NSG 210: exam 1

individual risk factors (pregnancy)

-biophysical factors (ex. nutritional, genetic) -psychophysical (ex. addiction, abuse, mental health) -sociodemo (ex. low income, race/ethnicity) -environment (ex. pollution, radiation)

Passage (childbirth)

-cartilage in pelvic bones soften -relaxin increases

estrogen's role

-causes uterus to inc. in size/weight -expands blood supply -contractions

second/third trimester complications

-congenital and chromosomal abnormalities -gestational diabetes -gestational htn / preeclampsia -infection

urinary system during labor

-decrease in sensing full bladder (ex. epidural numbness) -full bladder can inhibit fetal descent -bladder v active post partum

Duncan mechanism vs Schultz

-during 3rd stage Duncan: placenta separates from outer margins inwards so maternal surface of placenta delivered first Schultz: placenta separates from inside to outer margins, delivered fetal side presenting

hematopoietic system during labor (clotting factors)

-elevated fibrinogen (intra /post partum) -fibrinolysis decreases to promote coag at placenta site -protection from hemorrhage but increases risk for venous thrombosis (intra/post)

first stage: transition phase

-feeling anxious/out of control -restless -strong contractions q 1.5 - 2 min, 60 - 90 sec -increased rectal pressure -increase bloody show -ROM -amnesic between contractions -close to 10 cm

fetal protective mechanisms intrapartum

-fetal hemoglobin (higher o2 intake) -high hematocrit -high cardiac output

third stage of labor

-from birth til delivery of placenta (should be done within 30 min of birth) -uterus continues to contract to push it out

second stage of labor

-full dilation -contractions: frequency 1.5 - 2 min duration 60 - 90 s -strong -crowning -need to push -lots of encouragement -

objective data during gyno exam:

-hegar sign: softening/compression of lower uterine -goodell sign: softening of cervix -chadwich: violet blue vaginal mucosa/cervix at 6 weeks -englarged breasts

progesterone's role

-hormone of pregnancy bc allows it to be maintained -preps for lactation

respiratory system during labor

-hyperventilation is common -help slow breathing during labor to avoid hypercapnia

first trimester complications

-infections (Ex. rubella, toxoplasmosis) -ectopic preg -miscarriage: usually occurs d/t chromosome abn.

GI system during labor

-light meal during labor -ice chips -small amounts of liquids/juices -hard candy -GI motility is limited during labor

disorders affection male fertility

-low testosterone -hypopituitarism -endocrine disorders -structural disorders ex. testicular damage, hypospadias, varicocele -STIs -obesity -antispern antibodies -antihypertensive medications -with age: sperm shape, quality and quantity decline

what can cause failure to descend?

-malpresentation -multiple fetuses

what is the fetal biparietal?

-measured transversely b/w 2 parietal bones -avg. 9.5 cm -best when head is fully flexed

first stage: latent phase

-mild regular contractions -inc. in FDI -dilation -effacement -little/no descent -primigravida: 8.6 hours (no more than 20) -multipara 5.3 hr (no more than 14)

false labor characteristics

-no progressive dilating/effacement -irregular -do not increase in FDI -mainly in lower abdomen/groin -relived/unchanged by walking, changing position, water, shower/bath

a client in labor is having an indwelling urinary catheter inserted. which action by nurse would help prevent late decelerations during the procedure?

-place rolled towel under px right hip to displace uterus to the left which improves placental perfusion

common fetal complications from group B streptococcus infection

-preterm rupture -preterm birth -sepsis -pneumonia -meningitis

antibiotic prophylaxis treatment for GBS infection is required for a woman who:

-previous infant infection -bacteriuria -unknown status

factors affecting female infertility

-primary or secondary anovulation -hormone disorders -increased prolactin levels -developmental abnormalities -uterine adhesions -chronic cervicitis -PID -anemia -obesity there's many more of course; edit this/make card with exemplars

fetal pulmonary system during labor

-production of fetal lung fluid decreases as term approaches, and absorption increases -labor increases absorption -fluid comes out during delivery -left over is absorbed into its pulmonary and lymphatic circulation

true labor characteristics

-progressive dilation -effacement -regular -increase in frequency, duration and intensity -pain in back, radiating around abdomen -not relieved by ambulation

when are mom's vital signs best assessed during labor and why?

-time interval between the contractions because contractions decrease blood flow to placenta, which raises mom's BP and lowers pulse

uterine features during labor

-upper 2/3 of uterine muscle contracts to push fetus down -lower third and cervix remain less active so fetus can pass through the upper and lower uterus oppose each other during contractions and cause uterine cavity to become longer and narrow to help straighten fetus and pull it down toward pelvis

define embryonic period

-week 3 to 8 after fertilization -differentiation of body systems and organs occur -teratogenicity is biggest concern here

define fetal period

-weeks 9-birth

fetus presentation: left occipital anterior position

D

define amnioinfusion

Infusion of a sterile isotonic solution into the uterine cavity during labor to reduce umbilical cord compression; it may be done to dilute meconium in amniotic fluid.

define secundines

placental and fetal membranes expulsed after baby

4 P's of birth

power, passage, passenger and psyche

primary and secondary forces of labor

primary: uterine contractions secondary: abdomen muscles to bear down

define fetal attitude

relation of fetal body parts to each other

define station

relationship of the presenting part (head, whatever's coming first) to the ischial spines

define cortical reaction

response that occurs after a sperm binds to plasma receptors to prevent other sperm from fertilizing the egg

define synclitism

sagittal suture (on baby head) is midway between symphysis pubis and sacral promontory

in the cephalic anterior positions, the fetus is facing the mom's?

spine

ischial spine is also called

station zero / zero level / engaged once it makes it past ischial spine we say (+1, +2, +3, +4)

what's the nurse's responsibility when a client's labor is being stimulated with oxytocin?

stopping infusion is contractions become hypertonic

contraction intensity

strength of contraction mild: feeling like tip of the nose moderate: chin firm: forehead

what allow molding during birth?

sutures / fontanelles

define effacement

thinning and shortening of the cervix

immediately after amniotomy the nurse assesses the FHR for at least 1 full minute for signs of which complication?

umbilical cord prolapse

first stage: active phase

-anxiety -energy -focus -6 to 8 cm dilation -progressive descent -contractions increase in FDI

cardiovascular system during labor

-

fourth stage of labor

-1 to 4 hours after delivery maternal physiological changes: -blood redistributed to veins -moderate drop in BP -increased pulse pressure -moderate tachy -uterus contraction -N/V cease -thirsty, hungry -shaking/chills -maybe hypotonic bladder (urinary retention)

fetal cardio system during labor

-FHR: 110 to 160 bpm -premies may b higher

prostaglandins (PGs) role

-PGE: relaxes smooth muscle (Vasodilate) -PGF: vasoconstrictor

assessments and interventions after epidural insertion (4)

1.) maintain IV fluid 2.) O2 on hand (hypotension is common) 3.) check bladder for distention q 2 4.) monitor fetus

4 different types of ruptured membranes

1.) PROM: premature (before labor) 2.) SROM: spontaneous during height of intense contraction 3.) AROM: artificial rupture 4.) PPROM: premature premature; rupture < 37 weeks

administration of opioids during what phases of labor are contraindicated?

1.) birth is expected within 2 hours 2.) when birth is imminent (i.e.: second stage, once full dilation happens) reasoning: may cause respiratory depression in baby; too close to birth mom's consciousness can be altered

nursing interventions for variable decelerations

1.) change maternal position (side, knee chest) 2.) discontinue oxytocin if infusing 3.) administer O2 8-10L nonrebreather 4.) notify PCP 5.) relieve cord compression -amnioinfusion if ordered

characteristics of normal labor contractions

1.) coordinated (begin in the uterine fundus and toward cervix) 2.) involuntary: activity can stimulate them, anxiety and stress can diminish 3.) intermittent - this allows relaxation of the uterine smooth muscle so blood flow can go to and from placenta for essential nutrients

who/what are the passengers (childbirth)

1.) fetus: fetal head, lie, attitude, presentation, and position? 2.) membranes 3.) placenta

4 stages of labor/birth

1.) first stage: onset of true labor to complete dilation (10cm) -- has 3 sub phases 2.) second stage: complete dilation to birth 3.) birth of newborn to placenta delivery 4.) 1-4 hours after delivery (uterus contracts to control bleeding)

3 phases of contraction cycle

1.) increment: contraction starts in fundus 2.) peak/acme: most intense 3.) decrement: decreases intensity as uterus relaxes

3 divisions of true pelvis

1.) inlet (upper pelvic opening) 2.) midpelvis (pelvic cavity) 3.) outlet (lower pelvic opening)

premonitory signs of labor

1.) lightening: fetus settles into pelvic inlet (engagement) --increases pelvic pressure, urinary frequency, venous status (edema), vagina secretions --breathing eased --leg cramps 2.) Braxton Hick's: your body is getting ready for labor, but this isn't true labor bc not enough to affect cervix/descent 3.) ripening: cervix softens and stretches 4.) bloody show: pink tinged;; mucous plug. labor begins with 24 - 48 hours 5.) rupture of membranes 6.) burst of energy 7.) weight loss, diarrhea, indigestion, N/V

4 stages of menstruation

1.) menstrual phase: estrogen and progesterone decrease, endometrium sheds 2.) follicular phase: FSH and estrogen prepare ovary and follicle to release ovum 3.) ovulation phase: estrogen and luteinizing hormone increase, ovum goes from follicle to fallopian tube 4.) luteal phase: ovum goes into uterus, becomes corpus luteum and releases progesterone to prep for egg implantation; if it doesn't happen within 24 hours, it degenerates and cycle restarts

common issues new nurses face during taking care of pregnant px/fam

1.) pain: needs to be managed not eliminated 2.) inexperience/negative experiences 3.) unpredictability 4.) intimacy

4 factors specific to birth passage

1.) size of pelvis 2.) type of pelvis 3.) ability to dilate/efface 4.) ability of vaginal canal and external opening to distend

scenario: three contractions lasting 80 - 90 sec less than 2 minutes apart, client is receiving piggyback oxytocin to augment labor what's the correct order of priority nursing actions?

1.) titrate (slow/stop) the infusion to prevent rupture 2.) check FHR 3.) determine is contractions have diminished 4.) notify provider 5.) administer O2 6.) document

interventions for maternal hypotension

1.) turn woman to lateral position/place wedge 2.) maintain IV infusion at rate specificed 3.) O2 nonrebreather 10-12L 4.) elevate legs 5.) notify 6.) administer vasopressor if protocol 7.) stay with woman, monitor

Power (childbirth)

1.) uterine contractions 2.) maternal pushing efforts

fetal bones involved in birth (Structure)

5 major bones sutured together w strong/flexile tissue: -2 forehead bones -2 parietal on crown -1 occipital bone sutures and fontanels allow molding (adapting to shape of pelvis)

when is best time for breast exam?

5-7 days after onset of menstruation

when is GBS testing done?

35-37 weeks

assessment: -cervix is dilated 3 cm -50% effected -cephalic presentation in the right sacrum anterior (RSA) position Q: where would the nurse place the stethoscope to best locate fetal heart tones?

A RSA position: the baby's back is on the right side of the mom and its butt is in the lower portion of the fundus

fetus presentation: left sacrum anterior position

C

fetus presentation: right occipital posterior position where is fetal heart tone assessed?

B

what is fetal lie

The relationship of the spine of the mother to the spine of the fetus. It can be longitudinal, transverse (perpendicular), or oblique; what body part of fetus is entering first?

in the cephalic posterior positions, the fetus is facing the mom's ?

abdomen

which phase of labor is the optimal time for nurse to administer butorphanol?

active phase

contraction interval

amount of time between contractions when fetal exchange of o2, nutrients etc. occurs aka: resting tone

what positions should the nurse encourage the mom to lay in?

any that promote blood return return to the heart

what is the immediate action when px's membranes rupture spontaneously, releasing clear, odorless fluid? why?

assess FHR to see how the baby tolerated the rupture of membranes

when do majority of pregnancies end spontaneously?

before 12 weeks

contraction frequency

beginning of one contraction to the beginning of the next contraction; expressed in minutes (ex. 3 & 1/2 to 4 minutes apart)

contraction duration

beginning to end of one contraction; expressed in seconds

hematopoietic system during labor (blood loss)

blood loss: -500ml normal (estimated to be higher tho) -women gain 1 to 2 L during pregnancy

2 types of fetal presentations?

cephalic or breech

3 breech presentations

complete, frank, footling

hypertonic contractions

contractions that are too long or too frequent and do not allow a resting period long enough for optimal utero-placental exchange

post partum assessment normal findings: lochia

days 1-3: rubra (dark red) days 3-10: serosa (brownish red/pink) after 10 days: alba; yellow/white and scant

what should the nurse do when a 15 BPM acceleration of the FHR above baseline occurs during contraction?

document and continue to monitor

false versus true pelvis

false: supports weight of fetus, directs fetus into true true: lies below linea terminals, must be fit for fetal passage,

what does a bulging perineum indicate?

fetal head pushing against perineal area, usually means birth is about to happen

what baseline reading is needed prior to amniotomy?

fetal heart rate

post partum assessment abnormal findings: breasts

firmness/engorgement heat/pain normal: days 1-2: soft days 2-3: filling day 3-5: full, soften with breastfeeding

define gametogenesis

formation of gametes/germ cells - oocytes and spermatocytes

how to facilitate placental delivery?

gentle traction applied to cord while counterpressure exerted on lower uterine segment

define infertility

inability to conceive after 1 year of unprotected sexual intercourse

3 phases of contractions?

increment, acme, decrement

3 divisions of bony pelvis

inlet pelvic cavity outlet

the exchange of 02, nutrients & waste products occur b/w mom and fetus in?

intervillous space

hematopoietic system during labor (WBC)

leukocytes: -avg. 14 - 16; >25 possible infection

what divides the bony pelvis?

linea terminalis (pelvic brim) divides false pelvis and true pelvis

Where does fertilization normally occur?

lower third of fallopian tubes

interventions for early decelerations

none

define dilation

opening of cervix (0-10 cm)

define placenta previa

placenta partially or completely covers the cervical opening

4 cephalic presentations

vertex, military, brow, face

define engagement

when presenting part (head, legs, shoulder whatever) reaches / passes the pelvic inlet; determined by leopold / vaginal exam -primagravida ~2 weeks before term -multipara maybe many weeks before picture: the baby is at -2 station

hematopoietic system during labor (H&H)

~margin of safety H&H: -Hemo: 11g/dl -hema: > 33%

theories of onset of labor

•Changes in maternal estrogen •Prostaglandin secretion •Increased secretion of oxytocin •Oxytocin receptors increase •Fetal role •Stretching, pressure, and irritation of the uterus