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OB > Module 3 > Flashcards

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
Q

When a patient comes in stating “my water broke”, what should be done?

A

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

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26
Q

What are the P’s associated with labor and birth?

A

Powers
Passageway
Passenger
Position
Psyche
Pee pee
Placenta
Partner
Powerful parents or in-laws
Pain

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27
Q

What are the powers? Secondary powers?

A

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

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28
Q

What causes the cervix to dilate?

A

Contractions and pressure of baby’s head

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29
Q

What is physiologic pushing?

A

Grunting
More 02 to uterine muscle, placenta & baby
May take more time

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30
Q

What is close glottis pushing?

A

Take a deep breath & push to the count of 10’
Less 02 to baby, muscle & placenta

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31
Q

What needs to occur in the cervix during labor?

A

must come forward, soften, efface (thin) & dilate (open)

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32
Q

What needs to occur in the pelvic floor muscles during labor?

A

must be taut enough to help passenger’s head flex to fit through

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33
Q

What needs to occur in the vagina muscles during labor?

A

must be elastic

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34
Q

What cannot impede the passageway of baby?

A

Amount of adipose tissue must not impede passageway such as in vagina, thighs, etc.

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35
Q

What is 0% effacement? 100%?

A

0%: 5 cm long

100%: paper thin

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36
Q

What is closed dilation? Fully dilated?

A

Closed: 0cm

Fully: 10cm

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37
Q

What role does relaxin play during birth?

A

Acts on joints to allow extra room

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38
Q

What is fetal lie? What are the two types?

A

Relationship of long axis of fetus to long axis of mother

Longitudinal (vertex and breech)
Transverse (shoulder)

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39
Q

What is fetal presentation? What are the 3 types?

A

What enters the pelvis first, or “the presenting part”

Cephalic (Vertex)
Breech
Shoulder (Acromion)

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40
Q

Anything but cephalic presentation is considered?

A

malpresentation

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41
Q

What is attitude?

A

Relationship of the fetal parts to one another

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42
Q

What are the 4 attitude of labor?

A

Flexed (best)
Military
Brow
Face

43
Q

If the baby is breech, what 3 attitudes can be associated with this?

A

Complete: knees & hips flexed
Frank: hips flexed, knees extended
Footling: Single footling (incomplete)– 1 knee & hip flexed or Double footling–full extension

44
Q

What is fetal position? All fetal position besides _____ are malpositioned?

A

relationship of presenting part to maternal pelvis

Occipit

45
Q

What are examples of 3 different ways to describe these?

A

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
Q

What are the ways to describe decent?

A

-2, -1, 0, +1, +2, +3

47
Q

What are maternal positions?

A

Upright
Ambulating
Left lateral
Semi-recumbent
Hands and knees
Squatting
Sitting on
Birth ball

48
Q

What are psyche considerations?

A

Role of Psychological Stress
Role of Readiness
Cultural Beliefs
Support Persons Available

49
Q

What is the concern with a full bladder? What should you do to make sure there is not a full bladder?

A

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
Q

What are the characteristics of labor pain?

A

Purposeful
Anticipated
Intermittent
Normal

51
Q

What is the passageway of the fetal head?

A

largest diameters of the fetal head must negotiate past the smallest diameters (planes) of the bony pelvis

52
Q

What are continues nursing interventions? (just read)

A

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
Q

What is occurring in the second stage of labor? Woman affect?

A
54
Q

What is the nursing care in the second stage of labor?

A

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
Q

What are the cardinal movements in birth?

A

Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion

“tuck, turn, out”

56
Q

Since the birth canal is tight how do babies adjust? What do these allow for?

A

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
Q

What is molding?

A

Shaping of fetal head during movement through birth canal

Cone head

58
Q

What occurs in the third stage of birth? Mom’s affect?

A
59
Q

What is the nursing care in the 3rd stage of labor?

A

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
Q

What medications should be used to prevent hemrrorhage?

A

Pitocin 10-40 U in IV 500-1000 ml LR fast
Pitocin 10 Units IM
Fundal massage

61
Q

What should be considered for patients with placental accrete?

A

Tranexamic Acid (TXA) after cord clamped

62
Q

What could placental massage before the placenta is detached lead to?

A

Placental massage before the placenta has detached may cause partial separation -> postpartum hemorrhage

63
Q

What occurs in the fourth stage of labor? Mom’s affect?

A
64
Q

During the 4th stage of labor you should anticipate the needs for?

A

Suture
Sponges
New sterile gloves
Local anesthesia

65
Q

What should you do once the repair is fixed?

A

basin of warm water, washcloths, clean chux, clean gown, water to drink and warm blanket

66
Q

During the 4th stage what should be done to prevent hemorrhage?

A

Pitocin
Fundal massage

67
Q

During the 4th stage what should be done to treat hemorrhage?

A

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
Q

What are lacerations?

A

Despite adequate support of the perineum, the fetal head will take the room it needs

69
Q

What is a episiotomy?

A

Cut” performed to facilitate faster delivery of the fetal head due to

70
Q

What are the reasons for an episiotomy?

A

Maternal exhaustion
Fetal distress
OR in the case of:
Vacuum or forceps assisted birth
Shoulder dystocia (to allow room for hand maneuvers)

71
Q

What are the locations of lacerations?

A

Peri-urethral
Cervical
Vaginal wall (sulcus)
Labial tears
Clitoral tears
Perineum

72
Q

What is a first degree laceration?

A

vaginal mucosa or perineal skin

73
Q

What is a second degree laceration?

A

vaginal mucosa or perineal skin
bulbocavernosus muscle, transverse & deep transverse muscles & fascia

74
Q

What is a third degree laceration?

A

vaginal mucosa or perineal skin
bulbocavernosus muscle, transverse & deep transverse muscles & fascia
anterior anal sphincter

75
Q

What is a fourth degree laceration?

A

vaginal mucosa or perineal skin
bulbocavernosus muscle, transverse & deep transverse muscles & fascia
anterior anal sphincter
anterior rectal mucosa

76
Q

Which will heal better, laceration or episiotomy?

A

Lacerations heal as well or better than episiotomies

77
Q

What is a midline episiotomy?

A

vaginal mucosa or perineal skin and bulbocavernosus muscle, transverse & deep transverse muscles & fascia

78
Q

What is a mediolateral episiotomy?

A

deeper muscles of the perineal floor

79
Q

What are the risks associated with episiotomies?

A

Increased risk for extensions (3rd or 4th degree)
Associated with longer postpartum pain and dyspareunia (compared to lacerations)

80
Q

When does maximum slope in rate change start?

A

6cm

81
Q

What are things that could cause labor to begin?

A

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
Q

What does cervical mucous/bloody show mean? When does this occur?

A

Mucus plug falls out

Can happen a few weeks before labor

83
Q

Where do contractions start? What do they do?

A

Contractions start at the fondus

Push down on baby and pull up on cervix –> decent of baby and opening of cervix

84
Q

If flexed and face have the same diameter why is flexed preferred?

A

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
Q

How long does the second stage last if Nullip? Multip? What is they have an epidural?

A

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
Q

During the seance stage what do contractions look like? Other s/s?

A

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
Q

What is caput?

A

Edema or swelling in head after birth

Normal no damage to baby

88
Q

How long does the 3rd stage last? Are there contractions?

A

5-30 minutes

Uterus contracts to cause placental separation but mom might not even know because distracted by new baby

89
Q

What are the s/s of placental detachment?

A

Change in uterine shape
Lengthening of cord
Gush of blood
Uterine contractions perceived by patient
Urge to push again

90
Q

Why do you do a final massage after placental delivery? Do you want these effects to last?

A

do fundal massage to make sure it is contracted

Uterus needs to remain contracted to minimize blood loss from placental site

91
Q

What is placenta accreta? Prevention?

A

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
Q

What is placenta accreta? Prevention?

A

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
Q

What are the contraindications of methergine?

A

HTN

93
Q

What are the contraindications for hemabate? Side effect?

A

Asthma

Explosive diarrhea so less likely to use

94
Q

What are the contraindication for cytotec?

A

Known prostaglandin allergy

95
Q

What is the contraindication for TXA?

A

history of thrombolytic events

96
Q

What is the role of HCG? Peaks? Other use?

A

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
Q

What is the role of HPL?

A

Increases resistance to insulin
Stimulates maternal metabolism

98
Q

What is the role of progesterone?

A

Maintains endometrium and decreased contractility of uterus

99
Q

What is the role of estrogen?

A

Stimulates uterine growth and uteroplacental blood flow

100
Q

When labor starts, which hormone decreases?

A

Progesterone

101
Q

When should fetal kick counts start?

A

at 28 weeks

At least 10 movements in a 1-2 hour period per day to make sure baby is okay.

102
Q

How do you calculate the EDD by ultrasound? When should it be changed?

A

Measure crown to rump

Past 7 days in 1st
Past 14 days in 2nd
Past 21 days in 3rd

103
Q

When do you want the head to be down?

A

By 36 weeks

OB (16 decks)

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