N105 Intrapartal Nursing

Front 1

descent of presenting part as it becomes engaged. It may be gradual or sudden.

Back 1

lightening

Front 2

lightening is much more likely to be noticeable with primigravidas ___-___wks before labor.

Back 2

2-3

Front 3

lightening will generally occur about ___-___ days prior to labor

Back 3

10-14

Front 4

________ occur throughout pregnancy, no cervical change

Back 4

braxton hicks

Front 5

Cervical changes: prior to labor the cervix is ___, relatively ____ and _____. As labor approaches, it becomes ____, _____ and may slightly ______. These biochemical changes are referred to as :

Back 5

long, firm, closed.

softer, shorter, dilate

ripening of the cervix

Front 6

with effacement and dilation, it is loosened and expelled causing a small amt of breakage of capillaries in the cervix.

Back 6

mucous plug

Front 7

why is there an increase in mucous secretions?

Back 7

pressure of fetal head

Front 8

what color should the bloody show discharge be?

Back 8

light pink

Front 9

what is abnormal for the bloody show to be?

Back 9

frank bleeding with d/c of the plug

Front 10

what are the 4 p's affecting pregnancy?

Back 10

passenger
passage/pelvis
power
psyche

Front 11

what is the largest part of the passenger?

Back 11

fetal head

Front 12

sutures allow for overlapping which permits the head to decrease in size when the head passes through the pelvis

Back 12

molding

Front 13

when is molding of the head usually returned to normal shape?

Back 13

within 3days

Front 14

_______ diameter is the largest of the transverse diameters (9.25cm)

Back 14

biparietal

Front 15

fontanels form where?

Back 15

suture intersections

Front 16

this is the relationship between the maternal long axis and fetal long axis

Back 16

fetal lie

Front 17

99% of the time, what type of fetal lie is the baby in?

Back 17

longitudinal (mom and baby's spine are parallel)

Front 18

______ lie: baby's spine is sideways to moms spine

Back 18

transverse lie

Front 19

________lie: fetal spine diagonal to mom's spine

Back 19

oblique

Front 20

relationship of various parts of the fetus to itself.

Back 20

fetal attitude

Front 21

3 types of fetal attitude:

Back 21

flexed (normal)
Deflexed: head extended
military (head straight on)

Front 22

presenting part of portion of fetus that enters pelvis first

Back 22

fetal presentation

Front 23

96% of the time, the fetal presentation is:

Back 23

vertex/cephalic: head, occiput

Front 24

This is the most common type of breech. the legs are completly extended across abd.

Back 24

frank

Front 25

upside down normal: all parts flexed to abd but buttocks are coming first

Back 25

full/complete breech

Front 26

this type of breech is when one or both feet present first

Back 26

footling breech

Front 27

this is the relationship between the fetal part and pelvis

Back 27

fetal position

Front 28

what abbreviation is used for occiput?

Back 28

O

Front 29

what abbreviation is used for brow?

Back 29

Br

Front 30

what abbreviation is used for face/chin?

Back 30

M (mentum)

Front 31

what abbreviation is used for shoulder/scapula?

Back 31

Sc

Front 32

what abbreviation is used for sacrum/breech?

Back 32

S

Front 33

The fetal position is described how?

Back 33

in 3 letters

Front 34

What does the first letter refer to? (fetal position)

Back 34

which side of maternal pelvis: R or L

Front 35

what does the second letter refer to? (fetal position)

Back 35

fetal part presenting

Front 36

what does the third letter refer to (with fetal position)

Back 36

quadrant of maternal pelvis: anterior/posterior/transverse

Front 37

Posterior positions such as LOP/ROP cause:

Back 37

back labor
ineffectual UC's
prolonged labor

Front 38

you should not do leopold's maneuver until

Back 38

32+wks

Front 39

the 1st leopold's step:

Back 39

what's in the fundus?

Front 40

Feel the fundus to locate th buttocks. (they should feel:

Back 40

smooth, firm, nonballotable

Front 41

step 2 of leopolds maneuvers:

Back 41

where's the back?

Front 42

step 3 of leopold's maneuvers:

Back 42

what is the presenting part, what is at the symphysis?

Front 43

with step 3 of leopold's maneuvers, grasp above the pubic symphysis. The head should be

Back 43

hard and independently mobile

Front 44

step 4 of leopolds determines :

Back 44

the attitude

Front 45

if the baby is presenting vertex, the FHTs (fetal heart tones) will be where?

Back 45

lower quadrants

Front 46

if the baby is in a breech position, the FHT will be where?

Back 46

above umbilicus

Front 47

when the presenting part is at the level of the ischial spines

Back 47

engagement

Front 48

relationship between the maternal ischial spines and presenting part

Back 48

station

Front 49

4 types of pelvis's

Back 49

gynecoid
anthropoid
android
platypelloid

Front 50

this is the typical female pelvis (ideal for childbirth).

Back 50

gynecoid

Front 51

the ___________ pelvis is well rounded, forward and back

Back 51

gynecoid

Front 52

this is a typical male pelvis. It is heart shaped. (shallow posterior portion/pointed anterior)

Back 52

android

Front 53

this type of pelvis is fairly common. It is narrow transverse/longer ap (anterior posterior)

Back 53

anthropoid

Front 54

this type of pelvis is oval and smooth/shallow ap (anterior posterior)

Back 54

platypelloid

Front 55

the pelvic joints are:

Back 55

symphysis pubis
r and l sacroiliac jts
sacrococcygeal jt

Front 56

what increases the mobility of jts?

Back 56

hormones (progesterone)

Front 57

the bony pelvis is assessed by clinical pelvimetry:

Back 57

vag exam. bones palpated with fingers

Front 58

when should the bony pelvis be assessed?

Back 58

early pregnancy and in labor

Front 59

(AP diameter) This is the distance between the lower border of the symphysis pubis and the sacrum (vag exam)

Back 59

diagonal conjugate

Front 60

**how do you calculate the obstetrical conjugate?

Back 60

diagonal conjugate-2cm

Front 61

-distance b/n inner surgace of symphysis pubis and sacrum
-shortest diameter b/n inner aspect of pubis and the sacrum

Back 61

obstetrical conjugate

Front 62

the _______ diameter is the greatest diameter of the pelvic inlet

Back 62

biischial diameter

Front 63

this is an old way of plotting the progress of labor. Should not be used as no two women labor alike.

Back 63

freidman's curve

Front 64

a first time mom- once at 5cm, they'll dialate :

Back 64

1cm q2h

Front 65

repeat mother: once at 5 cm, dialate:

Back 65

1 cm q hour

Front 66

thinning and shortening of the cervix

Back 66

effacement

Front 67

primips will efface completely

Back 67

before dilation

Front 68

multips dilate and efface:_______________. when does it begin?

Back 68

at the same time

wks before

Front 69

opening of cervical os from mm to 10cm or size of fetal head

Back 69

dilitation

Front 70

what three things cause the cervix to dilate?

Back 70

UC's
pressure of BOW
fetal head

Front 71

In the uterus, the line b/n cells that contract and cells that retract

Back 71

retraction ring

Front 72

Upper uterine muscle cells _____ and______-uterus gets thicker

Back 72

contract
shorten

Front 73

the lower uterine segment (cells) ____, ____ and ______ allowing baby to be expelled downward

Back 73

retract
elongate
thins

Front 74

differentiation b/ upper and lower segments is separated by the

Back 74

retraction ring

Front 75

the contraction cycle has ___ phases or parts of the muscular contraction of the uterus

Back 75

3

Front 76

_____________: longest, building of the muscular contraction, begins in fundus and spreads throughout uterus

Back 76

increment

Front 77

where does the woman feel the increment part of the contraction?

Back 77

anywhere, back, low cramps etc.

Front 78

this is the height of the contraction, most painful

Back 78

acme

Front 79

this is when the UC subsides

Back 79

decrement

Front 80

the length of time contraction lasts in seconds is called:

Back 80

duration

Front 81

the duration of contractions in active labor:

Back 81

60-90 sec

Front 82

the strength of contraction by palpation

Back 82

intensity

Front 83

the intensity of a contraction can be :

Back 83

mild-moderate
strong

Front 84

____________:time between beginning of one contraction to the beginning of the next

Back 84

frequency

Front 85

(in active labor) we want the freq of contractions to be:

Back 85

2-5 mins apart and regular

Front 86

_______________: utilizes a tokodynamometer (pressure transducer) that picks up changes in pressure. (placed over fundus and records pressure changes)

Back 86

external monitoring

Front 87

what is a more accuracte way of electronic monitoring?

Back 87

internal monitoring

Front 88

what are the disadvantages of internal monitoring?

Back 88

invasive
maternal/neonate infection
uterine perforation

Front 89

internal monitoring can only be done if:

Back 89

BOW is ruptured

Front 90

set of maneuvers by the fetus to move through the birth canal

Back 90

mechanisms of labor

Front 91

what first 3 maneuvers occur virtually simultaneously?

Back 91

engagement
descent
flexion of fetal head

Front 92

this mechanism of labor is when the largest diameter of presenting part is at level is ischial spines

Back 92

engagement

Front 93

this starts slowly and picks up through labor. it is when the presenting part moves down through the pelvis

Back 93

descent

Front 94

occurs as descending head meets resistance from pelvic floor, cervix or pelvic wall so the smallest diameter passes through the pelvis.

Back 94

flexion of the fetal head

Front 95

when the fetal head reaches the perineum the neck acts as a pivot and the fetal head extends upwards as it passes under the symphysis pubis and the head is born

Back 95

extension

Front 96

after extension, ____ ___ occurs (now shoulders and body change position into AP)

Back 96

external rotation (really happens internally)

Front 97

______ shoulder is delivered, followed by _____ shoulder

Back 97

anterior
posterior

Front 98

after the head is birthed, it rotates to either the right or left position (the position it was in when it was engaged)

Back 98

restitution

Front 99

Once shoulders are delivered rest of body is easily born. birth occurs when the entire body has been born

Back 99

expulsion

Front 100

head rotates to fit AP diameter of pelvic outlet so that head passes through the pelvic cavity.

Back 100

internal rotation of the HEAD ONLY

Front 101

____% of bags break before labor begins

Back 101

12

Front 102

contractions become stronger with ____ and therefore the labor speeds up

Back 102

rupture of membranes

Front 103

role of the nurse with rupture of membranes: History:

Back 103

-time of break?
-color of fluid?
-baby moving?
-cord come out?
-how much water?

Front 104

role of the nurse with rupture of membranes: check fetal heart rate

Back 104

make sure there is no variation in FHR

Front 105

role of nurse with rupture of membranes: Check _______

Back 105

perineum

Front 106

role of nurse with rupture of membranes: assess color and consistency

Back 106

shouldn't have consistency; no foul odor

Front 107

role of nurse with rupture of membranes: Minimal vaginal exams

Back 107

advocate for pt.

Front 108

what test uses pH paper to confirm membranes have ruptured?

Back 108

nitrazine test

Front 109

nitrazine test will turn from yellow to ____ in presence of amniotic fluid

Back 109

blue

Front 110

if a swab of the cervix is taken, and put on a microscope slide, it will look like _____. This is called ______ and is 100% accurate in determining ROM>

Back 110

a fern
ferning

Front 111

Meconium precautions: if meconium is in fluid, they have to:

Back 111

wall suction the baby to prevent pneumonia

Front 112

10-15% women demonstrate vena cava syndrome (hypotension, tachycardia). Place them:

Back 112

in left lateral position

Front 113

_____ rises with contractions and returns to pre labor level between UCs

Back 113

BP

Front 114

___ decreases with UC's due to increase blood volume

Back 114

pulse

Front 115

strong contractions will diminish or stop flow to

Back 115

uterine artery

Front 116

advantage of external monitoring:

Back 116

non invasive
doesn't req. ROM and fetal descent

Front 117

woman's vulva is washed with antiseptic and electrode is screwed into fetal presenting part=break in continuity of the fetal skin

Back 117

internal monitoring

Front 118

disadvantage of external monitoring:

Back 118

-not accurate
-artifact
-woman must lie on back
-req. decreased maternal mvmt

Front 119

transducer strapped onto maternal abd and placed over fetal back.

Back 119

external monitor

Front 120

this is the most reliable way of obtaining FHT

Back 120

internal monitoring

Front 121

risks of internal monitoring incl:

Back 121

uterine infection
neonate infection

Front 122

what is internal monitoring used for?

Back 122

high risk labor

Front 123

rate of the fetal heart b/n contractions

Back 123

baseline rate

Front 124

normal baseline rate of fetus is:

Back 124

110/120-160bpm

Front 125

increase in FHR in RELATIONSHIP to contractions:

Back 125

accelerations

Front 126

this is a sign of fetal strengh when occuring with movement

Back 126

accelerations

Front 127

decrease in FHR in RELATIONSHIP to contractions

Back 127

decelerations

Front 128

if early decelerations are occuring due to head compression, what should the rn do?

Back 128

notify practicioner, set up for delivery

Front 129

early decelerations are common:

Back 129

late in labor

Front 130

early decels are generally

Back 130

benign

Front 131

These types of decels are due to utero-placental insufficiency and fetal hypoxia

Back 131

late decels

Front 132

if women is experiencing late decels, the rn should:

Back 132

administer Oxygen

Front 133

these types of decels are due to the compression of the umbilical cord

Back 133

variable decels

Front 134

if the woman is experiencing variable decels, the rn should

Back 134

change her position

Front 135

______ signifies fetal well being. NORMAL irregularity of the cardiac rhythm

Back 135

variability

Front 136

_________>160bpm lasting for more than 10 minutes

Back 136

fetal tachycardia

Front 137

______ is often the first sign of fetal distress as the fetus is trying to compensate for problems

Back 137

fetal tachycardia

Front 138

_______tachycardia is common with movement and and isn't pathological

Back 138

transient

Front 139

_________<120bpm lasting for more than 10 minutes

Back 139

fetal bradycardia

Front 140

Nsg care for FHR irregularities:
1. examine_______
2. shut off ______
3. administer________
4. place on _____
5.increase
6. monitor ___ and for ______
7. notify _____/_____
8. record all _____

Back 140

1.FHR pattern
2. pitocin
3. oxygen 7-12L/m without H2O
4. left side
5. rate of IV
6. VS/prolapsed cord
7. physician/midwife
8. procedures

Front 141

the fetal blood pH should be

Back 141

7.3-7.35

Front 142

pH of 7.25-

Back 142

acceptable (but will watch and repeat)

Front 143

pH of 7.24-7.2 is

Back 143

pre acidotic; repeat in 15 min (may do C/S, Vacuum)

Front 144

pH below 7.2=

Back 144

fetal distress; stat C/S, Vacuum

Front 145

enc. to empty bladder freq. to

Back 145

give more room

Front 146

a full bladder will result in :

Back 146

diminished/ineffective contractions

Front 147

enc voiding q

Back 147

2-3hr

Front 148

what is woman is unable to void?

Back 148

cath b/n contractions

Front 149

hard stools in rectum will

Back 149

impede descent

Front 150

3 types of narcotics given to take edge off, but doesn't take pain away

Back 150

stadol
demerol
nubain

Front 151

when is the lumbar epidural administered?

Back 151

3-4cm dilated

Front 152

nursing role with epidural: position client:

Back 152

knees elevated on stool
head flexed
back arched

(can lie on side with knees pulled up and back "cat arched")

Front 153

how much IV fluid is given before an epidural?

Back 153

500-1000mL (lactated ringers)

Front 154

6-8 mins after epidural, there will be:

Back 154

a long decel or variables

Front 155

__________ births views birth as a trauma, and sets goal of minimizing trauma, dim lights, soft noises, warm environment

Back 155

leboyer

Front 156

how many stages of labor are there?

Back 156

4

Front 157

Onset of labor to full dilation and effacement

Back 157

first stage

Front 158

full dilation to birth

Back 158

second stage

Front 159

birth of infant to birth of placenta

Back 159

third stage

Front 160

first 2 hours post partum

Back 160

fourth stage (unofficial stage)

Front 161

the latent phase in the first stage of labor: woman is dilated:

Back 161

0-3cm

Front 162

the latent phase may last:

Back 162

8-10hrs

Front 163

nulliparas' effacement is often :

Back 163

complete before dilation begins

Front 164

multipara: effacement and dilitation:

Back 164

occur simultaneously

Front 165

in the active phase of the first stage of labor, the woman is dilated ___-__cm

Back 165

4-7

Front 166

how long does the active phase of labor last?

Back 166

2-5hrs

Front 167

what is effleurage?

Back 167

massage

Front 168

transition phase of first stage of labor: woman is dilated ____-___ cm

Back 168

8-10

Front 169

how long does the transition stage last?

Back 169

20mins to 2hrs

Front 170

full dilation to birth of infant

Back 170

2nd stage of labor

Front 171

how long does the second stage of labor last in the primip?

Back 171

60mins

Front 172

how long does the second stage of labor last in the multip?

Back 172

20mins

Front 173

as the head buldges on the perineum, MD/CNM places towel over the rectum, push down on the baby's occupt and chin for greater control of delivery and prevents lacerations

Back 173

ritgen's maneuver

Front 174

MD/CNM may perform ___________ (cutting of perineum from vagina to just before rectum to enlaarge the vaginal outlet)

Back 174

episiotomy

Front 175

2 types of episiotomies:

Back 175

midline
mediolateral

Front 176

on right or left slant (prevents damage to anal sphincter but much more painful)

Back 176

mediolateral

Front 177

cut straight from vagina--> just before rectum

Back 177

midline

Front 178

when is the repair of the episiotomy done?

Back 178

after birth of placenta

Front 179

episiotomies are more common where in the world?

Back 179

US and Canada

Front 180

3rd stage of labor (placental stage)

Back 180

from birth to expulsion of placenta

Front 181

how long does the 3rd stage of labor last?

Back 181

2-20 mins

Front 182

the 3rd stage is most dangerous for the mother due to risk of:

Back 182

hemorrhage

Front 183

when is the apgar done?

Back 183

1 and 5 minutes after birth

Front 184

fourth stage of labor: the immediate pp period

Back 184

unofficial stage of labor but generally considered the first 2 hrs pp

Front 185

all decisions are based on the needs and risks of

Back 185

both mom and fetus

Front 186

what are the two shapes of the fontanels?

Back 186

anterior diamond shaped
posterior triangular

Front 187

if the fetal part is neither in anterior or posterior position it is

Back 187

transverse

Front 188

this is a signal for breech- you may miss the breech in Leopolds but the location of the ___ is a flag

Back 188

FH

Front 189

+5 station means head is where?

Back 189

on perineum

Front 190

if the head is above the ischial spines, it is

Back 190

negative station

Front 191

if the head is below the ischial spines:

Back 191

positive station

Front 192

Upper margins of pubic bones

Back 192

the pelvic inlet (brim)

Front 193

narrowest transverse plane

Back 193

pelvic cavity (midpelvis)

Front 194

Lower margins of pubic bones

Back 194

pelvic outlet

Front 195

how common is the anthropoid pelvis?

Back 195

fairly

Front 196

with this type of pelvis, transverse is narrow, AP is longer

Back 196

anthropoid

Front 197

can you still have a child with an android, or typical male pelvis?

Back 197

yes, if fetus is small enough

Front 198

one side of pelvic rim to the other side

Back 198

biischial diameter

Front 199

how is effacement described?

Back 199

%

Front 200

graph developed to asses progress of labor based on cervical dilitation and station, hopefully not used independently to manage labor, not an accurate tool. Labors are different and still "normal"

Back 200

friedmans curve

Front 201

Power with contractions comes in 2 ways

Back 201

primary and secondary

Front 202

The Primary power is involuntary:

Back 202

UC's

Front 203

the secondary power is :

Back 203

maternal pushing

Front 204

Uterine contractions-bld flow is cut off to fetus (fetus is stressed) @

Back 204

peak

Front 205

the women should have what b/n contractions?

Back 205

period of relaxation

Front 206

the freq of contractions is expressed in:

Back 206

minutes

Front 207

to determine regularity of contractions:

Back 207

count freq and pattern

Front 208

what are some advantages of external electronic monitoring

Back 208

-non invasive
-doesn't req. ROM
-can monitor freq & length of contractions

Front 209

what are some disadvantages or external electronic monitoring?

Back 209

-not very accurate
-no info on intensity
-req. decreased maternal movement

Front 210

catheter is passed through the vagina into uterus; catheter is filled with sterile water and attached to a pressure recorder. c each contraction, pressure in catheter changes

Back 210

internal monitoring

Front 211

once bag is ruptured, there is

Back 211

an increased risk of infection

Front 212

_______ during pushing straightens birth canal and aids in fetal descent

Back 212

squatting

Front 213

when is BOW usually ruptured?

Back 213

may break at any time prior to onset of labor

Front 214

if woman doesn't give birth in 24 hrs after bag is ruptured, this is considered:

Back 214

PROM premature rupture of membranes

Front 215

what is amniotic fluid is green or yellow?

Back 215

baby passed meconium b/c it was stressed

Front 216

there is no such thing as "dry labor" since:

Back 216

amniotic fluid is produced until delivery

Front 217

ROM may occur spontaneously (SROM) or artificially (AROM) with:

Back 217

amnihook

Front 218

EFM utilizes doppler

Back 218

external monitoring:

Front 219

where is external monitoring often charted?

Back 219

on permanent graph record

Front 220

when fetal head is engaged and cervix is slightly dilated an electrode is placed on fetal head and able to monitor a fetal EKG

Back 220

internal monitoring

Front 221

When should we look at HR?

Back 221

b/n contractions

Front 222

these provide a reassuring pattern and are common with breech presentations

Back 222

accelerations

Front 223

pressure on fetal ____ causes accelerations

Back 223

buttocks

Front 224

early decel's generally occur between ___-___cm and in ______stage of labor

Back 224

4-7
2nd

Front 225

uteroplacental insufficiency causes fetal hypoxia and results in acidosis and tachycardia b/n contractions

Back 225

late decels

Front 226

these are caused by: cord b/n fetus and maternal pelvis, cord around fetal part, short cord, knot in cord, prolapsed cord

Back 226

variable decel's

Front 227

these are characterized by a sudden sharp drop in FHR, creating "V", "U" or "W" shape.

Back 227

variable decel's

Front 228

what 2 positions help the woman experiencing variable decel's?

Back 228

butt in air, hands on knees

Front 229

sign of intact ANS and fetal well being. The more the better (sec to sec, min to min)

Back 229

variability

Front 230

change in FHR from one beat to the next: interval between one heartbeat and the next.

Back 230

short term variability

Front 231

if they don't have ___________, we cant get short term variability

Back 231

internal monitoring

Front 232

rhythmic waves of fluctuation which occur 3-5times/minute, detectable with external fetal monitoring

Back 232

long term variability