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Ivy Tech Nursing > OB Mod IV Review > Flashcards

OB Mod IV Review Flashcards

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1
Q

The passage, the fetus, the relationship between the passage and the fetus, the physiologic forces of labor, and the psychosocial considerations.

A

Five factors of critical importance in the process of labor and birth.

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2
Q

Four types of pelvis as classified by the Caldwell-Moloy system

A

gynecoid (most common)
android
anthropoid
platypelloid

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3
Q

The true pelvis consists of….

A

the inlet, pelvic cavity, and the outlet

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4
Q

Frontal suture

A

located between the two frontal bones, becomes the anterior continuation of the sagittal suture

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5
Q

Sagittal suture

A

located between the parietal bones, divides the skull into left and right halves

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6
Q

coronal sutures

A

located between the frontal and parietal bones, extend transversely left and right from the anterior fontanelle

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7
Q

lambdoidal suture

A

located between the two parietal bones and occipital bone, extends transversely left and right from the posterior fontanelle

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8
Q

2 pelvic types favorable for vaginal birth

A

gynecoid, anthropoid

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9
Q

2 pelvic types not favorable for vaginal birth

A

android, platypelloid

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10
Q

Skull landmark Mentum

A

fetal chin (face presentation; head is hyperextended)

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11
Q

Skull landmark Sinciput

A

anterior area known as the brow (brow presentation)

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12
Q

Skull landmark Bregma

A

diamond-shaped anterior fontanelle (sinciput presentation; no head extension or flexion)

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13
Q

Skull landmark Vertex

A

area between anterior and posterior fontanelles

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14
Q

Skull landmark Occiput

A

occipital bone (vertex presentation; most common type)

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15
Q

Primary physiologic force of labor

A

uterine muscular contractions

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16
Q

Secondary physiologic force of labor

A

use of abdominal muscles to push

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17
Q

Each contraction has three phases progressively:

A

increment, acme, decrement

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18
Q

Progesterone relaxes smooth muscle tissue, estrogen stimulates uterine muscle contractions, connective tissue loosens

A

identified factors at the onset of labor

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19
Q

Three phases of the first stage of birth

A

Latent, active, transition

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20
Q

Cardinal movements of labor

A
  1. descent
  2. flexion
  3. internal rotation
  4. extension
  5. restitution
  6. external rotation
  7. expulsion
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21
Q

Two phases of the third stage of birth

A

placental separation, placental delivery

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22
Q

Two presentations of the placenta

A

shiny Schultze, dirty Duncan

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23
Q

Under what circumstances should the mother come to the birthing unit?

A

ROM, regular and frequent uterine contractions, vaginal bleeding, decreased fetal movement

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24
Q

Contraction frequency 2-5 minutes, duration 40-60 seconds, moderate to strong intensity.

A

Active phase

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25
Q

Contraction frequency 1.5-2 minutes, duration 60-90 seconds, intensity strong.

A

Transition phase

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26
Q

Systemic medication considerations

A
  1. cross the placental barrier by simple diffusion
  2. action depends on liver enzyme metabolism
  3. high doses remain in fetus for long periods (fetal liver enzymes and kidney function insufficient)
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27
Q

Maternal assessment with medication administration

A
  1. willing to receive
  2. vital signs stable
  3. contraindications not present
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28
Q

Fetal assessment with medication administration

A
  1. FHR between 110 and 160
  2. Variability present
  3. fetal movement/ accelerations present
  4. fetus is at term
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29
Q

Labor assessment with medication administration

A
  1. documentation of contraction pattern

2. cervical status (position, consistency, effacement, dilatation, station)

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30
Q

Butorphanol tartrate (Stadol)

A

Synthetic agonist-antagonist opioid analgesic agent.

  1. respiratory depression, mother and fetus
  2. drowsiness, dizziness, fainting, hypotension
  3. urinary retention; not common
  4. protect med from light/ store at room temp
  5. has a ceiling effect
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31
Q

nalbuphine hydrochloride (Nubian)

A

Synthetic agonist-antagonist opioid analgesic

  1. crosses placenta/ nonreassuring fetal heart rate & respiratory depression
  2. IV infusion/ 10 mg over 3-5 minutes
  3. Has a ceiling effect
  4. choice over Stadol/ less nausea & vomiting and increased maternal sedation
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32
Q

Fentanyl (Sublimaze)

A

Short-acting opiate

  1. relives pain/ induces sedation
  2. 50-100 more potent than morphine
  3. does not cross placenta (less neonatal neurobehavioral depression than Demerol)
  4. less sedation, nausea, vomiting, pruritus compared with Demerol
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33
Q

Potentiate the effects of opioid analgesics permitting lower doses of opioids

A

analgesic potentiators: promethazine (Phenergan), hydroxyzine (Vistaril), propiomazine (Largon), and promazine (Sparine)

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34
Q

Used to counter opioids; reverse respiratory depression

A

Naloxone (Narcan)

1. if unresponsive to treatment may be readministered every 2-3 minutes

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35
Q

Two types of local anesthetic agents

A
  1. esters [procaine hydrochloride (Novocain), chloroprocaine hydrochloride (Nesacaine), Ropivacaine (Naropin), and tetracaine hydrochloride (Pontocaine)]
  2. amides [lidocaine hydrochloride (Xylocaine), mepivacaine hydrochloride (Carbocaine), and bupivacaine hydrochloride (Marcaine)]. More powerful than esters
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36
Q

Preferred treatment for mild toxic reaction to anesthetics

A

oxygen and IV injection of a short-acting barbiturate to diminish anxiety

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37
Q

Given to counter hypotension of 1-2 minutes after epidural regional block (after initial repositioning efforts to counter hypotension)

A

ephedrine 5-10 mg IV

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38
Q

Pruritus associated with an epidural infusion is treated with administration of what

A

diphenhydramine hydrochloride (Benadryl)

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39
Q

Given at 30-32 weeks gestation to facilitate growth of alveoli

A

corticosteroids

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40
Q

Cyclooxygenase (prostaglandin synthetase) inhibitors, calcium channel blockers such as nifedipine (Procardia), terbutaline sulfate (Brethine), and magnesium sulfate are used for what?

A

Tocolytics

41
Q

These tocolytics should not be used concurrently due to their calcium blockage potential

A

Nifedipine/ magnesium

42
Q

Five “P’s” of labor

A 
Powers:  contractions
Passageway:  birth canal
Passenger:  fetus and placenta
Position of the Mother
Psyche:  psychologic response
43
Q

Percent increase in circulating blood volume when pregnant

A

40-50%

44
Q

Normal placental implantation

A

Upper part of the uterus (1st stage of development)

45
Q

Infectious agents (teratogens) and possible effects on pregnancy

A

Rubella
Parovirus-chance of miscarriage or hydropsfetalis
Toxoplasmosis-cat feces
STD

46
Q

Cervical cerclage

A

Treatment for cervical incompetence (purse-string stitch)

47
Q

2 types of maternal fetal monitoring

A

Intrauterine pressure catheter

Internal fetal scalp monitor

48
Q

Premonitory signs of labor

A 
Braxton Hicks contractions
Lighteining (2-3 weeks b4 labor)
Increased vaginal mucous secretion
Bloody show
Energy spurt
Weight loss
49
Q

Theories of the causes of labor

A

Primarily hormonal changes
Increase in oxytocin receptors
Fetal production of oxytocin, cortisol, prostins
Increase stretching, pressure, irritation of uterus cervix

50
Q

Primary hormone changes during labor

A

estrogen to progesterone ratio increases
progesterone decreases
prostaglandins increase
oxytocin increases

51
Q

True Vs. False labor contractions

A

consistent pattern increasing frequency, duration, and intensity/ inconsistent change in activity

52
Q

True Vs. False labor discomfort

A

begins lower back and moves anterior/ annoying not painful

53
Q

True Vs. False labor cervix changes

A

effacement and dilation/ no change

54
Q

Uterine rupture (causes, S&S, nursing management, treatment)

A

Hemorrhage/ fetal anoxia/ fetal hemorrhage/ neonatal morbidity and mortality/ increased risk of maternal death
C-section birth/ hysterectomy

55
Q

Placenta previa (causes, S&S, nursing management, treatment)

A

Hemorrhage/ uterine atony

increase incidence of C-section/ fetal hypoxia/ acidosis/ fetal exsanguination/ increased prenatal mortality

56
Q

Chorioamnionitis (causes, S&S, nursing management, treatment)

A

Intra-amniotic infection resulting from bacterial invasion before birth/ PROM/ retained placenta and hemorrhage/ maternal sepsis/ maternal death

57
Q

First stage of labor

A

onset of true labor until full effacement and dilation of cervix (15-20 hours)

58
Q

First phase (latent)/ First stage of labor

A

0-3 cm dilated
Uterine contractions 5-20 min/ 30-45 sec
Mild tone
Nose

59
Q

Second phase (active)/ First stage of labor

A

4-7 cm dilated (Dr. will tell mom to come in)
Uterine contractions 2-5 min/ 45-60 sec
Moderate tone
Chin

60
Q

Third phase (transition)/ First stage of labor

A

8-10 cm dilated
Uterine contractions 1.5-2.5 min/ 60-90 sec
Firm tone
Forehead

61
Q

Nursing care interventions First Stage of Labor

A

I/O; Temperature; Vital Signs

62
Q

HCL

A

nuccal; cord around neck

63
Q

Nursing diagnoses during first stage of labor

A

dehydration

risk for falls

64
Q

Second stage of labor

A

Full effacement and dilation until birth

65
Q

Second stage of labor nursing responsibilities

A 
Blood pressure q15min/ FHR q15min
Comfort measures (positioning is important, rest, prepare for delivery, reassure, significant other or self involvement/ present to coach)
66
Q

Second stage of labor concerns

A

Pushing efforts
Descent
Birth of baby
Amniotic fluid appearance

67
Q

Third stage of labor

A

From birth of baby to birth of placenta

68
Q

Third stage of labor nursing responsibilities

A 
Prevent fluid loss/ maintain safety/ prevent trauma/ basic care and comfort
Prevent trauma (do not pull on cord: hemorrhage/ cramping before placental delivery)
69
Q

Fourth stage of labor

A

1-4 hours after birth for physiological and psychological stabilization and family attachment

70
Q

Fourth stage of labor nursing responsibilities

A

Teach about baby care (i.e. cord care, etc.)
Monitor HR, cardiac output, respiratory rate)
Gastrointestinal and urinary systems are affected

71
Q

Importance of relaxation between contractions

A

Tense muscles increase resistance to the descent of the fetus and contribute to maternal fatigue.

72
Q

Positional changes during labor (very important)

A

Encourage mom to move

Walking, rocking, chair, birthing ball, toilet assistance, moving side-to-side

73
Q

Most common type pelvis (50%) that is favorable for vaginal childbirth; wide and deep

A

Gynecoid

74
Q

Type of pelvis favorable for vaginal childbirth (25% white, 50% non-white); narrow and deep

A

Anthropoid

75
Q

Type of pelvis not favorable for vaginal childbirth (30%); heart shaped

A

Android

76
Q

Type of pelvis not favorable for vaginal childbirth (3%); wide and shallow

A

Platypelloid

77
Q

Consists of the inlet, mid (pelvic cavity measured in the U.S.), and outlet.

A

True pelvis

78
Q

True pelvis

A

Portion of the pelvis below the line terminalis (consists of the inlet, midpelvis, and outlet)

79
Q

The flared upper portion of the bony pelvis

A

False pelvis

80
Q

Soft tissue of the cervix and vagina

A

Birth canal

81
Q

Released by the placenta, this hormone influences pelvic relaxation

A

Relaxin

82
Q

How to increase pelvic diameter to facilitate the birth process

A

during labor squat and lie in a lateral Sims position

83
Q

Most common risks of VBAC

A

Hemorrhage/ uterine scar separation/ uterine rupture/ surgical injuries/ fetal death/ neurologic complications

84
Q

Aspects to consider with VBAC

A

Debate regarding safety
ACOG guidelines
Common risks

85
Q

ACOG guidelines

A

American College of Obstetricians and Gynecologists
The College guidelines state that women with two previous low-transverse cesarean incisions and women carrying twins may be considered
appropriate candidates for a TOLAC

86
Q

Injection of anesthetic into the epidural space between dura and spinal cord.

A

Epidural block; all drugs injected into epidural or subarachnoid space are preservative free

87
Q

Performed to determine placement of an epidural block

A

3 mL test

88
Q

Should be monitored before injection through an epidural block

A

Platelets should be high/ watch vitals/ 3 mL test/ I&O/ **always monitor BP every 15 min.

89
Q

Possible side effect of maternal narcotic analgesia

A

Newborn respiratory depression

90
Q

Adverse effects of an epidural block

A

Maternal hypotension/ bladder distension/ prolonged 2nd stage/ nausea and vomiting/ pruritus/ decreased RR for up to 24 hrs dura puncture (headache, fluid leakage)/ contraindicated if allergic to anesthetics.

91
Q

Intrathecal injection (spinal anesthesia)

A

Injection of preservative free opioid analgesic into subarachnoid space. May have to re-inject.

92
Q

Advantages of spinal anesthesia (intrathecal)

A

small doses, reduces pain, less sedation, no motor block, no hypotensive effects

93
Q

Disadvantages of spinal anesthesia (intrathecal)

A

Limited duration of action, inadequate relief for late labor and birth, has to be timed “right” for maximum effect

94
Q

Adverse effects of spinal anesthesia (intrathecal)

A

Nausea and Vomiting (N/V)/ pruritus (itching)

95
Q

Three types of C-section

A

Scheduled/ emergent (not a true emergency but must be done)/ emergency

96
Q

Indications for a C-section delivery

A

PIH (pregnancy induced hypertension), maternal disease, active genital herpes, HIV positive mom, previous uterine surgical procedure, fetal distress, prolapsed umbilical cord, fetal malpresentation, hemorrhagic conditions

97
Q

Contraindications for a C-section delivery

A

Conditions that are not desirable, intrauterine fetal demise (IUFD), preterm fetus (that wont survive), maternal coagulation defects

98
Q

Three types of breech presentation

A

Frank breech: bottom first, feet crossed
Complete breech: bottom first, feet crossed in front of the face
Single footing breech: one foot delivering first, second foot over abdomen

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