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4 Ps

Intrapartal

QuestionAnswer
What happens to the active and passive uterus during labor? Upper segment becomes thicker, the lower segment and the cervix becomes thinner and are pulled upward.
What happens to the active and passive uterus during contraction? The upper 2/3 contracts actively, the lower third and the cervix is passive.
What is the reason for passive contraction? To allow the baby to go thru.
Define effacement. Cervix gets shorter and thinner.
Uterine contraction and mother's pushing efforts is considered what part of intrapartal? Powers
Maternal pelvis is considered what part of intrapartal? Passage
What hormone is secreted during passage? Increased relaxin hormone
Which pelvic shape is considered the best for labor and the degree? Gynocoid at greater than 90 degree
Fetus, membranes, and placenta is considered what part of intrapartal? Passenger
What 2 fontanelles do doctors look for during delivery? Anterior and Occipital
Best way for a baby to be positioned during delivery is? Flexion
Complete flexion as a type of cephalic presentation is considered? Complete flexion
Moderate flexion as a type of cephalic presentation is considered? Military presentation
Poor flexion as a type of cephalic presentation is considered? Brow presentation
Full extension as a type of cephalic presentation is considered? Face presentation
Describe position of baby during Frank breech. Both feet near in front of the faced and crossed
Leopoids Maneuvers 1 1
Leopoids Maneuvers 2
Leopoids Maneuvers 3
Leopoids Maneuvers 4
Describe right occipitoposterior position of baby Back facing mom's anterior side with head facing left side
Describe right occipitoanterior position of baby Front of face facing mom's anterior with face facing mom's left side
what part of the baby do you auscultate FHR when positioned LSA or RSA (left or right sacrum area)? Upperback
Anxiety, fear, pain, prep for childbirth, and impact of technology is considered what part of intrapartal Psyche
When there is too much sympathetic action, what chemical can inhibit uterine contractility and placental blood flow? Catecholamines
What hormones are triggered from prostaglandin caused by fetal membranes? Estrogen
Define lightening descent
What signs would you look for when laboring? Braxton Hicks contractions, lightening, energy spurt, small weight loss, increase in clear and nonirritating vaginal secretions.
What are the mechanisms of labor? Descent, engagement, flexion, internal rotation, extension, external rotation, expulsion
First stage of labor is? Dilation and effacement of the cervix.
Begins and ends with? Begins with onset of true labor and ends with complete dilation and effacement of cervix.
What are the phases of the first stage of labor? Latent, active, and transition.
Latent (early stage) - size of cervical dilation? 3cm
Latent (early stage) - how often do contraction occur? To about 5 minutes apart
Latent (early stage) - what happens to the intervals of the contractions? decrease
Latent (early stage) - what happens to the duration of contraction? increases to 30-40 seconds
Latent (early stage) - what are the strength of the contractions? mild to moderate
Latent (early stage) - what happens to the back and abdomen? back discomfort progresses to the lower abs with each contraction
Latent (early stage) - how is the mom's response? sociable, excited, cooperative
Active phase - size of cervix? 4-7cm
Active phase - what happens to the pace of labor? increase
Active phase - what happens to the effacement? complete
Active phase - what happens to the contraction intervals? average of 2-5 minutes between them
Active phase - what happens to the duration of the contraction? 40-60 seconds each
Active phase - what is the intensity of the contractions? moderate to strong
How are the contractions different from latent phase? they reach their peak faster and stay there longer
Active phase - what is the response of the mother? more anxious or helpless, less sociable
Active phase - what is given at this stage? pain meds and anesthesia
Transition phase - what is the size of the cervix? 8-10cm
Transition phase - describe fetus and blood fetus descends further into the pelvis and bloody show increases
Transition phase - describe phase short but intense
Transition phase - what is the intensity of the contractions? strong
Transition phase - what is the duration and frequency of the contractions? 60-90 seconds duration and 1.5-2 minutes apart
Transition phase - side effects? leg tremors, nausea & vomitting
Transition phase - what is mom's reaction? irritable & lose control
What takes place in the 2nd stage? expulsion
2nd stage - size of cervix? 10cm
2nd stage - effacement %? 100%
2nd stage - begins and ends with? begins with dilation & full effacement of cervix and ends with the birth of the baby
2nd stage - average time for nullipara? 30 min - 3 hrs
2nd stage - average time for multipara? 5-30 min
2nd stage - what happens to the intensity of the contraction? diminish slightly
2nd stage - what happens to the fetal head? causes pressure on rectum & pelvic floor that causes involuntary pushing response from mom like a bowel movement
2nd stage - what is mom feeling pysically & emotionally? feel sensation of splitting or stretching; regains feeling of control to complete birthing process
What takes place in the 3rd stage? placental
3rd stage - begins and ends with? begins with baby delivered already and ends with expulsion of the placenta
3rd stage - duration? 5-10 min & up to 30 min
3rd stage - what happens to the uterus? size decreases with birth & causes separation of placenta edges
3rd stage - what are the sx of separation of the placenta? uterus has spherical shape, rises upward in abs as placenta descends, cord descends further from the vagina, a gush of blood appears
3rd stage - most common type of placenta delivery? Schultz "shiny" side first
3rd stage - least common type of placenta delivery? Duncan "dirty" side first
What takes place in the 4th stage of labor? physical recovery for mother & infant
4th stage - how long for the recovery? delivery through first 1-4 hours after birth
4th stage - what should be done with the uterus palpated through the abs
4th stage - what may occur to mom that is natural? chills & shivering
4th stage - what is mom's reaction? excited & exhausted
4th stage - time for? bonding
What do you look for when during artificial rupture of membranes? babies
IV push Fentanyl for contractions - what is the onset time, physical advantage, not use for which pt, and antagonist for? quick onset, physical advantage - less n/v/resp depression, not for pt opiate dependent, narcotic antagonist
List 3 adjunctive drugs for deliver? Phenergan, Benadryl, Hydroxyzine
What is the opiate antagonist when babies HR drops? Narcom
Purpose of Phenergan? antinausea
Purpose of Benadry? relieve pruritus (itching) caused by epidural narcotics
Purpose for Hydroxyzine? nausea and vomiting
What are some ways in providing comfort measures? Lignthing, temperature, mouh care, clenaliness, bladder, positioning, teaching & encouraging, pharmacologic measures, carin for birth partner
What are 2 ways in preventing injury for mom during birth? postioning & perineum
What is a priority responsibility of a nuse after birth? administer meds to contract uterus after delivery
After AROM what are the top 3 things you look for? Babies HR, check color & odor of fluid, meconium
What can be done to prevent pushing? blowing, must slow breath or at risk of hyperventilation
What can be done to help with second stage breathing and what is the purpose? closed glottis pushing to increase intrathoracic pressure and reduce O2 supply to fetus during contraction
What main med is given during 2nd stage? Advantage? Not for what type of pt? Fentanyl; less N/V/resp depression Opiate dependent pt
Purpose of Phenergan anti-nausea
Purpose of Benadryl anti-itching for epidural
When is Iv push administered during labor? during contraction so less meds go to the baby
What med to you administer to babies when HR dec? Narcom, an opiate antagonist
Name meds for short & long acting local anesthesia Novocaine & Lodocaine
Name 2 types of analgesics for labor Fentanyl & Morphine
What med is given for SVD and duration? Fentanyl - rapid onset, 1-4h
What med is given that takes 30-60 min onset? morphine
What contraindicates anesthesia? back surgery, bleeding disorder, infx, allergies
what are advantages of regional anesthesia? less N/V; repeated doses; less fetal respiratory depression
what are disadvantages of regional anesthesia? Need anesthesiologist or nurse anesthetist; decreased progress in labor, loss of bladder sensation, possible need for forceps or vacuum, inc incidence of c-section
what are adverse rx of regional anesthesia? respiratory paralysis, toxicity, infx, headache, back pain, hypotension, pruritus, N/V
How do you prevent hypotension during birth? prehydrate, side lying
s/s of hypotension? low bp, inc p, N/V, feel funny
What are tx for hypotension? IV fluids, L side, o2, call MD, ck FHR
What is the antitode for anesthesia? epinephrine; sympathetic blocking & brinb BP back up
Prior to anesthesia, what must be done? empty bladder or FC
What stage is epidural given and what cm dialation? during active stage (1)@ 4-6 cm dilation
How long is epidural good for? 12-24 hours
What needs to be monitored for mom after epidural is given? Resp sedation, puritis, nauses
What happens when epidural is given at a later stage? baby will depress; cause early labor
Spinal Anesthesia - used for, effect & how long, blocks, risk for? c-sections, rapid effect for 1-2 hours, sensory & motor, risk for spinal headache
Tx of spinal headaches? blood patch, keep pt supine, inc fluids, give caffeine
Cause of dystocia and results in? CPD or weak contractions; results in fluid or electrolyte imbalance, hypoglycemia, CPD or uterin overdistention
Tx for dystocia depends on cause, oxytocin, AROM, fluids, walking
When is labor induced with pitocin? what is assess first? above 40 weeks fetal fibronection
What is Bishop Score and requirements? what score is needed? readiness of labor; requires effacement, dilation, station, softness of cervix, position of cervix >6 favorable
When is pitocin augmentation given? when labor is too slow, increase frequency of contractions, ideal dilation 1 cm/hr
Norms for montevideo? 180-250
What are signs of hypertonic uterine for contractions and FHR? contractions duration more than 90 sec & occuring less than 2 minutes FHR - late decel
Interventions for hypertonic uterine? reduce or stop oxytocin, turn her sideways, give her O2, notify physician
Cause of PTL? infx or medical conditions, drug abuse, uterine distension/irritability
What med is given to stop PTL? tocolytics, terbutaline, magnesium sulfate, calcium antagonists
Side affect of calcium antagonists? dec bp & dec hr; therefore, baby gets less perfusion
What med given to baby for PTL & give definiton? betamethasone; to speed up a preterm fetus's lung development
Interventions for precipitous labor? side lying to dec vena cava compression, dec labor by giving tocolytics, O2 for mom, IV fluids, DC pitocin
PASSENGER/PASSAGE Macrosomia weight? 8.8 lbs
Type of maneuver for shoulder dystocia? what location does it get stuck? McRobert's maneuver symphysis pubis
What can be injured on baby during precipitous delivery? s/s? intracranial hemorrhage, nerve damage, hypoxia bradycarida or tachycardia
Signs of concealed hemorrhage in abruptio placentae r/t fundal, uterine, abdominal, fhr, vaginal bleeding inc fundal height high uterine baseline persistent abdominal pain persistent late decel vaginal bleeding that may be slight or absent
S/S of hypovolemic shock due to blood loss as it r/t emotions pr, rr, bp urine hgb & hct mental anxiety inc pr & rr falling bp weak pulses dec urinary output of <30 ml/hr dec hgb & hct change in mental status
how does hypovolemic affect baby as it r/t: hr amniotic fluid contractions - duration uterine bp temp no variability in hR AF meconium-stained contractions more than 90 sec incomplete uterine relaxation, intervals between contrc shorter than 60 sec hypo/hypertension fever
Signs of intrapartum infx as it r/t: heart temp smell color infx name fetal tachycardia 100.4F foul, smellling cloudy or yellow chorioamnionitis
Med name given to mother so it reduces HIV rate of transmission to baby zidovudine
Congestive Heart Failure s/s as it r/t:
Created by: jjcarmelbeach