Shared Flashcard Set

Details

HESI OB 414
HESI OB Practice cards-Intrapartum
31
Nursing
Undergraduate 3
05/05/2010

Additional Nursing Flashcards

 


 

Cards

Term
Describe phases of first stage of labor (dilation wise)
Definition

Latent- from beginning of true labor to 3-4 cm dilation

Active- From 4-7 cm dilation

Transition- From 8-10 cm dilation

Term
Difference bw TRUE vs FALSE Labor
Definition

True:

Pain in lower back radiating to abdomen, regular rhythmic contractions that intensify with ambulation, progressive cervical dilation and effacement.

False:

Discomfort localized in abdomenNO LBP, contractions decrease in intensity and/or frequency with ambulation

Term

 

 

 

Prodromal Signs of labor: false labor

Definition

 

 

>Lightening- fetus drops into true pelvis

>Braxton Hicks contractions

>Cervical softening and slight effacement

>Bloody show or expulsion of mucous plug

>burst of energy "nesting instinct"

Term

 

 

 

 

Normal findings VS for pt in labor:

Definition

FHR- 110-160 BPM

Maternal BP: <140/90

Maternal HR: <100 BPM

Maternal temp: <100.4 degrees F

 

 

Slight elevation is r/t dehydration and work of labor. Anything higher indicates infection and must be reported STAT

Term

 

 

 

 

Define frequency, duration, and strength of contraction

Definition

Frequency- (how often)from beginning of one to beginning of next contraction; measured in min

 

Duration- (how long)From beginning to end of one contraction

 

Strength- Intensity of strongest part (peak) of contraction.

 

Remember that they vary with stage of labor

Term
Symptoms of hyperventilation for woman in labor.
Definition

Dizziness, tingling of fingers, stiff mouth

 

Have her breath into cupped hands or paper bag to rebreath the CO2

Term
When (phase) do you want to give anesthesia/analgesia to woman in labor?
Definition

Mid-active phase of first stage.

 

If too early, will retard progress of labor.

 

If too late, narcotics increase risk of neonatal respiraroty depression

Term
What do you look for in cervix during vaginal exam?
Definition

To determine:

Cervical dilation (measured in 1-10cm)

Cervical effacement (thinning; expressed in 0-100%)

Cervical position (anterior to paltate is what's preffered. If posterior, it's hard to palpate)

Cervical consistency (firm to soft)

Term
Describe the FOUR stages of labor
Definition

Stage I: from beginning of regular contractions or rupture of membranes to 10cm dilation and effacement. Latent, Active, Transition

 

Stage II: 10cm to delivery

 

Stage III: Delivery of placenta

 

Stage IV: First 1-4 hrs following delivery (recovery)

Term
Describe STAGE II of labor
Definition
Involuntary need to push, 10 cm dilation, rapid fetal descent, and birth :-)
Term
Nursing assessment during Stage II of labor.
Definition

*Assess BP and pulse Q15 min- remember in RESTING phase of contraction

*Determine FHR with every contraction

*Observe perineal area for increased bloody show, bulging perineum/anus, and visibility of presenting part

*Palpate bladder for distention

*Assess amniotic fluid for color and consistency

Term
Description of THIRD Stage of Labor:
Definition
From complete expulsion of baby to complete expulsion of placenta
Term
Signs of placental separatation
Definition

-Lengthening of umbilical cord outside vagina

-Gush of blood

uterus changes from oval (discoid) shaped to globular

-Mother describes 'full' feeling in vagina

-Continued firm uterine contractions

Term
When should the nurse administer Oxytocin in 3rd stage of labor?
Definition
AFTER placenta is delivered because drug will cause uterus to contract. If given before, may result in retained placenta, which predisposes the pt to hemorrhage and infection.
Term
Application of perineal pads after delivery:
Definition

-Place 2 on perineum

-DO NOT Touch inside of pad (can contaminate)

-DO apply from front to back, being careful not to drag pad across anus

Term
What are the uterine stimulants used during labor? Used for uterine atony
Definition

 

 

 

-Oxytocin/Pitocin:

-Methergine:

-Hemabate:

Term
What to know about Pitocin/Oxytocin
Definition

 

 

For- Uterine atony

Adverse Effects- HTN

Nx Implications- given immediately after delivery of placenta

Term
What is uterine atony? How do you treat it?
Definition

Failure of uterine muscles to contract normally after baby and placenta are delivered, and bleeding continues.

 

Administer uterine stimulants; Oxytocin/Pitocin, Methergine, or Hemabate

Term
What to know about Methergine
Definition

Used for prevention of uterine atony

-Adverse effect:HTN

-NOT given to pts with HTN

-Take BP prior to giving; withhold if 140/90 or above and notify HCP

Term
What to know about Hemabate/Prostaglandin F2
Definition

 

 

To prevent uterine atony:

S/E: HA, N/V, fever, bronchospasm wheezeng

Not for: asthmatic pts, check temp Q1-2hrs, auscultate breath sounds frequently

Term
What does it mean when fundus is above umbilicus and up to the Right side of abdomen? (Postpartum)
Definition

 

 

Full bladder: most common reasons for uterine atony and/or hemorrhage in firs 24 hrs after delivery. Perform massage (if soft/boggy) then have ct empty bladder

Term
After delivery, how should fundus be?
Definition
Firm, midline, at or below umbilicus
Term
Signs of hypovolemic shock r/t excessive bleeding PP
Definition

Pale, clammy, tachycardia, light-headed, hypotension

 

 

Term

Place in order the 7 cardinal movements of the mechanism of labor that occur in a vertex presentation:

1.Descent

2.Engagement

3.Flexion

4.Expulsion

5.Extension

6.External rotation

7. Internal Rotation

Definition

 

 

 

2,1,3,7,5,6,4

Term

Analgesics during labor:

 

Demerol, Fentanyl, and Morphine Sulfate

 

FOR/ADVERSE REACTIONS/NX IMPLICATIONS

Definition

FOR- produce analgesia, euphoria, sedation in labor

Reactions- Resp depression, fetal narcosis/distress, hypotension, itching, urinary retention,

Implications-Do NOT give if resps <12/min, Narcan is antagonist, monitor resps, pulse, BP closely

Term

Analgesics during labor:

Stadol and Nubaind:

opioid agonist/antagonists

Indications/Adverse reactions/Nursing implications

Definition

Indications- For analgesia in labor, narcotic analgesic

 

Adverse reactions- women with preexisting narcotic dependency will experience withdrawal symptoms immediately (abstinence syndrome)

 

Nursing implications- IV/IM, obtaing drug hx before administration (drug dependence), monitor resps/pulse

Term

Narcan:

Indications/Adverse reactions/Nursing implications

Definition

Indications- for narcotic antagonist used to counteract narcotic effects on mother/fetus

 

Adverse reactions- decreased respirations rarely occur

 

Nursing implications- Monitor resps closely since drug action is shorter than the narcotic (may need to readminister), pain returns after administration to mother, can be administered to newborn after delivery to counteract narcotic depression

Term
Anesthesia is associated to cause ________ during labor. What to do when this occurs?
Definition

Hypotension:

-Turn client to L

-Increase IV infusion

-Begin O2 at 10L/min facemask

-Notify HCP STAT and have ephedrine available

-Assess FHR

Term
Contraindications to subarachnoid and peridural blocks:
Definition

a. ct's refusal or fear

b. anticoagulant therapy or presence of bleeding disorder

c. presence of antepartum hemorrhage causing acute hypovolemia

d. infection or tumor at injection site

e. allergic to _caine drugs

f. CNS disorders, previous back surgery, or spinal anatomic abnormality

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