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102 Cards in this Set
- Front
- Back
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What is baseline FHR? |
Mean Fetal Heart Rate rounded to increments of 5 beats per minute during a 10 minute window, excluding accelerations and decelerations. |
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What is baseline variability? |
Fluctuations in the baseline FHR that are irregular in amplitude and frequency. Measured in a 10 minute window, excludes accelerations and decelerations. - absent (undetectable) - minimal (range is visually undetectable, less than or equal to 5 bpm) - moderate (from peak to trough 6 to 25 bpm) - marked (over 25 bpm) |
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What are accelerations? |
Visually apparent, abrupt increase in FHR above the baseline. The peak of the acceleration is over or equal to 15 bpm over the baseline for anywhere between 15 seconds and 2 minutes. Before 32 weeks, it is over or equal to 10bpm and over 10 seconds. |
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What are decelerations? |
Transient decrease in the FHR from the baseline. |
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What kinds of decelerations are there? |
* Early * Variable * Late * Prolonged * Sinusoidal Pattern |
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What is early deceleration? |
Visually apparent gradual decrease in FHR below the baseline. Lowest point occurs at the same time as the peak of the UC (uterine contraction). The wave of the early deceleration mirrors the wave of the UC. |
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What is variable deceleration? |
Visually apparent abrupt decrease in the FHR below baseline. The decrease in the FHR is over or equal to 15bpm lasting 15 seconds or longer up to 2 min. in duration. |
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What is late deceleration? |
Visually apparent gradual decrease in FHR below baseline with the lowest point occurring after the peak of the contraction. In most cases the onset, lowest point, and recovery occur after the respective onset, peak and end of UC. |
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What is prolonged deceleration? |
Visually apparent abrupt decrease in FHR below baseline that is over or equal to 15bpm lasting 2 minutes to 10 minutes. |
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What is sinusoidal pattern? |
Visually apparent smooth sine-like wave like undulating pattern in FHR baseline with a cycle frequency of 3-5/min that persists for 20 min or longer. |
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What is fetal tachycardia? |
Baseline FHR over 160 bpm lasting longer than 10 min. |
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What is fetal bradycardia? |
Baseline FHR less than 110 bpm lasting longer than 10 min. |
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What could fetal tachycardia be a result of? |
* Early fetal hypoxemia, especially with decreased variability and decelerations (cord compression). * Maternal fever * Exposure to medications such as terbutaline * Infection * Dehydration * Maternal anxiety * Maternal anemia * Illicit drugs * Fetal activity/ Stimulation * Fetal cardiac abnormalities |
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What could fetal bradycardia be a result of? |
Less than 80bpm is an obstetrical emergency * Dehydration * Maternal hypotension * supine position * Maternal cardiac arrest * placental abruption * anesthetics * cord compression * chronic fetal head compression |
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What are the nursing actions for fetal tachycardia? |
* Assess maternal VS (temp & pulse) * give meds as ordered * use ice packs for maternal fever * assess hydration status * reduce anxiety by encouraging, reassuring and explaining * consider position change * oxygen * decrease or discontinue oxytocin * notify care provider |
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What are the nursing actions for fetal bradycardia? |
* Confirm that EFM is monitoring FHR and not maternal HR * Assess fetal movement * Assess fetal response to fetal scalp stimulation * Perform a vaginal exam and assess for prolapsed cord * Assess maternal VS (BP) * Assess hydration status * Consider position change * consider reducing or discontinuing oxytocin * oxygen * modify pushing to every other contraction or open glottis pushing (discourage sustained holding breath til baby recovers) * support mom and family * notify provider |
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What kind of deceleration is this? |
Late Decelerations - after the crest of the UCs. |
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What are the nursing interventions of early decelerations? |
None. They are benign and no interventions are needed. |
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When is the developing fetus most vulnerable to teratogens? |
In the first 8 weeks of gestation, during organogenesis. |
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What are the unique features of fetal circulation? |
* Ductus Venosus (O2 blood from umbilical vein to inferior vena cava) * Foramen Ovale (opening between right and left atria) * Ductus Arteriosus (connects pulmonary artery to the descending aorta) |
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What are the 4 ways that an infant loses heat? |
* Convection (air blown by baby) * Radiation (heat leaving baby's body) * Evaporation (from sweat or body fluids leaving the skin) * Conduction (something the baby is on or near that is cold stealing heat from the baby) |
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What is the nursing care of the neonate for the first 4 hours? |
* Universal Precautions * Maintain body heat * Support respirations * Apgar Scores * VS * ID bands * Neonate assessment * Gestational age assessment * Administer meds (eye oint., vitamin K, Hep B) * Bath * Promote parent-infant attachment |
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What are the meds given to an infant in the first 4 hours of life? |
* Erythromycin eye ointment (to protect from gonorrhea infection) * Vitamin K (to aid in clotting) * Hep B vaccine (to protect from Hepatitis B) |
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What are the normal pulse and respirations of a newborn? |
* P: 110-160 * RR: 40 - 60 |
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What are the stages of human milk? |
* Stage 1: Colostrum * Stage 2: Transitional milk * Stage 3: Mature milk (which has a foremilk - more watery and a hindmilk with more calories and fat) |
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Which stage of milk has the most immunoglobulins? |
Stage 1: Colostrum |
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What's the difference between a spinal block and an epidural block? |
* Spinal block is placed in the subarachnoid space of the spine (shared by the spinal cord) * epidural block is placed in the epidural space of the spine (outside the dura mater) |
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What is the difference between a classical and a lower segment Cesarean Section and what are the reasons for the two? |
* Classical is a vertical cut in the uterus (faster for an emergent situation * Lower Segment is a low, horizontal cut which runs along the fibers of the uterus, which takes longer to perform but heals quicker. |
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What are the postpartum stages of lochia? |
* Stage 1: Rubra (red and lasts 3-5 days) * Stage 2: Serosa ( pinkish and lasts 10 days to 2 weeks) * Stage 3: Alba (white and lasts 3-4 weeks) |
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What is the expected blood loss (EBL) for a vaginal delivery and a C-section? |
* 500mL for vaginal * 1000mL for C-section |
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Where is the fundus supposed to be located after delivery? What does it feel like and what are the implications if it doesn't feel right? What can a nurse do? |
Below the bellybutton. It should be hard. If it does not or not located below the bellybutton, it could mean hemorrhaging for the mother. Nurse could have the mother void, massage fundus and check again 30 min later, if does not respond, use standing order of oxytocin (Pitocin) |
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What are the functions of the placenta? |
* Metabolic and gas exchange (waste products from the fetus are sent to the mom via diffusion and nutrients and O2 are sent to the fetus via diffuse and active transport) * Hormone production (Progesterone, estrogen, hCG and hPL) |
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What are the functions of the amniotic fluid? |
* Acts as a cushion for the fetus * Prevents adherence of fetus to membranes * Allows freedom of fetal movement and aids in symmetrical musculoskeletal development * Provides a consistent thermal environment |
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What is polyhydramnios and what could it mean? |
Excess amniotic fluid. Could mean a chromosomal disorder, GI, cardiac or neural tube disorder. |
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What is oligohydramnios and what could it mean? |
Decreased amount of amniotic fluid. Could mean a congenital renal disorder. |
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What makes up the umbilical cord? |
* An umbilical vein carrying oxygenated blood to the fetus * Two umbilical arteries carrying deoxygenated blood and waste products from the fetus |
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Ms. Rogers, who plans to breastfeed, has just given birth to a male 38 week gestation infant. The nurse checks his blood glucoselevel immediately after birth and obtains a blood glucose level of 42. A priority nursing intervention wouldbe to A. Notify the physician of the abnormal results B. Chart the findings as normal for a preterm infant C. Inform the mother of the need to supplement with a bottle D. Provideroutine care, as this is a normal finding |
D. Provide routine care, as this is a normal |
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When is the embryonic stage? |
15th day to the 8th week |
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When is the fetal stage? |
8th week to delivery |
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When is the pre-embryonic stage? |
The first 14 days |
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At what week do kidneys produce urine? |
12 weeks |
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When does lanugo first start to appear? |
Between 13 and 16 weeks |
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When is the fetus covered in vernix caseosa? |
At 24 weeks |
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When is the alveoli beginning to form? |
24 weeks |
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Describe fetal development at 28 weeks. |
* Brain is developing rapidly * Weighs over 2 1/2 pounds * CNS is developed enough to provide some degree of regulation of body functions * Respiratory and circulatory systems have developed, but lungs still too immature * If born, would need extensive interventions to survive |
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When does lanugo begin to disappear? |
Around 36 weeks |
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What is the definition of 'preterm'? |
Anyfetus born after 20 weeks andbeforethe completion of 37 weeks |
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What would be considered 'late preterm'? |
Any fetus born between 34 and 36 completed weeks |
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What can inadequate maternal nutrition do? |
Especiallyinvolving amino acids, glucose, and fatty acids can possibly lead to learningdisabilities. |
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Why is it important for a woman to have all her vaccinations before getting pregnant? |
Getting sick (and spending time in hot tubs) during first trimester have raised concerns about possibleCNS defects and failure of neural tube closure. |
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In evaluating the effect of prior teaching regardingfunctions of the amniotic fluid, the nurse recognizes that more teaching isrequired when the client states: A) "The fluidhelps maintain environmental temperature." B) "The fluidhelps cushion the baby against harm." C) "The fluidaids in musculoskeletal development." D) "The fluid is responsible for oxygenexchange." |
D. "The fluid is responsible for oxygen exchange" |
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Who should Be Referred for Genetic Counseling? |
* Maternal age 35 years or older whenthe baby is born * Paternal age 50 years or older * Previous child,parents, or close relatives with an inherited disease, congenital anomalies,metabolic disorders, developmental disorders, or chromosomal abnormalities * Consanguinity (close blood relative) or incest * Pregnancy screeningabnormality, including alpha-fetoprotein, triple screen, amniocentesis, orultrasound * Stillborn withcongenital anomalies * Two or more pregnancylosses * Teratogenexposure or risk * Concernsabout genetic defects that occur frequently in their ethnic or racial group(for instance, those of African descent are most at risk for having a childwith sickle-cell anemia) * Abnormalnewborn screening |
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Where is the place of oxygen exchange between the mother and fetus? |
The placenta |
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What is brown fat and what is it's purpose? |
It is fat in a fetus that is used after the baby is born to help regulate metabolism if the baby gets cold because the baby cannot shiver. |
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Who should not breastfeed? |
Moms on medications that are contraindicated and those with HIV. |
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A woman is pregnant for 5th time. She has had 2 miscarriages, her son was born at 32 weeks and her daughter was born at 38 weeks. What is her GTPAL? |
G - 5 T - 1 P - 1 A - 2 L - 2 |
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What are the differences between true labor and Braxton Hicks contractions? |
* Braxton Hicks contractions don't get closer together or get stronger. True contractions do. * Exercise doesn't affect Braxton Hicks contractions or makes them go away. True labor they get stronger. * Braxton Hicks contractions tend to be felt more in the front, whereas true contractions tend to be felt all over. * Braxton Hicks contractions don't change the cervix. True contractions do. * The only way to know for sure is by cervical exam |
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If a mom says she thinks her water broke. What questions do you ask her and what mnemonic will help? |
T A C O T - timing "When did it break?" (hopefully not three days go) A - amount "Do you need a pad?" C - Color "What color is it?" should be white or yellow O - odor "Is there an odor?" shouldn't be |
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What is lightening? (not lightning). |
This is when the baby drops further into the pelvis giving mom the ability to breathe better. She typically needs to void more often since the baby has taken up space further down. |
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What is ballotable? |
When the fetus' head can be pushed up during a cervical exam. |
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When should a pregnant woman go to the hospital? |
First baby * contractions 5 min. apart for an hour * can no longer walk or talk through contractions * if the membranes are ruptured * bright red vaginal bleeding * decreased fetal movement Subsequent babies * any regular contractions over an hour |
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What are the 4 "P"s? (and 5th P) And what do they stand for? |
The 4 (or 5) things that can affect a woman's ability to delivery vaginally * Power - power of contractions and power of the pushing efforts* Passage - the shape of the pelvis of the mom * Passenger - the size and position of the baby * Psyche - a support person has a big affect on mom and she is less likely to be stressed and have an easier delivery * P - the fifth P refers to the Mom's laboring position which can help move things along. Upright uses gravity. |
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What are the 4 stages of labor? |
* First stage has 3 phases: Latent (0-3), active (4-7) and transition (8-10) * Second stage: Pushing * Third stage: delivery of placenta * Fourth stage: first 4 hours postpartum |
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What is the nursing care during the latent phase of the first stage of labor? |
* encouraging (to walk) * supportive * assessing mom and her pain * VS * FHR |
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What is the nursing care during the active phase of the first stage of labor? |
* involve support person by looking for ways for them to help make mom more comfortable * pain meds * hydration * assessing and her pain * discourage them from eating (which could come back up later) * VS * FHR |
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What is the nursing care during the transition phase of the first stage of labor? |
* teaching mom to focus (she will be very irritable) * involving support person - giving back rub, etc. * pain meds * assessment of mom and her pain * VS * FHR |
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What is the nursing care for the second stage of labor?
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* assist with pushing efforts * get set up for delivery, preparing for baby * assessment of mom and her pain * may help by waiting for mom to "labour down" by waiting for her to feel the urge to push with an epidural * VS * FHR |
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What is the nursing care for a mom before and after epidural anesthesia? |
Want to "avoid epidural dip" * bolus of IV fluid * after epidural have her tilted to her left so she's off her vessels * should not be getting up to void * draw bloodwork and look for platelets so she won't bleed into the epidural space. Anything less than 100k of platelets, should consider not doing an epidural * watch for return of sensation |
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What is the nursing care for the third stage of labor? |
Placenta should be delivered with 1/2 hour * check to make sure it's intact * check for the 3 vessels in the cord * doing apgar scores * drying baby off and giving him a hat * first assessment |
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What is the nursing care for the fourth stage of labor? |
* Looking at fundus * Looking at bleeding * VS * Medicate for pain * keep bladder empty |
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Can a mom have narcotics close to delivery? |
No, no narcotics close to delivery. If she happens to delivery close to the time she's received narcotics, baby will get Narcan. |
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Why can't a mom have general anesthesia for a C-section? |
The baby will also get the general anesthesia. |
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A mom gives birth to a 39 week gestation male. She does not want to give her baby any medications. She does want her baby to have a circumcision. What teaching will the nurse provide? |
* Erythromycin is to protect the baby from infection. * Hep B vaccine is also to protect the baby from infection * Vitamin K helps with clotting and it is not recommended that the baby get a circumcision without it. |
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A Mom has given birth for the first time to a healthy newborn. She is very focused on her pain and her birthing experience. She has asked the nurses to care for her newborn because she's in too much pain right now. What phase of attachment is she in? |
The first, or "taking in" phase. |
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List the phases of attachment that mothers go through and describe them. |
* First phase: Taking In phase (first 24 hours, very focused on self)
* Second phase: Taking Hold Phase (24-48 hours after giving birth, taking charge of some infant care, but still relying on nurses and/ or mother) * Third Phase: Letting Go phase (when the mom feels autonomous and is no longer dependent on Mother or nurses) |
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What are the degrees of perineal tears or episiotomies? |
* First degree is a small tear (or cut) * Second degree the perineal muscles are torn (or cut) * Third degree the anal sphincter is torn (or cut) * Fourth degree the rectum is torn (or cut) |
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A Mom has decided not to breast feed. She has become engorged and is very uncomfortable. What teaching does the nurse give her? |
* Wear a supportive or sports bra * No nipple stimulation * try not to run warm water across them in the shower |
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What are the cardinal movements of delivery? |
* Engagement * Descent * Flexion * Internal Rotation * Extension * External rotation * Expulsion |
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A laboring Mom ruptures her membranes. What is the first nursing action to take place? |
Get a fetal heart rate |
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What are the normal vital signs of a neonate? |
HR: 110-160 T: 97.7 - 99.3 RR: 40-60 |
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What is the name of the creamy white substance on a newborn? |
Vernix Caseosa |
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What are the 5 categories that the Apgar scores rate the neonate? |
Rated on a scale of 0-2 * Activity (movement) * Pulse (absent, below or above 100) * Grimace (reflexes) * Appearance (pale, blue extremities, pink) * Respiration (absent, slow/irregular, loud cry) |
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What is the thinning of the cervix called? |
Effacement |
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What are the 6 vertex positions referred as and which is the optimum? Which is the worst? |
* LOP (Left occiput posterior) * LOT (Left occiput transverse) * LOA (Left occipital anterior) - best * ROP (Right occiput posterior) - worst * ROT (Right occiput transverse) * ROA (Right occipital anterior) |
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What is the fetal position called where the baby is upright in the uterus with it's feet up near the ears and the bottom presenting first? |
Frank Breech position |
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How does a nurse tell the position of the baby in the uterus? |
* Location of the heartbeat on the mother's abdomen * Leopold's maneuvers (laying hands on mom's abdomen to determine baby's position) |
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What is mentum? |
Facial presentation of the baby |
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What is the brow? |
The top of the head presentation of the baby (not the crown or occiput) |
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What is acromion? |
Shoulder presentation of the baby |
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What are the parts of contractions on a strip? |
* Increment (going up) * Acme (Peak) * Decrement (going down) |
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What is the phase called in between contractions? |
Resting phase |
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What is VEAL CHOP? |
* Variable - refers to Cord compression * Early Decelerations - refers to Head compression * Accelerations - are Okay * Late decelerations refers to Placental insufficiency |
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What is the lowest part of the baby's drop in heart rate called on a strip? |
Nadir |
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What is CVS and what is it checking for? |
Chorionic Villi Sampling is a procedure where a small amount of placental tissue is removed and tested for chromosomal abnormalities. Risk of early labor is 7%. Cannot be done before 10 weeks. |
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What is an amniocentesis? |
A procedure where a sample of the amniotic fluid is taken and tested for genetic abnormalities and fetal lung maturity. Risk of early labor is less than 1%. |
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What is a NonStress test? |
Fetal monitoring of a mom not in labor. May be required if she is at high risk, have diabetes, not going into labor. Monitoring should be at least 20 minutes and must have fetal movement of at least 2 accelerations in a 20 min. period of 15 seconds long by 15 beats above baseline. |
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Why must a stress test be at least 20 minutes? |
A fetal sleep cycle is 20 minutes. If the fetus is sleeping, then the stress test will need to be longer. |
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What is VAS? |
Vibroacoustic Stimulation. Used if the baby hasn't moved or had accelerations during non-stress test or labor. It is a stimulator placed against the mother's abdomen to hopefully wake the baby. |
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What is a Contraction Stress Test? |
Mom is given a low dose of Pitocin (oxytocin) to incite contractions and the FHR is monitored for decelerations. A positive contraction stress test means the baby has decelerations. Not good. |
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What is the average amount of amniotic fluid? How is it measured? |
8-24 cm. of fluid. Less than that is oligohydramnios and more than that is polyhydramnios. The amniotic fluid index (AFI) is measured with an ultrasound. |
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If there are no accelerations during a non stress test, what is the next step? |
A biophysical profile done with an ultrasound watching fetal breathing, movement, fetal tone, AFI (amniotic fluid index). |
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If a mom is nervous about her baby's movement, what should she do? |
Drink or eat something sugary and lay flat to feel for movement. Should feel 4 movements in an hour or 10 in 2 hours. |
