OB Test 2 study guide
Which of the 4 "P"s of the labor process consists of the Uterus, Contractions, dilation and effacement of the cervix, descent and rotation of the fetus, separation of the placenta, maintenance of homeostasis postpartum?
Powers
1 minute after birth, the baby's heart rate is 125. The nurse notes that baby has acrocyanosis and has Active Muscle tone. The baby is not crying, but promptly jerks away from the doctor while he is suctioning. What is the baby's APGAR score?
7 HR 125= 2 Acrocyanosis = 1 Active Muscle Tone= 2 Not crying = 0 Promptly jerks away= 2
List the 4 signs that the placenta has separated.
. Lengthening of Cord b. Trickle or gush of blood c. Uterus changing from flat, round (disc) shaped to glob shape. d. Uterus rising in the abdomen
What is the normal fetal heart rate in a term fetus ?
120-160
How many Phases does the first stage of labor have ?
3
When monitoring FHR, the nurse notices that periodically, the fetus' heart rate rises above baseline for brief periods of time. What is this called and what does it mean?
Accelerations It means that the baby is doing well and is well oxygenated
The physician suspects that a pregnant patient's membranes have ruptured. The physician dips a Q-tip in the vaginal fluid, and then swipes the q-tip across Nitrazine Paper. The paper turns a purple/blue color. This result confirms that the vaginal fluid is what?
Amniotic Fluid
What are the two most important nursing assessments that should be performed after ROM?
Assess the FHR: (risk of umbilical cord prolapse). Assess the Amniotic Fluid for Color, Amount and Odor
fetus with respect to the birth canal is critical. What is the relationship of the fetal head to the rest of the body-vertex, brow or military, face. (similar to presentation)
Attitude
________________ is a premonitory sign of labor and is when the woman may experience a brownish or blood-tinged cervical mucus discharge
Bloody Show.
The Nurse notices variables in FHR. She knows that this is caused by what? and what interventions should she put in to place?
Cord Compression turn mom on left side and give her oxygen. usually 8-10 liters per min. If patient on Pitocin. STOP it
Name the Cardinal Movement of labor: downward progress of the fetus through the pelvis. Movement of the fetus through the birth canal during the first and second stages of labor.
Descent
List the 8 cardinal movements of labor!
Descent Flexion Engagement Internal Rotation Extension Restitution External Rotation Expulsion
When monitoring FHR, the nurse notices that the Fetus' heart rate drops, beginning with a contraction and goes back up when the contraction ends. The nurse knows that this is called ________________? What nursing intervention should she put into place?
Early Decelerations No Interventions, just continue to monitor
Name the Cardinal Movement of labor: widest diameter of the presenting part is at the level of the ischial spines ("0" station). When the greatest diameter of the fetal head passes through the pelvic inlet; can occur late in pregnancy or early in labor.
Engagement
Name the Cardinal Movement of labor: delivery of the rest of the infant. The shoulders and remainder of the body are delivered.
Expulsion
Name the Cardinal Movement of labor: anterior deflection of the fetal head when it reaches the floor of the perineum. Facilitated by the resistance of the pelvic floor that causes the presenting part to pivot beneath the pubic symphysis and the head to be delivered; occurs during the second stage of labor.
Extension
Name the Cardinal Movement of labor: shoulder rotation to an anterior - posterior position. During this movement, the sagittal suture moves to a transverse diameter and the shoulders align in the anteroposterior diameter. The sagittal suture maintains alignment with the fetal trunk as the trunk navigates through the pelvis.
External Rotation
Is the following a sign of true labor or false labor? Contraction felt in the Abdomen and fundus
False Labor
Is the following a sign of true labor or false labor? Contractions decrease in intensity with activity and walking
False Labor
Is the following a sign of true labor or false labor? Contractions have irregular pattern
False Labor
Is the following a sign of true labor or false labor? No cervical Change
False Labor
Is the following a sign of true labor or false labor? Contraction felt mostly in abdomen or fundus
False Labor.
fetus with respect to the birth canal is critical. What is the relationship of the long axis of the fetus to the long axis of the mother known as ?
Fetal lie
Name the Cardinal Movement of labor: normal position assumed by the fetus due to shape of the uterus. When the chin of the fetus moves toward the fetal chest; occurs when the descending head meets resistance from maternal tissues; results in the smallest fetal diameter to the maternal pelvic dimensions; normally occurs early in labor.
Flexion
The nurse knows that Early Decelerations in FHR is caused by what ?
Head Compression
When Monitoring fetal heart rate of a term fetus, the nurse notices that the fetus' heart rate is bradycardic (consistently), what is the first things he suspects What can she anticipate to do next ?
Hypoxia or Hypoxemia Apply Oxygen and begin IV fluid bolus
fetus with respect to the birth canal is critical. What is the Relationship of a reference point on the baby to the maternal pelvis known as?
Position
Name the Cardinal Movement of labor: rotation of the fetal head from transverse to anterior position. Usually starts at level of ischial spines. When the rotation of the fetal aligns the long axis of the fetal head with the long axis of the maternal pelvis; occurs mainly during the second stage of labor.
Internal Rotation
_____________________ is a premonitory sign of labor and refers to the descent of the fetus into the true pelvis that occurs approximately 2 weeks before term in first-time pregnancies. The woman may feel she can breathe more easily but may experience urinary frequency from increased bladder pressure.
Lightening
What are the premonitory signs of Labor
Lightening Braxton-Hicks Contractions Surge in Energy Cervical Changes Gastrointestinal Changes Backache Bloody Show
What can the nurse to promote the Cardinal Movements of Labor?
Move the mother from side to side and monitor baby to see how it is tolerating the movements.
First Stage of Labor: What is the most important thing for a patient to do during Phase 1 of labor
Move, walk, rock in rocking chair, shower.
Which one of the 4 "P"s of labor includes the bony pelvis and soft tissue of the cervix, pelvic floor, vagina, and the external opening to the vagina?
Passage
What are the 4 "P"s of the labor process
Passage, Passenger, Powers, Psyche
Which of the 4 "P"s consists of the fetus.
Passenger
First Stage of Labor: A patient's cervix is dilated to 2cm. Which phase of labor is the patient in
Phase 1: Early to latent phase of labor 0-3cm
First Stage of Labor: What is the hardest and shortest phase of labor?
Phase 3 : Transition Phase 8-10 cm
The baby and placenta have both been delivered. What medication can the nurse expect to push (per doctors order), after the expulsion of the placenta? this is done during vaginal deliveries and C-section deliveries
Pitocin
Which STAGE of labor involves expulsion of the placenta?
Third
First Stage of Labor: During the Second Phase of labor (the active phase), what is the most important thing for the nurse to do to promote the movement of the baby downward, and to eliminate unnecessary and preventable pain on the mother.
Promote bladder emptying
Which of the 4 "P"s of the labor process refers to the maternal response to labor and birth.
Psyche
Name the Cardinal Movement of labor: occurs after the head is delivered, rotates back to position occupied when entered the pelvic inlet
Restitution
During a sterile speculum exam a sample of fluid in the upper vaginal area is obtained, the fluid is placed on a slide and assessed for "ferning pattern" under a microscope. A ferning pattern confirms what?
Rupture of Membranes (ROM)
Which STAGE of labor is the "Pushing Stage"?
Second
First Stage of Labor: Which phase of labor is the best time for the patient to get an epidural?
Second phase: Active phase 4-7 cm
what are the 3 main narcotics used for pain management for a Laboring mother
Stadol, Nubain, Demarol
This stage of labor is the Recovery and postpartum Stage
Stage 4
At the onset of labor, the position of the fetus with respect to the birth canal is critical. What is the level of the presenting part in relation to the ischial spines known as?
Station
fetus with respect to the birth canal is critical. What is the part of the fetus that enters the maternal pelvis known as
The Presentation
Is the following a sign of true labor or false labor? Cervix Dilates
True Labor
Is the following a sign of true labor or false labor? Contraction felt from back to front
True Labor
Is the following a sign of true labor or false labor? Contractions are regular pattern
True Labor
Is the following a sign of true labor or false labor? Contractions increase when walking
True Labor
Is the following a sign of true labor or false labor? Fetus Descends
True Labor
What is the biggest difference between True labor and false labor
True labor has cervical changes and false labor does not
What cervical changes would the nurse assess for as premonitory sign of labor
cervix becomes soft (ripens) and may become partially effaced and begin to dilate.
A full term pregnant mother comes to the hospital describing consistent "vaginal leaking". The Physician uses a sterile speculum to look inside the patient to confirm that the patient's membranes have ruptured. What is the physician expecting to see?
fluid in the vagina vault (pooling)
When monitoring fetal heart rate of a term fetus, the nurse notices that the fetus' heart rate is tachycardic (consistently), what is the first thing she suspects? What can she anticipate to do next?
maternal Infection Start antibiotics
What premonitory signs of labor would the nurse expect to see in regards to the mother's Gastrointestinal system
some women may experience a 1- to 3- pound weight loss and some experience diarrhea, nausea, or indigestion preceding labor.