Toni - Week 3 - Exam 2 Flashcards
what are the 6 premonitory signs that indicate labor is near?
lightening, bloody show, cervical ripening, stronger braxton hicks, energy burst, and spontaneous rupture of membranes (SROM)
T/F: premonitory signs mean that labor is near or that it will occur in a set time frame.
FALSE. doesn’t necessarily mean labor
how is lightening defined?
occurs mostly with first time mothers; “baby has dropped” - mothers notice they can take a deep breath again
how is bloody show defined?
little capillaries break and vaginal mucus mixes with blood
how is cervical ripening described?
cervix feels as hard as your forehead/nose then softens to your lips
Stronger Braxton Hicks contractions can ___ the mother
confuse
what occurs during the sudden energy burst?
very common; women begin nesting, cleaning, folding baby clothes
how is the SROM described?
amniotic fluid bag ruptures, water has broken
what is the concern when bag membranes have ruptured?
the sterile environment has been open; bacteria migration is open;
what do we recommend when bag membranes have ruptured?
we recommend the mother comes into the hospital; she can put on a pad and we can test for amniotic fluids; we can do a sterile speculum we should start the clock b/c labor can start within 18 hrs
what is the definition of true labor? how many stages?
when contractions increasingly regular, longer, stronger, and more frequent - at least 40 - 45 second contractions; 4 stages
when is the first stage of labor?
onset of labor to complete dilation; contractions are closer together; progressive effacement and dilation; 10 cm or no cervix left
when is the second stage of labor?
complete dilation to birth
when is the third stage of labor?
birth to expulsion of the placenta - hemodynamic change - no more than 30 min or less
when is the fourth stage of labor?
first few hours after birth
when does a nurse use leopold’s maneuvers?
routinely when preparing fetal monitoring
what does the first maneuver consist of?
assess part of the fetus in the upper fundus
what does the second maneuver consist of?
assess location of the fetal back
what does the third maneuver consist of?
identifying presenting part
what does the fourth maneuver consist of?``
determine descent of presenting part - fetal attitude → feel both sides until hitting cephalic prominence
who performs the fourth leopold maneuver?
Only done by midwife or MD
what are the two ways to monitor fetal heart rate?
external FHR monitoring and internal FHR monitoring
what does external fetal monitoring consist of?
ultrasound is placed over fetal back - external on mother’s belly
what 3 things can interfere with external fetal monitoring?
maternal obesity, excessive fetal or maternal movement, and fetus in OP position (baby’s back faces back)
what does internal fetal monitoring consist of?
a fetal scalp electrode is attached to presenting part of fetus
who can perform an internal fetal monitoring test?
a nurse that has passed a competency test to do so
what is the risk of internal fetal monitoring?
it acts as another avenue for infection
what are the 2 necessary criteria in order for a woman to be eligible for internal fetal monitoring?
woman must be dilated to at least 2 cm + have ruptured membranes
T/F A nurse can rupture membranes.
FALSE!! We have to call an MD to rupture membranes.
what are the two ways to monitor uterine contractions?
external UC monitoring and internal UC monitoring
what does external UC monitoring consist of?
a tocodynamometer is place on woman’s fundus, which measures frequency and durationg of uterine contraction
T/F the tocodynamometer also measures intensity of a UC.
FALSE - only frequency and duration
what 2 things can interfere with external UC monitoring?
maternal obesity and excessive maternal movement
what does internal UC monitoring consist of?
intrauterine pressure catheter inserted through cervix into uterus pocket of fluid, measuring UC intensity
what are the 2 necessary criteria in order for a woman to be eligible for internal UC monitoring?
woman must be dilated to at least 2 cm + have ruptured membranes
Define “fetal heart rate”
the average FHR during a 10 minute period
what is the baseline for FHR?
normal baseline is 110-160
what are the perimeters for fetal bradycardia?
below 110 for 10 minutes or more
what are the 4 possible causes for fetal bradycardia?
maternal hypotension, fetal hypoxia/acidosis, epidural, and/or analgesic drugs
what are the perimeters for fetal tachycardia?
HR above 160 for 10 minutes or more
what are the 3 possible causes for fetal tachycardia?
maternal fever, fetal hypoxia (although often bradycardia), stimulant drugs (cocaine, amphetamine)
what does moderate fluctuation of FHR indicate?
normal; indicates fetal well-oxygenated; responding to environment
what does absent/minimal fluctuation of FHR indicate?
indicates possible acidosis and uteroplacental insufficiency (placenta/uterus not supplying uterus with what it needs); line is smooth = not good; not responding to environment; scary
what does marked (increased) fluctuation of FHR indicate?
It is uncommon, may be benign or indicate hypoxia
what are periodic fetal heart rate changes?
temporary recurrent changes in FHR baseline occurring in relation to uterine contractions.
how many different fetal heart rate changes are there? what are they?
4; accelerations, early decelerations, late decelerations, and variable decelerations
how are accelerations defined?
an increase above FHR baseline of at least 15 bpm for at least 15 seconds
what do accelerations indicate?
fetal well-being
what NI should occur with accelerations?
none; document.
how are early decelerations defined?
FHR deceleration begins and ends with UC; inversely mirrors contraction.
what do early decelerations indicate?
they are benign; caused by fetal head compression; may occur during pushing
what NI should occur with early decelerations?
none; not concerning
how are late decelerations defined?
begins after UC starts and return to baseline after UC ends; lowest point (nadir) occurs with the peak of UC
what do late decelerations indicate?
ominous sign of fetal hypoxia associated with uteroplacental insufficiency
what NI should occur with late decelerations?
oxygenate, rotate, hydrate (↑ IV rate; start IV), stop oxytocin if infusing
how are variable decelerations defined?
abrupt FHR deceleration with abrupt return to baseline; variable in shape (U,V,W)
what do variable decelerations indicate?
associated with umbilical cord compression; possibly when amniotic fluid has ruptured
what NI should occur with variable decelerations?
oxygenate, & rotate; stop oxytocin; amnioinfusion; vaginal exam to check for possible cord prolapse (cord b/t head and pelvis)
who can perform an amnioinfusion?
the health care provider in house
what are the 3 categories in the three-tier fetal HR interpretation?
normal. indeterminate, and abnormal
define category I normal heart rate interpretation?
predicts normal fetal acid-based status; no interventions
what is an example of category I: normal interpretation?
baseline FHR 110-160, moderate variability; presence or absence of accelerations or early decelerations
define a category II: indeterminate interpretation?
not predictive of abnormal fetal acid-base status; requires continued surveillance and reevaluation
what is an example of category II: indeterminate interpretation?
tachycardia, bradycardia w/o absent variability
define category III: abnormal interpretation?
abnormal fetal acid- base statusl; requires intervention
what is an example of category III: abnormal interpretation?
absent variability with recurrent late decelerations
what are 15 nonpharmacologic comfort measures that can be taken during labor?
- clean room
- soft lighting
- comfortable temperature
- mom clean and dry (BM, pads)
- mouth care - ice chips
- empty bladder (full bladder can impede head from coming)
- position changes (improves everything)
- minimize distractions
- hydrotherapy
- hot and cold towels (timed with UC)
- imagery (visualization)
- focal point (can be partner)
- breathing techniques
- massage
- acupressure (we can’t do this)
what is the systematic labor analgesia?
IV opioids, like fentanyl (short duration); have to be careful of timing; newborn respiratory drive effected; couple of hours before delivery
what are the advantages of systematic labor analgesia?
rapid onset; short duration
systematic labor analgesia may cause which 3 disadvantages?
↓ FHR variability, ↓ UC frequency and intensity (slows down labor), and newborn respiratory depression
what occurs when systematic labor analgesia is in the baby’s system when he/she is born?
the baby might not want to breath; we can give Narcan to the baby to reverse the effects
what is epidural analgesia?
local anesthetic and opioid injected into the epidural space
what is the advantage of epidural analgesia?
it provides excellent pain relief
what are the 4 disadvantages of epidural analgesia?
may cause:
- maternal hypotension/fetal distress
- motor loss
- urinary retention; usually cath within 30 minutes
- prolonged 2nd stage (may not have the secondary powers to push)
what are the 4 nursing responsibilities when it comes to epidurals?
- administer ordered IV fluid bolus before procedure d/t hypotension
- assist with maternal positioning during and after placement
- frequent maternal and fetal assessment
- insert foley if unable to void
T/F: with an epidural, the mother then becomes a high risk patient.
TRUE
what is the criteria for a epidural?
the mother must be at least 4 cm dilated.
define cardinal movements of labor.
changes in position of the fetus during labor to allow the smallest diameter to fit through the pelvis.
what are the 7 different cardinal movements?
descent, flexion, internal rotation, extension, restitution, external rotation, and expulsion
define an episiotomy.
a surgical incision into perineum to enlarge vaginal opening.
what are the two different styles of episiotomies?
midline incision and mediolateral incision
what are the advantages of a midline episiotomy?
muscle fibers split lengthwise, allows faster healing and less pain
what is the disadvantages of a midline episiotomy?
can extend into 3rd or 4th degree lacerations; impairs the integrity of the perineum
T/F those that have an episiotomy that have torn all the way to the rectum cannot have suppositories
TRUE
what are the advantages of a mediolateral episiotomy?
larger incision possible; avoids rectal structures
what are the disadvantages of a mediolateral episiotomy?
cuts across muscle fibers; more pain and slower healing
what are the two definitions of “crowning”?
- when the top of the fetal head no longer recedes during contractions
- widest part of baby’s head has passed through perineum
“burning feeling”
what is the 3rd stage of labor?
the discharge of the placenta
how long does the 3rd stage of labor take?
20-30 minutes
T/F the blood vessels of the uterus begin to seep and helps the placenta fall
TRUE
what are newborn security measures?
- mom, baby, and support person have bracelets on
- baby has 2 bracelets on (ankle/wrist)
