OB Exam2 Flashcards
2 Origins of Pain
Visceral - uterine/cervical radiation
Somatic -perineal tissue intense/sharp
Dick-read Preperation
deep to shallow, sustained pushing, breath holding
Lamaze Preparation
psychprophylactic PPM - mind control
Bradley Preparation
partner coached
Birthing from within, Hypnobirthing, professional association
Foster confidence!
Gate-Control Method
Only so much sense can go through nerve, other senses block pain
Local Perineal block is for…?
suturing lacerations
Pudendal block is for…? when?
supporting forcep/vacuum, 2nd - 3rd stage
Spinal block location and 3 ▲
L3 - L4
▲ HypoTN, breathing pattern, placental perfusion
Headache r/t block?
Use Blood patch to stop leak of fluid
Epidural block location
↓ L5
CSE - aka walking
Combo of opiod/analgesia
Naloxone
Counter to opiods if pt has respiratory depression
External/Internal FHR monitoring
Toco/Doppler - Intrauterine Pressure Cath and Fetal Spiral Electrode
FHR averages
Norm 110 - 160
Tach ↑ 160
Brad ↓ 110
FHR Variabilities (4)
Absent = 0 ▲ r/t baseline Minimal = ↑↓ 5 Moderate = ↑↓ 6 - 25 Marked = ↑ 25
Tracings (6)
Normal = Ø ▲ w/ contractions
Tach = ↑ 160 / 10 min
Brad = ↓ 110 / 10 min
Acceleration ↑ by 15 / 15 sec but ↓ 2 min (32: 10 / 10 sec)
Tachystole ↑ 5 UC / 10 min
Deceleration ↓ FHR with Nadir. ↓30s=cord ↑30s=head
Intensity Contractions FACE MODEL (4)
Mild = tip of nose
Moderate = chin
Firm = forehead
Resting - SOFT
Categories I, II, III
I = no action req. II = abnormal, evaluate III = one of the Tracings, resusictative measures
Resuscitative Measures (4)
Turn laterally, change pos, fluids, O2
Labor begins and ends when…?
First contraction, begin attachment with infant
First Stage starts…? 3 stages.
Regular uterine contractions
Latent = 3cm
Active = 4 - 7cm
Transition = 8 - 10cm
Second Stage starts…? 3 stages.
Full dilation and complete effacement (100%, 10cm, x)
Latent = passive decent
Descent = active push
Transition = pushing most effective
Third Stage what drops…?
Placenta in 15 - 20 minutes
Fourth Stage bis all about (2)…?
Recovery and transition
Nullip vs. Multip when birthing?
Nullip slower than multip (50/30min)
Ritgen Maneuver
Push up from bottom, grab head
Nuchal Cord
Cord is around neck
2 Types episiotomies and repair process
Mediolateral
Medial
dissolvable suture w/ local anesthetic
Birthing Care interventions (4)
Warm shower/compress for pain Cool cloth for face Urinate often - bladder Ice ships - bowel fx Ambulate
Reccurent Decelerations require…?
Fluid bolus (SLAM the bag, no pump)
PP: Post-Partum heal times (vaginal vs. C-section)
6 weeks vs. 8 weeks
PP: Linea Negra/Straie
fade w/ tie, sometimes permanent
PP: Uterus (3 possibilities)
Involution (1 -2cm q24hr, done in 2 weeks)
Subinvoution (failure b/c fragments/infx)
Inversion (it’s OUT! Nurse put back in)
PP: Contractions AKA + what equalizes and how + hormone?
After Pains
Hemostasis via blood vessel compression via contractions
Oxytocin via pituitary coodinates
PP: Lochia (3 and time), Bleeding =?
Rubra = red 3 - 4 days Serosa = clearish 22 - 27 days Alba = whitish 10 days - 6 weeks Bleeding = period
PP: Cervix state and time to regain shape
Soft, regains overs 12 - 18 hrs
PP: Vagina/Perinum. Hormone and ▲
↓ Estrogen = thinness, dryness, painful sex
Decreases in size but NEVER the same again!
NO SEX FOR HOW LONG?!
5 - 6 weeks
PP: Introitus (Vaginal Opening), state, episiostomy heal time, hemorrhoid heal time, what to eat.
swollen/erythematous.
Episio = 2 - 3 weeks
Hemorrs = 6 weeks
↑ fiber, prenatal vits
PP: Pelvic Muscles heal time, possible problem?
6 months, do Kegels!
Pelvix relaxation = muscles relax and organs drop into vaginal space
PP: Placental Hormones
DROP in everything to reverse effects of pregnancy
PP: Abdomen
Relaxed 2 weeks
Return to non-prego in 6 weeks
PP: BOOB function
All in the stimulation
Should feed 10-12x a day q2hr
PP: Urinary
Diuresis/Diaphoreis 12hrs/2-3days
PP: GI
Very hungry, no BM for potentially 2 - 3 days
PP: Cardiovascular blood volume ▲ and possible issue
Blood volume ↓ / 2 weeks and normal by 6 months.
THIS IS OK cause they’re hypervolemic during pregnancy
Cardiac output SAME for 48 hrs/elevated 12 weeks
↑ coagulability and immobility r/in thromboembolism.
PP: Neurologic ▲. Shaking? and time to normal.
Shaking is normal.
Discomforts (like carpal tunnel) should go away in 6 - 8 weeks unless prexisting
PP: Headaches?! Due to? Tx with?
cerebrospinal leak into extradural space
Otologist blood patch
PP: VS rounds and expectation.
Q15min x4 Q30min x2 Q1hr x 2 Q4-8hrs Should be stable unless HTN/Preclampic
Rubella Vaccine - sex lockout
3 months
Rogam given if…? time window to give? route?
Mom Rh+ Baby Rh-. Give within 72 hrs post-partum IM
PP: MusculoSkeletal heal time and shoe size?
6 - 8 weeks, ↑ shoe size 2
PP: Integumentary Chloasma Areolae/Linea Nega Vascular Abnormalities are b/c Spider Nevi, which hairs stay?
mask fades by end of pregnancy
Hyperpigmentation that fades
decline with declining estrogens
FOREVER, fine hair leaves, coarse stays
Care of Family - Nursing Role
Faciliate transition
Family Care 4 Educations
Prevent infx
Prevent excessive bleeding
Maintenance of uterine tone
Prevention of bladder distention
Emergency Treatment vs. Newborn Protection
Hospital MUST help laboring lady
By LAW must stay 2 days if VAG. Delivery, exceptions with multips
Estrogen FX on milk production
↓
Tub Bathing/hot tubbing?
NOPE!
Baby immunizations times (5)
2 mo, 4 mo, 6 mo, 1 year, 15 mo
Family Care Vaccinations and Routes (3)
Rubella SubQ lateral arm
Varicella SubQ
TDaP IM (10 years)
When to initiate breastfeeding
when baby is MOST ALERT 3- 4 hours post birth
BIG UTERUS + BREASTFEEDING = ???
PAIN!!!
4 Reasons for ▲ in PP discharge
Consumer demand
Medical necessity
Discharge criteria for lowrisk childbirth
Cost-containment measures
