OB Exam 2
obesity
maternal ____ can cause shoulder dystocia, macrosomia, increase hemorrhage risk, delayed wound healing dvts and infection rates
third
____ maneuver: determines the presenting part
first
____ maneuver: determines what part of the fetus is location in the fundus of the uterus
active
____ phase of first stage: 6cm-complete and 40-80% effaced, contractions are more intense at 2-5 minutes
transition
____ phase of first stage: from 8-10cm dilated and 100% effaced, intense contractions every 1-2 minutes
descent
progress descent of fetus through maternal pelvis
effacement
progressive thinning of cervix (0-100%)
trendelenburg
put patient in ____ position for umbilical prolapse
15 20
the cup of the vacuum should not be on the fetal head for longer than ___-___ minutes
head
the fetal _____ is the largest portion to come through the birth canal
maximum minumum
the goal of analgesia use during labor is to provide _____ pain relief at _____ risk for mom and baby
nubain severe
____ should never be given to a laboring mother for pain if she has a history or opiate dependence as it can cause a ____ withdraw
third
____ stage of labor includes: birth of infant to delivery of placenta
second
____ stage of labor: complete dilation to delivery of baby
third
____ stage of labor: delivery of baby to delivery of placenta
fourth
____ stage of labor: immediate postpartum
early latent
____/____ phase of first stage: 0-4cm dilated and effacement from 0-40% with mild intensity contractions every 5-10 minutes
position
____: freedom of movement during labor, allowing the woman to labor in the position she finds the most comfortable
culture
____: must be culturally aware and sensitive to the needs and practices
position
____: the fetal presenting part in relation to the back, front, or sides of the maternal pelvis
expectations
____: unrealistic expectations can cause anxiety and negative experiences
apgar score's
_____ _____: obtained at 1 and 5 minutes after birth, for reporting the status of the newborn and the response to resuscitation immediately after birth
presentation
_____: determined by the fetal lie and body part entering the pelvis first, Cephalic-head down, breech or shoulder-shoulder first
cesarean
complications from ___ may include: hemorrhage, bladder/bowel trauma, maternal resp depression and hypotension
intensity
contraction strength at its acme (mild, moderate, strong)
hypertonic uterine dysfunction
contractions are frequent and painful but ineffective in promoting dilation and effacement
post-maturity syndrome
decreased subcutaneous fat and lack vernix and lanugo
powers
5 P's of Labor: _____: when contractions are responsible for dilation and effacement
powers, passage, passenger, psyche, position
5 P's of labor
position
5 P's of labor: _____: maternal postures, physical positons
passage
5 P's of labor: _____: pelvis and birth canal
psyche
5 P's of labor: _____: response of woman
passenger
5 P's of labor: _____: the fetus
Leopold's maneuvers
determines the fetal position, station, and size
calcium gluconate
Given for Magnesium Toxicity
dystocia
difficult labor; "failure to progress"
d
The first stage of labor includes which of the following? a: latent phase b: active phase c: transitional phase d: all the above
fourth
____ maneuver: determines the location of the cephalic prominence
oxytocin
Uterotonic that Helps Induce Labor or Control/Prevent Postpartum Bleeding through IV or IM
skin to skin
___ ___ ___ contact: facilitates parent-infant bonding and attachment
fetal hypoxia
___ ___ due to umbilical prolapse can lead to disability or death
golden hour
___ ___: baby is placed skin-to-skin with mom so bonding can occur, best time to institute breastfeeding
second
___ stage of labor includes: begins with complete dilation, ends with birth of baby, mom feels an urge to push (feels like she needs to have a BM), cardinal movements, engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
fourth
___ stage of labor includes: preventing postpartum hemorrhage, using uterotonics, and an assessment of mom
first
___ stage of labor: onset of labor to complete cervical dilation
support system
____ ____: helps to decrease anxiety and women then feel more in control
nitrous oxide
____ ____: limited in the US, half (same term) and half oxygen, quick relief and dissipates quickly (50 seconds), allows complete control, easy to administer and no need for anesthesiologist, no effect on fetal HR or maternal BP, causes nausea and dizziness
presenting part
____ ____: the specific fetal structure lying nearest to the cervix
sutures
____ are used to identify positioning of the fetus
analgesia
____ include: morphine sulfate, butorphanol tartrate (stadol), nalbuphine hydrochloride (Nubain), sublimaze (fentanyl)
McRobert's
____ maneuver used to help a mom deliver a baby with shoulder dystocia, includes putting moms thighs as close to her shoulders as possible
second
____ maneuver: determines location of the fetal back
attitude
_____: the relationship of fetal parts to one another; fetal (same term), the head if flexed forward with the chin almost resting on the chest, the arms and legs are flexed
lie
_____: the relationship of fetal spine to maternal spine, longitudinal, transverse
uterine rupture
a ___ ___ is rare but most common during a VBAC
scheduled
a ___ cesarean occurs before the onset of labor
nonurgent
a ____ cesarean is needed due to failure to progress or failure to descend
vacuum-assisted delivery
a birth involving the use of a vacuum cup on the fetal head to assist with delivery of the head
3 5
a client arrives at a birthing center in active labor. after examination, it is determined that the client's membranes are still intact and the client is at a -2 station. the primary health care provider prepares to perform an amniotomy. what will the nurse relay to the client the most likely outcome of the amniotomy? select all that apply 1: less pressure on cervix 2: decreased number of contractions 3: increase the efficiency of contractions 4: the need for increased maternal blood pressure monitoring 5: the need for frequent fetal heart rate monitoring to detect the presence of a prolapsed cord
1
a client in labor is transported to the delivery room and prepared for cesarean delivery. after the client is transferred to the delivery room table, the nurse would place the client in which position? 1: supine position with a wedge under right hip 2: Trendelenburg's position with the legs in stirrups 3: prone position with legs separated and elevated 4: semi-fowler's position with a pillow under the knees
shoulder dystocia
a difficulty encountered during delivery if the shoulders after the birth of the head, which can be caused by macrosomia, maternal diabetes, a hx of this issue, and excessive weight gain.
2
a nurse has developed a plan of care for a client experiencing dystocia and includes several nursing interventions in the plan of care. the nurse prioritizes the plan of care and selects which intervention as the highest priority. 1: providing comfort measures 2: monitoring fetal heart rate 3: changing the client's position frequently 4: keeping the significant other informed on the progress of the labor
4
a nurse in the labor room is monitoring a client with dysfunctional labor for signs of fetal or maternal compromise. which of the following assessment findings would alert the nurse to a compromise 1: maternal fatigue 2: coordinated uterine contractions 3: progressive changes in the cervix 4: persistent non-reassuring fetal heart rate
c
a nurse is caring for a client in labor. the nurse determines that the client is beginning the second stage of labor when which of the following assessments is noted? a: contractions are regular b: membranes have ruptured c: cervix is dilated completelyy d: client begins to expel clear vaginal fluid
2 1 5 3 4 6
a nurse is monitoring a client in labor who is receiving oxytocin (pitocin) and notes that the client is experiencing hypertonic uterine contractions. list in order of priority the actions that the nurse takes 1: reposition client 2: stop oxytocin infusion 3: perform vaginal exam 4: check clients BP 5: administer oxygen by face mask at 8-10L/min 6: administer medication as prescribed to reduce uterine activity
c
a nurse is reviewing the record of a client in the labor room and notes that the nurse-midwife has documental that the fetus is at a -1 station. the nurse determines that the fetal presenting part is a: 1 inch below the coccyx b: 1 inch below the iliac crest c: 1 cm above the ischial spine d: 1 fingerbreadth below the symphysis pubis
d
a nurse is reviewing true and false labor signs with a multiparous client. the nurse determines that the client understands the signs of true labor if she makes which statement? a: i won't be in labor until my baby drops b: my contractions will be felt in my abdominal area c: my contractions will not be as painful if i walk d: my contractions will increase in duration and intensity
epidural
a regional anesthesia
disseminated intravascular coagulation DIC
a syndrome that occurs when the body is breaking down blood clots faster than it can for a clot (include abbreviation)
VBAC
a trial of labor and vaginal birth is attempted in a woman who has had a prior c-section
1 3
a weight loss of ___ to ___ pounds with low back ache and bloody show may be a sign of labor
vertical
a women cannot have a vbac if she has a ____ uterine incision
fetal maturity
accurate maternal menstrual dating, early ultrasounds determine
sweeping or stripping of the membranes
digital separation of the chorionic membranes from the wall of the cervix and lower uterine segment during a vaginal exam
transverse
advantages of a ___ incision: lies on the thinnest part of the uterus and involves less blood loss, only a moderate dissection of the bladder from myometrium, easier to repair, less likely to rupture with subsequent pregnancies, and a decreased risk of adherence of bowel or omentum to incision line
three
after ___ unsuccessful attempts at a vacuum birth, a cesarean is required
balloon catheters
along with cervidil and cytotec, ___ ___ are also used to help cervix dilate
anaphylactic syndrome
amniotic fluid embolism: amniotic fluid leaks and is driven into maternal circulation/lungs with sudden respiratory distress, acute hemorrhage, and circulatory prolapse. hemorrhagic shock, coma/maternal death, fetal death is birth is not immediate
urgent
an ___ cesarean is when a rapid delivery is needed due to malpresentation or placenta previa with mild bleeding
induction
an ____ can only happen if the mother is over 39 weeks if elective, an assessment of the cervix, pelvis, and fetal size/presentation must be done prior, gestational age, and maternal/fetal conditions are viewed
emergent
an ____ cesarean is an immediate need to deliver the fetus due to prolapse of umbilical cord or rupture of uterus
d
analgesics used during labor include: a: morphine sulfate b: butorphanol c: sublimaze d: all the above
amniotomy
artificial rupture of membranes to induce or augment labor with an amnihook during a SVE
rate of infusion
based on the physician/CNM protocol and careful assessment of the contraction pattern during induction
increment
building up; this is the longest phase of a contraction
nesting
burst of energy
fetal dystocia
caused by excessive fetal size, malpresentation, multifetal pregnancy, or fetal anomalies
Cervidil
cervical ripening agent
cytotec
cervical ripening agent, also used as uterotonic (contracts uterus) in postpartum hemorrhage, PO/Rectally
cervical changes
cervix becomes soft and partially effaced
neonatal resuscitation
common to perform if an infant is stuck in a shoulder dystocia situation for 5 minutes, requires assistance and notification to the neonatal team
vertical lower
disadvantages of a ___ ___ uterine incision: may extend down into cervix, requires more extensive dissection of bladder, hemostasis and closure more difficult, requires repeat cesarean due to higher risk of uterine rupture
classic
disadvantages of a ___ uterine incision: heavy blood loss, difficult to repair, increased risk of uterine rupture with subsequent pregnancy
transverse
disadvantages of a _____ incision: slower to cut, not used in emergency, limited in size because of uterine vessels on either side, greater tendency to extend laterally into uterine vessels, may stretch and become a thin window
powers passenger passage
dystocia can be related to ____, ____, or _____
oxytocin induction
effectively initiates uterine contractions to induce or augment labor
lightening
engagement; fetus descends into pelvic inlet, breathing is easier
LOA
example of position: occiput in left anterior quad of pelvis would be known as
ROA
example of position: occiput in right anterior quad of pelvis
LSP
example of position: sacrum in left posterior pelvis
tachysystole
excessive frequent contractions during labor
occiput O, sacrum S, mentum M, shoulder A
fetal landmark's that may present are ____, ____, ____, ____ (Include the letter they are known by)
anterior A, posterior P, transverse T
fetus may be laying ____, ____, or ____ in the maternal pelvis (include the letter they are known by)
hemabate
give for postpartum hemorrhage, contraindicated with a history of asthma IM
methergine
given for postpartum hemorrhage, contraindicated with hypertension PO, IM, emergencies IV
2 3 40 60
goal of induction is to achieve stable contractions every ___-___ minutes that lasts ___-___ seconds
prostaglandin
hormone that prepares the uterus and cervix for labor; con contract uterus/create contractions
suprapubic
if a baby is stuck due to shoulder dystocia, mcroberts maneuver is performed along with pressure to the ____ region
negative number
if the presenting part of the baby is above the ischial spine, the station is a _____ _____
forceps delivery
in which an instrument is used to assist with delivery of the fetal head
sudden unexpected newborn collapse SUNC
infant suddenly experiences respiratory and cardiac arrest (include abbreviation)
meconium
infants first stool
chorioamnionitis
intra-amniotic infection, also known as ____ is marked by: inflammation and infection, maternal fever, maternal or fetal tachycardia, elevated WBC, purulent fluid, needs antibiotics and antipyretics during post partum
stillbirth
intrauterine fetal demise is also known as ____: fetal death after 20 weeks' gestation
braxton-hicks contractions
irregular, intermittent, may not increase in frequency and discomfort, do not result in cerivcal changes
positive number
is the presenting part of the baby is below the ischial spine, the station is a _____ _____
zero
ischial spines are ___ station
color odor amount time
it is important to assess the ___, ___, and ___ of amniotic fluid and document ___ of rupture
precipitous labor
labor lasting fewer than 3 hours from onset of labor to birth
decrement
letting up phase of a contraction
terbutaline
management of preterm labor (risk of maternal and fetal tachycardia)
epidural
monitor VS, assess FHR, assess effectiveness, monitor for N/V, assess bladder distension, protect LE from injuries when mother has an ____
one hour
neonatal depression may occur is medication is given ___ ___ before delivery
umbilical cord prolapse
occurs when the cord lies below the presenting part of the fetus
hypotonic uterine dysfunction
occurs when the pressure of the contraction is insufficient to promote cervical dilation and effacement
dilation
opening of cervical os to permit fetus through (0-10cm)
uterotonics
oxytocin (pitocin) methylergonovine (methergine) carboprost (hemabate), misoprostol (cytotec) are types of ____
ruptured uterus
partial or complete tear in the uterine muscle
acme
peak; the strongest phase of a contractions
android
pelvic type: inlet heart-shaped with short posterior sagittal diameter, midpelvis diameter reduced, outlet capacity reduced
anthropoid
pelvic type: inlet oval in shape with long anteroposterior diameter, midpelvis diameters adequate, outlet adequate
platypelloid
pelvic type: inlet oval in shape with long transverse diameters, midpelvis diameters reduced, outlet capacity inadequate
gynecoid
pelvic type: inlet rounded with all inlet diameters adequate, midpelvis diameters adequate with parallel side walls, outlet adequate
1 20 30 minutes spontaneously
placenta delivery usually takes ___ to ___ minutes and should not exceed (30 minutes/one hour) and occurs (with help from doctor/spontaneously)
right left R L
position: fetus may lay on the ____ or ____ of the maternal pelvis, noted by letters __ and __
infection bleeding unplanned ROM
possible issues of a membrane sweep include ___, ___, or ____
vertical lower
preferred use of a ___ ___ uterine incision when mom has: multiple gestations, abnormal presentation, placenta previa, non-reassuring fetal status, preterm, microsomic fetus
post-term pregnancy
pregnancy that has reached or extended beyond 42 weeks' gestation
resting tone
pressure in the uterus between contractions
external cephalic version
procedure in which the fetus is rotated from the breech to cephalic presentation by manipulation through the mothers abdomen
AWHONN
results of quality nursing management during labor is through
dystocia
risk factors of ____: malpresentation of the fetus, cephalopelvic disproportion, maternal fatigue and dehydration, extreme maternal fear or exhaustion
vbac
risk/benefits of ____: rupture of uterus, fetal death, shorter hospital stay/recovery, fewer complications, fewer neonatal breathing problems
anaphylactic syndrome
s&s of ___: chest pain, dyspnea, cyanosis, frothy sputum, tachycardia, hypotension, massive hemorrhage
amniotomy
severe variable decelerations, bleeding from undiagnosed previa, and umbilical cord prolapse can be caused by an
perineal lacerations clavical
shoulder dystocia can cause severe ____ ____ for mom, a broken ____ on the infant, neonatal encephalopathy, asphyxia, or death
a b c
signs of delivery of the placenta include: a: an upward rising of the uterus into a ball shape b: lengthening of the umbilical cord c: sudden gush of blood from the vagina d: increase in HR and BP e: all the above
pelvic dystocia
small pelvis, abnormal pelvic shape
magnesium sulfate
smooth muscle relaxant that can help stop preterm labor or reduce complications with pre-eclampsia
15 45
stillbirth is more known in moms under ___ and older than ___
dexamethosone
stimulates production of surfactant, assisting in maturing fetal lungs
augmentation
stimulation of contractions when labor fails to progress
mold molding
the bones and the membranous space help the baby's skull to ____, and _____ is the ability of the fetal head to change shape
false true
the bony pelvis is divided into: ____ and ____ pelvis
2
the nurse has been working with a laboring client and notes that the client has been pushing effectively for 1 hour. what is the client's primary physiological need at this time 1: ambulation 2: rest between contractions 3: change positions frequently 4: consume oral food and fluids
1
the nurse in the labor room is caring for a client in the active stage of the first phase of labor. the nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. what is the most appropriate nursing action? 1: administer oxygen via face mask 2: place the client in a supine position 3: increase the rate of oxytocin intravenous infusion 4: document the findings and continue to monitor the fetal patterns
2
the nurse is admitting a pregnant client to the labor room and attaches an external fetal monitor to the client's abdomen after attachment of the electronic fetal monitor, what is the next nursing action. 1: identify the types of accelerations 2: assess the baseline FHR 3: determine the intensity of the contractions 4: determine the frequency of the contractions
1
the nurse is assisting a client undergoing induction of labor at 41 weeks of gestation. the client's contractions are moderate and occurring every 2 to 3 minutes, with a duration of 60 seconds. an internal FHR monitor is in place. the baseline FHR has been 120-122 bpm for the past hour. what is the priority nursing action? 1: discontinue the infusion of oxytocin 2: notify the primary health care provider 3: place oxygen on at 8-10 l/min via face mask 4: contact the client's primary support persons in not currently present
4
the nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. the nurse notes the presence of episodic accelerations on the electronic fetal monitoring tracing. Which action if most appropriate? 1: notify the primary health care provider of the findings 2: reposition the client and check the monitor for changes in the fetal tracing 3: take the clients VS and tell the client that bed rest is required to conserve oxygen 4: document the findings and tell the client that the pattern on the monitor indicates fetal well-being
1
the nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. the nurse notes that the FHR between contractions is 100 BMP. which nursing action is most appropriate. 1: notify the primary health care provider 2: continue to monitor the FHR 3: encourage the client to continue pushing with each contraction 4: instruct the client's coach to continue encouraging breathing techniques
4
the nurse is monitoring a client in labor. the nurse suspects umbilical cord compression if which is noted on the external monitor tracing during contractoin 1: variability 2: accelerations 3: early decelerations 4: variable decelerations
2
the nurse is performing an assessment of a client who is scheduled for a cesarean delivery at 39 weeks of gestation. which assessment finding indicates the need to contact the primary health care provider? 1: hemoglobin of 11g/dl (110mmol/l) 2: fetal heart rate of 180 bmp 3: maternal pulse rate of 85 bpm 4: WBC count of 12000mm3
cervical ripening
the process of physical softening, thinning, and dilating of the cervix in preparation for labor and birth
station
the relationship of the ischial spines to the presenting part of the fetus
three
there are ___ phases of first stage of labor
android platypelloid
these two types of pelvis are least favorable for vaginal birth: _____ and _____
gynecoid anthropoid
these two types of pelvis are most favorable for vaginal birth: _____ and _____
frequency
time from the beginning of one contraction to the beginning of the next
duration
time from the beginning to end of a single contraction
true
umbilical cord prolapse must be delivered by cesarean asap true false
bishop's 8
using ____ prelabor scoring to determine if an induction is an option, a score of ___ or higher is needed
d
what are ways to lower the risk of cesarean birth? a: allow labor to progress naturally b: use vacuum-assisted birth c: use forceps d: all the above
placenta
what deteriorates as it ages to trigger contractions?
estrogen
what hormone stimulates contractions?
oxytocin
what hormone stimulates uterine contractions?
e
what nursing interventions should be done for hypertonic uterine dysfunction a: evaluate cause of labor dysfunction b: hydrate to improve uterine perfusion and coordination c: provide pain management and allow women to sleep and prevent exhaustion d: provide emotional support e: all the above
e
what nursing interventions should be done for hypotonic uterine dysfunction a: augment labor with oxytocin b: perform amniotomy c: provide emotional support d: ambulate and hydrate e: all the above
meconium aspiration syndrome
when meconium is present in the amniotic fluid, the infant may have
3
which assessment finding after an amniotomy needs to be conducted first? 1: cervical dilation 2: bladder distention 3: fetal heart rate pattern 4: maternal blood pressure
d
which of the following is a method of induction? a: oxytocin b: sweeping the membranes c: cervical ripening d: all the above