MTN child test 2 Flashcards
1
Q
pt has history of HTN, today her BP is 156/102, starts in her eyes, and epigastric pain. what do you want to do first?
A
obtain clean catch urine sample
2
Q
RhoGAM is given when
A
at 28 weeks and the second is given postpartum
3
Q
first stage of labor
A
begins with uterine contractions and ends with complete effacement and cervical dilation
4
Q
phases of first stage of labor
A
latent phase, active phase, and transition phase
5
Q
latent phase of first stage of labor
A
0-3 cm will be walking around, usually still at home, drinking a lot of water.
6
Q
active phase of first stage of labor
A
rapid dilation of the cervix. 4-7 cm come to hospital when contractions are 5 minutes apart
7
Q
transition phase of first stage of labor
A
increased rate of decent of the presenting part. 8 - 10 cm super painful. can’t get an epidural anymore. contractions usually 1-2 minutes apart
8
Q
lab tests during first stage of labor
A
fern test, CBC, urinalysis, drug screen if no prenatal history, blood type and screen
9
Q
fern test
A
vaginal swab and look at it under microscope. if there is estrogen it will look like a fern and tells us that the membrane has ruptured
10
Q
why do we get a CBC
A
H&H baseline
11
Q
Leopold maneuver
A
feeling where the baby is by pressing on the moms belly
12
Q
check FHR and UC how often
A
for at least 15 minutes every hour
13
Q
what should a nurse be doing during the first stage of labor
A
encourage position changes, place wedge under hip to prevent SVC, non pharmacological and pharmacological management, education, and support
14
Q
SVC
A
superior vena cava syndrome
15
Q
second stage of labor
A
begins when cervical dilation complete until birth of the baby. women may have burst of energy
16
Q
latent phase of second stage of labor
A
fetus continues to descend passively through the birth canal and rotates to an anterior position
17
Q
active phase of second stage of labor
A
strong urge to push as baby pushes on stretch receptors
18
Q
nursing care during second stage
A
support and monitoring, instruct women to push during contraction, assess fetal response to pushing,
19
Q
en caul birth
A
infant born inside the amniotic sac
20
Q
assessment during second stage
A
assess that the peritoneum is flattened and vagina and rectum is bulged. contractions occurring every 2 minutes lasting 60-90 sec
21
Q
episiotomy
A
surgical cut made at the opening of the vagina to aid in the prevention of tissue rupture
22
Q
1st degree lacerations
A
perineal skin and vaginal mucosa membrane
23
Q
2nd degree lacerations
A
skin, mucosa, and fascia of the perineum
24
Q
3rd degree laceration
A
skin, mucosa, fascia, and muscle of the peritoneal body and extends to rectal sphincter
25
4th degree laceration
extends into the rectum and exposes the lumen of the rectum
26
third stage of labor
separation and expulsion of the placenta and membranes usually occurs 5-30 min after birth
27
signs to look for during third stage of labor
upward rising of the uterus with contractions, sudden gush of blood, lengthening of the umbilical cord
28
normal blood loss during birth
500 mL
29
babies blood when they are born
they are born with 2/3 their blood and the rest comes through the umbilical cord after birth
30
delayed cord clamping
allows for healthy blood volume and full count RBC, stem cells, and immune cells
31
risk of delayed cord clamping
increase risk of jaundice due to higher RBC
32
nursing care during 3rd stage
assess VS every 15 minutes, skin to skin after birth, breast feed within an hour, pain medication
33
once placenta is delivered what is ordered
oxytocin (Pitocin) is ordered for all women to reduce the risk of postpartum hemorrhage
34
fourth stage of labor
recovery and homeostasis beginning to be re-established
35
nursing goals during forth stage of labor
facilitating family bonding, fundal massage, pain meds, ice packs, monitor bladder for distention
36
first breastfeeding called
colostrum - first immunization. contains large numbers of antibodies
37
where should the uterus be after birth
one finger below umbilicus
38
how do you do a fundal massage and why
hold base of uterus and start massaging the top - do it to keep uterus firm so there is no postpartum hemorrhage
39
FHR should be
110-160 bpm
40
how do we monitor FHR
TOCO transducers and ultrasound transducer
41
best place to find the fetal heart beat
in on baby's back
42
tocodynamometer (TOCO)
uterine external monitoring - measures the frequency and duration of contraction but will not measure the intensity
43
intrauterine catheter (IUPC)
uterine internal monitoring- measures contractions
44
ultrasound transducer
external fetal monitor that is placed over fetal heart
45
fetal spiral electrode (FSE)
internal monitoring of fetal heart rate - spiral catheter placed on presenting part of fetus
46
early decelerations indicate
head compression and nurse doesn't need to do anything
47
what happens during late deceleration
deceleration starts after contraction and HR doesn't recover within 30 sec after contraction
48
late deceleration indicates
utter-placental insufficiency - not enough oxygen
49
late deceleration care
don't need to call doctor right away. turn pt, hydrate and oxygenate. if that doesn't work turn down Pitocin. if that doesn't work call doctor
50
variable decelerations indicate
cord is being squeezed/compressed
51
variable decelerations can happen with or without
contractions
52
what to do during variable decelerations
turn pt, if that doesn't work then amnioinfusion which might cause buoyancy so the cord can float, and if that doesn't work call the doctor
53
prolonged decelerations
HR drops more than 15 beats and lasts 2-10 minutes
54
prolonged decelerations indicates
fetal distress - baby telling us its not okay
55
what do you do for prolonged decelerations
emergency c section
56
maternal factors affecting labor
uterus stretches, increased estrogen stimulates uterus, progesterone decreases, and oxytocin is released which stimulates UC
57
fetal factors affecting labor
placenta ages and deteriorates triggering contractions, prostaglandins produced by fetus, and fetal cortisol increases and acts on placenta to decrease progesterone
58
5 Ps
powers (contractions), passage (pelvis), passenger (baby), position, psyche
59
we don't want contractions to last longer than
60-90 seconds
60
primary powers
involuntary - contractions, effacement, dilation, and Ferguson reflux
61
contractions
move downward over the uterus in waves
62
effacement
shortening and thinning of the cervix - 0%-100%
63
primips
first births
64
multips
multiple births
65
effacement with primips
usually happens before dilation
66
effacement with multips
dilate and efface happen together
67
dilation
widening of the cervical opening
68
Ferguson reflux
presenting part of the fetus reaches the stretch receptors and cause release of oxytocin that triggers the maternal urge to bear down
69
secondary powers
voluntary - bearing down efforts aid in getting the fetus out (pushing)
70
frequency of contraction
start of one contraction to the Strat of the next contraction
71
duration of contraction
start of contraction to the end of that same contraction
72
birth canal is composed of
bony pelvis, cervix, pelvic floor muscle, vagina, and introitus
73
introitus
external opening to the vagina
74
80% of birth canals a
gynecoid
75
baby's fetal station is at 0 when
it reaches the ischial spine
76
negative fetal station =
higher than the pelvic bone and positive is below
77
+3 fetal station
crowning
78
movement of the fetus through the birthing canal is dependent on
size of fetal head, fetal presentation, fetal lie, fetal attitude, and fetal position
79
what makes the fetal head flexible
sutures and fontanels make skull flexible to accommodate the brain and head during labor
80
fetal lie
relation of the spine of the fetus to the spine of the mother
81
fetal lie can be
longitudinal, vertical, transverse, or horizontal
82
fetal attitude
relation of the fetal body parts on one another
83
fetal position
reference of the presenting part to the four quadrants of the mother's pelvis
84
frank breech presentation
feet crossed and up with but presenting
85
complete breech presentation
legs crossed and down with feet and butt presenting
86
footling breech presentation
feet presenting
87
ROP/LOP cephalic presentation
head down and back posterior
88
ROA/LOA cephalic presentation
head down and back anterior
89
longitudinal fetal lie
baby's spine is parallel with mom's spine
90
transverse lie
baby's spine is at a 90 degree angle to moms spine
91
fetal attitude can be
vertex, military, brow, or face
92
vertex fetal lie
baby cradled up - chin down
93
military fetal lie
chin at 90 degree to body
94
brow fetal lie
chin up a bit and is the largest circumference of all fetal lies
95
face fetal lie
facial features come out first chin raised
96
how many fetal positions are there
there are 6 positions
97
first letter in fetal position
is the location of the mother - either left or right
98
second letter of fetal position
fetal presenting part -
- O- occiput
- S- Sacrum
- M - Mentum
- A - Shoulder
99
third letter in fetal position
relation to mothers pelvis -
- A=anterior
- P=posterior
- T=transverse
100
what position do we want
OA
101
sunny side up is what position
OP
102
lightening
the descent of the presenting part of the fetus into the pelvis
103
lightening in primip vs multips
primip- can happen 2-4 weeks before labor begins
| multips - can happen in labor
104
Braxton-hicks
irregular contractions that don't cause cervical change
105
bloody show
mucous plug will sometimes fall out as cervix ripens (softens) can cause old brown blood and mucus with red blood to mix. can cause 2-4 wks before labor begins
106
spontaneous rupture of membranes
can happen before onset of labor or in labor. if it happens before labor doctor has 24 hrs to deliver
107
onset of labor is from
an unknown cause
108
can get an epidural up until
7 cm
109
cardinal movement of labor
engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion
110
engagement
when the greatest diameter of the head passes through the pelvic inlet
111
descent
movement of the fetus through the birth canal during the 1st and 2nd stage of labor
112
flexion
when the chin of the fetus moves toward the fetal chest and happens when the head meets resistance from maternal tissues
113
internal rotation
happens in second stage of labor rotation of the fetal head aligns with the long axis of both its own body and maternal pelvis
114
extension
the head extends with the resistance of the maternal pelvic floor causing the head to maneuver its way under the pubic bone
115
external rotation
sagittal suture moves to a transverse diameter, the shoulders align in the anterior/posterior position to maintain alignment with fetal trunk
116
expulsion
shoulders and the remainder of the body deliver
117
gate control theory
pleasurable sensations reach brain faster than pain does
118
why should pain management be implemented before pain becomes too severe
if pain becomes too severe catecholamines increase and can prolong labor
119
do analgesia opioids cross the placenta?
yes and can have effect on the fetus
120
what can opioids do to labor
it can prolong it
121
what do you need to check before giving an epidural
platelet count
122
what should you give before giving an epidural
fluids because epidurals cause hypotension
123
epidurals are contraindicated in
hypotension, infection, thrombocytopenia, and cardiac condition
124
spinal anesthesia (block)
anesthetic injected into the 3rd, 4th, and 5th interspace into the subarachnoid space
125
side effects of spinal block
hypotension, urinary retention, headache, and ineffective breathing patterns
126
nerve block analgesia
injecting lidocaine into the skin - local
127
nitrous oxide
self administered and helps with pain
128
general anesthesia is used for
emergency c section
129
indication for induction of labor
pregnancy after 39 weeks, gestational hypertension, preeclampsia, fetal demise, chorioamnionitis, premature rupture on membrane
130
fetal demis
baby didn't make it
131
chorioamnionitis
inflammation of fetal membrane due to infection of the amniotic fluid
132
if water breaks baby needs to be out
within 24 hours
133
stripping the membranes
use the finger to gently separate the sac from the side of the uterus
134
artificial rupture of membranes AROM
rupturing the membrane with a tool called an amnihook
135
cervical ripening agents
cytotec - makes the cervix softer, causing it to dilate
136
after 4 hours of cytotec you may start
Pitocin if labor has not started
137
pitocin is a
high risk medication and needs a double RN check
138
Pitocin causes
uterine contractions
139
low dose oxytocin administration
begin at 2 mu/min and increase by 2 mu/min every 30 minutes until 5 contractions in 10 minutes
140
high dose Pitocin
begin at 4 mu/min and increase by 4 mu/min until 5 contractions in 10 minutes
141
max dose of pitocin
20 mu/min
142
hypertonic uterine dysfunction
uncoordinated uterine activity - contractions are frequent but ineffective in getting cervix to dilate
143
nursing actions in hypertonic uterine dysfunction
rest, hydrate, and sedation
144
hypotonic uterine dysfunction
pressure of the contraction is insufficient to promote cervical dilation - will have fewer than 2-3 contractions in 10 minutes
145
nursing actions in hypotonic uterine dysfunction
walking, artificial rupture of membrane, nipple stimulation, low dose Pitocin
146
precipitous labor
labor that lasts less than 3 hours from onset of labor to birth
147
in a precipitous labor the neonate is at risk for
hypoxia and CNS damage because rapid birth can cause other not to oxygenate
148
risk factor for precipitous labor
multiparous and history of precipitous birth
149
nursing actions during precipitous labor
frequent cervical checks, careful inspection of maternal tissue and placenta, and monitoring of post part hemorrhage
150
shoulder dystocia
difficulty encountered during delivery in which shoulder cannot pass under the maternal pubic arch
151
most common birth injury
broken clavicle
152
prolapsed cord
cord lies below presenting part of fetus
153
treatment for prolapsed cord
goal is to relieve pressure from the umbilical cord until delivery of the infant - administer O2, tocolytics, and possible emergency c-section
154
meconium stained amniotic fluid
fetus has passed first stool before birth
155
what does meconium stained fluid usually show for
fetal distress or umbilical compression
156
what does meconium stained fluid put fetus at risk for
meconium aspiration syndrome
157
vacuum assisted delivery should be limited to
3 pulls in 15 min
158
indications for vacuum assisted delivery
fetal distress and maternal exhaustion
159
risk to the fetus using vacuum assisted delivery
cephalohematoma, intracranial hemorrhage, bruising and laceration
160
risk to mother using vacuum assisted delivery
perineal and vaginal trauma and bladder trauma
161
nursing actions if using the vacuum assisted delivery
have mom push well with the vacuum assist
162
baby needs to be at least a _______ to use the vacuum assist
+1 - +2
163
risk when using forceps
can cause damage to nerves along baby's face
164
preterm labor
uterine contraction occurring between 20-37 weeks but can still make it to full term
165
preterm birth
birth that occur before 37 weeks
166
inbetweenies
babies born between 34- 37 weeks
167
care for preterm labor
administer tocolytic and antenatal coticsoteriods
168
tocolytics
suppress uterine activity and given between 20-34 weeks
169
corticosteroids
promote fetal lung maturity
170
examples of corticosteroids
betamethasone 12 mg IM every 24 hr x 4 doses and dexamethasone 6 mg IM every 12 hours x 4 doses
171
maternal findings with chorioamniontitis
maternal fever, fetal tachycardia, uterine tenderness, and foul odor or fluid
172
disseminated intravascular coagulation (DIC)
body is breaking down blood clots faster than it can form a clot. body depletes itself from clotting factors leading to bleeding
173
treatment for DIC
c-section and intravenous heparin
174
types of c-sections
elective (scheduled), unplanned (emergent)- have 30 minutes to get baby out, and emergency cesarean - have 3-6 minutes to get baby out
175
c-section incisions
lower segment transverse or vertical. need to cut both the uterus and abdomen
176
vertical incision more associated with
higher complications but necessary with preterm breech, anterior placenta previa, and hydrocephalus
177
complications of c-section
like any major surgery: bleeding, clotting, infection, UTI, dehiscence of wound
178
preoperative care for C-section birth
```
CBC and blood type screening
NPO
VS and FHR
IV with LR
consent signed
hair shaven
support person in bunny suit
sequential device placed
```
179
intraoperative care with C-section
position wedge, foley, support person at head of bed, documentation, and assist with surgical counts
180
immediate post op care for C-section
transfer to PACU, VS every 15 min, oxytocin, pain med, nausea med, and assessment
181
what is important to monitor pt for after c-section
may be drowsy and at risk for falling asleep while holding baby
182
is vaginal birth after c-section okay
yes there will be a trial if the women has gone through detailed medical history
183
in order to have a vaginal birth after c-section the inaction has to have been
a low transverse and reason for c-section can not have been from a maternal factor
