Ob Test2

Front 1

Time from the beginning of one contraction to the beginning of the next

Back 1

Frequency

Front 2

Length of time from the beginning of the contraction to the end

Back 2

Duration

Front 3

Begins with onset of first true labor contraction and ends with complete dilation of the cervix

Back 3

Stages of Labor:
First Stage (three phases)

Front 4

First true contraction to 3cm
Contractions mild, Q 5-20 min.
last 30-45 sec.
P8 M5 hrs.
Woman often happy, talkative, friendly

Back 4

Stages of Labor:
First Stage
PHASE 1: Latent Phase

Front 5

4-7cm.
Contractions mod-strong, Q 2-5 min. last 45-60 sec.
P4 M2 hrs.
Woman often more quiet, serious, focused. Less able to tolerate distractions. Keep conversation to a minimum

Back 5

Stages of Labor:
First Stage
PHASE 2: Active Phase

Front 6

8-10cm
Contractions strong, Q 2-3 min. last 60- 90 sec.
P50 min. M10-15 min.
Woman often panicky, irritable, feels out of control. N/V, wretches, shakes, rectal pressure. Bloody show increases.

Back 6

Stages of Labor:
First Stage
PHASE 3: Transition

Front 7

Reason for numbness and tingling of lips, fingers, toes and lightheadedness/dizziness

Back 7

Respiratory alkalosis due to hyperventilation during Transition (last phase of first stage of labor)

Front 8

If this is seen, have woman breathe into cupped hands or a paper bag.

Back 8

Numbness and tingling of lips, fingers, toes and lightheadedness/dizziness. (Respiratory alkalosis due to hyperventilation during Transition)

Front 9

Begins with complete dilation of the cervix and ends with birth of baby.

Back 9

Stages of Labor:
Second Stage

Front 10

Contractions strong, Q 2-4min./60-90sec. Stage lasts 5 min - 2-3hrs.
Change in contractions from crescendo to decrescendo to overwhelming urge to push, Woman often panicky, N/V, Pain may be overcome by tremendous pressure sensation.

Back 10

Stages of Labor:
Second Stage

Front 11

The fetal occiput is directed towards the mother's left, anterior side.

Back 11

LOA (Left Occiput Anterior )
(Most Common)

Front 12

The fetal occiput is directed towards the mother's right, anterior side.

Back 12

ROA (Right Occiput Anterior)

Front 13

The fetal occiput is directed towards the mother's left, posterior side.

Back 13

LOP (Left Occiput Posterior)

Front 14

The fetal occiput is directed towards the mother's right, posterior side.

Back 14

ROP (Right Occiput Posterior)

Front 15

The fetal sacrum is closest to the mother's symphysis and rotated slightly to the mother's right

Back 15

RSA (Right Sacrum Anterior)
(Breech)

Front 16

The fetal occiput is directed towards the mother's right

Back 16

ROT (Right Occiput Transverse)

Front 17

The fetal occiput is directed towards the mother's left

Back 17

LOT (Left Occiput Transverse)

Front 18

Lower back pain is associated with the baby in this position

Back 18

Posterior

Front 19

Interventions for lower back pain during delivery

Back 19

Mother on hands and knees, partner massages lower back

Front 20

In a cephalic presentation (head first), the FHB is heard loudest:

Back 20

Below the umbilicus

Front 21

In a sacral presentation (breech), the FHB is heard loudest:

Back 21

Above the umbilicus

Front 22

Relationship of presenting part to ischial spines

Back 22

Station

Front 23

Head level with ischial spines

Back 23

0 Station

Front 24

Head 1cm above ischial spines

Back 24

-1 Station

Front 25

Head 2cm above ischial spines

Back 25

-2 Station

Front 26

Head 1cm below ischial spines

Back 26

+1 Station

(*remember + is "positive" - good that baby is coming)

Front 27

Head 2cm below ischial spines

Back 27

+2 Station

(*remember + is "positive" - good that baby is coming)

Front 28

Station when head is seen at the perineum (crowning)

Back 28

+4 Station

Front 29

First action when membranes rupture?

Back 29

Check FHR, NO ambulation if head not at 0 Station (risk of cord prolapse

Front 30

To check for ROM during initial assessment...

Back 30

Use Nitrazine paper:

Normal vaginal secretions acid (<6.5) paper stays YELLOW

Amniotic fluid alkaline (>6.5) paper turns BLUE

Front 31

Another check for ROM during initial assesment...

Back 31

"Ferning" - When dry, vaginal fluid smeared on a glass slide creates a characteristic fern pattern

Front 32

Degree of flexion fetus assumes

Back 32

Attitude

Front 33

Good Attitude

Back 33

Neck to chin = complete flexion (smallest A-P diameter)

Front 34

When presenting part has settled far enough into pelvis to be at the level of the ischeal spines

Back 34

Engagement (engagement means lightening has occurred)

Front 35

If not engaged, fetus described as...

Back 35

Floating

Front 36

In primip, non-engagement of head at beginning of labor could be...

Back 36

CPD (abnormal presentation)
Cephalopelvic disproportion (pelvis too small or head too big)

Front 37

Relationship between long axis of fetus and woman

Back 37

Presentation or Lie
(99% are vertical, 1% horizontal & usually need c/s)

Front 38

This presentation/lie can be cephalic or breech

Back 38

Vertical
Vertex = head well flexed
(as opposed to brow, face chin presentation)

Front 39

Types of breech presentation

Back 39

Complete - thighs on abdomen, legs on thighs
Frank - thighs flexed, legs extended
Footling - one or both legs extended

Front 40

FHR decreases at beginning of contraction

Back 40

Early decelerations - Normal (r/t head compression)

Front 41

FHR decreases 30-40 sec. after contraction starts and stays low beyond end of contraction

Back 41

Late decelerations - Bad, due to uteroplacental insufficiency (not enough blood and O2), often Pitocin IV is to blame, (causes contractions)

Front 42

Treatment for late decelerations

Back 42

Turn on L side
Turn off Pitocin
Give O2
Increase IV rate
Call MD

Front 43

Decreased FHR at unpredictable times during contractions

Back 43

Variable decelerations
Due to cord compression

Front 44

Treatment for variable decelerations

Back 44

Turn on L side (or R if already on L)
O2
Call MD
Trendelenberg

Front 45

Are pain meds (ie. opioids/narcotics) OK to give mom when 8-9cm dilated (in transition)?

Back 45

NO (Mom at risk of respiratory depression when in transition)

Front 46

Third Stage of Labor

Back 46

Placental stage
(cord lengthens, rush of blood, active bleeding r/t separation)

Front 47

Stage 3 (Placental stage) Meds

Back 47

oxytocin (pitocin) and Ergonovine (methergine) given AFTER delivery of placenta -increase uterine contractions and decrease bleeding

Front 48

Check BP before giving this med

Back 48

Ergonovine (methergine) (increases BP so don't give to a woman with increased BP - & never before uterus empty, can cause retained placenta fragment)

Front 49

Irregular contractions
Felt in abdomen only
Go away with position change (walking)
No Effacement and Dilation of cervix

Back 49

False signs of labor

Front 50

Regular contractions
Felt in lower back & sweep to abdomen
Don't go away with position change
Cause Effacement and Dilation of cervix

Back 50

True signs of Labor

Front 51

Effacement (paper-thin cervix) and then dilation (0-10cm) happen with this type of mother

Back 51

Primip

Front 52

Effacement and dilation happen together with this type of mother

Back 52

Multip

Front 53

Can you get a spinal headache from an epidural?

Back 53

NO (dura not entered)

Front 54

When and why do you get a spinal headache and how long does it last?

Back 54

1-3 days after spinal anesthesia (due to loss of CSF) can last for days or weeks (pain in head unless flat)

Front 55

Pre-epidural, do what?

Back 55

Start an IV at a rapid rate to keep BP up.

Front 56

What is the common cause of a temperature in the first 24 hrs after delivery?

Back 56

Dehydration

Front 57

Comfort measures post-episiotomy

Back 57

Ice for the first 24 hrs, then heat (sitz bath)

Front 58

When assessing the fundus after delivery remember to...

Back 58

Have mom empty bladder first
Full bladder = Higher fundus
*also prevents uterus from contracting well

Front 59

Describe the mother's pulse postpartum

Back 59

Often see bradycardia for the first 24- 48 hrs (as heart compensates for decreased vascular resistance in pelvis)

Front 60

Describe the mother's urine output postpartum

Back 60

Should void large amounts frequently (at least 150cc at a time, extra fluid elimination during first 12 pp hours)

Front 61

Disadvantages of amniotomy (membrane rupture)

Back 61

Increased risk of infection
Increased risk of cord prolapse
Removal of cushion (more pressure on head)

Front 62

What do you do with a "boggy" postpartum fundus?

Back 62

Massage it. It should be round and firm.
boggy = increased risk of bleeding

Front 63

Word used to describe the decreasing size of the uterus after delivery

Back 63

Involution

Front 64

How often do you check uterine tone, position and height after delivery?

Back 64

Same time frame as vital signs (Q1hr x 4, etc.)

Front 65

Describe uterus for first 1-2 hrs after delivery

Back 65

Fundus midway between symphysis and umbilicus

Front 66

Describe uterus by 12 hrs after delivery

Back 66

Fundus at umbilicus or 1 cm above

Front 67

How much should fundal height decrease per day after delivery?

Back 67

1 cm (1 finger width)
*ie. day 2 = 2 cm below umbilicus, etc. until, at 2 wks, no longer palpable above symphisis and by 6 wks - pre-pregnant size.

Front 68

Postpartum breasts during first 2 days

Back 68

Soft (colostrum)

Front 69

Postpartum breasts on day 3

Back 69

Engorgement (milk)

Front 70

Postpartum pericare

Back 70

Wash front to back w/ squirt bottle & warm water after each void or BM, change pad Q2-3 hrs

Front 71

If the head can’t go through the birth canal its usually because the head is too big and not because its in the wrong position. True or False?

Back 71

False (The opposite is true)

Front 72

What maneuvers can be one after week 30 to determine fetal presentation and position?

Back 72

Leopold’s Maneuvers

Front 73

When auscultating, the FH is heard loudest where in cephalic presentations? Breech?

Back 73

Below umbilicus, above umbilicus

Front 74

What is the progesterone deprivation theory?

Back 74

Progesterone decreases at term and causes labor to start

Front 75

What is the fetal adrenal response theory?

Back 75

Increase cortisone from mature adrenal glands causes labor.

Front 76

What is the prostaglandin theory?

Back 76

Increased amounts produced by uterine decidua and cause labor.

Front 77

What are some preliminary signs of labor?

Back 77

Lightening, weight loss, full of energy, braxton hicks contractions, ripening of cervix, ROM, show.

Front 78

What is the difference between Braxton Hicks contraction and true contractions?

Back 78

BH contractions are irregular, felt in abdomen only, go away with position change, and no E& D of cervix. True contractions are regular, felt in lower back and sweep to abdomen, don’t go away, and cause E&D of cervix.

Front 79

If a women has ROM and the baby is not well engaged what does the MD check for?

Back 79

Cord prolapse. O2 may be getting cut off.

Front 80

What are the 3 things to make note of while having contractions?

Back 80

Duration, intensity, frequency

Front 81

How much time (minimum) needs to be in between contractions to allow uterine blood vessels to fill?

Back 81

1 minute.

Front 82

How do you determine the frequency of contractions?

Back 82

Time from beginning of one contraction to the beginning of the next.

Front 83

The thinning of cervix from 2cm to paper thin

Back 83

Effacement

Front 84

The opening of the cervix (0-10cm) due to contractions and pressure of presenting part.

Back 84

Dilation

Front 85

What are the 3 phases of the 1st stage of labor?

Back 85

Latent, Active and Transition phase

Front 86

During the latent phase how far dilated does the women get and what is she like?

Back 86

3cm usually happy

Front 87

During the active phase how far dilated does the women get and what is she like?

Back 87

4-7 cm she is more focused and less able to tolerate distractions

Front 88

During the transition phase how far dilated does the women get and what is she like?

Back 88

8-10cm she is panicky, feels out of control, wretches, shakes, irritable.

Front 89

If a woman begins to hyperventilate during the transition phase what should she do?

Back 89

Rebreathe into paper bag or cupped hands.

Front 90

What is the order of cardinal movements of labor?

Back 90

Engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.

Front 91

If the woman’s has ROM what color should the fluid be?

Back 91

Clear

Front 92

Upon ROM, what would yellow fluid indicate? Green or brown?

Back 92

Yellow- blood incompatibility, Green or Brown- Fetal distress passing of meconium. (Normal with breech due to squeezing)

Front 93

While doing a vaginal exam what do you want to check for?

Back 93

Lesions, cord, drainage, bleeding.

Front 94

What is the most common infection seen in L&D?

Back 94

STDs

Front 95

During labor there is an increase in P&R also R/T dehydration/infection. True or false?

Back 95

True

Front 96

How often do you check temperature if there is no ROM and temperature is normal?

Back 96

Q2-4H

Front 97

How often do you check temperature if there is ROM or temperature is not normal?

Back 97

Q1H

Front 98

Electronic fetal monitoring during lab can be done 2 ways external or internal. What is the internal called and what is important to remember when removing it?

Back 98

Fetal scalp electrode. Turn it counter clockwise to remove

Front 99

The FHR changes from 140 to 120 but you don’t need to report this to the MD because its still within normal limits. True or False?

Back 99

False

Front 100

----- ---- ----------- is the single most reliable indicator of fetal well being.

Back 100

Short term variability (2-3 beats)

Front 101

FHR --------- at beginning of contraction but rate returns to normal by end of contraction. Due to ---- -----------.

Back 101

Decreases, head compression

Front 102

How often should the woman void when fully dilated?

Back 102

Q2H

Front 103

What can you do to help with pain, foley insertion, etc.?

Back 103

Put roll under right hip.

Front 104

What are 2 examples of the types of positioning a woman can do for comfort while in labor?

Back 104

Hands and knees for posterior baby helps to rock and tilt pelvis, and squatting increases pelvic diameter 11/2-2cm and helps bearing down effects.

Front 105

What is something that is useful for comfort of the perineum stretching during the 2nd stage?

Back 105

Hot compresses

Front 106

What is the pushing called that is only 6-7 seconds long at a time along with slight exhalation?

Back 106

Open glottis pushing

Front 107

What are ways to avoid an episiotomy?

Back 107

gentle pushing, hot packs, no pushing after crowning, iron out perineum, oil to head, deliver side- lying or semi sitting.

Front 108

Which is worse a first degree or 4th degree laceration?

Back 108

4th

Front 109

1st degree is a laceration into what? 4th degree?

Back 109

skin or vaginal mucosa, lumen of rectum

Front 110

Immediately after delivery what do you want to do?

Back 110

Suction mouth AND THEN nose.

Front 111

What do you do if you see meconium-stained amniotic fluid?

Back 111

Intubate, deep suction before first breath

Front 112

A woman often has shaking chills after labor what should you give her?

Back 112

Warm blanket

Front 113

If placenta won’t separate what should you have the baby do?

Back 113

Nurse

Front 114

If uterus is not well contacted what are 3 things you can do?

Back 114

nipple stimulation, fundal massage, or pitocin IV

Front 115

How should you lay that baby to allow mucus to drain from mouth?

Back 115

Lay baby on side with head 30 degrees down

Front 116

If you suction a baby vigorously what can that cause?

Back 116

Bradycardia

Front 117

To prevent heat loss what do you want to increase?

Back 117

use of O2 and glucose

Front 118

While doing apgar scoring a baby with a score of 0-3 is in good condition True or False?

Back 118

False (0-3 indicates serious danger)

Front 119

Where do you put the prophylactic eye meds?

Back 119

In the lower conjunctival sac. (delay for first hour to allow mother-child bonding)

Front 120

When giving vitamin K to the newborn where should it be given?

Back 120

In the vastus lateralis
*given to promote synthesis of clotting factor

Front 121

What are 8 parts of the nursing care for mom after a vaginal devliery?

Back 121

Check temperature once then Q15 minutes x4, BP P R, check fundal tone, height and position, assess lochia and perineum, promote elimination, assess pain and promote comfort, monitor IV and assess effects of anesthesia.

Front 122

What should the newborns P R and temperature be?

Back 122

110-160, 30-60, 98-98.6

Front 123

This is an anesthesia injected local into cervix at 4 & 8 o’clock. Relieves ------- pain, but not vaginal or perineal sensation (can push).

Back 123

Paracervical Block, uterine

Front 124

This is an anesthesia injected into nerve at level of ischial spines. Relieves ------- and -------- pain. (can push)

Back 124

Pudendal Block, vaginal and perineal

Front 125

What can an epidural cause? What do you want to do for this?

Back 125

Maternal hypotension. Give lots of IV fluids before and during, check BP frequently, nausea is first sign.

Front 126

What is a disadvantage to general anesthesia?

Back 126

Newborn depression especially respiratory depression.
*it's the quickest though.

Front 127

During postpartum Hgb Hct and RBC are the same as prelabor True of False?

Back 127

True

Front 128

What is the normal WBC count?

Back 128

15,000- 30,000

Front 129

Blood clotting factors decrease during postpartum True or False?

Back 129

False (they increase)

Front 130

How often should vitals be done?

Back 130

Q1h x 4 then Q4H for 24H then Q8H

Front 131

A temp. of -----or greater on two or more occasions would suggest some type of infection.

Back 131

100.4

Front 132

P&R often see ----------- for the 1st 24-48H.

Back 132

Bradycardia

Front 133

Increased P&R could mean…?

Back 133

Hemorrhage, infection, or dehydration.

Front 134

How often should breasts be assessed?

Back 134

BID

Front 135

Milk production is under the influence of --------- .Let down reflex caused by --------

Back 135

Prolactin, Oxytocin.

Front 136

How should a women care for engorgement if BF?

Back 136

Nurse frequently, supportive bra, warm soaks or shower on breasts.

Front 137

How should a women care for engorgement if not BF?

Back 137

Decrease fluid intake to1000cc/day, supportive bra, no breast or nipple stimulation, ice packs

Front 138

Pain caused by uterine contractions after birth. Common in multips

Back 138

Afterpain

Front 139

Uterus may not stay well contracted anytime it has been -------------

Back 139

overdistened

Front 140

How much should a women void each time?

Back 140

150cc

Front 141

What is the lochia called the 1st 3 days pp? 4-9days pp? 10-?days?

Back 141

Lochia rubra (red)
Lochia serosa (pink to brown) Lochia alba (yellow to white)

Front 142

>---ml of blood loss in first 24 hours is considered hemorrhage

Back 142

500

Front 143

What is a major cause of post delivery hemorrage?

Back 143

Uterine atony

Front 144

When doing perineum care you should apply heat for the 1st 24 hours and then ice after that. True or False?

Back 144

False ( the opposite is true)

Front 145

Can a woman who had a C/S eat afterwards?

Back 145

No they are NPO until they have bowel sounds

Front 146

What are the 3 maternal phases ?

Back 146

Taking-in, taking-hold, and letting-go

Front 147

What one of the 3 maternal phases requires the most teaching?

Back 147

Taking hold

Front 148

Do sutures need to be removed if the women has an episiotomy etc.?

Back 148

No they dissolve

Front 149

Can BF be used as a form of birth control?

Back 149

No

Front 150

Immediately after ROM...

Back 150

Check FHR

Front 151

OK to ambulate during labor EXCEPT...

Back 151

If head is not engaged (0 station or below) & ROM

Front 152

Good APGAR score

Back 152

7-10

Front 153

Abdominal pain between contractions could mean...

Back 153

Full bladder or uterus not relaxing