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UTA NURS 4441 Exam 1

UTA NURS 4441 OB Exam 1

Chlamydia treatment for pregnant women azithromycin or amoxicillin
Gonorrhea treatment for pregnant women ceftriaxone (Rocephin) and azithromycin
Syphilis treatment for pregnant women benzathine penicillin G (If allergic to penicillin, should be desensitized and treated with penicillin anyway as there is no alternative)
Jarisch-Herxheimer syphilis treatment complication that can cause preterm labor and birth if precipitated in second half of pregnancy; acute febrile reaction is often accompanied by headache, myalgias, and arthralgias that develop within the first 24 hours of treatment
HPV treatment for pregnant women trichlorocetic acid (TCA) and bichlorocetic acid (BCA)
PID causes STIs and a wide variety of anaerobic and aerobic bacteria
Herpes affect on preferred method of delivery if visible lesions are present, a cesarean birth is recommended within four hours of labor
Hepatitis B breastfeeding precautions prophylactic Hepatis B immunization at birth
Hepatitis C breastfeeding precautions None. No reports of transmission through breast milk.
HIV transmission precautions Antiretroviral therapy and cesarean birth at about 38 weeks and no breastfeeding.
Bacterial vaginosis (BV) manifestations A fishy odor; profuse thin white or gray discharge, mild itching/pruritus; clue cells on microscopic examination, pH 4.5 or greater, amine smell when KOH is applied to secretions.
Trichomoniasis treatment for pregnant women Metronidazole (Flagyl)
Group B streptococci transmission precautions IV Penicillin G or Ampicillin during labor
Toxoplasmosis prevention precautions avoid raw or undercooked meat and cat litter
Rubella vaccination for pregnant women Live virus that is contraindicated in pregnancy; will be given post-partum if possible
Cytomegalovirus treatment for pregnant women No treatment is available during pregnancy
Primary genital herpes potential effects on pregnancy Miscarriage, preterm labor and intrauterine growth restriction
Dyspareunia Painful sexual intercourse, for either sex.
Fertilization location the ampulla (outer third) of the uterine tube
When implantation occurs Between 6 and 10 days after conception
Implantation Embedding of the fertilized ovum in the uterine mucosa; nidation.
Implantation sign slight implantation bleeding (slight spotting or bleeding) at the time of first missed menstrual period
Chorionic villi role anchor the placental unit to the mother and provide for exchange of nutrients and waste
Depth chorionic villi extend endometrium
Length of human pregnancy 10 lunar months, 9 calendar months, 40 weeks, or 280 days
Shunts in fetal circulation ductus venosus, ductus arteriosus, foramen ovale
Amount of oxygen carried by fetal hemoglobin 20-30% more than maternal hemoglobin
Fetal hemoglobin concentration 50% more than maternal hemoglobin
Normal fetal heart rate 110-160
Gestational age heart defects are most likely to occur 3-8 weeks
Reason Vitamin K is given to newborns no bacteria in the gut to manufacture V. K. until a few days after birth when there is food in it
Maternal HTN affect on fetal lung maturity Accelerates lung maturity
Cause of mammary engorgement at birth High maternal levels of estrogen
Sutures and fontanels affects on birth process allow the bones of the skull to mold, or move during birth, enabling the head to pass through the birth canal
Incidence of twinning 1 in 30 pregnancies (or 1 in 43 according to teacher’s notes)
Placental hormone used as basis for pregnancy tests hCG
hCG detection timeframe detected as early as 7 days after conception
pregnancy test instructions Use the first morning urine. Repeat in a week if it is negative. If the second one is negative and you still haven’t had your period, see your health care provider.
When fundus is able to be palpated at or just above the pubis 12-14 weeks
When fundus is able to be palpated at the umbilicus 22-24 weeks
When fundus drops with lightening 38-40 weeks
Uterine blood flow rate diagnostic use of doppler ultrasound to measure blood flow velocity
Leukorrhea a white or slightly gray mucoid discharge with a faint musty odor. It occurs in response to cervical stimulation by estrogen and progesterone and is never pruritic or blood-stained.
Operculum The mucus plug that acts as a barrier against bacterial invasion
Pregnancy affect of pH on vaginal secretions The pH becomes lower (more acidic) during pregnancy making the women more vulnerable to vaginal yeast infections
Breast changes during pregnancy hypertrophy of the Montgomery tubercles, Nipples & areola more pigmented, secondary lighter pinkish areola, blood vessels in breast dilate & become visible, nipples more erectile. progressive generalized enlargement of the breasts occur; striae gravidarum
Side heart rotates to during pregnancy left
Heart hypertrophy during pregancy cause increased blood volume and cardiac output
Abnormal heart manifestations that are normal in pregnancy In second trimester heart rate increases 10 – 15 beats/min, and this is sometime accompanied by palpitations, sinus arrhythmias, PACs, and PVCs. Also, extra heart sounds are common, such as splitting and S3, also systolic and diastolic murmurs.
Diastolic BP changes in pregnancy decreases until 24 – 32 weeks then gradually increases to pre-pregnancy levels by term
Blood volume changes at term Approx 1500 mL (1000mL plasma, 450 mL RBCs) or 40-45% above non-pregnancy levels. WBCs also increase.
Compensation for increased blood volume peripheral dilation
Physiologic anemia Plasma increases in volume more than the RBCs, so there is a corresponding decrease in overall hemoglobin.
Cardiac output changes in pregnancy By the 32nd week of pregnancy, cardiac output has increased 30-50%. By the 40th week, it declines to a 20% increase.
Coagulation changes in pregnancy There is a greater tendency for blood to coagulate during pregnancy because of increases in clotting factors VII, VIII, IX, X and fibrinogen. Fibrinolytic activity is also depressed during pregnancy and the postpartum period.
Position that increases cardiac output The lateral recumbent position (as opposed to supine).
Risk of increased coagulation in pregnancy thrombosis
Acid-base balance changes in pregnancy The changes in the respiratory system in pregnancy cause a compensatory respiratory alkalosis.
Respiratory tract changes in pregnancy and manifestations upper respiratory tract becomes more vascular and congested causing nasal and sinus stuffiness, epistaxis (nosebleed), changes in the voice and s/s of upper respiratory infection.
Ureter shape changes in pregnancy and manifestations The ureters elongate, become torturous, and form curves. She is more susceptible to UTI and can experience bladder irritability, nocturia, and frequency
Position used to increase renal perfusion in the pregnant woman side lying
Physiologic edema causes in late pregnancy Blood pooling in the lower legs resulting in decreased renal blood flow and GFR
Glucose changes in pregnancy glycosuria (glucose in urine) occurs when blood levels drop below 160 (vs. 160-180 in non-pregnant women)
Acceptable amount of proteinuria in pregnant women Trace to 1+, or less than 300 mg per 24 hours; higher than non-pregnant due to increased amount of amino acids
Hyperpigmentation locations in pregnancy Nipples and areola, axillae, vulva, face (chloasma), abdomen (linea nigra)
Chloasma Blotchy, brownish hyperpigmentation of the skin over the cheeks, nose, and forehead, especially in dark-complexioned pregnant women and some women taking oral contraceptives; also known as the mask of pregnancy.
linea nigra Pigmented line that appears on the middle of the abdomen and extends from the symphysis pubis toward the umbilicus, extending to the top of the fundus in the midline; seen in some women during the latter part of pregnancy.
Vascular changes in pregnancy varicosities in the legs or vulva, spider angiomas, palmar erythema, and gum hypertrophy or epulis. Nail growth and increase in hair growth.
Postural changes in pregnancy The woman's center of gravity shifts forward. An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region (exaggerated anterior flexion of the head) develops to help her maintain her balance.
Musculoskeletal aches and pains in pregnancy 39. Aching, numbness, and weakness in the upper extremities. Walking is more difficult, waddling may be the new walk. Pelvic instability may cause pain in the sacroiliac joints, peripheral joint laxity.
Diastasis recti abdominis Separation of the two rectus muscles along the median line of the abdominal wall. This is often seen in women with repeated childbirths or with a multiple gestation (e.g., triplets). In the newborn it is usually attributable to incomplete development.
Nausea and vomiting normal appearance and disappearance usually appears at 4-6 weeks of pregnancy and disappears by the end of the first trimester or at three months of pregnancy.
Pica Unusual craving during pregnancy; consuming nonfood substances (e.g., clay, soil, & laundry starch) or excessive amounts of foodstuffs low in nutritional value (e.g., ice/freezer frost, baking powder/soda, & cornstarch), influenced by cultural background.
GI tract manifestations during pregnancy Esophageal regurgitation, slower gastric emptying time, reverse peristalsis, heartburn, constipation, hemorrhoids, and bleeding of the hemorrhoids.
Ptyalism Excessive salivation (sometimes occurs when pregnant women are nauseated or from eating starch)
Gall bladder changes in pregnancy Because of decreased muscle tone and increased emptying time, increased cholesterol, etc., gallstones may develop.
Progesterone effects maintains pregnancy by relaxing smooth muscle like the uterus so that it does not contract and cause miscarriage. It helps to cause fat to be stored for energy reserves, it is responsible for initial lactation and also helps to block it until after birth.
Estrogen effects helps cause fat to be stored; enlargement of genitals, uterus, breasts, causes vasodilation; relaxation of pelvic ligaments & joints, alters metabolism increasing total body protein, sodium retention; & may decrease HCl acid & pepsin secretion.
Medications that cause false-positive pregnancy tests Anticonvulsants and tranquilizers
Medications that cause false-negative pregnancy tests Diuretics and promethazine
gravid pregnant
gravidity pregnancy
multigravida A woman who has had two or more pregnancies.
Nulligravida A woman who has never been pregnant.
Primigravida A woman who is pregnant for the first time.
Parity The number of pregnancies in which the fetus or fetuses have reached 20 weeks of gestation when they are born, not the number of fetuses (e.g., twins) born. Whether the fetus is born alive or is stillborn does not affect parity.
Multipara A woman who has completed two or more pregnancies to 20 or more weeks of gestation.
Nullipara A woman who has not completed a pregnancy with a fetus or fetuses who have reached 20 weeks of gestation.
Primipara A woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation; woman who has carried a pregnancy to viability whether the child is dead or alive at the time of birth.
term pregnancy A pregnancy is considered to be at term if it advances to the completion of 37 weeks.
postterm pregnancy Pregnancy that extends beyond the end of week 42 of gestation. Also called postdate pregnancy or prolonged pregnancy.
premature infant Infant born before completing week 37 of gestation, irrespective of birth weight; preterm infant.
viable (viability) Capable (capability) of living outside the uterus; applied to a fetus that has reached a certain stage of development, usually 22 menstrual weeks (20 weeks of gestation); however, there are no clear limits of gestational age or weight.
G/P method of describing OB history G (Gravidity) is the number of total pregnancies, including current pregnancy. P (parity) is the number of pregnancies that have reached 20 weeks.
GTPAL method of describing the OB history G (Gravidity)-total pregnancies. T (term)-births (not pregnancies) that advanced to 37 weeks. P (Preterm, NOT para)-births that occur before 37 weeks. A (abortions)-both spontaneous and induced abortions. L (living children)-children currently living.
presumptive signs of pregnancy Manifestations that are suggestive of pregnancy but are not absolutely positive. These include the cessation of menses, Chadwick's sign, morning sickness, and quickening.
Chadwick sign presumptive sign of pregnancy; Violet bluish color of vaginal mucous membrane and cervix that is visible from about the fourth week of pregnancy; caused by increased vascularity.
Quickening presumptive sign of pregnancy; Maternal perception of fetal movement (“feeling life”); usually occurs between weeks 16 and 20 of gestation, but may be felt earlier by multiparous woman.
probable signs of pregnancy Manifestations or evidence that indicates that there is a definite likelihood of pregnancy. Among the probable signs are enlargement of abdomen, Goodell's sign, Hegar's sign, Braxton Hicks sign, and positive hormonal tests for pregnancy.
Goodell sign a probable sign of pregnancy; Softening of the cervix occurring during the second month.
Hegar sign a probable sign of pregnancy; Softening of the lower uterine segment that may be present during the second and third months of pregnancy and is palpated during bimanual examination.
Braxton Hicks sign Mild, intermittent, painless uterine contractions that do not increase in intensity or frequency or cause cervical dilation (as true labor does). These contractions begin at 4 months and occur more frequently as pregnancy advances.
positive signs of pregnancy Definite indication of pregnancy (e.g., hearing the fetal heartbeat, visualization and palpation of fetal movement by the examiner, sonographic examination).
Folic acid recommendations for daily intake 400 mcg is recommended for women of childbearing age (though it may change to 800mcg in the future). 600 mcg is recommended for pregnant and 500 mcg for lactation.
kcal recommendations for daily intake during pregnancy First trimester, same as nonpregnant; second trimester, nonpregnant needs + 340 kcal; third trimester, nonpregnant needs + 452 kcal (rounded to 300 kcal)
kcal recommendations for daily intake during lactation First 6 months, nonpregnant needs + 330 kcal; second 6 months, nonpregnant needs + 400 kcal (rounded to 500 kcal)
weight gain recommendations during pregnancy Underweight women: Average women: (BMI 19.8 – 26) should gain 25 – 35 lbs.
weight gain recommendations during pregnancy for multiple gestation Average women: (BMI 19.8 – 26) should gain 37-54 lbs.
protein recommendations for daily intake during pregnancy 60-70 grams total
calcium recommendations for daily intake 1300 mg/day for <19yrs; 1000 mg/day otherwise
iron recommendations for daily intake Pre-pregnant: 18 mg; Pregnant: 30 mg; lactation: 9 mg
foods that enhance iron absorption Foods with vitamin C such as citrus, tomatoes, melons and strawberries
foods that decrease iron absorption Bran, tea, coffee, milk, oxalates and egg yolks
foods rich in calcium Sardines—since they include the bones, salmon, beans, tofu, greens, cornbread, figs, orange juice with calcium, pesto, cheese.
Vitamins that can reach toxic levels if too much is taken Fat soluble vitamins, like Vitamin A
Exercise teaching for pregnant women Moderate exercise is beneficial and special attention should be given to increased water and caloric needs
Caffeine maximum amount daily 200 mg
Caffeine excess complications Increased risk of miscarriage and IUGR (intrauterine growth restriction)
Pre-eclampsia cause unknown
Length of a human term pregnancy 9 calendar months, 10 lunar months, 40 weeks, or 280 days
Nägele’s rule Method for calculating the estimated date of birth (EDB) or “due date.” Also called Naegele's rule. Determine the first day of the LMP (last menstrual period), subtract 3 months and add 7 days and one year. Or count forward 9 months and add 7 days.
Typical prenatal care schedule Every month for the first two trimesters. Starting with week 28, they should be every two weeks until the last month (week 36) and then they should be weekly.
Height of fundus From gestational weeks 18 to 32, the height of the fundus in centimeters is approximately the same as the number of weeks of gestation.
Maternal serum alpha-fetoprotein (MSAFP) screening screens for neural tube defects and Down’s syndrome; ideally performed between 16-18 gestational weeks (acceptable 15-22 weeks)
Low MSAFP indicates Down’s syndrome
Pyelonephritis complications Sepsis or systemic septicemia
Minimum water intake during pregnancy 2 L/day
Hormone that causes joints and ligaments to relax and soften during pregnancy relaxin
Precautions when traveling or working for long periods They should walk or move and do some foot-circling and deep breathing hourly. They should wear seat belts.
Preterm labor Uterine contractions causing cervical change that occur between 20 and 37 weeks of pregnancy.
Complications associated with adolescent pregnancies Low birth weight, serious and long-term disability, and dying during the first year of life.
Multiple gestation complication Placenta previa
Placenta previa Placenta is implanted in the thin, lower uterine segment such that it completely or partially covers the cervix or is close enough to the cervix to cause bleeding when the cervix dilates or the lower uterine segment effaces.
the five P's that affect process of labor and birth passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychologic response
Fetal presentation The part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor. Main presentations are cephalic (head first), breech (buttocks, feet, or both first), and shoulder
Fetal lie Relation of the fetal spine to the maternal spine: vertical lie, maternal and fetal spines are parallel and the fetal head or breech presents; in transverse lie, fetal spine is perpendicular to the maternal spine and the fetal shoulder presents.
Fetal attitude Relation of fetal parts to each other in the uterus, the posture and flexion of the fetus (e.g., all parts flexed, all parts flexed except neck is extended).
Fetal position The relationship of a reference point on the presenting part (occiput, sacrum, mentum [chin], or sinciput [deflexed vertex]) to the four quadrants of the mother's pelvis
Anterior fontanel normal closure 18 months
Posterior fontanel normal closure 6-8 weeks
Fetal station measure of degree of descent; relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines (station 0 at level of ischial spines, negative numbers used before this point and positive numbers used after)
Occipitoposterior position The occiput of the fetal head is against the posterior part of the mom’s pelvis
Occipitoanterior position The occiput of the fetal head is against the anterior part of the mom’s pelvis
Engagement When the biparietal diameter of the head passes the pelvic inlet, the head is said to be engaged in the pelvic inlet
Pelvis most favorable to vaginal birth gynecoid
Cervical effacement The shortening and thinning of the cervix during first stage of labor
Cervical dilation The enlargement or widening of the cervical opening and the cervical canal that occurs once labor has begun
frequency of uterine contractions The time from the beginning of one contraction to the beginning of the next
frequency of contractions where presenting to hospital is warranted 10 minutes apart for a multigravida or 5 minutes for a primigravida
end of first stage of labor sign full cervical dilation
signs that precede labor Lightening, return of urinary frequency, backache, stronger Braxton-Hicks contractions, weight loss of 0.5 – 1.5 Kg., surge of energy, increased vaginal discharge and bloody show, cervical ripening or softening, and possible rupture of membranes.
First stage of labor last from the onset of regular uterine contractions to full effacement and dilation of the cervix (to 10 cm).
Second stage of labor fetus descends and rotates to an anterior position, then woman has strong urges to bear down as the presenting part of the fetus descends and presses on the stretch receptors of the pelvic floor
Third stage of labor The birth of the fetus and delivery of the placenta
Fourth stage of labor the period of immediate recovery, when homeostasis is reestablished
7 cardinal rotations, or mechanism of labor engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and finally birth by expulsion.
Blood that enters maternal circulation with each uterine contraction average of 400 mL
Cardiac output changes in first and second stage of labor increases by about 10% to 15% in the first stage and by about 30% to 50% in the second stage
Blood pressure changes in the first and second stage of labor first stage: systolic increases by 10 mm Hg during contractions; second stage: systolic increases by 30 mm Hg & diastolic increases by 25 mm Hg during contractions & both systolic and diastolic pressures remain somewhat elevated even between contractions
WBC count changes in labor increases
Temperature changes in labor slightly elevated
Respiratory rate changes in labor increases
Proteinuria in labor Proteinuria of 1+ is a normal finding because it can occur in response to the breakdown of muscle tissue from the physical work of labor
Gastric motility changes in labor Gastric motility and absorption of food will decrease. Manifestations of this are belching. nausea, vomiting, diarrhea or hard impacted stool.
Blood glucose changes in labor Metabolism will increase and glucose levels may fall with increased work of labor
causes of visceral pain during first stage of labor Distention of the lower uterine segment, stretching of cervical tissue as it effaces and dilates, pressure and traction on adjacent structures (uterine tubes, ovaries, ligaments) and nerves, and uterine ischemia
nervous system stimulation in response to pain sympathetic nervous system increased BP and HR
anxiety affect on progress of labor causes more catecholamine secretion, magnifying pain perception and slowing the progress of labor, decreasing effectiveness of uterine contractions
gate-control theory of pain theory explains the neurophysical mechanism underlying the perception of pain: the capacity of nerve pathways to transmit pain is reduced or completely blocked by using distraction techniques.
Analgesia Alleviation of the sensation of pain or the raising of the threshold for pain perception without loss of consciousness.
Anesthesia Encompasses analgesia, amnesia, relaxation, and reflex activity. Anesthesia abolishes pain perception by interrupting the nerve impulses to the brain. The loss of sensation may be partial or complete, sometimes with the loss of consciousness.
Combined Spinal-Epidural (CSE) Analgesia “walking epidural”; blocks pain transmission without compromising motor ability
Most difficult phase in first stage of labor to maintain control The transition phase, when the cervix dilates from 8cm-10cm
Respiratory alkalosis from hyperventilation management Breathing in to a paper bag enables her to rebreathe carbon dioxide and replace the bicarbonate ion. Also slowing breathing to no more than half normal rate.
Method of controlling urge to push taking panting breaths or by slowly exhaling through pursed lips (as though blowing out a candle)
Effleurage light stroking, usually of the abdomen, in rhythm with breathing during contractions
Position that exacerbates back pain When the fetal head is in a posterior position (an OP position, such as R(Right side) OP or L(Left-side) OP).
Counterpressure Pressure to sacral area of back during uterine contractions; technique used for back pain caused by pressure of the occiput against spinal nerves when the fetal head is in a posterior position (ROP, LOP)
Barriers in maternal-system that systemic analgesics may cross maternal blood-brain barrier, the placental barrier and the fetal blood-brain barrier. The fetal blood-brain barrier is crossed more easily than the maternal blood-brain barrier.
Analgesic affect on fetus compared to mother longer affect
Timing of opiod analgesics and birth birth should occur less than 1 hour before or more than 4 hours after administration of opioid analgesia
Opioid agonist-antagonist vs. opioid agonist The agonist-antagonist causes less respiratory depression than an opioid agonist.
Opioid antagonist given to either mom or baby in case of excessive respiratory depression Naloxone
Positioning for spinal or epidural insertion Sitting or lying on her side (ie modified Sims position) with back curved to widen the intervertebral space
Spinal anesthesia adverse effects Marked hypotension, impaired placental perfusion and an ineffective breathing pattern
Hypotension prevention from sympathetic nervous blockade A bolus of IV fluid (500-1000 ml of lactated ringers, or NS) is given
Postdural puncture headache cause Leakage of cerebral spinal fluid from the site of the puncture of the dura mater
Postdural puncture headache relief An epidural blood patch – the woman’s blood is injected slowly into the lumbar epidural space creating a clot that patches the tear or hole in the dura mater.
Turning of woman with epidural change sides every hour
percentage of American women that choose epidural analgesia for their plan of pain care during labor Two-thirds
epidural contraindications Active/anticipated maternal hemorrhage, Maternal hypotension, Coagulopathy, Infection, Increased ICP caused, Allergy, Maternal refusal or inability to cooperate, Some types of maternal cardiac conditions, Abnormal FHR and pattern requiring immediate birth
general anesthesia indications contraindication to a spinal or epidural block or if indications necessitate rapid birth without sufficient time or available personnel to perform a block
C/S rate has increased to 32.3% due to technology in labor and birth
Decreased fetal oxygen supply causes Reduction of blood flow through the maternal vessels, Reduction of the oxygen content in the maternal blood, Alterations in fetal circulation, Reduction in blood flow to the intervillous space in the placenta
Reassuring fetal heart rate (FHR) patterns baseline FHR in the normal range of 110 – 160 with no decels, and moderate variability; accelerations with fetal movement.
Non-reassuring FHR patterns associated with fetal hypoxemia
Average intrauterine pressure during contraction 50 to 85 mm Hg
Baseline fetal heart rate average rate during a 10-minute segment that excludes periodic or episodic changes
FHR normal range 110 to 160 bpm
Acceleration Increase in FHR (increase of 15 beats per minute for 15 seconds), usually seen as a reassuring sign.
Deceleration Slowing of fetal heart rate attributed to a parasympathetic response and described in relation to uterine contractions
Early deceleration cause fetal head compression (from uterine contractions, vaginal examination, fundal pressure, or placement of internal mode of monitoring); normal and benign finding
Late deceleration cause Uteroplacental insufficiency (caused by Uterine tachysystole, Maternal supine hypotension, Epidural/spinal anesthesia, Placenta previa, Placental abruption, HTN disorders, Postmaturity, Intrauterine growth restriction, DM, Intraamniotic infection)
Variable deceleration cause cord compression (caused by maternal position, cord around neck/arm/leg, short cord, knot in cord, prolapsed cord)
Amnioinfusion Infusion of room-temperature isotonic fluid (usually NS or LR) into the uterine cavity if the volume of amniotic fluid is low, in an attempt to increase the fluid around the umbilical cord and prevent compression during uterine contractions.
Prolonged or otherwise threatening decelerations management Shut off Pitocin, turn her to her side; if warranted and supported by protocol, IV rate and oxygen delivery may be implemented.
Frequency of taking vitals during labor q 30 min during everything but transition (q 15 min)
3 phases of first stage of labor and dilation present Latent stage: 0 – 3 cm; Active stage: 4 – 7 cm; transition phase: 8 – 10cm
True labor vs. false labor In true labor occur regularly vs. irregularly in false; more intense with walking vs. stopping; usually felt in the back & radiate to the lower abd. vs. only being felt in back or abd.; and continue despite comfort measures vs. stopping
Dilation that requires admission > 3 cm
Frequency of turning a laboring woman every 30-60 minutes
Food recommendations during labor Ice chips and sips of clear liquids are still the only oral intake recommended during labor in the US. If the healthcare provider allows the woman to eat it is advisable to only eat lighter foods.
procedure implemented to augment or induce labor, or facilitate placement of internal monitors Artificial rupture of membranes (AROM) or an amniotomy
AROM complications Infection is the major concern. This can lead to chorioamnionitis, placentitis and sepsis.
Most important thing to do after membranes are ruptured check fetal heart tones in case of cord prolapse
Frequency of voiding during labor every 2 hours
Bulb syringe use inserted first in mouth, then in nose
Gaskin maneuver woman moves to hands-and-knees position to resolve cases of should dystocia (Long, difficult, or abnormal labor, caused by various conditions associated with the five factors affecting labor; also called)
Dystocia Long, difficult, or abnormal labor, caused by various conditions associated with the five factors affecting labor; also called dysfunctional labor
Shoulder dystocia an emergency; shoulders are too big to be born easily, though the head has passed through the opening
First degree laceration Laceration that extends through the skin and structures superficial to muscles
Second degree laceration Laceration that extends through muscles of the perineal body
Third degree laceration Laceration that continues through the anal sphincter muscle
Fourth degree laceration Laceration that also involves the anterior rectal wall
Placental separation indications firmly contracting uterus; change in the uterus from a discoid to a globular shape, sudden gush of dark blood from the introitus, apparent lengthening of the umbilical cord as the placenta descents to the introitus, vaginal fullness (from the placenta)
Anesthesia recovery signs She should be able to raise her legs, extended at the knees off the bed, to flex her knees, place her feet on the bed and raise her buttocks off the bed. The numbness and tingling should be gone.
Ferguson reflex Reflex contractions of the uterus after stimulation of the cervix.
Nonreassuring or abnormal fetal heart rate and pattern manifestations fetal bradycardia (<110 bpm for >10 min), fetal tachycardia (>160 bpm for > 10 min), irregular FHR, absent or minimal baseline FHR variability, late, variable, and prolonged deceleration, absence of FHTs
Nonreassuring or abnormal fetal heart rate and pattern interventions notify provider, d/c Pitocin, change position, start IV, increase IVF, administer O2, check temp, assist with amnioinfusion, perform fetal scalp stimulation or vibroacoustic stimulation
Inadequate uterine relaxation manifestations Intrauterine pressure ≥80 mm Hg, Contractions consistently lasting >90 seconds, Contractions occurring more frequently than every 2 minutes
Inadequate uterine relaxation interventions notify provider, d/c Pitocin, change to side-lying position, start IV, increase IVF, administer O2, palpate and evaluate contractions, give tocolytics (terbutaline [Brethine])
Vaginal bleeding interventions notify provider, assist with ultrasound, start IV, begin continuous FHR and contraction monitoring, anticipate emergency cesarean birth, do NOT perform a vaginal examination
Prolapse of cord manifestations Fetal bradycardia with variable deceleration during uterine contraction, Woman reports feeling the cord after membranes rupture, Cord lies alongside or below the presenting part of the fetus, Major predisposing factors
Prolapse of cord major predisposing factors Rupture of membranes with a gush, Loose fit of presenting part in lower uterine segment, Presenting part not yet engaged, Breech presentation
Prolapse of cord management call for assistance/notify provider, use gloved hand to exert upward pressure, place rolled towel under hip, re-position, wrap protruding cord loosely in sterile towel, O2, IVF, monitor FHR, do NOT replace cord into cervix, immediate birth
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