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ABSN > OB exam 2 - Intrapartum 2 > Flashcards

OB exam 2 - Intrapartum 2 Flashcards

1
Q

what can a birth plan include

A

-environment
-pain mgt
-in case of emergency
-newborn care

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2
Q

where does the toco go

A

fundus of the uterus

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3
Q

where should ultrasound be put

A

in the area where the fetal shoulders are bc it will be the loudest area to hear the heart beat

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4
Q

fetal scalp electrode

A

-placed on a firm part of the baby’s head (avoid sutures & fontanels)
-gives a continuous trace of HR even if mom is moving
-gives better information about variability
-nurse can place
-requires rupture of membranes & dilation so increase risk for infection & injury

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5
Q

Intrauterine pressure catheter

A

used if the toco is not providing good readings but is invasive so only use when necessary
they tell intensity which a toco is unable to do

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6
Q

montevideo units (MVUs)

A

measures the intensity of contractions & helps dx if you have adequate labor
subtract the baseline of uterine pressure from peak of each contraction in a 10 minute time period then add all answers together -> greater than 200 indicates adequate labor & you do not want it to exceed 300

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7
Q

what should resting tone be

A

less than 25

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8
Q

what is the longest a contraction should last & max frequency

A

120 seconds & do not want more than 5 contractions in 10 minutes

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9
Q

what do you want to note of ROM

A

-spontaneous or artificial
-time, color of fluid, amount & odor (coat)

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10
Q

what to note during a vaginal exam

A

-cervix: posterior, mid position, anterior
-cervical dilation
-cervical effacement
-fetal presentation
-station

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10
Q

what does nitrazine tape test for

A

to see if someone’s water is broken
negative = yellow
positive = blue
noninvasive

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11
Q

ferning test

A

provider takes a sample of vaginal discharge and looks at it under a scope -> if crystallized “ferning” structure appears then it is positive and pt’s water is broken

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12
Q

amnisure test

A

swabs vaginal discharge -> puts into solvent for 1 min -> insert test strip & two lines equals positive test and pt water is broken

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13
Q

leopold’s maneuver

A

nurse manually tries to determine fetal positioning and presentation
1st: try to determine between butt (soft) and head (hard) @ fundus
2nd: feel for arms & legs (bumpy) or back (smooth)
3rd: feel for presenting part by palpating the synthesis pubis for head (hard) or butt (soft)
4th: feel outline of fetus w/ palms, higher head = feel more

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14
Q

episodic means

A

not associated with a contraction

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15
Q

periodic means

A

associated with a contraction

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16
Q

to determine fetal baseline, how long does FHR need to be monitored

A

10 minutes (normal is 110-160 bpm)

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17
Q

veal chop

A

variable = cord compression
early = head compression
acceleration = oxygenation / okay!
late = placenta insufficiency

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18
Q

how long will an early & late decel be

A

greater than 30 seconds to nadir

19
Q

in a late decel, what will cause decrease blood flow to placenta

A

-if pt has high or low BP
-if pt is bleeding bc it creates a volume problem

20
Q

how long is a variable decel

A

less than 30 seconds to nadir but can last up to 2 minutes

21
Q

uncoil (for decels)

A

UNdo what is occurring
Change position
Oxygen on or Oxytocin off
Ivf bolus
Lower head of the bed

22
Q

timing of prolonged deceleration

A

> / 2min but <10 minutes
if >10 than that is considered a baseline change

23
Q

what is a main reason for a prolonged decel / bradycarida

A

umbilical cord prolapse (a compressed cord stays compressed)

24
Q

sinusodial pattern

A

a perfect small wave pattern that would have an exact baseline -> means that baby could be acidodic and it is extremely important to deliver the baby
1st action is call provider

25
Q

what is the best indicator of fetal oxygenation

A

FHR variability

26
Q

FHR variability

A

absent: amp range is undetectable (acidotic, distress)
min: <5 bpm (sleep cycle, meds, mag sulf)
mod: 6-25 bpm (goal)
marked: >25 bpm

27
Q

tachy and brady time

A

below or above normal range for 10 minutes

28
Q

main causes of brady

A

prolapsed cord or maternal bleeding

29
Q

if your pt is tachy, what do you do first

A

check temp

30
Q

non reassuring fetal heart rate patterns

A

-decels persistent & severe
-late decels of any magnitude
-prolonged decels
-absence of variability
-sinusoidal pattern
-severe (marked) brady or prolonged tachy

31
Q

category 1 - normal

A

-normal FHR
-moderate variability
-no variable or late decels (early are ok)

32
Q

category 2 - intermediate

A

-minimal or marked variability
-no accels
-prolonged decels
-recurrent variable or late decels

33
Q

category 3 - abnormal

A

-sinusoidal pattern
-absent variability
-recurrent late or brady
needs to be delivered asap

34
Q

if you have late decels w/ oxytocin running, what is your first nursing action

A

turn off the oxytocin

35
Q

if contractions are lasting too long or happening too often, what can be done

A

administer a tocolytic

36
Q

if monitoring has non reassuring patterns and interventions are not working, what is the next step

A

prepare for immediate delivery
if vaginal delivery is near then can use forceps or vacuum to progress the birth & get the baby out quickly but if not then C section

37
Q

latent stage nursing interventions

A

-education & support
-encourage ambulation
-offer ice chips
-VS every hour
-temp every 4 hours every 2 if ROM
-intermittent FHR every 30-60 min (based on risk status and findings)

38
Q

active phase nursing interventions

A

-palpate contractions every 15-30 min or continuous monitoring
-vaginal exams
-encourage voiding every 1-2 hrs
-start IV fluids
-auscultate FHR every 15-30 mins
-assess VS every 15-30 mins
-assess amniotic fluids & FHR when ruptured
-change positions & pads

39
Q

transition phase nursing interventions

A

-palpate contractions every 15 mins or continuous monitoring
-sterile vaginal exams
-assess FHR every 15-30mins
-assist w/ breathing
-keep women from pushing until fully dilated

40
Q

who is the peanut ball good for and why

A

pt with an epidural bc it helps them open up their pelvis to promote fetal optimal rotation & it is really good if baby is in the OP position to hopefully get the baby to move to the OA position

41
Q

second stage nursing interventions

A

-sterile vaginal exams to assess fetal descent
-assess FHR every 5-15mins
-assess maternal VS every 30 min
-provide support and information about labor
-assist w/ pushing
-assist the physician w/ birth

42
Q

indications of imminent birth

A

-bulging of the perineum
-uncontrollable urge to bear down
-increased bloody show

43
Q

third stage nursing interventions

A

newborn care
-provide simulation & maintain warmth
-VS
-APGAR
- ID
-assessment
-give to mom & skin to skin
maternal care
-monitor for delivery of placenta

44
Q

fourth stage nursing interventions

A

-VS every 15 mins for the first hour
-assess temp hourly
-IV fluids w/ pitocin 20 U
-palpate fundus every 15 min for 1 hr
-assess vaginal bleeding & perineum
-encourage bonding
-assist w/ feeding
-count instruments & sponge used in delivery

45
Q

boggy fundus indicates what

A

increased bleeding

46
Q

palpation of fundus

A

put a hand to support the lower base of the uterus around the symphysis pubis & the other hand cuffs and feels the fundus of the uterus
should feel firm @ midline, if to side then possible full bladder that needs to be emptied

ABSN (90 decks)

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