Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nur 220 > Unit 2 (A-D) > Flashcards

Unit 2 (A-D) Flashcards

1
Q

Define engagement, fetal lie, and station.

A

Engagement: occurs when the largest diameter of the presenting part reaches or passes through the pelvic inlet.
Fetal lie:relationship of the long axis (spinal column) of the fetus to the long axis of the mother.
Station: relationship of the presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis. (0)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is fetal attitude? What is the norm?

A

Relation of fetal body parts to one another.

General flexion: head flexed so that chin on chest w/ arms crossed over chest and legs flexed at knees.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the powers of labor: forces? What do these achieve?

A

Primary: uterine muscular contractions. complete effacement and dilation of cervix.

Secondary: abdominal muscles. Push during 2nd stage of labor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When should bearing down (pushing) begin? What could happen if begins too soon?

A

When cervix is fully dilated.

Cervical edema, retarding dilatation (process of cervix opening), tearing and bruising of cervix, and maternal exhaustion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What physiological changes occur to the females body during labor?

A

Progesterone (smooth muscle relaxant): decreases so contractions take place.
Estrogen (stim uterine muscle):will increase
Connective tissue loosens permitting softening, thinning and opening of cervix.
Muscles of upper uterine segment shortens and cause cervix to thin and flatten.
Fetal body straightens as uterus elongates during contractions.
Pressure of fetal head causes cervical dilation.
Rectum/vagina drawn upward and forward each contraction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What hormonal changes cause onset of labor?

A

38-42 weeks inc estrogen induces oxytocin and this stims placenta to release prostaglandins stimulating more contractions. Corticotropin RH stims prostaglandins. hyaluronic acid.
Progesterone decreases.
Fetus inc cortisol.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are impending/premonitory signs of labor?

A 
*Warning Signs*
Lightening (engagement, allowing better breathing since diaphragm lowers. Pelvic pressure, inc venous stasis/edema/vag secretions, leg cramps)
Braxton hicks
Cervical changes (ripening)
Bloody show (mucous plug loss-labor 24-48hrs away)
ROM (SROM, PROM, PPROM)
Sudden burst of energy
N/V, diarrhea, backache, indigestion.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q 
Differentiate true and false labor.
Contractions
Intervals
Duration/intensity
Discomfort
Walking
Cervical dilation/effacement
A 
TRUE: 
contractions regular
Interval between contractions shorten
Contractions increase in duration/intensity
Discomfort begins in back and radiates to abdomen
Intensity increases w/ walking 
Cervical dilation/efface are progressive.
FALSE:
Contractions irregular
No change in contraction intervals
No change in duration/intensity
Discomfort in abdomen only
No change or lessens during walking.
No dilation/effacement.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How many stages are there in labor? What occurs in each?

A

1st: 1-10cm dilation
2nd: 10cm to birth (fetal expulsion)
3rd: after fetus born to delivery of placenta.
4th: after placenta delivered to maternal homeostasis (1-4 Hours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 phases of the 1st stage of labor?

A

Latent (early): 1-3cm dilated, mild effacement,ROM (8.6-20hrs)
Active:4-7 cm, contractions intensify, 1.2-1.5cm/hr
Transition: 8-10 cm (1-3 hr)

Epidural slows labor down by 1 hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What characteristics are present in phase 3 (transition) of stage 1 of labor?

A 
Inc bloody show
Hyperventilation
N/v
Sweat
Rectal pressure 
Irritability/restless
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What occurs in the 2nd stage of labor? Duration?

A

10cm crowning pushing to birth
15min to 3hrs
Spontaneous birth
Cardinal movements:
Descent: 4 forces (pressure of amnio fluid/uterine fundus, abd contract, fetal straightening) head enter inlet occipit transverse/oblique (fits pelvis best).
Flexion:fetal head meet resist in pelvis, chin goes down to chest.
Internal rotation: head rotate to anteroposterior
Extension:passing under symph
Restitution:shoulders pass oblique
External rotation:head turn to side, shoulders anteroposterior
Expulsion:anterior shoulder, posterior then body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What occurs in the 3rd stage of labor?

A

Placental separation

Placental delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What occurs in the 4th stage of labor?

A 
Vag delivery of blood (250-500ml) (section 700-1000ml)
Vs q15minX1hr, qhrX4hr
Uterus position
Shaking
Urinary retention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In the 4th stage of labor, what are important nursing considerations?

A

Keeping uterus firm (prevents bleeding)-keep bladder empty (bladder can press on uterus and soften)
Watch for common changes (dec bp, inc PP with tachy, then brady)
Locating uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the maternal responses to labor?

A

Dec pulse, inc bp/co (in 1st 24hrs post birth)
Insensible losses
Inc o2 demand, dec paco2=metab acidosis w/ resp alkalosis (hypervent)
Pushing=inc paco2 w/ blood lactate=resp acidosis
Delivery=metabolic acidosis w/ uncompensated respiratory alkalosis
Inc renin/angio, bladder edema
Dec gastric motility, absorption, emptying
Inc wbc, dec glucose levels
Pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the fetal responses to labor?

A 
HR Dec d/t intracranial pressure
Dec ph, o2 sat (try not to hold breath during pushing)
Dec blood flow
Sleep/active states between 36-38 wks
Tactile fetal sensation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Leopolds maneuver?

A

Palpation method to determine fetal position.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When and how is internal electronic fetal monitoring done?

A

ROM and atleast 2cm dilated. Presenting part known and is scalp.
Do not use in STIā€™s
Inc risk of infection
Sterile process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are 4 childbirth prep methods? Explain each.

A

Lamaze:dissociative relaxation, control muscle relax, specific breath pattern
Kitzinger:chest/abd breath
Bradley:12wk session, work on controlled breath, deep abdominopelvic breath, focus on natural childbirth.
Hypnobirthing:breath/relax techniques for body to work in neuromuscular harmony.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When is it appropriate for the pregnant woman to come to the hospital for the birthing process?

A

ROM, contractions (5min apart X1hr, multipara:6-8min apart), vaginal bleeding, dec fetal movement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the maternal nursing assessments during the 1st stage of labor?

A

BP, RR qhr
Latent:temp q4hr (unless over99.6, ROM then qhr), uterine contractions q30min
Active:BP, P, RR qhr, uterine cont palpated q15-30min
Transition:BP, P, RR q30min, cont q15min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the fetal nurse assessments during the 1st stage of labor?

A 
FHR q30min (low risk) q15 (highrisk), fetal activity, NST
Baseline 110-160
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the maternal nurse assessments during the 2nd stage of labor?
Fetal?

A

BP, P, RR q 5-15min
Temp q2hr
Cont palpated continuous

Fetal: FHR q15 (q5 high risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the maternal nurse assessment during the 3rd stage of labor?
Fetal?

A

Bp P RR q5min, cont intermittently to assess for placenta separation.

Newborn assess at time of birth, gest age assess, neuro assess w/i 1st hr. APGAR 1 and 5 min. Initial BP, AP, RR, and T. Umbilical cord 3 vessels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the maternal nursing assessment for the 4th stage of labor? Fetal?

A

VS 5-15 min x1st hour. Fundus, lochia, perineum, laceration/episiotomy, bladder distention, rectum q15min.

Complete exam:v/s gest age assess, phys exam, neuro reflex between hour 1-4. At 8hr, v/s and assess. Skin color q4hr.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When assessing FHR, when is it done?

A

During contraction and after

28
Q

What is precipitous labor? WhY? Maternal/fetal risks? What is important not to do?

A

Labor and birth w/i 3 hours.
Low resis in soft tissue cause rapid effacement/dilation.

Mom:tearing bleeding
Baby:hypoxia, myconium staining, injury, dec APGAR.

Do NOT leave patient or break the bed!

29
Q

What are the nurse managements w/ precipitous labor?

A

Call for precip pack
Scrub-sterile
Massage perineum, mom to pant w/ contract rather than push.
Break sac (if not already)
Deliver head between contractions, support perineum
Check nuchal cord, suction (mouth then nose)
Baby goes downward the upward pressure to deliv shoulder
Dry infant and place on mom-head lower than body.
Deliv placenta, clamp-cut umbilical, infant to breast.

30
Q

Why is immed breastfeeding so important w/ precip labor?

A

Releases natural oxytocin which will keep uterus contracted preventing hemorrhage.

31
Q

What is used to test for PROM? What will the nurse do? What are med managements for PROM vs PPROM? And before 34 weeks and 31/7?

A 
Nitrazine paper (blue-pos)
V/S, FHR, hydration status

PROM (>37):labor w/i 24hr or induce
PPROM (<37):bedrest, antibiotic, corticosteroid, NST, BPP, labs
34wk:fetal lung maturity test
<31/7: mag sulfate

32
Q

What is considered preterm labor? What is the goal? Med therapY?

A

20-36wks
Prevention

Progesterone
Betamethasone: 2 shots 24 hr apart
Terbutaline
Mag sul:smooth muscle relax, dec DTR/contract, inc HR, flush (calcium gluconate antiodote-keep at bedside)
Nifedipine
Cyclooxygenase: prostaglandin inhib-relax uterus.

33
Q

What fetal implications arise w/ placental previa? What indicates a c/s?

A

FHR changes, meconium staining, hypoxia (if mom bleeding profusely).
Partial/complete previa (hemor risk high), non reassuring fetal status

Will need to test baby after for anemia.

34
Q

What is expectant management for placenta previa?

A 
Bed rest w/ bathroom privileges
No vag exams
Mon blood loss, pain, contract
FHR (external monitor)
V/S
Lab:hemoglobin, hemat, RH, urinalysis
IV fluid (LR)
2 u cross matched blood (mom)
35
Q

What are the risks to cause uterine rupture?
S/S?
Tx?

A

Trauma, pregs <18mths apart, short umb cord, HTN.

Pain, tenderness, bleeding in abd, labor contractions stop, shock.

Blood trans, C/S, Hyst.

36
Q

When should cervical insufficiency monitoring begin?

TX?

A

16-24 wks transvag u/s

Cerclage (sew cervix closed) will be removed at 37 wks for vag delivery or left in place with c/s for use for subsequent preg.
Tocolytics
Antibiotic
Antiinflam

37
Q

What are implications for hydramnios?

A

(More than 2000ml)
DM, Rh sensa, TORCH infection, malformations in fetal swallow, neural tube defects, anencephaly, cardiac anomalies, esophageal or duodenal atresia.

38
Q

What are implications for oligohydramnios?

A

(Less than 500)
Maternal hypertensive d/os, postmaturity and IUGR,
CREATES DANGER FOR: anomalies skin, skeletalā€”adhesions and pulm hypoplasia (these d/t fetus not being able to move)
Renal agenesis, lower UTI obstructive lesions (not developing)

Must eval for cord compression

39
Q

What makes dysfunctional labor?

A

Dystopia-abnormal w/ power, passenger, passage
Tachystole labor: (hyperstim of contrac-no rest periods) >5contr in 10 min on 30min strip, <2min freq, >90sec duration.
Pain due to muscle anoxia, ineffective dilation or effacement.
Hypotonic labor: <2-3 cont in 10 min, irregular

40
Q

What are nurse managements for dysfunctional labor: tachysystole?

A 
D/C oxytocin
Left lateral position
IV bolus LR
O2 (8-10L)
Terbutaline
Rest, sedative
Reassurance
41
Q

What are nurse managements for dysfunctional labor: hypotonic labor?

A

Admin oxytocin, iv fluids
Teach nipple stim
FHR before/after contr

Amniotomy:(breaking membrane)
Asses hydration, void q2hr, mon s/s infection

42
Q

What risks are there in mothers with prolonged pregnancy? 42 weeks

A 
Probable labor induction
Inc risk for large gestational age-perineal trauma
Inc use for forceps/vacuum/c/s
Inc stress
Inc risk for infection
43
Q

What are the fetal risks in a prolonged (post term) pregnancy?

A

Dec placental perfusion
Oligohydramnios (cord comp risk)
Meconium aspiration
Low APGAR (5min)

44
Q

What is nursing management for post term birth?

A

Fetal movement count
NST, BPP
Assess fluid for meconium

45
Q

What are maternal risks for malposition? What are nurse txs?

A

Perineal lacerations, midline episiotomy.

Side to side lying, knee chest position and pelvic rock.

46
Q

What are nurse tx for mal presentations?

A 
Leopolds 
FHR position
External version (if 37-38 wks)
Meconium w/ ROM
Plan for OR or assisted delivery
47
Q

What defines macrosomia? What complications can arise? TX?

A 
Baby over 4000g (8.8lb)
Dysfunctional labor (cant engage), shoulder dystocia, suprapubic pressure, post part hem, lacerations (forceps)

Mon uterine fundus atony (softening)
Prep for fracture clavical/brachial plexus injury

48
Q

What pattern changes indicate non reassuring FHR? What intrauterine measures can the nurse take?

A

Deep, repetitive variable decelerations, prolonged decels, ongoing late decels.

Change positions. Current maternal hypo, d/c oxytocin, give terbutaline, inc iv fluid, vag assess for prolapsed cord.

49
Q

What are the req for use of internal scalp electrode? When would it be contraindicated?

A

Dilated by 2cm and ROM.

No use w/ HIV, Hep B, or herpes outbreak.

50
Q

What are risks associated with cephalopelvic disproportion?

A

May be caused by prolonged labor.

Cord prolapse
Uterine rupture

51
Q

What are the 4 types of placental variations?

A

Succenturiate: fetal lobe off to side of placenta
Circumvallate:double fold of amnion/chor around umb cord side
Battledore:umb cord at placenta margin
Velamentous:vessels develop distant from placenta

52
Q

What are the maternal/fetal risks with the 4 types of placental variations?

A

Succenturiate (distant fetal lobe): PP hemor from retaining. None for fetus.
Circumvallate (double fold): late abort, ante hemor, preterm labor. IUGR, premature, death.
Battledore (cord at margin):preterm labor, bleed. Premature, NRFHR.
Velamentous (distant long vessels): hemmor if one tears. NRFHR, hemor.

53
Q

What occurs w/ amniotic fluid embolism? S/S? Risks? Tx?

A

Small amount of amniotic fluid (or fetal cells/hair) escapes (through tear) and enters maternal system (blood then lungs).

SOB, dyspnea, cyanosis, frothy sputum, cor pulmonale, hemorrhage, DIC, tachy, hypo, shock, coma, death.

O2, IV, CPR, C/S, fresh whole blood (clot factors), CVP monitoring. ICU PT!!

54
Q

What happens w/ retained placenta and placenta accreta?

A

Retained: when still in after 30 min. Dr will manually or surg remove. Bleeding can be excessive.

Accreta: when chorionic villi attach to myometrium (complete/partial). Hemorrhage and failure to sep may necessitate hyst.

55
Q

What are the criteria to be met to have a version performed? 2 types? Procedure/nurse management? Contraindications?

A

Reactive NST, no abnormals

ECV (external), podalic (reach in)

Fast 8 hrs, NST reactive, terbutaline, FHR, V/S, IV, then attempt to move baby, U/S, monitor for 30 min. Instruct pt to monitor kick counts, reversion, and contractions at home.

Contra: nonreactive stress test, any stress, maternal issues: mult gest, cardiac, fluid, etc.

56
Q

What is the nursing care when AROM?

A

FHR, position, station (if not engaged, risk for prolapsed cord), amniotic fluid assess, temp q2hr.

57
Q

When should vacuum assist not be used? What is required before use?

A

Not for facial presentation, preterm, breech, or when mom cannot assist.
Causes more trauma to baby than forceps, but less trauma to mom than forceps.

Empty bladder, deflate indwelling cath balloon. Must be engaged, fully dilated, only use for 3 contractions.

58
Q

In fetal monitoring, what is bradycardia and tachy? Causes? TX?

A

Brady:<110bpm, fetal hypoxemia, drugs, maternal hypo. Turn to side, give O2, fluids.

Tachy:baseline above 160bpm. Maternal fever (infection), dehydration, anxiety, drugs, fetal sepsis, fetal hypoxia/anemia.

59
Q

Discuss the variabilities in FHR.

A

Absent: no change, flat. Drug baby-not good.

Minimal: less than 5 bpm change. Not great.

Moderate:6-25 bpm change. Great!

Marked:greater than 25 bpm change. BAD!

60
Q

What are some causes of minimal variability in FHR? What is the nurses role?

A

Hypoxemia, sleep cycle, pain meds, drugs, premature, cong. Anomalies.

Just monitor if no other s/s (decels)of other issues since can be caused by meds.

61
Q

What are causes for marked variable FHR?

A

Over stim baby, drugs, hypoxemia.

62
Q

What is considered reactive reassuring FHR?

A

Accelerations of 15bpm for 15 seconds 2x within 20min (10x10 for premature)

63
Q

When do early decels occur compared to the contraction on the strip? What is this related to? Tx?

A

Onset at begin of contraction, peaks meet.
Head compression.
Common when delivering thru pelvis.

Turn pt.

64
Q

When do variable decels occur compared to contractions on the strip? Causes? Tx?

A

Not related. Varies, looks like ā€œVā€ and has rapid decent/recovery (onset to peak less than 30secs w/ drop 15bpm for 15 secs less than 2 min)

Cord compression.

O2, fluids, and c/s if too long.

65
Q

When do late decels occur compared to contraction on strip? Causes? Tx?

A

Decent starts after peak of contraction.(onset to peak less than 30 secs)

Abruption, maternal HTN, HTN issues

O2, fluids

66
Q

What is prolonged decels? tx?

A

15bpm decel for longer than 2 min but less than 10 min.

O2, and fluids while OTW to OR!

67
Q

What is uterine hyperstimulation?

A

More than 5 contractions w/i 10 min time, no rest period.

Nur 220 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions