Ob Quiz 2

Front 1

VS AFTER AN EPIDURAL

Back 1

hypotension most common complication
hypotension - systolic BP less than 100mm Hg or a 20% reduction - notify anesthesia provider

lateral or upright positioning with uterine displacement to help avoid supine hypotension and/or superior vena cava syndrome

side effects to watch out for- NV, pruritis, resp depression, FHR alterations

check BP and FHR Q 5min for 15 min after bolus is given and /or epidural, then Q 15min

urinary retention is common - cath

assess motor function - legs

assess pulse and RR with BP

assess effectiveness of epidural and woman's pain discription

asess for HA - big indicator for a epidural in wrong location -spinal anesthesia

monitor uterine contractions b/c uterine activity slows down for 60min after epidural is administered.

assess Temp.

monitor for S/S of intravascular injection injury -
maternal tachycardia or bradycardia, HTN, dizziness, tinnitus, metallic taste, LOC

Front 2

EPIDURAL SIDE EFFECTS

maternal ________ or ________
variable _______ in FHR
________ labor pattern

Back 2

maternal hypotension
maternal HTN
variable decelerations in FHR
hypertonic labor pattern

Front 3

FRANK BREECH
what is it?

can cause _______ ______, ______ _____, and ______ cord

Back 3

thighs flexed alongside body, feet @ head

can cause:
dysfunctional labor, fetal injury, prolapsed cord

typically c section

Front 4

LIGHTENING

Back 4

decent of fetus 2 weeks before term in FIRST TIME PREGNANCIES

S/S
woman can breathe easier
increaded UO and frequency because baby is lower/increased bladder pressure.

in later pregos, lightening does not occur until labor begins

Front 5

INTERNAL MONITORING RANGES

TRANSITION PHASE

Back 5

electrode applied to presenting part of baby to detect FHR

pressure sensor applied to uterine cavity and measures contractions

clipped onto baby's scalp during a vaginal exam

measures FHR, baseline, variabilities in all types of accelerations

intrauterine pressure catheter is applied by the care provider

IUPC provides mm Hg measurements of contractions

monitor paper is used for the electronic fetal monitoring

each dark line = 1 min
lighter vertical line = 10 seconds

FHR recorded on top

UC recorded on bottom

Front 6

INTERNAL MONITORING RANGES

TRANSITION PHASE

(How Sarah interpreted this AOC)

Back 6

3rd phase of stage 1 labor

8-10cm dilated
80-100% effaced
20-60min (phase length)
contractions are 2-3 min apart
contraction strength - 70-90mm Hg by IUPC
UCs last 45-90 seconds
woman is in a regular pattern
moderate to heavy bloody show
severe pain, loss of control, difficult to follow instructions, irritable, difficulty communicating

woman has:
N/V
shakes
perspires
trembles
feels urge to push

Front 7

ASSESSMENT OF UCs WITH AN IUPC INCLUDES:

Back 7

frequency
duration
intensity
resting tone

Front 8

CH 8 QUESTION

primary reason for administering Nubain to a woman in active labor is to:

Back 8

relieve pain

Front 9

CH 8 QUESTION

labor pain in active labor is primarily caused by:

Back 9

UCs

Front 10

CH 8 QUESTION

passenger, as one of the 4 P's, refers to:

Back 10

fetus

Front 11

CH 8 QUESTION:

T or F?

nurses manage the care of patients receiving regional anesthesia?

Back 11

F

Front 12

CH 8 QUESTION

supportive activities in labor are:

Back 12

techniques used to help women in labor

Front 13

CH 8 QUESTION

an involuntary sign to push is most likely a sign of:

Back 13

low fetal station and imminent delivery

Front 14

CH 8 QUESTION

false labor is characterized by:

Back 14

irregular contractions with no cervical change

Front 15

CH 8 QUESTION

women who have a support person with them in labor are more likely to:

Back 15

have fewer birth complications

Front 16

CH 8 QUESTION

a sterile vaginal exam reveals that the woman is 5 cm and 80% effaced and 0 station. based on this exam the woman is:

Back 16

in the active phase of labor

Front 17

CH 8 QUESTION

a common side effect of epidurals:

Back 17

maternal hypotension

Front 18

EMTALA

Back 18

emergency medical Tx and active labor act

federal regulation enacted to ensure Tx for a woman seeking care in an emergency
or if she THINKS she is in labor regardless of her ability to pay.

nurses who work in L&D must be familiar with EMTALA regulations.

admission generally requires cervial dilation of 3-4cm and/or ROM
by law all prego women have access to medical care regardless of money issues

Front 19

RN ASSESSMENT AFTER AN EPIDURAL

Back 19

assess for:
HA
DROWSINESS
PRURITIS
N/V
URINARY RETENTION
WATCH UCs BECAUSE THEY SLOW DOWN
IF INTRAVASC INJURY SUSPECTED, ADMIN FLUIDS/BOLUS AND MEDS

Front 20

BREATHING TECHNIQUES LATENT LABOR

Back 20

deep cleansing breath at onset of contraction

shallow breaths will tire them out!

Front 21

ACTIONS DELEGATED TO A DOULA

Back 21

greek for woman's servant.

as assistant hired to give the woman support during pregancy, labor, birth and post partum

emotional support
nonpharmacological pain interventions
shorter labors
decreased need for analgesics
decreased need for many forms of medication
increased maternal satisfaction
decreased rate of operative delivery and complications

Front 22

FERNING TEST

Back 22

ROM test
backs up a + test result from nitrizine paper

it is a smear on a glass slide

looks like a fern if +

amniotic fluids are more basic than regular body fluids, nitrozine paper turns blue/purple

ferning test is a sterile speculum exam used to confirm ROM
a sample of fluid is taken in the upper vaginal area
fluid placed on a slide and assessed for a 'ferning pattern'

ferning pattern confirms ROM

Front 23

IMMEDIATE INTERVENTIONS IN ACTIVE LABOR

(SECOND PHASE)

Back 23

second phase of labor AKA active phase

3-6 hrs in length, shorter for multigravidas, cervical dilation 4-7 cm, woman may have decreased energy and have fatigue, effacement 40--80%, fetal decent continues, contractions are more intense, occuring Q 2-5min and lasting 45-60 seconds
discomfort increases, woman arrives at hospital.birthing center.

what to do:
RUPTER MEMBRANES (if not already done)
PERFORM INTERNAL MONITORING WITH INTERNAL FETAL ELECTRODE AND/OR UTERINE TRANSDUCER
ORDER PAIN MEDS
ORDER EPIDURAL
EVALUATE LABOR PROGRESSION
MONITOR FHR AND UCs Q 15-30 MIN
ASSESS MOM'S VS Q 2 HR, Q 1HR IF ROM HAS OCCURED
INTRAPARTAL VAG EXAM TO ASSESS CERVIX AND FETAL DECENT
ASSESS HER PAIN
ADMIN ANALGESICS PRN
EVALUATE EFFECTIVENESS OF PAIN MEDS/EPIDURAL
I&O, HYDRATION, N/V, ENCOURAGE FLUIDS AND ICE CHIPS, GIVE CLEAR EXPLANATIONS AND UPDATES, PROMOTE COMFORT MEASURES.
ASSIST WITH ELIMINATION NEEDS B/C BLADDER CAN GET IN THE WAY AND HINDER FETAL DECENT

Front 24

FALSE LABOR

Back 24

irregular/mild UCs with no increase in freq, intensity, or duration

felt in mid abd or groin area. can be physically and mentally tiring

little or no cervical dilation
no bloody show
activity and positions alter/lessen pain and contractions

contractions tend to get farther apart and go away

Front 25

TRUE LABOR

Back 25

regular increase in freq, duration, and intensity

begins in lower back and works its way to lower abd and the front side of the body

progressive cervical dilation
UCs get closer together and more intense

bloody show usually present with cervical changes
activity and walking increase UC intensity

Front 26

CARDINAL MOVEMENTS OF LABOR

Back 26

positional changes baby goes through to best navigate birth process

known as the mechanisms of labor

Front 27

INTERNAL MONITORING RANGES

TRANSITION PHASE

Back 27

TABLE 8-2 in the book, Nicole found it!

the answer is 70-90mm Hg

Front 28

INTERNAL MONITORING RANGES

TRANSITION PHASE

Back 28

TABLE 8-2 in the book, Nicole found it!

the answer is 70-90mm Hg

Front 29

FETAL POSITIONS

Back 29

the relation of the denominator or reference point to the maternal pelvis.

there are 6 presentations per presenting part .

Front 30

FETAL POSITIONS

(6 POSITIONS)

Back 30

right anterior
right transverse
right posterior
left ant
left trans
left post

Front 31

CEPHALIC PRESENTATION

Back 31

most common.

occiput (head)

Front 32

BREECH PRESENTATION

Back 32

sacrum is presenting

Front 33

ACROMION PRESENTATION

Back 33

shoulder is presenting

Front 34

FETAL PRESENTATION:
FIRST LETTER

Back 34

FIRST LETTER: represents location of presenting part to the L or R of the woman's pelvis.

"it's a L- - " the baby is coming out LEFT of the woman's pelvis. baby is facing mom's right thigh. back of baby's head facing mom's LEFT thigh. the L or R is in relation to where the BACK of the baby's head/body is facing. look a pg 147 if you are confused.

Front 35

FETAL PRESENTATION:
SECOND LETTER:

Back 35

SECOND LETTER: designates the fetal body part presenting.

occiput - O
sacrum - S
shoulder - A (for acromion! )

"it's a LS -" baby is coming out facing mom's right thigh, the presenting part is the sacrum - butt (breech!)

Front 36

FETAL PRESENTATION:
3RD LETTER

Back 36

THIRD LETTER: designates relationship of presenting fetal body part in relation to mom's pelvis as anterior or posterior or transverse

anterior - A
posterior - P
transverse - T

"it's a LSP!"

baby is coming out facing mom's RIGHT THIGH, the presenting part is the sacrum (breech!) and the baby is in the posterior position, meaning baby is coming out belly button facing the ceiling.

Front 37

LSA

Back 37

baby is coming out facing mom's RIGHT thigh, presenting part is the sacrum, baby is in the anterior position, meaning baby's belly button will be facing the floor. BUTT FIRST AND BELLY BUTTON TO FLOOR.

Front 38

ROA

Back 38

baby is coming out facing mom's LEFT thigh, presenting part is the occiput - head, and baby is in the anterior position, meaning the belly button is facing the floor. PERFECT LIFETIME MOVIE BIRTH!

Front 39

ROA

Back 39

PERFECT LIFETIME MOVIE BIRTH PRESENTATION.

Front 40

ROT

Back 40

baby is coming out facing mom's LEFT thigh, presenting part is the occiput - head, baby is in the transverse position, meaning baby is coming out sideways, NOT the less painful longways.

Front 41

ENGAGEMENT:

Back 41

when the greatest diameter of the feta head passes through pelvic inlet; can occur late in pregnancy or early in labor.

Front 42

DECENT:

Back 42

movement of fetus through birth canal during first and second stage of labor

Front 43

FLEXION

Back 43

chin moves to chest.
occurs when head meets resistance from pelvic floor.
result = smallest fetal diameter passing through.
occurs early in labor

Front 44

INTERNAL ROTATION:

INTERNAL BEFORE EXTERNAL. WHAT COMES BEFORE SHOULDERS??

Back 44

baby's head rotates and aligns with long axis of mom's pelvis.
2nd stage of labor.

Front 45

EXPULSION:

Back 45

shoulders and remainder of baby's body are delivered.

Front 46

EXTENSION:

Back 46

2nd stage of labor
baby meets resistance from pelvic floor
presenting part of baby is forced to pivot under pubic symphysis and presenting part (hopefully the head!) is delivered.

Front 47

EXTERNAL ROTATION:

________ align
_______ navigates

Back 47

shoulders align in the anteroposterior diameter the trunk navigates through pelvis