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NCLEX > Labor & Delivery > Flashcards

Labor & Delivery Flashcards

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1
Q

True Labor

A

contractions are regular with the interval getting shorter and shorter with time, contractions continue with rest, intensity increases, start in lower back and move towards the front of the abdomen

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2
Q

False Labor

A

irregular contractions that do not get closer together, stop with walking/resting/changing position, generally weak, pain felt in front

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3
Q

Amniotic sac rupture

A

can occur in active labor or when woman starts contracting, if rupture happens first contractions will follow, rarely gush of fluid will be more of a steady trickle of fluids

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4
Q

PROM

A

premature rupture of membranes; ruptures before contractions begin, can accurately tell by pH strip (blue/alkalotic = amniotic fluid)

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5
Q

PPROM

A

preterm premature rupture of membranes; before 37 weeks, if stays ruptured for long period of time and baby is not delivered soon there is risk for infection, commonly undiagnosed

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6
Q

AROM

A

artifical rupture of membranes (amniotomy); provider breaks water to induce labor using an amni hook

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7
Q

effacement

A

as cervix dilates it also thins out, is measured in percentages with help of index finger

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8
Q

measuring effacement

A

when finger inserted into cervix: goes to 2nd knuckle = 0%, goes to 1st knuckle = 50%, only fingertip = 100%

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9
Q

Tocolytics

A

slow contractions; terbutaline, magnesium sulfate

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10
Q

ocytotics

A

stimulate contractions; ocytocin

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11
Q

oxytocin is always given via

A

IV and piggy back

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12
Q

Misoprostol

A

prostaglandin; causes cervix to soften and uterus to contract

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13
Q

Dinoprostone

A

prostaglandin; stimulate muscles of uterus to contract and also causes cervical dilation

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14
Q

systemic analgesics in labor

A

lessens pain without loss of feeling or muscle movement, typically opioids given IV, do cross placenta so limited use is better as it can lead to resp depression in both mom and baby

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15
Q

local anesthetics in labor

A

often used if incision needs to be made to make vaginal opening bigger (episiotomy) or to repair a lac/tear that occurred during delivery

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16
Q

epidural

A

small catheter placed into lower spins that slowly pumps pain meds into that area, stops pain signals from traveling from spine to brain. Removed pain without slowing labor too much, mother is awake and lart and should still be able to feel pressure/contractions to know when to push, can drop bp closely

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17
Q

Spinal Block

A

used for pain during planned C section, injected directly into spinal cord fluid and will block pain for a couple of hours, takes effect very quickly so it may also be given if painful procedure needed during a vaginal delivery (such as a vacuum assist). May drop bp, can also lead to drop in FHR (rare cases)

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18
Q

Spinal headache

A

medication goes into membrane and CF begins to drain causing intense headache; occurs 24-48 hrs after epidural; if relief measures such as hydration and NSAIDs do not work can do a epidural blood patch (small amount of blood product inject into where epidural was to block CF from leaking)

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19
Q

general anesthesia in labor

A

reserved for only emergency situations, may rarely be used if epidural/spinal block does not work, will delay how quickly mother can bon to baby and often impacts BF

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20
Q

right fetal presentation

A

baby is facing R side

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21
Q

left fetal presentation

A

baby is facing the L side

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22
Q

occiput fetal presentation

A

baby’s head is presenting first

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23
Q

mentum fetal presentation

A

chin is presenting first

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24
Q

sacrum fetal presentation

A

sacrum is presenting first

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25
Q

anterior fetal presentation

A

baby (its back) is pointing towards the front

26
Q

posterior fetal presentation

A

baby’s back is facing towards back

27
Q

transverse fetal presentation

A

baby is laying directly towards one hip or the other (horizontally in womb)

28
Q

station

A

how far down the baby is in the birth canal, measures in relation to mom’s ischial spine (at the most narrow spot), at ischial spine = 0 station, the higher the + number the closer baby is to delivery (further down birth canal baby is)

29
Q

first stage of labor

A

when labor starts, contractions begin and cervical changes, latent phase, active phase, transition phase, first stage ends when cervix is fully dilated to 10cm

30
Q

an arrest of labor happens when

A

lack of cervical dilation for 4 hours or greater (despite adequate contraction) OR no change of cervix for 6 hours or greater; both of these are unlikely to lead to a spontaneous delivery an will likely be going for a c-section

31
Q

latent phase

A

when cervix dilates from 0 to 3 cm, slower period and less predictable

32
Q

active phase

A

dilation goes from 4 - 7 cm, faster and more predictable rate of cervical changes

33
Q

transition phase

A

dilation occurs from 8 - 10 cm, fetus continues to move into the pelvis

34
Q

second stage

A

begins when fully dilated and ends when neonates is fully delivered; 7 cardinal movements during this stage, typically lasts up to 3 hrs for nulliparous and up to 2 hrs for multiparous women, can take longer if mom gets epidural

35
Q

7 cardinal movements

A

engagement: active steady decent down birth canal

decent and flexion: happen at the same time; baby’s head is moving down through bony part of pelvis (ischeal spine) flexion is the chin pulling down to go through the birth canal

internal rotation: baby rotates head and body side-to-side and wiggling to navigate through narrow portion of pelvis

extension: delivery of head, face, and chain

external rotation: after head of baby is born it pauses and will slowly move 90 degrees towards one of the maternal thighs, does this to get the shoulders out

expulsion: rest of the body follows the head

36
Q

third stage

A

starts when fetus is fully delivered and ends when placenta has been delivered; usully takes 5-10 minutes, if takes >30min risk for PPH increases, placenta needs to be cleared to reduce risk of further bleeding

37
Q

3 distinct signs of placental separation

A

gush of blood from the vagina (this is the placenta detaching from the wall), lengthening of umbilical cord, globular shaped uterine fundus when palpate

38
Q

fourth stage

A

first 1-2 hrs after delivery; monitor mother closely for signs of infection, hemorrhage, and uterine atony, preliminary assessments and treatments for the baby

39
Q

placenta previa

A

placenta has attached over the brith canal instead of at the top of uterus, fetus cannot get through without causing trauma and hemorrhage

40
Q

placenta previa S&S

A

painless and bright red bleeding, can be complete or partial

41
Q

placenta previa interventions

A

never perform vaginal exam if suspected, monitor for blood loss, bed rest, c-section, monitor baby

42
Q

Placental abruption

A

placenta is properly attached at top of uterus but begins to tear/pull away and detach. Incomplete: only small portion tears away (blood will begin to fill gap where tear is happening), complete: entire placenta tears away from wall (massive amounts of blood loss)

43
Q

Placental abruption S&S

A

dark red bleeding, intense abdominal pain, board like abdomen (d/t internal bleeding), rigid uterus, hypotension (d/t blood loss), maternal tachycardia, fetal bradycardia

44
Q

placental abruption interventions

A

monitor for signs of fetal distress, monitor maternal bleeding, changes in fundal height, keep BP up with IVF and/or blood products, prepare for delivery, likely to be a c-section

45
Q

Prolapse umbilical cord

A

umbilical cord slip through cervix and into vagina after rupture of membranes and before baby descends into the birth canal, during delivery cord can be compressed by presenting part of fetus and cuts off oxygen to fetus

46
Q

prolapsed cord S&S

A

cord visualized protruding through vagina, cervical exam: something squishy, pulsing, mom might feel something between her legs

47
Q

prolapsed umbilical cord interventions

A

elevate part of presenting fetus off of the cord, knees to chest position (opens pelvis), trendelenburg (lets gravity shift baby off the cord), administer O2, wrap cord in moist sterile towel, never attempt to push cord back in, emergency C-section

48
Q

shoulder dystocia

A

one or both of the baby’s shoulers get stuck behind the mother’s pubic bone or sacrum during birth, recognized in second stage of labor after head is delivered and before rest of baby is born, noticed when pause of rotation to one side is longer than normal

49
Q

Complications of shoulder dystocia

A

maternal: 3rd or 4th degree tears, hemorrhage, damage to nerves, rectovaginal fistula, uterine rupture, separation of pubic bones

fetus: brachial plexus palsy, clavicle or humerus fractures, Horner’s syndrome, compresse umbilical cord

50
Q

Should dystocia diagnosed based on

A

baby’s head delivered but mother is not able to push shoulders out, at least one minute has passed since baby’s head was delivered, baby is determined to need medical intervention to be delivered successfully

51
Q

Turtle sign

A

after baby’s head has been delivered the head emerges and then pulls back into the perineum

52
Q

Shoulder dystocia interventions

A

evaluate for episiotomy, hold legs up so thighs are pressed against abdomen, press on lower abdomen above pubic bone to push shoulders out, HCP reaches in to vagina and tries to turn baby, HCP pulls out one arm, roll client onto hands and knees

53
Q

in shoulder dystocia fundal pressure should not be applied due to increased risk of

A

uterine rupture

54
Q

chorioamnionitis

A

membranes that surround the fetus are infected, complications for both mom and baby, caused by bacteria typically from the vagina or rectum that then spread to the uterus after water breaks

55
Q

chorioamnionitis S&S

A

fever, maternal and/or fetal tachycardia, very tender and painful uterus, vaginal discharge/lochia with a foul smell and unusual color, WBCs elevate, culture, gram stain, amniotic fluid sampling

56
Q

fetal complications of chorioamnionitis

A

sepsis, meningitis, pneumonia

57
Q

PPH S&S

A

boggy uterus, blood loss, shock (if large amounts of blood are lost), saturated 4+ pads in an hour

58
Q

PPH interventions

A

fundal massage (Q15min at minimum), estimate blood loss; weight pads 1g=1ml, monitor hemoglobin and hematocrit, oxytocin, methylergonovine, blood products

59
Q

Baby Blues vs depression

A

lasts for up to 2 weeks vs lasts longer than 2 weeks

frequent/prolonged crying vs does not feel like she can bond with baby, frequent recurring thoughts of death and suicide

60
Q

Postpartum Psychosis

A

can be delayed until months after delivery, confused/lost, obsessive thoughts about baby, hallucinations/delusions, paranoia, attempts to harm self or baby

61
Q
A

NCLEX (23 decks)

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