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Maternity Chapter 19

Nursing care of the family during labor and birth

1st stage of labor includes: Latent phase: 3cm irregular dilation lasting 6-8 hours Active phase: 4-7cm regular dilation lasting 3-6 hours Transition phase: 8-10cm regular dilation lasting 20-40 minutes
Assessment of pregnant mother begins when? begins on first contact ( by telephone or in person)
can nurses give advice over the phone? NO They should instruct the patient to come in or call their primary health care providers
Signs of true labor: Strong closer together contractions that do not go away with comfort measures Cervics shows progressive change (softening, effacement, and dilation signaled by the appearance of bloody show) Fetus engages -- easier to breath, but bladder compressed
True of false: The cervix moves to an anterior position during true labor TRUE
True of false: The cervix is in a posterior position; therefore, the women is in true labor. False
True or false: The fetus is engaged during false labor. False
True or false: Warm baths can inhibit uterine contractions and prolong the labor process. True
True or false: Warm showers are relaxing during early labor. True
What can happen if a woman gains too much weight during prenancy? A pregnancy weight gain greater than recommended may place the woman at a higher risk for cephalopelvic disproportion and cesarean birth.
What's BOW? bag of water
What's SROM? and how can it be detected? spontaneous rupture of membranes [SROM] In many instances, a sterile speculum examination and a Nitrazine (pH) and fern test can confirm that the membranes are ruptured.
How do you distinguish a bloody show from actual bleeding? Bloody show is pink and feels sticky. The amount increases with effacement and dilation of the cervix.
Physical assessment of the mother include: > a general systems assessment and an assessment of fetal status. > uterine contractions are assessed and a vaginal examination is performed.
What is the objective of performing a Leopold Maneuvers (Abdominal Palpation)? to determine: (1) number of fetuses; (2) presenting part, fetal lie, and fetal attitude; (3) degree of the presenting part's descent into the pelvis; and (4) expected location of the point of maximal intensity (PMI) of the FHR on the woman's abdome
The PMI of the FHR is usually located where? The fetal back.
Terms used to describe uterine contractions include: frequency, intensity, duration, and resting tone.
Palpating for uterine contractions can show what? • Mild: (feels like touching finger to tip of nose) • Moderate: difficult to indent fundus (feels like touching finger to chin) • Strong: Rigid boardlike fundus that is almost impossible to indent with fingertips (feels like touching finger to foreh
When should vaginal examinations be performed: on admission, before medications (analgesics, increasing oxytocin infusion), with changes in uterine activity, on maternal perception of perineal pressure or the urge to bear down, when membranes rupture, or with variable decelerations of the FH
Signs of potential complications: (pressure and contractions) intrauterine pressure greater than 80 mmhg or resting tone greater than 20 mmhg contractions lasting longer than 90 seconds more than 5 contractions in 10 minutes time btween contractions less than 20 seconds
Signs of potential complications: (fetal assessment) late, variable, or prolonged FHR decelerations Fetal bradycardia; tachycardia, irregular heart rate Appearance of meconium-stained or bloody fluid from the vagina arrest of effacement or dilation, and fetal descent
Some herbal teas and their functions: Chamomile tea can enhance relaxation, lemon balm or peppermint tea can reduce nausea, and teas of ginger or ginseng root are energizing
Voiding frequency during labor: every two hours, mother should be encouraged to void
True or false: The second stage of labor can last up to 50 minutes in nulliparous women. True In multiparous women, it lasts about 20 minutes.
Factors that influence the length of the second stage of labor include: In addition to parity, maternal size and fetal weight, position, and descent influence the length of this stage.
Upper limits of the length of the 2nd stage of labor • Nulliparous women: 2 hours with no regional anesthesia use 3 hours with use of regional anesthesia • Multiparous women: 1 hour with no regional anesthesia use 2 hours with regional anesthesia
What occurs during the latent phase of the second stage of labor: During this early phase the fetus continues to descend passively through the birth canal and rotate to an anterior position as a result of ongoing uterine contractions.
What occurs during the active phase of the second stage of labor: During the phase of active pushing (descent) the woman has strong urges to bear down as the Ferguson reflex is activated when the presenting part presses on the stretch receptors of the pelvic floor.
a very Certain objective sign that the second stage of labor has started: inability to feel the cervix
Other signs that the second stage of labor started include: urge to push bloody show increase shaking of extremities increase restlessness appearance of sweat on lips
Physical assessments for the 2nd stage of labor include: • every 5 to 30 min: maternal bp, pulse, and resps • every 5 to 15 minutes: FHR and pattern • every 10 to 15 min: vaginal show, signs of fetal descent, and changes in maternal appearance and partner • Assess every contraction and bearing-down ef
What to do at crowning? instruct mother to pant-blow, to minimize urge to push. It is very important to slow the delivery of the fetus to prevent complications.
After delivery, what to do: keep baby at same level with the uterus to prevent hypovolemia do not "milk" the cord do not tug on the cord suction baby with bulb syringe and clean
signs of placental delivery: Signs of placental separation include a slight gush of dark blood from the introitus, lengthening of the cord, and change in the uterine contour from a discoid to globular shape.
The three phases of the spontaneous birth of a fetus in a vertex presentation are: (1) birth of the head, (2) birth of the shoulders, and (3) birth of the body and extremities (see Chapter 16).
Created by: ekm