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Labor & Delivery > Midterm > Flashcards

Midterm Flashcards

1
Q

Mixed opioid agonist-antagonist compound

A

Systemic analgesic that provides analgesia without causing maternal or neonatal respiratory depression

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2
Q

Anesthesia

A

Abolition of pain perception by interrupting nerve impulses going to the brain. Loss of sensation (partial or complete) and sometimes loss of consciousness occurs.

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3
Q

Analgesia

A

Alleviation of pain sensation or raising of the pain threshold without loss of consciousness

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4
Q

Ataractic

A

Analgesic potentiator such as a tranquilizer

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5
Q

Epidural analgesia/ anesthesia (block)

A

Relief from pain of uterine contractions and birth by injection a local anesthetic and/or opioid into the peridural space

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6
Q

Autologous epidural blood patch

A

Method used to repair a tear or hole in the dura mater around the spinal cord as a result of spinal anesthesia; the goal is to prevent or treat postdural puncture headaches (PDPH)

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7
Q

Local infiltration anesthesia

A

Provides rapid perineal anesthesia for performing and repairing an episiotomy

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8
Q

Spinal anesthesia (block)

A

Single-injection, subarachnoid anesthesia useful for pain control during birth but not for labor

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9
Q

Opioid antagonist

A

Drug that reverses the effects of opioids, including neonatal narcosis (CNS depression of the newborn)

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10
Q

Paracervical (uterosacral) block

A

Anesthesia method used to relieve pain from uterine contractions and cervical dilation. It is associated with fetal bradycardia.

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11
Q

Pudendal nerve block

A

Anesthetic that relieves pain in the lower vagina, vulva, and perineum, making it useful for episiotomy, birth, and use of low forceps

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12
Q

Systemic analgesic

A

Medication such as an opioid analgesic that is administered IM or IV for pain relief during labor.

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13
Q

Sedative

A

Medication such as a barbiturate that can be used to relieve anxiety and induce sleep in prodromal or early latent labor.

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14
Q

Acceleration

A

Visually apparent abrupt increase in the FHR of 15 beats/min or more with return to baseline less than 2 minutes from the onset.

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15
Q

Early deceleration

A

Visually apparent decrease in and return to baseline FHR in response to fetal head compression.

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16
Q

Variability

A

Expected irregular fluctuations in the baselines FHR of two or more cycles per minute as a result of the interaction of the sympathetic and parasympathetic nervous systems.

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17
Q

Late deceleration

A

Visually parent gradual decrease in and return to baseline FHR in response to uteroplacental insufficiency; lowest point occurs after the peak of the contraction.

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18
Q

Variable deceleration

A

Visually abrupt decrease in FHR below baseline, which can occur at any time during a contraction or between contractions, as a result of cord compression.

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19
Q

Tachycardia

A

Persistent (10 minutes or longer) baseline FHR above 160 beats/min.

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20
Q

Prolonged deceleration

A

Visually apparent decrease in the FHR of 15 beats/min or more below the baseline, which lasts more than 2 minutes but less than 10 minutes

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21
Q

Bradycardia

A

Persistent (10 minutes or longer) baseline FHR below 100 beats/min.

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22
Q

Baseline FHR

A

Average FHR during a 10 minute segment that excludes periodic or episodic changes, periods of marked variablilyt, and segments of the baseline that differ more than 25 beats/min. It is assessed during the absence of uterine activity or between contractions.

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23
Q

Undetected variability

A

Absence of the expected irregular fluctuations in the baseline FHR.

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24
Q

Periodic changes

A

Changes from baseline patterns in FHR that occur with uterine contractions

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25
Q

Episodic changes

A

Changes from baseline patterns in FHR that are not associated with uterine contractions.

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26
Q

Obtain a _____ minute strip by electronic fetal monitoring (EFM) on all women admitted to the labor unit.

A

20

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27
Q

Low risk patient (risk factors are absent during labor): auscultate FHR/assess tracing every _______ in the active phase of the first stage of labor and every _______ in the second stage of labor.

A

30 minutes for first stage

15 minutes for second stage

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28
Q

High risk patient (risk factors are present during labor): auscultate FHR/assess tracing every ______ in the active phase of the first stage of labor and every ______ in the second stage of labor.

A

15 minutes

5 minutes

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29
Q

Ritgen maneuver

A

Technique used to control birth of fetal head and protect perineal musculature

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30
Q

Episiotomy

A

Incision into perineum to enlarge the vaginal outlet.

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31
Q

Oxytocic

A

Classification of medication that stimulates the uterus to contract.

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32
Q

Ferguson reflex

A

Occurs when pressure of present part against pelvic floor stretch receptors results in a woman’s perception of an urge to bear down.

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33
Q

Shultz mechanism

A

Technique used to control birth of fetal head and protect perineal musculature.

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34
Q

Caul

A

Intact amniotic membrane surrounds the newborn’s head at birth.

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35
Q

Valsalva maneuver

A

Prolonged breath holding while bearing down (closed glottis pushing)

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36
Q

Ring of fire

A

Burning sensation of acute pain as vagina stretches and crowning occurs

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37
Q

Crowning

A

Occurs when widest part of the head (biparietal diameter) distends the vulva just prior to birth.

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38
Q

Duncan mechanism

A

Expulsion of placenta with maternal surface emerging first.

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39
Q

Amniotomy

A

Artificial rupture of membranes (AROM, ARM)

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40
Q

Nuchal cord

A

Cord encircles the fetal neck

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41
Q

Prolapse of umbilical cord

A

Protrusion of umbilical cord in advance of the presenting part.

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42
Q

Nitrazine test

A

Method used to determine whether membranes have ruptured by assessing pH of the fluid.

*Nitrazine paper turns blue with alkaline amniotic fluid

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43
Q

Leopold’s maneuvers

A

Method used to palpate fetus through abdomen

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44
Q

Acrocyanosis

A

Slight bluish discoloration of feet and hands

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45
Q

Uterine contractions

A

The primary powers of labor that act involuntarily to expel the fetus and the placenta from the uterus.

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46
Q

Increment

A

“Building up” phase of a contraction

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47
Q

Acme

A

The peak of a contraction

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48
Q

Decrement

A

“Letting down” phase of a contraction

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49
Q

Frequency

A

How often the contractions occur; the period of time from the beginning of one contraction to the beginning of the next or from the peak of one contraction to the peak of the next.

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50
Q

Intensity

A

The strength of the contraction at its peak

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51
Q

Duration

A

The period of time that elapses between the onset and end of a contraction

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52
Q

Resting tone

A

The tension of the uterine muscle during the internal between contractions.

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53
Q

The five factors of labor are:

(5 P’s)

A
  1. Passenger (fetus, placenta)
  2. Powers
  3. (maternal) Position
  4. Psychologic responses
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54
Q

Fontanels

A

Membrane-filled spaces that are located where sutures in the fetal/neonatal skull intersect.

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55
Q

Molding

A

The slight overlapping of bones of the fetal skull that occurs during childbirth.

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56
Q

Presentation

A

The part of the fetus that enters the pelvic inlet first.

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57
Q

The 3 main types of presentation are:

A
  1. Cephalic (head first)
  2. Breech (buttocks first)
  3. Shoulder
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58
Q

Presenting part

A

The fetal body first felt by the examining finger during a vaginal examination.

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59
Q

The four types of presenting parts are:

A
  1. Occiput
  2. Mentum/chin
  3. Sacrum
  4. Scapula vertex
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60
Q

Vertex presentation

A

When the fetal head is fully flexed, making the occiput the fetal part first felt by the examining finger.

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61
Q

Fetal lie

A

The relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother

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62
Q

The two types of fetal lie are:

A
  1. Longitudinal/vertical
  2. Transverse/ horizontal
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63
Q

Longitudinal/ vertical fetal lie

A

When the spines of the fetus and mother are parallel to each other

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64
Q

Transverse/ horizontal fetal lie

A

When the spines of the fetus and mother are at right angles or diagonal or oblique to each other.

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65
Q

Attitude (posture)

A

The relationship of the fetal body parts to each other

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66
Q

General flexion

A

The most common type of attitude (posture)

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67
Q

Biparietal diameter

A

The largest transverse diameter of the fetal skull

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68
Q

Suboccipitobregmatic diameter

A

The smallest anteroposterior dimeter of the fetal skull to enter the maternal pelvis when the fetal head is in complete flexion.

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69
Q

Engagement

A

When the biparietal diameter (largest diameter) of the presenting part has passed through the maternal pelvic brim or inlet into the true pelvis reaching the level of the ischial spines or zero station.

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70
Q

Station

A

The relationship between the presenting part of the fetus to an imaginary line drawn between the ischial spines.

-It is measured in terms of centimeters above or below the ischial spines, thereby serving as a method of determining the progress of fetal descent.

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71
Q

Effacement

A

The shortening and thinning of the cervix during the first stage of labor.

Degree of effacement is expressed as a percentage (%)

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72
Q

Dilation

A

The enlargement or widening of the cervical opening (os) and the cervical canal, which occurs once labor has begun.

Degree of progress is expressed in cm (0-10)

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73
Q

Primigravida lightening

A

When the fetus’s presenting part descents into the true pelvis approximately 2 weeks before term.

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74
Q

Multiparous lightening

A

May not occur until after uterine contractions are established and true labor is in progress.

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75
Q

Involuntary uterine contractions

A

The primary powers of labor

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76
Q

Pushing & bearing down

A

The secondary powers of labor

77
Q

Bloody show

A

Discharge of brownish/blood tinged cervical mucus, representing the passage of the mucus plug as the cervix ripens in preparation for labor.

78
Q

Cardinal movement

A

Mechanism of labor referring to the turns and adjustments of the fetal head, to facilitate the passage through the maternal pelvis.

79
Q

The 7 parts of cardinal movement

A
  1. engagement
  2. descent
  3. flexion
  4. internal rotation
  5. extension
  6. restitution (external rotation)
  7. (finally birth by) expulsion
80
Q

What does the Valsalva maneuver do during the second stage of labor?

A

A pushing method during the second stage of labor characterized by a closed glottis with breath holding and prolonged bearing down

81
Q

Why is the Valsalva maneuver not recommended anymore?

A

It has been associated with fetal hypoxia and acidosis.

Perineal tears have been associated with direct pushing.

82
Q

What does the first stage of labor begin and end with?

A

Begins: the onset of regular contractions

Ends: dilation of cervix

83
Q

What are the 3 stages of the first stage of labor in order?

A
  1. latent
  2. active
  3. transition
84
Q

What does the second stage of labor last from?

A

Full cervical dilation to the birth of the fetus

85
Q

What does the third stage of labor last form after the birth of the fetus?

A

Until the placenta is delivered

86
Q

The fourth stage of labor consists of and lasts for how long?

A

Period of recovery following birth when hemostasis is reestablished.

~2-4 hours

87
Q

The four factors that affect fetal circulation during labor are:

A
  1. maternal position
  2. blood pressure
  3. uterine contractions
  4. umbilical cord blood flow
88
Q

Tocolytic

A

Classification of drugs used to suppress uterine activity

*Management of PTL

89
Q

Betamethasone

A

An antenatal glucocorticoid used to accelerate fetal lung maturity when there is risk for preterm birth

*Management of PTL

90
Q

Ritodrine (Yutopar)

A

A beta-adrenergic receptor stimulant often administered intraveneiosuly; the only drug approved by the FDA for the purpose of suppressing uterine contractions, even though its not currently marketed for PTL use.

*Management of PTL

91
Q

Terbutaline (Brethine)

A

A betamimetic often administered subcutaneously using a syringe or pump

*Management of PTL

92
Q

Magnesium sulfate

A

A CNS depressant used during preterm labor for its ability to relax smooth muscles; administered intravenously.

*Management of PTL

93
Q

Nifedipine (Procardia)

A

A calcium channel blocker that relaxes smooth muscles, including those of the contracting uterus; administered sublingually initially and then orally.

*Management of PTL

94
Q

Indomethacin

A

A nonsteroidal anti-inflammatory medication that relaxes smooth muscles as a result of prostaglandin inhibition; administered rectally initially and then orally.

*Management of PTL

95
Q

Oxytocin (Pitocin)

A

Pituitary hormone used to stimulate uterine contractions in the augmentation or induction of labor.

*For labor complications

96
Q

Misoprostol (Cytotec)

A

Cervical ripening agent used in the form of a tablet that can be administered orally but more commonly, intra-vaginally.

*For labor complications

97
Q

Dinoprostone (Cervidil)

A

Cervical ripening agent in the form of a vaginal insert that is placed in the posterior fornix of the vagina

*For labor complications

98
Q

Dinoprostone (Prepidil)

A

Cervical ripening agent in the form of a gel that is inserted into the cervical canal just below the internal os.

*For labor complications

99
Q

Terbutalie (Brethine)

A

Tocolytic medication administered subcutaneously to suppress hyperstimulation of the uterus

*For labor complications

100
Q

Prostaglandin

A

Classification of hormone that can be used to ripen the cervix and/or stimulate uterine contractions

*For labor complications

101
Q

Laminaria tent

A

Natural cervical dilator made from seaweed

*For labor complications

102
Q

12-hour newborn assessment

Crackles upon auscultation of the lungs

A

P- reflective of potential problems with adaption to extrauterine life

103
Q

12-hour newborn assessment

Respirations: 36, irregular, shallow

A

N- reflective of normal adaption or acceptable variation to extrauterine life

104
Q

12-hour newborn assessment

Episodic apnea lasting 5-10 seconds

A

N- reflective of normal adaption or acceptable variation to extrauterine life

105
Q

12-hour newborn assessment

Episodic apnea lasting 15-20 seconds

A

P- reflective of potential problems with adaption to extrauterine life

106
Q

12-hour newborn assessment

Nasal flaring & sternal retractions

A

P- reflective of potential problems with adaption to extrauterine life

107
Q

12-hour newborn assessment

Slight bluish discoloration of feet & hands

A

N- reflective of normal adaption or acceptable variation to extrauterine life

108
Q

12-hour newborn assessment

Blood pressure 78/42

A

N- reflective of normal adaption or acceptable variation to extrauterine life

109
Q

12-hour newborn assessment

Apical rate: 126 with murmurs

A

N- reflective of normal adaption or acceptable variation to extrauterine life

*murmurs are usually transient; however they do need further assessment/evaluation

110
Q

12-hour newborn assessment

Hyperextension of toes w/ dorsiflexion of big toe with sole is stroked upward (Babinski Reflex)

A

N- reflective of normal adaption or acceptable variation to extrauterine life

111
Q

12-hour newborn assessment

Temperature: 31.1oC axillary

A

N- reflective of normal adaption or acceptable variation to extrauterine life

112
Q

12-hour newborn assessment

Head 34 cm and chest 36 cm

A

P- reflective of potential problems with adaption to extrauterine life

113
Q

12-hour newborn assessment

Boggy, edematous swelling over occiput

A

N- reflective of normal adaption or acceptable variation to extrauterine life

114
Q

12-hour newborn assessment

Overlapping of parietal bones

A

N- reflective of normal adaption or acceptable variation to extrauterine life

115
Q

12-hour newborn assessment

White pimple-like spots on nose and chin

A

N- reflective of normal adaption or acceptable variation to extrauterine life

116
Q

12-hour newborn assessment

Jaundice on face & chest

A

P- reflective of potential problems with adaption to extrauterine life

* “abnormal” if <24 hrs. old

117
Q

12-hour newborn assessment

Regurgitation of small amount of milk after feedings

A

N- reflective of normal adaption or acceptable variation to extrauterine life

118
Q

12-hour newborn assessment

Liver palpated 1 cm below right costal margin

A

N- reflective of normal adaption or acceptable variation to extrauterine life

119
Q

12-hour newborn assessment

Absence of bowel elimination since birth

A

N- reflective of normal adaption or acceptable variation to extrauterine life

120
Q

12-hour newborn assessment

Spine straight with dimple at base

A

P- reflective of potential problems with adaption to extrauterine life

121
Q

12-hour newborn assessment

Adhesion of prepuce (foreskin); unable to fully retract

A

N- reflective of normal adaption or acceptable variation to extrauterine life

122
Q

12-hour newborn assessment

Edema of scrotum and labia

A

N- reflective of normal adaption or acceptable variation to extrauterine life

123
Q

12-hour newborn assessment

Hematocrit 36% and hemoglobin 12 g/dl

A

P- reflective of potential problems with adaption to extrauterine life

124
Q

12-hour newborn assessment

WBC 23,000/mm3

A

N- reflective of normal adaption or acceptable variation to extrauterine life

125
Q

12-hour newborn assessment

Blood glucose 40 mg/dl

A

N- reflective of normal adaption or acceptable variation to extrauterine life

*Borderline low

126
Q

Rooting Reflex

A

Touch infant’s lip, cheek, or corner of mouth with nipple-turns head toward stimulus, opens mouth, takes hold, and sucks

127
Q

Tonic Neck Reflex

A

Place infant in a supine position, and turn head quickly to one side as infant is falling asleep or is asleep-arm and leg extend on side to which head is turned while opposite arm and leg flex.

128
Q

Grasp Reflex

A

Place finger in palm of hand or at base of toes- infant’s fingers curl around examiners finger; toes curl downward

129
Q

Extrusion Reflex

A

Touch or depress tip of tongue- tongue is forced outward

130
Q

Glabellar Reflex

A

Tap over forehead, bridge of nose, or maxilla when eyes are open-blinks for first four to five taps.

131
Q

Moro Reflex

A

Place infant on flat surface and strike surface-symmetric abduction and extension of arms occur, fingers fan out, thumb and forefinger form a “C”, slight tremor may occur.

132
Q

Stepping (Walking) Reflex

A

Hold infant vertically, allowing one foot to touch table surface- infant alternates flexion and extension of feet

133
Q

Startle Reflex

A

Clap hands sharply-arms abduct with flexion of elbows; hands stay clenched

134
Q

Babinski Reflex

A

Use finger to stroke sole of foot beginning at heel, upward along lateral aspect of sole, then across ball of foot- all toes hyperextend, with dorsiflexion of big toe

135
Q

Trunk Incurvation Reflex

A

Place infant prone on flat surface, and run finger down side of back 4-5 cm lateral to spine- body flexes and pelvis swings toward stimulated side

136
Q

Magnet Reflex

A

Apply pressure to feet with fingers when the lower limbs are semiflexed-legs extend

137
Q

Cremasteric Reflex

A

Testes retract when infant is chilled

138
Q

T/F

Cracks, audibly grunting, nasal flaring and retractions of the chest are often noted during the second period of reactivity.

A

F

139
Q

T/F

The WBC will increase markedly when the newborn develops an infection

A

F

140
Q

T/F

Vitamin K administered IM to a newborn immediately after birth will enhance clotting, thereby preventing excessive bleeding

A

T

141
Q

T/F

Blood-tinged mucus on the diaper of a female newborn should be documented by the nurse as pseudo-menstruation and recognized as an expected assessment finding r/t the withdrawal of maternal estrogen.

A

T

142
Q

T/F

A newborn usually loses approximately 20% of its birth weight during the first 3-5 days of life as a result of fluid loss, and an increased metabolic rate.

A

F

143
Q

T/F

Jitteriness and tremors by indicate that the newborn is experiencing hypoglycemia.

A

T

144
Q

T/F

Physiologic jaundice in the full-term newborn disappears by the end of the first week of life.

A

T

145
Q

T/F

Kernicterus occurs when bilirubin invades the cells of the heart muscle, thereby weakening heart function.

A

F

146
Q

T/F

Abdominal movements are counted when determining the respiratory rate of newborns

A

T

147
Q

T/F

The first meconium stool often has a strong odor as a result of bacteria present in the fetal intestine during intrauterine life.

A

F

148
Q

T/F

The wink reflex can be used to test the anal sphincter.

A

T

149
Q

T/F

Breast tissue in full-term male and female newborns may be swollen and secrete a thin milky type of discharge.

A

T

150
Q

T/F

Presence of a click and asymmetrical movement during Ortolani’s maneuver indicates hip dislocation or dysplasia.

A

T

151
Q

T/F

Tympanic thermometers should not be used during infancy.

A

F

152
Q

T/F

In physiologic jaundice the level of unconjugated bilirubin rarely exceed 16 mg/dl in full-term newborns.

A

F

153
Q

Telangiectaci Nevi

A

Pinkish areas on upper eyelids, nose, upper lip, back of head, and nape of neck. Also known as “stork bites”

154
Q

Molding

A

Overlapping of cranial bones to facilitate passage of the fetal head through the maternal pelvis during the process of labor and birth.

155
Q

Caput succedaneum

A

Generalized, easily identifiable edematous are of the scalp usually over the occiput area.

156
Q

Cephalhematoma

A

Collection of blood between skull bone and its periosteum as a result of pressure during birth

157
Q

Mongolian Spots

A

Bluish-black pigmented areas usually found on back and buttock

158
Q

Acrocyanosis

A

Bluish discoloration of the hands and feet, especially when chilled

159
Q

Vernix caseosa

A

White, cheesy substance that coats and protects the fetus’ skin while in utero.

160
Q

Milia

A

White facial pimples caused by distended sebaceous glands

161
Q

Jaundice

A
162
Q

Yellowish skill discoloration caused by increased levels of indirect or unconjugated bilirubin

A
163
Q

Meconium

A

Thick, tarry, dark green-black stool usually passed within 24 hours of birth

164
Q

Erythema toxicum

A

Sudden, transient newborn rash characterized by erythematous macules, papules, or small vesicles

165
Q

Stabismus

A

Transient cross-eye appearance lasting until the third or fourth month of life.

166
Q

Harlequinsign

A

Color variation related to vasoconstriction on one side of the body and vasodilation on the other side of the body.

167
Q

Hydrocele

A

Accumulation of fluid in the scrotum, around the testes

168
Q

Thrush

A

Monomial infection of oral cavity resulting in white plaques on buccal mucosa and tongue that bleed when touched

169
Q

Fontanel

A

Membranous area formed where skull bones join

170
Q

Lanugo

A

Soft, downy hair on face, shoulders, and back

171
Q
A

Cause: Well oxygenated fetus

Pattern: Reassuring

Action: No specific action required

172
Q
A

Cause: utero-placental insufficiency

Pattern: Late decelerations that continue past the end of a contraction

Action:

Change positions (L or R)

Administer O2 via mask

Increase IV rate

Stop “pit” if running

Anticipate C-S (?)

173
Q
A

Cause: Fetal hypoxia or distress

Pattern: bradycardia w/ minimal variability

Action: Change positions (L or R)

Administer O2 via mask

Increase IV rate

Stop “pit” if running

Anticipate C-S (?)

174
Q
A

Cause: (fetal) head compression

Pattern: early decelerations

Action: early decels are reassuring so “action” not specifically needed.

175
Q
A

Cause: umbilical cord compression

Pattern: viable decels.

Action:

Change positions (L or R) Administer O2 via mask

Increase IV rate

If d/t ↓ amniotic fluid

→ administer amnio-infusion if ordered

176
Q
A

Pattern: tachycardia (i.e. 210 bpm)

Action:

Depends on cause (i.e. infection, etc)

Actions similar to late decels. may be needed for fetal distress (late)

177
Q
A

LOA

Left occiput anterior

178
Q
A

LOT

Left occiput transverse

179
Q
A

LOP

Left occiput posterior

180
Q
A

ROA

Right occiput anterior

181
Q
A

ROT

Right occiput transverse

182
Q
A

ROP

Right occiput posterior

183
Q
A

LMA

left mentum anterior

184
Q
A

RMP

right mentum posterior

185
Q
A

RMA

right mentum anterior

186
Q
A

LSA

187
Q
A

LSP

188
Q
A

Sc A

scapula anterior

Labor & Delivery (1 decks)

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