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OB > OB exam 2 > Flashcards

OB exam 2 Flashcards

1
Q

intermittent monitoring

A

fetoscope, doppler, ultrasound transducer

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2
Q
  • fetal well-being
  • s/s compromise
  • response of FHR & uterine contractions
A

EFM

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3
Q
  • toco
  • palpation
A

uterine contractions/activity

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4
Q

internal FHR

A

fetal scalp electrode (FSE)

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5
Q

internal uterine activity/contractions

A

intrauterine pressure catheter (IUPC)

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6
Q

if receiving pitocin/epidural, what type of monitoring is needed?

A

continuous

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7
Q

how often are strips reviewed during 1st stage labor?

A

q30min

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8
Q

how often are strips reviewed while pushing?

A

q15min

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9
Q
  • measured from time start to time ends
  • 10sec blocks
  • dark lines 1min
A

duration

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10
Q

beginning of one contraction to beginning of another contraction

A

frequency

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11
Q

intensity of contractions can be measured by:

A

palpation, IUPC

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12
Q

how much HR changes from second to second

A

variability

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13
Q

absent variability

A

flatline

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14
Q

minimal variability

A

0-5 beats change

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15
Q

moderate variability

A

6-25 beats change, goal

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16
Q

marked variability

A

25beats+ change

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17
Q

15beats lasting for 15 sec above baseline

A

acceleration

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18
Q

deceleration: variable

A

lasting less than 15 sec below baseline

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19
Q

varibale decels are due to

A

cord compression

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20
Q

early decels are due to

A

head compression

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21
Q

late dedels are due to

A

uteroplacental insufficiency

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22
Q

abrupt decreased FHR at least 15bpm lasting >2min but <10min

A

prolonged decels

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23
Q

variable decel interventions

A
  • change maternal position
  • decrease oxytocin
  • admin amniofusion PRN
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24
Q

early decel interventions

A

none needed, baby coming down pelvis

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25
Q

late decel interventions

A
  • change maternal position
  • discontinue oxytocin
  • IV bolus (999)
  • O2 admin
  • notify MD
  • anticipate c-section
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26
Q

only occur with contractions –> late & early decels

A

periodic changes

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27
Q

not always associated with contractions, but sometimes do –> acels (can be both), variable decels, prolonged decels (can be both)

A

episodic changes

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28
Q

nonstress test (NST)

A

20min monitoring EFM, goal = 2 acels

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29
Q

2+ acels observed during 20mins

A

reactive NST

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30
Q

<2 acels observed during 20mins

A

nonreactive NST

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31
Q

contraction stress test (CST)

A

mom has contraction, monitor FHR; goal = no late decels

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32
Q

no late decels observed after contractions start in CST

A

negative CST (goal)

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33
Q

late decels observed after contractions start inn CST

A

positive CST (bad)

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34
Q

measures frequency and duration of contractions only

A

toco

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35
Q

T/F: A fetal scalp electrode can be put in before ROM has occurred

A

F

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36
Q

guidelines:
- HIV neg, Hep B neg
- skilled practitioner inserts
- presenting fetal part low enough ti allow placement
- cervical dilation at least 2cm

A

fetal scalp electrode

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37
Q
  • internal contraction monitoring
  • goes inside uterus around baby, measures pressure around uterus
  • MVUs = measurement
A

IUPC

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38
Q

how many MVUs are required to progress labor & dilate cervix?

A

over 200, no more than 300

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39
Q

used for moderate-severe varibale decels, procider order
- infusion by gravity sterile NS or LR via IUPC

A

amnioinfusion

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40
Q

uterine contractions & pushing effort

A

power

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41
Q

anatomy of mother’s bony pelvis & soft tissues; ability of soft passageway to stretch

A

passageway

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42
Q

ideal pelvis shape for labor/delivery

A

gynecoid

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43
Q

scale to tell where baby is positioned

A

-5 to +5

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44
Q

ideal station positon:

A

head down

45
Q

soft spots, head bones not fused at birth

A

fontanels

46
Q

what attitude do we want the baby in?

A

vertex(full flexion)

47
Q

relationship of spine of fetus & spine of mother

A

lie

48
Q

baby & mom’s spines parallel

A

longitudinal lie (ideal)

49
Q

baby & mom’s spines perpendicular

A

transverse lie

50
Q

position of the presenting part of fetus as it comes down birth canal

A

presentation

51
Q

ideal presentation

A

face

52
Q

floating station

A

-3, -2

53
Q

fixed statin

A

-1

54
Q

engaged station

A

0

55
Q

midpelvis

A

+1, +2

55
Q

crowning

A

+3, +4

56
Q

anxiety, stress, dear, pain intolerance can have what affect on labor?

A

slow labor

57
Q

s/s labor:

A
  • SROM
  • regular contractions
  • bloody show
  • lightening
  • nesting impulse
    -wt loss 1-3lb
  • abdominal/back pain that intensifies with walking, not affected by mild sedation
58
Q

labor is confirmed by

A

cervical change (dilation, effacement)

59
Q

begins with regular contraction along w/ dilation & effacement of cervix, fetal descent

A

labor

60
Q
  • contractions may feel like menstrual cramps
  • mild to palpation
  • 5-30min apart, lasting 30-45sec
  • dilation may be 0-3cm
  • 6-8hrs
  • clear, pink mucous discharge or plug, scant amount
A

latent phase labor

61
Q
  • focused, anxious, restless
  • contractions regular & more painful
  • 3-5min apart, 40-70 sec
  • moderately strong to palpation
  • epidural
  • dilation 4-7cm
    -3-6h
  • +1/+2
  • pink or bloody mucous, scant-moderate amount
A

active phase labor

62
Q
  • strong & close together contractions
  • 2-3mins aprt, 45-90sec
  • out of control, irritable, dependent
  • intense urge to push
  • 8-10cm
  • 20-40min total
  • bloody mucous, copious amoutn
  • +2, +3
A

transition phase labor

63
Q

T/F: to prevent supine hypotension, always have a lateral tilt to the pt position

A

T

64
Q

IV fluids

A
  • maintain hydration in labor
  • bolus prevention maternal hypotension following regional anesthesia
  • safety measure
65
Q

opening of cervical os

A

dilation

66
Q

thinning of cervix

A

effacement

67
Q

assessing, using sterile gloves, lubricant, gentle insertion middle & index fingers into vaginal opening

A

vaginal exam

68
Q

1/0/-3; 9/100%/+1

A

dilation/effacement/station examples

69
Q
  • pink, contains mucous, scant at first
  • increases w/ effacement & dilation
A

bloody show

70
Q

PROM

A

premature ROM

71
Q

PPROM

A

preterm premature ROM

72
Q

positve “pool” of fluid in vagina

A

pooling

73
Q

positive when amniotic fluid turns pH paper dark blue/black

A

nitrazine paper test

74
Q

protein & sodium chloride content in amniotic fluid, smear fluid dried on one side, positive test shows presence of fern-like patterns –> amniotic fluid crystals

A

ferning

75
Q

concerns for meconium-stained amniotic fluid

A

aspiration of baby at delivery

76
Q

as baby delivers & after delivery of head amniotic fluid meconium stained; benign

A

terminal meconium

77
Q
  • facilitates uterine contractions
  • ## control bleeding PP
A

pitocin/oxytocin

78
Q

> 5 contractions within 10min

A

tachysystole

79
Q

second stage of labor

A

pushing; 10cm until fetus delivers

80
Q

fetal head at ischial spines

A

engagement

81
Q

fetal head past ischial spines

A

descent

82
Q

chin touches chest

A

flexion

83
Q

fetal chin comes off chest, neck arches as head is born

A

extension

84
Q

head rotates as shoulders move into new position

A

external rotation

85
Q

body born

A

expulsion

86
Q

vaginal, perineal; 1-4 degree

A

laceration

87
Q

only performed in emergencies, 1-4 degree

A

episotomy

88
Q

look for bright red bleeding with these injuries (rare)

A

cervical injuries

89
Q

3rd stage labor

A

placental delivery; from fetus to delivery placenta
- 5-30min
- uterus continues to contract

90
Q

failure to contract

A

uterine atony

91
Q

most common cause PP hemorrhage

A

uterine atony

92
Q

a bolus of what is indicated after delivery of the placenta?

A

oxytocin

93
Q

4th stage labor

A

recovery

94
Q

goal of pain management is to

A

reduce fear, control pain

95
Q

activation of nocioceptors of pelvic, thoracic, or abdominal organs

A

visceral pain

96
Q

first stage of p=labor pain is from:

A

contractions, baby descent, cervical change

97
Q

2nd stage pain

A

perineal pressure, pushing, tissues stretching

98
Q

what will help with 2nd stage labor pain?

A

delivery of baby

99
Q

3rd/4th stage pain is due to

A

contractions, cramping w/ fundal massage

100
Q

circular stroking of abdomen

A

effleurage

101
Q

fentanyl is a

A

short-acting opioid

102
Q

promptly reverse narcotic efects for newborn if mom had IV narcotics/opioids in 0-3h before delivery

A

narcan/naloxone

103
Q

most effective, most commonly continuous infusion w/ PCA
- numbs from umbilicus to toes
- can still feel pressure
- can have hot spots

A

epidural block

104
Q

disadvantages epidural

A

prolonged 2nd stage labor (pushing), limited mobility, urinary retention, hot spots/pressure points, hypotension

105
Q

nursing intervenitons prior to epidural administration:

A

verify/witness consent, IV fluid bolus, continuous EFM

106
Q

actions if pt becomes hypotensive during/after epidural

A

IV bolus, turn to side, lower HOB, notify MD, stay w/ pt

107
Q

one time injection into spinal space numbing nipple-feet, used for c-section

A

spinal block

108
Q
  • 2nd stage pain management
  • injection of lidocaine into pudendal nerves
  • numbs saddle area
  • 10-20min onset
  • admin for rapid labor, forceps delivery, episotomy, repair of perineum
A

pudendal block

OB (5 decks)

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