Maternal Child Test 4

Front 1

A patient concern is the ____________associated with birth

Back 1

pain

Front 2

A concern of the pt may be experience (it could be 5th child or 1st)
True or False

Back 2

True

Front 3

The unpredicitability of the natural process of birth may be a concern because_________

Back 3

birth is a natural process but it is on its own time schedule

Front 4

A concern of the pt/family may be intimacy. Why?

Back 4

They may view this as personal/private time

Front 5

A concern of the nurse may be that ___________is present but cannot be eliminated

Back 5

pain

Front 6

A nurse concern may be that she has never had a child
True or False

Back 6

true

Front 7

The nurse concern of unpredictability:

Back 7

there are guidelines but individuals vary

Front 8

A nurse concern is being allowed into families ____________and___________life and space

Back 8

personal
private

Front 9

Why during labor contractions is the maternal blood supply to the placenta gradually stopped?

Back 9

The spiral arteries supplying the intervillous space are compressed by the contacting uterine muscle

Front 10

List the three phases of the contraction cycle

Back 10

increment
acme
decrement

Front 11

The increment phase of the contraction cycle begins at the _________and spreads throughtout the _________

Back 11

fundus
uterus

Front 12

The acme phase of the contraction cycle is what?

Back 12

the most intense or peak of the contraction

Front 13

The decrement phase of the contraction cycle is the period of time in which the contraction _________intensity as the uterus _____________

Back 13

decreases
relaxes

Front 14

A nursing intervention of the nurse asking assistance of the husband sharing with wife when the contraction is at which phase of the contraction cycle

Back 14

ACME

Front 15

Describe Intensity

Back 15

how strong the contraction is

Front 16

How often the contraction are is the_____________

Back 16

frequency

Front 17

The duration of the contraction is from beginning to end. What is the duration of labor contractions?

Back 17

the average lenght of contractions

Front 18

Effective uterine contractions
(list 3)

Back 18

---pull the cervix upward at the same time
---the fetus and amniotic sac are pushed forward
--like pulling the cervix over the fetus and amniotic sac

Front 19

During uterine contractions blood flow to the placenta temporary stops causing what?

Back 19

---a relative increase in the mothers blood volume which in turns temporarily increases bp and slows pulse

Front 20

Before labor what is the shape of the cervix?

Back 20

cylindrical and 2cm long

Front 21

What causes causes the cervix to be pulled up and becomes shorter and thinner (effacement)?

Back 21

uterine contractions

Front 22

Effacement is what?

Back 22

the est. % of the amt the cervix has thinned
--fully thinned is 100% effaced

Front 23

What causes dilation?

Back 23

when the cervix is pulled up and the fetus pushes down the cervix dilates

Front 24

How is dilation measures? What is complete dilation?

Back 24

cm
10 cm

Front 25

A maternal response to pregnancy is increase of depth and rate of respirations which may lead to what?

Back 25

hyperventilation

Front 26

Hyperventilation is rapid, deep respirations that cause the laboring women to ____________co2 through exhalation resulting in resp __________

Back 26

lose
alkalosis

Front 27

How can you help a woman experiencing hyperventilation?

Back 27

---help her slow down respirations
--use brown bag or cupped hands to restore normal co2 level

Front 28

True or False
A full bladder may interfere with fetal decent

Back 28

true

Front 29

An increase in blood volume allows the woman to what?

Back 29

tolerate the normal blood loss of 500ml during vaginal birth

Front 30

List signs and symptoms of impending hypovolemic shock due to blood loss

Back 30

--increased pulse rate
--falling bp
--increased resp rate

Front 31

What is normal fetal HR?

Back 31

110-160

Front 32

When does engagement occur?

Back 32

when the presenting part fully enters the pelvic inlet

Front 33

List the components of the birthing process

Back 33

---powers
--passage
--passenger
--psyche

Front 34

List the powers of the birth process

Back 34

--uterine contractions
--maternal pushing efforts

Front 35

What are uterine contractions?

Back 35

1st stage of labor, primary force moving the fetus through the maternal pelvis

Front 36

What are maternal pushing efforts?

Back 36

second stage of labor (full cervical dilation to birth) women add voluntary pushing efforst to the force of contractions

Front 37

What are the passage elements of the components of birth?

Back 37

--maternal pelvis and its soft tissues
--bony pelvis is the more important to the outcome of labor
--bones and joints do not usually yield to the forces of labor
--softening of cartilage does occur with the hormone relaxin
--pelvic measurements are essential in determining if the fetus may be delivered vaginally

Front 38

True or False
The passenger component of birth is the fetus plus the membranes and placenta

Back 38

true

Front 39

What must occur to the head to accommodate the birthing process?

Back 39

the shape of the fetal head must change shape (molding)

Front 40

What is the fetal lie? (It is a variation in passenger component)

Back 40

orientation of the long axis of the fetus to the long axis of the woman

Front 41

What is the longitudinal lie? (It is a variation in passenger component)

Back 41

99% of the lie is longitudinal or parallel to the long axis of the woman
---either the head or buttocks of the fetus enters the pelvis first

Front 42

The transverse lie (a variation in the passenger component) is where the ________axis of the fetus is at __________angels to the womans long axis

Back 42

long
right
--only occurs in 1% of births

Front 43

An oblique lie is what? (It is a variation in passenger component)

Back 43

an angle somewhere b/w a longitudinal and transverse lie

Front 44

The normal fetal attitude is one of flexion, explain

Back 44

smallest anterior-posterior diameter of the fetal head enters the pelvis
--9.5 cm

Front 45

Name the 4 variations of cephalic presentation

Back 45

--vertex
--military
--brow
--face

Front 46

One variation of cephalic presentation is vertex, which is most common, explain postion

Back 46

head is fully flexed and is most favorable for normal progress

Front 47

Decribe the military variation of the cephalic presentation

Back 47

head is in a neutral position, neither flexed or extended

Front 48

The brow varation of cephalic presentation is what?

Back 48

fetal head is partly extended

Front 49

the face position varation of cephalic presentation is what?

Back 49

head is fully extended and fetal occiput is near the fetal spine

Front 50

Psyche component of the birthing process is what?

Back 50

a crucial part of child birth, anxiety, fear, fatigue interfere with the ability to cope

Front 51

What happens in lightening?

Back 51

--fetus descends towards the pelvic inlet near the end of the pregnancy
--increase in pelvic pressure causes greater urinary freq and more leg cramps

Front 52

What are signs of true labor?

Back 52

--contractions are progressive
--effacement begins to occur
--cervical dilation begins

Front 53

What are signs of false labor?

Back 53

--contractions are NOT progressive
--effacement does NOT occur
--cervical dilation--no dilation noted

Front 54

Why should the mother come to hospital for an eval when a trickle of fluid is coming from her vagina?

Back 54

--this may indicate rupture of membranes (ROM)
--requires eval for infection or cord compression

Front 55

_____________women usually have shorter labors than do nulliparous women

Back 55

multiparous

Front 56

When should a woman be instructed to come to the hospital for soon after labor begins

Back 56

if they are multiparous and have a hx of rapid deliveries

Front 57

Name the 3 phases of the first stage of labor

Back 57

latent
active
transition

Front 58

Why should vagnial exams only be preformed when necessary?

Back 58

the risk ofinfection by carrying microbes upward towards the uterus

Front 59

Which type of gloves should be used to do a vag exam after membrane rupture?

Back 59

STERILE

Front 60

Describe the latent phase of the first stage of labor

Back 60

--early & easy phase
--0-3cm cervical dilation
--lenght varies w. individual
--woman is social & excited

Front 61

If cath is required why is a small pillow placed under one hip to assist in displacing heavy uterus from the inferior vena cava?

Back 61

--promotes normal placenta blood flow while allowing adequate view of urethra

Front 62

Decribe the active phase of the first stage of labor

Back 62

--cervical dilation 4-7cm
--effacement is complete
--request for pain meds
--FHR should be assessed q 30 min, for high risk q 15 min (these are minimiums)

Front 63

To help mother relax what is a nursing intervention?

Back 63

if pt lying supine, recommend turning to side to prevent vena cava syndrome

Front 64

Frequent maternal position changes helps to (list 2 nursing interventions)

Back 64

--reduce discomfort from constant pressure
--promote fetal decent

Front 65

What is the essential part of nursing in labor?

Back 65

--help the woman manage pain
--pain is expected and normal and can not be fully relieved

Front 66

Describe the transition phase of the first stage of labor

Back 66

--8-10cm cervical dilation
--blood show increases with complete cervical dilation
--parter is confused b/c their actions they took a short while ago are not comforting now

Front 67

The second stage of labor is from _____________to ______________

Back 67

complete dilation
birth of newborn

Front 68

During the second stage of labor a vulva bulges and encircles the fetal head, this is described as_______

Back 68

crowning and is shortly before birth

Front 69

The third stage of labor is from _____________to_____________

Back 69

delivery of newborn
delivery of placenta

Front 70

The forth stage of labor is _____________to____________

Back 70

delivery of secundines
homeostasis
is usually defined as the initial hour of postpartum

Front 71

During the forth stage of labor, the mother usually chills for up to 20 min, what nursing intervention can be done?

Back 71

use of warm blankets comforts the mother

Front 72

After delivery the fundus is massaged to stimulate contraction. What should be done after 30 minutes if the fundus is soft?

Back 72

massage fundus

Front 73

Why after delivery does the nurse throughly dry the infant?

Back 73

to reduce heat loss from evaporation

Front 74

When does meconium stained amniotic fluid occur?

Back 74

--when fetal o2 is compromised, is causes relaxation of rectal sphinter which allows passage of meconium into the amniotic fluid

Front 75

--Ausculatation of FHR
--palpation of uterine activity
--noninvasive measures
These are examples of what?

Back 75

low technology

Front 76

List advantage of high technology

Back 76

--supplies more data
--printed record
--fetal responses to contractions
--coach can use monitor to anticipate the next contraction

Front 77

What are the disadvantages of high tech monitoring?

Back 77

--decrease mobility and freq monitor adjustments
--difficult to obtain clear tracing w. obsese mother
--mother may focus on getting a good tracing than being comfortable

Front 78

List nursing interventions r/t FHR monitoring with a doppler

Back 78

--gel is required
--warm gel in hand if possible
--let mom know before you apply gel
--wipe gel off after done

Front 79

What does the tocotransducer "Toco" monitor?

Back 79

uterine activity

Front 80

Where should the toco monitor be placed?

Back 80

--over the fundus
--where the most intensive uterine contraction occurs
--external use only
--belt holds in place

Front 81

When should the toco be used?

Back 81

with a woman who has a hx of HTN

Front 82

Should you teach the pt and family about the monitoring equipment

Back 82

yes

Front 83

When is continuous fetal monitoring used?

Back 83

--when oxytocin is used
--if utero-placental exchange may be compromised

Front 84

The scalp electrode is an internal fetal monitoring device that is used after ______________

Back 84

the membranes have ruptured

Front 85

What does an intrauterine pressure catheter measure?

Back 85

actual intrauterine pressure

Front 86

What is an assuring response of the vibroacoustic stimulation test?

Back 86

an increase in FHR by 1-20 bpm after stimulation

Front 87

When do early decel's occur?

Back 87

only during contractions as the fetal head is compressed

Front 88

T or F
Early decels are mirror images of contractions

Back 88

true

Front 89

Early decels are or are not associated with fetal compromise?

Back 89

are not

Front 90

Do early decels require intervention?

Back 90

NO

Front 91

When do late decels begin?

Back 91

well after the contraction begins

Front 92

Name the 3 phases of the first stage of labor

Back 92

latent
active
transition

Front 93

Why should vagnial exams only be preformed when necessary?

Back 93

the risk ofinfection by carrying microbes upward towards the uterus

Front 94

Which type of gloves should be used to do a vag exam after membrane rupture?

Back 94

STERILE

Front 95

Describe the latent phase of the first stage of labor

Back 95

--early & easy phase
--0-3cm cervical dilation
--lenght varies w. individual
--woman is social & excited

Front 96

If cath is required why is a small pillow placed under one hip to assist in displacing heavy uterus from the inferior vena cava?

Back 96

--promotes normal placenta blood flow while allowing adequate view of urethra

Front 97

When do late decels begin?

Back 97

well after the contraction begins (often near the peak)

Front 98

What does late decels reflect?

Back 98

impaired placental exchange or uteroplacental insufficiency

Front 99

What nursing intervention is needed to improve placental blood flow and fetal o2 supply?

Back 99

give o2 per face mask and turn mom to L) side

Front 100

What causes variable decels?

Back 100

reduced flow through umbilical cord (cord compression)

Front 101

What is the nursing intervention of variable decels?

Back 101

turn mom to L) side, if not relieved turn to her R)

Front 102

When a mom's membranes rupture what should we assess for? Why?

Back 102

variable decels
the amniotic fluid may carry the umbilical cord to a postion where it may be compressed b/w the maternal pelvis and fetal presenting part

Front 103

What are reassuring FHR patterns?

Back 103

--FHR acceleration w. movement
--fetus is tolerating intrapartum stressess

Front 104

What are nonreassuring FR patterns?

Back 104

--favorable signs are absent or sign that are associated w. hypoxia or acidosis of fetus is present
--but NOT to say fetal hypoxia or acidosis has occured

Front 105

Why does increasing non additive IV fluids increase fetal oxygenation?

Back 105

--fills vascular system
--makes more bllod available to perfuse the placenta
--corrects hypotension

Front 106

What should be done in response to nonreassuring FHR patterns?

Back 106

--identify the cause of the pattern
--evaluate for probable cause
--evaluate maternal VS
--identify prolapsed umbilical cord (if vaginal exam is not contraindicated)
--reposition woman to avoid the supine position and/or improve pattern

Front 107

What should be done to IV fluid rate to respond to nonreassuring FHR patterns?

Back 107

--increase rate of infusion of nonadditive IV fluid
--also adminster o2 via face mask at 8-10L/min

Front 108

List the physiologic effects of pain during labor

Back 108

--increase in metabolic rate and o2 demand
--increase in production of catecholamines, cortisol, glucagon
--less o2/waste exchange for fetus
--decreased placental perfusion*****

Front 109

List the sources of pain r/t labor

Back 109

--tissue ischemia: hypoxia of the uterine muscle

Front 110

List the four potential sources of pain r/t labor

Back 110

1) tissue ischemia:uterine tissue hypoxia during contractions****
2) cervical dialtion
3) Pressure and pulling on pelvic structures
4)distnetion of the vagina and perineum from presenting part

Front 111

One variable in childbirth pain is cervical dilation, explain

Back 111

stretching of the lower end of uterus

Front 112

Pressure and pulling on pelvic structures causes pain why?

Back 112

--pressure or pulling on structures such as ligaments, fallopian tubes, ovaries, bladder and perineum
--may have referred pain to back and legs

Front 113

Distention of the vagina and perineum causes pain why?

Back 113

--marked distention occurs with fetal descent
--feeling of burning, tearing or splitting (somatic pain) Enters spnal cord at S2, S3, S4

Front 114

Fetal positions can cause the woman to have increased discomfort. The fetal position that is L) occiput posterior causes.....

Back 114

--each contraction pushes the fetal head against the mother's sacrum
--results in intense back discomfort
--have support person apply firm pressure to the sacrum

Front 115

Psychosocial factors that influence the perception and tolerance of pain are

Back 115

--previous experience with pain
--preparation for childbirth

Front 116

Childbirth prep is considered successful if the outcome

Back 116

--pt rehearsed labor
--practiced skills to master or cope with the pain of labor

Front 117

When is the best time to ask questions or do procedures?

Back 117

after the contraction is over
duh

Front 118

When is the best time to teach non-pharmacologic pain management to an unprepared laboring woman?

Back 118

in the latent phase
--non pharm methods may be the best option in advanced labor (8cm dilation)

Front 119

What is progressive relaxation?

Back 119

teaches the mother to tense and relax muscle on cue

Front 120

What is touch relaxation?

Back 120

relaxation in response to touch of the individuals coach

Front 121

What is disassociate relaxation?

Back 121

Used in Bradely and Lamaze method (sense of contracting and relaxing muscles) Goal is to teach the women to consciously to release certain sets of muscles

Front 122

What does disassociate relaxation teach the mother?

Back 122

--helps the women learn to relax her body even when one group of muscles is strongly contracted

Front 123

What is visual imaging?

Back 123

--mom imagines her body opening up to let the baby out
--provides the individual with a physiological response to imagination

Front 124

What type of breathing is used during the first stage of labor?

Back 124

--cleansing breath
--various breathing techniques known as paced breathing

Front 125

Why is beginning and ending a contraction with a cleansing breath an important aspect of proper breathing?

Back 125

--helps the women clear her mind to focus on relaxation and the signals the coach that the contraction is beginning or ending

Front 126

What should be done if the woman is loosing control?

Back 126

--make eye contact with the women and breath along with her (support person supposed to do this)

Front 127

What is a direct effect on the fetus from pharm pain management?

Back 127

respiratory depression

Front 128

What are indrect effects of pharm management?

Back 128

--does not pass into placenta
--effects maternal response
--meds that cause hypotension may reduce blood supply to placenta
--fetal hypoxia may occur with poor placenta perfusion

Front 129

What should you admin a narcotic at the beginning of a contraction?

Back 129

--less meds will be transferred to the fetus
--during a contraction blood flow to the fetus is reduces which limits the transfer

Front 130

What is the least favorable position for labor and why?

Back 130

supine because of vena cava syndrome which reduces blood flow that can compromise fetal o2 supply

Front 131

After injection of the epidural what must the nurse monitor?

Back 131

--maternal bp
--epidural may produce maternal hypotension from vasodilation

Front 132

Why should the nurse place a wedge under the women's right hip after epidural injection?

Back 132

--tilting the hip to the L) relieves compression of the vena cava and compensates for a lower bp w/o interfering with dispersal of the epidural meds

Front 133

How often should we do an resp assessment after epidural injection?

Back 133

every hour

Front 134

What is a spinal h/a and adverse effect of a subarachnoid block?

Back 134

--leakage of spinal fluid
--postural
--treat with best rest and IV fluids
--may use blood patch

Front 135

What is a pudendal block and why is it used?

Back 135

--anesthetizes the lower vagina and perineum
--provides anesthesia for an episotomy and use of low forceps if needed

Front 136

A local provides anesthesia for the perineum at the site of the episotomy, is this the safest route?

Back 136

yes because it rarely has any adverse effects on either the mother or fetus

Front 137

What are the adverse effects of general anesthesia?

Back 137

--maternal aspiration of gastric contents
--resp depression
--uterine relaxation

Front 138

General Anesthesia****
Risk:Aspiration of stomach contents
What does the aspiration of acidic contents lead to?

Back 138

--possible airway obstruction
--potentially fatal complication of general anesthesia

Front 139

What are two contraindications for an amniotomy?

Back 139

--head must be engaged to prevent prolapse of the cord
--can not be at a negative station

Front 140

What is the priority nursing intervention after an amniotomy?

Back 140

Assess FHR for 1 minute

Front 141

What indicates cord compression?

Back 141

deep or long variable decels after contractions or persistent bradycardia

Front 142

What should you assess after amniotomy?

Back 142

--note quantity, color, odor of fluid
--assess temp q 2h and report above 100.4, FHR above 160 may precede temp elevation

Front 143

What must the nurse monitor after admin of oxytocin (pitocin)

Back 143

1) Uterine activity, FHR and pattern, perform Leopold's maneuver and vag exam to assure cephalic fetal presentation prior to admin of pit
2) when pit was started
3) throughout the labor

Front 144

When is it safe to use pit to induces?

Back 144

--pregnancy is past 42 weeks
--if contraction pattern represents hyperstimulation of the uterus, and inadequate resting time b/w contractions to allow placental perfusion
--contractions q 2 min lasting 90 sec

Front 145

Doc may order tocolytic drug to stop over stimulation of uterus

Back 145

--terbutaline (brethine) subq
--mag sulfate IV

Front 146

What is internal version and when is it used?

Back 146

--where they stick their hand up the vag area and turn baby around!!!
--mapresentation of second twin in a vag birth
--only used during vaginal birth to manipulate the second twin to a presentation that allows it to be vaginally

Front 147

Why is a tocolytic drug used when external version is necessary?

Back 147

--to relax the uterus before and during the version
--makes manipulation easier

Front 148

What indicates a comlication of external version?

Back 148

--fetal bradycardia persisting 10 min after version
--may indicate that the umbilical cord has been compressed and the fetus is having hypoxia

Front 149

Why does a empty bladder help with labor/delivery?

Back 149

--an empty bladder provides more room in the pelvis

Front 150

If forceps or vacuum is used what should be assessed after delivery?

Back 150

--assess infant for trauma
--assess mom for vaginal wall lacerations or hematoma (edema & discoloration of labia and perineal area)

Front 151

What nursing intervention can be used to help decrease swelling and pain if forceps or vacuum is used for delivery?

Back 151

apply ice

Front 152

What is a maternal indication for use of vacuum?

Back 152

materal exhaustion
--a mother who is exhausted will be unable to assist with expulsion of the fetus

Front 153

When is the only time that a mediolateral episotomy is to be used?

Back 153

if the woman has a short perineum

Front 154

Does the mediolateral episotomy extend in the rectum?

Back 154

NO NO NO
thank god

Front 155

What are nursing considerations for the mother with the mediolateral episotomy?

Back 155

--assess mother for vaginal wall lacerations or hematoma
--apply ice to decrease swelling and for pain relief for 1st 24 hours

Front 156

The woman who has had the classic inscison made into the upper uterine segment is at risk for uterine rupture because

Back 156

the upper part of the uterus contracts forcefully during labor, incision in the area may rupture in subsequent pregnancies

Front 157

Where must the foley bad be placed before the c section?

Back 157

--placed near the head of the table because the anesthesia clinician must monitor urine output during the surgery

Front 158

Why is an oral antacid administered before a c section?

Back 158

--general anesthesia may be needed unexpectedly
--oral antacid neutralizes gastric contents and reduces potential injury if the women vomits and aspirates during anesthesia

Front 159

What is the fetal risk of an elective c section?

Back 159

--preterm due to miscalculation of gestation
--inadvertent preterm birth

Front 160

What are the risks for mother and fetus post c section?

Back 160

--persistent fetal bradycardia (below 100)
--intensive maternal pain
--elevated materal pulse with decrease bp

Front 161

How often should the uterus be assessed after a c section?

Back 161

q 15 mintues: must maintain contraction of uterus to control bleeding from the placental site. Boggy or soft uterus after delviery (C-section or vag delivery)