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Module 3 Flashcards

1
Q

What are the s/s of impeding labor? (7)

A
  1. Lightening
  2. Cervical mucous/bloody show
  3. Weight loss due to increase in loose stools (Prostaglandins)
    4.Burst of energy
  4. Nesting
  5. Increase in Braxton-Hicks contractions (practice contractions)
  6. Change in sleep cycles
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2
Q

What is lightening? What does it cause?

A

The fetus drops into the pelvis

Easier to breathe, harder to walk
↑ in Braxton-Hicks push the fetus down into ‘ready’ position

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3
Q

What is SROM?

A

spontaneous rupture of membranes

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4
Q

What is AROM?

A

artificial rupture of membranes

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5
Q

What is PROM?

A

pre-labor rupture of membranes

Prior to onset of labor

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6
Q

What is pPROM?

A

preterm pre-labor rupture of membranes

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7
Q

What are the different types of amniotic fluid that occurs when membranes are ruptured?

A

Clear: straw colored +/- flecks of vernix
Meconium stained: greenish color from fetus’ BM
Non-malodorous vs. Malodorous: you can’t miss it

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8
Q

Are there different amounts on amniotic fluid when membranes rupture?

A

Yes

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9
Q

What are the risks of SROM? (3)

A

Infection
Prolapsed cord
Cord compression –> variable decelerations

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10
Q

What are four ways to confirm SROM?

A

nitrazine or pH paper (dry blue)
ferning
pooling
Valsalva

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11
Q

What should always be done r/t SROM?

A

Check FHTs

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12
Q

What is the first stage of labor? When does it start and end? When are these complete?

A

Cervical change (dilation/effacement)

Onset of regular contractions to complete effacement & dilation

10 cm dilated and 100% effacement

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13
Q

What is the second stage of labor? When does it start and end?

A

Birth of the BABY

Full dilation until delivery of the neonate
10 centimeters with descent of presenting part to birth

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14
Q

What is the third stage of labor? When does it start and end?

A

Birth of the placenta

Delivery of neonate to delivery of placenta

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15
Q

What is the fourth stage of labor? When is it? What else occurs in this stage?

A

Recovery and Postpartum Stabilization

1st 4 hours after delivery

Maternal-newborn bonding & breastfeeding

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16
Q

What is the early phase of the first stage of labor? How many cm? How long does it last?

A

Contractions may begin irregular and progressively become regular and closer together. Every 5-10 minutes lasting 30-60 seconds. Women is usually feeling excited and like they got this. Can have loose stools and backache. Encourage alternating rest/activity, distraction, hydration, light meals, shower

0-5 cm

8 hours but most variable stage

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17
Q

What is the active phase of the first stage of labor? How many cm? How long does it last?

A

Contractions are stronger and regular every 3-5 minutes lasting 60 seconds. Towards end of the phase they are 8-9 cm dilated and contractions are strong and close about every 1-3 minutes lasting 90 seconds

6-10cm

6 hours

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18
Q

What is the nursing care for the first stage of labor?

A

Educate women AND support people
Encourage ambulation and help with selecting and changing positions (q 30 min)
Assist with birth ball, squat bar, rocking chair, etc.
Encourage hydrotherapy: tub/shower
Teach/perform massage (effleurage, hand/foot, counter pressure, double hip squeeze)
Hydrate/light meals
Support non-pharm pain relief techniques (breathing techniques, visualization, warm/cold compresses, etc.)
Empty bladder (q2h)
Provide comfortable environment (adjusting lights, music, people, smells, etc. PRN)
Hygiene (chux, washcloth, mouthwash)
Support the support people
Medications PRN

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19
Q

What meals should the patient be eating in the first stage of labor?

A

Light meals with hydration

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20
Q

How often should the patient walk and change positions in the first stage of labor?

A

every 30 minutes

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21
Q

How often should the patient empty their bladder in the first stage of labor?

A

Every 2 hour

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22
Q

What are s/s of false labor? (4)

A

No rupture of membranes
Irregular
Space-out when lying down
No cervical change

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23
Q

What are the s/s of true labor?

A

Increased uterine contractions in Frequency, Duration and Intensity (strength)
Progressive cervical dilation, effacement & descent of presenting part
Rupture of membranes

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24
Q

Can you have true labor with membranes intact?

A

Yes

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25
When a patient comes in stating "my water broke", what should be done?
Review history- this pregnancy and prior ones; significant medical history Brief Physical Exam or systems assessment Interpretation of baseline EFM strip Labs Maternal vital signs Abdominal exam/ultrasound for presentation Psychosocial Cervical exam (if membranes intact) including dilation, effacement, station, presenting part
26
What are the P's associated with labor and birth?
Powers Passageway Passenger Position Psyche Pee pee Placenta Partner Powerful parents or in-laws Pain
27
What are the powers? Secondary powers?
Role of the uterus is to contract, pushing baby down on to the cervix, then out through the vagina Secondary powers are the bearing down efforts of the mother
28
What causes the cervix to dilate?
Contractions and pressure of baby's head
29
What is physiologic pushing?
Grunting More 02 to uterine muscle, placenta & baby May take more time
30
What is close glottis pushing?
Take a deep breath & push to the count of 10’ Less 02 to baby, muscle & placenta
31
What needs to occur in the cervix during labor?
must come forward, soften, efface (thin) & dilate (open)
32
What needs to occur in the pelvic floor muscles during labor?
must be taut enough to help passenger’s head flex to fit through
33
What needs to occur in the vagina muscles during labor?
must be elastic
34
What cannot impede the passageway of baby?
Amount of adipose tissue must not impede passageway such as in vagina, thighs, etc.
35
What is 0% effacement? 100%?
0%: 5 cm long 100%: paper thin
36
What is closed dilation? Fully dilated?
Closed: 0cm Fully: 10cm
37
What role does relaxin play during birth?
Acts on joints to allow extra room
38
What is fetal lie? What are the two types?
Relationship of long axis of fetus to long axis of mother Longitudinal (vertex and breech) Transverse (shoulder)
39
What is fetal presentation? What are the 3 types?
What enters the pelvis first, or “the presenting part” Cephalic (Vertex) Breech Shoulder (Acromion)
40
Anything but cephalic presentation is considered?
malpresentation
41
What is attitude?
Relationship of the fetal parts to one another
42
What are the 4 attitude of labor?
Flexed (best) Military Brow Face
43
If the baby is breech, what 3 attitudes can be associated with this?
Complete: knees & hips flexed Frank: hips flexed, knees extended Footling: Single footling (incomplete)– 1 knee & hip flexed or Double footling--full extension
44
What is fetal position? All fetal position besides _____ are malpositioned?
relationship of presenting part to maternal pelvis Occipit
45
What are examples of 3 different ways to describe these?
right or left side of maternal pelvis (which side their back is on) occiput (o), mentum (m), sacrum (s) anterior (a), posterior (p), transverse (t) (which way they are facing)
46
What are the ways to describe decent?
-2, -1, 0, +1, +2, +3
47
What are maternal positions?
Upright Ambulating Left lateral Semi-recumbent Hands and knees Squatting Sitting on Birth ball
48
What are psyche considerations?
Role of Psychological Stress Role of Readiness Cultural Beliefs Support Persons Available
49
What is the concern with a full bladder? What should you do to make sure there is not a full bladder?
Displaces the presenting part in the pelvis Interferes with the uterus’ ability to contract in a functional pattern Empty q2h Place a Foley or perform q2 hour straight catheterization with an epidural
50
What are the characteristics of labor pain?
Purposeful Anticipated Intermittent Normal
51
What is the passageway of the fetal head?
largest diameters of the fetal head must negotiate past the smallest diameters (planes) of the bony pelvis
52
What are continues nursing interventions? (just read)
Orient to environment Obtain informed consents Maintain hydration (PO or IV) Provide reassurance & information Encourage bladder emptying q 2 hours Assess pain or coping; provide comfort measures Encourage position changes q 30 min Prevent supine hypotension Prepare emergency equipment Monitor maternal and fetal well-being
53
What is occurring in the second stage of labor? Woman affect?
54
What is the nursing care in the second stage of labor?
Call MD, CNM Provide comfortable environment Support her in different positions Support non-pharm pain relief techniques (cold cloth, etc.) Keep bladder empty Get delivery table/warmer ready (need resuscitation gear ready for every birth) and tell them what you are doing! “Police” family & other visitors she might not want in the room Pericare, pericare, pericare
55
What are the cardinal movements in birth?
Descent Flexion Internal rotation Extension External rotation Expulsion "tuck, turn, out"
56
Since the birth canal is tight how do babies adjust? What do these allow for?
Fontanels (anterior & posterior ‘soft’ spots) Bones of the cranium are soft Sutures between the bones are non-calcified All allow soft tissue “swelling” ---> caput and overriding of the bones ---> “molding” Without damage to the brain
57
What is molding?
Shaping of fetal head during movement through birth canal Cone head
58
What occurs in the third stage of birth? Mom's affect?
59
What is the nursing care in the 3rd stage of labor?
Promote bonding and initiate breastfeeding Prevent hemorrhage (Active Management of 3rd stage—after delivery of anterior shoulder or cord clamped) Patients with placenta accreta consider: Tranexamic Acid (TXA) after cord clamped Fundal massage AFTER the placenta is out
60
What medications should be used to prevent hemrrorhage?
Pitocin 10-40 U in IV 500-1000 ml LR fast Pitocin 10 Units IM Fundal massage
61
What should be considered for patients with placental accrete?
Tranexamic Acid (TXA) after cord clamped
62
What could placental massage before the placenta is detached lead to?
Placental massage before the placenta has detached may cause partial separation -> postpartum hemorrhage
63
What occurs in the fourth stage of labor? Mom's affect?
64
During the 4th stage of labor you should anticipate the needs for?
Suture Sponges New sterile gloves Local anesthesia
65
What should you do once the repair is fixed?
basin of warm water, washcloths, clean chux, clean gown, water to drink and warm blanket
66
During the 4th stage what should be done to prevent hemorrhage?
Pitocin Fundal massage
67
During the 4th stage what should be done to treat hemorrhage?
Pitocin Methergine 0.2 mg IM Hemabate 250 mcg every 15 minutes IM, intracervical, intrauterine Cytotec (misoprostol) 800-1000 mcg rectally Tranexamic Acid (TXA) 1 gram in 50 mL NS IV over 10 minutes (Used in the first 3 hours after birth)
68
What are lacerations?
Despite adequate support of the perineum, the fetal head will take the room it needs
69
What is a episiotomy?
Cut” performed to facilitate faster delivery of the fetal head due to
70
What are the reasons for an episiotomy?
Maternal exhaustion Fetal distress OR in the case of: Vacuum or forceps assisted birth Shoulder dystocia (to allow room for hand maneuvers)
71
What are the locations of lacerations?
Peri-urethral Cervical Vaginal wall (sulcus) Labial tears Clitoral tears Perineum
72
What is a first degree laceration?
vaginal mucosa or perineal skin
73
What is a second degree laceration?
vaginal mucosa or perineal skin bulbocavernosus muscle, transverse & deep transverse muscles & fascia
74
What is a third degree laceration?
vaginal mucosa or perineal skin bulbocavernosus muscle, transverse & deep transverse muscles & fascia anterior anal sphincter
75
What is a fourth degree laceration?
vaginal mucosa or perineal skin bulbocavernosus muscle, transverse & deep transverse muscles & fascia anterior anal sphincter anterior rectal mucosa
76
Which will heal better, laceration or episiotomy?
Lacerations heal as well or better than episiotomies
77
What is a midline episiotomy?
vaginal mucosa or perineal skin and bulbocavernosus muscle, transverse & deep transverse muscles & fascia
78
What is a mediolateral episiotomy?
deeper muscles of the perineal floor
79
What are the risks associated with episiotomies?
Increased risk for extensions (3rd or 4th degree) Associated with longer postpartum pain and dyspareunia (compared to lacerations)
80
When does maximum slope in rate change start?
6cm
81
What are things that could cause labor to begin?
Uterine Distention (more distention --> time for birth) Placental Aging (placenta starts not working as well) Hormonal Mediation - hormone drop at end of pregnancy (Progesterone withdrawal, Prostaglandin synthesis, Corticotropin releasing hormone) Psychological aspects Fetal Adrenals
82
What does cervical mucous/bloody show mean? When does this occur?
Mucus plug falls out Can happen a few weeks before labor
83
Where do contractions start? What do they do?
Contractions start at the fondus Push down on baby and pull up on cervix --> decent of baby and opening of cervix
84
If flexed and face have the same diameter why is flexed preferred?
Face has the same diameter, but they have lost their ability to flex and extend which is necessary to come out. Can have vaginally delivery but much longer and hard to get baby out
85
How long does the second stage last if Nullip? Multip? What is they have an epidural?
Nullip: up to 3 hours Multip: up to 2 hours Epidural: add an hour - this will allow uterus to continue to passively push baby down before actively pushing
86
During the seance stage what do contractions look like? Other s/s?
Every 2-3 minutes lasting 60-90 seconds Intense rectal pressure Urge to push Possible urination and defecation Ring of fire as head emerges
87
What is caput?
Edema or swelling in head after birth Normal no damage to baby
88
How long does the 3rd stage last? Are there contractions?
5-30 minutes Uterus contracts to cause placental separation but mom might not even know because distracted by new baby
89
What are the s/s of placental detachment?
Change in uterine shape Lengthening of cord Gush of blood Uterine contractions perceived by patient Urge to push again
90
Why do you do a final massage after placental delivery? Do you want these effects to last?
do fundal massage to make sure it is contracted Uterus needs to remain contracted to minimize blood loss from placental site
91
What is placenta accreta? Prevention?
placenta has grown into myometrium layer or uterus --> placenta does not want to come out --> TXA after cord clamps to decrease risk of postpartum hemorrhage
91
What is placenta accreta? Prevention?
placenta has grown into myometrium layer or uterus --> placenta does not want to come out --> TXA after cord clamps to decrease risk of postpartum hemorrhage
92
What are the contraindications of methergine?
HTN
93
What are the contraindications for hemabate? Side effect?
Asthma Explosive diarrhea so less likely to use
94
What are the contraindication for cytotec?
Known prostaglandin allergy
95
What is the contraindication for TXA?
history of thrombolytic events
96
What is the role of HCG? Peaks? Other use?
Preserves function of corpus leutem --> continues supply or E & P Peaks at 60 days and decreases as placenta takes over Can use as a quantitative tool to determine is pregnancy is going well (should be doubling every 2-3 days)`
97
What is the role of HPL?
Increases resistance to insulin Stimulates maternal metabolism
98
What is the role of progesterone?
Maintains endometrium and decreased contractility of uterus
99
What is the role of estrogen?
Stimulates uterine growth and uteroplacental blood flow
100
When labor starts, which hormone decreases?
Progesterone
101
When should fetal kick counts start?
at 28 weeks At least 10 movements in a 1-2 hour period per day to make sure baby is okay.
102
How do you calculate the EDD by ultrasound? When should it be changed?
Measure crown to rump Past 7 days in 1st Past 14 days in 2nd Past 21 days in 3rd
103
When do you want the head to be down?
By 36 weeks

OB (16 decks)

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