T2-Advance Objectives Flashcards
Where is engagement?
Zero station (at ischial spines)
What is the post-birth uterine discharge called?
Lochia
What color is lochia initially after birth?
Bright red (loch rubra)
Is it normal if lochia rub contains small clots?
Yes
For the first 2 hours after birth, the amount of uterine discharge should be about that of ______
A heavy menstrual period
The flow of lochia rubra pales, becoming pink or brown after _____
3-4 days
What is pink or brown lochia…whats the technical name?
Lochia serosa
What color is lochia alba?
Yellow to white
How many days after birth till it becomes lochia alba?
10-14 days
What stage do you get epidural?
Stage one, phase 2
Expected irregular fluctuations of the baseline that are an indicator of fetal well being
Variability
How many beats are in absent variability?
0 beats or undetectable
How many beats are in minimal variability?
Undetectable (0) to 5
How many beats are in moderate variability?
6-25
How many beats are in marked variability?
Over 25
Visually apparent, abrupt increase in FHR about the baseline
Accelerations
How do we know it is an acceleration?
Peak 15 beats/min above baseline and lasts 15 seconds or more; return to baseline in 2 min from beginning of acceleration
What are the 3 types of decelerations?
Early, variable, and late
Early decelerations: gradual or abrupt?
Gradual
Early decels: Periodic or episodic?
Periodic
Early decelerations: Intervention or no intervention?
No intervention
Variable decelerations: gradual or abrupt?
Abrupt
Variable decelerations: Periodic or episodic?
Can be either
Late decels: Gradual or abrupt?
Gradual
Late decels: Periodic or episodic?
Periodic
What decl begins after contraction has started?
Late
What decel happens due to fetal head compression?
Early
What decel looks like V or W
Variable
What deceleration is because of uteroplacental insufficiency?
Late
What deceleration begins after the contraction has started?
Late
What deceleration is a mirror image of a contraction?
Early
What decel is due to compression of the umbilical cord?
Variable
Beginning of one contraction to the beginning of the next
Frequency
Measured in min
Beginning of the contraction to the end of the contracation
Duration
measured in seconds
How strong the contraction feels upon palpation
Intensity
Palpation of uterus when no contraction is taking place
Resting tone
What is late deceleration caused by?
Uterine placental insufficiency
What are the interventions for late decelerations?
- Change mom position
- Elevate legs (to correct the mom hypotension)
- Increase IV fluids
- Palpate uterus to check for tachysystole
- Stop oxytocin
- Administer oxygen
- Call doc
What are early decelerations caused by?
Fetal head compression
When do we typically see early decelerations?
During 1st stage of labor between 4-7 cm or during second stage when mom is pushing
What is the intervention for early decelerations?
Nothing; just document it
What are variable decelerations caused by?
Cord compression
What are the interventions for variable decelerations?
- Change mom position (side to side or knee to chest)
- Stop oxytocin
- Administer oxygen
- Call doc
- Assist with vag or speculum exam to assess for cord prolapse
- Assist with amnioinfusion if ordered
- Assist with birth if pattern can’t be corrected
What are accelerations indicative of ?
Fetal oxygenation and fetal movement
What is an amniotomy?
Artificial breaking of membrane
What do you assess for immediately after?
Check FHR for decelerations or variability; check the fluid for color, odor, etc (to see if it is meconium stained or not)
What is tested in APGAR?
Appearance Pulse Grimace Activity Respiratory
Why do we give oxytocin after delivery of placenta?
To prevent hemorrhage–it helps clamp down the uterus
Why are contractions that are closer than 2min apart not good?
Baby doesnt get enough oxygen
When do we give meds to mom?
At the top of a contraction
Why should we never give benzos?
Affects the baby thermoregulation
What do we do to the baby if it has respiratory depression?
Stimulate the baby and give fluids
*stadol cannot be reversed by narcan
Can we give dilaudid in active labor?
No
What are 2 reasons why we would want a laboring woman to keep her bladder empty?
- Can impede descent of baby
- Can cause bladder trauma (leads to decreased bladder tone or uterine atony after birth)
Why are women given an IV bolus before an epidural?
More fluid=more space
This helps keep mom from becoming hypotensive
What happens if mom has a hypotensive episode. What do we do?
- Turn to lateral position or use a wedge hip
- Increase fluids
- Administer O2
- Elevate clients legs (10-20 degrees)
- Call doc
- Give vasoconstrictor drug per order
What is an example of a vasoconstrictor drug?
Ephedrine
Relationship between the long axis of the fetus with the long axis of the mother
Fetal lie
What are the two types of lies?
Longitudinal lie
Transverse lie
The part of the fetus that lies closest to the internal os of the cervix
Presenting part
The relation of the fetal body parts to one another
Attitude
The back of the fetus is rounded so that the chin is flexed on the chest, the thighs are flexed on the abdomen, the legs are flexed at the knees, and the arms are crossed over the thorax
General flexion
Relationship of a reference point on the presenting part of the fetus to the front, back, or sides of the mother’s pelvis
Position
What position is the best way for baby to be born?
LOA
What types of positions and presentatiosn must be delivered C section?
- Mentum
- Shoulder presentation (transverse)
What is fetal tachycardia and what could cause this?
FHR > 160
- Mom has fever
- Maternal or fetal infection
- Maternal hypothyrodism
- Fetal anemia
- Response to certain drugs
What is fetal bradycardia and what is something that could cause it?
FHR
What is the criteria in order to apply an IUPC or ISE?
Membranes have to be ruptured already and have dilation of cervix some
The PMI of FHR is location on maternal ______ at which the FHR is heard the loudest; it is usually directly over the _____
Maternal abdomen directly over fetal back
Where would you find the FHT if the baby is cephalic?
FHR below the moms umbilicus in either RLQ or LLQ of the abdomen
Where can you find FHT if the baby is in breech position?
Above the moms umbilicus
What all are we checking besides VS in 4th stage of labor?
- VS
- Fundus
- Lochia
- Perineum
- PAR
- Bladder
- Breastfeed assistance
What do we do if fundus is boggy?
Massage it
Get client to empty bladder
Baby on breast
Where is the fundus supposed to be post birth?
Firm, midline and halfway between umbilicus and symphysis pubis
What color lochia should we expect post birth?
Rubra
Why do we check perineum after birth?
REEDA and chck for tears
What is PAR?
Post anesthesia record
-Can they feel legs?
-Wiggle toes?
-Conscious?
-How is breathing?
-How is BP?
-What is LOC?
-How is breast feeding and bonding?
…etc
“When the bladder is distended, the uterus is usually boggy in consistency well above the umbilicus, and to the woman’s right side”….What is the intervention?
- Try and get mom to void either spontaneously or catherize
- Reassess after mom has voided and make sure fundus is MIDLINE, FIRM, and bladder is NOT palpable
How long after a rupture can we wait before delivery needs to happen?
24 hours
- bacteria can cause infection
- temp taken q2h after rupture
What is #1 important thing to check when doing an AROM?
Baby FHR before and after amniotomy to detect any changes!!!!
What is normal amniotic fluid color?
Pale, straw
What color means baby had BM inutero?
Greenish/brown
What does yellow (thick cloudy with odor) mean?
Infection
Is it ok if there is caseous, cheese like (vernix) in the AF?
Yes, if its in small amounts
What is the main issue for a mom whose baby is in ROP?
More back pain and a longer labor
What if baby is in ROP, what are interventions?
- Change mom position to try and get baby to turn to anterior
- Counterpressure on mom back
- Try to hip squeeze mom
What does an ataractic do?
Reduces anxiety, apprehension, and NV and increases sedation
What are the 2 ataractics?
Promethiazine (phenergan) and hydroxyzine (vistaril)
What can ataractics negatively do?
Contribute to maternal hypotension and neonatal depression
What is true labor?
- Regular and predictable contractions
- Felt in LOWER back and sweep around to abdomen in a wave
- Continue no mater what comfort measures are tried
- Increase in duration, frequency and intensity
- CERVICAL CHANGE
What is false labor?
- Remain irregular
- Felt first in ABDOMEN and remain confined to abdomen and groin
- Disappear with ambulation and sleep (and fluid)
- DO NOT increase in D, F, or I
- NO cervical change
A woman who has completed 2 or more pregnancies to 20weeks gestation or more
Multipara
A woman who has not completed a pregnancy with a fetys or fetuses beyond 20 weeks
Nullipara
The enlargement or widening of the cervical opening and the cervical canal that occurs once labor has begin
Dilation
The shortening and thinking of the cervix during the first stage of labor
Effacement
_____ generally progresses significantly in first-time term pregnancy before more than slight dilation occurs
Effacement
In subsequent pregnancies, what progresses first: effacement or dilation?
Progress together
Relationship of the presenting fetal part to an imaginary line drawn between the ischial spines of the pelvis; it is a measure of the degree of descent of the presenting part of the fetus through the birth canal
Station
SNS of uterine infection?
- Pain in lower abdomen
- Fever
- Foul smelling discharge coming from vagina
- Rapid HR
- Swollen and tender uterus
T/F: Bacteria that normally live in the healthy vagina can cause an infection after delivery
True
