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SAC Exam #1
Module 1,2, & IV
| Question | Answer |
|---|---|
| Gestational Age | Calculated from 1st day of woman's last period |
| Term Gestation | 37-40wks |
| Late preterm | 35-37wks |
| Pre-term gestation | 35wks & below |
| Post term gestation | 42wks and above |
| Gravida | # of times woman has been pregnant INCLUDING PRESENT ONE |
| Para | # of woman's pregnancies that ENDED after 20wks, dead or alive |
| Stillbirth vs Abortion | stillborn- fetus born dead after 20wks abortion- pregnancy that ends before 20wks; SAB or TAB |
| Primip vs Multip | Primip- 1st time mom Multip- mom w/ multiple children |
| which part of uterus contracts | upper 2/3's |
| Physiologic retraction ring | the division between the upper/lower segments of uterus |
| 4 components of birthing process | Powers, Passageway, Passenger, Psyche |
| What are the Powers of birthing process? | Uterine contractions and Cervical changes |
| True components of labor | Dilation (0-10cm) and Effacement (0-100%) |
| What are the different ways a fetus can lie? | Longitudinal and Transverse |
| What are the different attitudes of a fetus? | Flexion and Extension |
| Fetal presentation? Different types? | Part of fetus that enters the pelvis first; Cephalic (vertex), Breech, Transverse |
| Fetal Postition | Relationship of reference point of fetal presenting part to one of the 4 quadrants of mom's pelvis: L/R & anterior/posterior |
| Fetal station | relationship of presenting part of fetus to imaginary line drawn between ischial spines of maternal pelvis |
| Types of Cephalic presentation | Vertex presentation (complete flexion), Military presentation (moderate flexion), Brow presentation (poor flexion [extension]), Face presentation (full extension) |
| Describe anterior & posterior fontanels | Anterior in front and diamond shaped; posterior above occipital bone and triangular |
| Types of breech presentations | Frank, Full, Footling |
| What is Lightening? | Descent of fetus into pelvis |
| Conditions of fetal compromise | FHR outside norm, little/no variability, persistent bradycardia, mec in amniotic fluid, foul odor to amniotic fluid, contractions >90sec, contractions <60sec apart, maternal HYPO/HYPERtension, maternal fever |
| 4 stages of labor? | !st- Dilating phase; 2nd- C/C to delivery of fetus; 3rd- delivery of fetus to delivery of placenta; 4th- 1-4hrs post-delivery of placenta |
| 3 phases of 1st stage of labor? | Latent- 0-3cm; Active- 4-7cm; Transition- 8-10cm |
| EBL (estimated blood loss) of delivery | Vag del= 300-500mL; C/S= 700-1000mL |
| What does Supine Hypotension lead to in fetus? | Late decelerations |
| What do Late Decelerations indicate in the mother? | Utero-placental insufficiency |
| What happens to mom's H&H post-delivery? | H&H decreases (norm: Hgb 12-16, Hct 36-46) |
| When do you suggest mom no longer sleeps on back? Why | After 20wks, because of Supine Hypotension; need to promote circulation |
| Uteroplacental insufficiency | Not enough O2 getting to uterus, through placenta, to oxygenate baby well |
| What s/s could indicate hemorrhaging mom? | Not wanting to hold baby, nausea, vomiting, drop in BP, rise in HR --> STAT emergency hysterectomy |
| Should obese patients have vag del or c/s? Why? | Vag del because more likely to bleed out w/ c/s |
| What is GBS and what meds for GBS(+)? | Group beta streptococcus; ampicillin (2g 1st dose & 1g q4hrs after; 3 doses to consider treated); or clindamycin if allergic to amp |
| IV fluid should run at what rate? | 125mL/hr |
| Why monitor I&O? | Bladder distention |
| Different pain relief measures? | IV, Regional anesthesia, non-pharm |
| What is best way to measure strength of Uterine Contractions? | Internal fetal monitor |
| Tool to break bag of water? | Amniohook |
| When is foley d/c'd in vag del? In c/s? | vag del- at 2nd stage; c/s- 1 day after delivery |
| Why is pitocin given after delivery? at what rate? how long after? | to control postpartum bleeding; wide-open, 999mL/hr; 2-8hrs for vagdel, 24hrs for c/s |
| Why does bladder become distended throughout labor process? | because of increased amount of IV fluid infused |
| What are you noting about fundus post delivery? | Location and tone |
| What med is given to control bleeding post delivery? | Methergine (0.2mg IM if BP <130/90) and/or Hemadate OR Cytotek |
| How often do you monitor resp effort post delivery? what else do you monitor? | q 15min for 1hr; longer for c/s; v/s, fundus, lochia, LOC |
| What is Duramorph? | morphine-like med in epidural; leads to complete loss of sensory/motor function; generally used for c/s |
| What can be used for swelling of perineum? | Ice packs, 24hrs post delivery; heat/sitz bath after 24hrs |
| How often can mom breastfeed? | Start at 10min, then 15 min on each breast |
| Taking "in" phase vs Taking "hold" phase | Taking in= mom taking care of self, no newborn teaching yet; Taking hold= mom can hold/process info to take care of baby (4-6wks) |
| Where does pain from cervical dilation enter spinal cord? Pain from vag/perineal distention? | Cervix= T10-T12, L1; Vag/perineum= S2-S4 |
| Pudendal block? Why given? | Local anesthetic that goes into pudendal nerve, done by midwives; simplest/safest method of perineal anesthesia, doesn't alter mom's oxygenation, circulation, and GI, doesn't affect UCs, doesn't suppress newborn |
| Where is epidural placed? | Between 2nd, 3rd, or 4th lumbar vertebra |
| When is Duramorph usually given? | during active phase (4-7cm) of 1st stage |
| What is a major effect of Duramorph? | Decrease in BP r/t vasodilation from local anesthetic agents; monitor resp function |
| What happens if maternal hypotension not corrected? | Bradycardia |
| Examples of opiods? | Duramorph, Fentanyl, Sufentanil |
| What is used to ease post-op pain for 1st 24hrs? | Duramorph |
| What do narcotics cause in newborn? | Resp depression |
| Examples of narcotics | Nubain, Stadol, Demerol |
| Nubain | Nubain (nalbuphine HCL) 10mg IM, SQ, or IV; onset 2-3min, peak 15-20min, duration 3-6hrs. |
| Stadol | Stadol (butorphanol tartrate)1-2mg IV or IM; rapid onset, peak 30-60min, duration 3-4hrs; |
| Demerol | Demerol 50-100mg IV/IM; immeidiate onset, peak 5-7min, duration 2-4hrs |
| If a Postpartum mom delivers 1-4hrs prior to you receiving report, what is the first thing you assess? | Bladder, fundus, lochia, vital signs |
| Postpartum c/s mom in recovery room. First action? | Attach O2sat and BP cuff (because she just came from major abd surgery) |
| Local complications of IV therapy? | Hematoma, infiltration, phlebitis, thrombophlebitis, extravasation |
| Systemic complications of IV therapy? | Septicemia, fluid overload, air embolism, speed shock, catheter embolism, erratic flow rate |
| Nursing action for Extravasation? | Stop infusion, call MD, take picture |
| What does narcotic do to fetal heart rate tracing? | Flattens out, less variability |
| What to expect after epidural? | drop in mom's BP (freq asses for 1st 20min) distended bladder (assess q 2hrs) |
| What med do you give if mom's BP drops? | ephedrine IVP (by anesthesia) |
| Meds to prevent hemorrhage in postpartum mom? | Pitocin, Methergine (not w/ high BP) |
| Advantage of Pudendal block? | Up to void ad lib |
| what do you do for late decelerations? | Inc. O2 by mask, reposition, inc. IV rate |
| early decels,late decels, and variable decels indicate what? | Baby's head being compressed while entering birth canal, uteroplacental insufficiency, and cord compression |
| when do you get info from patient? | between contractions |
| why do we try to discourage IV narcotics, especially in transition phase? | baby might have resp depression |
| why do we encourage skin-to-skin and breastfeeding immediately after birth? | promotes attachment and breastfeeding stimulates oxytocin release, contracting fundus, reducing postpartum hemorrhage |
| What to teach if mom does NOT want to breastfeed (Lactation Supression)? | don't breastfeed/pump at all (stimulates production), tight bra/clothes |
| 2 hormones from pituitary r/t breastfeeding? | Prolactin (milk production) and Oxytocin (let down reflex) |
| how often should she be breastfeeding? | 1 1/2 to 3hrs |
| How does she keep engorgement under control? | Must empty each breast w/ each feeding |
| What do you suggest for c/s postpartum mom on bedrest? | leg exercises and SEQs |
| How often do we do fundal assessments in the 4th stage of labor? | Every 15min for 1st hr, then q 30min |
| Indications for C/S | Previous c/s, failure to progress, cephalopelvic/disproportion, abnormal presentation, multiple gestation, fetal intolerance to labor (FITL), placenta previa/abruption, prolapsed cord |
| Primary focus of c/s procedure? Types? | Uterine incision; Vertical or Pfannenstiel |
| Lower uterine segment vertical incision is preferable for what? | multiple gestation, abnormal presentation, placenta previa, fetal distress, pre-term or macrosomic newborns, |
| Risks w/ lower uterine segment vertical incision? | Risk of bladder trauma and uterine rupture w/ next pregnancy |
| Describe classical incision c/s? | Upper segment of uterus is vertically cut for quick delivery of preterm baby or one w/ fetal distress. Risk for inc. blood loss and uterine rupture on repeat c/s |
| Pre-op actions for c/s? | Informed signed consent, choice of anesthesia, hang LR, place foley, skin prep, antacids 30min prior, collect CBCs and have 2 units of blood on hold, teach postop expectations, support |
| Nursing actions after c/s? | Prompt pt to turn, cough & deep breathe, prompt incentive spirometer use, encourage early ambulation, H&H labs, monitor I&O, monitor temp, advance diet as tolerated, active/passive ROM, fundal/lochia assessment, pericare |
| When are staples removed? | 3rd post op day |
Created by:
cobedad
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