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Nursing Block 3 Ob > OB Bootcamp > Flashcards

OB Bootcamp Flashcards

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1
Q

Stage 1 of labor

A

The stage of cervical dilation. Begins with the onset of regular contractions and ends when complete. Includes Latent, Active, and Transitional phases

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2
Q

Stage 2 of labor

A

Expulsion. Begins with complete cervical dilation and ends with delivery of the fetus

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3
Q

Stage 3 of labor

A

Placental stage. Begins immediately after the fetus is born and ends with the delivery of the placenta

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4
Q

Stage 4 of labor

A

Maternal homeostatic stabilization. Begins after the delivery of the placenta and continues for 1-4 hours after delivery.

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5
Q

Latent Phase

A

Dilation 0-3 CM
UC q 15-30 minutes
mom usually happy/excited
Part of stage 1

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6
Q

Active Phase

A 
Dilation between 4-7cm
UC 5-8 minutes
UC last 45-60 seconds
mom gets anxious. starts to feel more pain
Part of stage 1
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7
Q

Transition Phase

A 
Dilation between 8-10 cm 
UC 1-2 minutes apart
uc last 45-90 seconds
-Duration of strong intensity.
Part of stage 1
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8
Q

when shouldn’t you use external fetal monitoring

A

-if the fetus is dead
-mom refuses monitoring
-dr did not order
do not use continuously is the fetus is less than 23 weeks.

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9
Q

Clue for contractions. What the DIF??

A

D- Duration (how long)
I- Intensity (how strong)
F- Frequency (hoe often)

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10
Q

Disadvantages and risks of Internal Uterine monitoring

A

Disadvantages: membranes must be ruptured, must nbc inserted by skilled care provider.
RISKS: abruption, lower uterine segment perforation, infection, contraindicated with HIV and active herpes

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11
Q

what is the duration on a contraction

A

from the beginning of one contraction to the end of that same contraction

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12
Q

What is the Frequency of a contraction

A

beginning of one contraction to the beginning of the next contraction.

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13
Q

Tachysystole (hyperstimulation)

A

more than 5 UC in 10 minutes, over a 30 minutes or any single contraction lasting longer than 120 seconds

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14
Q

Causes for decreased FHR variability

A

hypoxemia, drugs, CNS depression, fetal sleep cycles, congenital anomalies, extreme prematurity, nueologic anomaly
ACTION: evaluate cause, stimulate fetus (scalp stimulation, vibroacoustic stimulation, trans abdominal halogen light), oxygen by mask, notify MD

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15
Q 
EFM TERMS:
Variability
Accelerations
Decelerations 
(early, late, variable)
A

variability: beat to beat variation. (Absent, mild: less than 5 bpm, Moderate: 6-25 ppm, Marked: greater than 25 bpm,
Bradycardia FHR: less than 110 bpm
Tachycardia FHR: greater than 160 bpm
Accelerations: Increase in FHR 15 beats for 15 seconds, good-reassuring.
Deceleration: EARLY: vagus nerve response to head compression- usually reassuring-appears with UC
LATE: utero placental insufficiency - always bad. appears during and after UC concludes
VARIABLE: cord compression, sharp deceleration with rapid return

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16
Q

What if the fetal HR drops below 55-60 bpm?

A

THINK HYPOXIA

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17
Q

VEAL CHOP

A

Variable. Cord
EARLY. HEAD
ACCELERATION. OK
LATE PLACENTA

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18
Q

FHR range

A

110-160 beats per min

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19
Q

FHR categories

A

1- WNL
2- Prblamatice patterns
3- Pathologic patterns

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20
Q

Prolonged decelerations

A

variable in shape and onset
often associated with rebound tachycardia and loss of variability
frequently an isolated event
CAUSES: cord compression or prolapse, tachysystole, maternal hypotension, rapid fetal descent, sustained maternal valsalva, SVE or FSE applications, maternal voiding or cvomiting

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21
Q

Nursing actions with late decelerations

A 
SVE to r/o cord prolapse or rapid decent.
Change maternal position
oxygen 10 LPM by mask
IVF bolus
notify MD
terbutaline PRN
stop oxytocin
sterile vag exam
correct maternal hypotension
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22
Q

POINTS

A 
P   Position
O   O2
I     IV  - open wide open
N   Notify DR
T.   Terbutaline
S.    STOP Pitocin & STERILE vag exam
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23
Q

SINUSOIDAL PATTERN

A

rare but ominous pattern associated with high rates of morbidity and mortality
Appears as regular, smooth, undulating form of a sine wave with frequency of 2-5 cycles per minute and amplitude of 5-25 BPM.
Indicates severe fetal anemia or severe fetal hypoxia

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24
Q

Cardinal Movements

A

Engagement- head at station 0
Descent- head moving out of pelvis
Flexion- chin to chest
Internal rotation: head rotation to midline
Extension: chin up as head passes symphysis pubis
External Rotation: Head transverse to allows holders to pass
Explusion: Head out

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25
Q

POSTPARTUM ASSESSMENT

A 
BUBBLE HE
Breasts
Uterus
Bowels
Bladder
Lochia
Episiotomy/laceration/C Section
Hemmorhoids & Hemmorhage
Emotions
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26
Q

Evaluation of Episiotomy heeling

A 
REEDA
Redness
Edema
Eccymosis
Drainage, Discharge
approximation
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27
Q

LATCH

A 
LATCH (0=to sleepy, 1=repeated attempt, holds nipple in mouth, have to stimulate to suck. 3=grasps breast, lounge down, lips flanged, rhythmic sucking)
AUDIBLE SWALLOWING (0=none, 1=few wth stimulation, 2=spontaneous and intermittent if more then 24 hours old. spontaneous and frequent if over 24 hrs old
TYPE OF NIPPLE (0=inverted, 1=flat, 2=everted)
COMFORTof breast/nipple (0=Engorged, cracked, bleeding, blisters, bruising. 2=Filling. reddened/small blisters or bruises. mild to moderate discomfort. 3 Soft, contender.
HOLD /positioning. (1=Full assist-staff hold infant at breast. 2=minima. assist-elevate head of bed, place pillow for support, teach one side and mom does other. 3=no assist from staff. mom able to position infant.
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28
Q

What is eyes and thighs

A

Eyes get erythromycin, Vitamin K (left thigh), Hep B(right thigh)

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29
Q

Station

A

the measurement of the progress of descent in centimeters above or below the midplane from the presenting part to the ischial spines. Station 0: at ischial spine. Minus station: above ischial spine. Plus station: below ischial spine.

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30
Q

Effacement

A

shortening and thinning of the cervix during the first stage of labor

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31
Q

Before you apply External fetal monitoring you should?

A

Complete maternal-fetal assessment
-Urinalysis, palpate fetal movement, Vital signs, labor assessment, leopards maneuver, maternal fetal hx, educate on EFM, detect contraindication

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32
Q

uterine contractions

A
  • Uterine contractions controlled by alpha receptors in uterine muscle cells
  • Begin in uterine fundus and proceed symmetrically down toward cervix
  • Pressure >50 mm Hg = no oxygen to fetus
  • Influenced by maternal hydration status and fear
  • –Fear= Catecholamines = PAIN
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33
Q

Fetal Bradycardia

A

Less than 120 beats per min

-Change position of the mother and administer oxygen as prescribed. The physician is notified

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34
Q

Fetal Tachycardia

A

greater than 160 BPM.

-Change position of the mother and administer oxygen as prescribed. The physician is notified

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35
Q

Variability (fetal)

A

a change in the baseline FHR in response to sleep, wake states, medications and hypoxia. A FHR that fluctuates 6-25 BPM at the baseline indicates a well-oxygenated functioning central nervous system

36
Q

Acceleration (fetal)

A

transient rise in FHR of more than 15 beats per minute for more than 15 seconds. May or may not be related to uterine contractions. Marked acceleration (more than 180 BPM) may be related to prematurity, maternal fever, hypoxia, fetal infection, or medications.

37
Q

Deceleration (Fetal)

A

transient decrease in the FHR. Early deceleration: decrease in the FHR below baseline. Can be due to head compression

38
Q

Variable deceleration

A

an abrupt decrease in FHR that is variable in duration, intensity, and timing. Can be due to cord compression.

39
Q

Late deceleration

A

decrease in the FHR below baseline. Due to uteroplacental insufficiency.

40
Q

Hyperstimulation

A

increasing resting tone or peak contraction pressures. Implementation for altered patterns: the physician is notified. Check for cord prolapse. Maintain the client in the left lateral position. Administer oxygen as prescribed. Oxytocin infusion is discontinued as prescribed. Fetal scalp pH is done to determine a blood pH value. IV fluids are increased as prescribed. Monitor and maintain blood pressure if hypotension occurs. Prepare the client for cesarean delivery as prescribed.

41
Q

Transducers

A

used to pick up the uterine contractions

42
Q

Where is the best place to listen to baby heart sounds in utero

A

where the babies back is

43
Q

Disadvantages for internal fetal monitoring

A
  • membranes must be ruptured

- must be inserted by health care provider

44
Q

Risks for internal fetal monitoring

A
  • Abruption
  • Lower uterine segment perforation
  • Infection
  • Contraindicated with HIV, active herpes
45
Q

Montevideo Units

A

Used to evaluate contractions in relation to labor progress.
FORMULA: MVU= the sum of the intensity of contractions in a 10 minute period

46
Q

contractions

DURATION

A

beginning to end of one contraction

47
Q

contractions

FREQUENCY

A

beginning of one contraction to the beginning of the next

48
Q

MONITORING
Where is the fetal heart rate displayed?
Where is Uterine activity displayed?

A

Fetal heart rate on top pane and uterine contractions in bottom pane

49
Q

how can contractions be measured?

A

From peak to peak

50
Q

Normal Uterine contractions

A

<5 contractions in 10 minutes averaged over 30 minutes

51
Q

Tachysystole (hyperstimulation) Uterine contractions

A

> 5 uterine contractions in 10 minutes, over 30 minutes OR any single uterine contraction lasting longer than 120 seconds

52
Q

Hypertonus uterine contractions

A

an elevated resting tone >20 mm Hg when on IUPC is in place (not possible to evaluate with a toco.)

53
Q

causes of Maternal Tachycardia

A

Fever, Anxiety, Medications (betasympathomimetrics, illicit drugs, OTC drugs)

54
Q

Causes of Fetal Tachycardia

A 
Hypoxemia
Fetal anemia/heart failure
Amnionitis
Fetal arrhythmia
SVT
55
Q

Causes of Maternal Bradycardia

A 
Hypothermia
Medications
Connective tissue disease (SLE)
Hypotension
Position
56
Q

Causes of Fetal Bradycardia

A 
Occiput posterior or transverse position
Fetal heart block
Fetal compromise:
--Hypoxemia 
--Decompensated fetus
57
Q

Causes of decreased FHR Variabilty

A 
Hypoxemia
Drugs
CNS depressants
Fetal sleep cycles
Congenital anomalies
Extreme prematurity
Neurologic anomaly
58
Q

Nursing Actions for decreased FHR Variability

A 
Evaluate cause
Stimulate fetus
--Scalp stimulation
--Vibroacoustic stimulation
--Transabdominal halogen light
Oxygen by mask
Notify MD
59
Q

types of variability

A 
Absent 
Mild: <5 bpm
Moderate: 6-25 bpm
Marked >25 bpm
Bradycardia FHR < 110
Tachycardia FHR>160
60
Q

types of decelerations

A

-Early : vagus nerve response to head compression-usually reassuring
Appears with contraction
-Late: utero placental insufficiency Always NON reassuring
Appears during and after contraction concludes
-Variable: Cord compression “shoulder”
Sharp deceleration with rapid return

61
Q

Why doesn’t a variable deceleration go below 55 to 60 bpm?

A

When the fetal parasympathetic nervous system is activated fully by cord compression of the umbilical arteries, it drops the fetal heart rate to what would be equivalent to a complete heart block with the recorded heart rate being the ventricular rate. If the fetal heart rate is below 55 to 60 bpm, think hypoxia!

62
Q

Early Decelerations

A

Reassuring, Waveform consistently uniform. Just prior to or
early in contraction. Consistently at or before midpoint of contraction. Usually within
normal range of 120-160 bpm. Can be single or repetitive

63
Q

Late Decelerations

A

Always nonreassuring, Waveform uniform, shape reflects
contractions. Late in contraction. Consistently after midpoint of contraction. Usually
in normal range with a high baseline (120-130 bpm); when severe may drop to 60
bpm. Occasional, consistent gradually increase.

64
Q

variable decelerations

A

Can be nonreassuring, Waveform variable, generally shape
drops and returns. Immediate with fetal insult; not related to contraction. Variable
around midpoint. Usually in normal range, can drop low. Variable, single or repetitive

65
Q

Category 1 -within defined limits

A

Baseline Fetal Heart Rate between 110-160
With one of the following variability patterns present:
-Minimal Variability with accelerations
-Minimal variability without accelerations for less than 90 minutes or for unknown time
-Moderate variability
With one of the following deceleration patterns present
-No decelerations
-Early decelerations
-Variable decelerations with abrupt decrease and abrup return to baseline (<2 minutes)
-Variable decelerations without slow return to baseline or overshoot
Benign Sinusoidal Pattern (e.g. narcotic induced)

66
Q

Nurses role with Category 1 WDL

A

-Continue to observe client
Document
-Notify physician “Routine”

67
Q

Category II: Problematic Patterns

A

Minimal Variability for more than 90 minutes with no deceleration and no accelerations
Variability or accelerations are present with one of the following:
Recurrent Late Decelerations
Recurrent Variable decelerations with one of the following:
Overshoot
tachycardia
Decreased Variability
Slow return to baseline
Single Prolonged Deceleration with Return to baseline
Within a 12 hour period
Tachycardia
Low baseline heart rate on initial EFM

68
Q

Prolonged deceleration Characteristics

A
  • Variable in shape and onset
  • Often associated with rebound tachycardia and loss of variability
  • Frequently an isolated event
69
Q

prolonged decelerations causes

A
  • Cord compression or prolapse
  • Tachysystole
  • Maternal hypotension
  • Rapid fetal descent, sustained maternal valsalva, SVE or FSE application
  • Maternal voiding or vomiting
70
Q

Prolonged deceleration nursing actions

A
  • SVE to r/o cord prolapse or rapid descent
  • Change maternal position
  • Stop oxytocin
  • Correct maternal hypotension
  • IVF bolus
  • Oxygen10 LPM by mask
  • Terbutaline prn
  • Notify MD, charge nurse
71
Q

Nurses role in Category II - Problematic Pattern

A 
Recognize and document
Institute IR
Notify Physician 
Request Physician Eval
Document Physician response
Document observations, actions, fetal/client response
Update physician
Anticipate potential to cat III
72
Q

Intrauterine resuscitation

Increase uterine perfusion by:

A 
Lateral maternal positioning
Correct maternal hypotension
IV fluid bolus (200-300ml LR)
Administration of ephedrine 
Modified trendelenberg  position
73
Q

Intrauterine resuscitation

Increase Oxygen Transfer by

A

Provide supplemental oxygen at 10 LPM

74
Q

Intrauterine resuscitation

Reduce Uterine activity by:

A

Discontinue oxytocin/cytotec/
prostaglandin
Administer terbutaline 0.25 mg SQ

75
Q

Intrauterine resuscitation

Promote Umbilical Blood flow by:

A

Maternal position change
Change pushing pattern
Amnioinfusion

76
Q

Intrauterine resuscitation

Increase fetal cerebral blood flow

A

Change pushing pattern

77
Q

POINTS

A 
P  -Position
0  - O2
I   - IV- Open wide open
N  - Notify physician
T  - Terbutaline
S  - Stop Pit
78
Q

Category III: Pathological Problems

A 
Absent variability and absent accelerations: With one of the following:
No deceleration or Unknown decelerations
Late decelerations
Recurrent Variable decelerations with one of the following:
Slow return to baseline
Overshoot
Tachycardia
Tachycardia
Prolonged deceleration > 1
Bradycardia (was previously normal)
Sinusoidal Pattern
Marked Variability (Saltatory)
Fetal heart Block on initial EFM
79
Q

Category III: Pathological Problems

Nurses Role

A 
Recognize and document
Institute IR
Notify attending Physician
Require On site assessment
Document physician response
Prepare for delivery 
Activate C/Section team
Prep Pt for delivery
Call for OB/General surgeon
Document observations, actions, fetal and maternal response
80
Q

SINUSOIDAL PATTERN

A

Rare but ominous pattern associated with high rates of morbidity and mortality
Appears as regular, smooth, undulating form of a sine wave
Frequency of 2 to 5 cycles per minute and amplitude of 5 to 15 BPM.
True pattern indicates severe fetal anemia or severe fetal hypoxia

81
Q

Cardinal Movements

A

Engagement: head at station 0
Descent: head moving into pelvis
Flexion: chin to chest
Internal Rotation: Head rotation to midline
Extension: chin up as head passes symphysis pubis
External Rotation: Head transverse to allow shoulders to pass
Expulsion: Head out

82
Q

Stage 4 of labor

A

The period from 1-4 hours after delivery.
Data collection: fundus remains contracted, in midline, midway between the umbilicus and symphysis pubis.
Implementation: monitor maternal vital signs frequently. Check lochia and fundus

83
Q

Evaluation of Episiotomy Healing

A 
R.   Redness
E.   Edema
E.   Ecchymosis
D.  Discharge/Drainage
A.  Approximation
84
Q

LATCH Scoring

A

LATCH- 0= no latch achieved 1=hold nipple in mouth/stimulate to suck. 2= grasps breast, tongue down, lips flanges, rythmatic sucking
AUDIBLE SWALLOWING. 0= none. 1= with stimulation. 2= spontaneous and intermittent
TYPE OF NIPPLE: 0=inverted, 1=flat, 2=everted
COMFORT. 0=engorged, 1=filing, mild discomfort. 2=soft, nontender
HOLD. 0=full assist, staff holing baby. 1. minimal assist. 2. no assist from staff

85
Q

What should the difference between infant head and chest size be

A

OFC and chest circumference should be 1-2 cm apart or the same.

Nursing Block 3 Ob (4 decks)

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