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Quiz #3
Women's Health
| Question | Answer |
|---|---|
| What are some symptoms that signal the end of pregnancy? | vena caval syndrome, varicosities/skin, heart burn/reflux bc fo pushing up, sleeping difficulties, frequent urination d/t pushing down of baby, "nesting" = getting ready for baby to survive |
| What are some lab work that is done at the end of pregnancy? | GBS testing (35 weeks), Fibrinogen (lab draw), WBC (check for risk of infection), H&H - hgb & hct (bc of loss of fluid and blood) |
| What are the premonitory signs of labor? | 1) lightening = bc baby dropped to pelvis (occurs 2 weeks before labor) *proven by dec in heartburn and inc room to breathe 2) inc vaginal discharge (d/t internal dilation & disintegration mucus plug 3) inc Braxton-Hicks |
| What is the difference between true and prodromal labor? | True = contractions + cervical change, discomfort in front and back, palpation of UC (hard), regular intervals, intensity inc with walking Prodromal = No cervical change, discomfort in front than back, palpation-not well coordinated or intense UC, |
| What is TRUE labor? | contractions + cervical change, discomfort in front and back, palpation of UC = hard, regular intervals, intensity increased with walking |
| What is PRODROMAL labor? | no cervical change, discomfort more in the front than back, palpation = not well coordinated/intense UC, irregular frequencies, interrupted w/ change in activity (contractions space out) |
| What is the onset of labor? | strong, regular contractions that result in cervical change |
| What is a brief overview of the 4 stages of labor? | 1) Onset of labor = Latent, Active, Transition 2) birth of baby 3) birth of the placenta 4) birth of placenta - to 2 hrs postpartum |
| What occurs during the 1st stage of labor? | onset of labor to 10 cm Latent (mother can do normal things): 0-4cm Active (5 mins apart): 4-7cm Transmission (when mothers feel burst of energy) 8-10cm |
| What occurs during the 2nd stage of labor? | 10 cm (complete dilation) to birth of baby - start pushing = can last 1-3 hrs |
| What occurs during the 3rd stage of labor? | birth of baby to birth of placenta - usually less than 30 mins & would use fundal massage/admin Pitocin during this tie |
| What occurs during the 4th stage of labor? | birth of placenta to 2 hrs postpartum = high risk of hemorrhage - known as RECOVERY period: close monitoring for bleeding |
| What are nursing actions when a mother comes in and in labor? | obtain hx (GTPAL, gestational age), VS, FHR, Contraction (frequency, intensity, duration), Pain level, ROM (rupture of membrane) |
| What exams and tests would be done when mother comes in labor? | SVE (Sterile Vaginal exam) = used to check dilation, effacement, station, cervical position, consistency, fetal presenting part Urine dipstick = check for protein, glucose IV placement/labs (if in true labor) **Encourage eating and drinking w/ IV |
| What occurs during the 1st Stage: Latent Phase? | regular contractions at 3-4 cm or irregular contractions q5-10 mins and lasting 20-40 secs w/ MILD intensity |
| What is the difference between primips and Multips in 1st stage: Latent Phase? | Primips (1st time moms) take longer = 8-12 hrs on avg in latent phase than Multips = 4-6 hrs |
| What occurs during the 1st Stage: Active Phase? | 4cm-10cm (complete) = contractions q2-5 mins and last 45-60 secs; w/ MODERATE to STRONG intensity |
| What is the difference between primips and Multips in 1st stage: Active Phase? | Multiparas are 2x faster in this stage than primiparas (2cm:1cm/hr) |
| How often are the contractions in transition phase? | q2-3 mins x 60-90sec long; STRONG intensity = 7-10 cm |
| When are the normal Fetal Heart tones checks in latent, active, and transitional phase? | Latent: q30 mins Active: q15-30 Transition: q15 |
| When are the normal Maternal VS checks in latent, active, and transitional phase? | BP qhr and temp q4hrs, if ROM, then q1hr bc of risk of infection Urine Output = q8hrs |
| What are the signs of second stage of Labor? | urge to push, increase in bloody show, bulging of perineum, anal changes, opening of vaginal introitus, presenting part is visible, burning with stretching of perineum (ring of fire) fr head |
| What is laboring down in the second stage of Labor? | "latent phase" of second stage of Labor = when 10 cms is reached and pushing is not yet occurred and helps with less pushing time overall |
| What is the "active phase" in Second Stage of Labor? | pushing phase |
| What are the nursing interventions in the Second Stage of Labor? | BP/pulse checks q5-15 mins, FHR qcontrax, ROM present = CHECK FHR (color/consistency of amniotic fluid --infection), assess bladder distention if not catheterized, repositioning, confort measures, open glottis pushing |
| What are the nursing interventions in the Third Stage of Labor? | Open pitocin = admin at the delivery of placenta or delivery of infant, assess for restart of contractions, assess placenta for "wholeness" = to prevent hemorrhage, EBL/QBL (estimated or quantitative blood loss), clean mother and redress them afterwards |
| What nursing interventions are done for the mother in the 4th stage? | BP after birth of infant and after placenta = q15mins x1hr then q30mins until stable |
| What nursing interventions are done for the mother in the 4th stage? | APGARS at 1&5 mins = q 30 mins until stable |
| What nursing interventions/comfort measures are done for the mother in the 4th stage? | fundus/perineum/lochia/bladder q15 mins, comfort care (for afterpains) w/ meds like tylenol, norco, advil, support mother/infant bonding, feeding, supporting warmth of newborn |
| What are the major ROMs? | SROM = spontaneous ROM and AROM = artificial ROM |
| What do ROM have a high risk for? | infection r/t vaginal examination after ROM |
| What are the nursing interventions done for mother with ROM? | keep vag exams to min, maintain excellent perineal hygiene, assess temp q2hrs, assess FHR for tachycardia (fr infection), assess for sx of infection = uterine tenderness, foul-smelling amniotic fluid/cloudy, ensure aseptic technique during procedures |
| What does in the caul mean? | birth inside the amniotic sac |
| What are the 4 P's of Labor (that affect Labor outcomes)? | 1) Passage 2) Passenger 3) Powers 4) Psyche |
| What are the most favorable pelvis? | gynecoid and anthropoid |
| What is breach burth? | butt, legs, knees come out first |
| What is the smallest AP Diameter? | suboccipitobregmatic = vertex, well-flexed |
| What are 4 things to look for in Passenger? | Lie, attitude, presentation, position |
| What is Lie? | relationship of long axis (spine) of fetus to that of the mother **longitudinal = fetal & maternal spine are parallel 99% *transverse = perpendicular (0.5%) |
| What is Attitude? | relationship of fetal parts to each other **flexion = chin down (occipit present) or extended chin = (face present) *hyperextension (possible but harder) |
| What is Presentation? | fetal part that is entering the pelvis = what part of baby is coming out first **Cephalic (occipit) or (mentum-face/chin first) *Breech (sacrum/feet present) *Shoulder (acromion - transverse) |
| What is Position? | relationship of landmark of presenting part to the maternal pelvis Cephalic = LOA/LMA Breech = LSA Shoulder = LAA |
| What are the 3 elements of Position? | 1) R or L side of pelvis 2) landmark of fetal presenting part 3) is Landmark Anterior, Posterior, or Transverse |
| What are the different landmark positions? | Cephalic = occiput - O, mentum - M Breech = sacrum - S Shoulder = acromion process - A |
| What is Power of Labor? | w/ each conctrax, the upper segment becomes thicker and the lower segment becomes thinner and distended *physiological retraction ring = area where upper and lower segments meet |
| What are the 3 elements of power? | cervical dilation = 0 (closed) to 10 (complete) percentage = 0% (long, thick to 100% (completely think station = -5 (ballotable) to +5 crowning (at ischial spines) |
| What are the 3 descriptions of power? | Frequency = measured in mins (fr begin of UC to next beg) Duration = measured in secs (beginning of UC to end) Intensity = per palpation (1+, 2+, 3+) or External Toco (mild, moderate, strong) or Internal IUPC |
| What is the most accurate description of power? | Internal IUPC |
| What do the straps mean on the External Monitoring Device? | top = toco transducer - that senses uterine activity bottom = ultrasound device - senses fetal heart beat |
| What is Montevideo Units? | examine a 10 min episode of UCs + peak of each UC Subtract baseline per UC Approx 180-220 mvu desired (indicates good time to give birth |
| What is Psyche of Labor? | Psychological factors that influence labor = - fear/anxiety have effects on hormonal factors associated with labor = can she do it?, woman's attitude, course of labor, motivation, preparation |
| What is the fifth P? | Provider = choices of care provider, experiences etc matter |
| What are some cultural considerations to be aware of? | touching, pain tolerance, involvement of others, personal privacy, personal preferences, who answers questions, how to work with interpreter |
| What are the instrumental methods of monitoring baby? | fetoscope, doppler = assesses hr and significant accels and decels but not continuous, ultrasound transducer (EFM), Internal fetal monitoring |
| What are the uses of EFM? | assess rate, variability, accels, & decels provides continuous assessment of FHR, provides permanent record of events, can be observed remotely, may misinterpret other signals |
| What are the uses of Internal Fetal Monitoring | assesses FNR, accels, decels provides continuous, permanent record May not be accurate with fetal demise = will pick up maternal pulse Risk of infection at site of FSE Risk of choreoamnioitis ***MORE Accurate Overall |
| What are the 4 steps to interpretation, like NSTs | 1) FHR baseline 2) Variability 3) Presence of Accels 4) Presence of Decels |
| What does VEAL? | V = variable deceleration E = early decelerations A = accelerations L = late decelerations |
| What does CHOP? | C = cord compression H = head compression 0 = oxygenation P = placental perfusion (uteroplacental) |
| What is the cause of early decels? | head compression w/ vagal stimulation |
| What are the characteristics of early decels? | onset and offset mirrors contraction mild w/ uniform shape nadir no more than 20-30 bts below BL usually associated w/ normal variability |
| What is the cause of late decels? | uteroplacental insufficiency or diminished placental function |
| What are late decels associated with? | pregnancy-induced HTN, chronic maternal disease, hyperstimulation of uterus, fetal growth restriction, postdate pregnancy, smoking, drugs, poor maternal nutrition |
| What is the cause of variable decels? | associated w/ cord compression and varies in depth, duration, shape, onset |
| Are variable decels related to contractions? | no, they are random and not a problem as long as they are not more than 45 secs |
| What are signs that variable decels are benign? | decel lasts less than 45 secs abrupt change from/to baseline baseline rate does not increase baseline variability dose not dec |
| What are signs that variable decels are ominous? | severe variable <70 bpm for 60 secs or more slow return to baseline (prolonged >2mins) decrease in baseline variability most ominous - combination of variable and late decels |
| What are the nursing interventions for early decels? | continue to monitor for changes = do NOTHING it is normal |
| What are the nursing interventions for late decels? | change position (L side lying to help perfusion) discontinue oxytocics (stop pitocin to stop uterus fr contracting) take maternal BP IV fluid bolus O2 per face mask terbutaline or nifedipine = to stop contractions fetal scalp stimulation |
| What are the nursing interventions for variable decels? | mild: monitor mod: change position severe/prolonged: change position, VE, call MD |
| What are fetal factors that affect FHR? | baroreceptors (respond to FBP changes and transfer info to para/sympathetic), chemoreceptors (respond to fetal O2 and CO2 changes) , CNS state, Sympathetic system- increases FHR, Parasympathetic system- Slows FHR |
| What causes a decrease in Fetal Oxygen Supply? | 1) dec in maternal bl flow to placenta (HTN, HypoTN=causes dec bl flow to uterus), HypoV) 2) dec in maternal O2-carrying capacity (d/t hemorrhage, severe anemia) 3) Alteration in fetal circulation (cord compression, placental separation, vagal response |
| What is Category 1 characteristics? | FHR 110-160 bpm moderate variability no late or variable decels early and accels present or not |
| What is Category 3 characteristics? | absent variability w/: recurrent late decels variable decels bradycardia sinusoidal pattern |
| What is Category 2 characteristics? | not a homogenous group include FHR patterns w/ the full spectrum of variability patterns with the full range of association or lack of |
Created by:
godblessyou808