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Mother/Infant > Intrapartum Nursing care > Flashcards

Intrapartum Nursing care Flashcards

1
Q

HOW TO CALCULATE EDD

A
  1. NAEGELE’S RULE
    add 7 days to first day of last menstrual period and subtract 3 months

-assumes 28 day cycles with ovulation on day 14

  1. GESTATIONAL WHEELS
    sometimes off a day or two
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2
Q

HOW TO CALCULATE EDD AMERICAN CONGRESS OF OBSTETRICIAN’S AND GYNECOLOGISTS:

A

a combination of Naegele’s wheel and ultra sound in first trimester

-crown to the rump measurement variation in size isn’t different in the 1st trimester

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3
Q

GRAVIDA

A

number of pregnancies current or past reguardless of outcome

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4
Q

EARLY TERM

A

37-38 wks 6 days

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5
Q

LATE TERM

A

41- 41WKS 6DAYS

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6
Q

POST DATES

A

42 wks or greater

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7
Q

PARA

A

number of pregnancies delivered at or after 20 weeks, 0 days, regardless of fetuses alive or dead

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8
Q

FULL TERM

A

39 wks - 40 wks 6 days

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9
Q

PRE TERM

A

20-36 weeks 6 days

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10
Q

ABORTION

A

up to 19 weeks 6 days ( miscarriages included)

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11
Q

LIVING

A

number of children living at home older that 28 days old

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12
Q

THE BIRTH PROCESS (4)

A
  1. PASSAGEWAY
  2. PASSENGER
  3. POWERS
  4. PSYCHE
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13
Q

PASSAGEWAY :BONY

A

BONY PASSAGEWAY

  • ischial spines
  • station: the position of fetal presenting part (typically head) in relation to maternal ishial spines (p 2116)
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14
Q

PASSAGEWAY : SOFT TISSUE

A

EFFACEMENT

  • thinning of cervix from 2-3 cm to 10 cm
  • 100% very thin
  • measured in %

DILATION

  • opening of cervix from being tightly closed to 10 cm
  • external and internal os becomes one
  • primatives efface before dilation
  • multives efface and dilate at same time
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15
Q

STATION

A

-3 - 3 cm above ischial spine (floating)
-2 - 2 cm above
-1 - 1 cm above
0- engaged head
1- 1 com below
2- 2cm below
3- 3 cm below
4- hit the floor

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16
Q

INTRAPARTUM : PASSENGER (PG 2117)

A

FETAL POSITION - three letter description

  • help determine where to listen for fetal heart tones
  • want baby to be in occiput anterior best route for delivery
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17
Q

1ST LETTER

A

is the presenting part of the fetus pointing to mom’s right or left (R or L)

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18
Q

2nd LETTER

A

what is the fetal presenting part
O= occiput (back of head /smallest diameter of head )
S= sacrum
M= mentum or face

19
Q

3RD LETTER

A

is the fetal presenting part pointing to the anterior (A)

posterior (P), or (T) transverse part of mom ?

20
Q

NORMAL FETAL HEART RATE

A

110-160 BPM

21
Q

FETAL BRADYCARDIA

A

< 110

22
Q

FETAL TACHYCARDIA

A

> 160

23
Q

4 CATEGORIES OF FETAL HEART RATE VARIABLITY

A

ABSENT = NONE (STRAIGHT LINE )(BAD)

MINIMAL = <5 BEATS/MIN

MODERATE= 6-25 BEATS/MIN

MARKED = >25 BEATS/ MIN

24
Q

INTRAPARTUM : POWERS

A

CONTRACTIONS:

DURATION: measured from beginning of 1 to it completion (sec)

INTENSITY : strength of contraction

FREQUENCY: measured from beginning of one contraction to beginning of the next

-as labor progresses DIF increases

25
Q

3 STAGES OF LABOR

A

FIRST STAGE : contractions 5min apart and regular until full dilation

SECOND STAGE: full dilation until birth

THIRD STAGE : birth until placenta delivery

26
Q

CONTRACTIONS

A
  • when uterus contracts mom’s oxygentated blood is decreased , relaxation allows for blood to refill
  • when the uterus contracts mom’s BP goes up , blood volume increases (sponge)
27
Q

EPIDURAL

A
  • regional anesthetic
  • BP drops due to vascular relaxation
  • pt given 1L of fluid
28
Q

AMNIOTIC FLUID

A
  • mainly made of baby urine
  • fluid within amniotic membranes that is constantly produced
  • SROM: spontaneous rupture of membranes
  • AROM: artificial rupture of membranes
  • should be colorless, odorless, green = fetal distress (BM)
  • green indicates some type of fetal distress
  • fetal HR must be assessed upon ROM
  • when fluid is gone , body weight can crush umbilical cord ( decreased HR)
29
Q

THREE STAGES OF FIRST STAGE LABOR

A

LATENT
ACTIVE
TRANSITION

30
Q

LATENT PHASE

A

onset of true labor until dilation 0-3cm

  • don’t go to hospital yet
  • preparatory phase
31
Q

ACTIVE PHASE

A

4-7cm stronger contractions frequency decreased

  • women turn inward for comfort
  • don’t lay down flat on back vena cava collapse ( decreased blood flow)
  • fetal HR every 2 HRS
32
Q

TRANSISTION PHASE

A

8cm to 10cm

- behavior changes

33
Q

VITALS TO MONITOR

A

pulse, HR ,RR, contractions , Temp(every HR)

  • hygiene
  • comfort
  • ice chips
  • wash cloths
  • pt centered care
34
Q

COMFORT

A
  • general hygiene
  • relaxation techniques
  • breathing techniques
35
Q

COMFORT PHARMOCOLOGICAL

A

IV analgesia: butophanol, nalbuphine

  • unknown if main effect is analgesia or sedative
  • only in early active labor (respiratory depression for fetus)
36
Q

RESPIRATORY DEPRESSION GREATEST RISK

A
  • mainly to neonatal
  • naloxone on hand
  • impact on fetal heart rate
    ~ decreased variability
    ~ sinusoidal pattern
37
Q

REGIONAL ANESTHISIA

A
  • epidurals and spinals refer to evidence based care sheet
  • placed below spinal cord in epidural apace
  • placed after active labor has been established
  • may cause hypotension
  • position on side with foley cath inserted
38
Q

WHAT DOES A EPIDURAL DO?

A
  • diminish pain, sensation, and motor function

- position pt carefully to get optimum outcome of med

39
Q

CESAREAN SECTION

A
  • birth through an abdominal and uterine incision
  • Analgesia- spinal or epidural
  • foley catheter
  • SCD”s
  • positioning during procedure
  • presence of significant other
  • skin to skin with baby
40
Q

INCISION TYPE

A

vertical - always has to have c- section with other kids

transverse- can have a v-back, preferred horizontal , uterus can rupture

41
Q

PRE ECLAMPSIA

A
  • new onset hypertension assoiciated with pregnancy after 20 weeks gestation with proteinuria
  • increased mortality and morbidity for mother and fetus
42
Q

C-SECTION POST OP

A

immediate post op care
typical post operative nursing care measures
fundal assessment

43
Q

TREATMENT OD PRE ECLAMPSIA

A

MAGNESIUM SULFATE

  • decreases neuro excitability
  • high risk drug
  • decreases risk of seizures
  • 4-6 grams loading dose over 15 min (stay in room )
  • 1-3 gram/hr maintenance
  • vitals and fetal assessment q 15 for first hour, q30 for 2nd, and at least q hour during maintenance
  • deep tendon reflexes at least q 2 hours
  • urinary output q 1-2 hours (20-30mls)
  • oxygen sat q hour
  • if women aren’t peeing out mag sulfate then women will stop breathing and die ( count RR if decrease stop med)
  • Calcium gluconate is annedote
44
Q

PITOCIN: OXYTOCIN

A
  • hormone given to increase uterine contractions
  • INTRAPARTUM: prescribed in milliunits via infusion pump to stimulate or augment labor

-overdosage will decrease oxygen to fetus and result in fetal distress, fetal death, uterine rupture

POSTPARTUM: prescribed in units on or off pump to contract empty uterus and decrease risk of postpartum bleeding

Mother/Infant (8 decks)

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