labor

duration
maternal behavior

what else happens here to prevent maternal exhaustion

A

begins with complete dilation and ends with birth

woman allowed to push

laboring down happens here

59
Q

episiotomy

A

incision in perineum during second stage to provide more space for presenting part

60
Q

risk of median/midline episiotomies

A

infection

61
Q

risk of mediolateral episiotomies

A

hurt more

62
Q

1st degree laceration

A

involves perineal skin and vaginal mucous membrane

63
Q

2nd degree laceration

A

involves skin, mucous membrane, and fascia of perineal body

64
Q

3rd degree laceration

A

involves skin, mucous membrane and muscle of perineal body and extends to rectal sphincter

65
Q

4th degree

A

extends into rectal mucose and exposes the lumen of the rectum

66
Q

third stage of labor

duration
what happens

A

begins with birth of baby and ends with explusion of placenta

shortest stage

placenta delivers and uterus compresses

67
Q

drugs to help uterus contract X4

A

oxytocin, methylergonovine, carbohost tromethamine, misoprostol,

68
Q

exsanguinate

A

bleed out

69
Q

fourth stage of labor

what?
duration
ideal for what
common symptom

A

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
Q

how often should you massage the fundus in the 4th stage of labor

A

every 15 minutes

71
Q

lochia

A

vaginal drainage in the 4th stage of birth

72
Q

what do ice packs applied to the perineum do

A

limits edema and hematoma formation

73
Q

what contractions indicate a need to go to the hospital

A

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
Q

when should a person go to the hospital following ruptured membranes

A

immediately - certain or suspected, contractions or not

75
Q

what should you do if bright red vaginal bleeding is seen

A

go to the ER

76
Q

what does proteinuria indicate

A

pregnancy induced HTN

77
Q

SVE Process

A

sterile glove, apply water soluble lubricant, insert fingers and assess for dilation, effacement, position, station, and presentation

78
Q

when should you not use lubricant in a SVE

A

when assessing ROM

79
Q

when should a low risk - no oxytocin pregnancy be monitored

A

every 30 minutes with intermittent

80
Q

when should a high risk with oxytocin pregnancy be monitored

A

every 15 minutes continuously

81
Q

SROM

A

spontaneous rupture of membranes

82
Q

how soon after ROM should a mom deliver

A

within 24 hours to reduce infection risk

83
Q

how frequently should temp be assessed after ROM and why

A

q 2 hours to show infection

84
Q

AROM

A

artificial rupture of membranes

85
Q

who performs an AROM

A

CNM or MD

86
Q

why is AROM done

A

induction or augmentation of labor or to allow for a FSE and IUPC

87
Q

PROM

A

any SROM before onset of labor

88
Q

PPROM

A

leakage/rupture of amniotic fluid before 37 weeks

89
Q

what does foul smelling/yellow amniotic fluid indicate

A

chorioamnionitis

90
Q

what 2 disorders are associated with polyhydraminos

A

TE Fistula and GI Obstruction

91
Q

what is oligohydraminos associated with X2

A

placental insufficiency or fetal urinary tract abnormalities

92
Q

risks associated with ROM include X3

A

prolapse of umbilical cord, infection, placental abruption

93
Q

what is the priority assessment following ROM

A

evaluation of fetal heart beat

94
Q

how do we determine if membranes have ruptured X4

A

speculum, nitrazine, fern test, amnisure

95
Q

nitrazine paper

A

turns blue-green to deep blue if positive since amniotic fluid is alkaline

96
Q

fern test

A

fluid from vagina is placed on a glass slide and allowed to dry.

97
Q

amnisure ROM test

A

rapid, non-invasive immunoassay test lab test taht is 99% accurate

98
Q

epidural block

A

started and maintained by anesthesiologist. contains a local anesthetic often combined with opioid

99
Q

what else can go in the epidural catheter

A

nothing

100
Q

CI for epidural X4

A

women with coag defects, allergy, infection and hypovolemia

101
Q

how do you prevent hypotension with epidural insertion

A

preload with 500-1000 mL of warmed LR or NS

102
Q

what drug helps with epidural related hypotension (name and dose)

A

ephedrine 5-10 mg

103
Q

what happens if maternal SBP drops below 100

A

baby will nto be perfused

104
Q

spinal block is done primarily before

A

just before c sections

105
Q

contraindications to inducting/augmenting labor

A

anything that would CI a vagina delivery

106
Q

bishop score

A

score of cervical ripening

107
Q

what is a bad bishop score

A

score of 6 or less indicates that vaginal delivery is unfaborable

108
Q

what is a dinoprostone vagina insert

A

a time release insert left up to 12 hours to stimulate cervical ripening

109
Q

how do you insert dinoprostone

A

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
Q

when can oxytocin be started after dinoprostone removal

A

30-60 minutes

111
Q

CI for dinoprostone

A

women with previous uterine scar

112
Q

when can oxytocin be used after misoprostol

A

4 hours

113
Q

CI for misoprostol

A

should NEVER be used with a woman who has a previous uterine scar

114
Q

how do you admin oxytocin

A

always via infusion pum[

115
Q

external cephalic version

A

attempt to change fetal position to achieve vaginal delivery

116
Q

when is an external cepahlic version done

A

37+ weeks

117
Q

amnio infusion

A

instillation of isotonic fluid throuhg an IUPC into uterus to restore amniotic fluid volume

118
Q

what temperature fluid is used during an amnioinfusion

A

warmed

119
Q

what do you monitor for during an amnioinfusion

A

weigh under pads to ensure fluid leakage and monitor for increased uterine resting tone or no relaxation

IM 6 Test 1 (5 decks)

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