HGTC OB Test 2
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Engagement | show 🗑
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| Process of engagement in cephalic presentation. Floating | show 🗑
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| Process of engagement in cephalic presentation. Dipping. | show 🗑
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| show | The biparietal diameter (BPD) of the fetal head is in the inlet of the pelvis. In most instances the presenting part (occiput) is at the level of the ischial spines (zero station).
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| Powers of Labor:Primary force | show 🗑
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| Powers of Labor: Secondary force | show 🗑
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| show | Lightening; Surge of energy; braxton hicks; ripening of cervix; rupture of membrane; bloody show
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| show | Fetus drops: Uterus sinks downward and forward--Occurs about 2 wks before term (Mulitparous: May be after contractions established)
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| Surge of energy | show 🗑
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| show | Frequent but irregular and intermittent -Become stronger -Abd and groin pain
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| show | Cervix becomes soft (ripens) -Increase in water -May begin to dilate
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| show | Membranes may rupture spontaneously --Labor within 12-24 hrs
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| show | Mucus plug expelled - Brownish or blood-tinged cervical mucus - Labor in 24-48 hrs
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| show | Diarrhea --N/V --Indigestion - Loss of weight: 1 to 3 lb; loss of water
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| Actual signs of labor | show 🗑
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| show | Regular, progressive - Increase in frequency, duration and intensity - Pain in back and radiated around abdomen
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| show | Thinning of cervix - Muscles of the upper uterine segment shorten -- Drawing upward of the internal os and cervical canal
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| Actual signs of labor:Dilation | show 🗑
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| show | Begins with onset of regular contractions (mild) - Ends with full dilation of cervix --Longer than 2nd & 3rd stages
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| First Stage of Labor consists of 3 phases: | show 🗑
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| show | Progressive effacement of cervix - Little increase in descent - Excited and anxious
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| First Stage consists of 3 phases: Phase 2 Active | show 🗑
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| First Stage consists of 3 phases: Phase 3 Transition | show 🗑
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| show | Lasts from the time cervix is completely dilated to birth of fetus - Avg 20 min for multip (30min) - Avg 50 min for nulliparous (3hr) - Crowning occurs when birth is imminent -- Head encircled by vaginal introitus - Sense of purpose -- Burning sensation
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| show | From birth of fetus - Until placenta is delivered - Placenta normally separates with 3rd or 4th contraction after fetus is born - Length from 3-5 min to 1 hr -Risk of hemorrhage increases as length of stage increases
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| show | Recovery 1-4 hours after delivery of placenta -- Avg 2 hr after birth - Period of immediate recovery, homeostasis -- Observe for complications: Abnormal bleeding
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| Types of deliveries: SVD | show 🗑
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| Types of deliveries: FAVD | show 🗑
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| Types of deliveries: FAVD : Outlet forceps | show 🗑
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| Types of deliveries: FAVD : Low forceps | show 🗑
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| Types of deliveries: FAVD : Midforceps | show 🗑
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| show | Threat to mother or fetus --History of Heart disease - Pulmonary edema - exhaustion
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| Conditions for forceps use | show 🗑
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| show | Ecchymosis and/or edema of face - Lacerations - Caput or cephalhematoma -- Hyperbilirubinemia - Transient paralysis -Cerebral hemorrhage
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| show | Lacerations of birth canal -- 3rd of 4th degree extension of episiotomy - Bleeding, bruising, edema
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| show | Correct labor dystocia PRN: Encourage position changes, ambulation -- Empty client bladder frequently / Correct FHR decelerations: Assist with maternal position changes -- Apply oxygen PRN - Increase fluid intake
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| show | Assist with ID of contactions - Reinforce pushing with traction - Assess newborn for edema, bruising, caput, cephalhematoma - Assess mother for REEDA -- Hematoma, infection
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| show | redness, edema, ecchymosis, drainage, approximation
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| show | Vacuum extractor used to apply suction to fetal head: Traction applied during contractions - Descent should be seen with first two pulls
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| show | cephalhematoma of newborn
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| show | Keep family informed; Assess FHR -- Reassure that caput will disappear within 3 days -Assess newborn for intracerebral hemorrhage, jaundice
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| show | Birth of infant through an abdominal and uterine incision: Repeat C/S - Elective C/C --Preservation of pelvic floor
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| Types of deliveries: VBAC | show 🗑
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| Perineal Episiotomy | show 🗑
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| Perineal Episiotomy: 1st degree | show 🗑
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| show | Extends though skin and muscle
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| Perineal Episiotomy: 3rd degree | show 🗑
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| show | Extends though skin/muscle/anal sphincter/ anal wall
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| show | Primigravida - Macrosomia LGA - Forceps or vacuum assisted delivery - Shoulder dystocia
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| show | Lithotomy positions -- Breath-holding during pushing -Limited time for 2nd stage
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| Episiotomy:Describe site and direction of incision: Median (midline) | show 🗑
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| Episiotomy:Describe site and direction of incision: Mediolateral | show 🗑
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| Episiotomy Prevention | show 🗑
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| Care of episiotomy | show 🗑
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| Complications Associated with Episiotomy | show 🗑
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| show | Progesterone: causes relaxation of smooth muscle tissue / Estrogen: causes stimulation of uterine muscle = contractions
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| Need for Mobility - Physiology of contractions:Muscle fibers | show 🗑
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| Uterine contractions: Frequency | show 🗑
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| show | Time between the beginning of a contraction to the end of the same contraction
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| Uterine contractions: Intensity | show 🗑
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| show | Tone of muscle in between contractions
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| Pelvis can be divided into 2 | show 🗑
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| True pelvis – divided into 3 parts | show 🗑
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| Pelvic inlet | show 🗑
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| Pelvic Outlet | show 🗑
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| show | Leopolds maneuvers; Vaginal exams; Auscultation of FHT; Sonography or X-ray
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| show | Occurs approx. 96 - 97% births --Head presented into passageway - Classified according to attitude of fetal head: degree of flexion or extension
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| Classification of Cephalic Presentations: Vertex Presentation | show 🗑
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| show | (Cephalic Presentation):Head neither flexed nor extended - Diameter presented to pelvis - Occipitofrontal 11.75 cm - Presenting part - Top of head
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| show | (Cephalic Presentation):Head is partially extended - Diameter presented to pelvis - largest anterior-posterior diameter - occipitomental --Presenting Part - sinciput
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| Breech Presentation | show 🗑
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| show | Complete, Frank, Footing
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| show | Knees and hips flexed; buttocks and feet present -- Landmark: sacrum
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| show | Hips flexed, knees extended; buttocks present -- Landmark: sacrum
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| show | Hips and legs extended, feet present - Single footling, Double footling - Landmark: sacrum
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| Pelvis can be divided into 2 | show 🗑
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| show | Inlet, outlet, mid-pelvis (pelvic cavity)
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| show | Upper border of the true pelvis; sacral prominence around superior aspect of symphysis pubis - Widest diameter: transverse 13.5 cm
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| show | Lower border of true pelvis; coccyx to ischial tuberosities to inferior aspect of symphysis pubic - Widest diameter: anterior/posterior: 9.5 – 11.5 cm - May be increased by 1.5 cm to 2 cm -Squatting, sitting
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| show | Leopolds maneuvers; Vaginal exams; Auscultation of FHT; Sonography or X-ray
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| Cephalic Presentation | show 🗑
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| Classification of Cephalic Presentations: Vertex Presentation | show 🗑
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| Classification of Cephalic Presentations: Military Presentation | show 🗑
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| Classification of Cephalic Presentations: Brow Presentation | show 🗑
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| Breech Presentation | show 🗑
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| Classifications of Breech Presentations | show 🗑
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| show | Knees and hips flexed; buttocks and feet present -- Landmark: sacrum
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| Breech Presentations: Frank | show 🗑
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| Breech Presentations: Footling | show 🗑
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| show | Presentation: Transverse lie / Horizontal lie - Most frequently, the presenting part is shoulder - Landmark: Acromion process of scapula
Other presenting parts --Arm, back, abdomen, side
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| Cardinal movements: Adaptations that fetus undertakes to maneuver through the pelvis during birth and labor. | show 🗑
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| Breathing techniques: Slow chest | show 🗑
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| show | Breathe in and out rapidly through your mouth about one breath per second. Keep your breathing shallow and light. Your inhalations should be quiet, but your exhalation clearly audible.
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| Breathing techniques: Variable (Transition) Breathing | show 🗑
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| Anesthetics: Regional | show 🗑
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| Anesthetics: Local | show 🗑
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| Anesthetics: General | show 🗑
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| show | Anesthetics: Spinal --Epidural --Intrathecal --Paracervical --Pudendal
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| show | Anesthetics:used in repair of perineum
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| show | Hot spots, Has to wear off, Itching,nausea & vomiting, Urinary retention,Side effects decreased with narcan
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| Anesthetics: Regional | show 🗑
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| Anesthetics: Local | show 🗑
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| Rupture of membranes: Spontaneous(SROM) | show 🗑
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| show | Anesthetics: used for C-section
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| show | Injected into epidural space (L4- L5 or L5- S1) Catheter placed (epidural)--Takes 20-30 minutes to work (epidural) --Lasts 2 hours then needs med re-injected
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| show | Injected into spinal fluid --Onset quick (intrathecal) --Lasts 18-24 hours
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| show | Hot spots, Has to wear off, Itching,nausea & vomiting, Urinary retention,Side effects decreased with narcan
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| Rupture of membranes: (kinds) | show 🗑
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| show | Rupture of membranes: Can initiate labor or occur anytime during labor --Usually during transition
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| Rupture of membranes: Prolonged (PROM) | show 🗑
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| Rupture of membranes: Nursing Management | show 🗑
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| Rupture of membranes: Artificial (AROM) | show 🗑
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| TACO | show 🗑
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| show | Assess FHR prior (if possible) -Assess FHR after - ? Decels – R/O prolapsed cord
- Assess color, odor, clarity, volume, time ----TACO
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| show | T = time the membranes ruptured, A = amount of fluid, C = color of the fluid and O = odor of the fluid.
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| show | Long, difficult, abnormal labor; Occurs often during 1st stage labor -Primary cause for C/S delivery
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| Suspected Dystocia (S&S) | show 🗑
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| Dystocia Etiology | show 🗑
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| show | Dysfunctional Labor
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| show | 1)Dysfunctional labor (powers); (2)Pelvic structure alteration (passage); (3)Fetal variations (passenger); (4) Mother’s response (psyche); (5) the ralationship between the passage and the passenger
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| Hypertonic Uterine Dysfunction: Primary Dysfunctional Labor : Occurrence | show 🗑
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| Hypertonic Uterine Dysfunction: Uterus | show 🗑
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| Hypertonic Uterine Dysfunction: Maternal complications | show 🗑
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| Hypertonic Uterine Dysfunction: Fetal complications | show 🗑
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| Hypertonic Uterine Dysfunction: Treatment | show 🗑
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| show | Normal progress into active labor at least 4 cm - Then UC’s become weak, inefficient --< 25mm Hg or stop completely - Uterine Contractions: Frequency (decreasing); Intensity (decreasing); Resting tone(unchanged)
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| show | Ultrasound or x-ray to R/O CPD: cephalic/pelvic disproportion - (CPD and malpositions common cause)Assess FHR and pattern, amniotic fluid (if ruptured) and maternal well being -If above normal, may ambulate, hydrotherapy, ROM - Pitocin augmentation
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| show | Fetal distress -Risk for Infection--tachycardia Maternal complications--Risk for Intrauterine infection -Exhaustion-Dehydration-Risk for postpartum hemorrhage
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| L & D Complication: Pathologic Rings – Soft Tissue Dystocia | show 🗑
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| Pathologic Rings: Treatment | show 🗑
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| show | Powers work too well (Labor less than or = 3 hours before birth) Characterized by 5 contractions in 10 minutes -May result from hypertonic UC’s --Intrauterine pressures may reach 50-70 mmHg --Lower uterine segment very soft
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| show | Emergency delivery --Stay calm!!! --Encourage to push between contractions -Apply gentle pressure to presenting part -nHead out - check for nuchal cord--Suction nose and mouth - After delivery, clamp cord, cut cord --Assess and place baby to breast
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| show | Possible lacerations of birth canal
No gradual stretching of the cervix, vaginal wall or perineum. -Gentle counter pressure placed on fetal head during delivery--Postpartum hemorrhage --Uterine rupture
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| show | Possible hypoxia (Resulting from frequent intense contractions, decreased rest periods) ; Trauma to head (Possible resistance of cervix--Intracranial hemorrhage) ; Possible lack of immediate care (lack of attendance of health personnel)
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| show | Extends into peritoneum but not into the peritoneal cavity;Abdominal tenderness-Pain with and without contractions;Usually internal bleeding;Palpable retraction ring;Distention of lower uterine segment;Failure of labor to progress
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| L&D Complications:Complete Uterine Rupture: | show 🗑
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| Complete Uterine Rupture: Management | show 🗑
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| show | Require laparotomy--Repair of uterus --Blood transfusion
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| Labor Induction: Prostaglandins | show 🗑
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| Labor Induction: Cervidil | show 🗑
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| show | Gel -0.5mg/2.5 ml syringe into cervical canal-Repeat in 6 hrs
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| Labor Induction: Laminaria | show 🗑
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| Labor Induction: Amniotomy- AROM | show 🗑
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| Labor Induction: Misoprostol (Cytotec) | show 🗑
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| show | Prior to induction, begin EFM, assess VS and UC’s -Begin primary infusion of IVF --Infuse Pitocin into lowest port of primary IV tubing -Control and titrate on IV pump --Monitor UCs - Monitor FHR closely --Observe fetal response to labor
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| show | UCs are closer than 2 minutes, last longer than 90 seconds, or any indication of fetal distress
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| Cord Prolapse: | show 🗑
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| show | Cord compression….hypoxia…Variable decelerations
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| Cord Prolapse: Nursing Management | show 🗑
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| Persistent Occiput Posterior (POP) Position: | show 🗑
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| show | Knee-chest/genupectoral position -Assist in left lateral position - Pelvic rock, lateral stroking -Walk or climbing stairs -Squatting, Hands and knees (all fours)
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| POP Management: Measures to relieve back pain: | show 🗑
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| BREECH Presentation: | show 🗑
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| show | C-section required
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| BREECH Presentation: Multigravida | show 🗑
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| show | Prolonged labor due to decreased pressure on cervix --PROM; increased risk of infection - C/S or forceps delivery-Trauma to birth canal-Intrapartum/postpartum hemorrhage
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| show | Sterile Vaginal Exam (SVE) – feel unusual presenting part -Can be delivered but sometimes causes severe facial bruising --May have difficulty sucking
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| show | Fetus lying sideways -Fetal axis perpendicular to maternal axis - May not feel fetal parts in fundus or above symphysis pubis - Shoulder is the common presenting part -Pathologic rings of the uterine muscle can occur ; Treatment: C/S
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| Shoulder Dystocia: Management | show 🗑
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| show | Prolonged second stage of labor -Excessive Fetal size -Maternal pelvic abnormality
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| show | Fractures of the humerus and clavicle-Edema, hemorrhage, Erb’s palsy - Caput succedaneum-Asphyxia
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| show | Bladder injury -Cervical, vaginal or perineal lacerations - Spontaneous separation of the symphysis - Uterine rupture - Uterine atony and Postpartum hemorrhage
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| show | Slowing progress of labor - Turtle sign- )(fetal head retracts or recoils against the maternal perineum) - External rotation may not occur
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| show | Time of maneuvers and time delivered.
Sample documentation:
1210 shoulder dystocia called by Dr. ___.
McRoberts maneuver immediately implemented and suprapubic pressure applied by ______.
1215 infants shoulder and body delivered.
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| show | Baby > 4000gms -C-section usually!!
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| Problems with Passageway: CPD : Cephalo-pelvic disproportion (C-section – only treatment): Nurse prepares patient for surgery by | show 🗑
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| Reasons for C-section / Cesarean delivery | show 🗑
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| show | Primary:First c-section ; Repeat:Second or third or etc. ; Pfannensteil incision: Bikini cut -Low-transverse; Classical incision:Vertical incision
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| show | IV, foley, prep, consent -Need lots of emotional support
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| show | What it expect after surgery -Pain management -Postanesthesia effects - T,C, & DB -Diet -Dressing -Fundal & lochial checks
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| show | Explain procedures if patient awake -Anesthesia -Sterile prep and drapes -Let mom see baby as soon as possible
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| Admission to Postpartum Unit: Receive C-section patient | show 🗑
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| show | Aspiration, Hemorrhage -Infections, Injury to bowel or bladder-Thrombophlebitis -Pulmonary embolism
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| show | Injury at birth -Respiratory problems
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| Maternal Response to Labor: Cardiovascular and Respiratory Changes | show 🗑
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| Maternal Response to Labor: Renal Changes: | show 🗑
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| show | Gastric motility decreased, emptying prolonged, volume increased -WBC count increases -Blood glucose decreases
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| Fetal Response to Labor | show 🗑
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| show | Birth until 6 weeks after
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| Puerperium Period: Cervical changes | show 🗑
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| Uterine Involution: Involution | show 🗑
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| show | allows for healing and is important part of involution
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| show | uncomplicated labor and birth -complete expulsion of placenta or membranes
–breastfeeding
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| Uterine Involution: Fundal position changes; After delivery of placenta | show 🗑
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| show | Uterus is at level of umbilicus
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| show | Decreases by one fingerbreadth per day -Descends into pelvis by 10th day - Pre-pregnancy size by 5-6 wks
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| Documentation: Fundus | show 🗑
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| show | red/fresh – day 1-3
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| show | pinkish-brown – day 3-10
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| show | white/yellow – additional wk or 2
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| Sterilization: Bilateral Tubal Ligation (BTL) – Female Sterilization | show 🗑
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| Sterilization: Bilateral Tubal Ligation (BTL) – Female Sterilization: Complications: | show 🗑
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| show | Surgical severing of the vas deferens in the scrotum– 3 – 36 ejaculations needed to clear the vas deferens ; Alternative birth control required untill then ; 2-3 sperm samples and Rechecked at 6 and 12 months
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| show | pain, infection, hematoma, granulomas
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| show | Initiated by decreased hormones -Initial milk is colostrum ; Prolactin stimulates the production of milk ; Suckling at the breast will continue lactation ; Milk comes in on the 3rd to 5th day
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| show | skin
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| Reproductive Assessment: Perineum ; Lacerations/Tears/ 2nd degree | show 🗑
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| Reproductive Assessment: Perineum ; Lacerations/Tears/ 3rd degree | show 🗑
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| Reproductive Assessment: Perineum ; Lacerations/Tears/ 4th degree | show 🗑
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| show | Median or Mediolateral
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| Evaluation of Episiotomy Healing:R E E D A | show 🗑
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| show | Increased need for protein -Increased need for iron
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| show | Additional 200 kcal above pregnancy requirements ; increase calcium, protein and fluids
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| show | 6-8 wks -If average wt gain 25 – 30 lbs
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| Postpartum Weight Loss: Initial loss | show 🗑
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| show | 5 lbs - Increased urination, sweating
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| Comfort/Sleep Interventions | show 🗑
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| show | First void since delivery-Palpate for fullness or distention - Amount of first voiding -Assess for perineal swelling
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| Elimination: Bladder Assessment: Fundus higher than normal upon palpation;Not in midline; Suspect distended bladder | show 🗑
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