MCN Word Scramble
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| Question | Answer |
| 5 P's | pelvis, passenger, pelvis/presenting part, power, psyche |
| Types of pelvis | gynecoid, android, anthropoid, platypelloid |
| gynecoid | favorable, rounded, nl female caucasian |
| android | not favorable, heart shaped, male, narrow |
| anthropoid | favorable, oval, non-caucasian, born OP |
| platypelloid | favorable, oval, born OT |
| fetal head | sutures, mentum, sinciput, occiput, fontanelles, |
| sutures | frontal, saggital, coronal, lamboidal |
| fontanelles | anterior(larger,daimond shape,front, closes 12-18months), posterior(smaller, harder to find, triangle, closes 8-12weeks) |
| mentum | chin |
| sinciput | brow |
| occiput/vertex | go together, area between fontanelles |
| bregma | also area of anterior fontanelle, where coronal and saggital sutures meet |
| fetal attitude | flexion |
| fetal lie | relationship of baby and mothers spine...longitudinal=parallel.. transverse=perpendicular(c-section) |
| fetal presentation | body part of fetus at pelvic passage |
| vertex presentation (subocciptobregmatic) | head flexed on chest, presenting part occiput |
| military presentation (occiptofrontal) | no flexion or extension, presenting part top of head |
| brow presentation (submentobregmatic) | partial extension, presenting part sinciput (brow) |
| face presentation (occipitomental) | head hyperextended, presenting part face |
| breece | but of feet presenting first (complete, frank, or footling) |
| transverse lie | shoulder presentation (C section) |
| engagement | when baby reaches station 0, 2-several weeks before onset of labor or during labor. |
| station | relation of presenting part with ischial spine. -5 to +5..fully dilated at +2 or 3 |
| fetal position | R or L of maternal pelvis, presenting part (O,M,S,A), anterior, posterior, or transverse (A,P,T)..OA most common |
| Powers-contractions | primary and secondary work together, 3 phases (increment,acme,decrement), |
| primary force | uterine contractions=effacement & dilation, rhythmic but intermittent, between contractions relaxation |
| secondary force | use of ab muscles to push during 2nd stage of labor, adds to primary force after full dilation |
| psyche | accomplish task of pregnancy, coping mechanism, previous experience, support, preparation, cultural influences |
| physiology of labor | usually occurs 38th-42nd wk., exact cause not understood. progesterone w/draw hypothesis, prostaglandin hypothesis, CRH |
| progesterone withdrawal hypothesis | decrease progesterone allows estrogen to stimulate contractions. progesterone is administered to prevent preterm birth. increases 10x during pregnancy then drops |
| prostaglandin hypothesis | used to induce labor, inhibitor of prostaglandin in used to stop preterm birth (PGE) |
| corticotropin-releaseing hormone (CRH) | increase throughout pregnancy with sharp increase at term. known to stimulate prostaglandin F & E by amnion cells |
| effacement | thinning of cervix 0-100%. drawing up of the internal os and the cervical canal into side walls of uterus. long & think to short &thin |
| myometrial activity | effacement leading to cervical dilation |
| signs of labor | lightening, braxton-hicks, cervical changes, bloody show, ROM, energy burst, wt loss, N/V/D, indigestion |
| cervical changes in labor | goes from rigid and firm to weak and soft. collagen fibers decrease and water increases. softening of cervix=ripening |
| braxton-hicks contractions | irregular, intermittent, occurs throughout labor, uncomfortable, pain in ab and groin, false labor |
| lightening | baby drops making easier to breath but sitting on bladder and frequent urinating |
| bloody show | mucous plug expelled, labor normally begin 24-48 hours |
| SROM | 80% of people with go into labor within 24 hours |
| AROM | augment labor, induce labor |
| burst of energy | 24-48 hours before labor, do not overexert to waste energy needed for labor. |
| true labor | regular contractions, interval between shortens, increase in I,D,F, discomfort in back-ab, intensity increase w walking, dilation and effacement progress |
| false labor | contractions irregular, pain in ab, no change in I,F,D,dilation or effacement |
| client education of true/false labor | feel free to come in for exam only way to tell is by vaginal exam, hard to distinguish the difference |
| stages of labor | 1st stage-true labor to 10cm 2nd stage-pushing 3rd stage-placenta delivery 4th stage-1-4 hrs post birth |
| first stage | true labor until 10cm dilation. SROM/AROM occurs. 3 phases: latent/early phase, active phase, transition phase |
| latent/early phase | 0-3cm, beginning of regular contractions, talking and smiling, increase in I,F,D |
| active phase | 4-7cm, nl ask for epidural, fetal descent progressive, insrease anxiety and pain, decrease coping |
| transition phase | 8-10cm, increase in I,F,D, fear of being left alone, restless, changing positions, needs support, fetal descent dramatically, contractions q11/2-2 min for 60-90s |
| second stage | pushing stage, begins with complete dilation and ends with infant birth, 15m-3hours. feel pressure & urge to push. burning from stretching tissue |
| cardinal movement of labor | DIDRED, descent thru pelvis, internal rotation, delivery and extension of head, restitution (baby stops), external rotation, delivery of shoulders. |
| third stage | delivery of placenta. 5 to no more than 30min. bleeding-lengthening of cord-placenta. |
| types of placent | shiny-shultze=baby side dirty-duncan=mom side |
| fourth stage | 1-4hours after birth, readjustment begins, blood loss range 250-500ml, decrease in BP, increase pulse pressure, moderate tachycardia. |
| uterus 1-4hours post partum | remains contracted in midline of ab, fundus midway between symphysis pubis&umbilicus, N/V cease, thirsy&hungry, shaking chills |
| maternal systemic response to labor | labor and birth effect almost all maternal physiological systems |
| mom cardiovascular changes | CO&BP increase w contractions, fear, and pain. position affects CO. supine CO,SV,BP decrease and HR increase |
| mom fluid and electrolyte changes | sweating, IV fluids or oral fluids needed |
| mom respiratory changes | O2 demand&consumption increase w contractions, hyperventilation= Low PaCO2=rep. alkalosis=metabolic acidosis compensated. quickly reversed in 4th stage w change in RR |
| mom renal system changes | increase maternal renin, plasma renin, angiotensinogen, polyuria |
| mom GI system changes | gastric motility, absorption, and emptying time decreased while stomach volume remain increased. |
| mom immune system and blood values changes | WBC increase to 25-30,000mm3 due to neutrophils from stress, difficult to ID infection. Blood glucose decrease from energy burned=need less insulin |
| reasons for pain in labor | complexity of physical causes. dilation, hypoxia of uterine muscles, pressure, uterine stretching, distention of vagina |
| factors affecting response to pain | prep classes, culture, fatigue, experiences, anxiety, less energy, lose ability to cope, anticipate discomfort |
| fetal HR changes | decelerations can occur with increased intra cranial pressure |
| fetal acid base status in labor | blood flow decrease=decrease pH, in 2nd stage labor w increased contractions pH decrease more rapid, fetal O2 sat drops 10% |
| fetal hemodynamic changes | fetal reserve is enough to see the fetus through anoxic periods unharmed |
| fetal behavioral states | sleep state should be no longer than 40 min |
| fetal sensation | @37-38 weeks fetus can experience light, sound, and touch. fetus experiences labor as women labors |
| intrapartal maternal assessment | name, age, hx, LMP, EDB, physician, blood type, HPI, problem in prenatal, pregnancy data, feed method, ed, NST, BPP, |
| intrapartal risk screening | abnormal presentation, multiple gestations, hydraminos, smoking, SA, ethol, culture, prenatal care, PTSD, DM, AIDS |
| assessment of labor progress | assess contractions, dilation, effacement |
| contraction assessment | palpate, continuous electrical monitoring, note I,F,D,relaxation, pain |
| cervical assessment | dilation&effacement evaluated, vaginal exam can also provide info about membrane status, amniotic fluid, fetal position and station |
| determination of fetal position and presentation | inspecting&palpating ab, perform vaginal exam, auscultate FHR. ultrasound may also be used |
| auscultating fetal heart rate | handheld doppler ultrasound or fetoscope used, most clearly heard at fetal back |
| leopolds maneuver | systemic way to evaluate maternal ab by palpating and finding position of fetus, empty bladder before, lie supine with legs bent, hard with obese and high amniotic fluid |
| EFM | electronic fetal monitoring, continuous tracing of FHR, done if 1 or more problems present. -previous stillborn, complications, induction of labor, preterm labor, labor after csection, low FHR, nonreassuring status, meconium staining of fluid |
| FHR baseline rate | average FHR |
| FHR baseline variability | interplay between sympathetic and parasypathetic over 10min period. absent, minimal, moderate, marked |
| FHR accelerations | increase in FHR normally cause by fetal movement |
| FHR decelerations | decrease FHR from decreased blood flow, compression of fetal head |
| types of FHR decelerations | early, late, variable, sinusoidal, episodic, intermittent, prolonged |
| early FHR decelerations | occur before contractions |
| late FHR decelerations | decreased blood flow and O2 to fetus |
| variable FHR decelerations | compressed cord, hypertension |
| sinusoidal FHR decelerations | waveform, anemia, hypoxia |
| episodic FHR decelerations | result from vaginal exams |
| intermittent FHR decelerations | occur with less than 50% contractions |
| prolonged FHR decelerations | leave baseline for 2 min but no more than 10 min. |
| BUBBLE H2E | breast, uterus, bladder, bowel, lochia, episiotomy, homans sign, hemorrhoids, emotional status |
| nl FHR | 120-160 bpm |
| nl fetal RR | 30-60 |
| nl fetal temp | 36.4-37.2-rectal 36.6-37.2-auxillary |
| electronic monitoring | provides an objective continuous record of the uterine activity and the FHR, internal or external, indications for use vary. |
| electronic monitoring of uterine activity/contraction pattern | assesses contraction pattern, continuous tracing of contraction pattern, allows for evaluation of effectiveness of labor. |
| uterine external and internal monitors | external=tocodynamometer (toco) internal=intrauterine pressure catheter (IUPC) |
| Purpose of fetal monitoring | visual assessment of FHR, continuous tracing of FHR, evaluate fetal well being |
| fetal external and internal monitors | external=ultrasound internal=fetal scalp electrode |
| external monitoring advantages | non-invasive, can be done at any time, does not require ROM, can monitor multiples |
| external monitoring disadvantages | belts may be cumbersome, tracing may be affected by artifact/movement, only shows F&D for uterus, only show LTV for fetus |
| internal monitoring advantages | shows LTV and STV, direct measure of FHR, no gaps in tracing, more comfortable, can measure intensity |
| internal monitoring disadvantages | requires ROM, requires cervix 2-3cm, invasive, risk of infection, risk of uterine rupture |
| BPP-all done by ultrasound except FHR done NST | comprehensive assessment of fetal breathing movement, movement of body or limbs, fetal tone, amniotic fluid volume, and FHR 0-2 for each score of 8-10/10 nl |
| BPP is indicated when.. | risk of placental insufficiency or fetal compromise because: IUGR, DM, HD, HTN, preclampsia, sickle cell, hx stillbirth... |
| NST | evaluate fetal status, should show at least 2 accelerations of FHR with fetal movement on 15bmp lasting 15s or more over 20min |
| AFI | the vertical diameter of the largest amniotic pocket in each of the 4 quadrants is measured...over 8cm=hydramnios, less than 5cm olgiohydramnios |
| fetal scalp blood sampeling | done while mom in laborby checking pH to see if there is enough oxygen going to the brain, also done to check platelet counts |
| scalp stimulation test | examiner applies pressure to fetal scalp while doing vaginal exam, fetus who is not in stress or distress responds with an acceleration of the FHR |
| cord blood analysis | done to determine if acidosis is present, recommended when apgar score is less than 7 at 5min of age, nl blood pH should be 7.25 |
Created by:
gudknecht
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