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OB Test #2

OB test 2

QuestionAnswer
Labor & Birth end of pregnancy & intrauterine life, beginning of extrauterine life, change in relationships
Theories of Labor Progesterone w/drawl hypothesis, Prostraglandin hypothesis-^sensitivity to oxytocin/Pitocin
5 Critical Factors in Labor passage, passengers, relationship btw passage/passengers, physiological forces of labor, psychological factors
Passage birth canal, cervix, vaginal canal, pelvic/perineal muscles
Passage-factors affecting type & size of pelvis, ability of cervix to dilate(need 10cm to push), ability of vagina to distend, ability of perineum to distend
Pelvis most conducive to delivery Gynacoid & Anthropoid
Passengers fetus, chorion/amnion membranes, placenta
Passengers movement-affected by fetal head, fetal lie, fetal attitude, fetal presentation, placenta
Passenger’s head largest & least compressible part, face-base of skull-vault of cranium
Vault of Cranium 2 parietal bones, 2 frontal bones, occipital bone—not fused, can overlap
Skull bones are united by Sutures
Sutures intersect at fontanels, anterior & posterior most useful, identifies position
Anterior fontanel junction of sutures, diamond shaped, 2cmx3cm, permits brain growth, remains open for 18 months
Posterior fontanel junction of posterior sutures, above occipital bone, triangular shaped, 1cmx2cm, closes 8-12wks after birth
Mentum fetal chin
Sinciput frontal lobe, anterior, brow
Bregma anterior fontanel, large, diamond shaped
Vertex area btw anterior & posterior fontanels
Occiput area beneath posterior fontanel, occipital bone
Passenger-Fetal attitude posture of body w/ reference to limbs, flexion or extension
Normal Attitude of Fetus flexion; flexion of head, flexion of legs, flexion of arms on chest
Passenger-Fetal Movement affected by Placenta normal placental implantation-uppermost posterior part of uterus, abnormal placental implantation-lower uterine segment(placenta previa), may cover part or all of cervical os->movement impeded
Passenger-Fetal Lie relationship of fetus’ long axis(cephalocaudal)to mother’s long axis(spine)
Longitudinal/vertical lie cephalocaudal axis of fetus is parallel to mom’s axis
Transverse lie cephalocaudal axis of fetus is perpendicular to mom’s axis
Oblique lie cephalocaudal axis of fetus is diagonal to mom’s axis
Passenger-Fetal Presentation determined by fetal lie and body part that enters pelvic passage first-presenting part
Presentation types cephalic, breech, shoulder->further categorized based on fetal attitude
Passenger-Fetal Position relationship of designated landmark on presenting part to specific part on maternal pelvis-four imaginary quadrants
Engagement largest diameter of presenting part reaches or passes through pelvic inlet->determined by vaginal exam, confirms adequacy of pelvic inlet only, in primigravida occurs 2wks before term
Floating fetal head is directed down toward the pelvis but can still easily move away from inlet
Dipping fetal head dips into the inlet but can be moved away by exerting pressure on the fetus
Engaged the biparietal diameter(BPD) of fetal head is in the inlet of the pelvis, most instances the presenting part(occiput) is at level of ischial spines(0 station)
Station relationship of presenting part to the ischial spines->narrowest diameter of normal pelvis, ischial spines marks 0 station, above spines -, below spines +, -5-+5
No Progress CPD? Cephalopelvic disproportion
Powers of Labor primary force-causes complete effacement/thinning of cervix->dilation/widening, secondary force-abdominal muscles->used to push during 2nd stage of labor
Preliminary/Premonitory/Prodromal Signs of Labor lightening, surge of energy, Braxton-hicks, ripening of cervix, rupture of membranes, bloody show
True/Actual Signs of Labor cannot be attrib to a single cause-changes in maternal uterus, changes in cervix/pit gland, aging of placenta, ^intrauterine pressure, uterine contractions change, efface/thinning, dilation-progressive enlarge/widening of cervical opening, dia ^1-10cm
First Stage of Labor Dilation-begins w/ onset of regular contractions(mild), ends w/ full dilation of cervix, longer than other stages, consists of 3phases
Early/Latent-1st phase of 1st stage of labor progressive effacement of cervix, little ^ in descent, excited and anxious
Active-2nd phase of 1st stage of labor contractions resume, dilates 4-7cm, bearing down efforts, fetal station advancing, anxiety ^-employ coping strategies
Transition-3rd phase of 1st stage of labor contractions more frequent-longer-stronger(90sec), more rapid dilation of cervix(8-10cm, ^ rate of descent, rectal pressure-low backache-belching-N/V, perspiration on brow, apprehensive-irritable-angry-withdrawn(breathe)
Second Stage of Labor Pushing-lasts from time cervix is completely dilated to birth of fetus, avg 20-50min, crowning occurs when birth is imminent, head encircled by vaginal introitus, sense of purpose, burning sensation
Third Stage of Labor Placental-from birth of fetus until placenta is delivered, normally separates eith 3rd or 4th contraction after fetus is born, from 3-5min to 1hr->risk of hemorrhage ^ as length of stage ^
Fourth Stage of Labor Recovery-1-4hs after delivery of placenta, avg 2hr after birth, period of immediate recovery-homeostasis, observe for complications-abnormal bleeding
SVD Spontaneous Vaginal Delivery-Cephalic/vertex, most common
FAVD Forceps Assisted Birth-Instrumental/operative vaginal delivery, Outlet forceps-fetal skull reached perineum, Low forceps-presenting part at station +2, Midforceps-fetal head is engaged
FAVD-Indications threat to mother or fetus, Hx of heart disease, pulmonary edema, exhaustion
FAVD-Conditions cervix completely dilated, engagement, ruptured membranes, vertex or face presentation, bladder empty, CPD ruled out
FAVD-Risks Newborn-ecchymosis/edema of face, lacerations, succedus caput or cephalhematoma->hyperbilirubinemia, transient paralysis, cerebral hemorrhage, Maternal-lacerations of birth canal, 3rd or 4th degree extension of episiotomy, bleeding, bruising, edema
FAVD-Nursing Care decrease need for oper vag birth, correct labor dyst PRN, encrage posit changes, amb, empty client bladder freq, correct FHR decel, apply O2 PRN, ^fluid intake, assist ID contracts, reinfrce push w/ tract, assess newborn, assess mom for REEDA/hematoma/inf
VVD Vacuum Assisted Birth-vacuum extractor used to apply suction to fetal head, traction applied during contractions, decent should be seen w/ first two pulls
VVD-Risk/Nursing Care cephalhematoma of newborn, keep family informed, assess FHR, assure that caput will disappear w/in 3 days, assess newborn for intracerebral hemorrhage, jaundice
Cesarean Birth/C-section birth of infant through an abdominal and uterine incision, repeat-elective-preservation of pelvic floor
VBAC Vaginal Birth After Cesarean-rule out CPD, adequate pelvis, low transvers incision
Perineal Episiotomy surgical incision in perineum to enlarge vaginal outlet-1st degree-extend through skin, 2nd degree-skin & muscle, 3rd degree-skin, muscle, & anal sphincter, 4th degree-skin, muscle anal sphincter & rectal wall
REEDA redness, ecchymosis, edema, discharge, approximation
Episiotomy-Median/midline most common in U.S., effective, easy to repair, least painful, extension to or through anal sphincter more likely
Episiotomy-Mediolateral need for posterior extension, 3rd degree laceration may occur, blood loss greater, difficult to repair, more painful
Episiotomy-Prevention prenatal Kegel exercises, perineal massage, natural pushing, side-lying pushing position, warm compresses, counterpressure
Episiotomy-Care assist w/ distraction and discomfort during repair, apply ice 20-30 min, inspect every 15min x4, REEDA
Contractions-Frequency beginning of on contraction to beginning of the next
Contractions-Duration time between beginning of a contraction to the end of same contraction
Contractions-Intensity strength of contraction at peak/acme, fundus palpated for indentibility, measured accurately with Intrauterine Pressure Catheter(IUPC)
Resting Tone tone of muscle between contractions
Contractions-Maternal Danger Signs hyperstimulation of uterus->uterine resting tone >25mmHg, uterine contractions >90sec, uterine resting period <30sec
Pelvic Inlet upper border of true pelvis; sacral prominence around superior aspect of symphysis pubis, widest diameter: transverse 13.5cm
Pelvic Outlet lower border of true pelvis; coccyx to ischial tuberosities to inferior aspect of symphysis pubis, widest diameter: anterior/posterior, 9.5-11.5cm, may be increased by 1.5-2cm w/ squatting/sitting
Cephalic Presentation 96-97% of births, head presented into passageway, classified according to attitude of fetal head: degree of flexion or extension
Cephalic Presentation-Vertex most common, head flexed on chest, smallest diameter-suboccipitobregmatic 9.5cm, presenting part-occiput
Cephalic Presentation-Military head neither flexed nor extended, occipitofrontal 11.75cm, presenting part-top of head
Cephalic Presentation-Brow head is partially extended, largest anterior-posterior diameter, occipitomental, presenting part-sinciput
Cephalic Presentation-Facial head complete extension, submentobregmatic, presenting part-face
Breech Presentations 3% of births, buttocks &/or feet presented to pelvis, sacrum is landmark
Breech Presentation-Complete knees and hips flexed; buttocks and feet present(cannonball)
Breech Presentation-Frank hips flexed, knees extended, buttocks present(pike)
Breech Presentation-Footling hips and legs extended, feet present, single or double footling
Shoulder Presentation transverse/horizontal, presenting part-shoulder, presenting part-acromian process of scapula
Cardinal Movements adaptions that fetus undertakes to maneuver through the pelvis during birth and labor
Pain Management breathing techniques-open mouth/pant & blow, analgesics, anesthetics, touch-effluerage/soft stroking
Analgesics decrease amount of pain perceived-Stadol, Demerol
Anesthetics regional, spinal, local, general
Anesthetics-Epidural med injected into epidural space, catheter/epidural, onset 20-30min, lasts 2 hours then re-injected
Anesthetics-Spinal Block med injected into spinal fluid, quick onset, lasts 18-24 hours
Anesthetics-Epidural/Spinal need baseline for mother and baby, must be in ACTIVE labor, monitor respiratory rate, SE; hot spots, has to wear off, itching, N/V, urinary retention, SE decreased w/ Narcan
Rupture of Membranes-Nursing Management assess fetal heart rate, color, odor, clarity, volume, and time
Labor Complications-Dystocia long, difficult, abnormal labor, often during 1st stage, primary cause for C/S delivery, often caused by dysfunctional labor
Hypertonic Uterine Dysfunction latent stage, cervical dilation <4cm, contractions uncoordinated, frequency ^, intensity decreasing but painful, resting tone ^
Hypertonic Uterine Dysfunction-Complications intrauterine infection, repeated vaginal exams, exhaustion, fetal distress, hypoxia, late decelerations, decreased uteroplacental blood flow, ^prolonged pressure on head, cephalhematoma
Hypertonic Uterine Dysfunction-Tx rest & fluids, narcotics-morphine sulfate/meperidine/tocolytics-inhibits uterine contractions, reduce pain, barbiturate-to allow sleep, usually will awake w/ normal labor pattern
Hypotonic Uterine Dysfunction normal/active labor progress to at least 4cm, then become weak/inefficient-<25mm Hg or stop compleatley, frequency decreasing, intensity decreasing, resting tone unchanged
Hypotonic Uterine Dysfunction-Tx ultrasound/x-ray to rule out CPD, assess FHR/pattern, amniotic fluid, maternal well-being, if those normal may ambulate, hydrotherapy, ROM, Pitocin augmentation
Hypotonic Uterine Dysfunction-Complications fetal distress, risk for infection, tachycardia, intrauterine infection, exhaustion, dehydration, risk for postpartum hemorrhage
Pathologic Rings-Soft Tissue Dystocia constriction rings/hourglass-rare-form and impedes fetal decent, contractions not starting at pacemaker, dangerous, give analgesics/anesthetics to relax rings, C/S
Precipitous Labor/delivery powers work too well, labor <3hrs before birth, 5 contractions in 10min, may be from hypertonic UC, pressure may reach 50-70mmHg, lower uterine segment very soft
Precipitous Labor/delivery-Management NEED dr, stay calm, encourage to push btw contractions, gentle counter pressure to presenting part, if head out check for nuchal cord, suction-mouth 1st then nose, clamp & cut cord, assess & place baby to breast
Precipitous Labor/delivery-Risks lacerations of birth canal, hemorrhage, uterine rupture, hypoxia, trauma to head, intracranial hemorrhage, lack of care/attendance of healthcare personnel, call for help-do not leave!
Uterine Rupture-Incomplete extends into peritoneum but not peritoneal cavity, may be partial separ of old C/S scar, abd tenderness, pain w/ and w/o contractions, small amt vag bleeding/usually internal, dist lower uterine segment, failure of labor to progress->early signs of shock
Uterine Rupture-Complete extends through entire uterus into peritoneal cavity, profuse bright red bleeding, tore away-sharp abd pain, abnormal feel/shape of uterus, rapid onset hypovolemic shock, rapid onset of fetal distress-bradycardia
Labor Induction cervical ripening agent 1st, Pitocin titrated to regular labor pattern
Created by: neffielewis