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Maternal Child > Labor > Flashcards

Labor Flashcards

0
Q

Latent stage

A
  • Contraction last 30 40 sec with increasing intensity
  • 0-3cm dilation
  • bloody show
  • usually unable to walk/talk
  • use diversion
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1
Q

First stage of labor

A

Dilating stage
Behind with the 1st true labor contraction and end with complete dilation of the cervix 10 cm
3 phases
Latent, active, transitional

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2
Q

Active stage

A
  • contraction are stronger, 45-60 sec, Q3-5 minutes
  • cervix dilates 4-7cm
  • not able to walk, mother tends to withdraw from the surrounding environment but desire companionship and encouragement
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3
Q

Transient

A
  • Sharp contraction, more intensified lasting 60-90sec, frequency is 2-3min
  • dilation 8-10cm
  • increase in bloody show
  • mother unregenerate to push or having a BM
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4
Q

2nd stage of labor

A

Delivery/expulsive stage: from complete dilation to the birth of baby (where almost everything happens)

  • crowning
  • delivery of the baby
  • clamping and cutting umbilical cord
  • increase bloody show
  • desire to bear down
  • nausea, irritability, uncooperative, severe discomfort, pleas for relief
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5
Q

3rd stage of labor

A

Placental stage: from baby delivery to placental expulsion

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6
Q

4th stage of labor

A

Recovery and stabilization phase

  • from placental delivery and uterus tends to relax
  • goal is to prevent hemorrhage
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7
Q

What is engagement, descent, flexion?

A

When the widest part of the baby’s head passes the ischial spines as as the head is flexed onto the chest

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8
Q

Mechanism of labor

A 
Engagement
Internal rotation
Extension
External rotation
Expulsion
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9
Q

What is LOA presentation?

A

Fetal occiput (back of the head) is facing towards the left side of the maternal pelvis and towards the front
LOA
(Left occiput anterior)

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10
Q

Full term fetal heart rate

A

120-160bpm baseline
Brady< 120
Tachy> 160

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11
Q

What FHR during contraction should do?

A

May increase or decrease by 30bpm and return to baseline immediately after

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12
Q

What to do if FHR does not vary with contraction?

A
  • assist woman to change position

- notify physician/ certified unreserved midwife

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13
Q

What generalized edema indicate?

A

Preeclampsia or pregnancy induced hypertension

Especially edema is face and hands

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14
Q

What is fetal station?

A

The relationship between the presenting part of the baby with the mother pelvis
(Presenting part/pelvis)

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15
Q

What is fetal lie?

A

Relationship between the head to tail bone axis for both the fetus and the mother
(Lie/alignment)

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16
Q

What is fetal attitude

A

The relationship of the fetal body parts to one another

Posture

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17
Q

What is fetal presentation?

A

Portion of the baby that enters the pelvis first (cephalic, breech, shoulder)

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18
Q

Lab test

A
  • urinalysis for protein
  • antibody screen at 28weeks if client is Rh negative
  • cervical culture for group B strep at 34-36 weeks gestation
  • hemoglobin/Hct
19
Q

When do you give rhogam?

A
  • To Rh negative female @ 28-30 weeks during pregnancy
  • after any possible mixing of fetal blood (ectopic pregnancy,miscarriage, MVA, amniocentesis, abortion….)
  • within 72h of giving birth
  • After the birth of a Rh positive newborn
  • after a negative or normal Coombs test
20
Q

How long the latent phase of the 1st stage of labor last?

A

Approximately 8hour for the primipara and 4-5hours for the multipara

21
Q

How long is the active phase of the 1st phase of labor?

A

About 4h for primipara and 2h for multipara

22
Q

What are nursing responsibilities before administration of epidural?

A

Take vs
Record FHR
Encourage to empty bladder or insert Foley catheter

23
Q

How often should the nurse monitor FHR and BP after epidural?

A

Every 5 min for 30 minutes!!
- then if stable Q15 to 30 min

If hypotension, or fetal bradycardia occur, turn the woman to her left side

24
Q

Serious side effect of epidural anesthesia

A

Headache
Shivering
Backaches
Nausea

25
Q

Postpartum endocrine adaptation

A
  • estrogen drop at birth, lowest in 1week
  • Progesterone drop at birth, undetectable in 72h
  • Oxytocin stimulate uterine contraction and milk letdown reflex
  • Progestin stimulates milk production
26
Q

When is loch is supposed to be pink to brown?

A

On days 3 to 7

Rubra (red) from day 1-3
Serosa (pink) 3-7
Alba (creamy white) on or around day 10

27
Q

During teaching about breast feeding the nurse should tell the mom to….?

A

Baby should nurse 10-15 min on each side Q2- 3hours
Encourage 8 oz of fluid with each feeding and 500calories extra per day
Suggest warm compress or shower prior to breast feeding to assist the let down reflex
Baby should be fed Q2-3 hours during day and night
Start with the breast last fed on
Avoid using soap and water on nipple

28
Q

What are postpartum warning signs for the mother to report?

A
  • Temperature >100.4F (38C)
  • Continued mood swing or depression
  • Appetite loss
  • Sleep disturbance
  • Elimination problems (GI/GU)
  • increased lochia clots or foul odor
  • Perineal pain or swelling
  • Calf tenderness
29
Q

Newborn warning sign to report?

A
  • temperature>100.4F
  • Inconsolable crying
  • Poor effort feeding
  • Inability to arouse (exceedingly sleepy)
  • No wet diaper in 8hours
  • vomiting or diarrhea
  • Yellowing of the skin
30
Q

What is colostrum?

A

The first milk which is high in protein and fat soluble vitamins and has anti-infective properties.

31
Q

What is Depo-provera?

A

An injection of progestin hormone (IM)
Each shot prevents pregnancy for three month
May delay conception for up to 2 years after discontinuation of the product

32
Q

When do we Never administer Rhogam?

A

To a Rh positive mother
Someone with a positive Coombs test
A Rh negative woman wha has just given birth to an RH negative baby
To the father of the child

33
Q

What is apgar score?

A

Rating of respiration, crying, reflexes, irritability, pulse,heart rate and skin color of the newborn
Score from 0 -10 given at 1 and 5 min from birth.

34
Q

What does an apgar score of 6 means?

A

Mean this the baby has some mild depression (5-7= mild depression)

  • The neonate may require some stimulation (gently but firmly slappy the sole of the frets or runnin the back/ spine.
  • This kids may require oxygen
35
Q

APGAR score

A

8-10= normal
5- 7= mild depression (need some stimulation, may need O2)
3- 4= moderate depression (baby will need O2 and may need insertion of feeding tune to decompress stomach)
0- 2= severe depression requiring immediate life support

36
Q

Why do we instill erythromycin eye drop to new born within the few first hour of birth?

A

To prevent and protect the child against chlamidial conjunctivitis

37
Q

Newborn vitals sign?

A

Temp: 97.9- 99.7 axial lark
Apical HR: 110-160bpm
BP: 50-75 mm hg
Resp: 30-60 resp per minute

38
Q

Hyperbillirubinemia for newborn

A

15mg/dL or greater (term baby)
10mg/dL or greater (preterm)
Persistent elevated of bilirubin in the body place the infant at risk for neurotoxicity or BIND (bilirubin induced neurological dysfunction)

39
Q

When do we screen the baby for PKU (Phenylketonuria)?

A

After 48 h of age and after adequate protein intake

40
Q

The 4th stage of labor is the placental separation and expulsion

True or false?

A

False
The 3rd stage of labor is the placental separation and last about 5-30 min. The 4th stage of labor is maternal adaptation!!! Occurring 1 to 2 hour after birth.

41
Q

When the fetus is active the FHR should increase by 15 bps

True or false?

A

True

When the fetus is active the HR will increase by 15 bpm above baseline

42
Q

What is chloasma?

A

Discoloration of the skin during pregnancy

43
Q

A gravida 3, para 3 woman should be rush to the delivery room once engagement has occurred

True or false?

A

False
Engagement just means that the head of the baby is no longer free floating, but has dropped into the pelvis. In a multipara, engagement normally occurs about 2 weeks before birth!

44
Q

The safest time for the fetus is to give the mother analgesia when her cervix is dilated 8- 10cm

True or false?

A

False!

The safest time to give analgesia is when dilation is between 4-7 cm

45
Q

What is the glabella reflex?

A

The baby will close his eyes when tapping on the glabella (flat bone between the eyebrows)

Maternal Child (3 decks)

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