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NRSG 344 > Midterm: wk 2, 3, 4 > Flashcards

Midterm: wk 2, 3, 4 Flashcards

1
Q

Probable causes of health disparities (4)

A

*Race: shorter life expectancy, higher infant/maternal mortality, more birth defects, more STDs
*Environment
*socioeconomic factors
*health behaviors

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2
Q

Family systems theory

A

Views family as a complex system of interconnected and interdependent individuals

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3
Q

Types of families

A

Traditional, non-traditional

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4
Q

Traditional and legal family definition

A

Family mems are related by legal ties or genetic relationships

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5
Q

Non-traditional fam def

A

2 people who say they are “family” and are bound by emotional ties

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6
Q

Family DEVELOPMENT theory (3 points) (think development stages)

A

*Family is a developing group which goes through stages
*fam mems must perform certain time specific tasks
*disequilibrium is common when entering a new stage w/goal of hemostasis w/i stages

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7
Q

Family SYSTEMS theory (3 points) (the system IIB)

A

*Inter-related: a change in one member affects the whole family
*Interaction: “who am I” and “who I have become” depends on fam relations and interactions
*Boundaries: Lines between fam mems and between the fam and the outside world

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8
Q

family STRESS theory (3 points)

A

*stress is a definite part of fam life
*one fam’s crisis is another fam’s challenge
*ability to handle depends on fam’s stability/attributes, resources/support, perception, and learned coping strategies

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9
Q

Family ROLE theory (5 points): roles are/have…

A

*defined by culture
*Most people serve several roles
*have expectations
*have stress or strain
*have transitions

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10
Q

Moral distress strategy: 4 Rs

A

*Recognize: be aware of complexities
*Release: what you can and can’t change
*Reconsider: reframe issues/view
*Restart: move forward in a positive way

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11
Q

Menstrual cycle: Endometrial development (4 points)

A
  1. Menstruation: surface of endometrium sheds resulting in menses
  2. Proliferative phase (follicular phase): endometrial cells proliferate and lining thickens
  3. Secretory phase (Luteal phase): egg is expelled from ovary (ovulation) into the pelvic cavity
  4. Premenstrual phase: Endometrium continues to mature until a sudden drop in hormone levels triggers menstruation (Week b4 period typically)
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12
Q

Ovarian cycle (3 points)

A
  1. follicular phase
  2. ovulation
  3. luteal phase
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13
Q

Follicular phase: Where, when, hormones

A

*Hormones: FSH stims graafian follicles (up to 20) which prepares egg for ovulation
*Where: Nerve cells in hypothalamus release GnRH into blood -> this stims the pituitary gland to make/release FSH and LH
*When: From start of period until ovulation

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14
Q

Ovulation: What

A

*Egg released into pelvic cavity -> fimbriae of fallopian tubes bring egg into tube

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15
Q

Luteal phase: Hormone, Where, Job (Lut the pro, the pre-placenta)

A

*Hormone: Progesterone
*Where: corpus luteum produces progesterone
*Job: if preg occurs, corpus luteum maintains pregnancy until placenta is mature enough to take over at 12 wks

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16
Q

Cephalocaudal direction

A

*Travel from head to toe in the 1st yr of life in increments of 3 mon
*2nd year of life in increments of 6 mon
*after 2 yrs, in increments on a year

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17
Q

Developmental milestones: 3 mon

A

maintains head upright (head)

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18
Q

Developmental milestones: 6 mon

A

Sits upright (trunk)

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19
Q

Developmental milestones: 9 mon

A

crawling (legs)

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20
Q

Developmental milestones: 12 mon

A

walking/taking 2-3 steps (feet)

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21
Q

Developmental milestones: 18 mon

A

running (legs)

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22
Q

Developmental milestone: 2 yrs

A

jumping (2 feet leave the ground)

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23
Q

Developmental milestone: 3 yrs

A

Can ride a tricycle (tri = 3)

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24
Q

Developmental milestone: 4 yrs

A

Hop on one foot

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25
Q

Average growth rate from 6-9 yrs

A
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26
Q

Piaget: cognitive development theory

A

A progressive reorganization of mental process as a result of biological maturation and environment experiences

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27
Q

Piaget: sensorimotor stage (age, definition, development)

A

(0-2 years)
*Infant explores world through direct sensory & motor contact.
*Object permanence and separation anxiety develop

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28
Q

Piaget: Preoperational stage (age, definition, development)

A

(2-7 yrs)
*Symbolic thinking, able to use proper syntax and grammar to express concepts, imagination and intuition strong but complex/abstract thinking weak
*Conservation developed

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29
Q

Piaget: Concrete operational stage (age, definition, development)

A

(7-11 yrs)
*Child moves from prelogical thought to solving concrete problems through logic. Able to see problems from other’s point of view
*Abstract thinking developed

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30
Q

Piaget: Formal operational (age, definition)

A

(11 yrs to adulthood)
*Able to think abstractly and logically

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31
Q

Erickson’s psychosocial development theory

A

personality develops in a predetermined order through eight stages of psychosocial development where the person experiences a crisis w/ pos and neg outcomes for personality development

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32
Q

Erickson’s crisis: Infancy (age/crisis/task)

A

(birth to 18 mon)
*trust vs. mistrust
*attachment to primary caregiver

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33
Q

Erickson’s crisis: Early childhood/preschool (age/crisis/task) (“i do it stage”)

A

(18 mon to 3 yrs)
*autonomy vs. shame & doubt
*gaining some basic control over self and environment

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34
Q

Erickson’s crisis: Late childhood (age/crisis/task)

A

(3-6 yrs)
*initiative vs. guilt
*becoming purposeful and directive

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35
Q

Erickson’s crisis: School age (age/crisis/task)

A

(6-12 yrs)
*industry vs inferiority
*developing social, physical, and learning skills

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36
Q

Erickson’s crisis: Adolescence (age/crisis/task)

A

(12-20 yrs)
*identity vs. role confusion
*developing some sense of identity

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37
Q

Erickson’s crisis: Early adulthood (age/crisis/task)

A

(20-35 yrs)
*intimacy vs. isolation, love, and friendship
*establishing intimate bonds of family, assist w/ return to work

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38
Q

Erickson’s crisis: Middle adulthood (age/crisis/task)

A

(35-65 yrs)
*generativity vs. stagnation
*fulfilling life goals, family, career, society

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39
Q

Erickson’s crisis: Late adulthood (age/crisis/task)

A

(65 yrs to death)
*integrity vs. despair
*looking back over life, accept it’s meaning

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40
Q

Kohlberg’s moral development theory

A

*moral development is sequential
*Stages cannot be skipped but someone may not make it to certain stages

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41
Q

Kohlberg’s stages: Pre conventional level

A

*stage 1: Avoiding punishment
*stage 2: Aiming at a reward

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42
Q

Kohlberg’s stages: Conventional level

A

*stage 3: Good boy & good girl attitude
*stage 4: Loyalty to law and order

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43
Q

Kohlberg’s stages: Post conventional level

A

*stage 5: Justice and spirit of the law
*stage 6: Universal principles of ethics

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44
Q

Overview of each Kohlberg level

A

*Pre conventional level: No internalization of right and wrong
*Conventional level: Intermediate internalization of right and wrong
*Post conventional level: Full internalization of right and wrong

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45
Q

Sigmund Freud’s Psychosexual development theory

A

personality developed through a series of childhood stages in which pleasure seeking energies from the child became focused on certain erogenous areas.

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46
Q

Freud’s stages, ages, and order

A
  1. Oral stage (birth to 1yr): mouth
  2. Anal stage (1-3 yrs): bowel and bladder
  3. Phallic stage (3-6 yrs): genitals
  4. Latent stage (6 yrs to puberty): libido inactive
  5. Genital stage: (puberty to death): maturing sexual interest
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47
Q

Separation anxiety stages

A
  1. protest: loud inconsolable crying, clinging (variable lengths of time)
  2. Despair: physical s/s mimic depression
  3. Denial/Detachment: no protest, happy w/strangers, development delays (prolonged separation >6mon
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48
Q

Stress reactions: infant s/s (3 points)

A

*searching w/ eyes for parent
*clinging to parent and rejecting strangers
*crying/screaming

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49
Q

Stress reactions: toddlers s/s (4 points)

A

*verbally attack strangers (“go away!”)
*physical resistance/run away
*continuous crying
*pleading parent to stay

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50
Q

Stress reactions: Pre-schoolers s/s (6 points)

A

*refusing to comply w/routine
*Bed wetting
*Difficulty sleeping (nightmares)
*indirectly expressing anger (breaking toys)
*Continually asking for parental return
*crying quietly

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51
Q

Stress reactions: School age kids s/s (3 points)

A

*act more stoic
*withdraw/show emotional coldness
*need to express anger (find alternative outlets)

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52
Q

Stress reactions: Adolescents s/s (6 points)

A

*Self-assertion/aggression
*Anger/frustration
*Uncooperativeness
*Withdrawal
*Questioning care
*lack concern for their privacy

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53
Q

Self reporting pain scale: age/resources

A

(>4 yrs)
*Faces pain scale
*VAS (visual analog scale)

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54
Q

FLACC scale

A

*Face, Legs, Activity, Cry, Consolability
*infants to 7yrs (those unable to communicate pain)

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55
Q

FACES (Wong-Baker) scale

A

*For children >3 yrs
*Allows child to rate their pain from 0 = no hurt/happy to 10 = worst pain/sad

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56
Q

OUCHER scale

A

*Features non-white ethnic groups
*For ages 3-13 yrs

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57
Q

Standard numerical rating scale NRS (0-10)

A

For ages >5yrs

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58
Q

Visual analog scale

A
  • Horizontal line scale with worst pain on left end to worst on right end of the line
  • For 4 ½ to 5 years
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59
Q

APPT pain scale

A

*Adolescent pediatric pain tool
*coloring areas of pain and intensity with dark or lighter red color on a body outline/graph
*(if child has sickle cell or other chronic disease with chronic pain)
*Preferred over NRS, Oucher, and FPS-R

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60
Q

Nonpharm pain management (8)

A

*Distraction: radio, cartoons, being silly, blowing bubbles, etc.
*Relaxation:
-Infant = well-supported rocking, repeat words
-Children = deep breaths, comfortable positioning, progressive relaxation
*Guided imagery: have child describe a pleasurable image/event
*Positive self talk
*Cutaneous stimulation: stimulate nerves via skin contact
*Containment swaddling: tight swaddling to mimic uterus
*Nonnutritive sucking: pacifier
*Kangaroo care: skin-to-skin contact with baby

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61
Q

DNA

A

Deoxyribonucleic acid
*Carrier of genetic info
*Main constituent of chromosomes

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62
Q

Genes

A

*Segments of DNA
*give physical characteristics that make you unique

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63
Q

Traits

A

*A gene is a segment of DNA that determines a trait
*traits are determined by genes on the chromosomes

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64
Q

Haploid

A

*Only sex chromosomes (gametes, eggs, sperm)
*Having a single set of unpaired chromosomes

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65
Q

Diploid

A

The presence of 2 complete sets of chromosomes in an organism’s cells, w/ each parent contributing a chromosome to each pair
*23 pairs, 46 chromosomes in all after fertilization
*As a result of this union, the offspring are formed with a mix of inherited genes

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66
Q

Homozygous

A

*term used to refer to an organism that has two identical alleles for a particular trait (TT or tt)

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67
Q

Heterozygous

A

Term used to refer to an organism that has two different alleles for the same trait (Tt)

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68
Q

Down’s syndrome (which chromosome and what)

A

Trisomy 21
*Extra chromosome at pair #21, resulting in total of 47 chromosomes

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69
Q

Chromosome that determines sex

A

*23rd pair of chromosomes are two special chromosomes X and Y

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70
Q

Autosomal Recessive inheritance

A

*autosomal genes are all but the 23rd (non-sex chromosomes)
* a way a genetic trait or condition can be passed down from parent to child.
*A genetic condition can occur when the child inherits one copy of a mutated (changed) gene from each parent.
*The parents of a child with an autosomal recessive condition usually do not have the condition.

71
Q

Examples of autosomal recessive disorders

A

*PKU (metabolic disorders)
*Cystic fibrosis (metabolic disorder)
*Sickle cell anemia

72
Q

Define autosomal dominant inheritance paterns

A

Only ONE abnormal gene from one parent is necessary for disease/disorder manifestation
*50% chance if there is an affected parent

73
Q

% chance a child will have a autosomal recessive disorder/disease

A
  • 25% chance child will have the disorder
  • 50% chance of child being a carrier
  • 25% chance of child being neither a carrier or having the
    disorder/disease
74
Q

Autosomal Dominant diseases/disorders

A

▪ Huntington disease
▪ Polycystic kidney disease
▪ Polydactyly (extra fingers/toes)
▪ Achondroplasia (short-limbed dwarfism)
▪ Neurofibromatosis

75
Q

5 structures involved in URI

A

*Nasal cavity
*Vocal cords in the larynx
*Sinuses
*Middle ear
*Pharynx

76
Q

3 structures involved in LRI

A

*Trachea
*Primary bronchi
*Lungs
(alveoli)

77
Q

Cues of resp difficulty in children (4)

A

*Tachypnea
*Retractions
*Nasal flaring
*Leaning forward/tilting head back to breathe

78
Q

4 cues of increased airway resistance

A

*Increased resp rate
*Retractions
*Nasal flaring
*Use of accessory muscles

79
Q

Nursing implications for use of metered dose inhalers (p. 1151

A
80
Q

Treatment guidelines for URI (5)

A

*Analgesics
*Maintain hydration
*NO ANTIBIOTICS
*RTC is symptoms persist beyond 7 days or worsens
*Prevention of spread

81
Q

Acute Otitis Media

A
  • Most commonly diagnosed illness in childhood
  • Inflammation of middle ear with rapid onset of symptoms/clinical signs
82
Q

Acute Otitis Media: who is most at risk and why

A
  • children between ages 6 months and 3 years—uncommon after age 8.
  • Breast-fed infants lower incidence than formula-fed infants because breast milk provides increase immunity that protects the eustachian tube and middle ear mucosa from pathogens.
  • Infants more predisposed because they have: Short, horizontally positioned eustachian tubes and Enlarged lymphoid tissue, which obstructs the eustachian tube opening
  • Bottle feeding infant in the supine position increases risk as position promotes pooling of milk in the pharyngeal cavity=infection.
83
Q

Acute Otitis Media: Treatment

A

*Analgesics
*Wait and see: 48-72 hrs, 6-23 mon old, non severe infection
*Antibiotics: < 6 mon, fever > 102.2F, ages > 2 w/ severe s/s
*Encourage prevention by breastfeeding, eliminate second-hand smoke exposure
*Myringotomy (incision of tympanic membrane)
*Tympanoplasty
*Severe (prophylactic antibiotics, assess hearing loss)

84
Q

Influenza: treatment

A

*Supportive therapy
*Antiviral prophylaxis like Tamiflu
*Immunization

85
Q

Croup: s/s

A

*BARKY COUGH
*inspiratory strider
*hoarseness
*fever
*URI symptoms

86
Q

Coup treatment: mild

A

*Hydration
*Humidified air
*Family education about worsening respiratory distress
*Most causes are self limiting for 3-5 days

87
Q

Bronchitis: def

A
  • Acute: transient inflammation of the larger lower airways
  • Chronic: poorly defined in children- rarely an isolated entity in children
88
Q

Bronchitis: tx

A

-Supportive if viral
-Avoidance of respiratory irritants
-Increase fluid intake and rest
-Bronchodilators??
-Inhaled steroids
-ANTIBIOTICS: if bacterial
-Pain meds for chest pain
-Humidification of air promotes comfort
-Cough medications??
-No antihistamines

89
Q

Bronchiolitis: def

A
  • Acute viral infection
  • Seasonal: most common in midwinter to early spring
90
Q

Bronchiolitis: tx

A

Supportive
-Hospitalization for some
infants

91
Q

Bronchiolitis: nrsg guidelines

A

*Don’t use bronchodilators, corticosteroids, or chest physiotherapy
*Use nebulized hypertonic saline, oxygen depending on sat
*DONT USE PULSE OX
*DONT USE ANTIBIOTICS UNLESS ANNOTHER INFECTION IS PRESENT

92
Q

RSV: most at risk (3)

A

*infants with…(congenital heart defects, underlying pulmonary disease, weak immune system)

93
Q

RSV: tx

A

*fluids, rest, 1-2 wks
*if not working Palivizumab IM, or Ribavirin

94
Q

RSV: Prevention

A

highly contagious
*wash hands, social distance, cover mouth when coughing

95
Q

difference between RSV and bronchiolitis

A

*RSV = pathogen
*Bronchiolitis = disease caused by RSV

96
Q

Pneumonia: def

A

*infection that inflames air sacs of one or both lungs
*fluid/pus fills air sacs

97
Q

bacterial pneumonia: clinical s/s (7)

A

-Varies greatly in age of child
-High fever
-Tachypnea
-Cough
-Crackles in the lungs
-Decreased breath sounds
-Abdominal pain

98
Q

bacterial pneumonia: usual tx

A

-Children < 5 years old with +CXR generally receive Rx for Amoxicillin
-Follow up within 12 hours to 5 days
*hospitalize if s/s of resp distress, apnea, hypoxemia, poor feeding

99
Q

bacterial pneumonia: prevention

A

*wash hands, social distance, cover mouth when coughing

100
Q

Tonsillectomy: post-op care (10)

A

*position to facilitate drainage
*cautious suctioning
*sit child up when awake
*no coughing frequently, clearing throat, blowing nose
*inspect secretions & vomitus for fresh blood
*tell parents about dry blood (brown) is fine
*Ice collar
*analgesics (iv or rectal)
*foods and fluids restricted when not fully awake then soft foods
*watch for shock: dropped BP and restlessness, continuous swallowing

101
Q

Tonsillectomy: pre-op care

A

*minimize activities
*soft liquid diet
*warm salt water gurgles
*warm fluids
*throat lozengers
*NSAIDS and Tylenol

102
Q

asthma: def

A

inflam of air passageway to lungs affecting sensitivity of the nerve endings in the airway making them irritated/narrowed and reducing air flow

103
Q

Asthma: possible triggers

A

animal dander, dust mites, pollen, molds, smoke

104
Q

3 phases of pregnancy

A

*antepartum: conception to onset of labor
*intrapartum: onset of labor to delivery of placenta
*postpartum: 6wks post delivery

105
Q

3 timeframes of antepartum

A

*First trimester: 0-12 wks
*Second trimester: 13-26 wks
*third trimester: 27-40 wks

106
Q

Naegele’s rule

A

first day of LMP - 3mon + 7 day

107
Q

cues: complete cell blood count

A

o Low H&H could indicate anemia and nutrition education is important
o Low platelets could indicate clotting disorder
o Unusually elevated WBC could indicate recent or ongoing infection

108
Q

cues: blood types

A

o ABO incompatibility – Mother type O, baby type A or B or AB – risk of newborn jaundice
o Rh incompatibility – Mother Rh negative, baby Rh positive – Rhogam indicated

109
Q

cues: rubella titer

A

*Education about risk for rubella infection
*Need for rubella immunization after delivery
*1-8 = immune status
*<1-8 = need shot for mom

110
Q

fundal height: wks

A

*distance in centimeters from the pubic bone to the top of the uterus
*after week 24 of pregnancy the fundal height for a normally growing baby will match the number of weeks of pregnancy — plus or minus 2 centimeters
*12 wks just above pubic bone
*20 wks at umbilicus
*36-38 wks: under sternum
*40 wks: drops down into pelvis

111
Q

typical wt gain in preg

A

25-35 lbs

112
Q

Which maternal nutrients cross the placenta

A

*Do: Water
inorganic salts/electrolytes
Carbohydrates
Proteins
Fats
Vitamins
Glucose
Amino acids
Albumin/gamma globulins

113
Q

Bad things that can cross the placental membrane

A

Viruses and some bacteria and protozoa
Caffeine
Alcohol
Nicotine
Carbon monoxide
Prescription and recreational drugs

114
Q

intrauterine growth restriction: symmetrical

A

*entire body is proportionally small

115
Q

intrauterine growth restriction: symmetrical/nutrients

A
116
Q

intrauterine growth restriction: asymmetrical

A

*normal head, small abd

117
Q

intrauterine growth restriction: asymmetrical/nutrients

A

indicates undernourishment: majority goes to brain and heart at expense of liver/other organs

118
Q

VS changes in pregnancy (what goes up and down)

A

*HR (higher) 10-20 +
*BP (lower in 2nd tri) systolic: 5-10, diastolic: 10-15

119
Q

hematologic changes

A

*plasma: increased by 50%
*RBC mass: increased by 33%
*WBC: increase 25000-30000 during labor and early postpartum
* H&H: lower
*coagulability: increased

120
Q

internal tasks of pregnancy

A

*Binding in: taking in
*Giving of herself: taking hold

121
Q

external tasks of pregnancy

A

*Seeking safe passage
*Acceptance of child by self and others

122
Q

nutrient intake during pregnancy (4)

A

*folic acid: greens
*calcium: dairy, leafy greens
*iron: veggies, eggs, greens
*Vit D: veggies, fruits

123
Q

cues of concern regarding wt gain/loss

A

*gain: sudden wt gain (preeclampsia)
*loss: hyperemesis

124
Q

recommended # of cal per day for normal wt per trimester

A

*Non preg per day: 1800-2000 cal/per day
*1sy tri: no change
*2nd tri: add 340 cal/day
*3rd tri: add 462 cal/day

125
Q

foods to avoid during pregnancy

A

*No alcohol obvi
*Raw seafood (can eat cooked salmon)
*Unpasteurized juice, cider, and milk
*Soft cheese and cheese made from unpasteurized milk
*Undercooked eggs
*Premade deli salads (egg, pasta, chicken etc…may contain Listeria)
*Raw sprouts (E. Coli or salmonella)
*Cold hot dogs and luncheon meats
*Undercooked meat and poultry

126
Q

pica in pregnancy: ex

A

Baking soda
Cotton balls
Laundry starch
Ice cubes
Generally inanimate objects

127
Q

adolescent preg: dietary recommendations

A
  • Her own body is still growing
  • Same caloric recommendations as other women
  • Needs adequate CALCIUM AND IRON
128
Q

G and TPAL

A

*(G)ravida: # of pregs
*Term births
*Preterm births
*Abortions
*Living children

129
Q

cues for preg risk (6)

A

◼ High BP
◼ Hx of previous postpartum hemorrhage
◼ Hx of previous shoulder dystocia
◼ Rh negative
◼ Gestational diabetes
◼ More than 5 previous births

130
Q

risk factors/risks for GBS infection in preg/labor (5)

A

◼ Gestation < 37 weeks gestation
◼ Ruptured membranes > 18 hours
◼ Maternal temperature > 100.4° F
◼ GBS bacteriuria this pregnancy
◼ History of infant with GBS disease

131
Q

risks for infant of DM moms (38)

A

◼ Macrosomia
◼ Birth trauma
◼ Congenital anomalies
◼ Respiratory distress syndrome
◼ Hypoglycemia
◼ Hyperbilirubinemia
◼ Fetal Malformations
◼ Fetal demise

132
Q

teratogens in preg

A

*smoking
*alcohol
*drugs
*occupational hazards
*viruses
*nutritional deficits

133
Q

TORCH

A

◼ T Toxoplasmosis
◼ O Other
◼ R Rubella
◼ C Cytomegalovirus
◼ H Herpes
◼ S Syphilis

134
Q

TORCH: mode of transmission

A

Infections may be acquired trans placentally, may ascend in the birth canal, or be acquired during passage through the vagina at birth
*T: cat feces, raw meat
*O: blood/body fluids

135
Q

TORCH: prevention

A

cook meats, wash hands and food prep surfaces, avoid cat feces, avoid infected blood/body fluids

136
Q

TORCH: tx

A

*Rubella: mom immunized b4 preg or b4 discharge postpartum
*Herpes: oral antiviral therapy

137
Q

TORCH: breastfeeding?

A

Hep B: breastfeeding is not contraindicated unless nipples are cracked and bleeding
HIV: breastfeeding IS contraindicated

138
Q

Leoplod’s maneuver : feeling for…

A
  1. determine fetal head: up, down, across
  2. presentation: head, butt, face, brow coming down first
  3. position: engaged in pelvis or nah
  4. assist in best site for FHR monitoring
139
Q

fetal station: what do + and - indicate

A

Relationship of presenting part to the ischial spines.
* “Minus 1” or “Minus 2, 3, 4, 5” means: Presenting part is above zero station and
higher than the ischial spines.
* “Plus 1” or “Plus 2, 3, 4, 5” means: Presenting part has descended lower than the ischial spines.

140
Q

where is the fetal head when at station zero

A

at the spines: engaged

141
Q

stages of labor

A

◼ 1st Stage
◼ Pre-Labor
◼ Phase 1 – Latent Labor
◼ Phase 2 - Active Labor
◼ Phase 3 – Transition
◼ 2nd Stage- Pushing
◼ 3rd Stage- Birth

142
Q

3 phases of stage 1 of labor

A

◼ Phase 1 – Latent Labor
◼ Phase 2 - Active Labor
◼ Phase 3 – Transition

143
Q

false labor/true labor: difference

A

*false: irregular intervals of pain w/ no cervical dilation
*Ture: reg intervals w/ cervical change. Bloody mucous in the cervical canal and tight, hot pain w/ contractions and back pain increases when walking

144
Q

factors that influence labor: 5 P’s

A

◼ Power: contractions
◼ Passenger: fetus
◼ Passageway
◼ Positions
◼ Psychology

145
Q

fetal lie: def and examples

A

*def: Relationship of long axis (spine) of the fetus to long axis of the mother
*longitudinal or oblique

146
Q

fetal presentations: cephalic

A

face

147
Q

fetal presentations: breech

A

buttocks

148
Q

fetal presentations: shoulder

A

shoulder dystocia

149
Q

fetal presentations: posterior

A

Back of the baby’s head is toward the bed.
“Sunny side up.” (severe back pain and slow progression)

150
Q

fetal presentations: anterior

A

head toward ceiling

151
Q

SROM: def and dangers

A

Spontaneous rupture of membranes
*increased risk of infection

152
Q

AROM: def and dangers

A

Artificial rupture of membranes
*risk of prolapse (monitor 30 min after)

153
Q

engagment

A

*Largest diameter of presenting part reaches or passes through pelvic inlet.

154
Q

LOA

A

Left Occipital Anterior: left side, head presenting, back of head toward ceiling

155
Q

LOP

A

Left occipital posterior: left side, head presenting, back of head toward the bed

156
Q

ROA

A

Right Occipital Anterior: Right side, head presenting, back of head toward ceiling (face down)

157
Q

ROP

A

Right Occipital Posterior: Right side, head presenting, back of head toward bed (face up)

158
Q

cardinal movements of labor

A

*engagement
*Descent: continuous
*Flexion: fetal head flexed against the chest
*Internal rotation: fetal head rotates from transverse to anterior
*Extension: head extends w/ crowning
*External rotation (aka Restitution): head turns transverse
*Expulsion: shoulders and torso of baby are delivered

159
Q

pain control options during labor: risks/benefits

A

*Iv analgesics
*Local/reginal anesthetics
*Epidural

160
Q

SE of epideral

A

*Hypotension
*Itching → Narcan to tx
*N/V
*Urinary retention
*Shivering
*Impaired motor ability

161
Q

contraindications for epidural

A

*Maternal refusal (duh)
*Local/systemic infection
*Coagulation disorders
*Low platelet count (less than 100,000)
*Hypovolemia
*Allergy to specific agents (again…duh)
*Suspicion of neurological disease

162
Q

2nd stage labor cues

A

*FHR variables
*Increase in vaginal show
*Suprapubic pain if epidural present
*“I’m going to 💩!”

163
Q

2nd stage labor interventions

A

*SVE to confirm 10 cm and station
*notify dr
*set up warmer/on
*delivery table
*document head and body delivery
*Prep pit bag
*warm hat and blanket
*APGAR

164
Q

cues for 3rd stage of labor

A

*pt uncomfy
*gush of blood
*umbilical cord protrudes
*mom may feel relief
*usually focused on baby

165
Q

risk for prolapsed cord

A

*Preterm labor
*Low birth weight
*Breech presentation
*Transverse lie
*Ruptured membranes with unengaged fetal head

166
Q

shoulder dystocia: risks

A

*Excessive maternal weight
*Short stature
*Hx of previous shoulder dystocia
*Hx of previous large baby
*Post dates

167
Q

shoulder dystocia: nrsg care

A

*lower mom’s head
*mcrobert’s maneuver: knees to chest

168
Q

c-section reasons

A

Multiples
Breech presentation
Previous uterine surgery (not c/s)
Vertical uterine incision w/prior c/s
Placenta previa
Placental abruption
No progress w/pushing after several hours
Fetal intolerance of labor

169
Q

frank breech

A

legs folded up towards head

170
Q

complete breech

A

both of the baby’s knees are bent and his feet and bottom

171
Q

footling breech

A

feet below bottom

172
Q

TOLAC

A

trial of Labor After Cesarean

173
Q

VBAC

A

Vaginal Birth After C-sec

NRSG 344 (11 decks)

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