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OB exam 2 notecards
exam 2 notecards
| Question | Answer |
|---|---|
| What is the purpose of antepartal testing? | to detect for congenital anomalies and to evaluate the condition of the fetus |
| What are some maternal medical conditions that are risk factors associated with antepartal testing? | diabetes and hypertension |
| What are the demographic factors associated with being risk ractors for antepartal testing? | age, poverty and OB history |
| True or false: ultrasounds capture low-frequency sound. | false. (explanation: ultrasounds are high-frequency sound waves that are beamed onto the abdomen) |
| What are ultrasounds? | high-frequency sound waves are beamed onto the abdomen |
| What do the echoes in an ultrasound record? | the fetus's location and size |
| What is the most common time to perform an ultrasound? | Can be performed in any trimester, most common at 20 weeks (2nd trimester) because structures visibly seen |
| What are some reasons to do a first trimester ultrasound? | to detect the baby's gestational age (typical with in an unplanned pregnancy) and if mom is going for further genetic testing |
| What can an ultrasound tell you? | - Positive sign of pregnancy - gestational age - IUGR - BPP |
| What variables does the biophysical profile (BPP) measure? | - fetal breathing movements - gross fetal body movements - fetal tone - amniotic fluid volume - reactive fetal heart rate tracing (non-stress test) |
| The results of a BPP test indicate a total score of 8-10. What does this mean? | Very good! Baby received max points indicating fetal well being. |
| The results of a BPP test indicate a total score of less than four. What does this mean? | May consider delivery at this time, poor result, indicating fetal ill-health. |
| The results of a BPP test indicate a total score of six. What does this mean? | equivocal; may need to do another test because this baby may be in trouble (hypoxic) |
| True or false: Biophysical profile's are typically done by the RN. | false (explanation: BPP typically done by the doctor/NP) |
| Each variable on the BPP receives what score for a normal response? | 2 |
| Each variable on the BPP receives what score for an abnromal or abspent response? | 0 |
| The Alpha-Fetoprotein test is done when? | offered at 16-18 weeks |
| If there are elevated levels of alpha-fetaprotein in mom's blood, what does that mean? | It can mean that the baby has neural tube defects |
| If there are decreased levels of alpha-fetaprotein in mom's blood, what does that mean? | It can mean that the baby has down syndrome. |
| True or false: the alpha-fetoprotein test is diagnostic. | false. explanation: the alpha-fetaprotein test is a SCREENING blood test. |
| The alpha-fetaprotein levels in a mom are found to be decreased. What does this mean, and what would you expect to do next? | decreased levels of alpha-fetaprotein are associated with downs syndrome. I would expect to do an ultrasound next because an alpha-fetaprotein DOES NOT DIAGNOSE!!. |
| What factors may affect an alpha-fetoprotein screening? | gestational age, maternal weight, twinse, race, diabetes. |
| True or false: there is a high rate of false positives associated with alpha-fetoprotein. | true |
| How do twins affect an alpha-fetoprotein screening? | more babies = more alpha-fetoprotein |
| True or false: the alpha-fetoprotein screening is a skin test done on mom. | false. explanation: the alpha-fetoprotein screening is a BLOOD test done on mom. |
| villi is a part of the ____________. | placenta |
| Describe chorionic villus sampling | It is a removal of a small piece of villi (placenta) under ultrasound guidance |
| When is chorionic villus sampling typically done? | between 10-12 weeks gestation |
| What is the purpose of chorionic villus sampling? | It is a test that determines genetic diagnosis early in the first trimester |
| How long does it take to obtain the results of hte chorionic viollus sampling? | one week |
| True or false: an ultrasound is a risky procedure. | false |
| True or false: a CVS is a risky procedure | true |
| Who would want to get a CVS? | someone who has a history of a fetus with a congenital abnormality |
| What complications can arise with a CVS? | spontaneous abortions (5%) |
| If mom is Rh negative and gets a CVS done, what is the nurse's responsibility at this point? | to administer rhogam |
| True or false: A mother who is GBS positive should not get the CVS. | True |
| True or false: A mom comes to you and wants the CVS. What do you need to test for? | You need to test for the GBS. If mom is GBS +, it is contraindicated to perform the CVS. |
| What is an amniocentesis? | Removal of the amniotic sample from the uterus. |
| The amniocentesis can be done when? | as early as 15-20 weeks |
| Fluid removed from an amniocentesis is used to do what? | to test for genetic abnormalities of the fetus |
| If a mom is GBS positive and wants to know about the genetic makeup of her baby, what would you reccomend? | That she wait for the 15 week mark and get an amniocentesis instead of a CVS. |
| Between 15-20 weeks is called ___ trimester. | mid |
| If an amniocentesis is done mid trimester, that is typically for what purpose? | karyotype - to determine trisomies and sex-linked disorders |
| What does the term karyotype mean? | determines down syndrome, other trisomes and sex linked disorders |
| If an amniocentesis is done in the third trimester, what is typically the purpose? | to rule out infection and to look at fetal lung maturity |
| If a mom is in the third trimester and contractions won't stop, what is your body trying to do and why? | There may be an infection so the body wants to get out the fetus to be safe. Mom will be asymptomatic but after an amniocentesis and lab testing it will show that the environment for the fetus is infected (or not) and decisions will be made from there. |
| During a mid-trimester amniocentesis, we want the bladder to be ________. | full |
| Why do we want the bladder to be full during a mid-trimester amniocentesis? | to help support the uterus (push the uterus up into the abdomen) |
| During a third trimester amniocentesis, we want the bladder to be _______. | empty |
| Why do we want the bladder to be empty during a third trimester amniocentesis? | so it will not be punctured |
| What is the L/S ratio? | lecithin/sphingomyelin ratio |
| What does the L/S ratio test for? | fetal lung maturity |
| How do we test for fetal lung maturity? | we use the L/S ratio |
| An L/S ratio of 2:1 indicates what? | adequate surfactant and mature fetal lungs |
| An L/S ratio of 1:2 indicates what? | poor surfactant and immature fetal lungs |
| What are the risks associated with an amniocentesis? | spontaneous abortion (1%), fetal injury and infection |
| True or false: There is a higher risk of spontaneous abortion with a CVS in comparison with an amniocentesis. | True |
| What is a Non-Stress Test used for? | used to determine fetal well-being in high risk pregnancy and especially useful in post-maturity |
| What does a non-stress test note? | the fetus response to its own movements |
| True or false: a non-stress test is invasive. | false. with a non stress test an external monitor is placed on mom |
| Describe what you want the fetus's heart rate to do in response to it's own movement for a non-stress test. | acceleration : 15 beats above it's baseline lasting 15 seconds at least twice in a 20 minute period |
| What is the normal heart rate range for a full term fetus? | 110-160 |
| The fetus that responds to its own movement by a fetal heart rate acceleration of 15 beats lasting for at least 15 seconds after the movment twice in a 20 minute period is classified as what? | "reactive" and healthy. |
| True or false: a "reactive" fetus may take up to 40 minutes to have two FHR accelerations at least 15 beats per minute above the baseline and last at least 15 seconds. | true |
| Why can we extend the time from 20 minutes to 40 minutes while classifying a reactive fetus after a non-stress test? | to allow for common fetal sleep-wake cycles |
| We ask pregnant mom's to lay on their side for an hour and to count what? | fetal kicks |
| Approximately how many fetal kicks are considered "normal" within the hour? | 10 or more |
| If a mother reports that her baby has decreased number of kicks what is the next step? | further evaluation is needed |
| What does electronic fetal monitoring measure? | contractions and the baseline fetal heart rate |
| The ultrasound transducer measures what? | the fetal heart rate |
| The tocotransducer measures what? | the frequency and duration of a contraction |
| True or false: the tocotransducer measures the intensity of contractions | false. explanation: the tocotransducer measures the frequency and duration of a contraction |
| How can the intensity of a contraction be measured? | via palpation |
| What is the FSE? | internal fetal scalp electrode |
| What is ISL? | Internal fetal scalp electrode |
| What does the internal fetal scalp electrode measure? | the fetal heart rate |
| What is the IUPC? | Intrauterine Pressure Cathether |
| What does the IUPC measure? | Contraction intensity in mm Hg |
| True or false: you can tell the intensity of a contraction using an internal fetal monitor. | true |
| When auscultating the fetal heart rate, where is it best heard? | over the fetal back |
| Define the baseline fetal heart rate | The range of the FHR between contractions monitored over a ten minute period |
| The FHR results from the balance between what two things? | the parasympathethic and sympathethic branches of the autonomic nervous system |
| What is variability? | characteristic of the baseline FHR and described as normal irregularity of the cardiac rhythm |
| True or false: variability is concerning | False (explanation: variability is charactertistic of the baseline FHR and is described as normal irregularity of the cardiac rhythm |
| What is one of the most reliable indicators of fetal well being? | variability |
| What are the different categories of variability? | absent, minimal, moderate and marked |
| What category of variability is best described: "Amplitude range is undetectable"? | absent |
| What category of variability is best described: "Amplitude range detectable up to and including 5 beats/minute"? | minimal variability |
| What category of variability is best described: " Amplitude rage 6-25 bpm"? | moderate |
| What type of variability is considered normal? | moderate variability |
| What category of variability is best described: "Amplitude range >25 bpm"? | marked variability |
| With a fetal heart monitor, what are nursing actions based on? | assessment of contractions and the assessment of fetal heart rate |
| What type of changes are best described: "FHR changes in relation to Uterine Contractions?" | Periodic |
| Accelerations and early Decelerations are classified as what type of changes? | Periodic |
| Accelerations of the fetal heart rate indicate what? | fetal well-being |
| True or false: accelerations of the fetal heart rate are concerning. | False. explanation: fetal heart rate accelerations occour NORMALLY in response to fetal movement and are a REASURRING sign. |
| To be classified as an acceleration, what has to happen to the heart rate? | increase of 15 beats for 15 seconds |
| An acceleration is a ________ fetal response. | sympathethic |
| What is best described? "heart rate slowly and smoothly deceleartes at the beginning of a contraction and returns to the baseline at the end of contraction" | early deceleration |
| True or false: early decelerations are concerning. | false. explanation: early decelerations are benign patterns caused by parasympathethic response |
| early decelerations are associated with what changes to the fetus? | head compression: briefly increases the intracranial pressure, causing the vagus nerve to slow the heart rate |
| What nursing actions are required with early decelerations? | none; just monitor the progress of labor and document the progress |
| True or false: variability changes are concerning. | true (explanation: absent, minimal or marked are concerning) |
| True or false: bradycardia is concerning. | true |
| True or false: accelerations are concerning | false |
| True or false: tachycardia is concerning. | true |
| True or false: variable decelerations are concerning | true |
| True or false: late decelerations are concerning | true |
| What FHR pattern is best described: "The FHR is absent or has minimal variability?" | variability changes |
| What are the causes of minimal variability? | hypoxia, acidosis, maternal drug ingestion (narcotics, CNS depressants like magnesium sulfate) and fetal sleep (usually 40 minutes or less with term fetus) |
| Nursing actions are based on what when FHR is absent? | based on the cause (hypoxia, acidosis, maternal drug ingestion or fetal sleep) |
| What FHR pattern is best described?: "FHR is below 110 bpm (assessed between contractions) for 10 minutes) | bradycardia |
| Late manifestation of fetal hypoxia is a cause of ___________ | bradycardia |
| What are the causes of bradycardia? | late manifestation of fetal hypoxia medication-induced (narcotics, magnesium sulfate) maternal hypotension prolonged umbilical cord compression |
| What FHR pattern is best described?: "Baseline FHR is above 160 bpm (assessed between contractions) for 10 minutes | tachycardia |
| Narcotics can cause what FHR situation? (hint: bradycardia or tachycardia?) | bradycardia |
| Magnesium sulfate can cause what FHR situation? (hint: bradycardia or tachycardia?) | bradycardia |
| Maternal hypotension can cause what FHR situation? (hint: bradycardia or tachycardia?) | bradycardia |
| Fetal heart block can cause what FHR situation? (hint: bradycardia or tachycardia?) | bradycardia |
| prolonged umbilical cord compression can cause what FHR situation? (hint: bradycardia or tachycardia?) | bradycardia |
| early signs of fetal hypoxia is a cause of what FHR situation? | tachycardia |
| late manifestations of fetal hypoxia is a cause of what FHR situation? (hint: bradycardia or tachycardia?) | bradycardia |
| Fetal Anemia is a cause of what FHR situation? (hint: bradycardia or tachycardia?) | tachycardia |
| Dehydration is a cause of what FHR situation? (hint: bradycardia or tachycardia?) | tachycardia |
| Maternal infection is a cause of what FHR situation? (hint: bradycardia or tachycardia?) | tachycardia |
| Maternal fever is a cause of what FHR situation? (hint: bradycardia or tachycardia?) | tachycardia |
| Terbutaline is a medication that can cause what FHR situation (hint: bradycardia or tachycardia?) | tachycardia |
| Atropine is a medication that can cause what FHR situation (hint: bradycardia or tachycardia)? | tachycardia |
| What FHR situation is best described: "characterized by an abrupt transitory decrease in the FHR that is variable in duration, depth of fall & timing relative to the contraction cycle. | variable deceleration |
| What is the cause of variable deceleration? | cord compression, but can also indicate rapid fetal descent |
| What does the "V" in the acronym "VEAL" stand for? | Variable Deceleration Pattern |
| What FHR situation is associated with cord compression? | Variable Deceleration Pattern |
| What FHR situation is classified as being the most common periodic pattern? | variable deceleration pattern |
| True or false: an occasional variable deceleration is typically benign. | true |
| What does the "E" in the acronym "VEAL" stand for? | Early decelerations |
| What FHR situation is associated with head compression | Early decelerations |
| What situation is best described: The FHR is a mirror image of the contractions. | early decelerations |
| True or false: variability changes can be caused by alkalosis. | false (explanation: variability changes can be caused by acidosis) |
| True or false: variability changes can be caused by acidosis | true |
| True or false: variabilty changes can be caused by narcotics | true |
| True or false: variability changes can be caused by atropine | false (explanation: variability changes can be caused by maternal drug ingestion of narcotics or cns depressants like mag sulfate) |
| True or false: variability changes can be caused by fetal sleep. | true |
| Describe the fetal sleep that can cause variability changes. | usually 40 minutes or less with term fetus |
| True or false: Variable Deceleration Pattern can be caused by rapid fetal descent. | true |
| True or false: Early Deceleration pattern can be caused by rapid fetal descent. | false (explanation: VARIABLE deceleration pattern can be caused by rapid fetal descent) |
| What nursing actions are associated with a variable deceleration pattern? | CHANGE MATERNAL POSITION discontinue pitocin if infusing Administer oxygen Perform vaginal exam Report findings to MD/CNM and document |
| True or false: with a variable deceleration pattern, you would perform a vaginal exam | true |
| Why would you perform a vaginal exam with a variable deceleration pattern? | to check for a prolapsed cord |
| If cord prolapse is detected with a vaginal exam, what is your next step? | to position the mother to relieve pressure on the cord with a Knee-chest position or to push the presenting part off the cord until immediate c-section delivery can be accomplished |
| VEAL CHOP. What is the V and C for? | Variable Decelerations: Cord compression |
| What is the purpose of positioning the mother in a Knee-Chest position with variable decelerations? | to relieve pressure on the cord |
| If variable deceleration pattern has been established and it is difficult to push the presenting part off the cord, what is your next course of action? | prep for c-section |
| What FHR situation is best described: "FHR below 70 bpm lasting longer than 30-60 seconds." | severe variable decelerations |
| Define severe variable decelerations | FHR below 70 bpm lasting longer than 30 to 60 seconds |
| True or false: severe variable decelerations have a slow return to baseline. | true |
| True or false: severe variable decelerations are typically associated with decreasing or absent variability | true |
| VEAL CHOP . What does E and H stand for? | Early decelerations: head compression |
| Late decelerations are indicative of what? | uteroplacental insufficiency |
| True or false: the depth of deceleration indicates the severity. | FALSE. |
| True or false: the depth of deceleration does not indicate the severity. | true |
| When does the FHR return to baseline with a late deceleration? | AFTER the contraction is over |
| True or false: late decelerations are okay. | FALSE. (explanation: late decelerations are very scary, an ominous sign!) |
| Variable decelerations have been established. In this situation, true or false: you should discontinue pitocin | true |
| Late decelerations have been established. In this situaiton, true or false: you should start pitocin | FALSE (explanation: you want to stop pitocin if infusing) |
| What does the acronym 'POISON' help you remember? | the nursing actions necessary for late decelerations |
| Late decelerations are occuring. What is associated with the "P" from the "POISON" acronym? | Prepare for delivery and position patient onto left side immediately |
| Late decelerations are occuring. How should you administer oxygen? | 10 L by tight face mask |
| Variable decelerations are occuring. How should you administer oxygen? | 10 L by tight face mask |
| True or false. You would expect to administer IV fluids with variable decelerations. | false (explanation: you would expect to administer IV fluids with late decelerations) |
| True or false: You would expect to administer IV fluids with late decelerations. | true (explanation: to correct hypotension) |
| True or false: Knee chest position is associated with late decelerations. | false (explanation: with variable decelerations you would want to position your patient in knee-chest to relieve pressure from the cord) |
| True or false: you should notify the MD of accelerations. | false (explanation: you want to notify the MD of ominous patterns such as variability changes or decelerations) |
| True or false: you should notify the MD of variability changes. | true |
| True or false: you should notify the MD of late decelerations. | true |
| True or false: you should notify the MD of variable decelerations. | true |
| True or false: you should notify the MD of early decelerations. | false (explanation: no nursing interventions are required with early decelerations other than to monitor and document the progress of labor) |
| Why does FHR decrease with early decelerations? | because the head compression causes a brief increase in intracranial pressure which causes the vagus nerve to slow the heart rate. |
| What is the definition of prodromal labor signs? | prodromal labor signs are early symptoms that mean that labor is coming |
| What are the prodromal labor signs? | lightining, braxton hicks contractions, cervical softening and slight effacement, bloody show and burst of energy |
| Describe the "lighting" Prodromal labor signs | The fetus drops into the true pelvis (inlet) |
| Describe braxton hicks contractions | they can be uncomfortable. some women don't feel them (don't say this to a woman who does!) |
| Describe what the "bloody show" is (hint: prodromal labor sign) | expulsion of the mucous plug |
| Describe the mucous plug | bloody show from the softening of the cervix, mucous and WBC |
| Describe the "burst of energy" (hint: prodromal labor sign) | "nesting instict) |
| pain in the lower back that radiates to the abdomen is indicative of true or false labor? | true |
| pain accompanied by regular rhythmic contractions is indicative of true or false labor? | true |
| contractions that intensify with ambulation is indicative of true or false labor? | true |
| discomfort localized in the abdomen is indicative of true or false labor? | false |
| no lower back pain is indicative of true or false labor? | false |
| contractions that decrease in intensity with ambulation is indicative of true or false labor? | false |
| contractions that decrease in frequency with ambulation is indicative of true or false labor? | true |
| Progressive cervical dilation is indicative of true or false labor? | true |
| effacement is indicative of true or false labor? | true |
| A mom is 2 cm dilated. What does this mean? | Her cervix is opened by 2 cm |
| What is nitrazine paper used for? | to see if "leakage" from the mom is urine or if her water actually broke |
| Black on the nitrazine paper indicates what? | rupture of membranes |
| Dark blue on the nitrazine paper indicates what? | rupture of membranes |
| What color(s) indicate rupture of membranes with nitrazine paper? | rupture of membranes |
| When a woman's water breaks in front of you, what should you be assessing and documenting? | the color, odor, amount and time color = clear or meconium-stained |
| What happens to vaginal fluid under a microscope? | it "ferns." |
| What is the priority assesment with rupture of membranes | fetal heart rate (explanation: must be monitored for distress) |
| Describe the first stage of labor. | The beginning of regular contractions or rupture of membranes to 10 cm of dilation and 100% effacement. |
| Describe the second stage of labor. | 10 cm to delivery of the fetus. |
| Describe the third stage of labor. | delivery of fetus to delivery of the placenta |
| Describe the fourth stage of labor | physical recovery (1-4 hours) |
| What stage of labor is best described: "the woman is at 8 cm dilated and 80% effacement." | first stage of labor (explanation: first stage of labor is from the beginning of regular contractions or the rupture of membranes to 10 cm of dilation and 100% effacement) |
| What event(s) start the first stage of labor? | beginning of regular contractions OR the rupture of membranes. |
| What event(s) start hte second stage of labor? | the woman being dilated to 10 cm |
| What event(s) end the second stage of labor? | delivery of the fetus |
| What event(s) end the third stage of labor? | delivery of the placenta |
| What event(s) start the third stage of labor? | delivery of the fetus |
| True or false: effacement is measured in terms of percentage | true |
| True or false: dilation is measured in terms of cm. | true |
| True or false: effacement is measured in terms of cm. | false (explanation: effacement is measured in terms of percentage) |
| What is dilation? | The cervix pulls upward and the fetus pushes downward |
| What happens to the cervix in dilation? | it pulls upward |
| What happens to the fetus in dilation? | pushes downward |
| What happens to the cervix during effacement? | thins and/or shortens |
| What is effacement? | the thinning and/or shortening of the cervical length. |
| What are the three phases of the first stage of labor? | latent (early), active and transition |
| What phase is best described: "0-3 cm dilation" | latent phase (of 1st stage of labor) |
| What phase is best described: "8-10 cm dilation" | transition phase (of 1st stage of labor) |
| What phase is best described: "4-7 cm dilation" | active phase |
| What routine tests would you expect to see ordered for every pregnant patient? | CBC, platelets and T&S |
| Why is a CBC ordered for every pregnant patient (meaning, what does it tell us)? | patient's hydration if acute infection |
| Why are platelets ordered on every pregnant patient? | in case they need emergency surgery or a regional anesthethic (will cause them to bleed out) |
| Why is a T&S ordered on every pregnant patient? | Type and screen - for the RH factor |
| What is a priority lab upon rupture of membranes? | GBS |
| Why is GBS a priority lab upon rupture of membranes? | mom may have the bacteria in peri-area, do not want baby to pick up during vaginal delivery for fear of GBS pneumonia |
| How long does latent phase typically last? | hours to days |
| How long does active phase typically last? | 3-5 hours |
| How long does transition phase typically last? | 1/2 - 2 hours |
| What stage of labor is known as the "pushing" stage? | 2nd stage of labor |
| What happens to blood volume during contractions? | increases |
| When should you take a laboring patient's blood pressure? | between contractions for an accurate reading |
| You are in clinical. What diastolic blood pressure indicates that you need to go tell our clinical instructor immediately? | any diastolic blood pressure > 85. |
| When does supine hypotension occur? | when the vena cava is compressed |
| Your laboring mother has supine hypotension. What do you do? | Position the laboring woman off her back. |
| True or false: there is increased oxygen consumption for the laboring woman. | true |
| True or false: pain/anxiety causes a decrease in the rate of respirations. | false (explanation: pain/anxiety causes an INCREASE in the rate of respirations) |
| True or false: pain/anxiety causes an increase in the depth of respirations. | true |
| True or false: pain/anxiety cuases a decrease in the depth of respirations | false (explanation: pain/anxiety causes an INCREASE in the rate and depth of respirations) |
| True or false: respiratory alkalosis is associated with hyperventilation | true |
| True or false: respiratory acidosis is associated with hyperventilation | False (explanation: respiratory ALKALOSIS is associated with hyperventilation) |
| Hyperventilation is associated with _______ alkalosis. | respiratory |
| Hyperventilation is associated with respiratory ________. | alkalosis |
| Your laboring patient is experiencing tingling of her fingers. What do you do? | tell her to cup her hands over her mouth and re-breathe her CO2 because she is hyperventilating. |
| What are the symptoms of hyperventilation? | tingling of fingers, dizziness, numbness |
| True or false: increased sensation is associated with hyperventilation. | false (explanation: numbness is associated with hyperventilation) |
| Describe the connection between hyperventilating and co2. | Hyperventilation = respiratory alkalosis. The patient who is hyperventilating is blowing off too much CO2. |
| Diarrhea in the laboring patient most typically occurs when? | in the latent/early phase |
| Describe motility with the laboring patient. | decreased motility (nausea, vomiting, belching) |
| True or false: the laboring patient will typically belch more. | true |
| True or false: the laboring patient has a faster absorption of solid foods. | false (explanation: absorption and digestion of solid foods slows) |
| True or false: dehydration is common in the laboring patient. | true |
| True or false: the laboring patient will often over-salivate. | false (explanation: dehydration common, dehydration = dry mouth) |
| True or false: in stage II labor, the patient may have an involuntary bowel movement | true |
| What nursing interventions are associated with the GI system changes of the laboring patient? | emesis basin, ice chips and peri-care |
| Why do you need to offer the bedpan or bathroom atleast q2 hours to the laboring patient? | a full bladder can lead to a longer labor, more discomfort and inhibits fetal descent |
| Describe the connection between contractions and the maternal urinary system. | cause decreased bladder sensation of bladder filling |
| true or false: a full bladder helps fetal descent. | FALSE (explanation: a full bladder INHIBITS fetal descent) |
| what do you expect the laboring patient's urine to look like? | a bloody show |
| True or false: a small amount of protein in the urine is okay for the laboring patient. | false. (explanation: any amount of protein in the urine is abnormal) |
| You find protein in the urine of your laboring patient. What do you suspect? | possibly gestational diabetes or bladder infection or kidney stones |
| How much blood volume is typically "gained" during pregnancy? | 1-2 liters (30-50%) |
| How much blood loss is expected with a vaginal birth? | up to 500 cc |
| How much blood loss is expected with a casarean birth? | up to 1000 cc |
| What stage of labor is associated with increased fibrinogen? | stage 3 (delivery of the placenta. descent of the placenta is associated with increased clotting factors) |
| what is fibrinogen? | cloting factor |
| What is the expected decrease of WBC during pregnancy? | trick question: NONE! (explanation: increase of WBC expected) |
| What is the expected increase of WBC during pregnancy? | 14,00-16,00 (for a total of approximately 24,00 since normally people have 5-10,00) |
| What nursing interventions are associated with changes to the pregnant and laboring patient regarding the hematopoietic system? | increase fluids check labs before and after birth |
| What is the expected hemoglobin range during pregnancy and labor? | 10-12 g/dl |
| What is the expected hematocrit during pregnancy and labor? | 32-40 percent |
| What is the expected platelet count during pregnancy and labor? | 150,000-400,000 |
| When would you expect a laboring patient to get a CBC? | On admission |
| When would you expect a laboring patient to get a platelet count? | on admission |
| When would you expect a laboring patient to get a type/screen? | on admission |
| What would you expect to draw on a laboring patient upon admission? | CBC, platelet count and type/screen |
| A successful labor depends on four integrated concepts which are what? | 4 P's: Powers Passage Passenger Psyche |
| Describe the components of the "powers" factor | uterine contractions + maternal pushing = forces to move the fetus |
| What are forces that move the fetus? | uterine contractions and maternal pushing |
| What provides the strength to move the fetus? | uterine contractions and maternal pushing |
| Uterine contractions and maternal pushing have what in common? | both are forces that help move the fetus and are part of the "powers" factor of birth assessment |
| What happens to blood flow to the placenta with each contraction? | During each contraction blood flow to the placenta is gradually decreasing |
| True or false: the primary power that drives the fetus to move during labor are the efforts of mom to push | false (explanation: the primary power are the uterine contractions) |
| True or false: the primary power that drives the fetus to move during labor are the uterine contractions | true |
| True or false: maternal pushing is a secondary power to move the fetus during labor | true |
| True or false: the lower segment of uterus can be characterized as being more active than the upper segment | false (explanation: the upper 2/3rds of the uterus actively push the fetus down while the lower 1/3rd segment is passively pulled) |
| Describe the job of the upper 2/3rds of the uterus during a contraction. | Contraction begins here and works to actively push the fetus down against the cervix. |
| Describe the job of the lower 1/3rd of the uterus during a contraction | To be passively pulled upward over the fetal presenting part in order to help thin the cervix (dilate) and efface (open the cervix) |
| What components are associated with the passage? | passage - bony pelvis and fetal station |
| True or false: a woman's pelvis is of adequate size | true |
| What is the most common pelvic shape? | gynecoid |
| Describe the location of a fetus at "station 0." | engaged at the ischial spine |
| True or false: -3 station means that the fetus is located inferior to the ischial spine. | false (explanation: -3 indicates that the fetus is 3 cm above station 0 which is at the ischial spines) |
| True or false: -3 means that the fetus is located superior to the ischial spine. | true |
| A fetus is at +1 station. Explain what this means. | This means that the fetus is located 1 cm below the ischial spine. |
| What are the components of the passenger factor? | fetal lie, fetal attitude, fetal presentation and fetal position |
| What is fetal lie? | the relationship of the spine of the fetus to the spine of the mother |
| What are the different ways fetal lie is classified? | longitudinal (up and down) transverse (perpendicular) oblique (slanted) |
| What does fetal attitude tell you? | the relationship of the fetal parts to one another |
| What are the different ways fetal attitude is classified? | flexion or extension |
| True or false: flexion is a classification of fetal lie | false (explanation: flexion and extension are classifications of fetal attitude. fetal lie is classified as being longitudinal, transverse or oblique) |
| True or false: flexion is a classifaction of fetal attitude | true |
| What fetal attitude classification is desired? | flexion |
| Why is flexion the desired fetal attitude classification? | so that the smallest diameter of the prsenting part is moving through the pelvis |
| The fetus' position can be described as "hugging herself." What fetal attitude is this? | flexion |
| The fetus' has an arm position that can be described as "sticking out". What fetal attitude is this? | extension |
| What does fetal presentation describe? | The part of the fetus that presents to the inlet FIRST |
| What are the different ways that fetal presentation is classified? | vertex, acromion, breech, sinciput, mentum |
| What does a vertex fetal presentation indicate? | head/cephalic is in the inlet first |
| What does an acromion fetal presentation indicate? | shoulder is in the inlet first |
| What does a breech fetal presentation indicate? | buttocks is in the inlet first |
| What does a sinciput fetal presentation indicate? | brow? Q? |
| What does a mentum fetal presentation indicate? | chin is first in the inlet |
| What does fetal position describe? | The relationship of a point of reference (occiput, sacrum, mentum) on the fetal presenting part (vertex, breech, shoulder) to the pelvis (right, left, transverse) |
| What is the most common fetal position? | left occiput anterior |
| What does the fetal "head molding" mean? | change in the shape of the fetal skull due to the force of contractions (allows passage of the head) |
| Why does fetal skull change shape during labor? | due to the force of contractions that allow for passage of the head |
| What stage of labor is best described: "involuntary need to push"? | second stage of labor |
| What enhances the mechanisms of labor? | the addition of abdominal force to the uterine contractions |
| What are the mechanisms of labor in order? | descent engagement flexion internal rotation extension external rotation expulsion |
| What is the first mechanism of labor? | descent |
| What is the second mechanism of labor? | engagement (order: descent, engagement, flexion, internal rotation, extension, external rotation, expulsion) |
| What is the third mechanism of labor? | flexion (order: descent, engagement, flexion, internal rotation, extension, external rotation, expulsion) |
| What is the fourth mechanism of labor? | internal rotation (order: descent, engagement, flexion, internal rotation, extension, external rotation, expulsion) |
| What is the fifth mechanism of labor? | extension (order: descent, engagement, flexion, internal rotation, extension, external rotation, expulsion) |
| What is the sixth mechanism of labor? | external rotation (order: descent, engagement, flexion, internal rotation, extension, external rotation, expulsion) |
| What is the seventh mechanism of labor? | expulsion (order: descent, engagement, flexion, internal rotation, extension, external rotation, expulsion) |
| What is another term for mechanisms of labor? | cardinal movements of labor |
| What is the "psyche" factor? | The psychological aspects associated with pregnancy and labor |
| What parts of a person's individual viewpoint impact the psyche factor? | past experiences, personal beliefs |
| What role do cultural norms play with the psyche factor? | society influences and family values |
| What does the A in Apgar represent? | the appearance, meaning color |
| What does a 0 score for A in APGAR represent? | pale or cyanotic |
| What score would you give a pale baby during the APGAR assesment? | A for Appearance would be 0 |
| What score would you give a baby with blue hands/feet during the APGAR assesment? | A for Appearance would be 1 |
| What score would you give a baby with an overall pink color during the APGAR assesment? | A for Appearance would be 2 |
| When is the APGAR assesment completed? | 1 min and 5 min after birth |
| What does the P in APGAR represent? | P for pulse |
| What score would you give a baby whose pulse is absent during the APGAR assesment? | P for Pulse would be zero |
| What score would you give a baby whose pulse is less than a 100 beats per minute during the APGAR assesment? | P for Pulse would be 1 |
| What score would you give a baby whose pulse is greater than a 100 beats per minute during the APGAR assessment? | P for Pulse would be 2 |
| What does the G in APGAR represent? | Grimace (reflex response) |
| What score would you give a baby who did not have reflex response during the APGAR assessment? | G for Grimace would be zero |
| What score would you give a baby who had minimal reflex response during the APGAR assessment? | G for Grimace would be 1 |
| What score would you give a crying baby during the APGAR assessment (for the grimace)? | G for Grimace would be two |
| What does second A in APGAR represent? | A for Activity (meaning muscle tone) |
| What score would you give a limp baby during the APGAR assessment? | A for Activity would be zero |
| What score would you give a baby with minimal flexion during the APGAR assessment? | A for Activity would be 1 |
| What score would you give a baby who was moving during the APGAR assessment? | A for Activity would be 2 |
| What does the R in APGAR represent? | Respiratory Effort |
| What score would you give a baby who had no spontaneous respirations during an APGAR assessment? | R for Respiratory Effort would be Zero |
| What score would you give a baby with slow respirations during an APGAR assessment? | R for Respiratory Effort would be 1 |
| What score would you give a baby with a weak cry during an APGAR assessment? | R for Respiratory Effort would be 1 |
| What score would you give a baby with a strong cry during an APGAR assessment? | R for Respiratory Effort would be 2 |
| What score would you give a baby with strong respirations during an APGAR assessment? | R for Respiratory Effort would be 2 |
| True or false: labor pain is constant | false (explanation: labor pain is intermittent) |
| Endorphin release during birth is ___genous | endogenous |
| True or false: pain during childbirth is considered part of the normal process. | tre |
| Labor pain ends with what event? | the birth of a baby |
| What factors influence pain response? | anxiety, fear, childbirth preparation, previous personal experiences, cultural influences, social and professional support |
| What is effleurage? | massage/touch |
| What are some relaxation techniques? | breathing, effleurage, imagery, focusing, water therapy, music, environment (quiet, dim lighting), acupuncture, accupressure, counter pressure, hypnosis, aromatherapy (like lavender), application of hot/cold packs, and birthing balls |
| How do narcotic analgesics work? | they reduce perception of pain |
| What are some narcotic analgesics used in labor? | nubain and morphine |
| True or false: Narcan is a narcotic antagonist. | true |
| How can ambien help a pregnant woman? | can help relieve anxiety and induce sleep |
| Why is IV administration preferred over IM administration for pain medications for the laboring woman? | IV administration has a much faster peak and onset and a shorter duration (things happen quick in OB, may not want side effects much longer) |
| What is the typical onsent of an IV administration? | 5 minutes |
| What is the typical onset of an IM administration? | within 30 minutes |
| What is the typical peak of an IV administration? | 30 minutes |
| What is the typical duration of an IV administration? | 1 hour |
| What is the typical peak of an IM administration? | 1-3 hours after injection |
| What is the typical duration of an IM administration? | 4-6 hours. |
| What is the action of narcan? | opioid antagonist |
| What is the indication of narcan? | to reverse opioid-induced respiratory depression |
| What dosage of narcan is used for neonates? | 1 mg/1 ml |
| safe dosage is classified for neonates based on what factor? | the neonate's weight, and is 0.1 mg/kg/dose |
| what route is typical for narcan? | IV, IM, SC or endotracheal |
| At what frequency can narcan administration be repeated? | 2-3 minute intervals |
| Mom has received pain medications that are causing fetal respiratory distress. What medication is needed? | Narcan |
| You have a 2000 gram neonate. How much narcan should your dose be? explain/show work | 2000 grams to kg = 2 kg. 2 kg x 0.1 mg / 1 kg= 2 times .1 = .2 mg of narcan |
| You can give 0.1 mg of narcan for every what of the neonate's weight? | 1 kg |
| What is 1-2% lidocaine used for? | episiotomy's and perineal repairs. |
| For an episiotomy, describe the type of anesthesia that would be used. | It would be called a regional block type of anesthesia further classified as local. 1-2% lidocaine would be used |
| For a perineal repair, describe the type of anesthesia that would be used. | It would be called a regional block anesthesia further classified as a local. 1-2% lidocaine would be used. |
| Describe what a pudendal block is. | When 1% lidocaine is injected just medial to each ischial spine |
| A pudendal block is done to relieve what type of pain? | pain in the lower vagina, vulva and perineum |
| What is used during a pudendal block? | 1% lidocaine |
| uterine relaxation needs to be atleast how long? | 30 seconds |
Created by:
skulkarni87