Test 1 A Flashcards
1
Q
3 stages of labor
A
Laboring
complete dilation-delivery
placental delivery
2
Q
Laboring stage description
A
cervix is dilating and contractions become more frequent
3
Q
complete dilation- delivery description
A
the cervix is fully dilated and the woman is able to push and deliver the baby
4
Q
Placental Delivery description
A
placenta is delivered
5
Q
3 Phases of Stage 1 of labor
A
Early latent
Active
Transitional
6
Q
Early Latent Phase - brief
A
pt is feeling light contractions that feel like menstrual cramps and is capable of normal activity
7
Q
Active Phase - brief
A
pt feels pressure on rectum/bladder as well as moderate-strong palpable visable contractions
8
Q
Transitional Phase- brief
A
pt feels intense ctx at regular intervals feels the urge to push
9
Q
Non-pharm Ix to alleviate pain
A
Guided imagery
Breathing
hydrotherapy
general comfort measures
10
Q
Positions recommended for labor
A
Squatting
kneeling
side-lying
Semi-sitting
11
Q
What is GBS
A
group B strep
12
Q
% of women that get GBS
A
1 in 4
13
Q
GBS vs strep throat
A
strep throat is caused by group A strep
14
Q
how is GBS Dx
A
ID’d by vaginal swab
15
Q
When and How is GBS treated
A
during labor
with IV ATB such as penicillin
16
Q
How does baby get GBS
A
Unknown but believed through contact with vaginal fluids during delivery
17
Q
S&S of GBS in babies
A
Fever difficulty feeding difficulty breathing Lethargy Irritability Jaundice Seizures
18
Q
How many babies get GBS
A
about 1000 in US/yr
about 2-3 dies/yr
19
Q
how is GBS treated in babies
A
with IV ATB
20
Q
complications of GBS
A
pneumonia
meningitis
septicemia
21
Q
Early latent phase dilation
A
0-3 cm
22
Q
Active phase dilation
A
4-7 cm
23
Q
Transitional phase dilation
A
> 8 cm
24
Q
Stage 2 dilation
A
should be 10 cm
25
ELP mom feels what
ctxs feel like menstrual cramps (q5 for 30-40s)
Does not look like in labor, generally comfortable
Can continue with day
Excited/Anxious
Able to move around
Back ache
26
ELP Ix
Encourage to walk around
| Can eat and drink
27
AP mom feels what
Palpable, visible, consistent ctx ( 2-3 min for 40-60s )
Ctx of moderate to strong pain
Trembling legs
Increased pressure on bladder and rectum
28
AP Ix
Offer support
meds for pain
Benefits from ambulation between ctx
---also repositioning, distraction, and breathing
29
TP mom feels what
```
Most demanding, tired
Strong ctx q 1,1.5-2 min for 60-90s
Hard to ambulate
Feels urge to push
Increasing sensitivity
May become emotional
Increased pressure on rectum
```
30
TP Ix
No meds after 7cm?
| Educate not to push until 10cm otherwise may cause tearing
31
S2 mom feels what
urge to push with contractions
| ring of fire?
32
S2 Ix
Reassure if she poops
Different positioning for birthing
Pushing while breathing, helps for fetal O2
Have warmer ready, delivery table with materials ready
33
PD mom feels what
mild contractions
34
PD Ix
>20 min for PD means retained placenta -> RF for hemorrhage
35
Postpartum cord actions
Delayed cord clamping allows for more blood to go to baby
| get blood from cord for testing
36
Epidural - when HoT
give 1000 mL bolus IV to prevent bottoming out
37
Epidural CI
preeclampsia, CV disease
| if healthy and obese its ok
38
Contraction strengths
Strong - forehead
moderate- chin
mild - nose
39
when are meds given
after 3 cm dilation
40
IBUBBLEHER - I
ID and IV
41
IBUBBLEHER - IV
Assess: for insertion site, dressing, tubing,rates, and soln
phlebitis
infiltration
infection
42
Phlebitis SS
Pain
swelling
redness
temp
43
Phlebitis Tx
warm compress and nonsteriod agent
44
Infiltration SS
swelling in nearby tissues
skin cool
firm
pale
45
Infiltration Tx
DC IV
46
Infection SS
redness
discharge
temp
47
IBUBBLEHER - B - Inspection
Breast - inspect size, sym, shape, nipple (erection, flatness, redness, bruising, open wounds, mastitis, colostium)
48
IBUBBLEHER - B Palp
fullness soft engorgement firmness, lumps
49
if breast engorged
Apply heat for <5 min to help with flow (>5 min may make things worse) before feeding
After feeding cold compress for 10 min
Gently massage and compress B when baby pauses sucking to help drain
Well-fitted bra or bra-less
Hand expression or pump helps soften nipple to help baby latch on
Single use of pump helps with engorgement
50
Mastitis SS
```
Infection of breast
breast pain
swelling
warmth
fever
chills
nipple discharge/ pus
```
51
IBUBBLEHER - U - finding loci
Uterus - after birth fundus is btwn symphysis and umbilicus
| after 12H back in umbilicus then contracts 1 finger a day
52
IBUBBLEHER - U - why left or right
if right side -> badder full and can stop contractions
53
IBUBBLEHER - U - firmness
firm the U with massage and express if boggy
| bogginess can cause hemorrhage
54
IBUBBLEHER - U - massage
one hand cups against uterus at symph to support U
| other hand is cupped to massage and gently compress fundus toward lower U segment
55
IBUBBLEHER - B 1 - assess
Bladder- Assess for distention incontinence retention UTI esp if pt had foley
56
IBUBBLEHER - B1 - when and how much void
woman should void normally within 1H after vag birth and 12 H after Csection
>30 mL
57
IBUBBLEHER - B1 - urine assess
color odor clarity amount
58
IBUBBLEHER - B2 - assess
for sounds in all 4Q
abd distention and pain
should have mvmt in 2-3 days
Ask about movements size color and shape
59
IBUBBLEHER - B2 Ix
Softeners PRN
60
IBUBBLEHER - L
Lochia
61
Lochia rubra
dark red occuring for a few days after delivery
| made up of blood, bits of fetal membrane, decidua (uterine lining), meconium , cervical discharge
62
Lochia serosa
pinkish brown at 4-10 D
WBCs > RBCs
wound discharge from placenta and other sites and mucus from cervix
63
Lochia alba
whitish yellow at 10 - 28 D
| for turbid fluid draining consisting of decidual cells mucus WBCs and epithelial cells
64
IBUBBLEHER - E
Episiotomy
65
IBUBBLEHER - H /H
Hemorrhoids and Homan's sign
66
IBUBBLEHER - E2
Emotional status
67
IBUBBLEHER - R
Rubella
68
IBUBBLEHER - E - Redness
0- none
1- with in 0.25 cm of incision bilaterally
2- with in 0.5 cm ''
3- beyond 0.5 cm ''
69
IBUBBLEHER - E - Oedema
0-none
1- Perineal, <1 cm from incision
2 - Perineal, and or btwn 1-2 cm from incision
3- Perineal , and or vuluar, >2 cm from incision
70
IBUBBLEHER - E - Ecchymosis
0- none
1- with in 0.25 bilateral or 0.5 unilateral
2- bwtn 0.25 -1 cm bilateral or 0.5 - 2 cm unilaterally
3- >1 cm bilaterally or 2 cm unilaterally
71
IBUBBLEHER - E - Discharge
0-none
1- serum
2- serosan-guinous
3- bloody, purulent
72
IBUBBLEHER - E - Approximation
0- close
1- skin sep <3cm
2- skin and SQ fat sep
3- skin, SQ fat, fascia layer sep
73
IBUBBLEHER - Hemorrhoids
increased RF bc of pressure and of pushing
| Assess for by visually looking for bulging around anus
74
IBUBBLEHER - hemorrhoids - SS
itching
bleeding
discomfort when sitting or during bowl mvmts
75
IBUBBLEHER - Hemorrhoids - Tx
cool compress
stool softeners
more fibre
anesthetics
76
IBUBBLEHER - Homans sign
Dorsiflexion sign --> DVT
| + if pain in popliteal region and calf as foot is dorsiflexed
77
Homans sign procedure
Leg/knee extended, examiner forcefully dorsiflexes ankle
78
Homans sign Ix
Teach for ROM and light activity
79
IBUBBLEHER - Emotional status
80% during first week peaking at 3-5 days because of hormonal changes
becomes: sensative cries irritable anxious and has mood swings
80
Postpartum depression Ix
```
> 2 weeks
observe behavior
ask how they do
establish who to call in case
to prevent shaken baby syndrome
```
81
Postpartum depression SS
```
sad hopeless empty overwhelmed
cries more than usual or no reason
over anxious or worrying
moody irritable restless
oversleeping
trouble concentrating and remembering
loss of interest
eats too little
withdrawing
```
82
IBUBBLEHER - R
Rubella- confirm immunity
| if need vax teach to avoid preg until 1M after MMR and best until immunity confirmed
83
Normal signs of Pregnancy (11)
NV, C, heart burn, backache, ptyalism, urinary frequency, insomnia, leg cramps, anemia, nasal stuffiness, varicose veins
84
Pregnancy - NV
normal for 1T, severe can cause ctx
85
Abnormal signs of Pregnancy
fluid leaking, seeing spots, headache, leg cramps, facial edema, vaginal bleeding
86
Pregnancy - fluid leaking
norm at 40 wks, but not <38 wks can be a result of miscarriage, leaking can be urine
87
Pregnancy - C
increased emptying time, and decreased motility; not normal when pain or no sounds;
Ix: fluids, exercise and fiber
88
Pregnancy - seeing spots
assess for HA and HT, related to preeclampsia
89
Pregnancy - heartburn
P causes lower esoph muscle to relax and upper displacement of stomach; Liver pain can manifest as heart burn sensation related to preeclampsia
90
Pregnancy - backache
3T change in balance;
| abn bc it could be labor
91
Pregnancy - ptyalism
excessive salivation caused by starch
92
Pregnancy - decreased fetal movement
mvmt sign of healthy baby (normal is 7-10/hr)
| usually bad try eating
93
Pregnancy - urinary frequency
caused by uterine enlargement; abn bc UTI can cause preterm ctx or bleeding
94
Pregnancy - insomnia
ask about stressors
95
Pregnancy - vaginal bleeding
abn amount dependent could be UTI
96
Pregnancy - leg cramp
norm when baby on sciatic nerve; abn bc could be DVT
97
Pregnancy - nasal stuffiness
more E causes more and or nose bleeds
98
Pregnancy - anemia
normal bc of hemodilution
99
Pregnancy - facial edema
abn assess for HT or HA, moonface, related to preeclampsia
100
Pregnancy - HA
normal but ask more Q as it could be related to preeclampsia
101
Pregnancy - varicose veins
normal but worry about clots
102
foods with folic acid
raw leafy greens, legumes (beans and peanuts), OJ, fortified cereal and pasta
103
foods with Fe
meats, greens, eggs, grains, enriched cereals, dried fruits, tofu, nuts
104
Lochia amounts
Scant - < 1in
light - < 4in
moderate - < 6 in
heavy - saturated with in 1 hr
105
CV changes in pregnancy
95% develop a murmur, increase in total volume by 45% (plasma by 40-60, 1200-1600; RBCs 20 -30% 250-500 mL), HoT when supine, CO increases by 50%
106
blood flow changes in pregnancy
more flow to placenta, kidneys, skin, breasts; inf vena cava and iliac vein exp more obstruction by uterus causing varicose veins ---- more fibrogen so RF blood clots
107
Respiratory changes in pregnancy
more O2 needs by 20% --- no change in RR but deeper breathing--- more likely to feel dyspnea
108
Mouth changes in pregnancy
E causes reversible gingivitis and hypertrophy --- ptyalism --- bleeding gums ---Ix eat small f meals
109
Esoph changes in pregnancy
pyrosis
110
stomach changes in pregnancy
P causes less movement and emptying
111
LI and SI changes in pregnancy
less movement and emptying but more nutrient absorption but less B vitamins; causes increased constipation
112
Liver and gall bladder changes in pregnancy
P changes gall emptying increasing RF gallstones --- 3t more AKP and less albumine and less protein
113
Pituitary gland changes in pregnancy
more prolactin --- less FSH and LH --- P inhibits O until birth
114
Thyroid changes in pregnancy
grows helps with fetal brain dev
115
parathyroid changes in pregnancy
smaller in 1t then grows
116
pancreas changes in pregnancy
fluctuates I, woman can dev HoGly between meals or at night, but can dev gestational DM
117
Adrenals changes in pregnancy
more cortisol for glucose and aldo for salt absorb
118
human chorionic gonadotropin hCG
grows corpus luteum and mks EP ; mks preg test +
119
E
mk by Placenta -- stim growth of uterus and its flow-- stim growth of breast ducts -- changes skin and exocrine ducts
120
P
prevents spont abortion
stim breat lobules
relaxes sphincter smooth muscles
stores fat
121
human chorionic somatomammotropin hCS
more gluc avail for baby
122
Relaxin
inhib uterine activity, softens cervix tissue
123
Metabolism changes in pregnancy
more wt
more water metabolism (6.5-8.5 L)
Dependent edema closer to term
more carb metab
124
Presumptive signs of Pregnancy
```
Amenorrhea
NV
fatigue
urinary frequency
breast and skin changes
vaginal and cervical color changes
fetal movement
```
125
probable signs of Pregnancy
```
abd enlargement
cervical softening (Goodells sign)
Bollottemant
Braxton Hicks ctx
palp fetal outline
uterine souffle (confusion with mothers pulse)
pregnancy test
Hegors sign (lower uterine segment easily compressable and flexable )
```
126
Positive signs of Pregnancy
FHR auscultation
Fetal movements felt by examiner
visualization of fetus
127
Special actions for VS for pregnant woman
prefer manual BP and used 5th korotkoff sound (>140/90 bad)
Apical pulse for 1 m
RR 16-24
