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87 Cards in this Set
- Front
- Back
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What is considered true labor?
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when there is cervical change
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What starts labor?
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most importantly the prostaglandins
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What are some signs of impending labor?
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braxton hicks, incr. vaginal mucus, baby drops (lightening), incr. energy, mucus plug comes out
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Where are true labor pains felt?
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they start in the lower back and radiate to the abdomen
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If your pt. has ruptured membranes (water breaks) when would you want her to deliver? why?
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you want her to deliver within 24 hour of rupturing because of the risk of infection
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Who is the passenger?
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baby and placenta
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How would you know if your pt. was experiencing false labor?
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her contractions might stop if she got up and walked around
the "contraction" pain is felt in the lower abd and groin |
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What happens to the cervix during true labor?
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it moves anteriorly and shows progressive change
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What happens to the cervix during false labor?
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it remains posterior and there is no change
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Explain presentation of the fetus
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its the way that the baby is positioned in the uterus
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What is the best possible presentation of the fetus?
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cephalic (head down)
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Explain LIE of the fetus
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it is the relationship of the long axis (spine) of the fetus to the long axis of the mother
you want them to be parallel longitudinally |
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Explain attitude of the fetus
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the relationship of the fetal body parts to each other (body flexion or extention)
you want flexion |
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Explain positioning of the fetus
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relationship of the presenting part of the fetus to the maternal pelvis
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The positioning of the fetus is decribed in a three letter abbr., decribe what each of the letters means.
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1st letter: describes whether the presenting part is tilted toward the R or L
2nd letter: describes the presenting part (sacral, occiput, etc) 3rd letter: describes whether the presenting part is posterior, anterior or transverse |
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Example: what would LOP stand for when explaining the positioning of a fetus?
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L = that the presenting part is tilted towards the left
O = the the presenting part is the occiput P = that the presenting part is located posteriorly in the pelvis |
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Explain what fetal station is
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the relationship of the presenting part to the mothers ischial spine
Example: ischial spine is considered 0 station, 2 cm above the ischeal spine is consider -2 station and 2cm below the ischeal spine is considered +2 station |
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When is the baby considered engaged?
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when the largest part of the presenting part enters the smallest diameter of the pelvis (true pelvis)
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What are some concerns you might have pre-engagement fo the fetus?
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prolapsed cord
cephalopelvic disproportion |
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What is effacement?
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thinning out of the cervix
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What is considered the passageway?
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the cervix
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What are primary powers (contractions)?
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contractions only (no pushing by mom)
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What are secondary powers (contractions)?
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they are contractions that are accompanied by mom pushing
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If you find the following listed on your pt's chart what would you know this to mean?
5/100/-2 |
that the pt. is 5cm dilated, 100% effaced and 2cm above the ischial spine
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Explain decent
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the downward movement of the fetal head until it is within the pelvic inlet
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Explain the first stage of labor
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begins with the onset of regular uterine contractions and ends with full cervical dilatation
there are three phases to this stage: latent, active and transition |
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Explain the latent phase of stage one labor
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0-3 cm dilated, contractions usually 10-30 sec and 5-10 min apart, mild to moderate pain, very little descent
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Explain the active phase of stage one labor
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4-7cm dilated, 30-45 sec contraction that are 3-5 min. apart, moderate or strong pain, starts fetal descent
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Explain the transition phase of stage one labor
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8-10 cm dilated, contraction usually 45-90 sec and 2-3 min apart, strong pain
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Explain stage two of labor
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begins at full dilation of the cervix and end with delivery of the baby
(mom starts pushing and baby comes out) |
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Explain stage three of labor
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placenta come out
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Explain stage four of labor
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recovery stage, 1st two hours after delivery
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What should any amniotic fluid look like?
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it should be clear in color and no odor
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What might you suspect if there is any bleeding from your expectant mother? would you do an exam?
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could have placenta previa and you could do more damage by performing an exam
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Where is the FHR best heard?
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at the location of the babies back
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Stage three of labor usually last anywhere from 3-5 minutes to an hour, what is your pt at risk for if as this stage increases in length?
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risk of hemorrhage
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At what stage is the most stress placed on mom and fetus?
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stage two
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What is the average FHR during a 10 min. period?
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110 -160 beats
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What is variability in regards to the FHR?
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the change in the FHR due to the interplay of the PNS and the SNS thus indicating if there is a problem
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What does normal variability of the FHR indicate?
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an intact medulla, mature CNS and a perfused, oxygenated CNS
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What are the two different types of FHR monitors?
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internal and external
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How is the external FHR monitor results classified?
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present, decreased or absent
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How is the internal FHR monitor results classified?
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absent (0-2 beats)
minimal (3-5 beats) moderate (6-25 beats) |
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If your pt is on an external FHR monitor and you begin to get concerned about the results what should you do?
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place them on an internal monitor, position mom laterally, incr. IV fluids, stop pitocin if in use
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When would you classify the FHR as bradycardic?
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less then 110 bpm sustained for 10 minutes
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What would you do for your pt whose FHR is bradycardic?
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oxygenate, lateral position, watch carefully, prepare for an operative delivery (can be forceps, etc, not just c-section)_
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When would you classify the FHR as tachycardic?
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more than 160 bpm for 10 min
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What is the first thing you think of if your FHR is tachycardic?
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that mom has a fever, take her temp
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What should you do for your pt. with a tachycardic FHR?
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watch for a decr. in variability (bad), oxygenate, lower maternal temperature
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What causes early deceleration of the FHR?
What treatment would you provide? |
caused by head compression
no treatment necessary |
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Explain amnioinfusion
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1liter of LR is inserted by tube into the uterus to help the baby float better thus relieving the pressure on the cord, this is performed when there is not enough amniotic fluid
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What causes variable decelerations of the FHR? What treatment would you provide?
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caused by cord compression
change moms position, Vaginal exam to r/o prolapsed cord, d/c pitocin, incr. IV fluids, oxygenate,amnioinfusion, tocolytics |
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What causes late decelerations of the FHR? What treatment would you provide?
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caused by uteroplacental insufficiency
d/c pitocin if infusing, incr. IV rate, lateral position, O2 mask at 10L, correct hypotension,scalp stim/sampling, prepare for operative delivery |
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What are positive signs of a fetus's well being?
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accelerations
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What are some indications for using an internal FHR monitor?
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non-reassuring pattern on external monitor
meconium stained fluid any high risk pregnancy dysfunctional labor (doesn't follow normal path) |
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What type of internal fetal monitoring would be used to track the FHR?
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FSE (fetal scalp electrode)
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What type of internal monitoring would be used to track the womans contractions?
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IUPC - internal uterine pressure catheter
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What does an IUPC measure?
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the frequency, duration and strength of a womans contractions
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What are your goals when it comes to pain relief for the mother in labor?
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to provide adequate pain relief without affecting the progress of labor
pain relief that does not incr. maternal or fetal risk |
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When would we not give an expectant mom a sedative?
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if we think that she will deliver within 24 hours
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If your expectant mom receives a sedative, what should you be watching for?
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drowsiness and respiratory depression
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What should you do if your pt. receives an epidural and then her BP bottoms out?
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put pt. on her side, call anesthesia personnel and give fluids
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What are some contraindications for giving someone an epidural?
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if they are hypovolemic, if infection at site of entry, allergies to meds., certain heart diseases
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What do you want to do for your pt. before they receive an epidural?
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give 500-1000ml of LR to correct any fluid deficits
monitor FHR apply BP cuff |
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How often do you want to check your pts BP once they go into labor?
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in between each contraction
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After your pt receives their epidural how often do you want to assess their BP?
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q 2 min. for the first hour
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When do you want to insert a foley into your pt post epidural?
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after the first 1/2 hour.
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What is the name of the scale that they use to determine whether a pt. should be induced or not?
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bishops scale
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What is your goal when giving your pt. pitocin?
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contractions q 2-3 min lasting no longer than 80-90 sec
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How is pitocin administered to your pt.?
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alway on a pump and piggybacked into main line at port closest to patient
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What are some concerns when giving your pt. pitocin?
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tissue perfusion, high risk for maternal injury, fluid volume deficit, can have premature ROM
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You have given your pt. prostaglandin to help ripen her cervix, at what point would you begin her pitocin?
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must be 4-6 hours after prostaglandin was given
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During the second stage of labor what should your cervical exam results be?
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10 cm dilated and cervix should be completely gone
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What is a good sign that your pt. is ready to give birth?
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when the babys head crowns during the contraction and does not recede between contractions
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When will your apgar score be determined?
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at one minute after birth and again at 5 minutes after birth. If there is a low apgar score at 5 min. or a problem is suspected then they will do another at 10 min
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What medications should your baby get within one hour of birth?
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Vit. K and antibiotic ointment for the eyes
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Your pt. is in her second stage of labor, while checking the FHR you notice that there are now late decelerations. What do you determine is the cause?
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the baby is under too much stress
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When would you use the vacuum extraction method for delivery?
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when the mother can't or should not push or if the baby is in distress
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What are the four stages of an episiotomy?
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1st - skin only
2nd - skin and muscle of the perineum 3rd - went into the sphincter 4th - through the rectal wall |
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Once the baby is born how often will you do an assessment on the baby and mother? What will it include?
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q 15 minutes for the first hour and q 30 minutes for the second hour. It should include: temp, pulses, breath sounds and respirations
Check for bladder distention, fundus and lochia |
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What do you do for your pt. who has been given duramorph?
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monitor their respirations q 2 hours for 24 hours
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What are the three signs of placenta separation?
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1. cord will lengthen outside the vagina
2. there will be more bleeding 3. uterus changes shape (more round and globular) |
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What do you give your pt. after birth to help prevent hemorrhaging?
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pitocin
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When palpitating to check the fundus after birth, what should you expect to find in an ideal situation?
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should be midline, firm and below the umbilicus
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Explain a reactive NST
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2 acceleration of at least 15 beats for 15 seconds in a 20 minute strip
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Explain a nonreactive NST
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inadequate or no accelerations
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What should you do if you have a nonreactive NST result?
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stimulate the fetus, feed the mother or do a biophysical profile
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