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OB EXAM 3.. 7 8 9
| Question | Answer |
|---|---|
| Tpoics that focus on the mother and infant | Birthing classes |
| Exercises that relieve back pain common during late pregnancy | conditioning- pelvic rock, tailor sitting, shoulder circling |
| Factors that distinguish child labor pain from other types of pain | part of the normal birthing process several months to prepare for pain self limiting and rapidly declnes after birth |
| almost universal part of the normal process of birth | pain |
| least amount of sensation that a person percieves as painful | pain threshold - pain perception |
| amount of pain one is willing to endure | pain tolerance |
| sources of pain during labor | dilation and stretching of cervix reduced uterine blood supply during contractions (ischemia) pressure of the fetus on the pelvis stretching of the vagina |
| Gate Control Theory | explains how pain impulses reach the brain for interpretation transmitted through small-diameter nerve fibers. stimulation of large-diameter nerve fibers temporarily interferes with conduction of the impulses through the small-diameter fibers |
| natural body substances similar to morphine | endorphins peak during labor- may explain why women in labor often need smaller amounts of analgesics or anesthetic |
| cervix naturally under goes prelabor changes that facilitate effacement and dilation in labor, if the cervix does not make these changes | more contractions are needed to cause effacement and dilation |
| significantly influences how readily the fetus can descend through the pelvis | size and shape |
| pelvic abnormalities can result in | longer labor and greater maternal fatigue |
| reduces pain tolerance and a woman ability to use coping skills | fatigue |
| most effectively cause effacement and dilation of the round cervix | fetal head- smooth and rounded |
| when does the fetus turn during labor | ealry labor- occiput is in the front L or R or right quadrant of the mothers pelvis |
| fetal occiput that is in a posterior postion results in | back pain (back labor) labor is often longer with this fetal position |
| interventions that add to pain during labor | IVS continuous fetal monitoring Amniotomy vaginal examinations |
| influences how a woman feels about pregnancy and birth and how she reacts to pain during childbirth | culture |
| help the woman to cope with labor before it has advanced far enough for her to be given medication | nonpharmacological methods |
| cannot be given until labor is well- established bc they tend to slow the progress of labor | pharmacological methods |
| concept of a fear-tension-pain cycle during labor | Dick-Read method |
| Husband- coached childbirth and was the first to include the father as apart of labor | Bradley method |
| Psychoprophylatic method, basis of most child birth prep classes- uses mental techniques that condition the woman to respond to contractions with relaxation rather than tension | Lamaze method |
| Lamaze breathing technique should be | no more than half of the woman baseline respiratory rate and no faster than twice the baseline resp rate |
| to reduce fear and anxiety | the woman is oriented to the labor area, any procedures that are done, and what is happening |
| stimulates the large-diameter nerve fibers that inhibit painful stimuli traveling though the small-diameter fibers | Effleurage |
| firm pressure against the lower back helps to relieve | back pains (back labor) |
| focus on an object or closing eyes to focus on an internal | focal point |
| each breathing pattern begins and ends with a | cleansing breath- deep inspiration and expiration- similar to a deep sigh |
| cleansing breaths help the woman to | relax and focus on relaxing |
| signs and symptoms of hyperventilation | dizziness, tingling of the hands and feet, cramps and muscle spams of hands, numbness around the nose and mouth, blurring vision |
| how to correct hyperventilation | breath slowly- esp in exhalation breathe into cupped hands place moist wash cloth over the mouth and the nose while breathing hold breath before exhaling |
| nure role in nonpharmacological techniques | assess knowledge, teach and control stimuli |
| systemic drugs that affect the entire body- reduce pain without loss of consciousness | analgesics |
| loss of sention, especially of pain | anesthetics |
| systemic drugs that cause loss of consciousness and sensation of pain | general anesthetics |
| physician who specializes in giving anesthesia | anesthesiologist |
| registered nurse who has advanced training in anesthetic administration | CRNA |
| pregnant women are at higher risk for ________ caused by the pressure of the enlarging uterus on the __________ | hypoxia diaphragm |
| sluggish gastrointestional track results in increased risk for | vomiting and aspiration |
| never lay a pregnant woman in this position bc the heavy uterus puts pressure on the abdominal aorta and causes hypotension | supine |
| most common means of labor analgesia in the US | opiods |
| the use of narcotics are avoided if labor is expected within | one hour |
| used to reverse respiratory depression on the infant caused by opiod drugs such as meperidine- not effective against respiratory depression from other causes (like intrauterine hypoxia) | Naloxone (Narcan) |
| enhannce pain relieving action of analgestics and reduce nausea | adjuctive drugs- hydroxyzine or phenergan |
| injection of the perineal area for an episiotomy is done just before birth- when fetal head is visible, may be done after placental erxpulsion to repair laceration, allow the anesthetic to become effective before beginning the episiotomy | local infiltration |
| used for vaginal births, does not block pain of contraction given just beofre birth- delay between injection and paresthesia- injects into the nerves on each side of the mothers pelvis- needle guide (trumpet) | Pudendal block |
| adverse effect of Pudenal block | vaginal hematoma or an abscess may occur |
| small space just outside the dura (outer most membrane covering the brain and spinal cord) | epidural space |
| if the test dose of an epidural is normal | no side effects and catheter is in right place |
| numbness or loss of movement after the smallest dose in the Epidural indicates | dura matter was punctured and the drug was injected into the subarachnoid block |
| numbness around the mounth, ringing in the ears, visual disturbances or jitteriness are symptoms that suggest injection is in | the vein |
| when the dura matter is punctured it is referred to as | wet tap |
| if the dura matter is punctured spinal fluid can leak from the hole resulting in | HA |
| do not use epidural block if the woman has | abnormal bleeding infection in the area of injection or systemic infection hypovolemia |
| most common side effect of epidural block | maternal hypotension and urinary retention |
| to counter act hypotension _______ is infused rapidly before the bloack is began | LR = 500 ml, 1000 ml or more |
| this in the mother can cause compromise fetal oxygenation | maternal hypotension |
| palpate the bladder every _______ to assess for full bladder | 2 or more hours |
| this can delay and cause hemorrhage after birth | full bladder |
| postion for this block is similar to an epidural except her back is curled around her uterus in a C-shape- dura is punctured with spinal needle- a few drops of spinal fluid confirm entry | subarachnoid (spinal) block |
| not often used for vag births but for C-sections- called "one shot" block bc it does not involve placing a catheter for reijection of the drug | subarachnoid (spinal) block |
| done by the CRNA or anesthesiologist to provide relief from postspinal HA | blood patch |
| the womans blood ( ___ - ___ ) is withdrawn from her vein and is injected into epidural space in the area of the subarachnoid puncture- blood clots and forms a seal | 10- 15 ml |
| adverse effects of the mother from General Anesthsia | regurgitation with aspiration |
| Adverse effects of the neonate from General Anesthesia | respiratory depression bc drugs given to mother may cross placenta |
| nurses responsibilty in pain management begin at | admission- question the womans allergies to food, drugs (including dental anesthetics) latex, last oral intake (time and type) |
| anesthetic drugs are injected between | contractions |
| if woman is given epidural or subarachnoid block you shoudl observe the woman for | hypotension- do BP every 5 min after block begins and with each reijection until BP is stable |
| injection of warmed sterile water or LR into the uterus via intrauterine pressure catheter during labor after the membranes have ruptured | amnioinfusion |
| for Amnioinfusion the nurse should change the underpads on the bed as needed to maintain patient comfort and should document | color, amount, and any odor expelled |
| Artificial Rupture of Membranes by using a sterile sharp intrument | Amniotomy- done to stimulate contractions |
| three complications associated with amniotomy may occur if a womans membranes rupture spontaneously | #1 prolapse of umbilical cord #2 infection #3 Abruptio placentae |
| nursing care after amniotomy or spontaneous membrane rupture | promote comfort and observe for complications |
| after amniotomy fetal heart rate is recorded for | one minute |
| amniotic fluid should be | clear, possibly with vernix, and no odor (color, odor, amount, characteristics) |
| amnio fluid that is cloudy, yellow and odorous suggest | infection |
| green amnio fluid suggest | meconium |
| how often is womans temp taken after her membranes rupture | 2-4 hours maternal temp of 100.4 or higher suggest infection |
| change underpads often to reduce the moist, warm enviroment that favors growth of | microorganisms |
| intentional initiation of labor before it begins naturally | induction |
| stimulation of contractions after they have begun naturally | augmentation |
| used to access the status of the cervix in determining its response to induction- score of 6 or more indicates favorable prognosis of induction | Bishops score |
| continuous _______ activity and ______ _______ ______ monitoring during labor is essential | uterine fetal heart rate |
| labor is not induced if | placenta previa, umbilical cord prolapse, abdominal fetal presentation, high station of fetus (pre term fetus or small maternal pelvis), active herpes infection |
| labor is induced if | GH, ROM without spontaneous onset of labor, infection uterus, medical problems of mother that worsen, fetal problems, placental insufficiency or fetal death |
| induciton of labor is easier if the cervix is | soft, partially effaced and beginning to dilate |
| form of a gel or commercially prepared vaginal insert softens the cervix when applied before labor induction | prostaglandin |
| examples of pharmacologic methods to stimulate contractions | cervial ripening (prostaglandins and laminara) oxytocin |
| examples of nonpharmacologic methos to stimulate contractions | nipple stimulation walking |
| oxytocin solution is | a piggyback solution and can be stopped quickly while an open IV line is maintained |
| most placental exchange of o2, nutrients, watse products occur between | contractions |
| occurs when oxytocin inhibits the excretion of urine and promotes fluid retention | water intoxication |
| most common signs of fetal compromise | fetal heart rate is outside the normal range (110-160), late decelerations, loss of variability |
| fetal heart rate is assessed every _____ minutes during active labor and every _____ minutes during transition | 15 5 |
| mehtod of changing fetal presentation, usually from breech to cephalic | version |
| a successful version reduced the likelihood that the woman will need | cesarean |
| contraindications for version | disproportion between the mothers pelvis and fetal size, abnormal pelvis or uterin size, abnormal placental placement, previous VERTICAL cesarean, Active herpes infection, low amnio fluid, poor placental function, multifetals, malfuctioning placenta |
| in version, the main risk of the fetus is | tangled umbilical cord (more likely to occur with inadequate room to turn or presence of twins or low amniotic fluid |
| done at 37 weeks gestation- but before onset of labor- begins with NST OR BBP to determine if the fetus is in good condition | external version |
| to relax the mothers uterus during version she is given | tocolytic drug |
| emergency procedure- done during vaginal birth of twins to change fetal presentation of the second twin | internal version |
| surgical enlargement of the vagina during birth | episiotomy |
| uncontrolled tear of the tissues- jagged wound | laceration |
| involves superficial vaginal mucosa or perineal skin | first degree |
| involves vaginal mucosa, perineal skin, and deeper tissues of the perineum | second degree |
| same as the second degree plus involves the anal shpincter | thrid degree |
| extends through the anal sphincter into rectal mucosa | fourth degree |
| helps prevent constipation | high fiber and increase fluids |
| episiotomy that is easier to repair and heals neatly | median episiotomy |
| provides more room, greater scarring during healing - may cause painful sexual intercourse | mediolateral incision |
| cold packs should be applied to perineum for at least 12 hours to | reduce pain, bruising and edema |
| after 12 - 24 hours of cold applications, warmth form of heat packs or sitz bath | increase blood flow, enhance comfort and healing |
| vacuum extractor is only used with an | occiput presentation |
| women with cardiac or pulmonary disorders often have forceps or vacuum extraction births bc | prolonged pushing can worsen these symptoms |
| main risk when forceps or vacuum extraction is used | trauma to maternal tissue or to fetal tissue |
| newborn sclap edema caused by vacuum extractor | chignon |
| before forceps or vacuum are used- the mother is catheterized to | prevent trauma to her bladder and make room in her pelvis |
| nopt usually done if the fetus is dead or too premature to survive or if the mother has abnormal blood clotting | cesarean |
| the physician often perfoms ______ to help prevent the unintentional birth of preterm fetus before a planned cesarean to determine lungs | amniocentesis |
| womans abdomen may be shaved from just above her umilicus to her mons pubis and where thighs come together | vertical incision |
| upper border of the shave is about 3 inches above pubic hair line | Pfanneristiel (transverse) |
| during C-section- the womans catheter bag is placed at the head of the operating table so the anesthesiologist can monitor | output- important indicator of woman blood volume |
| two incisions for c-section birth | skin and uterine |
| allows more room if a large fetus is being delivered and is usually needed for obese women | vertical incision |
| nearly invisible when healed but cannot always be used in obese women or in women with a large fetus | transverse |
| recovery room assessment after c-section | vitals-identify hemorrhage or shock, pulse ox is used to better identify depressed respiratory function, IV site and rate of solution flow, fundus for firmness, height, and midline position, dressing for drainage, lochia for color and presence of clots |
| labor that evidences a regular progression in | cervical effacement, dilation, and descent of the fetus |
| abnormal labor- does not progress | dysfuntional labor |
| term used to discribe difficult labor | dystocia |
| abnormalities in and length of labor ________ may result in a dysfunctional labor | powers, passengers, passage or psyche |
| risk factors for dysfuctional labor | maternal age, obesity, over distention of uterus (hydraminos or multifetal preg), abnormal presentation, CPD, overstimulation of the uterus, maternal fatigue, dehydration, fear, lack of analgesic assistance |
| usually occurs during latent phase of labor (before 4 cm of dilation) and characterized by contractions that are frequent, cramplike, and poorly coordinated- painful but nonproductive | increased uterine muscle tone |
| hypertonic labor dysfunction is less common than | hypotonic dysfunction |
| woman with increased uterine muscle tone are | uncomfortable and frustrated |
| help the woman sustain the energy level needed for effective pushing | promote relaxation, reduce fatigue, change positions, increase hydration |
| a large fetus (macrosomia) is generally considered to weigh more than | 4000 g (8.8lb) at birth |
| common cause of abnormal labor is that the fetus remains in | persistant occiput posterior postion |
| most favorbale pelvis for vaginal birth | gynecoid pelvis |
| the body responds to stress with "fight or flight" reaction that impedes normal labor by | using glucose the uterus needs for energy\ diverting blood from the uterus incresing tension of the pelvic muscles, which impedes fetal descent increasing perception of pain, creating greater anxiety and stress and thus worsening the cycle |
| promoting relaxation and helping the woman conserve her resources for the work of childbrith are the | principal nursing goals |
| average rate for cervical dialtion during active phase of labor | 1.2 cm/hr for woman having first child 1.5 cm/hr for woman who has given birth before |
| descent is expected to occur at a rate of | at least 1.0 cm/hr in fist time mom 2.0 cm/hr in woman who has had child before |
| used to graph the progress of cervical dialtion and fetal descent | Friedman curve |
| prolonged labor can result in several problems | maternal and fetal infection maternal exhaustion postpartum hemorrhage greater anxiety and fear in a ensuing pregnancy |
| birth completed in less than 3 hours and there may be no health care provider present | precipitate birth |
| spontaneous rupture of membranes at term (38 weeks of gestation) more than 1 hour before labor contractions begin | premature rupture of membranes (PROM) |
| rupture of membranes before term | preterm premature rupture of membranes |
| how is it tested to see if it is amniotic fluid | diagnosis is confirmed by testing the fluid with nitrazine paper, turns blue in the presence of amniotic fluid |
| inflammation of the fetal membranes | chorioamnionitis |
| oligohydramnios is confirmed if the amniotic fluid index is less than | 5 cm |
| oligohydraminos in gestation less than 24 weeks can lead to | pulmonary and skeletal defects |
| occurs after 20 weekd and before 37 weeks gestation- main risk are the problems of the newborn | preterm labor |
| protein produced by the fetal membranes that can leak into vaginal secretions if the uterine activity, infection, or cervical effacement occurs | fibronectin |
| presence of fibronectin in vaginal secretions occur between | 22-24 week of gestation- predictative of preterm labor |
| drug of choice for initiating therapy to stop labor. continuous IV infusion is given and therapeutic levels are monitored | magnesium sulfate |
| if it looks like preterm birth is inevitable, the physician may give the woman | steroid drugs (glucocorticoids) to increase fetal lung maturity if the gestation is between 24 and 34 weeks |
| as the placenta ages, it delivers oxygen and nurtients to the fetus | less efficiently - the fetus may lose weight and the skin may begin to peel- characteristics of postmaturity |
| period of 6 weeks following childbirth | postpartum - puerperium |
| placental site is fully healed in | 6-7 weeks |
| the uterine lining (called endometrium when not pregnant and the decidua during pregnancy)is shed when | the placenta detaches |
| when should the uterus return to prepregnant size? | 5-6 weeks after delivery |
| failure of the uterus to return to prepregnant state after 6 weeks is called | subinvolution |
| refers to the changes that the reproductive organs, partiularly the uterus, undergo after birth to return them to their pregnant size and conition | involution |
| this portion of the uterus descends at a predictable rate as the muscle cells contract to control bleeding at the placental insertion site and as the size of each muscle cell decreases | uterine fundus |
| after 24 hours the fundus begins to descend about | 1 cm each day -- by 10 days it should no longer be palpable |
| when assessing the fundus:::: | control bleeding first and then keep it controlled by emptying the bladder |
| vaginal discharge after delivery composed of endometrtial tissue, blood, and lymph | lochia |
| lochia that is red bc it is composed mostly of blood, last for about 3 days after birth | lochhia rubra |
| lochia that is pinkish bc of it blood and mucous content- last from about the third through the tenth day after birth | lochia serosa |
| lochia that is mostly mucous and is clear and colorless or white- last from the tenth day through the twenty-first day after birth | lochia alba |
| when massaging the fundus be sure the keep the other hand on the lower part of the uterus to keep from | inverting it |
| constant trickle of brighter red lochia is associated with bleeding from lacerations of the | cervix or vagina |
| rugae reappear how long after postpartum | 3 weeks |
| acronym that is used to assess the perineum for normal healing and signs of complication | REEDA |
| REEDA | redness-edema-ecchymosis-discharge-approximation |
| ovulation may occur at any time after birth, with or without | menstrual bleeding and pregnancy is possible |
| % increase in blood volume during pregnancy | 50 |
| normal blood loss during | 500 ml in vaginal birth 1000 ml in cesarean birth |
| when given the rubella vaccine the woman should not get pregnant for | one month after vaccine |
| a woman who has undergone a cesarean birth has a greater risk for | thrombophlebitis |
| when the woman is confined to the bed, the woman should take deep breaths and turn from side to side ever | 2 hours |
| normal blood pressure for infants | 65-95 systolic 30-60 diastolic |
| the cord is assessed for | the number and type of vessels soon after it is cut (AVA) |
| when can you tub bathe the infant | 10-14 days after birth |
| bleeding from the cord during the first few hours usually indicates | the clamp is too loose |
| a blood glucose less than _______ in the infant indicates hypoglycemmia | 40 |
| until the infants first sponge bath and shampoo, the nurse must | wear gloves when hadling the infant |
| refers to a strong emotional tie that forms soon after birth between the parents and the newborn | bonding |
| affectionate tie that occurs over time as an infant and caregivers interact | attachment |
| certain drugs that decrease breast milk volume | levodopa, barbituates, antihistamines, pyridoxine, estrogens, androgens, bromocriptine |
| can a mother breast feed her infant if she is Hep A positive? | yes, it is not contraindicated to breast feed bc the infant can recieve immunoglobulin and Hep A vaccine therapy |
| secreted by the breast during late pregnancy and for the first few days after birth | colostrum |
| when does transitional milk emerge from breast | app 7-10 days after birth, breast gradually shift from production of colostrum to production of mature milk |
| mature milk is secreted by | 14 days after birth |
| how many calories does breast milk have | 20 kcal/ oz and all the nurtients the infant needs |
| advatages of breastfeeding | promotes mother-infant bonding maintains infant temp infant suckling stimulates oxytocin release to contract the mothers uterus and control bleeding |
| newborn should be put on the breast within the first hour of delivery when alert for suckling and bonding- breastfeeding should not be delayed beyond _______ hours | 6 |
| focus of the nurse during the early hours of breastfeeding is to | help the mother position the infant correctly and help the infant have an open, gaping mouth in preperation for suckling |
| in breastfeeding early, regular, and frequent nursing promotes | milk production and lessens engorgement |
| the nursing mother needs _________ extra calories each day plus enough fluid to relieve thirst | 500 |
| duration of nursing on the first breast should be at least ______ minutes to stimulate milk production | 10 |
| postpartum check should include | status of fundus, lochia, breast, perineum, bowel and bladder elimination, vital signs, Homans sign, pain and evidence of parent-infant attachment |
Created by:
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