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OB > OB Test 1 Chapter 16 > Flashcards

OB Test 1 Chapter 16 Flashcards

1
Q

5 P’s

A 
passenger
passageway
powers
Position
psychologic factors
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2
Q

What determines how the fetus can move through the birth canal?

A 
the size of the fetal head
fetal position
fetal lie
fetal attitude
fetal presentation
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3
Q

What are fontanels and where are they located

A

membrane filled spaces

located on the head where sutures intersect

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4
Q

Anterior fontanel =

A

largest and is diamond shaped

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5
Q

Posterior fontanel =

A

smallest and is triangular shaped

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6
Q

When does the anterior fontanel close

A

18 months

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7
Q

when does the posterior fontanel close

A

6-8 week

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8
Q

Overlapping of the bones in the skull that happens while the baby is in the birth canal is called?

A

Molding

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9
Q

What is fetal presenation

A

refers to the part of the fetus that enters the pelvic inlet and leads through the birth canal during labor

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10
Q

What are the 3 main presentations

A
  1. cephalic (head first)
  2. Breech (butt, feet, or both first)
  3. Shoulder
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11
Q

Which is the most difficult presentaion?

A

Shoulder

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12
Q

What is the presenting part?

A

is the part of the fetus that lies in the internal os of the cervix

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13
Q

What is fetal lie

A

lie is the relation of the long axis of the fetus to the long axis or spine of the mother.

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14
Q

What are the 2 primary lies

A

logitudinal or vertical
and
horizontal, transverse, or oblique

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15
Q

Cephalic Presentation / Breech presenation =

A

vertical lie

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16
Q

Shoulder Presentation =

A

Transverse Lie

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17
Q

What is fetal attitude

A

attitude is the relation of the fetal body parts to eachother.

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18
Q

What is the normal fetal attitude

A

general flexion

the arms are crossed over the thorax, and the umbilical cord lies between the arms and the legs

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19
Q

Deviations from general flexion can cause difficulty in childbirth

A

pressure in the mothers back usually means the baby is posterior

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20
Q

What is fetal position

A

is the relationship of the reference point on the presenting part (occiput, sacrum, mentum [chin] or sinciput) to the mothers pelvis

position is denoted by a three part abbreviation

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21
Q

The first letter of the abbreviation is the location of the presenting part.

A

Right or Left Side of the mothers pelvis

R or L

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22
Q

The Middle abbriviation stands for the specific presentating part of the fetus

A

(occiput, sacrum, mentum [chin] or sinciput)

O S M Sc

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23
Q

The final letter is the location of the presenting part in relation to the anterior, posterior, or transverse portion of the mothers pelvis

A

A, P, T

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24
Q

Normal babies on a vaginal delivery shoud be

A

ROP
ROA
LOP
LOA

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25
Q

Passageway =

A

bony pelvis, soft tissue

26
Q

Full bladder can cause obstruction of

A

soft tissues of the cervix

27
Q

What is the classic type of female pelvis

A

gynecoid

28
Q

When is the assessment of the bony pelvis done

A

during the first prenatal visit

29
Q

The cervix ____, and _____ sufficiently to allow the first fetal portion to decend into the vagina.

A

effaces (thins) , and Dilates (opens)

30
Q

Efacing is measured as a

A

percent

31
Q

Dilation is measured in

A

cm

32
Q

What is primary powers

A

involuntary uterine contractions

these signal the beginning of labor

33
Q

What are secondary powers

A

once the cervix is dilated, voluntary bearing down to compliment primary powers

34
Q

What position is best for posterior positioned fetus

A

the all fours position

35
Q

What is the primary position in the US

A

Lithotomy

36
Q

What position can be used to rotate a fetus that is in a posterior postion

A

lateral position

37
Q

What stage is the longest stage of labor

A

1st

38
Q

What is considered the first stage of labor

A

is considered to last from the onset of regular contractions to full effacement and dilation of the cervix.

39
Q

What is the second stage of labor

A

lasts from the time that the cervix is fully effaced and dilated to the birth of the fetus

normal range is 2-3 hours

40
Q

What is the third stage of labor

A

lasts from the birth of the fetus until the placenta is delivered

the placenta is usulayy expelled within 15 min after the birth of the baby

41
Q

What is the 4th stage of labor

A

arbitrarily lasts 1-2 hours after delievery of the placenta

42
Q

What is mechanism of labor

A

the turns and other adjustments deemed necessary in the human birth process

43
Q

What are the 7 cardinal movements of the mechanism of labor

A
  1. engagement
  2. decent
  3. flexion
  4. internal rotation
  5. extention
  6. external rotation
  7. birth by expulsion
44
Q

Fetal Adaptation

A

several important psysiologic adaptions occur in the fetus.

These changes include fetal heart rate, fetal circulation, respiratory movements, and other behaviors.

45
Q

What is the average fetal heart rate

A

140 bpm

46
Q

What is the normal range for fetal heart rate

A

110 to 160 bpm

47
Q

The fetal heart rate slows down during

A

contractions

48
Q

fetal circulation is effected by what factors

A

maternal position
uterine contractions
blood pressure
and umbilical cord blood flow

49
Q

What is the normal rate to be having contractions

A

every 2-3 minutes for about 45 seconds or so

50
Q

Certain changes stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for initiating respirations immediately after birth.

What are these changes?

A

fetal lung fluid is cleared from the air passages during labor

fetal oxygen presure decreases

fetal arterial pH decreases

fetal bicarb level decreaes

fetal respiratory movements decrease during labor

(respiratory alk is normal)

51
Q

Maternal adaptation through labor

A 
cardiac output increases
heart rate slightly increases
BP increases
WBC can increase
respiratory rate increases
spontaneous voiding 
skin stretches
joint aches back aches

Initially may be euphoric in the first stage then gets serious with some amesia between contractions

motility and gi absorption decrease

progesterone decreases and estrogen and prostaglandins and oxytosin increase

52
Q

Do not use valsava maneuver because

A

fetal hypoxia can occur

53
Q

With regard to primary and secondary powers, the maternity nurse should understand that:

A. Primary powers are responsible for effacement and dilation of the cervix

B. Effacement generally is well ahead of dilation in women giving birth for the first time; they are more together in subsequent pregnancies

C. Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation

D. Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs

A

A. Primary powers are responsible for effacement and dilation of the cervix

The primary powers are responsible for dilation and effacement; secondary powers are concerned with expulsion of the fetus.

54
Q

Nurses can advise their clients that all are signs that precede labor except:

A. A return of urinary frequency as a result of increased bladder pressure

B. Persistent low backache from relaxed pelvic joints

C. Stronger and more frequent uterine (Braxton Hicks) contractions

D. A decline in energy, as the body stores up for labor

A

D. A decline in energy, as the body stores up for labor

A surge of energy is a phenomenon that is common in the days preceding labor.

55
Q

In order to accurately assess the health of the mother accurately during labor, the nurse should be aware that:

A. The woman’s blood pressure increases during contractions and falls back to prelabor normal between contractions

B. Use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia

C. Having the woman point her toes reduces leg cramps

D. The endogenous endorphins released during labor raise the woman’s pain threshold and produce sedation

A

D. The endogenous endorphins released during labor raise the woman’s pain threshold and produce sedation

In addition, physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother’s perception of pain.

56
Q

The nurse knows that the second stage of labor, the descent phase, has begun when:

A. The amniotic membranes rupture

B. The cervix cannot be felt during a vaginal examination

C. The woman experiences a strong urge to bear down

D. The presenting part is below the ischial spines

A

C. The woman experiences a strong urge to bear down

During the descent phase of the second stage of labor, the woman may experience an increase in the urge to bear down.

57
Q

All statements about normal labor are true except:

A. A single fetus presents by vertex

B. It is completed within 8 hours

C. A regular progression of contractions, effacement, dilation, and descent occurs

D. No complications are involved

A

B. It is completed within 8 hours

Although the amount of time varies with each woman, a normal uncomplicated labor is usually completed within 18 hours.

58
Q

Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate?

A. Latent: mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours

B. Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours

C. Lull: no contractions; dilation stable; duration of 20 to 60 minutes

D. Transition: very strong but irregular contractions; 8 to 10 cm dilation; duration of 1 to 2 hours

A

B. Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours

The active phase is characterized by moderate, regular contractions; 4 to 7 cm dilation; and a duration of 3 to 6 hours.

59
Q 
Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased?
A.  Semirecumbent
B.  Sitting
C.  Squatting
D.  Side-lying
A

C. Squatting

Kneeling or squatting moves the uterus forward and aligns the fetus with the pelvic inlet; this can facilitate the second stage of labor by increasing the pelvic outlet.

60
Q

Fetal circulation can be affected by many factors during labor. Accurate assessment of the laboring woman and fetus requires knowledge of these expected adaptations. Which factor will not affect fetal circulation during labor?

A. Fetal position
B. Uterine contractions
C. Blood pressure
D. Umbilical cord blood flow

A

A. Fetal position

Maternal position may affect fetal circulation; however, fetal position is unlikely to disturb umbilical blood flow.

61
Q

Fetal circulation can be affected by many factors during labor. Accurate assessment of the laboring woman and fetus requires knowledge of these expected adaptations. Which factor will not affect fetal circulation during labor?

A. Fetal position
B. Uterine contractions
C. Blood pressure
D. Umbilical cord blood flow

A

C. Blood pressure

Maternal blood pressure is likely to have a significant effect on fetal circulation.

62
Q

Concerning the third stage of labor, nurses should be aware that:

A. The placenta eventually detaches itself from a flaccid uterus

B. The duration of the third stage may be as short as 3 to 5 minutes

C. It is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface

D. The major risk for women during the third stage is a rapid heart rate

A

B. The duration of the third stage may be as short as 3 to 5 minutes

The third stage of labor lasts from birth of the fetus until the placenta is delivered. The duration may be as short as 3 to 5 minutes, although up to 1 hour is considered within normal limits.

OB (11 decks)

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