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NUR 102 Exam 1 Intrapartal Care > NUR 102 Exam 1 Intrapartal Care > Flashcards

NUR 102 Exam 1 Intrapartal Care Flashcards

1
Q

What is a visually abrupt increase in fetal heart rate of 15 or more beats per minute above baseline?

A

Accelerations

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2
Q

What’s a rapid assessment of five physiological signs that indicate the physiological status of the newborn at birth?

A

The Apgar score

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3
Q

What is Amniotomy?

A

(AROM) The artificial rupture of membranes?

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4
Q

What is the average FHR over 10 minute segment EXCLUDING episodic changes?

A

Baseline FHR

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5
Q

What is beat to beat changes in baseline?

A

Variability

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6
Q

What is a physiological and mechanical process in which uterine muscles contract and retract rhythmically resulting in delivery of baby & placenta?

A

LABOR

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7
Q

What is a force (contraction) exerted on a movable object (baby) meeting resistance (cervix&pelvic floor) resulting in a gove (effacement, dilation and descent)?

A

LABOR

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8
Q

> Fetus undergoes changes in position (rotation)
Purpose is to present smallest possible diameter of presenting part to irregular shape of pelvic canal
and to decrease resistance. This is called what?

A

The mechanism of Labor

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9
Q

What maternal factors trigger labor?

A

Secretion of hormones to stimulate contractions

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10
Q

What fetal factors trigger labor?

A

> Aging placenta

>Secretion of hormones by fetus

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11
Q

What are the 6 signs of impending labor?

A 
>Lightening = Baby drops
>Braxton-Hicks Contraction
>Cervical softening or "ripening"
>Weight loss and/or GI disturbances
>Burst of Energy
>Bloody show
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12
Q

Can you go into labor without any of the 6 signs of labor?

A

YES YOU CAN!

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13
Q

What are the 4 S&S of TRUE LABOR?

A

> Uterine contractions which are regular, become more frequent and intense
Cervical changes
Bloody show (loss of muscous plug)
Rupture of membranes (may occur before labor begins or during labor

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14
Q

Do Braxton -Hicks contractions change the cervix?

A

NOO NOT AT ALL!!

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15
Q

What is PROM?

A

Premature Rupture of Membranes

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16
Q

PROM can cause what?

A

Septicemia

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17
Q

The 5 “Ps” that affect labor are called what?

What do they stand for?

A

> Power-uterine contractions, abdominal muscles of mother while pushing
Passageway- Pelvis-size & shape; soft tissue
Passenger -size, position & presentation
Position- frequent changes during the 1st and 2nd Stages
Psyche- response of the woman i.e if she doesn’t want to push anymore.

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18
Q

What is a nice shape pelvis? (passageway)

A

Gynecoid

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19
Q

We want the baby’s head at what station? where is this located anatomically?

A

ZERO STATION

The Ischial Spine

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20
Q

What is it called when the baby’s (passenger) head is too large to fit through mother’s pelvis?

A

Cephelopelvic disproportion (CPD)

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21
Q

What’s another word for the “Position” of the baby?

A

Attitude

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22
Q

What is the normal attitude (position) for the passenger?

A

Norm=flexed:head toward the chest, arms and legs flexed over thorax, back curved in “C”

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23
Q

Baby is laying on pelvis with but up and elbow pointing toward pelvis is called what?

A

Malpresentation

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24
Q

Presentation, part that enters the pelvis first is called what?

A

Fetal position

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25
Q

What are the 2 primary lies for fetal position?

A

Longitudinal Lie

Transverse Lie

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26
Q

The longitudinal lie has what two ways? what is the percentage of each?

A

Cephalic -96-97%

Breech 3-4%

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27
Q

The transverse lie consists of what? & percentage?

A

Shoulder <1%

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28
Q

Why should the head come out 1st?

A

Because it’s the largest part of the body and it helps to stretch out the CERVIX.

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29
Q

If the baby is looking at the floor when delivered, what cephalic presentation is this?

A

Anterior

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30
Q

If the baby is looking up what cephalic presentation is it?

A

Posterior

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31
Q

If the baby is breech.. what is a major risk?

A

Prolapse cord

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32
Q

What is a major risk with a transverse lie or shoulder presentation? why?

A

Risk of infection.
If arm is hanging out and you have to do a C-Section the arm has to go back thru vagina-uterus..(it’s already been exposed to bacteria in vagina, etc..

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33
Q

If your PT says she had a transverse lie(shoulder presentation..arm was out..and ended up having a C-section..what are you going to be looking out for?

A

S&S of infection.FEVER, etc

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34
Q

What are some of the things in Psyche that affect labor?

A 
Anxiety/FEAR
Cultural
-expectations
-responses
-values
-rituals
-modesty
-power issue
Reality vs expectations
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35
Q

What would be your anticipatory Guidance to alleviate anxiety etc..

A

Offer childbirth classes so they know what to expect. The more you understand what’s happening w/your body the better you cope

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36
Q

What’s the nursing role when dealing with the Psyche of PT?

A

Support
Decrease anxiety
Promote sense of control

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37
Q

What is it called when you use 4 steps to determine the fetal position, station and size? What are they?

A

Leopold’s Maneuver

  1. Palpate fundus to determine presentation
  2. Hold hand on one side while palpating other side to determine which side is fetal back.
  3. Palpate the suprapubic area to confirm presentation
  4. Turn to face patients feet, hands on each side of uterus, fingers pointed toward pelvic inlet to determine if head is flexed or face.
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38
Q

What is an External Fetal Version?

A

“Flipping the baby”

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39
Q

Is External Fetal Version a benign procedure?

A

NO. & it’s painful for the mother!!!

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40
Q

What is the biggest risk with External Fetal Version?

A

Umbilical Cord Accident(compression)

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41
Q

REMINDER!! ALWAYS WEIGH RISK VS. BENEFITS!!

A

:)))

42
Q

What are some of the risks with External Fetal Version?

A

Umbilical Cord compression
Disruption of placental site and subsequent abruption
Mixing of maternal and fetal blood
Possible need for emergency C-SECTION if:
-Fetus returns to abnormal presentation
-Bleeding
-Fetal compromise results

43
Q

What are the tests for Rupture of Membranes?

A 
Nitrazine pH Test
\+Nitrazine pH test is
(alkaline pH 6.5-7.5)
Fern Test
Crystalline ferning under microscopic examination
44
Q

What kind of sign is Nitrazine pH Test?

A

Presumptive Sign

45
Q

What kind of sign is the Fern Test?

A

Positive Sign

46
Q

An amniotic fluid issue can lead to what?

A

Anmiotic Embolis which is FATAL!!

47
Q

What is the 1st priority of the Nurse regarding External Fetal version?

A

FETAL MONITORING - FHR & Observe for contractions, any bleeding, BP, ALWAYS THINK ABOUT THE BABY 1ST!!

48
Q

ALWAYS THINK ABOUT THE BABY 1ST

A

REMINDER

49
Q

How many stages of Labor are there?

A

4 Stages

50
Q

Which stage of Labor is: First true contraction> to FULL (complete) dilation?

A

Stage 1

51
Q

Which stage of Labor is: FULL (complete) dilation> to delivery of infant?

A

Stage 2

52
Q

What stage of Labor is: Delivery of infant to delivery of placenta?

A

Stage 3

53
Q

What stage of Labor is: Delivery of placenta to 1st to 4th hour postpartum?

A

Stage 4

54
Q

What is thinning of the cervix called?

A

Effacement

55
Q

What is opening of the cervix called?

A

Dilation

56
Q

What is another name for Engagement?

A

Lightening

57
Q

What is key in engagement?

A

Ishial Spines are key!!

58
Q

-Greatest transverse diameter of fetal head enters pelvis in transverse position
-Positive indication that inlet is large enough
-Ischial spines used as landmarks
are all regarding what?

A

Engagement (lightening)

Descent thru pelvis

59
Q

If baby is engaged 99% of the time this means the inlet is what?

A

Large enough

60
Q

Judgement at, above or below the ischial spines is called what?

A

Station

61
Q

Spines =0 means what?

A

The baby is engaged in the pelvis!

62
Q

”-“ station means what?

A

Above the ischial spines

63
Q

”+” station means what?

A

Below the ischial spines

64
Q

+ 2 means what?

A

The baby is more than engaged!

65
Q

+3 means what?

A

The baby is almost out!!

66
Q

The latent phases are in what stage of labor?

What are some of the characteristics?

A

Stage 1

  • 0-3/4 cm dilated
  • it’s a slow process
  • mother not uncomfortable; talkative and smiling
  • may be up and about
  • the contractions are mild and short
  • contractions become regular 15-40 sec q 10-20 min.
67
Q

The Active phases are in what stage of labor?

What are some of the characteristics?

A

Stage 1

  • 3/4 cm - 7cm
  • contractions are more intense, regular, longer
  • need women’s concentration
  • q2-3 min, up to 60 sec duration
68
Q

Do women know they are in the latent phase?

A

Yes some women will know..although they are uncomfortable!!!

69
Q

The transition phase is in what stage of labor?

A

Stage 1

70
Q

In what stage & phase has the cervix dilated from 7-10 cm?

A

Stage 1

Transition phase

71
Q

What are some of the characteristics of the transition phase?

A 
7-10 cm dilated
shortest & most uncomfortable
-mother irritable
-increased sensitivity to touch
-Hyperventilate
-Nausea and vomiting
-Contractions are longer, more frequent, stronger
-mom says"can't take it anymore"
-Feeling RECTAL Pressure and URGE to PUSH
72
Q

In what phase are the characteristics so prevalent that you almost don’t need to do a vaginal exam..

A

The TRANSITION PHASE

7-10 CM DILATED

73
Q

The PT can lose the urge to push when she has had what?

A

An Epidural

74
Q

Theoretically the duration of labor for a Primip is what?

A

14 hours (12-18 hrs of labor)

75
Q

Theoretically the duration of labor for a Multip is what?

A

8 hours (6-10 hrs of labor

76
Q

For a MULTIP- once you have a baby it’s usually easier for the 2nd baby because the body remembers what it did!!

A

NOTE!!

77
Q

What is the nursing care of the Laboring Client?

What does it require?

A

Provide physical & emotional support to mother AND her support people thru all four stages of labor

  • be accepting
  • be non-judgemental
  • observe closely mom and baby
  • be educated on all forms of pain management
78
Q

What are the 7 nursing observations in Stage 1 of Labor?

A
  • Fetal Heart Rate
  • Mother’s Vital signs
  • Contraction pattern
  • Membrane status
  • Lab values; GBBS, VDRL, H&H, HIV, Rubella titer, Blood type
  • How PT is coping with labor
  • Cultural beliefs
79
Q

If the patient is in the transition phase..should you leave the pt alone for a few..to relax?

A

NOO! You’re not going to leave her. You need to monitor her EVEN MORE!!!

80
Q

What does the frequency of monitoring depend on?

A

Stage of Labor and any complications but Every Hospital has they’re own policy & procedure

81
Q

What are some common side effects of labor?

A
  • Nausea and vomiting
  • Shaking
  • Chills
  • Irritability
  • Frustration, anxiety, especially during transition
  • Passing stool, especially when pushing
82
Q

Are some ways to provide pain relief?

A
  • TEACHING-EDUCATED COUPLE
  • Breathing:Lamaze, Bradley
  • Comfort measures; Back rub, effleurage (rythmic abd massage), position change, walking, dancing, rocking, birthing ball, hydrotherapy
  • Stay with patient and involve support person
  • Analgesics
  • Episiotomy; Pudendal Block, Epidural
83
Q

What two main things do laboring positions depend on?

A

What The station of the baby is & are membranes ruptured?

84
Q

If the baby is “above -3 station” & ROM can the PT be in walking position?

A

NO, we don’t want her walking because the baby is floating..she may have a prolapsed cord.
If it wasn’t ruptures, she can walk because the cord is safe in the sack!!

85
Q

Which stage is… “fully dilated to birth”?

What is happening in this stage?

A

Stage 2

  • Contractions are strong and long-up to 90 sec
  • Pushing may not be spontaneous and may take up to two hours or more if not contraindicated
  • Pelvic floor-begins to bulge “ring of fire”
  • Crowning -(When you see the head)
  • Forces
  • contractions
  • intra-abdominal pressure (pushing)
86
Q

What is the nursing care during 2nd Stage of Labor?

A

-NOTIFY MD/CNM that woman is fully dilated and whether or not she is starting to push
-Coach woman to push WITH contractions
-Include significant other as appropriate
>Holding a leg
>Counting
-Comfort measures
Cold wash cloth to forehead
Change positions as indicated
Keep patient as dry and clean possible

87
Q

As Nursing STUDENTS what can we do..and only if we are asked?

A
  • We can hold a leg
  • Put a wet compress on head
  • Change pad under patient
88
Q

When PT is pushing, is making noise a good thing?

A

NO, they are letting some of the air out?

89
Q

When preparing for Delivery involves what 4 things?

A
  • Baby Crowning
  • Notify MD/CNM
  • Position woman
  • Prep perineum
90
Q

What is the Nursing Care During Delivery?

A
  • Continue to monitor FHR until birth
  • Note the presence/absence of a nuchal cord
  • Watch for delivery of shoulders
  • Note time of delivery
91
Q

When the head it out only.. the baby CAN”T take a breath..because of what?

A

Cause, the chest is still in.. so the MD will suction the stuff out of mouth & nose.

92
Q

Steps for rotation thru the pelvis are what?

A
  • Floating
  • Engagement & flexion
  • Further descent and internal rotation
  • Complete rotation, beginning extension
  • Complete extension (crowning)
  • External rotation (restitution)
  • Delivery of anterior shoulder
  • Delivery of posterior shoulder
  • Expulsion
93
Q

What 4 phases happen in Stage 3?

A

Separation of Placenta: 5-30 min
Lengthening of the cord
A gush of blood
Expulsion of Placenta

94
Q

The placenta detached itself..but sometimes it doesn’t..can you pull on the cord?

A

NO!!

Sometimes..the MD may give a very slight tug..but that’s it.

95
Q

Sometimes the uterus gives up after the placenta comes out and doesn’t contract..what is this called, what happens and what should we as nurses do?

A
  • Atony
  • A bunch of bleeding happens
  • 1st MASSAGE THE UTERUS!!!!!
96
Q

In the Expulsion of Placenta..which side does the baby see? Where the placenta separtes from inside to outside?

A

Shiny Shultz
The Schultz mechanism
Fetal side presenting

97
Q

In the Expulsion of Placenta…which side separates from outer margin inward?

A

Dirty Duncan
The Duncan Mechanism
Maternal presenting

98
Q

Which Expulsion of Placenta is more likely to be associated with postpartum & hemorrhage?

A

Dirty Duncan!

99
Q

Why does the Dirty Duncan look messier?

A

Because it was attached to the “Uterine Wall”!

100
Q

What should we expect and monitor in Stage 4? What is stage 4 again:-)

A

First 1 to 4 hours after Birth

  • Stage of physical recovery for mom and baby
  • Contraction of uterus
  • Monitor for signs of excessive blood loss, full bladder, clots
  • Pain management
  • Chills and shaking
101
Q

What stage of Labor is Transition in?

A

Stage 1

NUR 102 Exam 1 Intrapartal Care (4 decks)

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