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MCN 2 Lec (Midterms) > Problems with Power > Flashcards

Problems with Power Flashcards

1
Q

Time-honored term to denote sluggishness of contractions

A

Inertia

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2
Q

The force of labor is less than usual

A

Inertia

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3
Q

Dysfunction can occur at any point in labor but it is generally classified as

A

Primary (occurring at the onset of labor)
Secondary (occurring later in labor)

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4
Q

Having a prolonged labor are usually at risks of what conditions

A
  1. Postpartum infection
  2. Hemorrhage
  3. Infant mortality
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5
Q

Factors that can lead to having a prolonged labor

A
  1. Fetus is large
  2. Contractions are hypotonic, hypertonic, or uncoordinated
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6
Q

Components of Pregnancy

A

Power
Passenger
Passageway
Psyche
Placenta

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7
Q

Force that propels the fetus

A

Power

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8
Q

It refers to the fetus itself

A

Passenger

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9
Q

It refers the birth canal

A

Passageway

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10
Q

Perception of events both the birthing parent’s and the family

A

Psyche

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11
Q

2 phases of Uterine Contraction

A

Contraction (systole)
Relaxation (diastole)

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12
Q

Cervical dilatation during active phase

A

Nullipara - 1.2cm/hr
Multipara - 1.5cm/hr

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13
Q

Denotes sluggishness of contractions or force of labor

Dysfunctional labor

A

Inertia

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14
Q

Number of contractions is unusually low or infrequent

Resting tone remains less than 10mmHg

A

Hypotonic Contractions

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15
Q

Signs of Hypotensive Shock

A
  1. Rapid, weak pulse
  2. Falling blood pressure
  3. Cold, clammy skin
  4. Dilatation of the nostrils from air starvation
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16
Q

Strength does not rise above 25mmHg

May occur after administration of analgesia or if there is bladder distention

A

Hypotonic Contractions

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17
Q

Hypotonic Contractions may occur at what conditions?

A
  1. May occur after administration of analgesia
  2. Bladder distention is present
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18
Q

Occurs in the uterus which is overstretched, larger than usual single fetus, polyhydramnios, or lax uterus

A

Hypotonic Contractions

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19
Q

Management of Hypotonic Contractions

A
  1. Palpate the uterine fundus
  2. Obtain the patient’s blood pressure
  3. Assess the amount of lochia every 15 minutes
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20
Q

Increasing in resting tone to more than 15mmHg

A

Hypertonic Contractions

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21
Q

Occurs frequently in the latent phase of labor

More painful, myometrium becomes tender because of lack of relaxation

A

Hypertonic Contractions

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22
Q

Uterine pacemakers arise in other areas of the uterus

A

Hypertonic Contractions

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23
Q

What are the possible dangers? (having problems in power of contractions)

A
  1. Could lead to fetal anoxia
  2. Contractions are strong but ineffective
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24
Q

Management of Hypertonic Contractions

A
  1. Apply external uterine and fetal monitor
  2. Prepare for possible cesarean birth
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25
Q

More than one pacemaker may be initiating contractions or receptor points in the myometrium may be acting independently

A

Uncoordinated Contractions

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26
Q

Occur erratically, may be difficult for a woman to rest between contractions

A

Uncoordinated Contractions

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27
Q

Management for Uncoordinated Contractions

A
  1. Apply uterine and fetal monitor
  2. Administer oxytocin
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28
Q

Dysfunction at the First Stage of Labor

Give the 4 phases

A
  1. Prolonged Latent Phase
  2. Protracted Active Phase
  3. Prolonged Deceleration Phase
  4. Secondary Arrest of Dilatation
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29
Q

Dysfunction at the First Stage of Labor

Latent phase that is longer than 20hrs in a nullipara or 14hrs in multipara

A

Prolonged Latent Phase

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30
Q

Dysfunction at the First Stage of Labor

It may occur if the cervix is not “ripe” at the beginning

A

Prolonged Latent Phase

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31
Q

Management of Prolonged Latent Phase

A
  1. Rest the uterus
  2. Adequate hydration
  3. Pain relief - morphine sulfate or epidurals
  4. Providing comfort measures (decrease noise and stimulation, etc.)
  5. Oxytocin administration
  6. Amniotomy
  7. Cesarean birth
32
Q

Etiology of Prolonged Latent Phase

A
  1. Longing to complete the pregnancy
  2. Having difficulty managing the uncertainty
33
Q

Dysfunction at the First Stage of Labor

Usually associated with cephalo-pelvic disproportion or fetal malposition

A

Protracted Active Phase

34
Q

Protracted Active Phase is usually associated with what conditions?

A
  1. Cephalo-Pelvic Disproportion (CPD)
  2. Fetal malposition
35
Q

Dysfunction at the First Stage of Labor

Prolonged if cervical dilatation does not occur at a rate of 1.2cm/hr in a nullipara or 1.5cm/hr in a multipara

A

Protracted Active Phase

36
Q

Dysfunction at the First Stage of Labor

Active phase is longer than 6hrs in multigravida

A

Protracted Active Phase

37
Q

Management of Protracted Active Phase

A
  1. Cesarean birth
  2. Augmentation of labor
38
Q

Dysfunction at the First Stage of Labor

A deceleration phase has become prolonged when it extends beyond 3hrs in a nullipara and 1hr in multipara

A

Prolonged Deceleration Phase

39
Q

Dysfunction at the First Stage of Labor

A prolonged deceleration phase most often results from abnormal fetal head position

A

Prolonged Deceleration Phase

40
Q

Dysfunction at the First Stage of Labor

Cesarean births is frequently required during this phase

A

Prolonged Deceleration Phase

41
Q

A prolonged deceleration phase is most often results from what condition?

A

Abnormal fetal head position

42
Q

Dysfunction at the First Stage of Labor

Occurs if there is no progress in cervical dilatation for longer than 2hrs

A

Secondary Arrest of Dilatation

43
Q

Dysfunction at the First Stage of Labor

Cesarean birth may be necessary during this phase

A

Secondary Arrest of Dilatation

44
Q

Dysfunction at the Second Stage of Labor

Give the 2 phases

A
  1. Prolonged Decent
  2. Arrest of Decent
45
Q

Dysfunction at the Second Stage of Labor

Contractions have been of good quality and proper duration

A

Prolonged Decent

46
Q

Dysfunction at the Second Stage of Labor

Contractions become infrequent and poor quality

A

Prolonged Decent

47
Q

Dysfunction at the Second Stage of Labor

Management for Prolonged Decent

A
  1. Rest
  2. Fluid intake
  3. IV oxytocin
  4. Artificial rupture of membranes
48
Q

Dysfunction at the Second Stage of Labor

Results when no descent has occurred for 1hr in multipara and 2hrs in nullipara

A

Arrest of Decent

49
Q

Dysfunction at the Second Stage of Labor

Expected descent or engagement does not occur

A

Arrest of Decent

50
Q

Interferes with fetal descent

A

Pathologic Retraction Ring (Bandl’s Ring)

51
Q

Hard band forms across the uterus, at the junction of the upper and lower uterine segment

A

Pathologic Retraction Ring (Bandl’s Ring)

52
Q

Fetus is gripped and cannot advance beyond the point

A

Pathologic Retraction Ring (Bandl’s Ring)

53
Q

Dangers associated with Pathologic Retraction Ring

A
  1. Uterine rupture
  2. Neurologic damage to fetus
54
Q

Management for Pathologic Retraction Ring (Bandl’s Ring)

A
  1. IV morphine sulfate
  2. Tocolytic agents
  3. Emergency CS
55
Q

Occurs when the uterus undergoes more strain than it is capable of sustaining

A

Uterine Rupture

56
Q

Contributing factors of Uterine Rupture

A
  1. Prolonged labor
  2. Abnormal presentation
  3. Multiple gestation
  4. Unwise use of oxytocin
  5. Obstructed labor
  6. Traumatic maneuvers of forceps or traction
57
Q

Contraction stop two distinct swellings are visible

A

Complete rupture

58
Q

Complete Uterine Rupture, contraction stops at two distinct locations

A
  1. Extrauterine fetus
  2. Retracted uterus
59
Q

Localized replacement therapy

Persistent, aching pain at the lower uterine segment

A

Incomplete rupture

60
Q

Incomplete Uterine Rupture can be confirmed by what diagnostic procedure?

A

Ultrasound

61
Q

Management for Uterine rupture

A
  1. Fluid replacement therapy
  2. IV oxytocin - for contraction and to minimize bleeding
  3. Possible laparotomy (hysterectomy or tubal ligation) - to control bleeding
62
Q

Uterus turns inside out

A

Inversion of the Uterus

63
Q

May occur if tractions is applied to the umbilical cord to remove the placenta

A

Inversion of the Uterus

64
Q

Signs of Inverted Uterus

A

Sudden gush of blood
Fundus not palpable in the abdomen
Signs of blood loss

65
Q

Management for Inverted Uterus

A
  1. Never replace the inversion - handling of the uterus could increase the bleeding
  2. Never attempt to remove the placenta if it is still attached - it creates a larger surface area for bleeding
  3. Start an IV fluid line (large-gauge needle)
  4. Administration of oxygen by mask
  5. Assess vital signs
  6. Tocolytic agents to relax the uterus
  7. General anesthesia or possible nitroglycerin
  8. Manual replacement
  9. Administration of oxytocin
  10. Antibiotic therapy - to prevent infection
66
Q

Amniotic fluid is forced into an open maternal uterine blood sinus through defects in the membrane, rupture of the membrane, premature separation of the placenta

A

Amniotic Fluid Embolism

67
Q

Women in strong labor sits up suddenly grasp her chest because of sharp pain and inability to breathe

A

Amniotic Fluid Embolism

68
Q

Signs and Symptoms of Amniotic Fluid Embolism

Blood pressure may drop significantly with loss of diastolic measurement

A

Hypotension

69
Q

Signs and Symptoms of Amniotic Fluid Embolism

Labored breathing and tachypnea may occur

70
Q

Signs and Symptoms of Amniotic Fluid Embolism

Tonic-clonic seizures are seen in 50% of patients

71
Q

Signs and Symptoms of Amniotic Fluid Embolism

Usually a manifestation of dyspnea

72
Q

Signs and Symptoms of Amniotic Fluid Embolism

As hypoxia/hypoxemia progresses, circumoral and peripheral cyanosis and changes in mucous membranes may manifest

73
Q

Signs and Symptoms of Amniotic Fluid Embolism

In response to the hypoxic insult, FHR may drop to less than 110bpm

A

Fetal Bradycardia

74
Q

Signs and Symptoms of Amniotic Fluid Embolism

This is usually identified on chest radiograph

A

Pulmonary edema

75
Q

Signs and Symptoms of Amniotic Fluid Embolism

A
  1. Hypotension
  2. Dyspnea
  3. Seizures
  4. Cough
  5. Cyanosis
  6. Fetal Bradycardia
  7. Pulmonary Edema
  8. Cardiac Arrest
  9. Uterine Atony
  10. Coagulopathy or severe hemorrhage in absence of other explanation (DIC)
  11. Altered mental status/confusion/agitation
76
Q

Management of Amniotic Fluid Embolism

A
  1. Oxygen administration
  2. Flat or in a slight Trendelenburg position - to improve the venous blood return and perfusion of the CNS
  3. Fluid therapy
  4. Administration of pharmacological agents
  5. Electrocardiographic monitoring to detect and treat arrhythmias

MCN 2 Lec (Midterms) (8 decks)

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