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final two 133 quizzes! > labour & delivery, neonatal > Flashcards

labour & delivery, neonatal Flashcards

1
Q

what is the passage?

A

fetus and placenta-

impacted by the size of fetal head, fetal presentation, fetal lie, fetal attitude, fetal position

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2
Q

what has the most impact on the birthing process?

A

size of fetal head due to size and rigidity

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3
Q

what are fontanelles?

A

located where sutures intersect, palpation of fontanelles reveals presentation, position, and attitude

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4
Q

anterior fontanelle?

A

larger, diamond shaped, closes by 18 months

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5
Q

posterior fontanelle?

A

triangular, closes at about 6-8 weeks

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6
Q

what is fetal presentation?

A

part of fetus that enters the pelvic inlet first and leads through the birth canal during labour

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7
Q

what is the presenting part?

A

part of fetus that lies closest to the internal os of cervix

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8
Q

what are the three presentations?

A

cephalic, breech, shoulder

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9
Q

cephalic presentation is?

A

head first, presenting part is the occiput

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10
Q

breech presentation is?

A

buttocks or feet first, presenting part is sacrum

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11
Q

shoulder presentation is?

A

presenting part is scapula

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12
Q

what is fetal lie?

A

the relation of long axis (spine) of the fetus to the long axis (spine) of the mother

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13
Q

two main lies?

A

longitudinal/vertical OR transverse/oblique

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14
Q

what is the longitudinal lie?

A

spine is parallel to mothers, either cephalic or breech presentation

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15
Q

what is the transverse lie?

A

long axis is perpendicular or at an angle to the mothers

-cannot be birthed vaginally

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16
Q

what is fetal attitude?

A

relation of fetal body parts to one another- characteristic posture (attitude) in utero is due to the fetal growth and the way the fetus conforms to the shape of the uterine cavity

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17
Q

what is general flexion?

A

back is rounded, chin is flexed down to chest, legs are tucked into abdomen, arms are crossed over the thorax

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18
Q

what is biparietal diameter?

A

largest transverse diameter of fetal head (usually around 9cm), widest part entering pelvic inlet

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19
Q

what is suboccipitobregmatic diameter?

A

most critical diameter, when head is in complete flexion, this diameter allows fetal head to pass through true pelvis easily

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20
Q

what is anteroposterior diameter?

A

increases as the head extends. can cause head to be too large to pass through

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21
Q

what is fetal position?

A

relationship of a reference point on the presenting part (occiput, sacrum, mentum (chin), or sinciput (deflexed vertex) to the 4 quadrants of the mothers pelvis

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22
Q

what is the first letter of the fetal position system

A

LOCATION of presenting part in mothers pelvis (side to side)

  • R= right
  • L= left
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23
Q

what is the second letter of the fetal position system

A 
PRESENTING PART 
O- occiput
S- sacrum
M- mentum (chin)
Sc- scapula
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24
Q

what is the third letter of the fetal position system

A

LOCATION of presenting part
A- anterior
P- posterior
T- transverse

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25
Q

what is station?

A

relationship of the presenting part to an imaginary line drawn between the maternal ischial spines and is a measure of the degree of descent through birth canal- measured in cm above or below the ischial spine

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26
Q

-1 is 1cm….____ the spine

A

above the spine

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27
Q

when is birth imminent?

A

when the presenting part is at 4+ to 5+

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28
Q

what is engagement?

A

indicates the largest transverse diameter of the presenting part has passed through the maternal pelvic brim into the true pelvis (usually corresponds to station 0)
-occurs in the weeks leading up to labour in the nullipara and occurs during labour in the multipara

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29
Q

what is the passageway?

A

the birth canal. composted of:

mothers rigid bony pelvis

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30
Q

what are the 4 pelvic joints?

A

symphysis pubis, right and left sacroiliac joints, and sacrococcygeal joints

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31
Q

what are the two parts of the pelvis?

A

true pelvis: below brim/inlet, involved in birth

false pelvis: part above the brim, no role in child-bearing

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32
Q

what are the 4 types of pelves?

A

gynecoid: classic female type
android: male pelvis
anthropod: anthroid apes
platypelloid: flat

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33
Q

what is the pelvic floor?

A

muscular layer that separates the pelvic cavity from the perineal space below
- helps rotate fetus anteriorly

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34
Q

what are powers?

A

contraction (involuntary and voluntary!)

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35
Q

involuntary (primary powers)?

A
  • originate at the pacemaker points in the uterine wall
  • described in terms of frequency, duration, intensity
  • responsible for effacement and dilation of cervix
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36
Q

what is effacement

A

shortening and thinning of cervix

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37
Q

is the cervix palpable when fully dilated?

A

NO

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38
Q

what is the ferguson reflex?

A

stretch receptors in posterior vagina cause release of endogenous oxytocin that triggers maternal urge to bear down

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39
Q

what are voluntary secondary powers?

A

presenting part reaches pelvic floor, contractions change in character, become expulsive
involuntary urge to push
aid expulsion of fetus
compression of diaphragm and abdominal muscles compress fetus downwards

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40
Q

what are signs preceding labour?

A
  • lightening (presenting part descends into true pelvis)
  • vaginal mucus more profuse
  • cervix softens (ripens) partially effaced
  • membranes may rupture
  • losing 0.5-1.5 kg in weight due to water loss
  • surge of energy
  • nausea, vomiting, indigestion, and diarrhea
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41
Q

onset of labour is?

A

not linked to a single cause!
other factors:
-changes in maternal uterus, cervix, pituitary gland
-hormones produced by normal fetal hypothalamus
-uterine distension
-increased intrauterine pressure, increased estrogen, decreased progesterone

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42
Q

what does the normal labor consist of?

A

regular progression of uterine contractions

  • effacement and progressive dilation of cervix
  • progress in descent of the presenting part
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43
Q

what is the first stage of labour?

A

lasts from onset of regular uterine contractions to full dilation of cervix
-active labour= more rapid dilation of cervix

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44
Q

what is the second stage of labour?

A

cervix fully dilated to birth of the fetus

  • latent phase: no strong urge to push, fetus descends passively
  • active phase: strong urge to push
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45
Q

what is the third stage of labour?

A

lasts from birth of fetus to birth of placenta

-placenta usually separates with the third or fourth contraction after fetus is delivered

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46
Q

what is the fourth stage of labour?

A

lasts from 2 hours after delivery of the placenta

-recovery, hemostasis is recovered

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47
Q

what are the 7 cardinal movements of labour?

A
  • engagement
  • descent
  • flexion
  • internal rotation
  • extension
  • external rotation
  • birth by expulsion
48
Q

what is the psyche?

A

psychological outlook is preserved

  • knowledge
  • fear
  • support
  • trust
  • beliefs, values, culture
49
Q

psychological assessment of the labouring woman should include?

A

verbal interactions (does she ask questions?)
perceptual ability (understanding the nurse?)
body language
discomfort level

50
Q

what is the postpartum period?

A

interval between the birth of the newborn and the return of reproductive organs to normal nonpregnant state

  • approx 6 weeks
  • also known as puerperium or fourth trimester
51
Q

what is prodromal labour?

A

false labour

  • contractions do not increase in frequency, duration, or intensity
  • cervix does not dilate or efface
52
Q

what is true labour?

A 
contractions rhythmic and regular
increase in freq duration intensity 
pattern does not change 
increase in discharge
cervix begins to dilate or efface
53
Q

nurses role in labour?

A
  • assess onset and pattern of contraction
  • assess contraction freq, duration, strength
  • provide info related to maternal self care
  • reassurance
54
Q

three stages of first stage of labour?

A

latent (0-3 cm)
active (3-7cm)
transition (7 to 10cm)

55
Q

cardiovascular responses to labour

A

cardio output increases
increased WBC
peripheral vascular changes (cold hands and feet)
compression of vena cava may cause dizziness nausea anxiety

56
Q

resp response to labour

A

increase in O2 consumption due to uterine activity

increase in resp rate

57
Q

gastrointestinal response to labour

A

gastric motility decreases, emptying time of stomach increases
clear fluid and light diet recommended

58
Q

physiological change: lochia

A

separation of uterine decidua into 2 layers
new endometrium forms inner layer of uterus
outer layer sloughs off

59
Q

physiological change: perineal changes

A

intact perineum

  • odematous, tender bruised
  • possible haemorrhoids
60
Q

physiological change: circulatory

A
  • blood loss at delivery
  • increased WBC
  • increased plasma fibrinogen
  • increased diuresis due to excess fluid in pregnancy
61
Q

psychological change, three phases of transition in parenthood?

A

taking in (time of reflection)
taking hold
letting go

62
Q

taking in phase

A
  • relies on nurse more
  • tired
  • wants to talk about pregnancy and birth
  • wants rest, getting to know baby
63
Q

taking hold phase

A
  • more assertive
  • interested in learning about newborns needs
  • seeks assistance
  • looks for guidance
64
Q

letting go phase

A
  • begins to define new role
  • lets go of previous role
  • make adjustments
65
Q

what are the postpartum blues

A

occur between days 3-5, no apparent reason

mood swings, anxiety

66
Q

uterus: postpartal change

A

involution begins immediately, contracts back to normal size

  • encourage mom to empty bladder often
  • breast feeding helps contractions go faster
67
Q

fundus: postpartal change

A

may rise 1 cm above umbilicus (12 hours pp), then descends 1 to 2 cm every 24 hours
-not palpable after 2 weeks

68
Q

afterpains: postpartal change

A

less with first time mothers, more in stretched uterus

69
Q

cervix: postpartal

A

remains open after birth for over 1 week, infection risk

70
Q

ovaries: postpartal

A

menstruation begins in 6 to 10 weeks, 8 weeks to 18 months in breastfeeding mothers

71
Q

perineum: postpartal

A

tender, does not return to prepregnant state

72
Q

endocrine system: postpartal

A

prolactin for breast milk increases, estrogen and progesterone decreases, thyroid levels return to normal

73
Q

normal blood loss for birth?

A

500 vaginal 1000 C section

74
Q

VS return to normal quick after birth however…

A

stroke volume, cardiac output, end-diastolic and end-systemic vascular resistance remain elevated for 12-24 weeks

75
Q

joints stabilize by?

A

6-8 weeks

76
Q

en face position

A

direct eye contact is beginning of attachment

77
Q

engrossment

A

father and mother gazing for prolonged periods of time at baby

78
Q

melesma is?

A

chosma or mask of pregnancy, usually disappears, remains in 30% of woman

79
Q

3 postpartum changes that protect woman by increasing blood volume

A
  • elimination of uteroplacental circlation reduces size of maternal vascular bed
  • loss of placental endocrine function removes stimulus for vasodilation
  • mobilization of extravascular water stored during pregnancy
80
Q

when is plasma volume replenished

A

3rd postpartum day

81
Q

colostrum is

A

clear yellow early milk

82
Q

postpartal: urinary system

A

decreased urge to void, may result in bladder distension

-kidney function returns to normal within 1 month

83
Q

does external os regain prepregant state

A

no, loses circular shape, becomes jagged slit

84
Q

lochia rubia=

A

mainly blood and debris, dark red colour

85
Q

lochia serosa=

A

old blood, leukocytes, debris, 4 to 10 days.

-pinkish brown

86
Q

lochia alba=

A

whitish yellow, 10 to 28 days

87
Q

involution?

A

return of uterus to non pregnant state

88
Q

what is apgar scoring?

A

rapid assessment of newborns transition to extrauterine existence on basis of 5 signs

89
Q

5 signs in apgar scoring

A 
heart rate
resp rate
muscle tone
reflex irritabiliy
generalized skin colour
90
Q

0-3 apgar score=

A

severe distress

91
Q

4-6 apgar score=

A

moderate difficulty

92
Q

7-10 apgar score=

A

minimal difficulties

93
Q

when is apgar scoring done

A

at 1 to 5 minutes after nurse

94
Q

when is apgar reassessed and why

A

at 10 to 20 mins if score is less than 7 at five minutes

95
Q

infant who has difficulty clearing mucus can be temporary placed in

A

side lying position until secretions are cleared

96
Q

ideal way of promoting warmth for baby

A

skin-to-skin contact on mothers chest with blanket!

97
Q

administration of vitamin K is done how?

A

intramuscularly to prevent hemorrhagic disease
either 0.5 or 1.0 mg depending on weight
-given 6 hrs after birth

98
Q

a more thorough physical assessment should occur when?

A

12 to 18 hours after birth

99
Q

temp, HR and RR for newborn

A

temp 37
HH 110 to 160
RR 30 to 60
BP not usually taken, very high after birth, varies with activity

100
Q

typical weight of babies

A

2500 to 4000g

101
Q

infants whose weight is appropriate for gestational age is?

A

between tenth and ninetieth percentiles, persumed to have grown at a normal rate

102
Q

ballard scale?

A

measures gestational age
-assesses 6 external and 6 neuromuscular signs
each sign has a number score and a cumulative score
-9 possible categories AGA, SGA, LGA term preterm posterm

103
Q

preterm or premature

A

before 37 weeks gestation

104
Q

late preterm

A

between 34 0/7 and 36 6/7

105
Q

early preterm

A

between 37 and 38 +6 weeks

106
Q

full term

A

week 39 and end of week 40 +6

107
Q

late term

A

41st week

108
Q

post term

A

after 42 week

109
Q

postmature

A

after completion of week 42, showing effects of progressive placental insufficiency

110
Q

what is caput succedaneum

A

edema of scalp, resolves in a few days

111
Q

cephalohematome

A

collection of blood between periosteum and skull bone due to birth trauma. may take few weeks to resolve

112
Q

craniotabes

A

softening of cranial bones in utero, may take several months

113
Q

hyperbilirubinemia

A

very common, jaundiced skin.

  • best therapy is prevention
  • goal is to reduce newborns serum levels of unconjugated bilirubin
114
Q

thermoregulation of infant

A

very important- can lose lots of heat through evaporation conduction, convection, radiation; skin to skin is important

115
Q

cold stress..

A

can increase need for oxygen and may deplete glucose stores

-infant may react to exposure to cold by increasing resp rate and becoming cyanotic

116
Q

can a healthy baby become hypothermic

A

yes. many reasons why. rapid warming however can cause apnea and acidosis, warming process must be monitored

117
Q

what is hypoglycemic

A

BS of <2.5 mmol/L

final two 133 quizzes! (2 decks)

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