TEST 2 Flashcards
1
Q
what is dinoprostone gel used for?
A
Cervical ripening
2
Q
what is tachysystole?
A
Excessive uterine contractions
3
Q
what does POOF mean?
A
Position (L), Oxytocin (off), Oxygen on (10 LPM), Fluids (IV/amnio)
4
Q
why do we use peanut/birthing balls in labor?
A
factilitates rotation of baby
especially in posterior position
5
Q
what V/S should be monitored after placing an epidural?
A
Blood pressure
6
Q
what is placenta previa
A
Placenta is encroaching on/covering part or all of the cervix
7
Q
what is the Bishop score?
A
assess cervical ripening
8
Q
without internal monitors how do we assess contraction strength?
A
palpation
9
Q
what do the 3 different contraction levels feel like with palpation?
A
mild: Nose
moderate: Chin
severe/intense: Forehead
10
Q
what is the primary purpose of the FIRST stage of labor?
A
cervical effacement/dilation
descent of the fetus thru pelvis
11
Q
what is the PRIORITY intervention for umbilical cord prolapse?
A
Alleviate/keep pressure off cord
DO THAT BY: Put mom in hands/knees & hold baby head up
12
Q
what type of laceration involves the vaginal mucosa and perineal skin?
A
1st
13
Q
what is affected with a 2nd degree laceration?
A
Fascia of perineal, perineal skin & vaginal mucosa
14
Q
what is affected with a 3rd degree laceration?
A
previous + tear to rectal sphincter
15
Q
what is affected with a 4th degree laceration (besides your soul)
A
previous + all the way into rectum & exposure of lumen
16
Q
what is the baseline FHR?
A
110-160
17
Q
how would you describe minimal variabilty?
A
fluctuations of 5 or less BPM
18
Q
describe marked variability?
A
Fluctuations greater than 25 bpm
19
Q
describe absent variability?
A
no fluctuation in rate
20
Q
describe moderate variability?
A
fluctuations of 6-25bpm
21
Q
how would you describe flexion (fetal attitude)?
A
head: chin touching chest
arms are crossed across chest
knees tucked
22
Q
how would you describe moderate flexion (Fetal attitude)?
A
chin not touching chest but in “military position”
23
Q
how would you describe extension?
A
head is tilted back but not touching back of neck
more “brow” like position
24
Q
which stage of labor begins with pushing & ends with delivery of baby?
A
2
25
which stage beings after delivery & ends with placenta delivery?
3
26
which stage of labor begins with contractions & ends with complete dilation/effacement of cervix?
1st
27
what/when is the 4th stage of labor?
begins after delivery of placenta & includes the first 2 hours of recovery post birth
28
what are the s/sx of true labor
cervical change
rupture of membranes
pain with walking/movement
pain start in back & go to front
regular contraction
29
s/sx of false labor?
irregular contractions
pain in abdomen
pain relieved with movement
no cervical change
30
normal rate of progression of labor/dilation for a primipra (1st baby) mom?
1cm/hour
31
normal rate of progression for labor/dilation for multipara mom?
1.5-2cm/hr
32
how to assess presence of amniotic fluid vs generalized "wet feeling"
pH test
Nitrazine
33
what would be a negative(urine) result with Nitrazine?
4.5
34
what would be a positive result with Nitrazine?
6.5-7.5
35
what is primary intervention for shoulder dystocia?
McRobert's position & suprapubic pressure
36
can you apply pressure to the fundus?
no
37
what are s/sx of mg sulfate toxicity?
decreased LOC
resp depression
decreased deep tendon reflex
38
What is the best action for a laboring patient who is experiencing a "non-reassuring" FHR?
Move pt into L lateral position
39
if a pt at 32 weeks gestation has abruptio placentae with BP of 110/66
HR 96
R: 19
FHR: 156
what is the priority assessment?
Blood draw for CBC, PT and electrolytes
40
when can you not administer narcotics? & why?
transition phase
resp depression of baby on delivery
41
what are 5 P's?
Power (physiological forces)
Passageway
Passenger
Position
Psych
42
what falls under "powers"
uterine contractions: Cervical dilation & effacement
maternal pushing: Facilitate expulsion of fetus
43
how is frequency of contractions measured?
Beginning of 1 contraction to the beginning of the next
44
how is duration of contraction measured?
From start of one contraction to the end of same contraction
45
how to measure intensity of contractions?
Palpation
Mild: Nose feeling
Mod: Chin feeling
Strong: Forehead
46
maternal pushing before complete dilation can result in what?
cervical edema/damage
47
what is "station" in relation to passanger/passageway?
level of presenting part to maternal ischial spines
48
what station would mean presenting part is at pelvic outlet?
+4
49
what station level would mean presenting part is level with ischial spines?
0
50
how would a fetal attitude of flexion (vertex) appear?
chin touching chest w/ arms folded across chest & legs are criss crossed abdomen
51
describe moderate flexion
chin not touching chest but in "military position"
center/top of head (occipital frontal) = presenting part
52
what is the presenting part/area of a fetus in partial extension ?
brow area
53
what is preferred position for birth (attitude)?
flexion
allows smallest part of fetal skull to enter first
54
what presentation is associated with complete flexion?
vertex
55
what presentation is associated with moderate flexion?
military
56
poor flexion/partial extention is associated with what presentation?
brow
57
full extension is associated with what presentation
face (back of head is almost touching neck)
58
what conditions can lead to breech presentation?
preterm birth or fetal abnormalities (hydrocephaly)
59
complications associated with breech position?
Increased risk of umbilical cord prolapse
Cord compression
60
what pelvic shape is the best for delivery?
Gynecoid
61
what is the least optimal pelvic shape?
Platypeoid
62
what causes variable decels?
cord compression
63
what do variable decels look like?
abrupt drop w/ abrupt return
64
how long do variable decels last?
greater or = to 15 sec but less than 2 min
65
what do early decels look like?
Gradual decrease in fetal heart rate with gradual return to baseline
66
where do early decels peak?
line up with peak (acme) of contraction
67
what is the intervention for early decel?
prepare for delivery
check cervix dilation/fetal station
68
what is cause of early decel?
fetal head compression
69
what is the qualifications for accelerations?
increase in FHR of greater or = 15bpm for 15+ sec
70
when do accelerations usually occur?
with contractions
71
what are acelerations indicative of?
oxygenated baby = fetal well being
72
what is a late decel?
gradual decrease in FHR w gradual return
73
when/where is a late decel?
at or after peak of contraction
TO THE RIGHT OF CONTRACTION
74
what is cause of late decel?
placental insufficiency
(improve blood flow - HOPP)
75
what are prolonged decels?
decrease in FHR of 15+bpm that lasts longer than 2 min but less than 10min
76
interventions for prolonged?
HOPP + call for help
77
what are prolonged decels indicative of?
fetal hypoxia --> emergency delivery
78
how does the fern test work? & for what?
Amniotic fluid & if its present will look like a fern under microscope
79
what is a fetus at risk with w/ rupture of membranes & too high of station?
high risk of cord prolapse
80
the longer membranes are ruptured the risk for _______ increases?
infection
81
what is meconium stained amnio fluid indicative of? (or can be) & what does it look like
yellow/green tint
need further assessment & monitor FHR
could be fetal distress *
but could be presentation & pressure on abdomen*
82
what can cause meconium amnio fluid?
Distress
pressure on abdo
cytotec/misoprostl (adverse)
83
3 phases of first stage of labor?
Latent
Active
Transition
84
contraction in latent phase are?
irregular freq
Q 5-10 min
last 30-45 s
mild-moderate
85
dilation of latent phase
0-3cm
86
active phase contractions are ________?
regular pattern of 2-5 min apart
40-60sec in length
mod to strong
87
how dilated are active phase patients?
4-7cm
88
what is the freedman curve?
starts @4cm
prediction of dilation
89
mom psych state in active?
focus on staying calm, in control & manage pain
may need coaching
quiet/inward focus
90
mom pysch state in latent?
talkative, excited, anxious or confident
91
what physical s/sx may appear in latent phase?
low back ache/menstural cramp feeling contraction
92
how long can latent phase last?
10-14hr
93
transition phase contractions are _______?
2-3 min apart
lasting 60-90sec
strong by palpation
94
dilation of transition phase?
8-10cm
95
mom psych in transition phase?
may have coping difficulty
irritable
"can't do it" (hopeless)
tired
96
important med edu about transition phase?
NO opioids can be given
97
how are contractions in stage 2?
occur similar to transition (s1) --> 2-3 min
98
what position is encouraged in pushing?
upright/semiupright
99
what can squatting/kneeling position help with in stage 2 labor?
increase dimension of mat pelvis
100
what can hands on knees/leaning over position help with in stage 2 labor?
pressure off mom spine
help reduce back ache of fetal OP position
101
how long does stage 3 last
5-30min
102
intervention (&timing) of retained placenta?
isnt delivered in 30min
turn off pitocin
103
how should fundal massage feel?
firm
104
what can you do to stimulate UC for placental delivery to minimize bleeding?
oxytocin
105
what is primary goal of stage 4?
bonding
106
what V/S to monitor in stage 4?
BP & pulse
(temp may still be high)
107
what is the other name for cytotec?
Misoprostol
108
when is cyto/miso given & what for?
cervical ripening agent
bishop score of 6 +
109
adverse effects of Cyto/Miso?
Tachyststole
fetal passage of meconium
110
what is tachysystole? & why is it a problem?
Rapid/frequent contractions, 5UC w/in 10 min
111
complications of tachysystole?
fetal hypoxia
uterine rupture
112
interventions for tachysystole
turn off Pit/remove cervical agent (cervidil)
possibly give terbutaline
IV fluids
position patients to L lateral to max blood flow to placenta
O2 at 10L/min
113
contraindications of cyto/miso?
Nonassuring FHR
maternal fever
vaginal bleeding
Hx of C/S or uterine scar
transverse position
114
when to give oxytocin w/ cyto/miso?
4 hr after last dose if labor isnt progressing
115
caution in what type of patients for Cyto/Miso?
Hx of asthma, glaucoma, renal+hepatic or CV disorders
116
What is other name for Cervidil? & when is used
Dinoprostone
cervical ripening, Bishop 6+
117
what are cervical ripening agents for?
induction of labor
118
diff btwn Cervidil & Dinoprostone
C = insert
D = gel
119
cervidil induces contractions when?
5-7 hr after admin
120
release rate for Cervidil?
10mg/12hr
121
what to monitor for after insertion of Cervidil?
Fever for 15-45 after insertion
122
edu about Cervidil insert?
keep frozen until use
remove after 12 hr or labor onset
123
how must dinoprostone be admin?
refrigerated then brought to room temp
continue admin until UC are 3/10min
124
dosage of Dino?
0.5mg/2.5mL
125
low dose of Oxytocin? & risk?
2mu/min
increased risk of C/S bc of slowed labor
126
high dose of oxy & risk?
4mu/min
increased risk of tachysystole
127
oxytocin complications? & s/sx
U tachysystole (longer than 90s & more than Q 2 min)
resting Ut tone greater than 20-25
FHR baseline less than 100 or greater than 160
128
conditions to never admin oxy to?
vasa previa
complete placenta previa
transverse fetal lie
U cord prolapse
previous C/S delivery
Active genital herpes
129
what is complete placenta previa?
placenta is located completely over cervix
130
what are the types of meds for pain management in labor?
Opioid agonists
Opioid agonists-antagonists
131
ex of opioid agonists?
Hydromorphone/Dilaludid
Meperidine Hydro/Demerol
Fentanyl citrate/Sublimaze
132
Ex of opioid ag/ant?
Butorphanol/Stadol
Nalbuphine/Nubian
133
maternal side effects for opioid agonists?
Altered LOC, tachycardia, resp distress
(may effect bowel elimination)
134
fetal side effect for OA (ag)
Decrease in variability
135
OA admin edu?
Give less than 1hr or more than 4hr before birth to decrease neonate depression
136
Opioid agonists & ag/ant are also called what?
systemic analgesia
137
when are systemic anaglesics given?
during contractions to decrease fetal exposure
138
s/sx of maternal hemorrhage?
Mat HR greater than 110
15% drop in BP (late sign)
O2 sat less than 95
139
what med is given for PP hemorrhange prevention/tx
Methylergonovine
140
nursing intervention for PP hemorrhage
check location/condition of fundus Q15min for first PP hr
monitor MAP for BP drop
141
intervention for IP hemorrhage?
Take VS q5min (unstable) or q15min (stable)
Large bore IV w/ saline
142
whats included in spinal
local anesthetic + fenty itno subarachnoid space
143
pt positioning for Vaginal birth Spinal anesthesia?
"C" position sitting then
Remain sitting 1-2 min after
144
side effects of spinal?
Maternal hypotension
Decreased placenta perfusion
Ineffective breathing pattern
Increased risk of operative birth
145
asses what after spinal admin?
Bp, HR, RR & FHR q5-10min
MONITOR URINE OUTPUT
146
interventions for Postural headache?
supine position
caffeine
dark room
hydration
147
assess mom for what in late decel?
Maternal hypOtension
Admin IV fluids & elevate legs
palpate for tachysystole
148
whats given in an epidural?
Bupivacine + fenty
148
3 interventions for late decel?
Stop Pitosin
IV bolus
10L O2
position change
149
advantage of epi over spinal?
reduced amount of anesthetic required
150
what would be the priority intervention if a FHR showed minimal variablity
admin to O2 to mom w/ non rebreather @8-10L/min
151
what are expected maternal behaviors in 3rd stage? (organ/emo)
uterus moves upward
mom crying/relieved
cramps as placenta delivers
152
when is it appropiate to listen to the fetal hr
in btwn contactions
(only time you can get FHR baseline)
153
if a patient at 37 reports a gush of clear fluid, what does the nurse advise?
have pt come in
154
what is oligohydramnios?
less than 300ml of amniotic fluid
155
what risks are associated with oligohydramnios?
increase for nuchal cords (kinked cord)
increased risk for variable decels
156
what can we preform for deep variable r/t to oligohydramnios?
amnioinfusion
157
what to monitor with amnioinfusion?
output
158
what finding would be indicate not correct output/stop or decrease amnioinfusion?
rigid abdomen
hypotension
bradycardia
159
what is polyhydramnios?
greater than 2L of amniotic fluid
160
risks associated with polyhydramnios?
- increased risk for prolapsed cord
- premature ROM
- Maternal diabetes at risk
* especially if first baby
161
what to monitor with Meconium-stained amniotic fluid?
- FHR
- thickness of meconium in fluid
162
intervention if meconium in fluid is thick?
Amnioinfusion
163
how long does 2nd stage last?
2/3hr
164
during a cervical exam, if felt a diamond shape what is it indicative of?
baby is in vertex/head presentation
165
how many contractions a min & over 30 min = tachsystole?
1-1.5 a minute
&
5contactions in 10min/30
166
mom has pain with contractions but baby isnt descending as expected, what ? should the nurse ask?
"have you peed/when is the last time you peed?"
-
check bladder
167
variable decels intervention
change mom position (HOPP)
Amnioinfusion if HOPP doesnt work
168
nursing intervention to help turn baby to OP to OA?
birthing ball
169
uterine tachysystole - give what meds?
Tocolytics
- terbutaline
170
ex of nonassuring FHR? & intervention
variable decels
prolong decels
&
fetal scalp blood sampling
171
intervention if mom has temp (100.3) in 4th stage of labor / is it normal?
yes
&
hydrate + remove blankets
172
who is at higher risk fo C/S?
Hx of shoulder dystocia
Obesity
Gestational diabetes
173
important when pt comes in for scheduled CS?
- Consent
- IV
- Bloodwork
- Assess mom & baby
174
the laboring room should be what/avoid what?
NO eating in room
&
Quiet/relaxed
Dim
175
obtain what prior to epidural admin?
baseline V/S & hydration staus
176
who would be priority for induction?
Pre-eclampsia
Maternal risk
&
fetal distress
177
instruction/intervention for hyperventilation?
Bag breathing
178
how would uterine rupture present?
rigid abdomen
tachycardia
decreased BP
increased RR
179
intervention for uterine rupture?
C/S
180
preeclampsia "qualifications"
BP 160/110+
Proteinuria
181
mom experiences tachysystole, pain with contractions then stops + the baby is presenting w/ bradycardia or decels, what is likely?
mom has complete uterine rupture
183
what drug to give when you need to treat pain but can’t give narcotics
mep/dem
184
