T2- Advance Organizer (Josh) Flashcards
APGAR:
What Activity gets a 1?
arms and legs flexed w/ little movement
The part of the fetus that lies closest to the internal os of the cervix?
Presenting Part
When would we see Lochia Alba?
10-14 days after birth
***yellow to whight
***leukocytes, decidua, epithelial cells, mucus, serum, and bacteria
How long can lochia be seen post birth?
4-8 wks
Nursing actions for Variable Decel?
Change mom position
Elevate legs
Increase IV fluids
Palpate uterus to check for tachysystole
Stop oxytocin
Administer O2
Call MD
How long does Phase 1 of Stage 1 last?
Primagravia = 6-8 hrs
Multigravida = 4-5 hrs
How long does the Active Phase of Stage 1 last?
3-6 hrs
Should the bladder be palpable after delivery?
NO
they need to void to empty it to allow fundus to contract
— are expected irregular fluctuations of the baseline FHR that are an indicator of fetal well being.
Variability
Usual duration of UC during Phase 3?
45-90 secs
Before AROM, what must first happen?
presenting part needs to be engaged to prevent cord prolapse
woman needs to be free from infection
Which Decel is caused by impairment of placental/oxygen exchange?
Late
At station -3 is said to be at which Station?
3 cm ABOVE the ischial spines
What is the usual length of Stage 2?
Nulliparas: 50 mins
Multiparas: 20 mins - 3 hrs (depending on anasthesia)
What would Marked Variability be a sign of?
D-fib
APGAR:
What appearance gets a 1?
pink centrally
bluish extremities
Uteroplacental Insufficiency causes which type of Decel?
Late Decel
What color of AF could indicate an infection?
Yellow (thick cloudy color)
What APGAR scores are we looking for?
10 is best, 8 or 9 is good
When would we see Lochia Serosa?
3-4 days after birth
***pal pink or brown
***old blood, serum, leukocytes and tissue debris
Which Opioids did we talk about?
Dilaudid (Hydromorphine)
Meperidine
Normeperidine
Fentanyl
Sufenta - more potent than Fentanyl
Which class of meds should we NEVER give?
Benzos
***will affect thermoregulation of infant
APGAR stands for …
Appearance Pulse Grimace Activity Respiratory
How do opioids affect mom and baby?
decrease maternal HR and BP
affects fetal oxygenation
Before epidural, what do we give?
IV bolus (1000mL in less than 30 mins)
***increase epidural space
***protects from hypotensive episode
Opioid Agonist Antagonists:
Butorphanol Tartrate (Stadol)
Nalbuphine HCl (Nubain)
***may precipitate withdrawal symptoms in opioid dependent moms and newborns
For the first 2 hours after birth, what amount of discharge should we see?
like that of a heavy menstrual period
Should we give Naloxone (Narcan) if mother or infant is opioid dependent?
NO
causes abrupt withdrawal
If the fundus has deviated to the RIGHT of the mom’s umbilicus, what should we do?
encourage to void to decrease size of bladder
***catheter if necessary
What can result from ataractic drugs like Promethazine?
mom gets sleepy,
baby gets sleepy,
moderate variablity becomes minimal b/c baby is asleep
APGAR:
What Respiratory effort gets a 1?
slow, irregular breathing
weak cry
At the Ischial Spines is said to be at which Station?
0
What color of AF could indicate meconium?
Greenish Brown
APGAR:
What Grimace (reflex irritability) gets a 1?
facial movement only
What do we give if baby has respiratory depression?
Stimulation
Fluids
***stadol can cause some resp depression and will not be reversed by Narcan
Which type of Decels must be periodic?
Early and Late
***Variable can be either Episodic or Periodic
After an epidural, how often are vitals charted?
q 5 mins for fist 20 mins
q 30 mins after 20 mins
APGAR:
What pulse gets a 1?
Usual duration of UC during Phase 1?
30-45 secs
NOT regular
When the bladder is distended, what does this indicate?
uterus will be boggy and above and to the right of the woman’s umbilicus
Intervention for Variable Decel?
Caused by cord compression
- Turn mom
- Stop oxytocin
- Administer O2
- Call MD
Which Decel is a ‘mirror image’ of the contraction?
Early Decel
***don’t chart!
***needs no intervention
What do we consider a an acceleration of FHR longer than 10 mins?
considered a change in baseline
What is the usual length of Stage 3?
5-30 mins
***if more than 30 mins, it’s a problem
What causes Early Decels and when would we see them?
Fetal Head Compression
Phase 2 of Stage 1
Stage 2 (when mom is pushing)
When would we see Lochia Rubra?
post birth
***bright red and may contain small clots
If mom gets a hypotensive episode, what is nursing action?
Turn mom
Increase fluids
Administer O2
Elevate legs (10-20 degrees)
Call MD (order for ephedrine)
What would happen if we fail to give IV Bolus before Epidural?
Hypotensive episode (systolic falls below 100)
No accels or moderate variability for baby (nonreassuring FHR)
Where the the PMI usually located?
fetal back
***below umbilicus if cephalic presentation
***above umbilicus if breech
Which Decel is likely caused by a cord compression?
Variable Decel
***V looks like a Vice
Where should the fundus be in the 4th stage?
firm, midline, and halfway b/t umbilicus and symphysis pubis
After ROM, check temp —- and call Doc if it is higher than —
q 2 hr
38c (100.4)
Usual frequency of UC during Phase 2?
3-5 mins
Usual frequency of UC during Phase 3?
2-3 mins apart
Usual duration of UC during Phase 2?
40-70 secs
Variability levels:
Absent =
Minimal =
Moderate =
Marked =
Absent = 0 or undetectable
Minimal 0-5 bpm
Moderate = 6-25 bpm
Marked = > 25 bpm
What accels are we looking for at 32 wks?
What about 33 wks or more?
10 x 10
15 x 15
S/S of Uterine Infectoin
Pain in lower abdomen
Fever
Foul-smelling discharge
Rapid HR
Swollen, tender uterus
Usual frequency of UC during Phase 1?
5-30 mins
What do Barbituates do to the neonate?
CNS depression
***avoid if birth is within 12-24 hrs
What will a Variable Decel look like on the strip?
abrupt drop (30 secs)
periodic or non-periodic
What could cause tachycardia (FHR > 160)?
mom having a fever
prolonged rupture of membranes
Drugs:
- atropine
- hydroxyzine
- terbutaline
- cocaine or meth
— are visually apparent, abrupt increase in FHR above the baseline.
Accelerations
***onset to peak
During Stage 3, when would we give Pitocin?
we don’t give Pitocin during stage 3
***we give high dose of Pitocin AFTER delivery of placenta
What is the minimal amount of time we want b/t contractions?
at least 2 minutes to allow for perfusion to fetus
What is the maximum length that Stage 3 should be?
30 mins
***Call nurse if it lasts longer
Nursing intervention for Occiputposterior position?
Change mother’s position often to facilitate baby to move to OA position
Counter pressure on mom’s back (sacrum)
Hip squeeze to push the pelvis back into a relaxed position to relive pressure of stretch
What is Fetal Bradycardia and what could cause it?
FHR
What can cause fetal head compression and which Decel would it lead to?
Early Decel
- UC
- Vag exam
- Fundal pressure
- Placement of internal monitoring node
Relationship b/t the long axis (spine) of fetus with long axis (spine) of mom?
Fetal Lie
In order to apply an IUPC or an ISE, what must first happen?
rupture of membranes
How long does the Transition Phase of Stage 1 last?
20-40 mins
