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
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
3
Q
What is Amniotomy?
A
(AROM) The artificial rupture of membranes?
4
Q
What is the average FHR over 10 minute segment EXCLUDING episodic changes?
A
Baseline FHR
5
Q
What is beat to beat changes in baseline?
A
Variability
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
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
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
9
Q
What maternal factors trigger labor?
A
Secretion of hormones to stimulate contractions
10
Q
What fetal factors trigger labor?
A
> Aging placenta
>Secretion of hormones by fetus
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
12
Q
Can you go into labor without any of the 6 signs of labor?
A
YES YOU CAN!
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
14
Q
Do Braxton -Hicks contractions change the cervix?
A
NOO NOT AT ALL!!
15
Q
What is PROM?
A
Premature Rupture of Membranes
16
Q
PROM can cause what?
A
Septicemia
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.
18
Q
What is a nice shape pelvis? (passageway)
A
Gynecoid
19
Q
We want the baby’s head at what station? where is this located anatomically?
A
ZERO STATION
The Ischial Spine
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)
21
Q
What’s another word for the “Position” of the baby?
A
Attitude
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”
23
Q
Baby is laying on pelvis with but up and elbow pointing toward pelvis is called what?
A
Malpresentation
24
Q
Presentation, part that enters the pelvis first is called what?
A
Fetal position
25
What are the 2 primary lies for fetal position?
Longitudinal Lie
| Transverse Lie
26
The longitudinal lie has what two ways? what is the percentage of each?
Cephalic -96-97%
| Breech 3-4%
27
The transverse lie consists of what? & percentage?
Shoulder <1%
28
Why should the head come out 1st?
Because it's the largest part of the body and it helps to stretch out the CERVIX.
29
If the baby is looking at the floor when delivered, what cephalic presentation is this?
Anterior
30
If the baby is looking up what cephalic presentation is it?
Posterior
31
If the baby is breech.. what is a major risk?
Prolapse cord
32
What is a major risk with a transverse lie or shoulder presentation? why?
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..
33
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?
S&S of infection.FEVER, etc
34
What are some of the things in Psyche that affect labor?
```
Anxiety/FEAR
Cultural
-expectations
-responses
-values
-rituals
-modesty
-power issue
Reality vs expectations
```
35
What would be your anticipatory Guidance to alleviate anxiety etc..
Offer childbirth classes so they know what to expect. The more you understand what's happening w/your body the better you cope
36
What's the nursing role when dealing with the Psyche of PT?
Support
Decrease anxiety
Promote sense of control
37
What is it called when you use 4 steps to determine the fetal position, station and size? What are they?
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.
38
What is an External Fetal Version?
"Flipping the baby"
39
Is External Fetal Version a benign procedure?
NO. & it's painful for the mother!!!
40
What is the biggest risk with External Fetal Version?
Umbilical Cord Accident(compression)
41
REMINDER!! ALWAYS WEIGH RISK VS. BENEFITS!!
:)))
42
What are some of the risks with External Fetal Version?
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
What are the tests for Rupture of Membranes?
```
Nitrazine pH Test
+Nitrazine pH test is
(alkaline pH 6.5-7.5)
Fern Test
Crystalline ferning under microscopic examination
```
44
What kind of sign is Nitrazine pH Test?
Presumptive Sign
45
What kind of sign is the Fern Test?
Positive Sign
46
An amniotic fluid issue can lead to what?
Anmiotic Embolis which is FATAL!!
47
What is the 1st priority of the Nurse regarding External Fetal version?
FETAL MONITORING - FHR & Observe for contractions, any bleeding, BP, ALWAYS THINK ABOUT THE BABY 1ST!!
48
****ALWAYS THINK ABOUT THE BABY 1ST****
REMINDER
49
How many stages of Labor are there?
4 Stages
50
Which stage of Labor is: First true contraction> to FULL (complete) dilation?
Stage 1
51
Which stage of Labor is: FULL (complete) dilation> to delivery of infant?
Stage 2
52
What stage of Labor is: Delivery of infant to delivery of placenta?
Stage 3
53
What stage of Labor is: Delivery of placenta to 1st to 4th hour postpartum?
Stage 4
54
What is thinning of the cervix called?
Effacement
55
What is opening of the cervix called?
Dilation
56
What is another name for Engagement?
Lightening
57
What is key in engagement?
Ishial Spines are key!!
58
-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?
Engagement (lightening)
| Descent thru pelvis
59
If baby is engaged 99% of the time this means the inlet is what?
Large enough
60
Judgement at, above or below the ischial spines is called what?
Station
61
Spines =0 means what?
The baby is engaged in the pelvis!
62
"-" station means what?
Above the ischial spines
63
"+" station means what?
Below the ischial spines
64
+ 2 means what?
The baby is more than engaged!
65
+3 means what?
The baby is almost out!!
66
The latent phases are in what stage of labor?
| What are some of the characteristics?
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
The Active phases are in what stage of labor?
| What are some of the characteristics?
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
Do women know they are in the latent phase?
Yes some women will know..although they are uncomfortable!!!
69
The transition phase is in what stage of labor?
Stage 1
70
In what stage & phase has the cervix dilated from 7-10 cm?
Stage 1
| Transition phase
71
What are some of the characteristics of the transition phase?
```
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
In what phase are the characteristics so prevalent that you almost don't need to do a vaginal exam..
The TRANSITION PHASE
| 7-10 CM DILATED
73
The PT can lose the urge to push when she has had what?
An Epidural
74
Theoretically the duration of labor for a Primip is what?
14 hours (12-18 hrs of labor)
75
Theoretically the duration of labor for a Multip is what?
8 hours (6-10 hrs of labor
76
For a MULTIP- once you have a baby it's usually easier for the 2nd baby because the body remembers what it did!!
NOTE!!
77
What is the nursing care of the Laboring Client?
| What does it require?
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
What are the 7 nursing observations in Stage 1 of Labor?
- 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
If the patient is in the transition phase..should you leave the pt alone for a few..to relax?
NOO! You're not going to leave her. You need to monitor her EVEN MORE!!!
80
What does the frequency of monitoring depend on?
Stage of Labor and any complications but Every Hospital has they're own policy & procedure
81
What are some common side effects of labor?
- Nausea and vomiting
- Shaking
- Chills
- Irritability
- Frustration, anxiety, especially during transition
- Passing stool, especially when pushing
82
Are some ways to provide pain relief?
- 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
What two main things do laboring positions depend on?
What The station of the baby is & are membranes ruptured?
84
If the baby is "above -3 station" & ROM can the PT be in walking position?
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
Which stage is... "fully dilated to birth"?
| What is happening in this stage?
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
What is the nursing care during 2nd Stage of Labor?
-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
As Nursing STUDENTS what can we do..and only if we are asked?
- We can hold a leg
- Put a wet compress on head
- Change pad under patient
88
When PT is pushing, is making noise a good thing?
NO, they are letting some of the air out?
89
When preparing for Delivery involves what 4 things?
- Baby Crowning
- Notify MD/CNM
- Position woman
- Prep perineum
90
What is the Nursing Care During Delivery?
- Continue to monitor FHR until birth
- Note the presence/absence of a nuchal cord
- Watch for delivery of shoulders
- Note time of delivery
91
When the head it out only.. the baby CAN"T take a breath..because of what?
Cause, the chest is still in.. so the MD will suction the stuff out of mouth & nose.
92
Steps for rotation thru the pelvis are what?
- 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
What 4 phases happen in Stage 3?
Separation of Placenta: 5-30 min
Lengthening of the cord
A gush of blood
Expulsion of Placenta
94
The placenta detached itself..but sometimes it doesn't..can you pull on the cord?
NO!!
| Sometimes..the MD may give a very slight tug..but that's it.
95
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?
- Atony
- A bunch of bleeding happens
- 1st MASSAGE THE UTERUS!!!!!
96
In the Expulsion of Placenta..which side does the baby see? Where the placenta separtes from inside to outside?
Shiny Shultz
The Schultz mechanism
Fetal side presenting
97
In the Expulsion of Placenta...which side separates from outer margin inward?
Dirty Duncan
The Duncan Mechanism
Maternal presenting
98
Which Expulsion of Placenta is more likely to be associated with postpartum & hemorrhage?
Dirty Duncan!
99
Why does the Dirty Duncan look messier?
Because it was attached to the "Uterine Wall"!
100
What should we expect and monitor in Stage 4? What is stage 4 again:-)
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
What stage of Labor is Transition in?
Stage 1
