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NCM-109 > Nursing Care of a Family Experiencing a Complication of Labor or Birth > Flashcards

Nursing Care of a Family Experiencing a Complication of Labor or Birth Flashcards

1
Q

A difficult labor that can arise from any of the four main components of the labor process (4 Ps):

A

DYSTOCIA

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2
Q

force that propels the fetus (uterine contractions)

A

POWER

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2
Q

The fetus is also known as

A

PASSENGER

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3
Q

Common Types of Deviations That Can Cause Complications During Labor or Birth: PASSAGE

A
  • Inlet contraction
  • Outlet contraction
  • Trial labor
  • External cephalic version
  • Forceps birth
  • Vacuum extraction
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3
Q

Common Types of Deviations That Can Cause Complications During Labor or Birth: POWER

A
  • Ineffective uterine force
  • Dysfunctional labor and associated stages of labor
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4
Q

The birth canal

A

PASSAGEWAY

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4
Q

woman’s and family’s perception of the event

A

PSYCHE

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4
Q

Assessment for complications in labor and birth is based on careful ______

A

UTERINE & FETAL MONITORING

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4
Q

Therapeutic interventions for HYPOTONIC CONTRACTIONS

A

Oxytocin
Ambulation
Nipple stimulation
Enema
Amniotomy

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5
Q

Common Types of Deviations That Can Cause Complications During Labor or Birth: PASSENGER

A
  • Umbilical cord prolapse
  • Multiple gestation
  • Problems with fetal position, presentation, or size
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5
Q

can occur at any point in labor, but it is
generally classified as Primary or Secondary

A

DYSFUNCTION

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6
Q

This dysfunction occurs LATER in labor

A

SECONDARY DYSFUNCTION

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6
Q

denote that
sluggishness of
contractions, or
the force of labor,
has occurred.

A

INERTIA OR DYSFUNCTIONAL LABOR

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6
Q

are the basic force moving the
fetus through the birth canal.

A

UTERINE CONTRACTIONS

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7
Q

This dysfunction occurs at the ONSET of labor

A

PRIMARY DYSFUNCTION

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7
Q

Complications w/ POWER

A

> Ineffective Uterine Force
Dysfunctional Labor and Associated > Stages of Labor
Contraction Rings
Precipitate Labor
Induction & Augmentation of Labor
Uterine Rupture
Inversion of Uterus
Amniotic Fluid Embolism

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7
Q

3 types of uterine dysfunction

A
  • Hypotonic Contractions
  • Hypertonic Contractions
  • Uncoordinated Contractions
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8
Q

When uterine contractions become abnormal or ineffective they are called

A

INEFFECTIVE UTERINE FORCE

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9
Q

Common causes of Dysfunctional labor

A

-Primigravida status (first pregnancy)
-Pelvic bone contraction that has NARROWED the pelvic diameter (CPD); could occur in a woman with rickets
Posterior fetal position; extension of the fetal head
-Unripe cervix
-Full rectum or urinary bladder; impedes fetal descent
-Woman exhausted from labor
-Inappropriate use of analgesia (excessive/too early administration)

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9
Q

Etiology of hypotonic contractions

A
  • Overstretching of the fetus
  • Bowel/bladder distention
  • Excessive use of analgesia
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10
Q

Symptom of hypotonic contractions

A

PAINLESS

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10
Q

HYPERTONIC CONTRACTIONS:

Number of Contractions:
Resting Tone:
Phase of Labor
Symptom:
Cause:

A

Number of Contractions: NOT PRODUCTIVE; frequent prolonged contractions
Resting Tone: >15 mmHg
Phase of Labor: Latent (1st Stage)
Symptom: PAINFUL
Cause: Muscle fibers of myometrium (outer layer of uterus) do not relax after contraction

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10
Q

Number of Contractions: not more
than 2 or 3 occurring in a 10-minute period

A

HYPOTONIC CONTRACTIONS

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10
Q

Complication of Hypertonic Contractions

A

FETAL ANOXIA

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11
Q

Hypotonic Contractions:

Number of Contractions:
Resting Tone:
Strength of Contractions:
Phase of Labor
Symptom:

A

Number of Contractions: <2 or 3 in 10 minutes
Resting Tone: <10 mmHg
Strength of Contractions: ≤25 mmHg
Phase of Labor: Active Stage (1st Stage)
Symptom: PAINLESS

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12
Q

frequent prolonged contractions that are not productive

A

HYPERTONIC CONTRACTIONS

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13
Q

Management for hypertonic contractions to avoid fetal anoxia

A

Provide comfort measures
Bed rest/position changes
Hydration
Mild sedation
Tocolytics
Cesarean delivery

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14
Q

more than one pacemaker may be
initiating contractions, or receptor
points in the myometrium may be
acting independently of the
pacemaker.

A

UNCOORDINATED CONTRACTIONS

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14
Q

may occur so closely together that they do not allow good cotyledon( one of the
visible segments on the maternal
surface of the placenta) filling.

A

UNCOORDINATED CONTRACTIONS

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15
Q

Dysfunction at the First Stage of Labor

A

Prolonged latent phase
Protracted active phase
Prolonged deceleration phase
Secondary arrest of dilatation

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15
Q

is usually associated with
cephalopelvic disproportion (CPD) or fetal malposition, although
it may reflect ineffective myometrial activity.

A

Protracted Active Phase

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15
Q

Dysfunction at the Second Stage of Labor

A

Prolonged descent
Arrest of descent

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16
Q

Contractions that become ineffective during the first stage of labor
* Latent phase that is longer than 20 hours in a nullipara or 14 hours in a multipara.

A

PROLONGED LATENT PHASE

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16
Q
  • Uterus tends to be in a hypertonic
    state.
  • Relaxation between contractions is
    inadequate, and the contractions
    are only mild (less than 15 mm Hg
    on a monitor printout) and
    therefore ineffective.
  • One segment of the uterus may be
    contracting with more force than
    another segment.
A

PROLONGED LATENT PHASE

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17
Q

Progress in dilation slows after 8 cm and uterine contractions become dysfunctional, even after
oxytocin administration.

A

Prolonged Deceleration Phase

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17
Q
  • This phase is prolonged if cervical dilatation does not occur at
    a rate of at least 1.2 cm/hr in a nullipara or 1.5 cm/hr in a
    multipara, or if the active phase lasts longer than 12 hours in a
    primigravida or 6 hours in a multigravida.
A

Protracted Active Phase

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17
Q

This has occurred if
there is no progress in cervical dilatation for
longer than 2 hours.

A

Secondary Arrest of Dilatation

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18
Q

occurs if the rate of
descent is less than 1.0 cm/hr in a nullipara or 2.0
cm/hr in a multipara.

A

PROLONGED DESCENT

19
Q

Can be suspected if second stage lasts over 3 hrs in multipara

A

PROLONGED DESCENT

20
Q

results when no descent has occurred for 1 hour in a multipara or 2 hours in a nullipara.

A

Arrest of Descent

20
Q

This has occurred when expected descent of the fetus does not begin or engagement or movement
beyond 0 station has not occurred.

A

ARREST OF DESCENT

20
Q

The most frequent type seen is termed a ____ which usually appears during the second stage of labor and can be
palpated as a horizontal indentation across the abdomen

A

Pathologic Retraction ring (Bandl’s ring).

20
Q

a hard band that forms across the uterus at
the junction of the upper and lower uterine segments and
interferes with fetal descent

A

Contraction Rings

21
Q

The most likely cause for arrest of descent during the
second stage is ___

A

CPD

22
Q

> occur when uterine contractions are so strong that a woman gives birth with only a few, rapidly occurring contractions.

> It is often defined as a labor that is
completed in fewer than 3 hours.

A

Precipitate labor

22
Q

cervical dilatation that occurs at a rate of 5 cm or more per hour in a primipara or 10 cm or more per hour in a multipara

A

Precipitate dilatation

22
Q

This is a risk to fetus

A

SUBDURAL HEMORRHAGE

23
Q

Conditions for Induction of Labor

A

> Fetus is in longitudinal lie
Cervix is ripe; ready for birth
Presenting part is engaged
NO CPD

23
Q

This means that labor is started
artificially

A

INDUCTION OF LABOR

23
Q

change in the cervical
consistency from firm to
soft

A

CERVICAL RIPENING

23
Q

It refers to assisting labor that
has started spontaneously but is not effective.

A

AUGMENTATION LABOR

24
Q

Conditions for induction of labor

A

> Fetus is in a longitudinal lie
Cervix is ripe, or ready for birth
Presenting part is engaged
No CPD
Fetus is estimated to be mature by date, demonstrated by lecithin -sphingomyelin ratio or ultrasound biparietal dimeter to rule out preterm birth

25
Q

What are the complications of augmentation of labor

A

-Overstimulation of contractions
-Water Intoxication

26
Q

Pharmacological method to stimulate contraction

A

OXYTOCIN INDUCTION

26
Q
  • Occurs when a uterus undergoes more strain that it can sustain
A

UTERINE RUPTURE

26
Q

This is done to relieve pressure on cord

A

AMNIOINFUSION

26
Q

Non-pharmacological methods to stimulate contraction

A

-Ambulation
-Sitting upright
-Nipple stimulation

26
Q

If amniotic fluid embolism is suspected, what would the nurse do first?

A

OXYGEN ADMINISTRATION

26
Q

Ideal occiput presentation during birth

A

LOA & ROA

26
Q
  • Uterus turning inside out with either birth of the fetus or delivery of the placenta
A

UTERINE INVERSION

26
Q

What are the signs of shock

A

> rapid, weak pulse
falling BP
cold & clammy skin
dilatation of nostril from air hunger

26
Q
  • Occurs when amniotic fluid is forced into an open maternal uterine blood sinus through some defect in the membranes or after membrane rupture or partial premature separation of the placenta
A

AMNIOTIC FLUID EMBOLISM

27
Q

What will the patient be experiencing if she has uterine rupture?

A

a sudden, severe pain during a strong labor contraction, which she may report as a “tearing” sensation

27
Q

2 types of uterine rupture

A

COMPLETE & INCOMPLETE

27
Q

part of the baby’s body that is closes to the birth canal

A

FETAL PRESENTATION

27
Q

due to cord compression (preventing venous return to fetus and arterial vasospasm—secondary to exposure to air)

A

BIRTH ASPHYXIA

27
Q
  • Descent of the umbilical cord through the cervix
A

CORD PROLAPSE

27
Q

In cephalic presentation, this is the presenting part

A

OCCIPITAL FONTANEL

27
Q

A persistent occipito-posterior pos’n results from what?

A

a failure of internal rotation prior to birth

27
Q

occiput is placed over RIGHT sacroiliac joint

A

Right Occipito Posterior (ROP)

28
Q
  • Vertex position where the occiput is placed posteriorly over the sacroiliac joint or directly over the sacrum
A

OCCIPITO-POSTERIOR POSITION

28
Q

How many degrees does the fetal head rotate during internal rotation

A

APPROX. 135 DEGREES

28
Q

occiput points TOWARDS the sacrum

A

Direct Occipito Posterior Position

28
Q

occiput placed over LEFT sacroiliac joint

A

Left Occipito Posterior (LOP or KO

29
Q

What should the nurse teach the client to aid rotations from a posterior position

A

-Hands and knees position (on all 4s)
-Squatting
-Lying to the side opposite the fetal back

30
Q

experienced by the woman in her lower back due to sacral nerve compression when fetal head rotates against the sacrum

A

PRESSURE & PAIN

31
Q
  • Also called ASYNCLITISM or fetal head presenting at a different angle than expected
A

FACE PRESENTATION

32
Q

The rarest among presentations

A

BROW PRESENTATION

33
Q

-Occurs during 2nd stage of labor
-When fetal head is born but the shoulders are too broad to enter and be born through the pelvic inlet

A

SHOULDER DYSTOCIA

34
Q

occurs because the head becomes jammed in the brim of the pelvis as the occipitomental diameter presents

A

OBSTRUCTED LABOR

34
Q

instruct woman to flex her thighs sharply on her abdomen to widen the pelvic outlet and allow the anterior shoulder to be born

A

MCROBERT’S MANEUVER

35
Q

A fetus that weighs more than 4000-4500g

A

MACROSOMIA

35
Q

Macrosomic babies usually weigh ____ at birth

A

> 4000-4500

36
Q

to compare size of fetus w/ the woman’s pelvic capacity

A

PELVIMATERY

37
Q
  • Narrowing of the anteroposterior diameter to less than 11 cm or the transverse diameter to 12 cm or less
A

INLET CONTRACTION

38
Q

Narrowing of the transverse diameter at the outlet to less than 11 cm

A

OUTLET CONTRACTION

39
Q
  • A forceps outlet procedure in which forceps are applied after the fetal head reaches the perineum
A

FORCEPS BIRTH

39
Q
  • Determination of the progress of labor in a woman who has borderline inlet measurement with a good fetal lie ad position
A

TRIAL LABOR

40
Q
A
40
Q

Turning of the fetus from a breech to a cephalic position before birth

A

EXTERNAL CEPHALIC VERSION

40
Q
A
40
Q
A
41
Q
A

NCM-109 (9 decks)

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