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OB TEST 2
OB
139
Nursing
Undergraduate 4
04/02/2013

Additional Nursing Flashcards

 


 

Cards

Term
Hypertonic Labor Patterns
Definition
Contractions more frequent but ineffective
Intensity may decrease
Innefective in dilating or effacing cervix
Seen in early latent phase
May prolonged latent phase
Term
Hypotonic Labor Patterns
Definition
Usually develops in the active phase
Fewer than 2-3 contraction in a ten minute period
May be due to overstretched uterus, medications, malpositions
Term
Hypertonic labor
Definition
Increase discomfort due to uterine muscle cell anoxia
Stress
Exhaustation, fatigue
Dehydration
Infection risk
Term
Fetal in hypertonic
Definition
Prolonged pressure

Excessive molding
Caput succedaneum
Cephalhematoma
Term
Care for Hypertonia
Definition
Bed rest
Sedation-Nembutal, seconal, morphine
Pitocin administration
Ammiotomy
Term
Treatment for Hypotonia
Definition
Oxytocin infusion
Nipple stimulation, breast pump
Ammiotomy
IV fluid
AMOL
Surgical birth if needed
Term
AMOL
Definition
active management of labor

Preventing protracted labor and arrest of progress
Term
Risk AMOL
Definition
Increased risk of infection
Excessive intervention
Increased instrument-assisted birth
Term
Indications for Labor induction
Definition
DM
Pre-eclampsia, PROM
With fetal maturity, chorioaninitis, post gestation-esp w/oligohydrammnios, IUFD(intrauterine fetal death), IUGR (intrauterine growth restriction)
Allowimmunization, non reassuring fetal testing
Term
Contraindication for labor induction
Definition
Client refusal
Placenta previa
Floating presenting part
Prior uterine scar/incision
Active genital herpes
Umbilical cord prolapse
Acute fetal distress
Absolute CPD

Relative:

Cx carcinoma
Malpresentation
Funic presentation
Term
Prelabor status evaluation scoring system
0
Definition
Cervical dilation closed
cervical effacement 0%-30%
Fetal station -3
Cervical consistency Firm
Cervical position Posterior
Term
Prelabor status evaluation scoring
1
Definition
1-2
40%-50%
-2
Moderate
Midposition
Term
Prelabor status evaluation scoring
2
Definition
3-4
60%-70%
-1
Soft
Anterior
Term
Prelabor status evaluation scoring
3
Definition
5-more
80% or more
1+, or lower
+1 or lower
Term
Cervical Ripening
Definition
Consist of effacement and softening of the cervix
Cytotex and prostaglandin agents
Term
PGE2 Prostaglandin gel, cervidil, prepidil
Definition
intravaginally
causes softening and effacement or cervical ripening

S/E abdominal cramping, n/v, diarreah
Term
PGE1 Misoprostol cytotec
Definition
Synthetic prostaglandin oral, vaginal to induce contractions
Continuos monitoring of FHR, uterine act. VS

S/E sudden onset of hypertonic contractions fetal distress
Term
Stripping of the membranes
Definition
Gloved finger inserted into internal os and rotated 360 degrees twice. separating amniotic membranes lying against lower uterine segment
no need monitoring
may cause bleeding
Term
Oxytocin
Definition
delivered piggyback
active phase maintain dose, contraction 40-90, 2-3 min 1 cm
Term
Risk Oxytocin
Definition
Tumultuous labor
Premature separation of the placenta
Rupture of the uterus
Laceration of the cervix
infection
Water intoxication
DIC

fetal:
Asphyxia
Neonatal hypoxia
Term
Uterine Rupture
Definition
as a result of VBAC (vaginal birth after cesarean), trauma, excess pitosin adm, fetal lie, difficult forceps/assisted birth
Term
Symptoms of uterine rupture
Definition
pain
contraction
decrease in FHR
bleeding
sharp pain followed by no contraction
C/S
Term
Precipitous Labor
Definition
Labor that is completed in less than three hours
Term
Precipitous Labor contributing factors
Definition
multiparity
large pelvis
previous precipitous labor
small fetus in a favorable position
Term
Postterm pregnancy increased possibility of
Definition
induction
forceps or vacuum/assisted or Cesarean birth
decreased amount of amniotic fluid and possible cord compression
meconium aspiration
macrosomia or a loss of fat and muscle mass SGA newborn
Term
Malposition
Definition
Persistent occiput posterior (OP) sunny side up
causes:

Poor quality contractions
Abnormal flexion of head
Incomplete rotation
Inadequate maternal pushing efforts
Large fetus
Term
Implications of malpositione fetus
Definition
Prolonged labor or arrested descent
Increased risk of episiotomy and laceration
Vaginal trauma
Increased fetal morbidity and mortality
Facial bruising
Exxagerated fetal molding
Term
Malposition nursing assessment
Definition
S/S intense back pain
Dysfunctional labor patterns
Arrest of dilation or fetal descent
FHR heard laterally on abdomen
OP

POSITION KNEE CHEST
Changing positions
Term
Malpresentations
Definition
Breech
Face
Brow
Transverse/shoulder
OP
Term
Treatment for malpresentation
Definition
Manual rotation
External cephalic version-prior to labor btw 36-38 weeks EGA
C/S
Term
Brow presentation
Definition
Presenting part-forehead is slightly flexed, occitomental
Term
Causes of Brow presentation
Definition
high parity
placenta previa
anomalies
Low birth weight (LBW)
Large infants
Term
Outcomes from Brow presentation
Definition
converts to vertex, C/S, epiosiotomy if vaginal del
Term
Implications of Brow Presentation-fetal
Definition
trauma to trachea or larynx
Facil bruising and edema
Exaggerated fetal head molding
Increased fetal mortality from cerebral and nucheal compression
Term
Face Presentation
Definition
No evidence of CPD
Mentrum anterior
Effective labor pattern
Reassuring FHR

Cesarean if mentum posterior
Term
Breeach Presentation
Definition
Fetal head is not present part. 3-4%
Preterm birth
placenta previa
hydramnios
multiple gestatio
Fetal anacephaly, hydrocephaly
Term
types oh breech presentation
Definition
Frank-flexion thighs, extension knees, buttocks present

Complete- flexion at thigs and knees, feet and sacrum buttocks present

Footling- single or double, ext. thighs and knees, foot or feet pres.

Kneeling-extension thighs, flexion at knees, knees present (most common)
Term
Transverse Lie
Definition
preterm fetus
Excessive abnormal fliud
Placenta previa
Contracted pelvis

Risk of Prolapsed cord
Cesarean delivery
Term
Treatment for Malpresentation
Definition
ECV external cephalic version prior to labor after 36 weeks
Cesarean if not succesfull
Tocolytics
Term
Macrosomia
Definition
Newborn weighing more than 4000 g

Shoulder dystocia
Maternal tissue damage
Post partuum hemorrhage
Term
Macrosomia
Definition
McRoberts maneuver
C/S
Baby: check for chaphalhematoma
Erb´s Palsy
Fractured clavicles or brachial plexus
Term
Preterm Labor
Definition
onset of labor btw 20-37 completed weeks of pregnancy
Tocolytics
Term
Tocolytics
Definition
Beta adrenergics agonist . terbutaline, magnesium sulfate
Prostaglandin synthetase inhibitors, indomethacin
Calcium channel blockers. Procardia
Term
Intrauterine resuscitation
Definition
corrective measures used to optimize oxygen exchange within maternal fetal circulation
Term
Intrauterine Resuscitation
Definition
turn woman to left lateral position to treat hypotension
Begin or increase IV
Perform vaginal exam to check for cord prolapse
Knee chest position is cord prolapse suspected
Term
Intrauterine Resuscitation
Definition
Discontinue pitosin
O2
Physician
info about fetus
Term
Cord Prolapse
Definition
Umbilical cord precedes fetal presenting part placing pressure on cord and diminishing blood flow to fetus

Bed rest

Assess for non reassuring fetal status
Term
Cord Prolapse nursing care
Definition
Avoid cord compression
Knee chest/trendeleburg
Bed rest w/o engagement
Assess for nonreasuring
Expedite CS/death
Term
Cephalopelvic Disproportion (CPD)
Definition
Occurs when fetus is larger than pelvis diameter

Shortest AP diameter <10cm
Diagonal conjugate <11.5 cm
Greatest transverse diameter <12 cm
Term
CPD
Definition
Vaginal birth depending
AVOID lithotomy
Cesarean
Term
Multiple Gestation
Definition
Care of woman with more than one fetus
Assist in ECV
Rest prior birth
Term
Internal Version Podalic version
Definition
used to turn second twin during vaginal birth
Tocolytics
Only if second fetus does not descend
Physician grabs feet and pulls
Term
Amniotic Fluid Embolism
Definition
Sudden onset respiratory distress
Acute hemorrhage
Circulatory collapse
Cor pulmonale
Hemorrhagic shock
Coma
fetal death
Term
S/S Amniotic Fluid Embolism
Definition
Dyspnea
Frothy sputum
Chest pain
Tachycardia
Hypotension
Mental confusion
Massive hemorrhage
Term
Succenturiate Placenta
Definition
One or more accessory lobes of fetal villi will develop of the placenta
Term
Circumvallate placenta
Definition
a double fold of chorion and ammion form a ring around the umbilical cord, on the fetal side of the placent
Term
Battledore Placenta
Definition
The umbilical cord is inserted at or near the placental margin
Term
Velamentous insertion
Definition
The vessels of the umbilical cord divide some distance from the placenta in the in the placental membranes
Term
Retained placenta
Definition
Retention of the placenta beyond 30 minutes after birth 2-3%
if not must be removed, conscious sedation may be required
Term
Hydramnios
Definition
Excess amniotic fluid
SOB
Edema
Cesarean
Abruptio placentae
PP hemorrhage
Term
Oligohydramnios
Definition
Small amount of amniotic fluid
Postmaturity
Renal agenesis
Dysplatic kidneys
Mostly renal
Skin and skeletal abnormalities
head compression
Term
Forceps-assisted birth
Definition
maternal heart disease
Infection
Exhaustion
Fetal stress
Term
Forceps delivery
Definition
an instrument with two curved blades is used to assist in the birth of the fetal head
Term
Forceps delivery
Definition
fully dilated
Presenting part must be engaged and vertex presentation.
membrane rupture
Low forceps +2
mid forceps engaged
Term
Types of forceps
Definition
Outlet forceps-fetal skull in perineum
Low forceps +2
Midforceps engaged
Term
Risk forceps
Definition
Bruising, edema, facial lacerations, cephalhematoma, cerebral hemorrhage

Vaginal laceration
infection
Bleeding
Bruising
Perineal edema
Term
Vacuum delivery
Definition
utlizes a vaccum cup to the fetal head, use negative pressure to assist in birth of the fetal head

fully dilated
cup cause caput form

Increase risk for jaundice, alceration hematoma
Term
Cesarean skin incision
Definition
Vertical
Transverse (Pfannenstiel)
Term
Types of uterine incisions
Definition
Transverse (Kerr incision)
Vertical low segment
Vertical upper segment
Term
Episiotomy types
Definition
midline
mediolateral

local anesthesia
Term
DIC (disseminated intravascular coagulation)
Definition
overstimulation of the coagulation process triggered by underlying disease and vascular injury
Term
Labor
Definition
begins with complete dilatation and ends with delivery of placenta

4 stages
Term
The Birth Passage
Definition
Ability of pelvis and cervix to accommodate passage of fetus and for the introitus (external vaginal) opening to distend
Term
True Pelvis
Definition
Forms bony canal through which fetus must pass

Divided into three sections: inlet pelvic cavity outlet
Term
Gynecoid pelvic
Definition
Favorable for vaginal birth
Outlet adequate
Term
Android Pelvic
Definition
Not favorable
midpelvis reduced
Term
Anthropoid pelvic
Definition
favorable for vaginal birth
inlet in oval shape
Term
Platpelloid pelvic
Definition
not favorable for vaginal birth
inlet in oval shape
Term
Fetal skull
Definition
has three major parts

Face
Base of skull
Vault of Cranium
Term
Molding
Definition
Cranial bones overlap under pressure of the powers of labor and demands of unyielding pelvis
Term
Landmarks of the fetal skull
Definition
Mentum: chin
Sinciput: area of the brow
Bregma: anterior fontanel-large diamond shape
Vertex: are btw the anterior and posterior fontanell
Posterior fontanelle-btw posterior cranial sutures
Occiput: area of the occipital bone/posterior fontanelle
Term
Sutures of the fetal skull
Definition
Sagittal
Lamboidal
Coronal
Frontal
Term
Bones of the fetal head
Definition
two parietal bones
Two temporal bones
Frontal bone
Occipital bone
Term
Diameters of the fetal head
Definition
Occipitofrontal -12 cm
Occipitmental -13.5 cm
Suboccipitobregmatic- 9.5 cm
Biparietal - 9.25 cm
Term
Fetal attitude
Definition
refers to relation of fetal of body parts to each other flexion, extension. it is the posture of the fetus in utero
Term
The normal attitude
Definition
flexion of the head, back rounded, thighs flexed on the abdomen, arms crossed over thorax
Term
Fetal Lie
Definition
is the relation of the long axis (spine) of the fetus, to the long axis of the mother. May be longitudinal or transverse
Term
Fetal Presentation
Definition
determined by fetal lie and by body part of fetus that enter pelvic passage first. this portion of fetus called presenting part
Term
Longitudinal Fetal Lie
Definition
Vertical. Long axis of the fetus is parallel with long axis of the mother
Term
Transverse Fetal Lie
Definition
Horizontal. long ais of the fetus is at right angle to that of the mother- vaginal birth no possible
Term
Cephalic presentation divided
Definition
Vertex
Military
Brow
Face
Term
Malpresentations
Definition
difficulty deliveries
Term
Military presentation
Definition
No flexion or extension
Term
Presentation Part
Definition
cephalic -occiput
Breech- sacrum
Shoulder-Scapula
Term
Engagement
Definition
Of presenting part ccurs when largest diameter of presenting part reaches or passes through pelvic inlet
Term
Station
Definition
refers to relationship of presenting part to imaginary line drwn btw ischial spines of maternal pelvis
Term
Onset of Labor
Definition
Progesterone: decrease

Estrogen: stimualtion of uterine muscle contractions

Prostaglandins: effect not known but effects successful in inducing labor Protaglandin E

Corticotrophin: releasing Hormone sharp increase prior to labor
Term
Forces of Labor
Definition
Primary force: uterine muscular contractions, responsible for effacement and dilation of the cervix

Secondary force: Is use of abdominal muscle to push during second stage of labor. Down effots with abdominal muscles and perineal muscles
Term
Physiologic Forces of Labor
Definition
Frequency: time of one contraction
Duration: leght of contraction
Intensity: strenght of the contraction
Term
Contraction
Definition
Pressure of fetal head causes cervical dilation
Rectum and vagina are drwan upward and forward with each contraction

During secodn stage, anus evert
Term
Premonitory SIgns of Labor
Definition
Lightening
Braxton Hicks contractions
Cervical changes
Bloody show
loss cervical mucuos plug
Loss 1-3 pounds
Diarreah, indigestion,N/V
Rupture of membranes
Sudden burst of energy
Term
True Labor
Definition
contractions occur at regular intervals
interval btw contractions gradually shorten. increase in duration and intensity

Discomfort begins in back and radiates around to abdomen

intensity increase with walking

cervical dilation and effacement are progressive
Term
Stages of Labor
Definition
1st stage from onset of true labor to complete dilaion of cervix

2nd stage begins with complete cervical dilation and ends with birth of infant

3rd Stage begins after the delivery of the baby and ends with delivery if the placenta

4th Stage process when woman experience chills , hunger, euphoria, thirsty
Term
First Stage
Definition
Latent phase: 0-3 cont. every 10-30 min, 30-40 min duration

Active phase: 4-7, 1-2 min, 40-60 sec, moderate to strong

Transition phase: 8-10, 1-2 min, 60,0 sec strongs
Term
Second stage
Definition
Complete dilation
every 1-2 min 60-90 sec strongs
Out of control, helpless panicky
Term
Cardinal Fetal Movements
Definition
Engagement
Descent
Flexion
Internal rotation
Extension
Restitution
External rotation
Expulsion
Term
Cardinal Movements
Definition
EDFIEREE
Term
Descent
Definition
Refers to the progress of the presenting part though the pelvis
F
Term
Flexion
Definition
occurs as the descending head meets resistance from the cervix, pelvic wall, or pelvic floor
Term
Internal rotation
Definition
Fetal head must rotate to fit the diameter of the pelvic cavity, which is the widest in the anteroposterior diameter
Term
Extension
Definition
when the fetal head reaches the pereneum for birth, it is defleted anteriorly by the perineum
Term
Restitution
Definition
A brief rotation of the head to the position it held when it was engaged in the pelvic inlet. sort of untristing of the neck
Term
External Rotation
Definition
as the shoulders engage and descend the head further rotates
Term
Expulsion
Definition
after the birth of the head and shoulders the rest of the body is expelled
Term
Fetal Responses to Labor
Definition
FHR normal range 120-160 bpm
PV exam
Rupture of membranes
Infections
Contractions
Fundal pressure
Fetal cord compression
fetal respiration affected
Term
Bishop Scoring
Definition
factor 0: closed, 0-30%, -3, Firm, posterior
Factor 1: 1-2, 40-50%, -2, moderate, midposition
Factor 2: 3-4, 60-70%, -1, soft, anterior
Factor 3: 5 or more, 80% or more, +1 or lower
Term
Vaginal examination us used to assess
Definition
Cervical dilatation
Cervical effacement
Station
true labor
ROM-characteristic of amniotic fluid
Fetal position
Term
labor initiated at term
Definition
by spontaneous rupture of membrane in 25 % of pregnancies
Term
Assessing for Amniotic fluid
Definition
Nitrazine test paper to determine ph. acid=urine, pus, blue=ammiotic fluid
or
In the lab Fern Test presence of ferning=amniotic fluid
Term
Amniotic fluid
Definition
Normal=pale, straw colred, watery, no strong odor, 500-1200 ml
Greenish brown= hypoxia
Yellow stained=fetal hypoxia
Port wine-bleeding
Thick cloudy, foul smelling=infection
Fluid lmore 1200ml-hydramnios-congenital anomalies
Fluid less 500 ml oligohydramnios=incomplete or absent kidney
Term
Leopold´s Maneuver
Definition
empty bladder
Lie on her back with feet on bed
knes bent
Universla precautions
Palpate
One hand held steady as other explore abdomen
Term
FHR auscultation
Definition
most clearly at fetal back
Leopolds maneuvers first to locate FHR
Vertex= FGT heard below the umbilicus
Breech= FHR heard above the umbilicus
Term
Ambulation
Definition
is encouraged if membranes are intact, engaged presenting part after ROM, no medication for pain
Term
External FHR monitoring
Definition
Tocodynameter
Ultrasound
Term
Internal Monitoring
Definition
IUPC
FSE
Term
woman admitted with vaginal bleeding
Definition
NO VE
FHR
amount blood loss
evaluate labor pattern
physician
Term
Presence of greenish or brownish ammiotic fluid
Definition
FHR
dilatation, chech for cord prolapse
presentation
bed rest
physician
Term
absence of FHR
Definition
physician
stay with couple
Term
Prolapse of umbilical cord
Definition
Relieve pressure on cord manually
FHR
physician
knee chest position
oxygen
Term
Birth Imminent
Definition
EDB
Hx
OTC illicit drugs?
problems?
FHR, VS
Blood type and Rh
physician
stay
gloves
Term
Fetal Heart Rate Variability
Definition
Variability irregular fluctuation in FHR baseline

Minimal-undetected but not by more than 5 beat
Moderate 6-25 beats difference
Marked 25 beats per minute

Absence or undetected variability is non-reassuring
Moderate variability is reassuring
Term
Fetal Heart Rate Changes
Definition
Aceleration are transient increases in fetal heart rate normally cuased by fetal movement, usually with contractions

Decelarations are periodic decreases in FHR from baseline. Can be early, late, and variable
Term
Types of Deceleration
Definition
Early: occur before onset of uterine contaction, fetal head compresion

Late: Onset occurs after onset of a uterine contraction caused by uteroplacental insufficiency

Variable: Due to compression of the umbilical cord which results in a decrease in blood flow btw placenal and fetus. Varies on timing
Term
Systemic Drugs
Definition
Opioid
Stadol, Nubain, Demerol, fentanyl

Analgesic potentiarors: vistaril, phenergen
Term
Epidural Anesthesia
Definition
Injection of anesthesic agento into epidural space. Produces little or no feeling to area from uterus downward

Need floey due to loss of bladder sensation
Term
Spinal anesthesia
Definition
Local anesthesic agent injected directly into spinal canal. higher use of rcesarean birth or lower vaginal birth

Severe headache
Term
Local anesthesia
Definition
injected into preineum prior to episiotomy
Pain relief
No effects in VS
Term
General Anesthesia
Definition
induced unconsciousness
Complication: fetal respiratory depression
Cricoid pressure per request
Term
Pudendal anesthesia
Definition
Local anesthesia directly to into pudendal nerve which produces anesthesia to lower vagina, vulva, perineum
Has no effect on fetus or progress of labor

Cont: brad ligament hematoma, perforation of rectum, sciatic nerve trauma
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