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NURS 414: OB > Labor and Delivery > Flashcards

Labor and Delivery Flashcards

Exam 1

1
Q

Delivery Location Options

A
  1. Hospitals
  2. Home births
  3. Birthing centers
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2
Q

Where do most women choose to deliver?

A

Hospitals

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3
Q

Why do many women choose home births?

A

Many choose home births because of negative hospital experiences; Women may feel more comfortable, empowered, and in control at home.

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4
Q

Labor consists of five components, referred to as the five Ps: What are they?

A

Power

Passageway

Passenger

Psyche

Position

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5
Q

Five P’s of labor: Power

A

Refers to uterine contractions and pushing efforts

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6
Q

Five P’s of labor: Passageway

A

Refers to the anatomy of the patient’s bony pelvis and soft tissues

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7
Q

Five P’s of labor: Passenger

A

Refers to the fetus

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8
Q

Five P’s of labor: Psyche

A

Refers to the patient’s state of mind

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9
Q

Five P’s of labor: Position

A

Refers to patient position

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10
Q

Five Ps of Labor: POWER- what are the primary powers of labor

A

1 _ Primary powers of labor are the involuntary uterine contractions.

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11
Q

Five Ps of Labor: POWER- where do the primary powers of labor occur?

A

Primary powers occur in the upper two-thirds of the uterus and apply pressure to the fetus.

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12
Q

Primary powers occur in the upper two-thirds of the uterus and apply pressure to the fetus. What occurs as a response to the pressure?

A

In response to the pressure, the cervix dilates and effaces, allowing for passage of the fetus.

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13
Q

What effects power?

A

Contraction frequency, duration, and intensity affect power.

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14
Q

What can be administered to augment contraction power?

A

Oxytocin can be administered to augment contraction power.

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15
Q

Five Ps of Labor: POWER- what are the secondary powers of labor

A

2 _ Secondary powers are the voluntary action of pushing.

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16
Q

Secondary powers are the voluntary action of pushing- what does this mean?

A

Secondary powers are the maternal pushing efforts after the cervix is completely dilated.

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17
Q

What should occur with contractions?

A

Effective pushing should occur with the contractions and may require coaching from the nurse.

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18
Q

Which pelvis shape provides the most ideal passageway

A

Gynecoid pelvis shape provides the most ideal passageway.

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19
Q

What does passageway depend on?

A

The passageway also depends on the ability of soft tissue to stretch.

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20
Q

When would soft tissue be an issue for fetal passage?

A

Soft tissue is rarely an impediment to fetal passage but may be a problem if a woman has scar tissue from gynecologic surgery.

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21
Q

What helps to turn and orient the fetus through the cardinal movements of delivery?

A

The muscles of the pelvic floor help turn and orient the fetus through the cardinal movements of delivery.

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22
Q

Fetal station

A

The relationship between the fetal presenting part and the pelvis is assessed by fetal station.

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23
Q

A Zero Station

A

A zero station means the presenting part is at the level of the ischial spines.

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24
Q

Important factors related to the fetus and labor are:

A

Fetal head size, fetal presentation, fetal attitude, fetal lie, and fetal position.

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25
Q

Five Ps: Passenger: What is the largest part of the fetus?

A

The fetal head is the largest part of the fetus.

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26
Q

Five Ps: Passenger: What qualities of the fetal skull allow it to pass through the birth canal?

A

The fetal skull bones are not fused and allow for the head to adjust to the birth canal.

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27
Q

Fetal presentation

A

Fetal presentation - refers to the part of the fetus entering the pelvis first.

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28
Q

Fetal presentation: The majority of babies are in what position?

A

The majority of babies are in a headfirst or cephalic(vertex) presentation.

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29
Q

What is breech position?

A

A breech presentation means the baby is in a buttocks or feet first presentation.

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30
Q

Fetal attitude

A

Fetal attitude- refers to the position of the fetal parts in relationship to itself

( chin to chest best)

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31
Q

Fetal lie –

A

fetal position in relation to mother’s spine

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32
Q

Three main Fetal Presentation groups

A
  1. Cephalic
  2. Breech
  3. Shoulder
33
Q

Cephalic (vertex) types:

A

Flexed
Military
Brow
Face

34
Q

Breech Fetal presentation includes:

A

Frank
Full or complete
Footling or double footling

35
Q

Fetal position landmarks:

A
  1. occipital bone [O]. vertical presentation
  2. chin (mentum [M]) face presentation
  3. buttocks (sacrum [S]) breech presentation
36
Q

Examples of Psyche that can influence labor?

A

Anxiety
Stress
Fear
Pain tolerance

37
Q

What (part of psyche) can augment labor?

A

Relaxation can augment labor.

38
Q

Five Ps of Labor: Position

When are contractions more effective?

A

Contractions are generally more effective when a patient is in an upright position.

39
Q

Five Ps of Labor: Position

What can assist a successful labor and delivery?

A

Gravity

40
Q

What angle of the pelvis is most conducive to birth?

A

The angle of the pelvis most conducive to birth is when the patient’s hips are sharply flexed, like when squatting

41
Q

What is associated with improved outcomes of birth?

A

Encouraging movement into positions of comfort is associated with improved outcomes.

42
Q

How did the lithotomy position of birth come to be?

A

Lithotomy position for birth may have evolved for the ease of the provider.

43
Q

Signs of impending labor

A

Contractions become regular
Presence of bloody show
Descent of the fetus into the birth canal (lightening), may occur about two weeks before labor for a primigravida
Nesting impulse
GI distress (heartburn, nausea, diarrhea)
Weight loss of 1 to 3 lb just before onset of labor

44
Q

What is labor confirmed by?

A

Labor is confirmed by cervical change - dilation (0-10) and effacement (0-100%).

45
Q

How many stages of labor are there?

A

4 stages

46
Q

First stage of labor

A

First stage: dilation and effacement of the cervix.

47
Q

What are the three substages of the first phase?

A

Latent phase: 0 to 6 cm dilation
Active phase: 6 to 10 cm dilation
Transition phase: 8 to 10 cm dilation

48
Q

Second stage:

A

pushing started with the cervix completely dilated and ends with the birth of the baby.

49
Q

Third stage

A

begins with the birth of the baby and ends with delivery of the placenta

50
Q

Fourth stage

A

Fourth stage: begins with the delivery of the placenta and ends after 4 hours or when the patient becomes clinically stable.

51
Q

True labor- Where are contractions felt

A

Contractions are felt in the lower back and abdomen, pressure is felt in the pelvis.

52
Q

True labor- How long are contractions

A

Contractions at least 60 seconds long approximately every 4 minutes may indicate labor.

53
Q

True labor- What happens to contractions over time?

A

Contractions become stronger and closer together over time.

Rest or hydration do not resolve contractions.

54
Q

False labor- where are contractions felt

A

Contractions are felt in the abdomen.

55
Q

False labor- how are contractions felt

A

Contractions may become regular for short periods of time, but mostly they are irregular.

Contractions often stop.

56
Q

False labor- what would resolve the contractions

A

Rest or hydration often resolve contractions.

57
Q

Stages and Phases of Labor: First Stage #1

Latent phase characteristics (contractions etc)

A

Longest lasting phase of labor

Period of excitement

Contractions feel like menstrual cramps and are mild to palpation

58
Q

Stages and Phases of Labor: First Stage #1. Active phase characteristics:

A

Patient may become more focused, anxious, or restless.

Contractions become more regular and painful.

Contractions are moderately strong to palpation.

59
Q

Stages and Phases of Labor: First Stage #1.

Transition phase characteristics:

A

Contractions strong and close together
Patient may feel out of control, irritable, or dependent.
Shortest lasting phase of labor

60
Q

Stages and Phases of Labor: Second Stage

Why may pushing be delayed

How long does this stage last

A

Pushing may be delayed until the patient feels the urge to push.

Second stage may last 20 minutes to 2 hours.

61
Q

Stages and Phases of Labor: Second Stage

As fetus descends, what happens

A

As the fetus descends through the birth canal, the fetal head rotates for optimal delivery. These movements are called cardinal movements.

62
Q

Cardinal movements of second stage

A

Engagement: Fetal head reaches level of the ischial spines.

Descent: Fetus moves past the ischial spines.

Flexion: Fetal chin touches chest in
response to pressure from maternal tissue.

Internal rotation: Fetal head rotates

Extension: Fetal chin comes off the chest and the neck arches as the head is born.

External rotation (restitution): Fetal head is born and rotates again as the shoulders move into position for birth.

Expulsion: Body of the fetus is born.

63
Q

Stages and Phases of Labor: Third Stage

How long does this stage take?

A

The third stage is complete within approximately 5 to 30 minutes.

64
Q

Stages and Phases of Labor: Third Stage
What occurs?

A

The uterus contracts to deliver the placenta.

65
Q

Stages and Phases of Labor: Third Stage
What occurs after the placenta is delivered?

A

After delivery, of the placenta, the uterus continues to contract to “pinch” or close the open blood vessels in the decidua to prevent maternal hemorrhage

66
Q

Stages and Phases of Labor: Third Stage
Failure to contract is called what? What is it a primary cause for?

A

Failure to contract is called uterine atony and is a primary cause of postpartum hemorrhage.

67
Q

During the Fourth Stage of Labor, what should the nurse do?

A
  1. Assess uterine position, vaginal bleeding (lochia), and vital signs
  2. administer pain meds as needed
  3. assist the pt with skin to skin contact and initiating breastfeeding
68
Q

Fetal monitoring

A
  • assessment of the fetal heart rate (FHR) for patterns that indicate fetal compromise.
69
Q

Fetal monitoring- what is associated with positive outcomes?

A

A normal (or reassuring) pattern is associated with positive outcomes for the neonate.

70
Q

Fetal monitoring- abnormal (nonreassuring) patterns are associated with what?

A

Abnormal (or nonreassuring) patterns are associated with hypoxemia and may lead to hypoxia.

71
Q

Fetal Monitoring: Intermittent monitoring

A

Intermittent monitoring generally includes auscultation of the FHR every 15 to 30 minutes during the active phase of labor and every 5 to 15 minutes in the second stage of labor.

72
Q

Fetal Monitoring: How often are low risk woman monitored?

How about high risk women?

A

Low risk woman monitoring, every 30 minutes during first stage and every 15 during the second stage.

High-risk woman, the fetal monitor strips are reviewed more frequently.

73
Q

Fetal monitoring: Baseline HR

A

Baseline HR: assessed over a 10-minute period between 110 and 160 bpm.

74
Q

Fetal monitoring: Variability

A

Variability: irregular fluctuations in the baseline FHR.

75
Q

Fetal monitoring: Moderate Variability

A

Moderate variability has an amplitude of 6 to 25 minutes and is assessed over a 10-minute period.

76
Q

Fetal monitoring: Accelerations

A

Accelerations are an increase in baseline of at least 15 beats and lasting at least 15 seconds in a term fetus.

77
Q

Fetal monitoring: decelerations

A

Decelerations are decreases in the fetal heart rate from baseline.

78
Q
A

NURS 414: OB (15 decks)

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