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Exam 2 NUR113
Intrapartum Care
| Question | Answer |
|---|---|
| What five factors are important for the process of labor and birht? | Passage way (birth canal), passenger (fetus & placenta), Position (relation between passage and fetus), Power (physiological forces of labor), Psychological and psychosocial considerations |
| The birth canal is comprised of what 3 sections? | inlet, pelvic cavity, outlet |
| What is the purpose of a vaginal exam? What is checked during the exam? | To check fetal position; dilation, station, effacement |
| What are fontanels? | intersection between cranial sutures (soft spots) |
| What is fetal attitude? | the relation of the parts to one another (incl. flexion or extension of head/extremities) |
| What is fetal lie? | the position of the fetus in relation to mom's axis (the spinal cord to spinal cord) |
| What is fetal presentation? | determined by fetal lie and by the body part of the fetus that enters the pelvic passage first |
| Name the 3 types of presentation. | Cephalic, Breech, shoulder (transverse lie) |
| What is the purpose of fontanels? | to allow molding during birth (so the head gets out a little easier) |
| Name the 4 types of fetal cephalic presentation. | A - Vertex B - Military C - Brow D - Face |
| What part of the baby is felt during a vaginal exam for a baby in the Vertex (breech) presentation? | Crown/top of head/anterior fontanels; optimal position, |
| What part of the baby is felt during a vaginal exam for a baby in the Military (breech) presentation? | top of head is felt; chin is untucked, |
| What part of the baby is felt during a vaginal exam for a baby in the Brow (breech) presentation? | Forehead is felt |
| What part of the baby is felt during a vaginal exam for a baby in the Face (breech) presentation? | Nose/mouth felt; requires a c section |
| Name the 3 types of breech. | Frank, full/complete, footling/incomplete |
| What is a high risk due to breech presentation? | umbilical cord prolapse, getting stuck |
| What should you do if you see a prolapsed umbilical cord? | Push the body part back inside, don't touch the cord, call for help, admin O2 |
| Describe the fetal position in a frank breech? | butt first legs up |
| Describe the fetal position in a Full/Complete breech. | butt first legs crossed |
| Describe the fetal position in a Footling/Incomplete. | feet first, could be one or both feet |
| Describe the fetal position in a shoulder presentation/ | Shoulder is felt during VE, fetus is laying horizontally across the pelvis |
| How long does a stuck baby have? | 7 minutes or less |
| True or false: babies breech presentation can always be born vaginally. | False, breech babies are typically born via c-section |
| What is fetal engagement? | largest diameter of presenting part reaches or passes through pelvic inlet (fetus being in the pelvic, not the abdomen) |
| *What is important about the relationship between the fetus and the passage? | Engagement - Station - relationship of the presenting part to line between ischial spines of maternal pelvis - Fetal position - |
| What is fetal station? | relationship of presenting part to the line between ischial spines of maternal pelvis (location of the babies head in relation to the inlet or outlet) |
| What is fetal position? | relationship between landmark on presenting fetal part and areas of maternal pelvis (what quadrant is it in and what is the presenting part) |
| A positive fetal station indicates what? | Baby is in outlet and it's coming |
| What muscular changes occur in the pelvic floor during labor? | muscles thin out |
| Name the premonitory signs of labor. | Lightening, Braxton-Hicks contractions, Cervical changes, Bloody Show, rupture of membranes (ROM) |
| Describe lightening. | when the baby drops into the pelvis AKA Engagement |
| What are braxton-hicks contractions? | "fake" contractions that occur on the sides of the uterus; can be very painful |
| How does the cervix change during labor? | softening and dilation |
| What is a bloody show? | blood/mucous discharge |
| What do the premonitory signs of labor indicate? | labor will begin w/i 24-48hrs |
| Name the 4 types of Rupture of Membranes (ROM). | Spontaneous (SROM), Premature (PROM), Preterm Premature (PPROM), Artificial (AROM) |
| What are the possible risks/complications of ROM? | Infection, prolapsed cord |
| Who can perform an AROM? | Dr or Midwife only |
| Difference between PROM and PPROM. | PROM - water breaks prior to labor at any gestational age PPROM - fetus is premature (>37wks) and is a break or leakage of fluid |
| What are the physiological forces of labor? | Primary (contractions) and secondary (mom pushing) forces |
| How are contractions measured? | Frequency (beginning of one to the beginning of next) Duration (how long it lasts) Intensity (How hard) |
| What can happen if the cervix is not fully dilated and mom bears down? | cervical edema |
| What are some psychosocial considerations? | Parent readiness Maternal mental preparation for labor Fear of pain Support System Influence Birth experience may influence mothering |
| What are signs of true labor? | Effacement (cervix dilation), stimulated by oxytocin |
| What musculature changes happen in the pelvic floor? | The muscles thin out to help baby come |
| What is the KEY difference between true and false labor? | true labor will have effacement/cervical dilation and will be a regular intervals that increase in frequency, duration, and intensity; occur at fundus |
| Describe false labor. | irregular contractions, no effacement, may occur in lower abdomen or groin |
| What is assessed in the intrapartum high risk screening? | physical conditions, comorbidities, Socioeconomics, cultural variables, mental illness, drug use, smoking, any abnormal antepartum results |
| How are contractions assessed? What should resting tone be? | External and internal electronic monitoring; resting tone should be 20-30 |
| What are the stages 4 of labor?* | 1 - onset of true labor to complete dilation 2 - complete dilation to birth of newborn 3 - birth of newborn to delivery of placenta 4 - 1-4 hrs post delivery to controlled bleeding |
| What happens during the first stage of labor? What do you do?* | Latent, active, and transition phase Limited vag exams, palpate uterus, BP, FHR q30min, encourage voiding, manage discomfort, encourage pant-blow breathing |
| What happens during the second stage of labor? What do you do?* | fetal head descends, perineum distends, crowning, can push, burning sensation as baby begins to exit BP Q30min, FHR q15min, make sure FHR returns to baseline after contractions, encourage rest between contraction, comfort measures |
| What happens during the third stage of labor? What do you do?* | placental separation & passage about 5 mins after birth Initial care of newborn, delivery of placenta, palpate fundus (should be firm) inspection of placenta |
| What happens during the fourth stage of labor? What do you do?* | bleeding begins to decrease; monitor closely for 1-4hr inspect for lacerations, asses fundus firmness, wash perineum, provide ice packs/tucks pads; inspect discharge for amount of blood and type of flow, may faint upon standing, prevent hemorrhage |
| What is happening during the first stage of labor during the Latent phase? | beginning of regular contractions, cervix dilates 0 - 3cm |
| What is happening during the first stage of labor during the active phase? | cervix dilates 4-7cm; progressive fetal descent; rate of cervical dilation increases; contractions 2-5min apart; 40-60secs long; anxiety, sense of need for energy/focus |
| What is happening during the first stage of labor during the Transition phase of labor? | Last part of first stage; may feel anxious, out of control, tired; strong contractions every 1.5-2mins; last for 60-90secs; 8-10cm dilation; increased rectal pressure, desire to bear down; increased bloody show; may have increased vomiting |
| What nursing care is provided on admission? | Auscultate FHR, vitals, contractions, any bleeding/fluid leaking; vaginal exam; assess effacement, dilation, ROM |
| What lab tests are done on admission? | H&H (hgb, hct), platelets; low platelets is a problem |
| How often should you asses FHR, vitals, and contractions? | q30min for low-risk pregnancies; temp is q4h is water is unbroken, 1-2hr if broken |
| What is laboring down? What should you do? | Patient is fully dilated but not pushing/no urge; wait several hrs if baby is fine; reposition q30min; Foley cath in place to keep bladder empty; fetal head will descent from power of contractions |
| What positions can women give birth in? | Upright, squatting, kneeling, standing, sitting, recumbent lithotomy (most common) |
| When is a placenta considered retained? | when 30mins have passed since birth |
| What are the signs of placental separation? | uterus rises, umbilical cord lengthens, sudden trickle of blood from vag, fundal massage makes bleeding stop |
| How is Pitocin run? | slow during labor, high after to help expel the placenta |
| How do you perform a fundal assesment? | Support bottom of uterus then palpate. If boggy, massage until it firms |
| Name 5 symptoms to report in a postpartum patient. | hypotension tachycardia uterine atony = boggy uterus excessive bleeding hematoma |
| True or false: It is normal for a woman during labor to have a WBC of 25,000-30,000 | True |
| What can be used to ripen the cervix? What nursing care is provided at that time? | Cytotec (Misoprostol), Prostaglandin agents, mechanical methods (the thing w/ water) asses fetal VS for baseline, asses fetus for at least 30mins; contraindicated for previous c section or bad FHR, fetal monitor strip needed for at least 30min prior |
| Describe elective v medical labor induction | Medical: induction required to be medically safe d/t medical conditions etc. Elective: date is set; not induced before 39wks (due date is +/- 2wks) |
| What are some reasons for induction? | Diabetes, renal disease, preeclampsia, PROM, Chorioamnionitis, post term gestation (42wks), mild abruptio placentae, uterine fetal demise, isoimmunization, Nonreassuring fetal status |
| What are some contraindications to labor induciton? | client refusal, transverse fetal lie, active genital herpes, umbilical cord prolapse, baby's head is too big to fit, placenta previa |
| Why is vacuum extraction used and how? | prolonged second stage or labor or Nonreassuring FHR; Suction is used against occiput of fetal head; preferred over forceps |
| What is an episiotomy? | surgical incision of perineal area |
| What does VBAC stand for? | Vaginal Birth After C-section |
| True or false: C-sections have a lower mortality and morbidity rate than vaginal births. | False, rate is higher and it increases risks in subsequent pregnancies |
| How are c sections cut? | transverse typically, vertical in emergency situations |
| Nursing care of a woman during VBAC | - High risk birth - blood count, type & screen on admission - Patent IV - Continuous fetal monitoring and nurse @ bedside - supportive/comfort measures |
| What are some preterm labor risk factors? | african american, maternal age <16 or >40, hx of preterm births, low pregnancy weight for height, multi-gestation, STIs, Placenta issues, Late or no prenatal care, hydramnious, domestic violence |
| What is used to treat preterm labor? | Tocolytic therapy - use of drugs to stop contractions - mag sulfate - indomethacin/Indocin : prostaglandin inhibitor - nifedipine/Procardia: cal chan blocker - betamethasone/celestone: steroid given to increase fetal surfactant |
| What is monitored if mag sulfate is given during preterm labor? | BP q10-15mins, serum mag levels, urine output |
| What is Abruptio Placentae? What does it lead to? | separation of placenta from uterus leading to maternal death (d/t hemorrhage) and fetal death (d/t compromised fetal blood supply) |
| What are s/s of Abruptio Placentae? | dark red bleeding (bleeding may be concealed), severe knife-like pain, uterine tenderness, contractions, decreased FHR & movement, decreased urine output, stiff uterus that does nor soften, shoulder pain |
| What is Placenta Previa? | when the placenta implants over the cervix |
| What is a clear indicator of Abruptio Placentae? | Decreased FHR |
| True of false: Placenta Previa is painful and allows for vaginal birth | False, placenta previa is not painful and requires c-section when baby becomes term |
| How does a nurse manage placenta previa? | accounting for blood loss by counting/weighing pads, avoiding vag exams, monitoring FHR; support and education; effects of prolonged bed rest, prep for c section |
| How can you tell that there is a prolapsed umbilical cord? | If not seen already, FHR will drop |
| What is an Amniotic Fluid Embolism? | when a tear occurs between the amnion and chorion causing amniotic fluid to enter mom's blood stream and travel to her lungs (similar to PE) |
| What should you do if a patient has a suspected amniotic fluid embolism? | administer O2, quickly est. IV access, CPR if necessary |
| What are the Leopold Manuvers? | palpation method that can be used to determine the position of the baby |
| What is done during the fetal assesment? | Assessment of fetal position and lie, vaginal exam and ultrasound, Auscultation of FHR (listen for full minute, heard clear through back) |
| What is Nonreassuring fetal status? What can be done to change status? | baby isn't doing well; change mom's position, assess FHR & amniotic fluid, put mom on sides or hands and knees |
| What is the normal FHR Range? | 110-160 bpm |
| What does a wandering FHR baseline indicate? | oxygenation issue - intervene immediately to enhance oxygenation |
| Describe fetal tachycardia | FHR sustained at or above 161pbm (caused by nicotine, drugs, stimulants, etc.) for 10mins |
| Describe fetal bradycardia | FHR less than 110 for 10mins |
| What is variability? | measure of interplay between sympathetic and parasympathetic nervous system; indicates if baby is okay |
| True of false: Reduced variability best predictor for determining fetal compromise | True |
| What are the types of variabilty? | Excessive, moderate (goal), minimal, absent |
| What are accelerations? | transient/intermittent increases in FHR caused by fetal movement |
| What are decelerations? How many types are there? | periodic decreases in FHR; 3 |
| What are the types of decelerations? Remember VEAL = CHOP | Variable deceleration = Cord compression Early deceleration = Head compression Accelerations = Okay Late deceleration = Placental insufficiency |
| Describe variable decelerations and what to do about them. | V/W shape on strip, severe drop below baseline, can happen at anytime call Dr |
| Describe Early decelerations and what to do about them | dips roll w/ contractions d/t head squeezing on cord; can't do anything about it |
| Describe late decelerations and what to do about them | starts late in contraction and come up late; looks like early; baby isn't getting enough blood/placental insufficiency, call DR, reposition mom, give fluid bolus |
| True or false: High risk moms do not need to be on a continuous monitoring | False |
Created by:
failingstudent88
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