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Intrapartum/postpartum > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What is the purpose of the Ritgens manever?

A

To achieve fetal extension. It assists mother when bearing down.

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2
Q

What is the maximum amt of licocaine that may be administered ?

A

10ml

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3
Q

Indications for an episiotomy?

A
  1. maternal exhaustion
  2. fetal distress
  3. forceps or vacuum delivery
  4. progress has ceased
  5. bleeding occurs around the head indicating a vaginal laceration
  6. previous 3rd degree or scarring
  7. the need for deeper hand maneuvers (shoulders)
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4
Q

What do you repair an episiotomy with?

A

2-0 or 3-0 with a rounded needle

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5
Q

Describe the steps to suturing an epis

A
  1. anchoring stitch above apex
  2. close the deep area with locked stitches above the hymenal ring and running stitches below it
  3. close the skin edges with a subcuticular stitch
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6
Q

What does a first degree laceration involve?

A
  1. vaginal mucosa
  2. post. forchette
  3. perineal skin
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7
Q

What does a second degree laceration involve?

A
  1. vaginal mucosa
  2. post. forchette
  3. perineal skin
  4. BULBOCAVERNOSUS MUSCLE
  5. SUPERFICIAL AND DEEP TRANSVERSE PERINEAL MUSCLES
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8
Q

What does a third degree laceration involve?

A
  1. vaginal mucosa
  2. post. forchette
  3. perineal skin
  4. Bulbocavernosus muscle
  5. Superficial and deep transverse perineal muscles
  6. ENTIRE THICKNESS OF RECTAL SPHINCTER
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9
Q

What does a fourth degree laceration involve?

A
  1. vaginal mucosa
  2. post. forchette
  3. perineal skin
  4. Bulbocavernosus muscle
  5. Superficial and deep transverse perineal muscles
  6. Entire thickness of rectal sphincter
  7. ANERIOR RECTAL WALL
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10
Q

3 facts about chromic

A
  1. absorbs easily
  2. strong strength
  3. less synthetic than vicryl
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11
Q

3 facts about vicryl

A
  1. less skin reactions
  2. easier to use
  3. takes longer to absorb
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12
Q

The lower the number the ______ the suture

A

thicker

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13
Q

What would you use a 4- 0 chromic on a small needle for?

A

periurethral, periclitoral

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14
Q

What would you use a 2-0 for?

A

vaginal wall, cervical lacerations, deep interrupted when repairing pelvic muscles

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15
Q

What would you use a 3-0 for?

A

vaginal mucosa, subcutaneous tissue, subcuticular tissue

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16
Q

GBS is present in ________% of all women

A

15-40%

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17
Q

What is the leading cause of newborn morbidity?

A

GBS infection

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18
Q

If a women has GBS in urine early in pregnancy what is the course of action?

A

She is treated in pregnancy AND in labor. She is NOT retested at 37 weeks

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19
Q

What are the two exceptions to GBS screening at 35-37 weeks?

A
  1. the woman tested positive during pregnancy

2. the woman had a baby previously who HAD gbs disease

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20
Q

What is the DOC for GBS?

A

PCN

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21
Q

What is the dosage of PCN when treating GBS?

A

Pen G 5 million units IV then 2.5 units every 4 hours till delivery
OR
Ampicillin 2gm then 1gm every 4 hours till delivery

22
Q

What can be given for GBS if PCN allergy?

A

Cefazolin 2gm then 1gm every 8 hours
Clindamycin 900mg every 8 hours
Vancomycin 1gm every 12 hours

23
Q

What do endorphins do?

A

provide a sense o relaxation. They are increased during pregnancy, labor, and several days pp.

24
Q

What will pain meds do to endorphins?

A

they will suppress the mothers own endorphins

25
Q

Where is the origin of pain in the first stage?

A

VISCERAL

  1. uterus
  2. cervix
  3. adnexa
  4. pelvic ligaments
  5. fetal descent
26
Q

Where is the origin of pain in the second stage?

A
  1. distention of perineal structures

2. further fetal descent

27
Q

Activity in the upper uterine segment is often felt ________ and is present during _________

A

lower abd.

efficient labor

28
Q

Pain in the back s related to __________-

A

tension in the lower uterine segment and cervix

29
Q

In normal labor when is back pain felt?

A

early labor

30
Q

What is one PROMINANT reason for back pain in labor?

A

posterior position

31
Q

What are the 7 pain theories?

A
  1. dissociation
  2. cognitive control
    3 interference
  3. gate theory
  4. Endogenous pain control theory
  5. Hawthorne effect
  6. relaxation
32
Q

What is dissociation? example?

A

Focusing on a non-painful element of the contractions. EX: motion o the contraction, downward movement of the baby

33
Q

What is cognitive control and an example

A

physiological strategies: attempting to focus on other mental activities instead of the pain EX: cards, tv

34
Q

What is interference and a example?

A

having stimulation outside of the pain that interferes with the completion of the transmission of the pain EX: *may be passive (cards, tv) or active (breathing techniques, visualization)

35
Q

What is the gate theory

A

Since pain signals are transmitted through small fibers to the substantia galatinosa, pre synaptic inhibition is accomplished by stimulating large fibers.

36
Q

What so the large fibers in the gate theory?

A

conduct the stimulus to the brain and the closes the gate to pain perception one stimulus at a time.

37
Q

Reactivation of the gate occurs when _________

A

changing the sit or type of stimulation

38
Q

How long must habituated fibers rest?

A

15-20 minutes

39
Q

What is the endogenous pain control theory of 1975?

A

Increasing the body’s natural endorphins decreases perception of pain.

40
Q

Endorphins are _____like substances from the ______

A

morphine, pituitary

41
Q

Endorphins travel to _______ ______ where they _____ pain transmission

A

opiate receptors, inhibit

42
Q

What is the Hawthorne effect?

A

When someone performs better when positively reinforced, praised, and encouraged.

43
Q

Describe the relaxation theory

A

trying to decrease # of catecholamine’s because they increase pain and anxiety.

44
Q

cord length is a function of ________ ________

A

fetal activity

45
Q

thin cord are related to ….

A

lesser amt of amniotic fluid

46
Q

Cord thickness is related to

A

volume of amniotic fluid

47
Q

thicker cords are found with

A

premature births

48
Q

cord has _____ artery

A

2

49
Q

cord has ______ vein

A

1

50
Q

In chorio, absesses originate from ______ vessels and migrate into _____ and ______

A

maternal

chorion and amnion

51
Q

In funisitis, absesses originate from ______ vessels of the umbilical cord and migrate into the ____ _____

A

fetal

whartons jelly

52
Q

When does the 4th stage of labor occur?

A

1 hour pp

Intrapartum/postpartum (7 decks)

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