Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
153 Cards in this Set
- Front
- Back
Time from the beginning of one contraction to the beginning of the next
|
Frequency
|
|
Length of time from the beginning of the contraction to the end
|
Duration
|
|
Begins with onset of first true labor contraction and ends with complete dilation of the cervix
|
Stages of Labor:
First Stage (three phases) |
|
First true contraction to 3cm
Contractions mild, Q 5-20 min. last 30-45 sec. P8 M5 hrs. Woman often happy, talkative, friendly |
Stages of Labor:
First Stage PHASE 1: Latent Phase |
|
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 |
Stages of Labor:
First Stage PHASE 2: Active Phase |
|
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. |
Stages of Labor:
First Stage PHASE 3: Transition |
|
Reason for numbness and tingling of lips, fingers, toes and lightheadedness/dizziness
|
Respiratory alkalosis due to hyperventilation during Transition (last phase of first stage of labor)
|
|
If this is seen, have woman breathe into cupped hands or a paper bag.
|
Numbness and tingling of lips, fingers, toes and lightheadedness/dizziness. (Respiratory alkalosis due to hyperventilation during Transition)
|
|
Begins with complete dilation of the cervix and ends with birth of baby.
|
Stages of Labor:
Second Stage |
|
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. |
Stages of Labor:
Second Stage |
|
The fetal occiput is directed towards the mother's left, anterior side.
|
LOA (Left Occiput Anterior )
(Most Common) |
|
The fetal occiput is directed towards the mother's right, anterior side.
|
ROA (Right Occiput Anterior)
|
|
The fetal occiput is directed towards the mother's left, posterior side.
|
LOP (Left Occiput Posterior)
|
|
The fetal occiput is directed towards the mother's right, posterior side.
|
ROP (Right Occiput Posterior)
|
|
The fetal sacrum is closest to the mother's symphysis and rotated slightly to the mother's right
|
RSA (Right Sacrum Anterior)
(Breech) |
|
The fetal occiput is directed towards the mother's right
|
ROT (Right Occiput Transverse)
|
|
The fetal occiput is directed towards the mother's left
|
LOT (Left Occiput Transverse)
|
|
Lower back pain is associated with the baby in this position
|
Posterior
|
|
Interventions for lower back pain during delivery
|
Mother on hands and knees, partner massages lower back
|
|
In a cephalic presentation (head first), the FHB is heard loudest:
|
Below the umbilicus
|
|
In a sacral presentation (breech), the FHB is heard loudest:
|
Above the umbilicus
|
|
Relationship of presenting part to ischial spines
|
Station
|
|
Head level with ischial spines
|
0 Station
|
|
Head 1cm above ischial spines
|
-1 Station
|
|
Head 2cm above ischial spines
|
-2 Station
|
|
Head 1cm below ischial spines
|
+1 Station
(*remember + is "positive" - good that baby is coming) |
|
Head 2cm below ischial spines
|
+2 Station
(*remember + is "positive" - good that baby is coming) |
|
Station when head is seen at the perineum (crowning)
|
+4 Station
|
|
First action when membranes rupture?
|
Check FHR, NO ambulation if head not at 0 Station (risk of cord prolapse
|
|
To check for ROM during initial assessment...
|
Use Nitrazine paper:
Normal vaginal secretions acid (<6.5) paper stays YELLOW Amniotic fluid alkaline (>6.5) paper turns BLUE |
|
Another check for ROM during initial assesment...
|
"Ferning" - When dry, vaginal fluid smeared on a glass slide creates a characteristic fern pattern
|
|
Degree of flexion fetus assumes
|
Attitude
|
|
Good Attitude
|
Neck to chin = complete flexion (smallest A-P diameter)
|
|
When presenting part has settled far enough into pelvis to be at the level of the ischeal spines
|
Engagement (engagement means lightening has occurred)
|
|
If not engaged, fetus described as...
|
Floating
|
|
In primip, non-engagement of head at beginning of labor could be...
|
CPD (abnormal presentation)
Cephalopelvic disproportion (pelvis too small or head too big) |
|
Relationship between long axis of fetus and woman
|
Presentation or Lie
(99% are vertical, 1% horizontal & usually need c/s) |
|
This presentation/lie can be cephalic or breech
|
Vertical
Vertex = head well flexed (as opposed to brow, face chin presentation) |
|
Types of breech presentation
|
Complete - thighs on abdomen, legs on thighs
Frank - thighs flexed, legs extended Footling - one or both legs extended |
|
FHR decreases at beginning of contraction
|
Early decelerations - Normal (r/t head compression)
|
|
FHR decreases 30-40 sec. after contraction starts and stays low beyond end of contraction
|
Late decelerations - Bad, due to uteroplacental insufficiency (not enough blood and O2), often Pitocin IV is to blame, (causes contractions)
|
|
Treatment for late decelerations
|
Turn on L side
Turn off Pitocin Give O2 Increase IV rate Call MD |
|
Decreased FHR at unpredictable times during contractions
|
Variable decelerations
Due to cord compression |
|
Treatment for variable decelerations
|
Turn on L side (or R if already on L)
O2 Call MD Trendelenberg |
|
Are pain meds (ie. opioids/narcotics) OK to give mom when 8-9cm dilated (in transition)?
|
NO (Mom at risk of respiratory depression when in transition)
|
|
Third Stage of Labor
|
Placental stage
(cord lengthens, rush of blood, active bleeding r/t separation) |
|
Stage 3 (Placental stage) Meds
|
oxytocin (pitocin) and Ergonovine (methergine) given AFTER delivery of placenta -increase uterine contractions and decrease bleeding
|
|
Check BP before giving this med
|
Ergonovine (methergine) (increases BP so don't give to a woman with increased BP - & never before uterus empty, can cause retained placenta fragment)
|
|
Irregular contractions
Felt in abdomen only Go away with position change (walking) No Effacement and Dilation of cervix |
False signs of labor
|
|
Regular contractions
Felt in lower back & sweep to abdomen Don't go away with position change Cause Effacement and Dilation of cervix |
True signs of Labor
|
|
Effacement (paper-thin cervix) and then dilation (0-10cm) happen with this type of mother
|
Primip
|
|
Effacement and dilation happen together with this type of mother
|
Multip
|
|
Can you get a spinal headache from an epidural?
|
NO (dura not entered)
|
|
When and why do you get a spinal headache and how long does it last?
|
1-3 days after spinal anesthesia (due to loss of CSF) can last for days or weeks (pain in head unless flat)
|
|
Pre-epidural, do what?
|
Start an IV at a rapid rate to keep BP up.
|
|
What is the common cause of a temperature in the first 24 hrs after delivery?
|
Dehydration
|
|
Comfort measures post-episiotomy
|
Ice for the first 24 hrs, then heat (sitz bath)
|
|
When assessing the fundus after delivery remember to...
|
Have mom empty bladder first
Full bladder = Higher fundus *also prevents uterus from contracting well |
|
Describe the mother's pulse postpartum
|
Often see bradycardia for the first 24- 48 hrs (as heart compensates for decreased vascular resistance in pelvis)
|
|
Describe the mother's urine output postpartum
|
Should void large amounts frequently (at least 150cc at a time, extra fluid elimination during first 12 pp hours)
|
|
Disadvantages of amniotomy (membrane rupture)
|
Increased risk of infection
Increased risk of cord prolapse Removal of cushion (more pressure on head) |
|
What do you do with a "boggy" postpartum fundus?
|
Massage it. It should be round and firm.
boggy = increased risk of bleeding |
|
Word used to describe the decreasing size of the uterus after delivery
|
Involution
|
|
How often do you check uterine tone, position and height after delivery?
|
Same time frame as vital signs (Q1hr x 4, etc.)
|
|
Describe uterus for first 1-2 hrs after delivery
|
Fundus midway between symphysis and umbilicus
|
|
Describe uterus by 12 hrs after delivery
|
Fundus at umbilicus or 1 cm above
|
|
How much should fundal height decrease per day after delivery?
|
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. |
|
Postpartum breasts during first 2 days
|
Soft (colostrum)
|
|
Postpartum breasts on day 3
|
Engorgement (milk)
|
|
Postpartum pericare
|
Wash front to back w/ squirt bottle & warm water after each void or BM, change pad Q2-3 hrs
|
|
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?
|
False (The opposite is true)
|
|
What maneuvers can be one after week 30 to determine fetal presentation and position?
|
Leopold’s Maneuvers
|
|
When auscultating, the FH is heard loudest where in cephalic presentations? Breech?
|
Below umbilicus, above umbilicus
|
|
What is the progesterone deprivation theory?
|
Progesterone decreases at term and causes labor to start
|
|
What is the fetal adrenal response theory?
|
Increase cortisone from mature adrenal glands causes labor.
|
|
What is the prostaglandin theory?
|
Increased amounts produced by uterine decidua and cause labor.
|
|
What are some preliminary signs of labor?
|
Lightening, weight loss, full of energy, braxton hicks contractions, ripening of cervix, ROM, show.
|
|
What is the difference between Braxton Hicks contraction and true contractions?
|
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.
|
|
If a women has ROM and the baby is not well engaged what does the MD check for?
|
Cord prolapse. O2 may be getting cut off.
|
|
What are the 3 things to make note of while having contractions?
|
Duration, intensity, frequency
|
|
How much time (minimum) needs to be in between contractions to allow uterine blood vessels to fill?
|
1 minute.
|
|
How do you determine the frequency of contractions?
|
Time from beginning of one contraction to the beginning of the next.
|
|
The thinning of cervix from 2cm to paper thin
|
Effacement
|
|
The opening of the cervix (0-10cm) due to contractions and pressure of presenting part.
|
Dilation
|
|
What are the 3 phases of the 1st stage of labor?
|
Latent, Active and Transition phase
|
|
During the latent phase how far dilated does the women get and what is she like?
|
3cm usually happy
|
|
During the active phase how far dilated does the women get and what is she like?
|
4-7 cm she is more focused and less able to tolerate distractions
|
|
During the transition phase how far dilated does the women get and what is she like?
|
8-10cm she is panicky, feels out of control, wretches, shakes, irritable.
|
|
If a woman begins to hyperventilate during the transition phase what should she do?
|
Rebreathe into paper bag or cupped hands.
|
|
What is the order of cardinal movements of labor?
|
Engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.
|
|
If the woman’s has ROM what color should the fluid be?
|
Clear
|
|
Upon ROM, what would yellow fluid indicate? Green or brown?
|
Yellow- blood incompatibility, Green or Brown- Fetal distress passing of meconium. (Normal with breech due to squeezing)
|
|
While doing a vaginal exam what do you want to check for?
|
Lesions, cord, drainage, bleeding.
|
|
What is the most common infection seen in L&D?
|
STDs
|
|
During labor there is an increase in P&R also R/T dehydration/infection. True or false?
|
True
|
|
How often do you check temperature if there is no ROM and temperature is normal?
|
Q2-4H
|
|
How often do you check temperature if there is ROM or temperature is not normal?
|
Q1H
|
|
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?
|
Fetal scalp electrode. Turn it counter clockwise to remove
|
|
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?
|
False
|
|
----- ---- ----------- is the single most reliable indicator of fetal well being.
|
Short term variability (2-3 beats)
|
|
FHR --------- at beginning of contraction but rate returns to normal by end of contraction. Due to ---- -----------.
|
Decreases, head compression
|
|
How often should the woman void when fully dilated?
|
Q2H
|
|
What can you do to help with pain, foley insertion, etc.?
|
Put roll under right hip.
|
|
What are 2 examples of the types of positioning a woman can do for comfort while in labor?
|
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.
|
|
What is something that is useful for comfort of the perineum stretching during the 2nd stage?
|
Hot compresses
|
|
What is the pushing called that is only 6-7 seconds long at a time along with slight exhalation?
|
Open glottis pushing
|
|
What are ways to avoid an episiotomy?
|
gentle pushing, hot packs, no pushing after crowning, iron out perineum, oil to head, deliver side- lying or semi sitting.
|
|
Which is worse a first degree or 4th degree laceration?
|
4th
|
|
1st degree is a laceration into what? 4th degree?
|
skin or vaginal mucosa, lumen of rectum
|
|
Immediately after delivery what do you want to do?
|
Suction mouth AND THEN nose.
|
|
What do you do if you see meconium-stained amniotic fluid?
|
Intubate, deep suction before first breath
|
|
A woman often has shaking chills after labor what should you give her?
|
Warm blanket
|
|
If placenta won’t separate what should you have the baby do?
|
Nurse
|
|
If uterus is not well contacted what are 3 things you can do?
|
nipple stimulation, fundal massage, or pitocin IV
|
|
How should you lay that baby to allow mucus to drain from mouth?
|
Lay baby on side with head 30 degrees down
|
|
If you suction a baby vigorously what can that cause?
|
Bradycardia
|
|
To prevent heat loss what do you want to increase?
|
use of O2 and glucose
|
|
While doing apgar scoring a baby with a score of 0-3 is in good condition True or False?
|
False (0-3 indicates serious danger)
|
|
Where do you put the prophylactic eye meds?
|
In the lower conjunctival sac. (delay for first hour to allow mother-child bonding)
|
|
When giving vitamin K to the newborn where should it be given?
|
In the vastus lateralis
*given to promote synthesis of clotting factor |
|
What are 8 parts of the nursing care for mom after a vaginal devliery?
|
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.
|
|
What should the newborns P R and temperature be?
|
110-160, 30-60, 98-98.6
|
|
This is an anesthesia injected local into cervix at 4 & 8 o’clock. Relieves ------- pain, but not vaginal or perineal sensation (can push).
|
Paracervical Block, uterine
|
|
This is an anesthesia injected into nerve at level of ischial spines. Relieves ------- and -------- pain. (can push)
|
Pudendal Block, vaginal and perineal
|
|
What can an epidural cause? What do you want to do for this?
|
Maternal hypotension. Give lots of IV fluids before and during, check BP frequently, nausea is first sign.
|
|
What is a disadvantage to general anesthesia?
|
Newborn depression especially respiratory depression.
*it's the quickest though. |
|
During postpartum Hgb Hct and RBC are the same as prelabor True of False?
|
True
|
|
What is the normal WBC count?
|
15,000- 30,000
|
|
Blood clotting factors decrease during postpartum True or False?
|
False (they increase)
|
|
How often should vitals be done?
|
Q1h x 4 then Q4H for 24H then Q8H
|
|
A temp. of -----or greater on two or more occasions would suggest some type of infection.
|
100.4
|
|
P&R often see ----------- for the 1st 24-48H.
|
Bradycardia
|
|
Increased P&R could mean…?
|
Hemorrhage, infection, or dehydration.
|
|
How often should breasts be assessed?
|
BID
|
|
Milk production is under the influence of --------- .Let down reflex caused by --------
|
Prolactin, Oxytocin.
|
|
How should a women care for engorgement if BF?
|
Nurse frequently, supportive bra, warm soaks or shower on breasts.
|
|
How should a women care for engorgement if not BF?
|
Decrease fluid intake to1000cc/day, supportive bra, no breast or nipple stimulation, ice packs
|
|
Pain caused by uterine contractions after birth. Common in multips
|
Afterpain
|
|
Uterus may not stay well contracted anytime it has been -------------
|
overdistened
|
|
How much should a women void each time?
|
150cc
|
|
What is the lochia called the 1st 3 days pp? 4-9days pp? 10-?days?
|
Lochia rubra (red)
Lochia serosa (pink to brown) Lochia alba (yellow to white) |
|
>---ml of blood loss in first 24 hours is considered hemorrhage
|
500
|
|
What is a major cause of post delivery hemorrage?
|
Uterine atony
|
|
When doing perineum care you should apply heat for the 1st 24 hours and then ice after that. True or False?
|
False ( the opposite is true)
|
|
Can a woman who had a C/S eat afterwards?
|
No they are NPO until they have bowel sounds
|
|
What are the 3 maternal phases ?
|
Taking-in, taking-hold, and letting-go
|
|
What one of the 3 maternal phases requires the most teaching?
|
Taking hold
|
|
Do sutures need to be removed if the women has an episiotomy etc.?
|
No they dissolve
|
|
Can BF be used as a form of birth control?
|
No
|
|
Immediately after ROM...
|
Check FHR
|
|
OK to ambulate during labor EXCEPT...
|
If head is not engaged (0 station or below) & ROM
|
|
Good APGAR score
|
7-10
|
|
Abdominal pain between contractions could mean...
|
Full bladder or uterus not relaxing
|