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Nursing 3 Exam 2 > Unit 19 Labor & Delivery > Flashcards

Unit 19 Labor & Delivery Flashcards

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1
Q

During an admission of a gravida PT what basic things would you assess?

A

Fetal HR
Mother VS
Contraction status

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2
Q

What do the different amniotic colors mean? Red, Green/Yellow, White and clear.

A

Red could indicate bleeding

Green/Yellow usually from bile/ meconium staining

White/clear is normal

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3
Q

How and what is assessed for in uterine activity?

A

Assessed by palpations or electronic monitoring

Assessing for frequency, duration, intensity

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4
Q

In what phase of the first stage of labor would you introduce medications if needed? What happens if Rx is given in transition phase?

A

The active phase

If given in transition phase, baby will be lethargic, cyanotic, etc.

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5
Q

Describe the contraction frequency and duration during the phases in the first stage of labor and the cervix dilation.

A

Latent phase: Contractions are 10-30 minutes apart lasting 30 seconds then 5-7 minutes apart lasting 30-40 seconds 1-3cm cervix

Active phase: 2-5 minutes apart lasting 40-60 seconds
4-7 cm cervix

Transition phase: 1 1/2- 2 minutes apart lasting 60-90 seconds 8-10 cm cervix

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6
Q

When does the abdomen become hard in labor?

A

When woman has contraction

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7
Q

How is frequency timed during labor?

A

Timed from the beginning of a contraction to the beginning of the next one with no monitor,

With a monitor it’s from one peak to the next.

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8
Q

What will too few rest periods between contractions create?

A

Fetal hypoxia, which will cause learning disabilities

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9
Q

How is duration timed?

A

Beginning of a contraction to the end of the same contraction

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10
Q

What is the other word for peak of a contraction?

A

Acme

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11
Q

What does effacement mean?

A

To become shorter and thinner [the cervix]

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12
Q

What does each fingertip equal in centimeters and what does the cervix dilate up too?

A

Each finger is about 2 cm.

Cervix dilates up to 10cm.

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13
Q

What are some medications to soften the cervix when it is just too rigid during labor, their action, and side effects?

A
  • dinoprostone (Cervidil) [Prostaglandin class of meds]
  • misoprostol (Cytotec)
  • (Laminaria)

they are hydrophilic, bringing water to the area which helps dilate/soften the cervix and stimulate contractions.

Side effects: Maternal nausea, vomiting, diarrhea (usually when stomach is full)

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14
Q

What are signs of true labor?

A
  • Effacing followed by dilating
  • Progressive dilation (usually the mother is 10-20% effaced prior to labor pattern
  • Contraction that occur regularly, become stronger, last longer, and occur more closely together
  • More intense with walking
  • Contractions usually felt in lower back radiating to lower portion of abdomen
  • Contractions that continue despite comfort measures
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15
Q

Describe the mother behavioral patterns/signs and symptoms during the 3 phases of the first stage of labor.

A

Latent phase: little descent, irregular contractions, talking and happy, using breathing and focusing techniques.

Active phase: serious, intense, tired, more demanding, using breathing techniques

Transition phase: Effacement complete, fearful, nausea, vomiting, rectal discomfort, shakes from fluid volume shift (not cold), paced breathing desire to have bowel movement

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16
Q

What does the desire to have bowel movement during labor or before labor indicate?

A

Fetal pressure on bowels and head descent

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17
Q

How would a woman’s bladder be emptied during labor and what is difficult unless bladder is empty?

A

Foley catheter to relieve full bladder, baby will have difficulty coming with full bladder

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18
Q

Describe the second, third, and fourth stages of labor.

A

Second stage: Complete effacement/dilation to delivery, the “pushing stage”. Head on vaginal wall. If woman is nullparas (never given birth yet) could take up to 3 hours.

Third stage: Birth to delivery up placenta

Fourth stage: Immediate recovery (offer ice chips, flat ginger-ale instead of water)

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19
Q

What could slow, lazy contraction be from?

A

Possibly an epidural that was given

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20
Q

Where are the following places in the cervix…anterior, posterior, midposition.

A

Anterior refers to by the opening of the vagina

Posterior refers to the far back of the vagina

Mid-position is midway

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21
Q

What is an artificial rupture of the membrane (AROM) also known as and what instrument can be used?

A

amniotomy

amnihook

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22
Q

What tests can be performed to evaluate for amniotic fluid leak/rupture?

A

Nitrazine strip against cervix, will turn blue/positive when exposed to amniotic fluid

Fern test done by resident- cervix is swabbed side to side and if green like a fern it’s positive/reactive

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23
Q

After amniotic fluid is ruptured what is the first thing assessed?

A

Fetal HR! (almost always assessed first)

24
Q

What is the appropriate amount of amniotic fluid at 20 weeks gestation? 36-38 weeks gestation?

A

20 weeks = 400ml

36-38 = 1000ml

25
Q

What are the two amounts of amniotic fluid referred as and describe what results of it.

A

Oligohydramnios- too little fluid, incomplete or absent kidney, obstruction of urethra, fetus cannot secrete(create) or excrete

Polyhydramnios- too much fluid, causes congenital anomalies, anecephalcy

26
Q

What is the best pelvis for delivery?

A

gynecoid (heart shaped)

27
Q

What are the cardinal movements of labor?

A
  1. Lightening (baby drops into lowest point of pelvis)
  2. Engagement (head stays in pelvis)
  3. Descend
  4. Flexion (chin flexing)
  5. Internal rotation
  6. Extension (looks at floor-anterior delivery)
  7. Restitution (external rotation, head re-aligns with shoulders)
  8. External rotation expulsion
28
Q 
Define the following abbreviations.
LOA
LOP
ROA
ROP
LMA
RMA
LSA
RSA
Footling breach
RADP
RADA
LADA
LADP
A 
LOA Left occipital anterior 
LOP Left occipital posterior
ROA
ROP
LMA Left mentrum (facial presentation) anterior
RMA
LSA Left sacral anterior 
RSA
LSP
RSP
Footling breach
RADP
RADA  ------- Right and left acromio dorsal (transverse)
LADA
LADP
29
Q

Which direction is baby looking during delivery regarding anterior and posterior? What is the best presentation of delivery?

A

Anterior is baby looking down to floor

Posterior baby is looking up to ceiling

Best way to arrive is LOA

30
Q

If delivered breech what is an important intervention to be taken? What instrument is used to extract baby?

A
  • Use warmed blankets so fetus does not cry while head is still in vagina
  • Use piper forceps
31
Q

The posterior fontanelle is what shape? anterior?

A

Posterior- triangle

Anterior- diamond

32
Q

What is Leopold’s Maneuver?

A

Using two hands you push on the sides of the belly to see where baby is lying

33
Q

What is version? What is the worry/issue?

A

Trying to turn the baby around to head down, issue is you might rip cord?

34
Q

What/how is station determined and what do the levels mean?

A

Where the baby is in terms of coming out, each finger is equal to one station. The higher the number (ex: +3) the closer to delivery.

  • Feeling just the top of the head during vaginal check is 0 station.
  • -1, -2 the baby is high up
35
Q

What is iatrogenic cause?

A

Illness caused by the healthcare team

36
Q

What is fetal hyperactivity a sign of?

A

Fetal hypoxia, not getting enough blood/oxygen

37
Q

What is nuchal cord?

A

Cord wrapped around the neck

38
Q

How is baseline FHR calculated? What is bradycardic FHR seen in/caused from?

A

Average of the FHR over 10 minute period

-Seen in cases of maternal hemorrhage, uterine rupture, and narcotics use for pain management

39
Q

What is an appropriate FHR range and beat to beat variability?

A

10 below and 10 above the baseline FHR.

1-5 mild beat to beat variability
6-10 moderate beat to beat variability

40
Q

Where is less beat to beat variability seen?

A
  • Seen in premies
  • With the use of Stadol a synthetic pain reliever used in OB
  • Also seen with fetal approach to death
41
Q

When a medication is being pushed, what changes regarding FHR and what doesn’t?

A

Baseline NEVER changes

Beat to beat variability narrows/changes

42
Q

Each line on a fetal monitoring strip is how many seconds? What is the top of the strip and the bottom?

A

10 seconds

Top is FHR

Bottom is UC

43
Q

Describe the the following fetal monitor pattern: Acceleration

A
  • Baby swimming in 1000 ml :)
  • Increase in FHR, reassuring indication of health
  • Understand HR rises during intense contraction because it is still in amniotic fluid! Returns to baseline after contraction
  • Good pattern
44
Q

Describe the the following fetal monitor pattern:

Early Deceleration

A
  • Only good deceleration pattern
  • Looks like mirror image of contraction
  • Rapid return to baseline FHR

-Each contraction the head is pushing up against cervix
in attempt to dilate

45
Q

Describe the the following fetal monitor pattern:

Late Deceleration

A
  • Non reassuring pattern on distress
  • Indicative of fetal hypoxia also known as uteroplacental insufficiency

-Usually result of hemorrhage from uterine rupture or
tear in umbilical cord, too much pressure during contraction,

-Occur AFTER contraction

give fluids and 02

46
Q

Describe the the following fetal monitor pattern:

Variable

A
  • Combo package of early and late pattern
  • Indicative of cord issues
  • Occurs suddenly usually with pressure on the cord

-Most often cord around the neck or knot in cord
(remember if someone is strangled they’ll have a bowel movement thus good indicator is green amniotic fluid upon rupture)

  • Babies will often have stain umbilical cords at birth
  • reposition mother
47
Q

Why would you see green amniotic fluid during a breech birth with variable fetal pattern?

A

Each contraction gut in squeezed rather than the baby’s head

48
Q

What does sinosoidal pattern mean?

A

Prematurity/fetal death

49
Q

Where is the external fetal lead placed? External uterine lead?

A

fetal lead: Placed on the baby’s back just below the head, jelly needed

uterine lead: Consistently placed on the fundus regardless of the presentation and position
no jelly needed

50
Q

Describe internal leads.

A
  • Require rupture of membranes
  • Placed in sterile conditions
  • Accurate in determining uterine pressure
  • Goes on scalp of fetus

**If forgotten to be taken off prior to delivery and baby comes out with it on, mother places on IV antibiotics post delivery

51
Q

What is the IV fluid of choice for labor and delivery?

A

Lactated Ringer

52
Q

What are simple interventions for increasing fetal profusion?

A

Place mother on left side

After repositioning administer O2 7-10L by mask if needed

53
Q

What are non-pharmacological options for pain management during labor?

A

Dick-Read method: birth without fear by education and environmental control and relaxation

Lamaze: psychophrophylaxis with conditioning and breathing

Bradley: Husband coached childbirth and support by working with pain rather then being distracted from it

**Essentially various breathing techniques, ice packs, warm baths, scented oils

54
Q

What is a good protocol to follow in hypotension during labor and delivery?

A

-Give fluids, lay to side, empty bladder

55
Q

Name and describe effects of some pharmacological treatments for labor discomfort.

A

morphine: CNS and resp. depression, avoid close to delivery time, usually 1 hour, constipation postpartum

meperidine (Demerol): same as above

butorphanol (Stadol) or nalbuphine (Nubain): stadol affects fetal strip so nubain is preferred

sublimaze (Fentanyl) neonatal CNS depression, hypotension, NandV, FHR changes

promethazine (Phenergan) hydroxyzine (Vistaril): given with narcotics, increases effect

epidural: most common complication is hypotension, others include respiratory depression, alterations in FHR

56
Q

What is true regarding labor and delivery and urinary retention?

A

Baby will not deliver with full bladder blocking the way. It is important to empty.

Regarding Rx’s monitor for urinary retention

Nursing 3 Exam 2 (9 decks)

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