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What is the first thing you do prior to any analgesic administration?
do a complete assessment
What does APGAR stand for?
appearance, pulse, grimace, activity, respiration
what is amniotomy?
artificial rupture of membranes
What should you assess when a patient is getting general anesthesia?
assess when they last ate or drank
Where is the fundus located?
at the midline at the umbilicus
What is abruptio placentae?
Premature separation of a normally implanted placenta.
What are the two forces of labor in critical factor 4?
Primary powers secondary powers
Which description explains striae gravidarum encountered in a client in her 26th week of gestation?
Reddish streaks on the abdomen and breasts
Offspring of men of advanced paternal age are at an increased risk for which condition?
Schizophrenia
A client is being initiated on bisphosphonates. Which advice will the nurse provide?
"Take it on an empty stomach."
A client has just given birth to an infant with Down syndrome. The mother is crying and asks the nurse what she is supposed to do now. Which response would the nurse give?
"Tell me what you know about Down syndrome."
What is the maximum score for apgar?
10
The school nurse would teach the students that the ovum is no longer viable at which time interval after ovulation?
24 hours
What is nulliparas?
5 minutes apart for 1 hour
Which statement is an accurate description of dysmenorrhea?
Pain with menses
What is fetal attitude?
The relationship of the fetal parts to one another.
What are the risks with a episiotomy?
blood loss, pain, infection, perineal discomfort
What are the phases of contractins?
increment acme decrement
what is the most favorable fetal position?
occiput anterior
What side of the placenta is the fetal side?
the shiny side
What triggers the development of DIC?
thromoplastin
What is the frequency of contractions?
timing from the beginning of one contraction to the beginning of the next contraction
What do you need to make sure when the baby is born?
to suction the nose and mouth. If not they will aspirate
What is a pudendal?
transvaginal, intercepts signals to the nerve perineal anesthesia
What does the mom need to know before giving the pain medications?
type of med administration route usual effects of medication (how will she feel) affects to the neonate or fetus safety measures (remain in bed with side rails up)
WHen do you give a epidural block?
used to control labor and birth pain block a certain section of the peri area
what is a B back?
vaginal birth after cesarean
what is vertex presenation?
very top of the head is coming down through the pelvis chin is tucked
What is the cause of abruptio placentae?
we do not know
What position do you put the mom after a cervical ripening?
wedge under right hip, mom on her left side
When do we use the apgar system?
when the baby is born
what is modling?
when the bones overlap during delivery
When do you give a women analgesic during Nulliparas?
when the cervix is 4 to 5 cm dilated
When do you given a women analgesic during multiparas?
when the cervix is dilated to 3 to 4 cm.
What is Alba lochia?
whitish yellow and last for 10-28 days
A 16-year-old high school student comes to a community health center because of the fear of having contracted herpes. The teenager is upset and shares this information with the community health center nurse. Which response would the nurse provide?
"You sound worried. Let me make arrangements to have you examined."
How much dilation with the first stage of labor?
0-3 pain located in lower belly and back
What are the 4 stages of labor?
1. cervical dilation: Begins from contractions and ends with dilation to 10 cm. (two phases latent-first 2-4 cm dilation and active-rapid effacement and dilation) 2. Stage of expulsion Begins with complete dilatation and ends with the birth of the baby 3. placental stage Begins with the birth of the baby and ends with the birth of the placenta 4.maternal homeostatic stabilization stage From delivery of placenta to stabilization of mother (usually about 6 hours)
When should you start ushing?
10 cm because you can cause cervical edema and trauma and may delay birth
How much dilation with the 4th stage?
10 with pushing pain in the perineum
When will labor be induced?
12-24 hours if it does not occur after rupture of membranes
How much CO increases with a contraction?
15 %
The nurse is teaching a family planning class about ovulation and conception. For which period of time would the nurse inform the class that the ovum is capable of being fertilized after ovulation?
24 to 36 hours
How much additional daily protein intake is required by the lactating client?
25 G
What does the WBC's increase to with labor?
25,000 to 30,000 due to stress
What is early labor contraction?
25-40 mm hg
What is increment?
build up of contraction (longest phase)
What is the criteria for external cephalic version?
36 weeks gestation reassuring non-stress test fetal breech is no engaged
what is the typically time considered full term?
38th to 42 weeks
how much dilation with the second stage of labor?
4-8 pain in all belly
What is longitudinal breech presentation?
butt first
What is the success rate for external cephalic version?
50%
What is active labor contractions?
50-70 MM HG
What is multiparas?
6 to 8 minutes apart for 1 hour
What is a good apgar score?
7-10
What is pushing contractions?
70 to 100 mmhg
what is transition contractions?
70 to 90 mm hg
When does the posterior fontanelle close
8 to 12 weeks after birth
How much dilation with the third stage?
8-10 pain starts in belly and upper thigh and low back
How long can a vacuum assisted birth be left on?
8-10 minutes
What passageway is not favorable for birth?
Android because it is short and reduced
What is sinciput presentation?
Anterior fontanel (diamond shape) presents first chin not tucked or extended
What is uterine contractions?
cause cervical dilation and effacement ischemia due to decreased blood flow -the contraction pain is transmitted through the spinal cord
What is the most common regional analgesia and anesthesia for labor?
Epidural block or intrathecal spinal block pudendal block local infiltration
The nurse is caring for four postpartum clients, each with a different medical condition. Which condition will result in the primary health care provider advising the new mother not to breast-feed?
Human immunodeficiency virus (HIV) infection
Which definition would the nurse use to explain osteoporosis?
It involves a decrease in bone substance.
What are the 5 critical factors of labor?
Passageway passenger positions of mother power psychologic
What are the three areas of the pelvis?
Pelvic inlet midpelvis pelvic outlet
Which sexually transmitted infection is caused by protozoa?
Trichomoniasis
what are the complications after having a c section then giving vaginal birth?
Uterine rupture, infection thromboembolism and hysterectomy
What is central abruptio placentae?
separates centrally blood is trapped and is concealed cant see the blood
What is marginal abruptio placentae?
separates the edges, blood escapes vaginally
What are the different types of placenta previa?
low lying partial marginal compete
What are the different types of c sections?
low transverse incision classical incision low umbilical incision
what is the treatment for DIC?
maintain the cardiovascular status of the mother and the developing a plan for both of the fetus. csection crossmatch, fresh plasma, iv fluids
What does the nurse need to do within the first 4 hours after birth?
massage the fundus to make sure it is contracted
What is complete abruptio placentae?
massive vaginal bleeding
what are the risk factors to getting a epidural?
maybe ineffective "patchy" relief low BP increase length of labor result in ineffective pushing (which leads to a vacuum extraction or forceps delivery) headache/backache long term spinal nerve damage
What are the types of episiotomy?
midline and mediolateral
What are moderate adverse reactions to getting a epidural?
more severe degrees of milk symptoms plus n/v, hypotension and muscle twitching
What is used to reverse respiratory depression?
narcan
What happens to the fundus at the 4th stage of birth?
needs to stay well contracted without this the mom will continue to bleed a lot and hemorrhage
What does a apgar score less than 3 at 5 minutes mean?
neonatal mortality
What happens with thromboplastin is triggered?
normally elevated fibrinogen levels drop drastically
What is external rotation?
of shoulders to anteroposterior potion in pelvis
What is +4 engagement?
on the floor (at outlet) past the ischial spine
What is a precipitous birth?
one that occurs rapidly without MD
What is partial lying placenta previa?
os is partially covered
What can pain and stress lead to with dilvery?
oxygen and resp issues decreased o2 for the baby metabolic acidosis
What are mild adverse reactions to getting a epidural?
palpaitations, tinnitus, apprehension, confusion, metallic taste in mouth
What is acme?
peak of contraction
What are the two origins of pain?
perineal uterine contractions
What can we do to prevent having to do a episiotomy?
perineal massage to help stretch it natural stretching
What is serosa lochia?
pinkish brown color and last 4-10 days
What do we give for labor induction and augmentation?
pitocin
What is placenta previa?
placenta that is implanted in the lower uterine segment
What is brow presentation in fetal attidude?
poor flexion chin extended
What is lochia?
postbirth uterine discharge
What does foggy fundus mean?
soft and shushy we need to massage it if we feel this *means there is pooling of blood*
After treatment for a bladder infection, a client asks whether there is anything she can do to prevent cystitis in the future. Which response would the nurse give?
"Increase your daily fluid consumption."
What pain management is used during labor?
stadol fentanyl demerol nubain used early and labor intermittently or given through a PCA *use in caution with anyone who has a history of substance abuse*
What does estrogen do?
stimulates uterine muscles
What is the intensity of contractions?
strength of the estimated by palpation contractions, mild moderate or strong
What is tripping the membrans?
stretch and sweep rotate 360 degrees twice used to separate the amniotic membranes from the lower uterine segment helps to release protogadins that start contractions
What is perineal
stretching and expulsion local from laceration or tear
What happens when the mom is laying supine?
the CO decreases HR increases SV decreases
What helps identify the fetal head during vaginal examination?
the fontanels and sutures
What is the chunky side?
the moms side make sure it is fully there, if not could be still in the mom's uterus
What is a low-lying placenta previa?
the placenta is implanted in the lower uterine segment and is near the internal os but does not reach it
What is descent?
the progress of the presenting part through the pelvis
When looking for breech what are you going to feel for?
the sacrum
why would we use a forceps and vacuume?
premature placental seperation none reasuuring fetal status shortten the second stage and assist the women in pushing ineffetive pushing
what are the risks with episiotomy?
primigravida lithotomy position large baby LOP or ROP forceps or vacuum
What makes a higher risk of placenta previa?
prior c-section
A primigravida in the first trimester tells the nurse that she has heard that hormones play an important role in pregnancy. Which hormone would the nurse tell the client maintains pregnancy?
progesterone
What is secondary powers?
pushing with abdominal muscles causes expulsion of fetus and aids in the primary force after dilation
What does progesterone do?
relaxes smooth muscle tissue
WHat happens with the mother is side lying? (best postion)
CP increases HR decreases SV increases
What is brow presentation?
Cephalic presentation when fetus head is extended rather than flexed - will cause edema and bruising of the face
What is vertex presentation?
Cephalic presentation where it is a delivery in which the head comes out first. complete flexion chin tucked to chest
What is face presentation?
Cephalic presentation where neck is sharply extended and back of head is arching to the fetal back
What is military presentation?
Cephalic presentation with moderate flexion
What does metabolic acidosis lead to in delivery?
release of catecholamine which can cause the maternal blood vessel constriction
What is decrement?
release of contraction
what can happen when using the narcotic analgesics for mother during labor?
respiratory depression of both mother and fetus
What happens with a apgar of 7?
resuscitative measures
Which cause may produce abnormal uterine bleeding?
Hypothyroidism Failure to ovulate Bleeding disorders Unidentified pregnancy Use of oral contraceptives Benign lesions of the uterus
What is cervical ripening?
Increases cervical readiness for labor through promotion of cervical softening, dilation and effacement cervidal or cytotec makes the contraction harder and longer can be given because of hemorrhage-to stop it
When should a mother come to the birthing unit?
rupture of membranes reg, frequent contractions vaginal bleeding decreased fetal movement
Which information about nausea and vomiting in the first trimester would the nurse provide to the pregnant client?
It may be related to an increased human chorionic gonadotropin level.
What are severe adverse reactions to getting epidural?
LOC, coma, bradycardia, respiratory depression and cardiac arrest
What are the three types of abruptio placentae?
Marginal Central Complete
What are the fetal malpostion?
Mentum Sacrum Acromium
What can we use to help with respiratory depression of baby after birth?
Narcan
The nurse teaches a pregnant client regarding the necessity for a folic acid supplement. Folic acid taken in the first trimester of pregnancy helps reduce the risk for which neonatal disorder?
Neural tube defects
Which action would the nurse include in the plan of care for a client who is being treated for a sexually transmitted infection and reports fever and irregular bleeding?
The use of analgesics Abdominal palpation Complete blood count Culture of the cervical canal Administration of antibiotics as prescribed Teaching about negative effects of douching
A pregnant client tells the nurse that she has two toddlers at home and that their father abandoned the family last month and she doesn't know what to do. Which conclusion would the nurse make about the client's emotional state?
she feels overwhelmed by the situation
What do we do to aid the mom with contracting the fundus?
short injections of pitocin im or iv
What should we do with a precipitous birth?
attend to the women and guide the infants passage through the birth canal, clamp the umbilical cord and transport the infant to nursery care focus care on the women and the delivery of the placenta and contraction of the uterus
What are the nursing interventions for placenta previa?
bed rest, monitor blood loss, pain and contractility, FHR, vital signs, H&H, rh factor, IV and have blood ready for transfusion will need c-section
What is extension?
begins after head browns
After the client gives birth, her vital signs are temperature 99.3°F (37.4°C); pulse 80 beats per minute, regular and strong; respirations 16 breaths per minute, slow and even; and blood pressure 148/92 mm Hg. Which vital sign would the nurse check more frequently?
blood pressure
What is longitudinal transverse presentation?
shoulder first
What is primary powers?
singals geninning of labor uterine contractions involuntary contractions responsible for effacement and dilation
what happens with DIC occurs?
hemorrhage, hemorrhagic shock, renal failure caused by shock, vascular spasm, intravascular clotting small clots are formed within the blood vessles that consume coagulation proteins and platelets abnormal coagulation and bleeding results in various systems=micro clots disrupt normal blood flow to major organs and can lead to organ failure
What is fetal lie?
how the baby is positioned in the birth cancal?
What is aminoinfusion?
increase amniotic fluid volume help with premature labor put on continuous fetal monitoring have to do frequent vital signs
What is local infiltration?
inject anesthesia into the subq and IM areas of the perineum used to repair of tear or episiotomy
What is placental separation?
lengthening of the umbilical cord small spurt of blood change in uterine shape rise of the fundus in the abdomen
What do they use in a amniotomy?
a amnihook mom has to be at least 2 cm dilated can shorten the labor
What are the manifestation of abruptio placentae?
abdomen firm to stony hard, sudden dark red blood, uterus maybe enlarged and change shape may cause DIC
What is the goal with giving pitcocin?
achieve contractions every 2-3 minutes that lasts for 40-60 seconds with progress of labor.
What do you do prior to anesthesia?
administer prescribed meds such as antacid place wedge under mothers right hip to displace the uterus and prevent vena cava compression laying on left side o2 prior to start iv access
What is episiotomy?
an incision made in the perineum (skin just behind the vagina)
WHen do you give a spinal block?
anesthesia for C- section block from the best below one local section
When do we do the rating of the apgar scoring system?
at 1 minute and again at 5 minutes
What is external cephalic version?
changing fetal presentation
What is complete placenta previa?
completely covered
What is disseminated intravascular coagulation (DIC)?
damage to the uterine wall causes clotting with central abruption
What is rubra lochia?
dark red and last for 3-4 days
What happens with labor with the gastrointestinal?
delayed gastric emptying frequent n/v
What is expulsion?
delivery of rest of body
What is the purpose of the anterior fontelle?
diamond shape allows the growth of the brain does not close till 18 mo of age
WHen do you give local infiltration?
during birth or prior to episiotomy
WHen do you give pudendal block?
during birth or prior to episiotomy
What is marginal placenta previa?
edge of the placenta is covered
What is 0 engagement?
engaged at the ischial spine
What are the three things we look at when looking at the fetal skull?
face base of skull roof of the skill
What is the most important part of the assessment of the baby?
feeling of the cord after cut right by the belly button. feel it for 10 seconds and multiply by 18 and will tell us the HR
What is a common complication of general anesthesia for the fetus?
fetal depression
What is flexion?
fetal head meets resistance and chin flexes againts fetal chest
WHat is internal rotation?
fetal head rotates to fit pelvic cavity
What do we need to know before we use forceps and a vacuum?
fetal postion has to be known the membranes must be ruptured cervix had to be dilated type of pelvis has to be known bladder should be empty no cephalo disportation
What is lightening
fetal settles into pelvis
What is -4 engagement?
floating above the ischial spine
What is the duration of contractions?
from the beginning of one contraction to the end of the same contraction
What is the most common and most favorable pelvis for birth?
gynecoid
What are the different kinds of pelvises?
gynecoid-most fav android-not fav anthropoid-yes platypelloid-not fav
Where would the fundal height be located in a pregnant client at 16 weeks' gestation?
half the distance to the umbilicus
What is longitudinal vertex presentation?
head down
What is restituation
head turns to realign with body
What are signs of labor?
lightning braxton hicks contractions cervical softening and effacement blood show sudden burst of energy 1-3 lbs of weight loss
What is the 2 positions in the fetal lie?
longitudinal transverse