OB Test 2 Flashcards
list situation when the labor client should be directed to go to the hospital
- Are having regular contractions that are five minutes apart for one hour.
- Are having contractions that are five to 10 minutes apart for one hour, if it’s not your first baby.
- Are uncomfortable and unable to talk or walk through contractions.
- Feel contractions in your lower back that move to the front, with a hardening belly.
- Have your water break or you are leaking fluids (note the time it happened, how much, and if there is any color or odor to the fluid).
- Have pinkish or bloody vaginal discharge.
- Are resting or lying down and it doesn’t slow your contractions, and walking tends to make them stronger
discuss the interventions for the client who is experiencing light headedness and tingling during labor
- Avoid standing for long periods
- Get up slowly
- Eat regularly, small frequent meals
- Avoid lying on your back
- Wear loose, comfortable clothing
list the nursing interventions for the client following an amniotomy
when they break the fluid open
- When an amniotomy is performed, the nurse should record a baseline assessment of the FHR prior to the procedure and continuously during and after the procedure.
- The nurse should assess the amount, color, consistency, and odor of the amniotic fluid.
- The nurse should document the time of the amniotomy and the findings.
- Limit activity
- Obtain temperature every 2 hours
discuss two methods for treating preterm labor
- activity restriction
- ensuing hydration
- Medications such as nifedipine, magnesium sulfate, indomethacin, betamethasone
list the s/s of magnesium sulfate toxicity
- Loss of deep tendon reflexes
- Urinary output less than 30 mL
- Respiratory depression less than 12/min
- Pulmonary edema
- Chest pain
- Nausea/vomiting
- Lethargy
- Muscle weakness
- Cardiac arrest
list four potential causes of variable decelerations
- Umbilical cord compression
- Short cord
- Prolapsed cord
- Nuchal cord (around fetal neck)
- Oligohydramnios
discuss the cardinal movements of labor
- Engagement- he baby’s head has officially entered its mother’s pelvis.
- Descent- specifically named by its position relative to the ischial spines of the maternal pelvis
- Flexion- During flexion, uterine contractions push the fetus downward against the cervix. Its chin becomes tucked, touching its chest as if preparing to do a forward roll. This position allows for the smallest head diameter to pass through the pelvis
- Internal Rotation- As the head reaches the pelvic floor, it typically rotates to accommodate for the change in diameters of the pelvis.
- Extension- After internal rotation is complete and the head passes through the pelvis at the nape of the neck, a rest occurs as the neck is under the pubic arch. Extension occurs as the head, face and chin are born.
- External Rotation- After the head of the baby is born, there is a slight pause in the action of labor. During this pause, the baby must rotate so that his/her face moves from face-down to facing either of the laboring woman’s inner thighs. This movement, also called restitution, is necessary as the shoulders must fit around and under the pubic arch.
- Expulsion- Almost immediately after external rotation, the anterior shoulder moves out from under the pubic bone (or symphisis pubis). The perineum becomes distended by the posterior shoulder, which is then also born. The rest of the baby’s body is then born, with an upward motion of the baby’s body by the care provider.
list the adverse reactions to oxytocin (pitocin)
- FLUID RETENTION
- UTERIN TETANY
- Uterine hyperstimulation
- Hypertensive crisis
- Water intoxication
- Headache
- Nausea/vomiting
- Palpitations
- Chest pain
- Drowsiness
why is betamethasone used during pregnancy
to enhance fetal lung maturity and surfactant production.
when does the first stage of labor end
ends with complete dilation at 10cm
discuss the purpose of Leopold Maneuvers
performing external palpations of the material uterus through the abdominal wall.
done to determine the number of fetuses, presenting part, fetal lie, and fetal attitude, and exception location of the point of maximal impulse (PMI)
done to know what position the baby is in.
how should the laboring client be told to breath when he baby’s head is crowning?
Rapid pant pant bow breathing pattern. One method is to make a “hee” or “hoo” sound in a pattern. The pattern may vary, but typically after the cleansing breath, the patient breathes in a 3-to-1 pattern – “pant-pant-pant-blow” or “hee-hee-hee-hoo” throughout the entire contraction and ends with a cleansing or focused breath
list two signs seen on the fetal monitor strip that might indicate fetal distress
- fetal bradycardia
- late deceleration
- variable deceleration
how does the nurse know that her client’s uterine contractions are effective
Contractions are effective when labor progresses with 1 cm per hour or more. This can only be checked with a vaginal examination.
discuss the care of the client in between contractions
- Discourage pushing efforts until cervix is completely dilated
- Observe for perineal bulging or crowning
- Encourage clients to begin bearing down with contractions once the cervix is fully dilated. Listen for client statements expressing the need to have a bowel movement. This sensation is a sign of complete dilation and fetal descent.
- Assist with providing pain management
which position should be avoided while in labor and why
never stay flat on back for hypotension and vena cava syndrome
why is the client who has issues with the FHR pattern as to turn onto her left side
INCREASE OXYGEN
increases blood flow to the uterus and to decrease hypotension from being supine.
describe what the nurse should document about uterine contractions
- duration
- frequency
- intensity
- resting tone
list the normal range for baseline FHR
110-160/bpm
list he nursing interventions for a fetal heart tracing showing late decelerations
- Place client in side lying position
- Assist with the start of an IV line if not in place or increase with the IV rate
- Discontinue Pitocin if being infused
- Administer O2 8-10 L/min per mask
- Notify provider
- Prepare for an assisted vaginal birth or ceaseran birth
define “fetal position”
In this position, the back is curved, the head is bowed, and the limbs are bent and drawn up to the torso.
compare early decelerations to late decelerations
Early decelerations: Slowing of FHR with start of contraction with return of FHR to baseline at end of contraction
Causes:
- Compression of the fetal head resulting from uterine contraction
- Vaginal exam
- Fundal pressure
Late decelerations: NEVER GOOD. Slowing of FHR after contraction has started with return of FHR to baseline well being after contraction has ended
list effective interventions for the client having back labor
- Hot or cold compresses applied to the back
- Strong counterpressure (sacral)
- Hydrotherapy
- Back rubs or massage
- Acupressure
- Frequent maternal position changes
define effleurage. when is it indicated?
Light, gentle circular stroking of the client’s abdomen with the fingertips in rhythm with breathing during contractions. Indicated for relaxation and pain relief.
discuss the nursing assessment following an amniotomy
what the heart rate of the baby!
note color of the fluid - straw color
check temperature and vitals
Chart the time of the amniotomy, the color and approximate amount of fluid, and the effects on the woman. If labor does not begin spontaneously after amniotomy, induction with medications will usually follow. Watch the woman for signs of uterine infection if delivery does not occur within 24 hours
list the complications of epidural anesthesia
- MATERNAL HYPOTENSION (WATCH THE FHR!)
- fetal bradycardia
- inability to void
- loss of bearing down reflex
discuss the significance of meconium stained amniotic fluid
- Occurs due to fetal distress such as hypoxia. Amniotic fluid is black to green, yellow or brown.
- Fetuses are at risk for meconium aspiration syndrome after birth
- Meconium can be a clinical marker for fetal distress or hypoxia which can lead to asphyxia
- Meconium increases the risk for infection
- Postdated infants often pass meconium
define the following stages of labor: active, complete, latent, transitional
active: rapid dilation and effacement, some fetal descent, feelings of helplessness, anxiety and restlessness increase as contractions become stronger
complete: Rapid dilation and effacement; some fetal descent; feelings of helplessness; anxiety and restlessness increase as contractions become stronger
latent: some dilation and effacement, talkative and eager to get the baby out. contractions 5-30 minutes lasting 30-45 seconds.
transitional: complete dilation at 10cm. they will be tired, restless, and irritable. she will state she’s tired and doesn’t want to do this. can vomit, will have the urge to push but don’t let them! increased rectal pressure, increased bloody show. most difficult part o labor.
list two signs that the client is entering the second stage of labor
- Cervix 8 cm
- Strong to very strong contractions
- Frequency 2-3 minutes
- Duration 45-90 seconds
- Ends with complete dilation of 10 cm
- BLOODY SHOW
- HAIR
- BABIES HEAD
- “FEELS LIKE SHE HAS TO POOP”
explain how to determine the duration of a client’s contractions
The time between the beginning and the end of one contraction. Duration greater than 90 seconds can cause a decrease in fetal oxygenation
how is rupture of membranes confirmed
- a positive Nitrazine paper test (blue, pH 6.5-7.5)
or
- positive ferning test is conducted on amniotic fluid to verify rupture of membranes
list the order of movement the fetus makes during the birthing process
Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
discuss kegel exercises
Alternate tightening and relaxation of pubococcygeal muscles to reduce stress incontinence.
what is the most reliable indication of fetal well being
FHR variability
describe the assessment on the client upon arrival to the labor unit
- fetal heart rate and mothers vitals should be first priority upon entering the labor unit
- determine what blood type mom is
- be culturally competent
- obtain admission history and birth plan
- check status of amniotic fluids
- determine if client is in true labor
list two reasons for slowed labor
- Large size of baby
- Baby is in an abnormal position
- Birth canal is too small
- Weak contractions
BLADDER IS FULL
define brixton-hicks contractions
false labor
compare the four stages of labor
1st stage:
- Duration- 12.5 hours
- Begins with- Onset of labor
- Ends with- Complete dilation
- Maternal characteristics- Cervical dilation, 1 cm for clients who are primigravida (1st pregnancy) and 1.5 cm for clients who are multigravida ( 2 or more pregnancies)
2nd stage:
- Duration- Primigravida: 30 min to 2 hrs; Multigravida: 5 to 30 min
- Begins with- Full dilation and then progresses to intense contractions every 1-2 minutes
- Ends with- Birth
- Maternal characteristics- Pushing results in birth of fetus
3rd stage:
- Duration- 1 to 4 hours
- Begins with- Delivery of placenta
- Ends with- Maternal stabilization of VS
- Maternal characteristics- Achievement of VS homeostasis; Lochia scant to moderate rubra
4th: recovery
discuss how to tell the difference between true and false labor
True Labor:
Contractions:
- Can be irregular but become regular in frequency
- Stronger, last longer and are more frequent
- Felt in lower back, radiating to the abdomen
- Walking can increase contraction intensity
- Continue despite comfort measures
Cervix (Determined by vaginal exam):
- Progressive change in dilation and effacement
- Moves to anterior position
- Bloody show
Fetus:
- Presenting part engages in pelvis
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False Labor:
Contractions:
- Painless, irregular frequency and intermittent
- Decrease in frequency, duration and intensity with walking or position changes
- Felt in lower back or abdomen above umbilicus
- Often stop with sleep or comfort measures such as oral hydration or emptying of the bladder
Cervix (determined by vaginal exam):
- No significant change in dilation of effacement
- Often remains in posterior position
- No significant bloody show
Fetus-
- Presenting part is not engaged in pelvis
list the nursing intervention for the client receiving oxytocin (pitocin)
- Monitor risk factors such as multiple deliveries
- Monitor for headache, nausea, vomiting and increasing blood pressure
- Monitor intake and output and LOC
- Monitor length, strength and duration of contractions
- For hyperstimulation, turn the patient on her side, stop the infusion and administer oxygen
- Be prepared to administer a uterine relaxant
- Monitor FHR and rhythm and report signs of fetal distress
identify the following fetal heart rate patterns: early deceleration, normal FHR pattern, late deceleration, variable deceleration
normal FHR: 110-160/min with increases and decreases from baseline.
early deceleration: slowing of FHR with start of contraction with return of FHR to baseline at end of contraction
late deceleration: slowing of FHR after contraction has started with return of FHR to baseline well after contraction has ended
variable deceleration: transitory, abrupt slowing of FHR less than 110 beats/min, variable in duration, intensity and timing in relation to uterine contraction
describe how the nurse assesses a client labor status
- Monitor BP, HR and RR
- Monitor frequency, duration and intensity of contractions
- Cervical dilation
- Bloody show
- Fetus engaged in pelvis
when is an episiotomy typically done during labor
during childbirth to aid in difficult labor
list the priority interventions for the client who has had membranes rupture for more than 12 hours
- assess electronic FHR
- check cervical dilation
what does it mean when the laboring client is engaged
classified as true labor. means the babies largest part is in position to move down
explain how to place an internal scalp electrode
THE SAC NEEDS TO BE RUPTURED FIRST BEFORE ELECTRODE CAN BE PLACED
Continuous internal fetal monitoring with a scalp electrode is performed by attaching a small spiral electrode to the presenting part of the fetus to monitor the FHR. The electrode wires are then attached to a leg plate that is placed on the client’s thigh and then attached to the fetal monitor.
list the nursing intervention for labor client who has fetus with a prolapse cord
- Call for assistance immediately
- Have another nurse notify the provider immediately
- Use a sterile- gloved hand, insert two fingers into the vagina and apply finger pressure on either side of the cord to the fetal presenting part to elevate it off of the cord
- Place a rolled towel under the client’s hip to relieve pressure on the cord
- Reposition the client in a knee-chest Trendelenburg or a side lying position
- Apply a sterile, saline soaked towel to the cord to prevent drying and to maintain blood flow if the cord is protruding from the vaginal introitus
- Assist charge nurse to-
- Monitor FHR
- Administer O2 at 8-10 L/min via face mask to improve fetal oxygenation
- Prepare client for cesarean birth
explain the significance of the client expressing, “I feel like I need to have a bowel movement”
It means the baby is nearing coming out. SECOND stage of labor.
