Week 2 Flashcards by Madeliene VanSipe

What information is provided by monitoring uterine contractions?

Frequency
Duration
Strength
Resting Tone
Relaxation Time

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Where may you see intermittent auscultation being done at?

Birthing center- or those not getting oxytocin

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T/F

Intermittent auscultation can be used on all patients and is less invasive than EFM

False- because not the WHOLE statement is true.

Intermittent auscultation should not be used on obese patients (difficult to use) and is only for those who are low risk (not on oxytocin). However, it is less invasive than EFM

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What is the external monitor called that goes on moms belly that monitors contractions?

Tocodynamometer (Toco)

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Uh oh… 2 parts.

1) What is an IUPC?

2) T/F

In order for a patient to be eligible to use an IUPC- the patient must have had their amniotic fluid ruptured.

1) Intrauterine pressure catheter (IUPC). Monitor that goes under fetal scalp

2) TRUE WILL BE ON TEST

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What are the 3 tiers for EFM (external fetal monitoring) interpretation?

Cat I: Normal
Cat II:Indeterminate
Cat III: Abnormal

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Bradycardia in a fetus is considered below what HR?

What is an example it could be from?

<110 BPM

EX. Mom received IV fentanyl

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Tachycardia in a fetus is considered above what HR?

What is an example it could be from?

> 160 BPM

EX. Mom is sick or dehydrated

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What are the 4 possible categories of variability?

Absent
Minimal
Moderate
Marked

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What type of variability do we want to see?

Moderate

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Are fetal accelerations a good or bad thing?

Good- indicate fetal wellbeing

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Accerlations are at least ____ BPM above baseline for at least ____ BPM. However, before 32 weeks gestation: defined as greater than or equal to 10 BPM and duration of greater 10 seconds

15, 15

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What are things that may cause accelerations?

Vaginal exam (touching baby)
Baby moving

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T/F

Decelerations are good and expected in a fetus HR

False

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Early deceleration is seen with….

It looks like…

Head compression and looks like a mirror image of the contractions

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Late decelerations are seen with _______ ________ __________ and looks like…

uteroplacental insufficiency and looks like…. the fetus hr climbs after the mothers contractions

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Variable decelerations are seen with _____ ________ and look like…..

Cord Compression and look like V’s on the monitor

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Prolonged Decelerations last more than ___ minutes but less than ___ minutes. This is seen when what happens?

Prolonged Decelerations last more than 2 minutes but less than 10 minutes.

This is seen when the cord comes out before the baby

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T/F

Contractions cause increased blood flow to placenta

False- contractions decrease blood flow to placenta and fetus

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Tachysystole is considered how many contractions in less than how many minute window (averaged over 30 minutes)?

Why is this such a big deal?

More than 5 contractions in 10 minutes (averaged over a 30 minute window).

It’s a big deal because the blood flow and oxygen flow gets slower to baby during contractions and the baby tires out when too many is short time.

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When you notice your patient going into tachysystole, what is the first thing you should do?

See if your patient is on pitocin and stop it if they are.

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The top (strongest point of a contraction) is called the what?

Acme

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The lowest (weakest point of a contraction) is called a what?

Nater

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You are OB nurse educating a 25 week old mom on what contractions should feel like in relation to parts of her body.

What parts of her body could the nurse describe as mild, moderate, and strong contractions?

Mild CONTRACTION: tip of nose
Moderate CONTRACTION: chin
Strong CONTRACTION FEELS LIKE YOUR: forehead

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5 components of FHR training that must be evaluated regularly are......

- Baseline rate - Baseline variablilty - Accelerations - Decelerations - Changes/Trends over time

When is LIONS PIT used?

When there's a problem with placental perfusion or fetal oxygenation

What does LIONS PIT stand for?

L- Left side: Place laboring patient in left lateral position I- IV Open: Improves placental blood flow O- Oxygen: Give supplemental O2 (Improves 02 to fetus) N- Notify Provider S- Stop PITocin

An amnioinfusion may be done with what complication?

Cord compression to relieve pressure

You are the nurse caring for a newborn with a 1-minute Apgar score of 4 and a 5-minute Apgar score of 6. Which test does the nurse anticipate may be performed following the birth of this newborn? A. Serum bilirubin level B. Umbilical cord blood gas analysis C. Newborn metabolic screening D. Capillary blood glucose level

B. Umbilical cord blood gas analysis

First stage of labor is divided into what two phases?

Latent & active

Which stage of labor? Dilation: 0-6cm Onset: Beginning of true labor Cxn Frequency: Last short time, occur farther apart Cxn pain: Mild- Moderate Cervical Change: Slow dilation and effacement

Latent phase of first stage of labor

Which stage of labor? Dilation: 6-10cm Onset: Dilation begins to accelerate Cxn Frequency: Closer together and last longer Cxn pain: Strong Cervical Change: Rapid Dialation

Active phase of first stage of labor

You a Labor and Delivery Nurse working in triage when a 38 week gestation mom states that she had a SROM. What are your priority nursing questions? Then, T/F Cervical checks need to be performed often because baby is imminent.

- What time did your water break? (We want her delivered within 18 hours to reduce risk of infection to baby) -What color was it? -Was there any odor? Then, False. We want to avoid cervical checks because we could introduce infection to baby since that water sac is no longer present

What nursing intervention needs to be a priority during the first stage of labor? What if my patient can't pee?

Ensuring the patient is voiding every 2 hours- if not it can impede baby from coming down and can also cause uterine atony If your patient can't pee then she needs to be straight cathed

What things can a doula assist with?

Massaging the patient and emotional support NO MEDICAL CARE

The second stage of labor begins with........

Full cervical dilation (10cm)

Which stage of labor is the infant born?

Second stage

What is the reflex called in which the woman has the triggers oxytocin release?

Ferguson reflex

What degree tear requires surgical repair?

4th degree

T/F Fundal pressure is never permitted because it increases the risk for shoulder distolgia and PPH.

True!

How does an episiotomy need to be assessed?

With the patient lying on her side. That is the only way to assess!

Which is the shortest stage of labor?

3rd stage

The placenta is usually expelled within how many minutes after birth? After ____ minutes of no placenta after the baby- it becomes problematic.

The placenta is usually expelled within 10-15 minutes of birth. After 30 minutes of no placenta after the baby- it becomes problematic.

This stage of labor begins with expulsion of placenta and lasts until woman is stable in immediate postpartum period, usually within the first 1-2 hours after birth.

4th stage of labor

What are signs in the 4th stage of labor that there is potential problems with mom?

- Excessive blood loss - Changes in vitals - Changes in level of consciousness

Your patient has just came out of the OR from giving birth va C-section. You must give her a recovery score component. What are the 5 things that go into account of this score?

1) Activity 2) Respirations 3) Blood Pressure 4) LOC 5) Color

What are the 5P's of L&D nursing? What do they mean?

- Passenger: fetus and placenta - Passageway: Birth canal - Powers: contractions - Position of the laboring woman - Psychology/psychological response

You are educating mom and dad about when the soft spots of the babys head should close. What should they be told?

Anterior fontanels closes at approximately: 18 months Posterior fontanels closes at approximately: 6-8 weeks

Grandma is visiting her brand new grand baby is the laboring room. She comments on the babys head and how it's cone shapped. She asks the nurse if it will be like that forever. How should the nurse respond?

The baby's head appears coned due to molding or overlapping of bones as baby was coming through moms pelvis. The baby's head should assume normal shape within 3 days.

What is the fetal presentation cephalic mean?

Baby is coming occiput (head) or vertex first

What is the fetal presentation breeched mean?

Baby is coming feet first (In the slide it says sacrum)

What is the fetal presentation shoulder mean?

Baby is coming with their scapula or shoulder out first

Describe fetal station

It is in relation to the ischial spines of the pelvis. If the number is negative - the baby is higher. If the number is positive- the baby is lower.

What is engagement?

Refers to 0 station- baby's head is in moms pelvis

Gynecoid Pelvis

Good type of pelvis. Easiest for birthing

Android Pelvis

Male shaped pelvis which makes vaginal birthing more difficult

Anthropoid Pelvis

Oval shaped pelvis - more difficult to vaginally birth children

Platypelloid Pelvis (Platypus)

More flattened shaped pelvis which makes it difficult to vaginally birth children

What is effacement?

Thinning and shortening of the cervix

When the cervix is 100% effaced- is it thin or thick?

Thin!

T/F When fully dilated- the cervix cannot be felt

True

What is the primary power in a patient giving birth?

Contractions

What is the secondary power in a patient giving birth?

Bearing down efforts from mom

T/F Mothers should avoid frequent position changes while in active labor.

False. Frequent adjustments help with circulation and allows equal pressure on the cervix.

Your patient is actively pushing and wants to lie on her side. Which side will you tell her to lie on and why?

Left side. If she lies on the right side it could compress the large arteries and main vessels decreasing circulation to the placenta

Which hormone is released in a woman who is highly stressed and anxious in the birthing process?

Catacholimine

Why may patients experience back pain prior to labor?

Their bodys release relaxin - a hormone which helps their muscles and ligaments stretch more during the birthing process

How is true labor defined? **Will be on test**

DILATION AND EFFACEMENT OF CERVIX AND DECENT OF THE FETUS

7 Cardinal Movements of Labor:

E-Engagement D-Descent F-Flexion I-Internal Rotation E-Extension R-Restitution (External Rotation) E-Expulsion

Explusion is the last phase of the __________ (phase of labor). It's also the ______ phase of the 7 cardinal movements of labor.

1) 2nd phase 2) Last phase

The first stage of labor lasts from......

The time dilation begins to the time when the cervix is fully dilated

The 2nd stage of labor is......

from the time of full cervical dilation to the birth of the infant

The 3rd stage of labor is from......

the infant’s birth to the expulsion of the placenta.

The 4th stage of labor is from.....

the delivery of the placenta through the first 2 hours after birth.

Contractions will cause which type of pain? What may they do?

Visercal. They may radiate

Somatic pain is described how? What is it from?

Described as: Burning, sharp, stinging From tissues ripping or stretching

Where is 1st stage and early 2nd phase labor pain felt?

Lower back, hips, and belly

Where is late 2nd stage and actual pain felt?

Vaginal region (worst), abdomen, back

Why can't epidurals be given too late in labor?

Fentanyl will cross placenta and decrease respirations and breathing to baby

Why cant opioid dependent patients recieve narcan?

They may go into a withdrawl state which could send them into seizure like activity

A spinal is typically indicated for patients who are giving birth how?

Via c-section

What needs to be done when a patient gets a spinal or epidural? What's also good to know?

Q5 minute vitals These can also wipe her sensation to feel out so she may need to be told when to push

1) What needs to be given and done 15-30 minutes before an epidural or spinal? 2) What needs to be done 20-30 minutes before a epidural or spinal?

1) 500-1000mL bolus of LR (because meds can drop BP) 2) Vital signs and FHR strip

Where is a spinal placed?

L3, L4, or L5

What things are needed in order for your patient to be eligible for an epidural? **Test question**

- Platelets at least 100,000 (or else risk of hematoma) - Pt needs to be able to cooperate) - Pt needs to be able to sit up and round back or lie on side in fetal position

T/F Patient needs to have an empty bladder prior to spinal/epidural

True

T/F Moderate FHR variablity is good as it indicates adequete fetal oxygenation, normal signs of acid base balance, and a well functioning central nervous system. Heart rate flucuations are 6-25 BPM.

True!!! We want moderate variability

Each small square on the monitor represents how long?

10 seconds

When using an external monitor- where does the FHR monitor go (top or bottom) and what is it used for?

Bottom and used to assess the babies HR response to the contractions

Week 2 Flashcards

(90 cards)