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126 Cards in this Set

  • Front
  • Back
Gravida
a woman who is or has been pregnant
Para
the number of pregnancies that reached viability (20 weeks)
Primigravida
a woman who is pregnant for the first time
Primipara
woman who has delivered one viable fetus
Multigravida
a pregnant woman who has been pregnant before
Multipara
a woman who has delivered more than one viable fetus
Nulligravida
woman who has never been pregnant
Nullipara
a woman who has not carried a fetus to variability
G.T.P.A.L
a. G= gravida (pregnancies)
b. T= term births or pregnancies delivered (37+)
c. P= premature births (20-36.6 weeks)
d. A= abortions (spontaneous or induced)
e. L= number of living children
Presumptive Signs
those that suggest but do not positively indicate pregnancy
Probable Signs
strong indicators of pregnancy, short of confirmation. Two or more are highly suggestive of pregnancy. Detected at about 12th week
Positive Signs:
absolute confirmation of pregnancy
What are the Presumptive Signs of Pregnancy
Amenorrhea: absence of menstruation
Nausea/vomiting: due to metabolic and hormonal changes
Breast changes: enlargement, tingling, increased sensation to touch, darkening of nipples and areola
Urinary frequency: due to pressure on bladder from uterine enlargement
v. Fatigue: due to increased metabolism
vi. Quickening: fluttering sensation when fetus moves (16-20 weeks gestation)
What are the Probable Signs of Pregnancy
Pigmentation changes: linea nigra, chloasma (mask of pregnancy)
Abdominal enlargement: as uterus rises out of the pelvis (after 12 weeks)
Chadwick’s Sign: purplish color of cervix
Hegar’s Sign: softening of the lower uterus
v. Ballottement: detection of fetus floating in amniotic fluid
vi. Braxton Hicks contractions: irregular, painless uterine contractions
vii. Goodell’s Sign: softening of a normally-firm cervix
Positive pregnancy test: Maternal blood or urine test for human chorionic gonadotropin (hCG). (Testing one week after a missed period usually provides more accurate information)
Hegar’s Sign: A Softening of the Lower Uterus
Mask of Pregnancy (chloasma)
What are the Positive Signs of Pregnancy
Detection of fetal heart tones
Palpation of fetal movement
Ultrasonic evidence of a fetus
First trimester
First day of LMP to week 13
Second trimester
14 weeks to 27 weeks
Third trimester
27 weeks to 40 weeks
Hegar’s Sign
softening of the lower uterus
Goodell’s Sign
softening of a normally-firm cervix
Braxton Hicks contractions
irregular, painless uterine contractions
A Probable Sign of Pregnancy
Ballottement
detection of fetus floating in amniotic fluid
A Probable Sign of Pregnancy
Chadwick’s Sign
purplish color of cervix
A Probable Sign of Pregnancy
Rh Sensitization
May occur when mother is Rh negative but fetus is Rh positive
RhoGAM
Treats Rh Sensitization
given prophalactally at 28 weeks gestation and again within 72 hours of childbirth. Remember this second dose is only given if the infant is Rh+
T.O.R.C.H. Infections
a. T= Toxoplasmosis
b. O= Other*
c. R= Rubella
d. C= Cytomegalovirus
e. H= Herpes

*Other includes gonorrhea, syphilis, varicella, Hepatitis B, Group B strep and HIV
What are the 3 things that the L&D RN need to assess to differentiate between true and false labor
a. Uterine contractions
b. Status of cervix
c. Status of membranes (bag of water)
What are the characteristics of contractions in TRUE labor
May be irregular at first, usually become regular, longer, and closer together

Walking makes them stronger

Lying down does not makes them go away


Usually felt in lower back and radiates to front
What are the characteristics of contractions in FALSE labor
Usually irregular and short, don’t get longer, stronger or closer

Walking does not make them stronger

Lying down may make them go away

Usually felt in upper uterus and groin
What are the characteristics of the cervix in FALSE labor
The cervix may soften but there is little thinning or opening

NO change in position for the baby
What are the characteristics of the cervix in TRUE labor
The cervix softens , thins and opens

Baby begins to move into the pelvis
What are the preliminary signs of TRUE labor
a. Lightening
i. Baby “drops.” Relief of pressure on the diaphragm and stomach, increased pressure on the bladder
b. Increased vaginal secretions
c. Slight weight loss
d. Mucous plug, bloody show
e. Thinning and softening of cervix
f. Persistent backache
g. Increased Braxton-Hicks
i. (intermittent painless uterine contractions)
What is COAT and what does it stand for?
The tool used to assess the BOW
Color of fluid
Odor
Amount of fluid
Timing of rupture
How are ruptured membranes confirmed?
Nitrazine Paper test - If paper turns blue, fluid is alkaline which confirms amniotic fluid

OR


ii. Fern Test
1) Vaginal fluid swabbed and placed on microscope slide. Fern pattern confirms amniotic fluid. Used if further confirmation is needed.
What are the 5 P's of the Labor Process?
Passenger (fetus) Passageway (pelvis)
Powers (contractions)
Position of mother
Psychological factors (psyche)
Engagement
the widesst diameter of the presenting part that has passed through the pelvic inlet
Molding
reshaping of the fetal head to facilitate birth
Station
relationship of the widest diameter of the preseting part and the ischial spines of the pelvis

Graded on a 1-5 scale
Attitude
relationship of the fetal parts to one another
Lie
relationship of the longitudinal axis of the fetus to the longitudinal axis of the mother

*think L in Lie is L for LONGITUDE!
Presentation
fetal part entering the pelvis first
Position
relatinship of the fetal presenting part to the maternal pelvis
What are four methods used to determine fetal postion
Leopold’s Maneuvers
Vaginal exam
Ultrasound
Auscultation of fetal heart rate (FHR)
What are the cardinal movements
descent
engagement
fexion
internal rotation
extension
external rotation
expulsion
Descent
Continues throughout labor
If this does not occur, none of the other mechanisms can occur
Engagement (cardinal sign of labor)
level of ischial spines into the pelvic inlet
Flexion
must occur now (after descent and engagement) for other mechanisms to follow.
Head and neck flex, allowing the smallest diameter of the head to come first
Internal Rotation
may be prolonged, head must rotate up to three times in order to pass navigate the pelvic canal e. :
Extension
allows head to pass under pelvic arch
External Rotation
involves two movements allowing shoulders to position
Expulsion
rest of the body follows the anterior shoulder
What do the cardinal movements depend on?
Passenger
Passageway
Powers
Psyche
How many stages of Labor are there
4
What are the 3 phases in the 1st stage of labor
latent
active
transitional
What cervical changes happen in the 1st stage of labor
The cervix dialtes from 0-10cm
What cervical changes happen in the 2nd stage of labor
Complete dilation
the baby is born
What cervical changes happen in the 3rd stage of labor
Placenta is delivered
What cervical changes happen in the 4th stage of labor
Immediate recovery period
2 hours
When is an epidural given
during the active phase in the 1st stage of labor
What is the mother doing in the 2nd stage of labor
PUSHING
What actions take place in the 3rd stage of labor
Cord clamped; delivery of placenta
Vagina, cervix and perineum inspected and repaired if needed
Assess fundal height, firmness
Massage fundus (manually contracts the uterus)
v. Give oxytocin (chemically contracts the uterus)
Promote family bonding/breastfeeding
What is the most important RN implication in the fourth stage of labor
Monitoring the mother for hemorrhage
When do perineal lacerations usually occur
When the head is being delivered
What is a 1st and fourth degree laceration
1st is skin
4th is through the rectal wall
Episiotomy
an Incision made in the perineum to enlarge the vaginal opening
Effacement of the Cervix
a. Shortening and thinning of the cervix, measured in percentages (25%,50%,75%,100%)
What is the greatest amount the cervix will dialate
10cm
What are the three ways the fetus can present?
cephalic - vertex, brow, face, mentum (chin)

breech - complete, frank, footling

shoulder
Define station and Engagement and how it is measured
When fetal head is level with the ischial spines, fetus is engaged
Level of engagement is zero (0) station
Define Induction of Labor
initiation of labor by artificial means
what drug is used to induce labor
Oxytocin
What are some indications for inducing labor
dysfunctional labor
fetal demise
post term pregnancy
elective
maternal complications - diabetes, hypertension
What is the Bishop score used for
to assess cervical ripeness
takes into account amount of dilation, effacement, station, cervical consistency and cervix position.

scored 0-3

0=closed
1=1-2
2=3-4
3=>5
What does a high Bishop score indicate?
the greater the success of induction of labor
What are two things that can be used to assist in ripening the cervix
Prostaglandin gel
Evening primrose oil
What does oxytocin assist with
contractions
When the membrane has been ruptured either through AROM or SROM what is essential to confirm and how?
fetal well-being by assessing fetal heart tones
Why is it essential to confirm fetal well being after membrane rupture?
Risk of prolapsed cord when fluid gushes out of vagina
Amniotomy
The physician reaches up and nicks the membrane which is followed by a gush of amniotic fluid.

ESSENTIAL to assess fetal well being after r/t prolapsed cord
What are the 4 purposes of giving oxytocin
Induction of labor
Augmentation of labor
Contraction stress test (CST)
Prevention of hemorrhage
What is the drug of choice for labor pain
Stadol
What is the major complication of giving Stadol or demerol too close to delivery
significant respiratory depression in the infant
What drug is given to counteract the effects of Stadol or demerol
Narcan IM
What is a local anesthetic used for in labor
episiotomies
Pudendal block
Anesthesia used for major perineal repair
Lumbar epidural block is used for
vaginal births
spinal (subarachnoid) block is used for
C sections
General anesthesia is used for
ER C sections
What are the advantages of an epidural
Mother alert, cooperative, relaxed
Airway and reflexes intact, only motor paralysis
Gastric emptying not delayed
Fetal distress rare
Can be modified quickly to allow mother to push
Provides rest period for long labors
What are the disadvantages of an epidural
IV required
Occasional dizziness
Weakness of legs, not able to ambulate
Difficulty emptying bladder
Hypotension, convulsions or parasthesias
Increased C-sections due to inability to bear down
Occasional high spinal anesthesia resulting in depressed/arrested respiration
What are the two major complications/adverse reactions to a spinal block
1) Respiratory depression
rate must be assessed EVERY hour for the first 24 hours after birth

2) Spinal headache
Lie flat 8-12 hours after injection.
Treated with spinal blood patch.
What are some RN interventions to facilitate bonding/attachment
1. Skin-to-skin (kangaroo care)
2. Breastfeeding
3. Father cutting the cord
4. Family-centered care
What are some methods to give to the pt to prepare for childbirth?
1. Lamaze
2. International Childbirth Education Association
3. Breastfeeding
4. Sibling
5. C-Section Teaching
6. Baby care
7. Daddy Boot Camp
What are the 3 problems that can occur with the passenger
fetal malpostion/malpresentation
prolapsed umbilical cord
fetal distress
What is the cause of a prolapsed umbilical cord
1) fetus is not firmly engaged, allowing room for the cord to move beyond (prolapse) or along the presenting part
What will display on the FHM in the event of a prolapsed cord
Variable decels
What are the 3 types of prolapsed cord
Partial - trapped beside the presenting part
Hidden -
Complete - cord is visible in vagina, comes out first
What RN interventions should be done in the event of a prolapsed cord
knee to chest / trendelenburg position
examiner (RN) pushes presentin part upward to relieve pressure on the cord
if cord protrudes throug the vagina applice sterile saline soaked dressing
O2 by face maske at 8-10L
prepare for rapid delivery
Define fetal distress
insufficient O2 supply to meet the demands of the fetus
What are 2 causes for fetal distress
umbilical cord compression
uteroplacental insuffieciency
What adverse reaction can decreased oxygenation to the fetus cause and how can it be treated
relaxation of anal sphincter, passage of meconium stool and gasping
amnioinusion to dilute meconium
Where should pressure be applied in the event of shoulder dystocia
suprapubic. - a) Allows the sholder to pass below the pubic bone

NEVER fundal - Forcing can cause the uterus or bladder to rupture
McRoberts positioning
used in the event of shoulder dystocia

The thighs are flexed up to the abdomen.

Helps to enlarge the pelvic outlet
Define Cephalopelvic Disproportion (CPD)
Fetal head is too large to pass through the bony pelvis
Shoulder Dystocia
An obstetrical emergency resulting from difficulty/inabilitity to deliver the shoulders
Oligohydramnios
Inadequate amount of amniotic fluid
What is a normal amount of amniotic fluid
800-1000mL
How much fluid is requred for vaginal birth
a 2cm pocket
An inadequate amount of amniotic fluid may be r/t ?
problems with fetal renal development

may also be caused by some NSAIDS
Polyhydramnios/Hydramnios
Excessive amounts of amniotic fluid
An excessive amount of amniotic fluid may be r/t ?
problem with GI fetal development

Baby is not drinking / using fluid therefore there is too much
What risk to the mother can polyhydramnios cause?
postpartum hemorrhage
How can excess fluid be removed?
amniocentesis or ibuprofen therapy
Labor dystocia
Difficult labor that is prolonged or more painful
What can labor dystocia cause?
maternal dehydration, infection, fetal injury or death
What are th 2 types of contractions that can occur in labor dystocia
hypertonic
hypotonic
Define premature labor
contrations occuring between 20-37 weeks gestation
What are the s/s of Preterm Labor
Contractions occurring q 10 minutes or less
Dilated to 1 cm or more
80% or more effacement
Low abdominal cramping with or without diarrhea
Intermittent pelvic pressure, urinary frequency
Low back ache (constant or intermittent)
Increased vaginal discharge
Leaking amniotic fluid
Positive biochemical marker (fetal fibronectin)
What is fetal fibronectin
a protien detected in maternal blood.
. A negative fFN has a high predictive value (up to 95% accurate) that the woman will not deliver in 7-14 days
better at detecting who will not deliver preterm than who will deliver preterm
What are the RN interventions that need to be taken with preterm labor
bedrest
monitor uterine activity and FHR
admnin tocolytic agent
admin corticosteroids
tocolytic agent
Stops contractions
Why and when is corticosteroids ( betamethason or dexamethasone adminstered
between 28-24 weeks
can cross the placenta and stimulate fetal lung maturity and production of surfactant
What are some problems with the psyche r/t risks during labor
Fear and anxiety
Perception of the problem
Self-image
Preparation for childbirth
Support systems
Coping ability
What is the purpose of doing a C section
to preserve the health of the mother and fetus
Major Indications for C/Sections
Dystocia or CPD
Fetal distress
Breech presentation
Previous cesarean birth
What are the risks to the mother with a C section
i. Aspiration, hemorrhage, infections, injury to bladder/bowel, thrombophlebitis, pulmonary embolism