Midterm Flashcards
Mixed opioid agonist-antagonist compound
Systemic analgesic that provides analgesia without causing maternal or neonatal respiratory depression
Anesthesia
Abolition of pain perception by interrupting nerve impulses going to the brain. Loss of sensation (partial or complete) and sometimes loss of consciousness occurs.
Analgesia
Alleviation of pain sensation or raising of the pain threshold without loss of consciousness
Ataractic
Analgesic potentiator such as a tranquilizer
Epidural analgesia/ anesthesia (block)
Relief from pain of uterine contractions and birth by injection a local anesthetic and/or opioid into the peridural space
Autologous epidural blood patch
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)
Local infiltration anesthesia
Provides rapid perineal anesthesia for performing and repairing an episiotomy
Spinal anesthesia (block)
Single-injection, subarachnoid anesthesia useful for pain control during birth but not for labor
Opioid antagonist
Drug that reverses the effects of opioids, including neonatal narcosis (CNS depression of the newborn)
Paracervical (uterosacral) block
Anesthesia method used to relieve pain from uterine contractions and cervical dilation. It is associated with fetal bradycardia.
Pudendal nerve block
Anesthetic that relieves pain in the lower vagina, vulva, and perineum, making it useful for episiotomy, birth, and use of low forceps
Systemic analgesic
Medication such as an opioid analgesic that is administered IM or IV for pain relief during labor.
Sedative
Medication such as a barbiturate that can be used to relieve anxiety and induce sleep in prodromal or early latent labor.
Acceleration
Visually apparent abrupt increase in the FHR of 15 beats/min or more with return to baseline less than 2 minutes from the onset.
Early deceleration
Visually apparent decrease in and return to baseline FHR in response to fetal head compression.
Variability
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.
Late deceleration
Visually parent gradual decrease in and return to baseline FHR in response to uteroplacental insufficiency; lowest point occurs after the peak of the contraction.
Variable deceleration
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.
Tachycardia
Persistent (10 minutes or longer) baseline FHR above 160 beats/min.
Prolonged deceleration
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
Bradycardia
Persistent (10 minutes or longer) baseline FHR below 100 beats/min.
Baseline FHR
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.
Undetected variability
Absence of the expected irregular fluctuations in the baseline FHR.
Periodic changes
Changes from baseline patterns in FHR that occur with uterine contractions
Episodic changes
Changes from baseline patterns in FHR that are not associated with uterine contractions.
Obtain a _____ minute strip by electronic fetal monitoring (EFM) on all women admitted to the labor unit.
20
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.
30 minutes for first stage
15 minutes for second stage
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.
15 minutes
5 minutes
Ritgen maneuver
Technique used to control birth of fetal head and protect perineal musculature
Episiotomy
Incision into perineum to enlarge the vaginal outlet.
Oxytocic
Classification of medication that stimulates the uterus to contract.
Ferguson reflex
Occurs when pressure of present part against pelvic floor stretch receptors results in a woman’s perception of an urge to bear down.
Shultz mechanism
Technique used to control birth of fetal head and protect perineal musculature.
Caul
Intact amniotic membrane surrounds the newborn’s head at birth.
Valsalva maneuver
Prolonged breath holding while bearing down (closed glottis pushing)
Ring of fire
Burning sensation of acute pain as vagina stretches and crowning occurs
Crowning
Occurs when widest part of the head (biparietal diameter) distends the vulva just prior to birth.
Duncan mechanism
Expulsion of placenta with maternal surface emerging first.
Amniotomy
Artificial rupture of membranes (AROM, ARM)
Nuchal cord
Cord encircles the fetal neck
Prolapse of umbilical cord
Protrusion of umbilical cord in advance of the presenting part.
Nitrazine test
Method used to determine whether membranes have ruptured by assessing pH of the fluid.
*Nitrazine paper turns blue with alkaline amniotic fluid
Leopold’s maneuvers
Method used to palpate fetus through abdomen
Acrocyanosis
Slight bluish discoloration of feet and hands
Uterine contractions
The primary powers of labor that act involuntarily to expel the fetus and the placenta from the uterus.
Increment
“Building up” phase of a contraction
Acme
The peak of a contraction
Decrement
“Letting down” phase of a contraction
Frequency
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.
Intensity
The strength of the contraction at its peak
Duration
The period of time that elapses between the onset and end of a contraction
Resting tone
The tension of the uterine muscle during the internal between contractions.
The five factors of labor are:
(5 P’s)
- Passenger (fetus, placenta)
- Powers
- (maternal) Position
- Psychologic responses
Fontanels
Membrane-filled spaces that are located where sutures in the fetal/neonatal skull intersect.
Molding
The slight overlapping of bones of the fetal skull that occurs during childbirth.
Presentation
The part of the fetus that enters the pelvic inlet first.
The 3 main types of presentation are:
- Cephalic (head first)
- Breech (buttocks first)
- Shoulder
Presenting part
The fetal body first felt by the examining finger during a vaginal examination.
The four types of presenting parts are:
- Occiput
- Mentum/chin
- Sacrum
- Scapula vertex
Vertex presentation
When the fetal head is fully flexed, making the occiput the fetal part first felt by the examining finger.
Fetal lie
The relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother
The two types of fetal lie are:
- Longitudinal/vertical
- Transverse/ horizontal
Longitudinal/ vertical fetal lie
When the spines of the fetus and mother are parallel to each other
Transverse/ horizontal fetal lie
When the spines of the fetus and mother are at right angles or diagonal or oblique to each other.
Attitude (posture)
The relationship of the fetal body parts to each other
General flexion
The most common type of attitude (posture)
Biparietal diameter
The largest transverse diameter of the fetal skull
Suboccipitobregmatic diameter
The smallest anteroposterior dimeter of the fetal skull to enter the maternal pelvis when the fetal head is in complete flexion.
Engagement
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.
Station
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.
Effacement
The shortening and thinning of the cervix during the first stage of labor.
Degree of effacement is expressed as a percentage (%)
Dilation
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)
Primigravida lightening
When the fetus’s presenting part descents into the true pelvis approximately 2 weeks before term.
Multiparous lightening
May not occur until after uterine contractions are established and true labor is in progress.
Involuntary uterine contractions
The primary powers of labor
Pushing & bearing down
The secondary powers of labor
Bloody show
Discharge of brownish/blood tinged cervical mucus, representing the passage of the mucus plug as the cervix ripens in preparation for labor.
Cardinal movement
Mechanism of labor referring to the turns and adjustments of the fetal head, to facilitate the passage through the maternal pelvis.
The 7 parts of cardinal movement
- engagement
- descent
- flexion
- internal rotation
- extension
- restitution (external rotation)
- (finally birth by) expulsion
What does the Valsalva maneuver do during the second stage of labor?
A pushing method during the second stage of labor characterized by a closed glottis with breath holding and prolonged bearing down
Why is the Valsalva maneuver not recommended anymore?
It has been associated with fetal hypoxia and acidosis.
Perineal tears have been associated with direct pushing.
What does the first stage of labor begin and end with?
Begins: the onset of regular contractions
Ends: dilation of cervix
What are the 3 stages of the first stage of labor in order?
- latent
- active
- transition
What does the second stage of labor last from?
Full cervical dilation to the birth of the fetus
What does the third stage of labor last form after the birth of the fetus?
Until the placenta is delivered
The fourth stage of labor consists of and lasts for how long?
Period of recovery following birth when hemostasis is reestablished.
~2-4 hours
The four factors that affect fetal circulation during labor are:
- maternal position
- blood pressure
- uterine contractions
- umbilical cord blood flow
Tocolytic
Classification of drugs used to suppress uterine activity
*Management of PTL
Betamethasone
An antenatal glucocorticoid used to accelerate fetal lung maturity when there is risk for preterm birth
*Management of PTL
Ritodrine (Yutopar)
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
Terbutaline (Brethine)
A betamimetic often administered subcutaneously using a syringe or pump
*Management of PTL
Magnesium sulfate
A CNS depressant used during preterm labor for its ability to relax smooth muscles; administered intravenously.
*Management of PTL
Nifedipine (Procardia)
A calcium channel blocker that relaxes smooth muscles, including those of the contracting uterus; administered sublingually initially and then orally.
*Management of PTL
Indomethacin
A nonsteroidal anti-inflammatory medication that relaxes smooth muscles as a result of prostaglandin inhibition; administered rectally initially and then orally.
*Management of PTL
Oxytocin (Pitocin)
Pituitary hormone used to stimulate uterine contractions in the augmentation or induction of labor.
*For labor complications
Misoprostol (Cytotec)
Cervical ripening agent used in the form of a tablet that can be administered orally but more commonly, intra-vaginally.
*For labor complications
Dinoprostone (Cervidil)
Cervical ripening agent in the form of a vaginal insert that is placed in the posterior fornix of the vagina
*For labor complications
Dinoprostone (Prepidil)
Cervical ripening agent in the form of a gel that is inserted into the cervical canal just below the internal os.
*For labor complications
Terbutalie (Brethine)
Tocolytic medication administered subcutaneously to suppress hyperstimulation of the uterus
*For labor complications
Prostaglandin
Classification of hormone that can be used to ripen the cervix and/or stimulate uterine contractions
*For labor complications
Laminaria tent
Natural cervical dilator made from seaweed
*For labor complications
12-hour newborn assessment
Crackles upon auscultation of the lungs
P- reflective of potential problems with adaption to extrauterine life
12-hour newborn assessment
Respirations: 36, irregular, shallow
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Episodic apnea lasting 5-10 seconds
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Episodic apnea lasting 15-20 seconds
P- reflective of potential problems with adaption to extrauterine life
12-hour newborn assessment
Nasal flaring & sternal retractions
P- reflective of potential problems with adaption to extrauterine life
12-hour newborn assessment
Slight bluish discoloration of feet & hands
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Blood pressure 78/42
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Apical rate: 126 with murmurs
N- reflective of normal adaption or acceptable variation to extrauterine life
*murmurs are usually transient; however they do need further assessment/evaluation
12-hour newborn assessment
Hyperextension of toes w/ dorsiflexion of big toe with sole is stroked upward (Babinski Reflex)
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Temperature: 31.1oC axillary
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Head 34 cm and chest 36 cm
P- reflective of potential problems with adaption to extrauterine life
12-hour newborn assessment
Boggy, edematous swelling over occiput
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Overlapping of parietal bones
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
White pimple-like spots on nose and chin
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Jaundice on face & chest
P- reflective of potential problems with adaption to extrauterine life
* “abnormal” if <24 hrs. old
12-hour newborn assessment
Regurgitation of small amount of milk after feedings
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Liver palpated 1 cm below right costal margin
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Absence of bowel elimination since birth
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Spine straight with dimple at base
P- reflective of potential problems with adaption to extrauterine life
12-hour newborn assessment
Adhesion of prepuce (foreskin); unable to fully retract
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Edema of scrotum and labia
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Hematocrit 36% and hemoglobin 12 g/dl
P- reflective of potential problems with adaption to extrauterine life
12-hour newborn assessment
WBC 23,000/mm3
N- reflective of normal adaption or acceptable variation to extrauterine life
12-hour newborn assessment
Blood glucose 40 mg/dl
N- reflective of normal adaption or acceptable variation to extrauterine life
*Borderline low
Rooting Reflex
Touch infant’s lip, cheek, or corner of mouth with nipple-turns head toward stimulus, opens mouth, takes hold, and sucks
Tonic Neck Reflex
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.
Grasp Reflex
Place finger in palm of hand or at base of toes- infant’s fingers curl around examiners finger; toes curl downward
Extrusion Reflex
Touch or depress tip of tongue- tongue is forced outward
Glabellar Reflex
Tap over forehead, bridge of nose, or maxilla when eyes are open-blinks for first four to five taps.
Moro Reflex
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.
Stepping (Walking) Reflex
Hold infant vertically, allowing one foot to touch table surface- infant alternates flexion and extension of feet
Startle Reflex
Clap hands sharply-arms abduct with flexion of elbows; hands stay clenched
Babinski Reflex
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
Trunk Incurvation Reflex
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
Magnet Reflex
Apply pressure to feet with fingers when the lower limbs are semiflexed-legs extend
Cremasteric Reflex
Testes retract when infant is chilled
T/F
Cracks, audibly grunting, nasal flaring and retractions of the chest are often noted during the second period of reactivity.
F
T/F
The WBC will increase markedly when the newborn develops an infection
F
T/F
Vitamin K administered IM to a newborn immediately after birth will enhance clotting, thereby preventing excessive bleeding
T
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.
T
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.
F
T/F
Jitteriness and tremors by indicate that the newborn is experiencing hypoglycemia.
T
T/F
Physiologic jaundice in the full-term newborn disappears by the end of the first week of life.
T
T/F
Kernicterus occurs when bilirubin invades the cells of the heart muscle, thereby weakening heart function.
F
T/F
Abdominal movements are counted when determining the respiratory rate of newborns
T
T/F
The first meconium stool often has a strong odor as a result of bacteria present in the fetal intestine during intrauterine life.
F
T/F
The wink reflex can be used to test the anal sphincter.
T
T/F
Breast tissue in full-term male and female newborns may be swollen and secrete a thin milky type of discharge.
T
T/F
Presence of a click and asymmetrical movement during Ortolani’s maneuver indicates hip dislocation or dysplasia.
T
T/F
Tympanic thermometers should not be used during infancy.
F
T/F
In physiologic jaundice the level of unconjugated bilirubin rarely exceed 16 mg/dl in full-term newborns.
F
Telangiectaci Nevi
Pinkish areas on upper eyelids, nose, upper lip, back of head, and nape of neck. Also known as “stork bites”
Molding
Overlapping of cranial bones to facilitate passage of the fetal head through the maternal pelvis during the process of labor and birth.
Caput succedaneum
Generalized, easily identifiable edematous are of the scalp usually over the occiput area.
Cephalhematoma
Collection of blood between skull bone and its periosteum as a result of pressure during birth
Mongolian Spots
Bluish-black pigmented areas usually found on back and buttock
Acrocyanosis
Bluish discoloration of the hands and feet, especially when chilled
Vernix caseosa
White, cheesy substance that coats and protects the fetus’ skin while in utero.
Milia
White facial pimples caused by distended sebaceous glands
Jaundice
Yellowish skill discoloration caused by increased levels of indirect or unconjugated bilirubin
Meconium
Thick, tarry, dark green-black stool usually passed within 24 hours of birth
Erythema toxicum
Sudden, transient newborn rash characterized by erythematous macules, papules, or small vesicles
Stabismus
Transient cross-eye appearance lasting until the third or fourth month of life.
Harlequinsign
Color variation related to vasoconstriction on one side of the body and vasodilation on the other side of the body.
Hydrocele
Accumulation of fluid in the scrotum, around the testes
Thrush
Monomial infection of oral cavity resulting in white plaques on buccal mucosa and tongue that bleed when touched
Fontanel
Membranous area formed where skull bones join
Lanugo
Soft, downy hair on face, shoulders, and back
Cause: Well oxygenated fetus
Pattern: Reassuring
Action: No specific action required
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 (?)
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 (?)
Cause: (fetal) head compression
Pattern: early decelerations
Action: early decels are reassuring so “action” not specifically needed.
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
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)
LOA
Left occiput anterior
LOT
Left occiput transverse
LOP
Left occiput posterior
ROA
Right occiput anterior
ROT
Right occiput transverse
ROP
Right occiput posterior
LMA
left mentum anterior
RMP
right mentum posterior
RMA
right mentum anterior
LSA
LSP
Sc A
scapula anterior
