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Unit 3 > Intrapartum nursing > Flashcards

Intrapartum nursing Flashcards

1
Q

What is acme?

A

The peak or most intense part of the uterine contraction.

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2
Q

What is the decrement?

A

Period after the acme that the contraction is waning.

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3
Q

What is the increment?

A

Period before the acme that the contraction is building.

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4
Q

What is effacement and how is it measured?

A

Thinning and shortening of the cervix. Shortens and thins as baby nears the cervix. Estimated at a percentage. 100% is fully effaced.

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5
Q

What is cervical dilation?

A

As the fetus nears the cervix, it is pulled apart and upward. This dilation is measured in cm and 10 is full dilation.

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6
Q

What is intensity of the contraction and how is it measured?

A

The strength of the contraction. Measure in:
Mild-uterus feels like tip of nose
Moderate-uterus feels like chin
Strong-uterus feels like forehead

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7
Q

What is the duration in contraction language?

A

Length of contraction from beginning to end. Start at beginning of increment to end of decrement. Usually measured in seconds.

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8
Q

What is the interval in contraction language?

A

Length from end of one contraction to the beginning of the next. This is when the exchange of fetal nutrients, waste, oxygen across the placenta take place.

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9
Q

When are mom’s vital signs best assessed during labor?

A

Between contractions (during the interval period)

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10
Q

What are the four factors of the birth process? (also called the 4 p’s)

A

Power (of contractions and pushing)
Passage-(how mom is built)
Passenger
Psyche

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11
Q

What is the first stage of labor?

A

Onset of labor to full dilation

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12
Q

What is the second stage of labor?

A

Full dilation through birth of baby

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13
Q

What are the two major fontanelles?

A

Anterior-Diamond shaped and formed by the two coronal, one sagittal and one frontal sutures
Posterior-Triangular and formed by 3 sutures (one sagittal and two lamboid) It is very small and feels more like a slight depression in skull.

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14
Q

What is the fetal lie?

A

How the baby is LYING in uterus (longitudinal or transverse or oblique)

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15
Q

What is the fetal attitude?

A

The relation of the baby’s body parts to each other (head, arms, legs flexed or extended)

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16
Q

What is the fetal presentation?

A

Which part is PRESENTING to outside world first-1. Head (cephalic) 2. breech 3. Shoulder

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17
Q

What is concern in breech births?

A

Umbilical cord gets in a bind and can be compressed while waiting on head to be delivered. Head delivery is rushed.

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18
Q

What is frequency in contraction language?

A

Period of time from start of one contraction to start of next contraction. This is what is commonly used to measure nearness of delivery.

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19
Q

What is fetal position?

A

Presentation in relation to maternal pelvis. Maternal pelvis divided into 4 quadrants -anterior, posterior, right, left. What part is presenting is oriented to position of mom’s pelvis. So occiput, mentum (chin) or sacrum can present in anterior, posterior, left, right quadrants.

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20
Q

What are cardinal movements of labor?

A

Natural changes of position of baby as it makes its descent through pelvis and out. See other slides for breakdown of position changes.

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21
Q

What is first and second cardinal movement of labor?

A

Descent-baby’s presenting part starts into true pelvis
Engagement-Head in pelvic cavity

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22
Q

What are 3rd and 4th cardinal movements of labor?

A

Flexion-Chin down
Internal rotation-head twists to fit through widest part of pelvis

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23
Q

What are 5th, 6th, 7th cardinal movements of labor?

A

Extension-chin up (this happens as baby is crowning and head delivers)
External rotation-Twist of head, shoulders to allow for shoulders to deliver
Expulsion-finish delivery

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24
Q

What is molding in labor language?

A

Head shape changes to fit through birth canal

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25
Q

What is supine hypotensive syndrome?

A

Mom lies flat-baby impedes blood flow-BP drop in mom

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26
Q

What is bloody show?

A

Warning sign of impending labor called a premonitory sign. Mix of thick, bloody mucus discharge shows cervical ripening

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27
Q

What are Braxton Hicks contractions?

A

Milder, irregular, contractions that are a warm up for real labor. Called a premonitory sign.

28
Q

What is lightening in labor language?

A

Dropping of baby as fetus descends toward pelvis. Premonitory sign of impending labor.

29
Q

What is false labor called?

A

Prodromal labor

30
Q

What are the three phases of stage 1 labor?

A

Latent (early)-Start to about 3-5cm
Active-4-8cm contractions more intense-Internal rotation happening.
Transition-8-10 cm contractions the most intense.

31
Q

What is an amniotomy?

A

Artificial Rupture of Membranes (AROM)

32
Q

What does SROM mean?

A

Spontaneous rupture of membranes

33
Q

What 5 things does APGAR assess?

A

Appearance, pulse, grimace, activity, respiration.

34
Q

What is a normal fetal heart rate range?

A

110-160 bpm

35
Q

When is Apgar done after delivery?

A

minute 1 and minute 5

36
Q

Heart rate on Apgar is classed as
0
1
2
What does this mean?

A

0=no heart beat
1=less than 100 bpm
2=100 bpm or more

37
Q

Respiratory effort on APGAR is classed as
0
1
2
What does this mean?

A

0=no respirations
1=slow respirations or weak cry
2=spontaneous respirations and strong cry

38
Q

Muscle tone on APGAR is classed as
0
1
2
What does this mean?

A

0=limp
1=minimal flexion of extremities, sluggish movement
2=flexed body posture, spontaneous and vigorous movement

39
Q

Reflex response on APGAR is classed as
0
1
2
What does this mean?

A

0=no response to suction or gentle slap on soles
1=minimal response to suction or gentle slap on soles
2=responds with cry or active movement to suction or gentle slap on soles

40
Q

Color on APGAR is classed as
0
1
2
What does this mean?

A

0=pallor of cyanosis
1=bluish hands and feet only
2=pink or absence of cyanosis
In dark skinned baby look at mucous membranes

41
Q

If an Apgar score is <3 what actions should be taken?

A

Resuscitation

42
Q

If APGAR score is 4-6 what actions should be taken?

A

Gently stimulate by rubbing and administering oxygen. May be from pain meds

43
Q

If APGAR score is 7-10 what action should be taken?

A

None

44
Q

What is tocodynamometer?

A

TOCO-Measures strength of contractions. Pressure sensor strapped to belly

45
Q

What is fetal tachycardia?

A

> 160 bpm for 10 minutes

46
Q

What is fetal bradycardia?

A

<110 bpm for 10 minutes

47
Q

How is Doppler used in labor?

A

Used to listen to baby’s heartbeat to gather rate, rhythm, and changes

48
Q

What is included in EFM?
—Electronic Fetal Monitoring–

A

Several different methods of gathering info but basically getting fetal heart rate (FHR) and uterine activity on strip. Can leave on continuously or intermittently

49
Q

What is baseline fetal heart rate?

A

The average bpm rounded to the nearest 5, measured over 2 minutes with no interfering factors or contractions. Classed as normal, tachy or brady.

50
Q

What is variability in EFM?
—Electronic fetal monitor–

A

Variability is the fluctuations in the baseline FHR. Look like irregular waves in the line. These are closely studied because they can indicate how well baby is oxygenated and tolerating labor. But it also is affected by any interference and can be tricky getting an accurate reading.

51
Q

What are accelerations?

A

Increase in FHR that lasts at least 15 seconds and increases at least 15 bpm. Usually from fetal movement and a positive sign of healthy baby.

52
Q

What are three types of decelerations?

A

Early
Late
Variable
These are based on their shape and relationship to contractions.

53
Q

What are early decelerations?

A

Normal. FHR decreases as contraction peaks. Caused by baby’s head being squeezed by contraction. The “nadir” is the low point of FHR during contraction.

54
Q

What are late decelerations?

A

Not a good sign. Same as early decelerations except the nadir in FHR is slightly to right of peak of contraction. Sign of poor oxygenation in baby.

55
Q

What are variable decelerations?

A

Drop in FHR that has no relationship or pattern

56
Q

What is an IUPC?

A

Intra Uterine Pressure Catheter
Inserted into uterus through vagina to measure contractions. Some allow for amnioinfusion-which is infusion of sterile solution into uterus.

57
Q

What is meant by precipitous labor and birth?

A

Fast! Less than 3 hours. Greater risk for bleeding.

58
Q

What is meant by malpresentation?

A

Breech. Not head first.

59
Q

What does caput mean?

A

Cone head

60
Q

What does it mean when baby is vertex?

A

Head down and occiput presenting

61
Q

What is it called when shoulder gets stuck in delivery?

A

Shoulder dystocia

62
Q

What is engagement?

A

Station of baby in relationship to ischial spines (little nodules on inside of pelvis) This is the tightest point and if baby’s head can pass through this then he will be able to fit. Range of -3 to +3 with 0 being the point of top of head at ischial spines.

63
Q

How long do contractions typically last in latent phase of labor?

A

Frequency is 10-30 min in early then progressing to 5-7 min later in early labor
Duration is 30 seconds and mild intensity

64
Q

Character of contractions in active phase of labor.

A

Frequency is every 2-5 min
40-60 seconds in duration
Moderate in intensity

65
Q

Character of contractions in transition phase of labor.

A

Frequency is 1.5 -2 min
60-90 seconds in duration
Strong in intensity

66
Q

What happens to WBC in labor?

A

Elevated to 25-30K

67
Q

How are FHR strips categorized?

A

Cat 1-normal
Cat 2-indeterminate
Cat 3-abnormal

Unit 3 (6 decks)

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