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OB > Resource Guide: CKA Test > Flashcards

Resource Guide: CKA Test Flashcards

1
Q

Electronic Fetal Heart Rate Monitoring:
What is the normal BPM?
(Over a 10 minute segment, between contractions)

A

110-160 BPM

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2
Q

Electronic Fetal Heart Rate Monitoring:
What is the bradycardia BPM?
(Over a 10 minute segment, between contractions)

A

<110 BPM

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3
Q

Electronic Fetal Heart Rate Monitoring:
What is the tachycardia BPM?
(Over a 10 minute segment, between contractions)

A

> 160 BPM

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4
Q

What is the most important indicator of fetal well-being? Visually detectable FHR oscillations from the baseline.

A

Variability

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5
Q

What does variability represent?

A

Represents intactness of fetal CNS

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6
Q

What are the 4 different levels of variability?

A

absent, minimal, moderate, or marked variability

Depending on the amplitude of the waves

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7
Q

What are periodic changes?

A

Changes from the fetal heart rate baseline that are associated with uterine contractions

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8
Q

What are episodic changes?

A

Changes from the fetal heart rate baseline that are not (or are in between) associated with uterine contractions

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9
Q

What is this describing?

  • May be either periodic or episodic
  • Are visually apparent abrupt increases in FHR above baseline
  • Goal: peak > 15 BPM, duration >15 sec but
A

Accelerations

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10
Q

What is this describing?

  • Are periodic
  • Are visually apparent gradual decreases in FHR below baseline. Onset to nadir > 30 sec and coincident with the onset, peak, and ending of contractions
  • Does not require additional nursing action
A

Early decelerations

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11
Q

What are early decelerations caused by?

A

Fetal head compressions

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12
Q

What is this describing?

  • Are periodic
  • Visually apparent gradual decrease in FHR below baseline
  • Onset to nadir > 30 sec and delayed in timing to peak of contraction
  • Requires interventions
A

Late decelerations

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13
Q

What causes late decelerations?

A

uteroplacental insufficiency/fetal hypoxia

-requires interventions to enhance fetal oxygenation and placental perfusion

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14
Q

What causes variable decelerations?

What are the interventions?

A

Caused by cord compression

Interventions aimed at eliminating cord compression, increasing fetal oxygenation

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15
Q

What causes prolonged decelerations?

A

Many causations: prolapsed cord, tachysystole, rapid decent, abruption, etc

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16
Q

What term is this describing?
Mean FHR rounded to increments of 5 bpm during a 10 minute segment excluding periodic or episodic changes, periods of marked variability and segments of baseline that differ by 25 bpm. Duration must be > 2 minutes

A

Baseline Rate

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17
Q

What term is this describing?
Fluctuations in the baseline FHR of 2 cycles/min or greater. Visually quantitated as the amplitude of the peak-to-trough in beats per minuute

A

Variability

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18
Q

What term is this describing?

Amplitude from peak to trough undectable

A

absent variability

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19
Q

What term is this describing?

Amplitude from peak to trough >undetectable and < 5 bpm

A

minimal variability

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20
Q

What term is this describing?

Amplitude from peak to trough 6-25 bpm

A

moderate variability

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21
Q

What term is this describing?

Amplitude from peak to trough > 25 bpm

A

marked variability

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22
Q

In gestations <32 weeks, peak of 10 bpm and duration of 10 seconds is….

A

Acceleration, if >32 weeks is 15 bpm and 15 sec

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23
Q

What term is this describing?
Visually apparent abrupt decrease (onset to nadir is < 30 sec) in FHR below baseline. Decrease is >15bpm, duration >15 sec and < 2 min

A

Variable deceleration

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24
Q

What term is this describing?
Visually apparent abrupt decrease (onset to nadir s < 30 sec) in FHR below baseline. Decrease is > 15 bpm, duration >2min but <10 min

A

Prolonged deceleration

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25
Q

What are the 3 phases of the first stage of birth?

A
  • Latent phase
  • Active phase
  • Transition phase
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26
Q

What is the approximate time for the Latent Phase?

A

6-8 hours

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27
Q

What is the dilation for the latent phase?

A

0-3cm

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28
Q

What are the contractions frequency, duration and intensity in the Latent Phase?

A

Every 5-30 minutes
30-40 sec
Mild progress to moderate
25-40 mmHg IUPC

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29
Q

What is the approximate length of time for the Active Phase?

A

Approx. 3-6 hours

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30
Q

What is the dilation in the Active Phase?

A

4-7cm

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31
Q

What are the contractions frequency, duration, and intensity in the Active Phase?

A

Every 3-5 min
40-70 sec
Moderate progress to strong
50-70 mmHg by IUPC

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32
Q

What is the approximate length of time for the Transition Phase?

A

approx. 20-40 minutes

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33
Q

What is the dilation in the Transition Phase?

A

8-10 cm

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34
Q

What are the contractions frequency, duration, and intensity in the Transition Phase?

A

Every 2-3 minutes
45-90 sec
Strong by palpation
70-90 mmHg by IUPC

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35
Q

How long is the second stage? Nullipara and Multipara

A

Influenced by regional anesthesia
Nullipara: 50 min-2hr
Multipara: 20 min-1hr

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36
Q

What are the 3 types of breathing patterns to comfort for labor and birth?

A 
Slow Breathing Pattern
  -in through nose, out through mouth
  -begin when mom has difficulty walking      
  during contractions
Light Breathing or Accelerated Breathing
  -Use when tense
  -silent inhale, audible exhale
  -"greet" the contraction w/ cleansing breath
  -end contraction with another "blow it away"
Transition Breathing
  -pant-pant-blow
  -he-he-he-blow
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37
Q

What are some techniques to relieve backache during labor and birth?

A

hands and knees position, pelvic rocking, lunge, walking, stair climbing, slow dancing, birthing ball, changing positions, cold packs, rolling pressure (tennis balls, rolling pins), counter pressure

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38
Q

What are some other effective comfort measures?

A

Visualization/attention focusing, music and aroma therapy, tub/shower, cold or hot pack, massage techniques, palm massage, effleurage

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39
Q

What are 3 bearing down techniques?

A
  • “Laboring down” or push only with the urge
  • Directed pushing or valsalva pushing
  • Open-glottis pushing
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40
Q

What are 4 positions for comfort?

A

Squatting, semi-sitting, hands and knees (easy, help rotate baby, may help the FHR), and dangling (elongates the trunk, relaxes the pelvis)

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41
Q

Postpartum assessment:
How often should you assess lung sounds, RR, cardiac, and neuromuscular (temperature, anesthesia regression, dermatomes, epidural site)?

A

every 4 hours

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42
Q

Assess BUBBLE HEAVN twice a shift. What does BUBBLE HEAVN stand for?

A 
Breast
Uterus
Bowel
Bladder
Lochia
Episiotomy/perineum
Homan's sign (bend leg, if pain possible DVT)
Emotional bonding and baby
Abdomen
Vital Signs
Nutrition
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43
Q

Assess CHESS once a shift. What does CHESS stand for?

A 
Culture/ethnicity/language
Health beliefs
Economic/educational
Spiritual Beliefs
Significant others
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44
Q

Where is the fundus located in the first 24 hours postpartum? Recedes ____/day postpartum.
How do you document?

A
  • Near umbilicus
  • Recedes 1cm/day
  • U/1= 1cm below umbilicus
  • 1/U- 1cm above umbilicus
  • Midline or deviation from midline
  • Tone: Firm, boggy
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45
Q

Pitocin is never…

Pitocin can cause increase in…

A

given IV push! always ordered rate

-Pitocin can cause increase in BP

46
Q

Where will the bladder be if distended? What happens when the bladder is full?

A

Rise up to the right

It increases vaginal bleeding and it prevents uterine contractions

47
Q

1st BM is usually… (postpartum mother)

A

2 days postpartum

-No enema or digital exam if pt has 3rd or 4th degree lacerations!

48
Q

When should you report Lochia?

A

if saturation of OB-Pad in 2 hours or less

-You are assessing to precent hemorrhage and shock

49
Q 
Inspect lochia for color, amount, odor, and presence of clots.
Color:
Days 1-4: \_\_\_\_\_\_
Days 4-10: \_\_\_\_\_
Days 10-3rd to 6th week: \_\_\_\_\_\_
Color shouldn't....
A

Days 1-4: Rubra
Days 4-10: Serosa (in some women may last 27 days)
Days 10-3rd to 6th week: Alba
Color shouldn’t revert to earlier stage

50
Q 
Lochia:
-Slight or scant:\_\_\_\_\_
-Moderate:\_\_\_\_\_\_
-Heavy: \_\_\_\_\_
1cc=\_\_\_\_\_
Clots? Odor?
A

Slight or scant: 4 pads/day
-Moderate: 4-8 pads/day
-Heavy: 8 pads
1cc=1gm
Few small clots in first few days is normal but document any clots present.
Earthy, faintly musky; if foul ma indicate infection

51
Q

What are 3 ways to help prevent thrombophlebitis?

A
  • Early ambulation
  • Teach pt stretches and ROM exercises if on bed rest
  • Avoid constricting clothing and crossed legs
52
Q

What are the 3 emotional phases after birth for the mother?

A

1) Taking in- immediately after birth
- sleeps, depends on others, relives events surrounding birth
2) Taking hold- few days pp
- begins to gain control of body functions, becomes preoccupied with present, is concerned about her health, abby’s health, and ability to care for baby, show independence in self-care and baby care
3) Letting go
- re-establishes relationships with others

53
Q

What does REEDA stand for? When is it used?

A 
Used to assess C-section incision
Redness
Edema
Ecchymosis
Discharge
Approximated edges
54
Q

What baby temperature should you call your instructor or nurse?

A

below 97.7F (36.5C) OR above 98.9F (37.2C)

55
Q

What baby RR should you call your instructor or nurse?

A

below 30 OR above 60

56
Q

What baby pulse should you call your instructor or nurse?

A

below 100 or above 160

57
Q

What baby glucose level should you call your instructor or nurse?

A

=/<45 mg/dl
OR
above 150 mg/dl

58
Q

When else should you call your instructor or nurse? (regarding newborn)

A
  • When newborn has not voided or stooled on your shift
  • Bilirubin above 10 mg/dl
  • Bleeding at circumcision
59
Q

When should you call your instructor or nurse? (regarding mother) 4 things

A
  • Fundus above the umbilicus or deviated from the midline
  • Palpable bladder
  • Not voided in past 4 hours
  • Saturating a peripad in 2 hours or less (sooner than 2 hours)
60
Q

How often do you assess and document on the mother?

A

Every 4 hours, New admission: every 2 hours, first 3 voids (must measure and record)

61
Q

How often do you assess and document on the newborn?

A

Every 4 hours

62
Q

What are the 5 reflexes you check on a newborn? (Upper body)

A

Grasp reflex, Moro reflex, Rooting reflex, Gag reflex, Blink reflex

63
Q 
Newborn Vital Signs
Pulse: \_\_\_bpm
  -During sleep as low as \_\_\_\_bpm
  -If crying up to \_\_\_ bpm
Apical pulse counted for \_\_\_\_\_
A

Pulse: 100-160 bpm
-During sleep as low as 80 bpm
-If crying up to 180 bpm
Apical pulse counted for 1 full minute

64
Q

Newborn Vital Signs

  • RR: ____/minute
  • Predominantly ___ but synchronous with abdominal movements
  • Obligate nose breathers
  • Respirations are counted for _____
A

30-60 respirations/minute
Predominantly diaphragmatic
Respirations are counted for 1 full minute

65
Q

Newborn Vital Signs
Blood pressure at birth: ___ mmHg
At day 10: _____ mmHg

A

Birth: 80-60/45-40 mmHg

Day 10: 100/50 mmHg

66
Q 
Newborn Vital Signs
Temperature normal range: \_\_C
Axillary:\_\_\_C
Skin: \_\_C
Rectal: \_\_\_C
A

Normal range: 36.5-37.2C (97.7-98.9F)
Axillary: 36.5-37.2C
Skin: 36-36.5C
Rectal 36.6-37.2C

67
Q

When should you preform a Neonatal Infant Pain Scale (NIPS)?

A

(taken with vitals)

immediately before and 30 after painful procedures

68
Q

What 6 things are you evaluating in the Neonatal Infant Pain Scale?

A

(0 or 1 for each, except cry is 0-2)

  • Facial expression
  • Cry (1=whimper, 2=vigorous cry)
  • Breathing (relaxed or changed), arms (relaxed or flexed/extended)
  • Legs
  • State of arousal (sleeping/awake or fussy)
69
Q

When should you intervene for NIPS score?

A

Score of 2 or more

70
Q

What are some interventions for NIPS score?

A

reposition, swaddle in warm blanket, skin-to-skin, reduce stimulation (dim lights, quiet), hold and rock in vertical position, light massage/stroking, breast or feed, pacifier (if parents have/allow), oral sucrose as ordered

71
Q

What is a limitation to the NIPS score?

A

A falsely low score may be seen in an infant who is too ill to respond or who is receiving a paralyzing agent

72
Q

Bottle Feedings

Do not let the baby sleep longer than _____ if formula fed (during the day) between feedings for the first 6 weeks

A

4 hours

73
Q

Bottle Feedings (Frequency and Amount)

  • First 48 hrs: ________, _________
  • First 2 weeks: _______, ________
  • 2-4 weeks: ________, _________
  • 1-3 months: _______, __________
  • 3-7 months: _________, ________
A
  • First 48 hrs: 6-8 feedings, 10-15 mL/feeding
  • First 2 weeks: 6-10 feedings, 60-90mL/feeding
  • 2-4 weeks: 6-8 feedings, 90-120mL/feeding
  • 1-3 months: 5-6 feedings, 145-175 mL/feeding
  • 3-7 months: 4-5 feedings, 175-205 mL/feeding
74
Q

Breastfeeding
Teach to feed _______. Do NOT go longer than ____ during daytime and or ___ hours at night without attempting to feed for the first 6 weeks.

A

Teach to feed as often as baby desires.

3 hours
4 hours

75
Q

Never ____ bottle or ____ a baby for feedings

A

prop a bottle or leave a baby unattended for feedings

76
Q

Do not bottle feed a baby in _______

A

an infant seat (support head well)

77
Q

After a feeding, always place the baby _________

A

on its back for sleeping

78
Q

Breastfed babies do not have to be _________

A

burped routinely

79
Q

What 3 positions is burping performed?

A

1) Over the shoulder
2) Across the lap
3) Sitting with chin supported

80
Q

If the baby has been _____ it might be necessary to burp the baby before feeding

A

crying

81
Q

Burp the baby when sucking ______ or ____ or after ____ for newborns

A

slows down or stops or after 1/2 to 1 oz for newborns

82
Q

What are the 4 forms of formula?

A

1) Concentrated (liquid): must add water
2) Powdered: Must add water
3) Ready to use: Place required amount in bottle
4) Prepackaged Ready to Use: Open and serve

83
Q

Where should you store all prepared formulas?

A

in a refridgerator

84
Q

How should you save formula left in a bottle?

A

Don’t! You should never save leftover formula. Throw it away.
Change liners or wash bottles in warm soapy water after feedings

85
Q

How many diapers should a baby go through in days 1-5?

A

Same number as day of life (Day 1=1 diaper, Day 2=2 diapers, etc)

86
Q

How many diapers should a baby go through after day 5?

A

If the baby is getting enough to eat voids are 6-8 times/day

87
Q

How should you clean diaper area is stool is present?

A

Use a mild soap and water if present.

If absent, clean with warm water

88
Q 
Stools (What should the baby have)
First 2 days: \_\_\_\_\_\_
About day 3:\_\_\_\_\_ (color)
End of first week: \_\_\_ (color)
  -breastfed stools: \_\_\_\_\_
  -bottle fed stools:\_\_\_\_\_
A 
First 2 days: Meconium (dark green/back, thick, sticky)
About day 3: greenish to yellow green
End of first week: yellowish
  -breastfed: loose, non-smelly
  -bottle fed: formed with odor
*Should have at least one stool per day
89
Q

What should you tell the mother to do if she has trouble waking her baby up?

A

call the baby’s doctor

90
Q

When should the mother call the dr? (in terms of vomiting)

A

When spitting up a large part or all of a feeding two or more times

91
Q

When should the mother call the dr? (In terms of diarrhea)

A

Three or more green, liquid stools (stools have a water ring around them)

92
Q

When should the mother call the dr? (in terms of feedings)

A

when the baby refuses to eat 2 feedings in a row

93
Q

When should the mother call the dr? (in terms of cord)

A

reddening around the cord area or a bad smell from the cord

94
Q

When can the baby have a tub bath?

A

After the cord is dry and falls off, approximately 7-10 days

95
Q

Cleanse the cord with soap and water only when….

A

urine or feces gets on the cord

96
Q

How should you tell the parents to dress the baby?

A

Like the warmest person in the family dresses. Do not overdress the baby, they can get too hot

97
Q

Breasts

When/what days is colostrum produced?

A

first 2-3 days

98
Q

Breasts

Transitional milk begins by approx. _____days after birth. Continues to change in composition for about _____ days

A

Transitional- 3-5

continues to change 10 days

99
Q

When is mature milk established?

A

approx. 2 weeks

100
Q

What are 2 reasons why a postpartum mother should wear a bra?

A

1) Comfort

2) To decrease engorgement and tenderness

101
Q

Fluid build-up usually ______ days after delivering and____ hours before milk comes in

A

2-3 days after

24 hours

102
Q

How should mothers wash their nipples?

A

With warm water, no soap!

-can use lanolin on breasts and nipples

103
Q

What are the 2 signs of possible breast infection and 3 actions to treat?

A
  1. Pain, warm, hard, redden area
  2. Fever, feeling ill
  3. Change baby’s nursing position
  4. Increase frequency of nursing
  5. Call provider
104
Q

Why is the fundus palpated after delivery?

A

To check for position change from bleeding or full bladder

105
Q

What are 5 ways to facilitate bladder emptying?

A
  1. Squatting or standing to void
  2. Sound of water running
  3. Voiding in a sitz bath
  4. Relaxation techniques
  5. Pouring water over perineal area
106
Q

If lactating, increase caloric intake by ____ for a singleton delivery and double this for a twin pregnancy

A

200-500 calories

107
Q

What should a postpartum mother do when she voids? (in terms of perineal hygiene)

A
  • Change pad every time she voids
  • Use peri-bottle to wash with after each void
  • Put on peri-pad from front to back and remove it the same way
108
Q

Need to report to MD if lochia has ____ or if changes from ______ to _______

A

foul odor or if changes from whitish to bright red

109
Q

What are 4 factors that an influence when sexual intercourse can be resumed?

A
  1. Degree of perineal tenderness
  2. Length of time of lochia discharge
  3. Healing of placental site
  4. Preference of couple
110
Q

What are some comfort measures for an episiotomy?

A

ice packs initially after delivery up to 24 hours, heat later; sitz bath; anesthetic sprays, creams or witch hazel pads (if ordered)

111
Q

Reassure pts with episiotomy that bowel movement….

A

will not cause damage to episiotomy
And inform of proper position while at toilet (leaning back with feet elevated on a stool helps to relax anal sphincters)

OB (5 decks)

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