Chapter 66

Front 1

postpartum

Back 1

after delivery

Front 2

How many stages are in Labor?

Back 2

four stages

Front 3

_is a series of events during which a woman's uterus contracts and expels a fetus and completes the birthing process.

Back 3

Labor

Front 4

What happens during stage I of Labor?

Back 4

Dilation: uterine contractions cause the cervix os of the cervix to open and move the fetus downward into the birth canal.

Front 5

How many phases do Stage I of labor have?

Back 5

three: latent, active, and transitional

Front 6

What happens during stage II of labor?

Back 6

Expulsion: uterine contractions continue and increase in intensity until the baby is delivered through the vaginal opening

Front 7

What happens during stage III of labor?

Back 7

Placental: uterine contractions expel the placenta after the delivery of the newborn

Front 8

What happens during stage IV of labor?

Back 8

Recovery: uterine contractions continue and close off open blood vessels to prevent excessive blood loss.

Front 9

How long does postpartum last?

Back 9

last until the end of the sixth week after the birth

Front 10

CNM

Back 10

certified nurse midwife

Front 11

NP

Back 11

nurse practitioner

Front 12

PA

Back 12

physician assistant

Front 13

What is a birthing room?

Back 13

a room where both the labor and the delivery take place

Front 14

LDRP

Back 14

labor/delivery/recovery/postpartum rooms

Front 15

_is a written document in which the expectant mother expresses her desires for labor and birth.

Back 15

birth plan

Front 16

What are some items that may be included in the birth plan?

Back 16

-The woman's choice of a partner for support during labor

-The woman's feelings about having an intravenous (IV), electronic fetal monitoring, or an episiotomy

-The type of pain-relief measures the woman desires

Front 17

What is the nurse's role when helping the mother with the birthing plan?

Back 17

to inform the woman or couple preparing a birth plan of the policies of the birth setting and birth attendant, and of the need for flexibility if complications develop.

Front 18

_is a term used to compare the position of the fetal spinal cord (the "long part") to that of the woman.

Back 18

Lie

Front 19

What is the normal lie of the fetus?

Back 19

longitudinal (up and down), which means the fetal spine is parallel to the woman's

Front 20

_the fetus is lying crosswise in the uterus and cannot be delivered until the lie is altered.

Back 20

transverse lie

Front 21

_refers to the body part of the fetus that lies closet to the pelvis and will enter the birth canal first.

Back 21

presentation

Front 22

What is the usual presenting part?

Back 22

the head: aka the cephalic presentation

Front 23

Why does vertex presentation occur?

Back 23

occurs when the fetal head is flexed well against the fetal chest

Front 24

What are the types of cephalic presentations?

Back 24

vertex, face, and brow

Front 25

_is when the buttocks, foot, or knee is the presenting part.

Back 25

breech presentation

Front 26

_is the term used when the fetal head has moved downward in the birth canal until it can no longer be pushed up and out of the pelvis.

Back 26

Engagement

Front 27

another name for "first time delivery"

Back 27

nulliparous

Front 28

In nulliparous women, engagement often happens when?

Back 28

before the onset of labor

Front 29

Another name for having a history of more than one birth

Back 29

parous

Front 30

In parous women, engagement usually occurs when?

Back 30

during labor

Front 31

_refers to the relationship between standardized points on the presenting part of the fetus to a designated point on one of four quadrants of the woman's pelvis.

Back 31

Position

Front 32

refers to a woman who has never been pregnant

Back 32

nulligravida

Front 33

refers to a woman who has never delivered a live child; also seen as "para 0"

Back 33

nullipara

Front 34

relates to the woman who is pregnant for the first time

Back 34

primigravida

Front 35

is the term for a woman who has had more than one pregnancy

Back 35

multigravida

Front 36

is the term for a woman who has given birth to one child

Back 36

primipara

Front 37

is a woman who has given birth to more than one viable infant

Back 37

multipara

Front 38

What are the three breech positions?

Back 38

complete breech, Frank breech, kneeling

Front 39

Breech type

the fetus has both legs drawn up, bent at both the hip and the knee

Back 39

complete breech

Front 40

breech type

Either one or both legs are extended at the hip, flexed at the knee

Back 40

Frank breech

Front 41

breech type

Either one or both legs are extended both at the hip and knee

Back 41

Footling breech

Front 42

In all types of ____, the sacrum is the assigned point.

Back 42

breech presentations

Front 43

Some positions of the fetus make delivery difficult or dangerous. For example, in a footling breech position, there is a chance of

Back 43

the umbilical cord could prolapse bc there is so much empty space with the uterus.

Front 44

What are the common variables of labor, know as the 4 P's?

Back 44

passage, passenger, powers, psyche

Front 45

The passage includes

Back 45

the diameter of the body pelvis and its soft tissues

Front 46

The passenger includes

Back 46

the fetus, umbilical cord, and placenta

Front 47

The powers include

Back 47

the uterine contractions

Front 48

the psyche include

Back 48

the process of birthing, the attitude and behaviors of the parents, and the evaluation process of the stages of labor

Front 49

_is the settling of the fetus into the pelvis

Back 49

lightening

Front 50

_is usually painless, short, and irregular. They are also known as false labor.

Back 50

Braxton-Hicks contraction

Front 51

A mucous plug seals the cervix during pregnancy, Just before labor, the cervix opens slightly and this plug dislodges. At the same time, some capillaries of the cervix rupture, staining the sticky mucus a pinkish color. The process is called__

Back 51

the show or bloody show

Front 52

What does "the show or bloody show" indicate

Back 52

labor is about to begin

Front 53

True vs False labor

contractions

Back 53

false - irregularly spaced

True- Regular, rhythmic

Front 54

True vs False

duration, frequency, and intensity

Back 54

False-variable

True-increases and becomes closer and stronger over time

Front 55

True vs False

Effect of position or activity change

Back 55

False-contractions lessen

True- Becomes stronger with ambulation or activity

Front 56

true vs false

Location where felt

Back 56

False-primarily in low abdomen

True- starts in back, radiate to abdomen

Front 57

True vs False

Cervical change and presence of "show"

Back 57

False- none

True- progressive effacement and dilation, show is usually present

Front 58

Contractions help create _a_ and _B_ of the softened cervix.

Back 58

a- effacement (thinning)

b- dilation (opening)

Front 59

What is the most important difference between true and false labor is

Back 59

whether or not the cervix changes

Front 60

_of the uterine muscles bring about the birth of the fetus.

Back 60

contractions

Front 61

When the contraction ends and the uterus is at rest, the muscles remain slightly shorter that when it started. This is called_

Back 61

retraction of the muscles.

Front 62

Three stages of labor contractions

Back 62

1. Increment

2. Acme

3. Decrement

Front 63

Increment phase

Back 63

This phase, during which the contraction builds from the resting phase to full strength, is longer than the other two combined

Front 64

Acme phase

Back 64

This is the time during which the contraction is at full intensity. This phase becomes longer as labor progresses

Front 65

Decrement phase

Back 65

during this phase, the uterine contraction eases, until the resting state is achieved.

Front 66

The time between contractions is called_ and is equally as important as the contractions themselves.

Back 66

relaxation time or rest interval

Front 67

The fetus lies in a two-layered sac filled with amniotic fluid commonly called__

Back 67

"bag of waters"

Front 68

The breaking of the bag of water without medical intervention is termed

Back 68

spontaneous rupture of membranes (SROM)

Front 69

In about 75% of births, the birth attendant may perform artificial rupture of the membranes (AROM), a procedure called

Back 69

amniotomy

Front 70

amniotomy is performed using a special hook called

Back 70

amniohook

Front 71

What should you do if you see any yellow, green, or cloudy amniotic fluid?

Back 71

report immediately! Normal amniotic fluid is clear and colorless, and slightly salty odor.

Front 72

Yellow or green amniotic fluid may indicate

Back 72

the fetus has passed meconium

Front 73

meconium is

Back 73

stool passed by the fetus

Front 74

White or cloudy amniotic fluid may indicate what

Back 74

pus in response to infection

Front 75

What is the Nitrazine test?

Back 75

a simple test that determines if the amniotic sac has ruptured. it detects the pH of the fluid

Front 76

What color will the Nitrazine strip turn if the pH is correct for amniotic fluid?

Back 76

blue, but it may also turn blue for blood and urine so it's important not to touch other body fluids with the paper.

Front 77

What do you record when providing nursing care to a woman whose membranes has ruptured?

Back 77

time, method of rupture- SROM or AROM, color of fluid, and fetal heart rate

Front 78

What is an important nursing intervention that should be performed once the membranes have been ruptured?

Back 78

get a baseline temperature and check her temp every two hours until delivery

Front 79

What is the first stage of Labor?

Back 79

Dilation

Front 80

_ begins with the onset of true labor contractions and ends with complete cervical effacement and dilation.

Back 80

stage I of labor (dilation)

Front 81

Stage I of dilation is divided into three phases: ?

Back 81

latent, active, and transitional

Front 82

latent stage freq of contractions, duration, intensity, and dilation

Back 82

5-20 min contractions, 30-50 sec duration, irregular & mild intensity, 0-4cm dilation

Front 83

Active phase freq, duration, intensity, and dilation

Back 83

2-4 min contractions, 45-60 sec duration, reg (moderate to strong) intensity, and 4-8 cm dilation

Front 84

transitional phase freq, duration, intensity, and dilation

Back 84

2-3 min freq, 60-90 sec duration, reg (very strong) intensity, 8-10 cm dilation

Front 85

What are the two distinct changes that occur during stage I

Back 85

effacement and dilation

Front 86

_refers to the thinning of the cervix

Back 86

effacement

Front 87

_the cervical os(opening), normally held close in a tight circle, begins to open.

Back 87

dilation

Front 88

What is Stage II of the stages of labor

Back 88

Expulsion

Front 89

_begins with the complete cervical effacement and dilation and ends with the expulsion of the fetus.

Back 89

stage II (expulsion)

Front 90

The rectum dilates, the perineum bulges, and the top of the fetal head appears. This know as

Back 90

crowning

Front 91

What is Stage III of the stages of labor?

Back 91

Stage III (placental)

Front 92

_extends from the time the newborn is delivered until the placenta and membranes are expelled.

Back 92

Stage III (placental)

Front 93

What is Stage IV of the stages of labor?

Back 93

Stage IV (recovery)

Front 94

_includes the first 1 to 4 hours following the expulsion of the placenta. During this time, the woman's body begins the process of involution.

Back 94

Stage IV (recovery)

Front 95

_ is the process of the woman's reproductive organs returning to their normal pregnant size.

Back 95

involution

Front 96

What are the two critical phases in Stage IV (recovery)

Back 96

involution and bonding

Front 97

Nursing Alert

What is an extremely important question that you should ask the woman upon admission that can prevent a life threatening problem?

Back 97

allergies to betadine, lidocain, and any other drugs, and latex

Front 98

Why should you ensure the woman's bladder is empty?

Back 98

a full bladder prevents the fetal head from descending into the woman's pelvis and thereby slows labor's progress. It may also result in trauma to the bladder.

Front 99

A small catheter is inserted into the epidural space within the spinal column. This is called _

Back 99

epidural anesthesia, aka lumbar epidural block

Front 100

__is rarely used because the client receiving this type of anesthesia is asleep when the newborn arrives. Babies born this way may not breathe spontaneously and may be difficult to awaken.

Back 100

general anesthesia

Front 101

What should you report for a woman receiving anesthesia that can be fatal to the woman and/or the fetus?

Back 101

-Inability to move the legs, numbness in the legs, ringing in the ears, dizziness, metallic taste, hypotension or seizures

Front 102

What is the normal fetal heart rate (FHR)?

Back 102

120-160

Front 103

_ is to record the rate and quality of the fetal heartbeat during contraction and relaxation.

Back 103

fetal monitor

Front 104

a pressure-sensitive device used to monitor the frequency of the contractions.

Back 104

tocodynamometer

Front 105

upper curve of the uterus

Back 105

fundus

Front 106

_is the vaginal discharge that occurs following delivery.

Back 106

Lochia

Front 107

is seen for the first 2 days, It is mostly red and bloody, It should smell like blood (slightly metallic); a foul odor indicates infection.

Back 107

Lochia rubra

Front 108

_starts after the bleeding diminishes, The color of the lochia changes to pink or brown-tinged for approximately the next 7 days. It has a slightly earthy odor.

Back 108

Lochia serosa

Front 109

which is yellow or white, starts on about day 10. At this point, the lochia has decreased greatly in amount. It has an earth smell.

Back 109

Lochia alba

Front 110

a thin yellowish secretion that provides vitamins and immune substances that protect the newborn against infection.

Back 110

colostrum

Front 111

the secretion of breast milk

Back 111

lactation

Front 112

What two hormones are responsible for the production of milk?

Back 112

prolactin and oxytocin

Front 113

_is the response of the breast to the presence of an increased volume of milk and a sudden change in hormones.

Back 113

engorgement

Front 114

What measures help relieve engorgement for nursing mothers?

Back 114

-wearing a supportive bra, freq breastfeeding, applying warm packs to the breast for 15 minutes before nursing or standing in the shower

Front 115

What measures help relieve engorgement for non-nursing mothers?

Back 115

wearing a supportive bra, avoiding excessive fluid intake, placing cold packs on her breasts 3 to 4 times per day, avoiding stimulation (hot showers), using medications (acetaminophen) as prescribed for discomfort

Front 116

What are some abnormal urinary system findings for a mother after birth?

Back 116

voiding in small amounts, residual urine, dysuria, bladder infection, urinary retention

Front 117

What are after-pains?

Back 117

painful cramps that occur bc the uterine muscles are contracting back to normal size