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OB Lecture > Quiz 2 Content > Flashcards

Quiz 2 Content Flashcards

1
Q

S/Sx of Labor

A

Lightening, braxton hicks, cervical changes, bloody show, ROM, “nesting.”

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2
Q

Definitions: Lightening

A

Fetus settles/drops into pelvis. Can happen a few weeks prior to labor or just before beginning of labor.

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3
Q

Lightening: Effects on Body

A

Easier breathing, increased urinary frequency, leg cramps, increased LE edema.

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4
Q

Definitions: SROM

A

Spontaneous Rupture of Membranes

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5
Q

SROM: Nursing Considerations

A

Increased risk of infection (ABX possible), optimal to deliver within 24 hr of rupture - can be induced with pitocin
C: color (clear or straw)
O: Odor (fleshy)
A: Amount (gush or trickle)
T: Time

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6
Q

Definitions: Bloody Show

A

Mucousy lining in cervix during labor is expelled.

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7
Q

Cervical Changes During Labor

A

Dilation (Door opening): 0-10 cm

Effacement (thinning/shortening): 0-100%

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8
Q

Definitions: Braxton Hicks

A

Backache and contractions of the uterus occur throughout pregnancy. They are intermittent and irregular. They do NOT cause cervical changes and can lead to women believing they are in labor.

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9
Q

Nursing Education for Nesting

A

Encourage women not to overdo it or become fatigue

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10
Q

Definitions: Pre-term Birth

A

Birth occurs before 37 weeks of pregnancy (5-18% of births).

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11
Q

Definitions: Pre-term Labor

A

Cervical changes and uterine contractions that occur between 20-37 weeks.

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12
Q

What is the Best Biochemical Marker for Preterm Birth?

A

Salivary Estriol

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13
Q

Definitions: PPROM

A

Preterm Premature Rupture of Membranes. Occurs in 25% of preterm cases, cause is unknown but is often preceded by infection (Chorioamnionitis).

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14
Q

Definitions: Post Term Pregnancy

A

Pregnancy extending beyond 42 weeks.

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15
Q

Post Term Pregnancy: Maternal Risks

A

Dysfunctional labor/birth canal trauma R/T large infant.

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16
Q

Post Term Pregnancy: Fetal Risks

A

Prolonged labor, shoulder dystocia, birth trauma, asphyxia R/T macrosomia, effects of “aging” placenta.

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17
Q

Definitions: Version

A

Turning of fetus from one presentation (position) to another.
Start IV before hand; wait until 37-39 weeks, start the cascade

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18
Q

Definitions: Shoulder Dystocia

A

Head of baby is “born,” but anterior shoulder cannot pass under the pubic arch.

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19
Q

Shoulder Dystocia: Infant Risks

A

Birth injury R/T asphyxia, brachial plexus damage, and fracture.

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20
Q

Shoulder Dystocia: Maternal Risks

A

Blood loss R/T uterine atony or rupture, lacerations, extension of episiotomy, or endometritis.

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21
Q

Definitions: Prolapsed Umbilical Cord

A

Cord lies below presenting portion of fetus.

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22
Q

Prolapsed Umbilical Cord: Etiology

A

Cord > 100 cm, breech position, transverse lying, unengaged presenting part.

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23
Q

Uterine Rupture: Etiology

A

Separation of scar from previous classic cesarean birth, uterine trauma (R/T accidents or surgery), congenital anomalies.

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24
Q

Amniotic Fluid Embolism: Pathophysiology

A

Amniotic fluid containing debris (e.g., hair, meconium) enters maternal circulation and obstructs pulmonary vessels resulting in respiratory distress and circulatory collapse.

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25
Q

Definitions: Pelvic Dystocia

A

Contractures of pelvic diameter that reduce size of the pelvis.

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26
Q

HELPERR Mnemonic

A

H - help (call for assistance)

E - evaluate for episiotomy

L - legs (McRoberts Maneuver)

P - pressure (suprapubic)

E - enter the vagina

R - roll the patient to hands and knees

R - remove the posterior arm

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27
Q

Forceps Mnemonic

A

A - anesthesia

B - bladder

C - cervix

D - determine position (think dystocia)

E - equipment

F - forceps

G - gentle traction

H - handle

I - incision

J - jaw

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28
Q

Vacuum Mnemonic

A

A - anesthesia

B - bladder

C - cervix

D - determine position (think dystocia)

E - equipment and extractor

F - fontanelle; cup positioned near

G - gentle traction

H - halt traction or procedure

I - incision

J - jaw

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29
Q

Definitions: Decelerations

A

A decrease in fetal heart rate below the baseline rate. These can be early, variable, late - or a combination of more than one!

30
Q

Early Deceleration: Cause

A

Head compression. Usually seen during the later portion of active labor or with breech babies. Not expected in early labor.

31
Q

Late Decelerations: Cause

A

Uteroplacental insufficiency.

32
Q

Variable Decelerations: Cause

A

Umbilical cord compression.

33
Q

Definitions: Hypoxemia

A

Low levels of O2 in blood.

34
Q

Definitions: Hypoxia

A

Low levels of O2 available in tissue - cannot meet metabolic needs.

35
Q

Definitions: Intrauterine Growth Restriction (IUGR)

A

Growth restriction below the 10th percentile in gestation.

36
Q

Compare/Contrast: Symmetric IUGR vs. Asymmetric IUGR

A

Symmetric: Results from perinatal infections (e.g., cytomegalovirus) and chromosomal abnormalities. Develops early in pregnancy. Less common than asymmetric. Poor prognosis.

Asymmetric: Occurs later in pregnancy, more common than symmetrical. R/T uteroplacental insufficiency. Better prognosis.

37
Q

Definitions: Intermittent Decelerations

A

Decelerations that occur with < 50% of uterine contractions in any 20 minute window.

38
Q

Definitions: Prolonged Deceleration

A

Decrease in fetal heart rate from baseline by > 15 bpm, lasting longer than 2 minutes but less than 10 ( > 10 minutes = baseline change).

39
Q

Definitions: Recurrent Decelerations

A

Decelerations that occur with > 50% of uterine contractions in any 20 min window.

40
Q

Definitions: Episodic Changes

A

Accelerations/decelerations occurring without relationship to uterine contractions (e.g., fetal movement).

41
Q

Definition: Category I Fetal HR

A

Fetal HR tracings normal.

42
Q

Definitions: Category II Fetal HR

A

Fetal HR tracings are indeterminate. Essentially, not adequate evidence to classify as category I or category III

43
Q

Definitions: Category III Fetal HR

A

Fetal HR tracings are abnormal. Require prompt evaluation.

44
Q

Category III Fetal HR: Interventions

A

Dependent on clinical situation. Can include: provision of maternal O2, d/c labor stimulation, Tx maternal hypotension.

45
Q

When May Internal Fetal Monitoring Be Used?

A

When the external monitor is of questionable quality, maternal abdominal obesity, maternal movement impairing ability to externally monitor.

46
Q

Internal Fetal HR Monitoring: Benefits

A

Eliminates need to readjust monitor, eliminated possibility of tracing maternal HR.

47
Q

Internal Fetal HR Monitoring: Requirements

A

Membranes are required to be ruptured.

48
Q

Definitions: Precipitous Labor

A

Labor lasting less than 3 hours.

49
Q

Labor: Non-pharmacological Interventions

A

Massage, touch, heat, cold, focal point, distraction, effeurage, distraction, positioning, hydrotherapy, imagery, hypnosis.

50
Q

General Anesthesia: Maternal/Fetal Risks

A

Maternal aspiration of gastric contents, maternal respiratory depression, uterine relaxation, neonate respiratory depression

51
Q

Laboring Women With Hx Sexual Abuse: Nursing Considerations

A

Memories of abuse can be triggered by labor (e.g., exams, pain, loss of control, etc). Offer support, promote comfort, assess, and monitor.

52
Q

Left/Right Side Lying is Optimal for Baby

A

Left side lying.

53
Q

Nursing Interventions Throughout Labor (general)

A

Provide for maternal and infant safety, monitor maternal VS, monitor cervical dilation PRN, monitor fetal HR, monitor contractions, monitor labor progress, monitor coping, include coach.

54
Q

Nursing Interventions: Active Labor (Stage 1, Phase 2)

A

Keep hydrated, provide comfort measures, pharmacologic interventions, provide reassurance, support to laboring woman and coa ch.

55
Q

Stages of Labor: Stage 1

A

Dilation 0-10 cm

Further divided into phases

Latent
Active
Transition

56
Q

Stages of Labor: Stage 1 (Latent Phase)

A

0-3 cm dilated
0-30 % effaced
Contractions short/far apart
Monitor fetal HR for late decels

57
Q

Stages of Labor: Stage I (Active Phase)

A

4-7 cm dilated
100% effaced
Breathing techniques and pain management
Contractions stronger and longer

58
Q

Stages of Labor: Stage 1 (Transition Phase)

A

7-10 cm dilated
100% effaced
Help mom focus and stay in control
Contractions strongest and closest
Anxiety/vomiting/BM
DO NOT push until 10 cm dilated
Bloody shown can be seen at this stage
Assess color of amniotic fluid

59
Q

Stages of Labor: Stage 2

A

10 cm dilated - baby is TRANSITIONING out.

Here we see significant increase in contractions, urge to push (Ferguson reflex), and urge to poop.

60
Q

Definitions: McRoberts Maneuver

A

Pressing the laboring woman’s legs to her abdomen. Used with shoulder dystocia to create more room for baby.

61
Q

Stages of Labor: Stage 3

A

Baby to placenta is out

62
Q

Stages of Labor: Stage 4

A

Recovery

63
Q

Definitions: Station

A

Relationship of presenting part of fetus to ischial spines of pelvis (-4 to +4).

64
Q

Station of +4 Indicates…

A

Baby being born

65
Q

Station of -4 or Greater Indicates…

A

Fetus floating or unengaged

66
Q

Primary Powers Include…

A

Uterine contractions + Cervical Dilation (0-10 cm)

67
Q

Secondary Powers Include…

A

Pushing (10 cm - birth)

68
Q

Early Labor: Nursing Interventions

A

Early Labor = Early education and encouragement.

Orient to unit/room, admission Hx and physical, build rapport, intake of birth plan, order labs, begin comfort techniques.

69
Q

How Can You Differentiate Between True and False Labor?

A

4 Signs of True Labor: Bloody show, SROM, true labor contractions (increasing in frequency, intensity, and duration. Not relieved with position/activity changes).

70
Q

How Can You Differentiate Between Real vs. Braxton Hicks Contractions?

A

Braxton Hicks contractions are relieved with walking/position changes and are not accompanied by any cervical changes.

71
Q

A Laboring Mom Should NOT Push Until They Are _____ cm Dilated

A

10 cm

Risk for cervical swelling and lacerations if they begin pushing sooner.

OB Lecture (11 decks)

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