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
