Maternity Exam 2 Flash Cards

Front 1

What starts labor? ( theories of labor)

Back 1

A combination of factors, such as oxytocin and prostaglandin -biochemical factors in stimulating uterine contractions
Estrogen increases uterine response and progesterone decreases it.
Basically estrogen, oxytocin and prostaglandins help start contractions, while progesterone inhibits.

Front 2

Symptoms of FALSE Labor

Back 2

Irregular contractions
discomfort is localized in abdomen
no change in cervix
contractions do not become closer together
ambulation has no effect

Front 3

Premonitory Signs of Labor: weeks before real labor

Back 3

1- Lightening the fetus settles into pelvic cavity
2-Braxton hicks
3-Babies head pushes agains cervix causing relaxation and effacement
4-Nesting/Burst of energy, cleans house, sets up nursery, as a result of increased epinephrine resulting from decreased progesterone
5-cervix in posterior position

Front 4

Signs of TRUE Labor

Back 4

Bloody show
ROM

1- Regular contractions
2-discomfort begins in back and spreads to abdomen
3-there is progression in cervical dilation and effacement
4-ambulation increases the intensity of contractions
5-contractions increase in duration and intensity

Front 5

ROM- Rupture of membranes... not range of motion ;-)

Back 5

Labor usually occurs within 24 hours, Multiparas sooner, it can either be a big gush or slow trickle

Front 6

PROM- Premature rupture of membranes

Back 6

If sooner than term, will expect to administer antibiotics...as it may lead to uterine infection membrane may actually seal its self, if this does present, temp q 4 and monitor vitals for signs of infection

Front 7

How many stages of Labor are there?

Back 7

4 in all

Front 8

First stage of Labor

Back 8

Onset of labor to complete dilation at 10 cm

3 Phases-

Latent- 0-3 cm contractions mild/ irregular
Active**- 4-7 cm, contrations 5-7 minutes apart and last from 45 secs to 1 min, moderate to strong intensity

Transitional- dilation of 8-10 cm, contractions 1-2 minutes apart and last 60-90 seconds strong intensity

NO PUSHING TILL FULLY DILATED,

Pain meds, up until a certain point.... Kiraly mentions up to 8-9 cm for epidural, not after

Front 9

With multiple vaginal exams, it puts the patient at risk for....

Back 9

Infection

Front 10

Second Stage of Labor

Back 10

Birthing the baby THE MOST PAINFUL PART

when at 10 cm..
can take 1/2 hour plus ( up to three) depending on mom ( primip vs. multip)

Mom will have strong urge to push down, crowning will occur when infant is at +4 + 5 station

may need episiotomy

Front 11

Third stage of labor

Back 11

The delivery of the placenta- it should be automatic, in some cases it may be manually removed....

DO NOT Palpate non contracted uterus-possible eversion

Front 12

TWO priority nursing diagnosis within 24 hours post-partum?

Back 12

Risk for infection
Risk for hemorrhage

Front 13

The fourth stage of labor

Back 13

" The recovery"
placenta is out, mother recovers for 1 hour until transferred to postpartum unit...

if baby doesnt cry, she doesnt go to mom until baby is stable

Front 14

NURSING INTERVENTIONS DURING LABOR

Back 14

* Triage
*emotional support and rest
*progress of labor
*Monitor and document contrx and fhr q 15
*monitor and document maternal vs q 1-4 hrs
*assess pain and provied relief per md order
*provide comfort measures
*explain equipments and procedures
*observe and document time of ROM
*supine hypotension -position on side , pressure of vena cava
*role of coach during active and transitional stages
*assist with pushing during second stage
*record time of delivery and apgar score, spontaneous cry and or resuscitative efforts to infant
*monitor for extra uterine life adjustment
*encourage family bonding
*peri care as needed
*I& O
*IV RL with 18 or 16 gauge needle just incase blood trnasfusion

Front 15

Name 3 breathing techniques- read description in power point ( doubt really will be on test but just for review)

Back 15

Slow chest
Combination
pant-blow
open glottis breathing

Front 16

Elimination

Back 16

monitor urinary output q 2-4
pressure of fetal head reduces bladder tone
a full bladder inhibits labor
if catheterized, remove after delivery

Front 17

Hydration

Back 17

IV to hydrate
pt. diaphoretic, and NPO , up to a certain point they will allow ice chips

Front 18

What IV Solution is used during LABOR and why?

Back 18

Ringers Lactate

its a good volume expander

Front 19

What gauge IV would you expect a woman in labor to have and why?

Back 19

16 or 18 gauge ( may need local anesthetic to start)

because the possibility of blood transfusion

Front 20

What is dilation?

Back 20

the opening of the cervix can be 0-10 cm

Front 21

What is effacement?

Back 21

the thinning of the cervix , 0- 100 %, needs to be 100% to push

Front 22

What is the station?

Back 22

relationship between the presenting part of fetus and mothers pelvis.... the ischial spines of pelvis are midway

Front 23

What does 0 station refer to?

Back 23

the baby being engaged....midway

Front 24

At what station does the baby crown?

Back 24

+3- +4

Front 25

At what station is the babies head out?

Back 25

+5

Front 26

Mechanism of labor

Back 26

passage of fetus thru birth canal involves position changes called cardinal movements, they are spontaneous and mechanical

Front 27

Descent is when there is a ......

Back 27

downward movement thru pelvic inlet thru dilated cervix, reaches posterior vaginal floor, Mom feels like pushing, the widest part ... the head passed through pelivs

Front 28

Flexion

Back 28

pressure from the pevic floor causes head to flex toward chest...
good/ bad attitudes- the degree offlexion they have

Front 29

The best flexion to be in/ the one with the smallest diameter is ?

Back 29

Chin to chest

Front 30

What are the 4 factors affecting labor?

Back 30

1. The passenger- the baby
2.The passageway- the pelvic opening
3.The powers- the contractions and moms effort
4. Psyche- Moms emotional state

Front 31

1.The widest part and most difficult for mom to pass thru vaginal canal is?

2. What overlaps to allow skull to pass thru birth canal?

Back 31

fetal head
cranial bones

Front 32

What are fontanelles? what is their purpose?

Back 32

Soft spaces created by junctures of suture lines, covered by membranes, they compress during delivery to aid in the passage of the fetus


think of molding

Front 33

How is dysfunctional labor measured?

Back 33

friedmans curve- describes progress of two variables over time, dilation of cervix and descent of baby

Front 34

How is fetal position described

Back 34

In 3 letters
1st letter presenting part in relation to moms right or left
2nd letter-presenting part
3rd letter- occiput in relation to moms spine

Front 35

Fetal lie

Back 35

Vertex of breech - longitudinal
horizontal- transverse lie
diagonal- obilique

Front 36

What is Bersion?

Back 36

turning of breech babies manually , done during 2nd stage after epidural, sterile gloves and sonogram guided

Front 37

The passageway refers to the fetus passing through the uterus, cervix, vaginal canal, it is the single most important mechanism of labor... There are four types of pelvis listed for reference

Back 37

gynecoid-50% normal, female pelvis , easy delivery

android-20% true male pelvis, prob c/s

anthropoid- 20-25%, probably assisted vaginal, usually with forceps

platypelloid <5 % women, usually indication for c/s, vaginal birth difficult.

Front 38

the 4 steps that help the clinition determine presentation and posture are know as what?

Back 38

Leopold's Maneuver

Front 39

Leopold's maneuvers are useful because in addition to determining position they

Back 39

give you an idea where to place the fetal HR monitor

Front 40

True Pelvis vs. False pelvis

Back 40

False pelvis is the outer/broader hip bones

True pelvis is the internal narrower portion that holds bladder, rectum and reproductive organs,

There are 3 parts to true pelvis....
the inlet, the mid pelvis, and outlet

think- cephalopelvic disproportion

Front 41

the narrowest part of the true pelvis is the

Back 41

mid pelivs

Front 42

The Powers

Back 42

contractions are primary force in moving fetus through moms pelvis during 1st stage of labor

maternal efforts during the second stage " pushing"

although epidural can alter... monitor amount and effect of medication

Front 43

Psyche

Back 43

psychological response to birth process
* did she prepare for child birth with classes?
* did she have previous child birth? Was it complicated?
* does she have support from sig. other? marital status? abuse? FOB involved?
*Emotional status-anxiety, depression etc.
*culture, cultural influence on response to pain?
*fear anxiety make pain worse

Front 44

EFM- electronic fetal monitoring

Back 44

measures fetal heart rate and uterine contractions

Front 45

Toco measures?

Back 45

uterine contractions externally

Front 46

Cardio measures

Back 46

FHR externally

Front 47

What are the 3 phases of a uterine contraction?

Back 47

a. increment
b. Acme ( peak)
c.Decrement


as contractions intensify , labor progresses

Front 48

Assessment of EFM

Back 48

Intermittent is 20 minutes of standard tracing

continuous for active labor or complications

the durations goes from beginning of 1 contrax, to end of same contrax, in early labor will last around 30 seconds, in active labor can be 60 secs

the frequency; the beginning of on contrax to beg of next, in early labor its about q 5-30. in active q 2-3

if on pitocin and too frequent, d/c pitocin....

** if contractions are too frequent it could cause possible uterine rupture or fetal distress

Front 49

What is the normal fetal heart rate?

Back 49

110-160

Front 50

Internal monitoring

Back 50

more accurate, but disadvantages

do not do for preemies,
will most likely need catheteritization, risk for infection

Front 51

baseline FHR

Back 51

average fetal hr that occurs between contractions, during a 10 minute period 110/120-160

Front 52

Fetal Bradycardia

Back 52

FHR < 110 for 10 minutes, < 100 BPM sign of fetal hypoxia, and a danger sign, seen with prolapsed cord

Front 53

Fetal Tachycardia

Back 53

FHR > 160 for 10 minutes, associated with maternal temp, and infection such as chorioamnionitis ( prom, foul smelling amniotic fluid)

Front 54

Fluctuations in normal heart rate are know as

Back 54

variability, and they are normal and expected, should present on graph as jitters- clinically it is seen as fetal well being
nurses should monitor tracing every 15 min, and it should show 6 to 25 fluctuations
preemies dont have as much variability

Front 55

Causes of decreased variability

Back 55

hypoxemia/acidosis rt fetal distress
fetal sleep cycles, drugs, prematurity, arrhythmias, fetal tachycardia, preexisting neurological abnormality, congential anomolies

Front 56

Nursing interventions for decreased variability of fhr

Back 56

accousitc stimulation to wake fetus, narcan, amnionfusion-decreases cord compression-diliutes miconium, left/ right lateral position or knee chest, notify md, fetal scalp ph, possible emergency c/s. IVF, o2,
Flat tracings or minimal mean fetal distress, must be corrected or delivered

Front 57

Decels in FHR

Back 57

Uterine contrax can effect FHR, by increasing or decreasing, the rate in association with any given contraction

decels can be due to fetal head compression, umbilical cord compression, uterine myometrial vessel compressions

early decels mirror image of contraction, and last as long as the contraction, there are no interventions needed as this is normal( but if occurs inearly labor may be sign of cpd)

Late decels are a problem can signify placental insufficiency, could be related to maternal disease, or too much pitocin, narcotics, reposition of back.... not emergency but need intervention, on the graph late decels follow the contraction, interventions - increase iv flow rate, left lateral position, d/c pitocin, assit with fetal blood sampling, prepare for emergency c/s if decels persit

bradycardia ro prolapsed cord- if not 911 c/s

veal chop

Front 58

Variable decelerations of fhr

Back 58

cause is compression of cord
shape on graph is u or v. occur in no relation to contractions, clincially significant bc it could mean baby is lying on cord, occurs more with rom, less fluid as cushion....

nursing interventions, o2 mask, iv fluids, change maternal position, take pressure of cord, continue monitoring efm
amnioinfusion, sterile warm 500 ml, ns/rl into uterus,

Front 59

V C
E H
A O
L P

Back 59

variable decels-cord compression
early decels-head compression
accelerations ok
late decels -placental insufficiency

Front 60

vacuum assisted delivery

Back 60

dick shaped cup placed on scalp and vacuum pressure applies.... pull will deliver infant, not done in preemies bc soft skull

can cause caput for 1 week
risk for hematoma

Front 61

What is VBAC?

Back 61

Vaginal Birth after Cesarean

ok after lower abd incision, not after classical (vertical), as there is a risk for uterine rupture
shouldnt be done in smaller hopsitals

Front 62

Cesarean- types of uterine incisions

Back 62

Low transverse=bikini cut
most desired and less visible right above pubic bone

verticle= classical incision, visible scar, emergency cases

Front 63

What are the major indications for C-section

Back 63

-Active genital herpes or overgrowth of genital warts
-HIV infection
-CPD
-severe HTN (toxemia)
-failure to progress with labor
-previous c/s with vertical incisions
-placenta previa
-placental abrubtion
-cord prolapse
-breech positions
-macrosomnia ( large fetus)
-fetal distress
-transverse lie

Front 64

Induction of labor- without meds

Back 64

amniotomy: artificial rom, monitor for prolapsed cord, continue efm

cervix must be ripe before labore is induced, effacement and dilation ( cervidil)

Front 65

Induction of labor with meds

Back 65

pitocin is the drug of choice, 1/3 of all deliveries

-fetal maturity 39 weeks even tho full term is 37 weeks,
-cervical readiness- ripe. 3 cm dilated
-longitudinal lie, presenting part engaged (if not c/s)
-fetal demise, arrest in labor

Induction give pitocin IVPB increase slowly as labor progresses, shut of if contractions are too strong

Front 66

Induction of labor, nursing interventions

Back 66

-IVF
-IVPB pitocin if ordered
-gradually increase pitocin to establish effective contraction pattern
-monitor contractions for frequency, rate and intensity
-maternal bp, pulse, temp,
-i and o
notify md of progress
-chart q 15 on graph
-prepare for the delivery- radiant warmer, o2, suctioning,
-if hyper stimulation of uterus, shut of pitocin as per md

Front 67

What is Bishop's score

Back 67

it determines cervical readiness to determine if it is ready or will respond to induction of labor

Front 68

Cervical ripening

Back 68

artificial softening of cervix before labor, cervidil - prostaglandin gel 0.5 mg or dinoprostone 10 mg, 2-3 times q 12 for max of 24 hours, most need several doses

Front 69

The treatment of pain relief during labor depends on

Back 69

- clients tolerance of pain
-ability to focus on labor
-ability to remain motivated

70 % do epidural
alternative pain relief methods?
warm bath , breathing, massage

Front 70

methods of pain relief should exhibit

Back 70

-simplicity
-safety
-preservation of fetal homeostasis

monitor client closely bp, pulse, rr, fhr, anesthetic levels, maternal o2 level

Front 71

Analgesia is

Back 71

loss of sensitivity to pain

Front 72

pain meds can be sufficient to get through labor along with alternative methods such as

Back 72

aromatherapy, music, visualization

Front 73

What are the factors that need to be considered whey using systemic drugs?

Back 73

-effects on mom
-effects on baby all systemic drugs cross placenta by simple diffusion
-fetal liver and kidney function as the are immature, and drugs metabolize slowly and have longer lasting effects
- affect progress of labor, can slow labor

Front 74

Assessment for analgesia/sedation during labor

Back 74

- assessment of mom, informed consent and stable vitals
-assessment of fetus, fetal hr 110-160 with no late or variable decels, variability average, normal fetal movement and accelerations present, term fetus, no miconium,

-Labor assessment
-contraction pattern well established
-cervix 4-5 cm dilated in primips and 3-4 in multips
-progressive decent of presenting part
-no complications
delivery at least 2-3 hours away

Front 75

Narcotic pain relief

Back 75

look at slide not focusing much on drugs not listed in blueprint

Front 76

Anesthesia

Back 76

reversible loss of sensation and movement in region of the body

Front 77

types of anesthesia

Back 77

Local---goes to a local area

Pudendal Block- reginal anesthesia, injection of local anesthetic around nerve or spinal cord but a limited part of the body
-i.e epidural , spinal

General anesthesia- total induced unconsciousness

Front 78

Epidural Anesthesia

Back 78

Usually marcaine into epidural space between 3rd and 4th lumbar, catheter left in place, single does or continuous infusion, given before active labor established, good pain relief w/o cns depression of mom or baby, blocks from t-10-s-5
epidurals slow labor and may need pitocin

Front 79

Epidural Complications

Back 79

Mom hypotension can lead to fetal bradycardia and late decels
-should have 1000 mls rl pre-loaded ivf
-tx hypotension with ephedrine to vasoconstrict
-may become total spinal block, or resp paralysis
-can interfere with moms ability to push
-can elevate moms temp
-loss of bladder sensation-foley cath
-longterm problems such as back ache, head aches, migraines, neck aches tingling in hands or fingers

Front 80

Nursing Technique for epidural anesthesia

Back 80

- get informed consent
-monitor bp, p, fhr, q 1-2 min for 15 minutes after bolues of local anesthesia
-maintain verbal communication with patient
-hydrate with rl 500 ml to 1000 ml to maintain bp
-patient maintains lateral or sitting position-
-anesthesiologist identifies epidural space and catheter is threaded3 cm
-test does is given, nurse helps observe for signs and symptoms of toxicity such as metalic taste , ringing in ears, or palpitations
- place head in lateral or low semifowler position to prevent aortocaval compression,
-maternal bp monitored q 5-15 min
-assess analgesia level with pain scale

Front 81

Spinal Anesthesia

Back 81

subarachnoid space , provides spinal block, passes through dura and csf reached, meds are inserted and needle is removed

- the spinal cord is above that site
-used in c/s and blocks from level of 8th thoracic dematome ( xiphoid process)
-longer anesthetic effects
-should feel nothing
-needs narcotic onboard.... ie marcain and fentanyl....
- narcs cause resp depression, nausea, vomiting, check loc, , itching, urinary retention

Front 82

Complications with spinal anesthesia

Back 82

-Hypotension- a 20% decrease from baseline
manage by L side positioning, and hydration w 500 -1000 cc of rl/ns, ephedirine 5-10 mg

Spinal headache-CSF fluid leaks from dura matter
treatment - lie flat for a few hours, vigorous iv hydration, blood patch, obseve vitals

Front 83

Post -OP pain management

Back 83

Given by, IVP, IM or PCA
meds such as fentanyl, morphine, demerol

vital signs monitored closely q 15 for first hour

patient education, teaching on pca

Front 84

General Anesthesia

Back 84

total induced unconsciousness

-fetal distress.... failed epidural, spinal, allergy

-pre- o2, wedge under right hip to prevent vena caval compression

-induced unconsciousness by inhalation or iv therapy

-halothane, ketamine, nitrous oxide,etc
-endotracheal intubation
-cricoid pressure on trachea occules esophagus and prevents aspiration

-after intubation, additional meds via iv or et tube to maintain anesthesia for remainder of surgery
-used for emergency delivey

- complications are pulmonary aspiration of gastric contents, failied intubation, aspiration pneumonia, neonatal depression, npo for about 8 hours

Front 85

What changes happen physiologically during the post partum period

Back 85

-reproductive system system changes, uterus begins to contract after birth and delivery of placenta
-placental site seals
-involution of uterus... uterus reduces gradually for 8 to 10 days, pt. at risk for hemorrhage until complete
-oxytocin is released to help contract uterus