Term
| cause relaxation of smooth muscle tissue during most of pregnancy |
|
Definition
|
|
Term
| ~34 weeks, estrogen and contraction associated proteins _____________, while uterotonic inhibitors________ |
|
Definition
|
|
Term
| __________ and ____________ receptors increase in myometrium in prep. for labor |
|
Definition
|
|
Term
|
Definition
|
|
Term
| prostaglandins are produced.... |
|
Definition
| in the decidua, placenta, chorion and amnion |
|
|
Term
| oxytocin is produced in the..... |
|
Definition
| posterior lobe of maternal and fetal pituitary glands |
|
|
Term
| when the uterus contracts, the cervix |
|
Definition
| stretches and becomes thin and flat |
|
|
Term
| as uterus contracts, fetal body... |
|
Definition
|
|
Term
| pressure of the fetal head contributes to... |
|
Definition
|
|
Term
|
Definition
fetus descends into pelvic inlet
pressure on bladder and heartburn decrease |
|
|
Term
|
Definition
| softening and weakening of cervix |
|
|
Term
|
Definition
loss of mucous plug
causes blood-tinged discharge |
|
|
Term
|
Definition
| sudden burst of energy, usually 24-48h before labor |
|
|
Term
|
Definition
| loss of 1-3 pounds, diarrhea indigestion, nausea, vomiting, rupture of membranes, nesting, ripening, bloody show |
|
|
Term
| in true labor, contractions... |
|
Definition
| are at regular intervals and increase in duration and intensity |
|
|
Term
| in true labor, activity ____________ contractions and they are not relieved by _______________ |
|
Definition
| intensifies, resting or warm water |
|
|
Term
| In true labor, contractions produce.... |
|
Definition
| cervical effacement and dilitation |
|
|
Term
| in false labor, contractions are _______ and do not _________ |
|
Definition
| irregular, increase in duration or intensity |
|
|
Term
| in false labor, contractions are __________ by walking or rest |
|
Definition
|
|
Term
| How does false labor effect the cervix? |
|
Definition
|
|
Term
|
Definition
| fetal cranial bones overlap under pressure |
|
|
Term
|
Definition
| inlet, pelvic cavity, outlet |
|
|
Term
| most favorable type of pelvis |
|
Definition
|
|
Term
|
Definition
|
|
Term
refers to relation of fetal parts to one another
ex: extended military
flexed (preferred) |
|
Definition
|
|
Term
|
Definition
| relationship of cephalocaudal axis of fetus to cephalocaudal axis of woman |
|
|
Term
|
Definition
| fetal lie + body part that enters pelvic passage first |
|
|
Term
fetal presentation (3 letters)
1st?
2nd?
3rd? |
|
Definition
1-mother's left or right side
2-fetus presenting part
3-mother's posterior or anterior side |
|
|
Term
| most favorable presentation |
|
Definition
| LOA: left occiput anterior, also most frequent |
|
|
Term
| when largest diameter of presenting part reaches or passes through pelvic inlet |
|
Definition
|
|
Term
| primary force of labor is _______________ |
|
Definition
| uterine muscular contractions |
|
|
Term
| secondary force of labor is use of ______________ |
|
Definition
|
|
Term
| first stage of labor, def and 3 stages |
|
Definition
beginning till complete dilitation
latent
active
transitional |
|
|
Term
| physiologic changes of latent labor |
|
Definition
reg, mild contractions increase in intensity and freq
cervical effacement and dilation |
|
|
Term
| Psychological changes of latent labor |
|
Definition
| relief to begin, excitement, anxiety |
|
|
Term
| active physiological changes |
|
Definition
contractions 2-3 min apart
dilation from 4-7cm
fetus descends into pelvis |
|
|
Term
|
Definition
fear of loss of control
anxiety |
|
|
Term
| transition phase physiologic changes |
|
Definition
dilation 8-10cm
fetus rapidly descends into passage
rectal pressure
N/V |
|
|
Term
|
Definition
| increased anxiety, irritable, eager to finish, needs support! |
|
|
Term
| Second stage of labor physiological changes |
|
Definition
complete dilation to birth
overwhelming urge to push |
|
|
Term
| second stage of labor psyche |
|
Definition
| sense of purpose, out of control, frightened, irritable |
|
|
Term
| third stage of labor physiologic |
|
Definition
| placenta separation and delivery |
|
|
Term
|
Definition
increased HR, decreased BP
uterus contracted
euphoria, energized
thirsty hungry
shaking chill
urine retention |
|
|
Term
| blood pressure __________ with each contraction |
|
Definition
|
|
Term
WBC count _______ during labor
blood glucose __________ |
|
Definition
|
|
Term
gastric motility is ___________
gastric emptying is________________ |
|
Definition
|
|
Term
First stage pain
second stage
third stage |
|
Definition
1st-dilation of cervix, hypoxia of uterine muscle cells
2nd-hypoxia of contractions, distention of perineum
3rd-contractions and dilation, placenta |
|
|
Term
| FHR may _____________ as head pushes against cervix |
|
Definition
|
|
Term
| most complications of labor occur from ________ or _______ |
|
Definition
|
|
Term
| purpose of maternal assessment |
|
Definition
|
|
Term
| goals for intrapartal nursing care |
|
Definition
maternal status: physical and mental resources, pain
fetal status: position, tolerating labor
progress in labor |
|
|
Term
|
Definition
| artificial rupture of membranes |
|
|
Term
| purposes of Leopold's maneuver |
|
Definition
estimate gestational age
locate fundus
locate back
what's presenting
presentation |
|
|
Term
| when to ascultate for FHR |
|
Definition
| before, during, after contractions---listen for decelerations |
|
|
Term
|
Definition
1st Stage: q30 min
2nd: q15 min |
|
|
Term
|
Definition
|
|
Term
| baseline FHR of _________ is reassuring |
|
Definition
|
|
Term
| absence of FHR ___________ is reassuring |
|
Definition
|
|
Term
| normal FHR variability is .... |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| caused by narcotics or fetal anemia, BAD SIGN, non-reassuring |
|
|
Term
|
Definition
means severe variable deceleration
decreases to 60 bpm or
60 bpm below baseline and
and deceleration lasts 60 seconds |
|
|
Term
| severe variable decelerations are caused by... |
|
Definition
| cord compression, non-reassuring |
|
|
Term
| late decelerations are caused by... |
|
Definition
utero-placental insufficiency
(preeclampsia, abruption, smoking, pitocin) |
|
|
Term
|
Definition
| mild hypoxemia with exaggerated variability, non-reassuring |
|
|
Term
| with ________ patterns there is time to correct the problem |
|
Definition
|
|
Term
|
Definition
undulating baseline
HR <80
HR >160 with diminished variability
no FHR variability |
|
|
Term
definitions of FHR variability:
absent
minimal
moderate
marked |
|
Definition
undetectable
0-5
6-25 (saltatory)
>25 |
|
|
Term
fetal bradycardia
tachycardia |
|
Definition
|
|
Term
| at 32 weeks, accelerations should last __ secs and peak __ bpm above baseline |
|
Definition
|
|
Term
| prolonged acceleration is __ mins but less than __ mins |
|
Definition
|
|
Term
| reassuring accelerations as seen on NST are... |
|
Definition
| 15 sec x 15min x 2 in 20 mins |
|
|
Term
|
Definition
| nadir occurs after peak of UC |
|
|
Term
|
Definition
FHR decrease of15bpm lasting btwn 2-10 mins
seen with abruption and cord prolpase |
|
|
Term
| EFM: systematic assessment includes... |
|
Definition
contraction frequency, duration, intensity
FHR baseline
variability
accelerations, decelerations |
|
|
Term
| NSG: variable deceleration, isolated or occasional |
|
Definition
report
position change
D/C oxytocin
vag exam (prolapsed cord or change in progress)
monitor FHR |
|
|
Term
| NSG: variable decelerations, severe and uncorrectable |
|
Definition
O2, report, prep for c/s
vag exam for prolapsed cord or change in labor |
|
|
Term
|
Definition
| O2, report, monitor FHR, mother on L side, IV fluids, D/C oxytocin,maternal BP (hypotension), fetal blood sampling: pH < 7.2 prep for birth |
|
|
Term
| NSG: late decelerations with tachyc or decreasing variability |
|
Definition
| report, maternal L side positioning, O2 7-10L, DC oxytocin, maternal BP and HR, IV fluids, assess progress, prep for C/S, assist w/ fetal blood sample |
|
|
Term
| NSG: prolonged decelerations |
|
Definition
| vag exam, change maternal position, dc oxytocin, notify, iv fluids, tocolytic if hypertonus noted, anticipate nl FHR recovery |
|
|
Term
|
Definition
uterine contractions
FHR
maternal VS
ruptured membranes? |
|
|
Term
| normal characteristics of uterine contractions upon admission |
|
Definition
freq of not <2 mins
duration <75 secs
uterine relaxation btwn contractions
most intense discomfort only with contractions |
|
|
Term
|
Definition
| FHR, maternal VS, contraction status, dilation/effacement, presentation/station of fetus, urinalysis, H/H, US, EDD, prenatal care?, wt gain, probs |
|
|
Term
|
Definition
| living situation, support network, resources, preparedness |
|
|
Term
|
Definition
| fam violence, sexual assault, drug use, STIs, late prenatal care, missed appts, legal probs, health probs |
|
|
Term
|
Definition
tell her what to expect
encourage ambulation + rest
fluids
eat easily digestible foods |
|
|
Term
|
Definition
palpate contractions q15-30m (freq, duration, intensity)
FHR q30m
IV fluids needed?
color/odor of amniotic fluid
vag exam (dilation, effacement, position, station)
encourage pt to void
VS q1h |
|
|
Term
| patients should go to the hospital when contractions are ____________ min apart |
|
Definition
|
|
Term
|
Definition
palpate q15m
sterile vag exams to assess progress
maternal VS q30m
FHR q30m
assist w/ breathing
keep pt from pushing till fully dilated |
|
|
Term
|
Definition
vag exams to assess descent
VS q5m
support and info about progress
assist w/ pushing
assist physician |
|
|
Term
|
Definition
new born care
delivery of placenta (oxytocin) |
|
|
Term
|
Definition
palpate fundus q15m for 1h
assess bleeding
encourage bonding, breastfeeding
assess perineum
peri care |
|
|
Term
| breast feeding in the first hour is best because... |
|
Definition
helps uterus contract
teach baby to nurse
clears airway of secretions |
|
|
Term
|
Definition
| relax btwn contractions, distractions, firm pressure on back/sacrum, visualization, controlled breathing |
|
|
Term
|
Definition
| same as first, cool cloths, rest btwn contractions, assist into pushing position, ice chips, reassurance |
|
|
Term
|
Definition
|
|
Term
|
Definition
| maintain respirations, warmth, Apgar score, physical assessment, ID, skin to skin, delay eye ointment 1h, minimize separation |
|
|
Term
| if pt is admitted with vag bleeding or hx of painless vag bleeding.... |
|
Definition
do not perform vag exam
assess FHR
evaluate amt of blood loss
eval labor pattern
notify MD |
|
|
Term
| if presence of green/brown amniotic fluid |
|
Definition
| monitor FHR continuously, evaluate dilitation/prolapsed cord/presentation, complete bedrest on L side, notify MD |
|
|
Term
| if absence of FHR and movement |
|
Definition
| notify MD, be truthful, stay with couple |
|
|
Term
|
Definition
| relieve pressure manually, monitor FHR, notify MD, assist to knee-chest position or trendelenberg position, O2 |
|
|
Term
|
Definition
| prep for immediate birth, assessment of preg hx, get someone else to contact MD, DO NOT LEAVE, provide support, glove up |
|
|
Term
|
Definition
HR, resp effort, muscle tone, reflex irritability, color
each worth 2 points |
|
|
Term
| infants need stabilization if... |
|
Definition
Apgar <8 at 1min, <9 at 5 min
RR <30 or >60, retractions and/or gruntin
pulse <110 or >160
<36.5 C
pale blue
<38 or >42 weeks
very small or very large
anomalies involving open areas |
|
|
Term
| opioid agonist analgesics |
|
Definition
meperidine HCL (Demerol), morphine
not often used due to effects on RR |
|
|
Term
| anxiolytics names and when they are used in labor |
|
Definition
Seconal (also antiemetic), Ambien
latent labor to promote rest |
|
|
Term
| H1 receptor antagonists names and when used |
|
Definition
Phenergan (antiemetic), Vistaril (IM ONLY), benedryl (also antiemetic)
used early to promote rest and reduce anxiety |
|
|
Term
| opioid agonist-antagonist analgesics |
|
Definition
|
|
Term
| complications of narcotic analgesia... |
|
Definition
affect maternal RR, BP
cross placental barrier--fetal liver and kidneys are immature |
|
|
Term
| types of nerve block analgesia |
|
Definition
local perineal infiltration
pudendal nerve block
spinal |
|
|
Term
| types of epidural anesthesia |
|
Definition
lumbal
caudal
walking
spinal--duramorph |
|
|
Term
| NSG: lumbal epidural precaution |
|
Definition
| watch for blood pooling in legs-->pass out |
|
|
Term
| epidural is used during... |
|
Definition
| all stages of labor and for episiotomy repair |
|
|
Term
| pudendal block is used during... |
|
Definition
| second and third stages of labor and for episiotomy repair |
|
|
Term
| when to not use epidural... |
|
Definition
inability to cooperate
hemorrhage
anticoagulant therapy
infenction
allergy
HoTN |
|
|
Term
| complications of spinal anesthesia |
|
Definition
HoTN
shivering
level of pain relief
allergy, toxicity |
|
|
Term
| why general anesthesia is rarely used |
|
Definition
depressed fetus
uterine relaxation = hemorrhage
aspiration risk |
|
|
Term
| to prevent aspiration during general anesthesia, administer _____________ and apply pressure to the _______ |
|
Definition
Bicitra (antacid)
Cricoid cartilage |
|
|
Term
| maternal ________ __________ is essential during spinal and epidural nerve blocks |
|
Definition
|
|
Term
| Nubain is a _______ ________ |
|
Definition
synthetic analgesic
no resp depression, but could cause acute withdrawl |
|
|
Term
| frequent, painful uterine contractions that do not dilate or efface the cervix |
|
Definition
|
|
Term
| NSG: hypertonic uterine contractions |
|
Definition
comfort and rest
freq position changes
fluids
monitor for anxiety, fetal status, effectiveness of meds |
|
|
Term
| irregular, weak contractions with some progress |
|
Definition
| hypotonic uterine contractions |
|
|
Term
| treatments of hypotonic uterine contractions |
|
Definition
amniotomy
oxytocin
patience |
|
|
Term
| NSG: hypotonic contractions |
|
Definition
monitor amniotic fluid for blood, meconium
VSs and hydration (esp at ROM)
empty bladder q2-3h
continuous fetal and uterine monitor
alleviate anxiety (upright and mobile)
promote comfort |
|
|
Term
| when entire labor and birth process takes < 3 hours |
|
Definition
|
|
Term
|
Definition
establish rapport quickly
monitor fetal responses to labor
slow pushing
stay calm |
|
|
Term
|
Definition
declining fx of placenta
macrosomia --> labor dystocia, shoulder dystocia, injury, surgical interventions |
|
|
Term
| Bishop's Score is used to predict _________ by measuring _______________ |
|
Definition
success of induction
dilation, effacement, station, consistency of cervix, cervical position |
|
|
Term
| Prostaglandins that induce labor |
|
Definition
Dinoprostone prostaglandin E2
Cytotec prostaglandin E1 |
|
|
Term
| side effects of prostaglandins |
|
Definition
| HA, n/v/d, hyperstimulation of uterus |
|
|
Term
| manual methods to induce labor |
|
Definition
sweep membranes--painful!
amniotomy |
|
|
Term
|
Definition
| note time, color and quantity of fluid, note fetal response |
|
|
Term
| 1/2 of umbilical cord prolapses are caused by... |
|
Definition
|
|
Term
| risk of oxytocin induction |
|
Definition
| uterine hyperstimulation and fetal distress |
|
|
Term
| goal of induction with oxytocin |
|
Definition
| 3 UCs at least 45 sec long, moderate strength in 10 min |
|
|
Term
| fetus that weighs more than 4500g |
|
Definition
|
|
Term
|
Definition
observe for dysfunctional labor
prep for shoulder dystocia
suprapubic pressure |
|
|
Term
|
Definition
| head is born but anterior shoulder cannot pass under the pubic arch, unpredictable, unpreventable |
|
|
Term
|
Definition
head sucks back in
sign of shoulder dystocia |
|
|
Term
| fetal risks of shoulder dystocia |
|
Definition
| asphyxia, brachial plexus injury, fractures |
|
|
Term
|
Definition
| McRoberts maneuver, squat or side lying position, suprapubic pressure, mark the time, deliver posterior arm first, break bones |
|
|
Term
| fetal tachycardia is a sign of __________ |
|
Definition
|
|
Term
| limits of vacuum extraction |
|
Definition
not longer than 30 mins
stop using after 3 pop offs |
|
|
Term
|
Definition
HTN (smoking, preeclampsia, DM, drugs), trauma
DIC, hypoxia |
|
|
Term
|
Definition
| pain between contractions, dull all the time |
|
|
Term
| if cord protrudes from vagina..... |
|
Definition
position with butt in air to relieve pressure
oxygen
iv fluids
moist compress on visible cord |
|
|
Term
| criteria for external cephalic version (turning) |
|
Definition
unengaged presenting part
fetus 36+ weeks
ample amniotic fluid
singleton preg |
|
|
Term
greater than 2000ml amniotic fluid
cause |
|
Definition
polyhydramnios
major congenital anomalies, fetus doesn't swallow fluid |
|
|
Term
| #1 complication of polyhydramnios |
|
Definition
|
|
Term
| total fluid pocket space is <6cm |
|
Definition
|
|
Term
| oligohydramnios is associated with ___________ |
|
Definition
| renal malformations and placental insufficiency |
|
|
Term
|
Definition
continuous EFM
IV fluids
position changes
amnioinfusion |
|
|
Term
| placenta attached to surface of myometrium |
|
Definition
|
|
Term
|
Definition
| tissue invades myometrium |
|
|
Term
|
Definition
| tissue extends all the way thru myometrium |
|
|
