module 5

Question 1

what are the four factors for adequate oxygenation of the fetus?

Answer 1

normal maternal blood flow and volume to the placenta
normal oxygen saturation in maternal blood
adequate exchange of oxygen and carbon dioxide
open circulatory path between the placenta and the fetus through vessels in the umbilical cord

Question 2

continuous fetal monitoring

Answer 2

there is a machine that does this. it produces a graphic record of the FHR pattern.
the objective is to give information about fetal oxygenation and prevent fetal injury from hypoxia. helps detect FHR changes early before they are prolonged and profound

Question 3

fetal response to labor

Answer 3

labor is a period of physiologic stress
frequent monitoring of fetal status is part of nursing care during labor
fetal oxygen supply mist be maintained during labor to prevent compromise

Question 4

what can cause the fetal oxygen supply to decrease

Answer 4

• reduction of blood flow through maternal vessels as a result of hypertension and hypotension
• reduction of oxygen content in maternal blood as a result of hemorrhage or severe anemia
• alterations in fetal circulation with compression of the umbilical cord
• reduction in blood flow to intervillous space in the placcenta

Question 5

low risk maternal fetal assessment

Answer 5

first stage of labor: every 30 mins

second stage every 15 mins

Question 6

high risk maternal fetal assessmetn

Answer 6

first stage: every 15 mins

second stage: every 5 mins

Question 7

external monitoring

Answer 7

FHR: ultrasound transducer
UC: tocotrandsucer

Question 8

internal fetal monitoring

Answer 8

for high-risk pregnancies only
it is invasive and uses a spiral electrode. it measures frequency, duration, and intensity. measured in Montevideo units.

Question 9

wireless electronic fetal monitoring

Answer 9

tend to pick up more artifact than other monitoring. makes it look like there is increased variability.

Question 10

what is monitored when it comes to fetal heart rate

Answer 10

rate
regularity
absence of decrease from baseline
baseline is noted on admission and used as a gauge for FHR during second stage of labor

Question 11

FHR variability

Answer 11

expect to see these fluctuations with fetal sleep and activity. there are classifications of variability and factors that decrease it

Question 12

baseline fetal heart rate

Answer 12

the average during a 10-minute segment excluding periodic or episodic changes, periods of marked variability, segments of the baseline that differ by more than 25 bpm

Question 13

variability types

Answer 13

absent or minimal: abnormal or indeterminate. could mean fetal hypoxemia or metabolic acidemia
moderate: normal. predicts normal fetal acid-base balance
Marked: unclear significance, sinusoidal pattern

Question 14

normal FHR

Answer 14

110-160 bpm

Question 15

variability

Answer 15

irregular waves/ fluctuations in baseline FHR for 2-minute cycle

Question 16

fetal bradycardia and maternal/ fetal causes

Answer 16

• a FHR < 110 for > 10 mins
• maternal causes: supine hypotension, hypoglycemia, hypothermia, medications ex: opioids
• fetal implications: structural defects: cardiac, AV dissociation (heart block), heart failure

Question 17

clinical significant of bradycardia

Answer 17

not only related to decreased oxygen but it depends on the underlying cause and accompanying FHR patterns, including variability, acceleration, or decelerations

Question 18

FHR acceleration

Answer 18

a normal pattern signifies fetal well-being. caused by:
-spontaneous fetal movement, vaginal exam, electrode application, scalp stimulation, breech presentation, occiput posterior presentation, fundal pressure, abdominal palpation

Question 19

VEAL CHOP

Answer 19

variable decelerations: cord compression
early decelerations: head compression
accelerations: okay
late decelerations: placental insufficiency

Question 20

early decelerations

Answer 20

cause: fetal head compression
clinical significance: normal pattern; not associated with fetal hypoxemia or low APGAR scores.
Interventions: none except oversee, document, and prepare for delivery.

Question 21

variable decelerations

Answer 21

umbilical cord compression

-umbilical cord compression occurs in 50% of labors and is usually correctable

Question 22

FHR category 1

Answer 22

baseline 110-160
moderate variability
late or variable decels absent
early decals and acels may be present or absent
this is the normal finding

Question 23

category II FHR

Answer 23

include ALL FHR tracings not categorized as I or III
bradycardia/ tachycardia
minimal or marked variability
indeterminate: require evaluation and continued surrvailence and reevaluation

Question 24

category III

Answer 24

absent variability and any of the following:
recurrent late decels, recurrent variables, bradycardia, sinusoidal pattern.
ABNORMAL: require prompt evaluation

Question 25

prolonged decelerations

Answer 25

interruption to fetal oxygen supply

Question 26

care management

Answer 26

- EFM pattern recognition and interpretation: categorize FHR tracings and manage abnormal patterns - assessment techniques - patient and family teaching - documentation

Question 27

as the nurse dealing with a complication

Answer 27

- must know the normal birthing process - prevent and detect deviations from normal - when complications arise the risk of morbidity and mortality increases - sometimes complications are expected especially with high risk pregnancies

Question 28

indications of preterm birth

Answer 28

- gestational diabetes - chronic hypertension and preeclampsia - obstetrical disorders - insufficient uterine size - fetal disorders on the NST and BPP

Question 29

how to identify those at risk for preterm labor and birth

Answer 29

risk factors fetal fibronectin: positive result indicates the amniotic sac is not sticking to the uterine wall cervical length: soft, dilated, anterior are concerning -symptoms of PTL

Question 30

prevention of a preterm birth

Answer 30

assessment of risks along with history and physical interventions: prevention and early recognition and diagnosis with the FFN - lifestyle modifications: activity restriction, especially sexual, home care, transfer hospital, prophylaxis against GBS, antenatal glucocorticoids, and mag sulfate

Question 31

signs and symptoms of preterm birth

Answer 31

``` change in type of vaginal dishcharge pelvic or lower abdominal pressure constant low and dull backache mild abdominal cramps with wor without diarrhea regular Braxton hicks ROM ```

Question 32

promotion of fetal lung development

Answer 32

antenatal glucocorticoids stimulate fetal lung maturation by promoting the release of enzymes that include the production and release of lung surfactant. takes 48 hours for the optimal benefits

Question 33

mag sulfate

Answer 33

CNS depressant that relaxes the smooth muscle inhibiting uterine activity

Question 34

BEta adrenergic agonist

Answer 34

terbutaline: relaxes smooth muscle inhibiting utering acticity

Question 35

prostaglandin synthetase inhibitors (NSAIDS)

Answer 35

inhibits prostaglandins and inhibits uterine activity. encourages lung development

Question 36

calcium channel blickers

Answer 36

nifedipine blocks calcium entry into smooth muscles thus inhibiting uterine activity

Question 37

premature rupture of membranes

Answer 37

PROM. rupture of the amniotic sac and leakage of amniotic fluid benign at least 1 hour before the onset of labor at any gestational age above 37 wks

Question 38

preterm premature rupture of membranes

Answer 38

membrane rupture before 37 0/7 weeks of gestation infection is a major risk factor: responsible for one-third of all preterm births there is pathologic weakening of the amniotic membranes: inflammation, stress from uterine contractions, and other factors

Question 39

treatment of ROM

Answer 39

-no unsterile digital cervical exams until a woman is in active labor,,. expect to manage underdeveloped fetal lungs

Question 40

nursing assessment for ROM

Answer 40

risk factors, signs and symptoms of labor, FHR monitoring, COAT, nitrazine testing, fern testing

Question 41

chorioamnionitis

Answer 41

bacterial infection of the amniotic cavity. clinical findings: maternal fever, fetal tachy, uterine tenderness, foul odor of the amniotic fluid care: delivery ASAP, may give antenatal glucocorticoid and broad spectrum antibiotics for 7 days

Question 42

posterm pregnancy, labor, birth

Answer 42

maternal risks: C-section, dystocia, birth trauma, hemorrhage, and infection fetal risks: macrosomia, shoulder dystocia, brachial plexus injury, low APGAR score, postmaturity syndrome fetal kick counts for eval of well being

Question 43

dysfunctional labor

Answer 43

dystocia long, difficult, and abnormal labor ineffective uterine contractions(power), alterations and pelvic structure (passage), fetal causes (passenger), maternal position, and psychologic response

Question 44

risk factors of dystocia

Answer 44

``` epidural multiple gestations maternal exhaustion abnormal fetal position fetal macrosomia overweight and obese ```

Question 45

breech presentation nursing assessments

Answer 45

``` FHR bradycardia variable decels comfort vital signs ```

Question 46

induction

Answer 46

stimulating contractions vis medial or surgical means`

Question 47

augmentation

Answer 47

enhancing ineffective contractions after labor has begun

Question 48

indications of induction or aumentation

Answer 48

prolonged gestation, prolonged premature rupture of membranes, gestational hypertension, cardia disease, renal disease chorioamnionitis, dystocia, intrauterine fetal demise, diabetes

Question 49

the bishop score

Answer 49

the rating system used to determine the level of cervical inducibility assesses cervical dilation, effacement, consistency, position, and fetal station labor induction is most likely to be successful with a higher score of 9+ for nulliparous or 5+ for multiparous

Question 50

induction: cervical ripening

Answer 50

chemical agents: prostaglandin gel mechanical agents: balloon dilators or amniotic stripping oxytocin

Question 51

what does oxytocin do ?

Answer 51

normally produced by the posterior pituitary and stimulates uterine contractions and aids in milk let down Pitocin is synthetic oxytocin and it is used for induction or augmentation. watch out for contractions that are too strong or last longer than 60 seconds and more frequent than 3 minutes

Question 52

amniotomy

Answer 52

amnihook: nonpharmacological intervention to augment and induce labor or facilitate placement if intrauterine monitors there is a risk of infection or fetal injury monitor vs, FHR, dilation, effacement, contractions

Question 53

stripping membranes

Answer 53

provider sweeps a gloved finger over the membrane that connects the amniotic sac to the wall of your uterus may cause relate in prostaglandins and start contractions there is discomfort and risk of infection and accidental ROM

Question 54

elective induction of labor

Answer 54

labor is initiated without a medical indication many are for the convenience of the woman or her primary health care provider risks are increased c-section, morbidity and cost

Question 55

why is oxytocin high alter

Answer 55

it can cause placental abruption, uterine rupture, unnecessary c-section, hemorrhage, infection, fetal hypoxemia or acidemia

Question 56

indications for forceps or vacuum

Answer 56

prolonged second stage of labor, non reassuring FHR pattern, failure of presenting part to fully rotate and descend, limited sensation or inability to push effectively, presumed fetal jeopardy or fetal distress. r there is a risk of tissue trauma to mother and newborm

Question 57

pre requisites for vacuum or forcepts

Answer 57

``` fully dilated cervix ROM engaged head vertex position no evidence of CPD ```

Question 58

TOL/ VBAC

Answer 58

trial of labor observation of a woman and her fetus for a specified length of time to assess the safety of vaginal birth VBAC: vaginal birth after cesarean birth: indications for primary c section such as should dystocia, breech, or fetal distress are often non recurring, may be a candidate to attempt vaginal birth

Question 59

shoulder dystocia

Answer 59

the head is born, but the anterior shoulder cannot pass under the pubic arch. newborn is likely to experience birth injuries such as asphyxia, brachial plexus damage, and fracture -mothers' primary risk stems from excessive blood loss from uterin atony or rupture, laceration, an extension of episiotomy or endometritis

Question 60

nursing actions shoulder dystocia

Answer 60

stay calm and call for help empty bladder pull legs back towards chest (McRobert's maneuver) or have them go on hands and knees stand on a stool and give suprapubic pressure prn no fundal pressure

Question 61

meconium stained amnitotic fluid

Answer 61

indicate that the fetus has passed the first stool before birth, this puts the infant at risk for meconium aspiration syndrome and requires the team skilled in neonatal resuscitation

Question 62

prolapse umbilical cord

Answer 62

``` partial or total oclusion of cord with rapid fetal deterioration contributions: -long cord -malpresentation -transverse lie -unengaged presenting part -multiple gestations ```

Question 63

nursing actions for a prolapsed cord

Answer 63

call for assistance, glove hand and push up on presenting part to relieve pressure, knee to chest positon, or rolled towel under hips, do not attempt to replace cord into vagina or cervix, if it is protruding place under the warm saline towel. admin oxygen and start IV, monitor FHR and prepare for delivery

Question 64

rupture of uterus

Answer 64

cause: scared uterus as a result of previous c section s/s: abnormal FHR tracing with sudden brady, low of fetal station, abdominal pain, shock assessment: risk factors and onset of fetal distress management prepare for a c section, and continue to monitor FHR and maternal HR

Question 65

amniotic fluid embolism

Answer 65

amniotic fluid contains particles of debris, acute onset of hypotension, hypoxia, cv collapsed and coagulopathy, maternal mortality is high and neonate outcome is poor assessment: difficulty breathing, hypotension, cyanosis, seizure, tachy, coagulation failure, pulmonary edema, uterine atony and hemorrhage, cardiac arrest management support measures to maintain oxygenation and hemodynamic function and to correct coagulopathy; crucial care monitoring.