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167 Cards in this Set
- Front
- Back
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What is VBACs?
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vaginal birth after C/S
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What should be taught about the first trimester of pregnancy?
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nutrition
exercise |
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What should be taught about middle to late pregnancy?
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preterm labor
newborn classes |
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What should be taught about late pregnancy?
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preparation for birth
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What class must a child take if they want to be in the delivery room?
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sibling class
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What are the benefits of a natural birth?
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baby free of anagelseia or anistethic effects
may have a shorter labor process mom's satisfied |
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What do both models of natural childbirthing teach?
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relaxation techniques
conditioning muscles some type of breathing pattern |
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How does lamaze work?
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prevent pain by using mind by concentration on relaxing
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What kind of relaxation does lamaze use?
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touch relaxation
disassociation relaxation |
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What are the breathing patterns of lamaze?
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3 levels that change as contractions get worse
cleansing breath |
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What is the bradley method?
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partner coached
low intervention ambulation encouraged natural process have birth plan |
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Which of the natural birthing methods may result in a home birth?
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bradley
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What should you monitor closely for with a pt practicing the bradley method?
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dehydration
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What is the leboyer method of birthing?
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dim lights, warm, soft music playing, take baby and immediately put in warm bath
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What is the encompassing theory?
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oxytocin stimulates contractions
uterus stretches to a point and begins to contract less progesterone production initiates contractions prostaglandin production at term stimulates contractions |
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What are some preliminary signs of labor?
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lightening
increase in level of activity braxton-hicks contractions ripening of the cervix |
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What are some true signs of labor?
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uterine contractions that require cervical change and increase in intensity, frequency, and duration
show rupture of membranes |
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What would you document about ROM?
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time, color and any odor of fluid
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What would you assess q2h after ROM?
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temp
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What are some risk with ROM?
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infection
prolapse |
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What are the four P's of labor?
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passage
passenger psyche powers |
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What is the passage?
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adequate size and contour
ability of the cervix to dilate ability of vagina to stretch |
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If there is a disporportion of the pelvis and fetus, what's usually the problem?
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inadequate pelvis
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What are used to determine the position of the fetus?
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anterior fontanelle
posterior fontanelle occiput |
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What do you want to feel when you are determining the position of the fetus?
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longitudinal sutures
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What is the smallest diameter of the fetus's skull?
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occiput
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What is molding?
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change in the shape of skull from pressure of contractions and trying to fit thru pelvis
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What is the attitude of the fetus?
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degree of flexion
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What is the ideal attitude of a fetus?
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chin to chest
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What is engagement of a fetus?
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largest diameter reaches or passes thru the iscal spine
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What is the station of a fetus?
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relationship of presenting part to iscal spine
measured in cm |
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What does station tell you about the fetus?
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it's descending thru pelvis
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What are some reasons the fetus may not be able to descend thru pelvis?
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Cephalopelvic Disproportion
short umbilical cord |
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What is fetal lie?
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the relationship of the cepholocaudal axis of the fetus to the cepholocuadal axis of the mother
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What is vertex presentation?
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fetal head is flexed on chest and occiput is first
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What is a military presentation?
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not extended or flexed
straight |
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What is a brow presentation?
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partially extended
usually not vaginally delivered |
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What is face presentation?
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totally hyperextended
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What is transverse lie?
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where the baby's head is on one side and the butt is on the other side
can't be vaginally delivered |
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What is a complete breech?
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C/S required
fetal knees and hips are flexed feet and butt presenting |
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What is the frank breech?
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hips are flexed
can be delivered vaginally |
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What is a single footling breech?
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C/S required
one leg up and one down |
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What is a double footling breech?
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both legs down
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Which positions put more pressure on the mom's back?
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LOR, ROP
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What are the most common position of a fetus?
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LOA & ROA
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What are the four ways to assess fetal presentation and position?
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abdominal inspection/palpation
vaginal exam auscultation of fetal heart tones sonography |
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What are powers?
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contractions with cervical change
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What is effacement?
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shortening and thinning of cervix
2cm to paper thin |
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What is dilation?
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enlargement of the cervical opening to permit passage of the fetus
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In a primip when does effacement take place?
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be4 dilation
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In a multitip when does dilation take place?
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be4 effacement
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What is the psyche?
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mom's mental attitude
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What is the first stage of labor?
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0-10cm
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What is the second stage of labor?
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10cm to the birth of baby
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What is the third stage of labor?
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birth to the delivery of the placenta
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What is the fourth stage of delivery?
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placenta to 1-4 hrs after birth
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How much dilation occurs in the latent phase?
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1-4cm
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How long does the latent stage occur for a primip?
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8.5 hrs
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How long does the latent stage occur for a multip?
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5.3 hrs
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What are the contractions like in the latent stage?
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mild about 15 sec
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How much dilation occurs in the active phase?
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4-7cm
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How much should a primip dilate in the active phase?
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1cm/hr
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How much should a multip dilate in the active phase?
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1.5-2cm/hr
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How much dilation occurs in the transition phase?
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7-10cm
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How long does the transition phase last for a primip?
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< 3 hrs
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How long does the transition phase last for a multip?
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< 1 hr
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What are the contractions like in the active phase?
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2-5 min apart lasting about 30-60 sec
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What happens to the fetal head in the active phase?
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starts to descend
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What are the contractions like in the transition phase?
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1.5-3 min apart lasting 45-90 sec
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How much does CO rise during labor?
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40-50%
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What happens to BP during labor?
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increase
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What happens to WBC during labor?
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increased
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What is a normal WBC during labor?
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25-30000
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What happens to 02 demands and RR during labor?
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increase
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What respiratory problem can happen during labor?
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hyperventilation
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What can happen to temp during labor?
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increase by 1 degree
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What can also effect the pulse and BP during labor?
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positioning
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What happens to fluid balance during labor?
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increased insensible loss d/t increased RR and sweating
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When should BP be taken during labor?
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b/t contractions
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What does urine look like during labor?
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concentrated
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Why might a woman feel she has to empty her bladder during labor?
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pressure
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When should a woman void during labor?
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q2h
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What happens to the muscoskeletal system during labor?
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joints and cartilage stretch
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What happens to the GI during labor?
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fairly inactive d/t blood flow to the uterus, decreased gastric emptying
may have NV |
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What would be some immediate info to get if there is no time for an initial assessment?
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due date, any bleeding, ROM, last meal, allergies, which baby is this
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When should vaginal exams be done?
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q3h to prevent infection
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What are the advantages of external monitoring of contractions?
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continuous and non-subjective
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What are the disadvantages of external monitoring of contractions?
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does not give intensity of contractions
uncomfortable, bedridden |
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What are the advantages of internal contraction monitoring?
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measures intensity and gives uterine relaxation info
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What are the disadvantages of internal contraction monitoring?
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requires ROM, bedridden, invasive
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What MVUs show good contractions?
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180-240
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What pts would have to have continuous monitoring?
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previous worrisome hx
VBAC, SROM, risk for prolapse cord inductions pre-term labor evidence of fetal stress/distress meconium stained fluid |
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What are the advantages of external fetal monitoring?
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baseline and b/t contraction info
non-invasive easy to use |
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What are the disadvantages of external fetal monitoring?
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uncomfortable
bedridden continuous reading may be problematic d/t position of mom and baby |
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What are the advantages of internal fetal monitoring?
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accurate continuous data
does not depend on pt size or position |
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What are the disadvantages of internal fetal monitoring?
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requires ROM
Icm bedridden increased risk for infection |
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Where is a cath placed for internal fetal monitoring?
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on bone not fontanelle
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What a normal FHR?
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120-160
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What is tachycardia of a fetus?
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> 160 for 10 min
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What is bradycardia of a fetus?
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< 120 for 10 min
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What does variability indicate?
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intact CNS
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What are accelerations caused by?
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fetal movement
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What may continuous early decelerations indicate?
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CPD
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What causes early decelerations?
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head compression
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What do early declerations look llike?
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uniform and shallow
mirrors uterine contraction |
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What causes late decelerations?
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utero-placental insuffiency
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What do late decelerations look like?
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begins after onset of contraction
ends after contraction has ended |
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What are some interventions for late decelerations?
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left side
increase IV fluids assess maternal VS 02 by mask decrease or stop pitocin notify MD document |
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What can continuous late decelerations lead to?
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hypoxia
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What causes variable decelerations?
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cord compression
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What do variable decelerations look like?
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rapid decrease FHR
rapid return to baseline V or W shaped |
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What are continuous variable decelerations a sign of?
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prolapse cord
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What are some interventions for variable decelerations?
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r/o cord prolapse by vaginal exam
position changes amnioinfusion continued close observation |
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What can continuous variable decelerations lead to?
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hypoxia
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What is an amnioinfusion?
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put fluid into uterine cavity
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What can a sinusoidal pattern indicate?
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CNS is so impaired there is no variability
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What do late decelerations look like?
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begins after onset of contraction
ends after contraction has ended |
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What are some interventions for late decelerations?
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left side
increase IV fluids assess maternal VS 02 by mask decrease or stop pitocin notify MD document |
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What can continuous late decelerations lead to?
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hypoxia
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What causes variable decelerations?
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cord compression
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What do variable decelerations look like?
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rapid decrease FHR
rapid return to baseline V or W shaped |
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What are continuous variable decelerations a sign of?
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prolapse cord
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What are some interventions for variable decelerations?
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r/o cord prolapse by vaginal exam
position changes amnioinfusion continued close observation |
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What can continuous variable decelerations lead to?
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hypoxia
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What is an amnioinfusion?
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put fluid into uterine cavity
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What can a sinusoidal pattern indicate?
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CNS is so impaired there is no variability
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When would a scalp stimulation be done?
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if there is little variability
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When would oxygen monitoring be done?
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limited variability
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What is a good fetal 02?
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30%
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How would a sick baby respond to a scalp stimulation?
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no responses, deceleration
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How would a healthy baby respond to a scalp stimulation?
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big acceleration
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What is stage 2?
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pushing
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How long is stage 2 for a primip w/ epidural?
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3 hrs
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How long is stage 2 for a primip w/o epidural?
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2 hours
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How long is stage 2 for a multip w/ epidural?
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2 hours
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How long is stage 2 for a multip w/o epidural?
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1 hour
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What urges may a woman feel during stage 2 of labor?
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to push, feel need to defecate
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What happens to the perineum during stage 2 of labor?
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bulges and flattens
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What is crowning?
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when the baby's head is visible w/o pushing
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When do cardinal movements of labor begin?
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as baby descends thru pelvis
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What are the responsibilites of the nurse during delivery?
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notify MD
patient positioning perineal prepping |
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When does the mouth and nose be aspirated?
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delivery of head
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What should be aspirated first after delivery of the head?
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mouth
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What should be aspirated second after delivery of the head?
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nose
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What is an episiotomy?
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surgical incision of the perineum made to prevent teraing with birth and to release pressure on the fetal head with birth
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What is a midline episiotomy?
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straight down toward rectum
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What is a mediolaterla episiotomy?
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toward leg
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Why would a mediolateral episiotomy be done?
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to prevent tearing into rectum
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What is stage three of labor?
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delivery of infant to delivery of placenta
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How long does stage 3 last?
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1-30 minutes
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What is the EBL during delivery?
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300-500
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What is considered hemorrhage during delivery?
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>500
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What should you never do to the umbilical cord to deliver the placenta?
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pull on it
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What are the responsibilites of the nurse in the third stage of labor?
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immediate care of infant
record time of delivery inspect cord for 2 arteries 1 vein pitocin administration after placenta is delivered |
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Why is pitocin given after the placenta is delivered?
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get uterus to contract and prevent hemorrhage
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When should VS be monitored the 1st hr after delivery?
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q15min
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When should VS be monitored the 1-2 hrs after delivery?
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q30min
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Where should the placement of the uterine be after delivery?
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midline to body @ or above umbilicus
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How should the uterus feel after delivery?
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firm
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What can help the uterus if it's soft and boggy?
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massage
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What would a deviated uterus indicate?
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full bladder
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How can you help the perineal after delivery?
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ice on bottom
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What are some maternal danger signs?
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increased or decrased BP
abnormal pulse inadequate or prolonged contractions increasing apprehension |
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What could an increased or decreased BP indicate?
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PIH, hemorrhage
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What could an abnormal pulse indicate?
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hemorrhage, hematoma
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What are some fetal danger signs?
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high or low FHR
meconium staing fetal hyperactivity fetal acidosis |
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When would fetal acidosis be seen?
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prolonged variable or late decelerations
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