OB EXAM 2

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britsands
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172778
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OB EXAM 2
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2012-09-23 20:54:50
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exam NP3
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Exam 2 on chapters 17 18 19 20 23 24 27 25 26 30
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  1. Relationship to mother and baby's spine
    Fetal Lie
  2. Presentation
    head down
    Cephalic
  3. Head down
    -baby chin on chest, smallest part of head presents
    - head normal, occipitalfrontal presents
    -neck extended, occipital and largest anteropost presents
    -neck is hyperextended, submentobreg,ato diameter presents

    which ones usually end in c-section?
    • vertex
    • military
    • brow
    • face

    Brow and face
  4. Knees and hips attitude, sacrum landmark noted on presentation
    Breech presentation
  5. hips and knees completely flexed, sacrum is presenting
    complete
  6. hips flexed, knees extented, buttocks presentation
    Frank
  7. Shoulder presenting, and acromion process of the scapula is landmark to be noted
    Shoulder aka transverse lie
  8. relationship of maternal pelvis and fetal presenting part
    Postition
  9. engagement
    1st baby?
    2nd+?

    indicates what?
    • 2 weeks before
    • not dropping until labor

    adequate inlet, but not midpelvis or outlet
  10. relationship to baby and ischial spine
    station, engagement is a 0 station
  11. postion

    1.
    2.
    3.
    • 1. R or L of the maternal pelvis
    • 2. The landmark of the fetal presenting part. O,M,S,A
    • 3. Landmark is on the A,P,T of the pelvis
  12. Position
    2.
    M:
    O:
    S:
    A:
    • M: mentum- face
    • O: occipital
    • S- Sacrum
    • A: acromion process
  13. Increment
    the building up of a contraction (longest)
  14. acme
    the peak of the contraction
  15. decrement
    letting up of the contraction
  16. frequency
    time between the begining of one to the beginning of the next
  17. Intensity
    the strength of the contraction
  18. Duration
    bginning to the end of the the same contraction
  19. physiology of labor
    • Estrogen- stimulates uterine muscle to contact
    • Progesterone - decreases
    • Posteioglandins- increase
  20. the drawing up of the internal os and the ervical canal into the uterine side walls
    Effacement
  21. First stage of labor
    0-10 cm
  22. Latent phase

    How long for primigravida? Multigravida?
    0-3 cm

    • P: 8.6 hours
    • M: 5.3 hours
  23. Active Phase

    How long for nullipara? multipara?
    4-7 cm

    • N: 4.6 hours
    • M: 2.4 hours
  24. active:
    contrations have a frequency of ____ 
    the duration of ___
    intensity of____
    • frequency of 2-5 minutes
    • duration of 40-60 sec
    • Intensity of 50-70mm Hg
  25. Latent:
    frequency
    duration
    intenstiy
    • frequency: 10-30 minutes
    • duration: 30 sec
    • Intensity: 25-40
  26. Transition phase
    How long
    nulli
    multi
    • 8-10 cm
    • n: 3 hours
    • M: less than an hour
  27. Transition:
    Frequency
    Duration
    Intensity
    • Frequency: 1.5-2 min
    • Duration: 60-90 sec
    • Intesity: 70-90
  28. Nursing responses to nonreassuring decilerations
    • Change position
    • increase iv fluids
    • provide o2
    • turn down or off pitocin
    • notify the md and document
    • prep for c section of vaccum birth
  29. Second stage
    10cm - birth of infant
  30. pressure of the amnotic fluid
    direct pressure of the uterine fundus
    contraction of the abdominal muscles
    extention and straightening of the fetal body

    All cause what/
    Descent
  31. fetal head secends and meets resistance from soft tissures of pelvis, the muscle s of th pelvic floor and the cervix
    flexion
  32. fetal head must rotate to fit the diameter of the pelvic ccavity, which is the widest in the anteroposterior diameter
    internal rotation
  33. head passes under the symphysis pubis, emerge form the vagina
    extension
  34.  neck untwists, turning the head to one side (resitiution) and aligns with the psition of the back in the birth canal
    restitiution
  35. as the shoulders rotate to the anteropsteriro position in the pelvis the head turns farther to one side
    external rotation
  36. shoulders meet the undersurface of the symphysis pubis and slips uner it, shoulders and body are born
    expulsion
  37. Third stage
    after birth of baby and birth of the placenta
  38. Placenta is shiny side up, released inside to outer margins
    Schultze - aka shiny schultze
  39. Placenta sperated outer to inner, mom side up
    duncan, dirty duncan
  40. What changes in vitals should you expect in fourth stage of labor
    • Blood loss from 250-500mL
    • Moderate decrease in bp
    • increase in pulse pressure
    • increase pulse
  41. Factors for continuous fetal monitoring
    • previous history of still birth at 38+
    • Presence of complication
    • Induction of labor
    • decreased fetal movement
    • meconium stained fluid
    • trial of labor following c-section
    • maternal fever
    • placenta problems
  42. baseline rated refers to the what
    acerage fhr rounded to increments of 5bpm observed during a 10- minuted period of monitoring
  43. normal fhr
    110-160
  44. causes of fetal tachycardia
    • early fetal hypoxia
    • maternal fever
    • maternal dehydration
    • beta- sympathomimetric drug
    • amnionitis
    • maternal hyperthyroidism
    • fetal anemia
    • tachydysrhythmias
  45. fetal bradycardia causes
    • late fetal hypoxia
    • maternal hypotension
    • prolonged umbilical cord compression
    • fetal arrhythmia
    • uterine hyperstimulation
    • abruptio plancete
    • uterine rupture
    • vagal stimulation
    • congential heart block
    • maternal hypothermia
  46. Absent variblitiy
    amplitude undetectable
  47. Minimal variability
    amplitude detectable but less than 5bpm
  48. Moderate variablity
    amplitude 6-25 bpm
  49. marked variablity
    amplitude greated than 25 bpm
  50. best single predictor for determining fetal compromise
    reduced variablity
  51. accelerations
    2 15bpm above baseline lasting 20 sec
  52. Cause of early decelerations
    head compression
  53. cause of late decelerations
    uteroplacental insufficiency
  54. Cause of variable decelerations
    cord compression
  55. if painless bleeding do not
    do vaginal exam
  56. Latent phase monitor vs
    without complications
    • temp: q4hours
    • when waters break q1-2hrs
    • bp, pulse, respirations- q1hr
    • FHR q30min
  57. Latent phase vs fhr
    complications
    fhr every 15 min
  58. Active phase
    vs and fhr
    • bp, p, r q1hr
    • if high risk q30 min
  59. Transition
    vs
    • every 30 min if low risk
    • every 15 minutes if high
  60. s&s of hyperventelation
    tingling or numbness in the tip of the nose lips fingers or toes, dizziness, spots, spasms in hand and feet
  61. hbg for pregant
    10-14
  62. Drugs not to be given with opiate dependancy
    • stadol
    • nubain
    • demerol
    • sublimaze- fentanyl
  63. Stadol contradiction
    not to be given to mom with hypertension
  64. fentanyl disadvantage
    30-60min of effectiveness
  65. advantages of nubain
    • associated with less n&v
    • lower incidence of respiratory distress
    • mother sedation (rest)
  66. advantages for fentanyl
    • relieve pain and sedation immediately
    • 50-100 times more potent than morphin
    • doesnt cross the placenta
  67. onset, peak, duration for stadol
    • rapid
    • 30-60
    • 3-4
  68. fentanyl
    onset
    peak
    duration
    • immediately
    • 30-60
    • 30-60
  69. Drugs used for local
    • nesacain
    • xylocain
    • prontocain
    • carbocain
  70. Risks for episotomy
    increase prolapse bladder, uterus, bowel
  71. rapid reduction in size and the return of the uterus to a nonprego state
    involution
  72. Ruba
    2-3 days
  73. serosa
    3-10 days
  74. alba
    additional week or 2
  75. medications that may be on standing order for postpartum bleeding
    • pitocin
    • methergine
    • hemabate
  76. Postpartum monitor vs
    • q15min for 1 hour
    • q30 min X2
    • then per protocal
  77. postpartum prevention of bladder distention
    encourage to void within 6-8 hours after birth
  78. Chemical initial breath
    increase in pCO2 and Decrease in pO2
  79. mean blood pressure for newborn
    50-55
  80. NB neutral thermal environment
    32-34*C
  81. when does brown tissue develop?
    26-30 weeks until 2-5 weeks after delivery
  82. Accucheck for newborns
    40
  83. Iron storage for newborn
    lasts 4-6 months, 270mg
  84. Glucose storage for newborn
    4-6 hours, only min if diabetic mom,
  85. reason for low clotting facctors, lowest, increases when
    • sterile gi
    • lowest 2-3 days
    • increases 5-8 days
    • Vit k shot
  86. Life span for newborn rbc
    80-90 days
  87. Causes for prenatal hyperbilirubinemia
    • hemolytic disease of the newborn (rbc being attacked by antibodies combs +)
    • diabetes
    • intauterin infections
    • oxytocin administration
    • medication
  88. Causes for newborn hyperbilirubinemia
    • polycythenia (HbG >65)
    • pyloric stenosis
    • biliary atresia or obstruction
    • uti
    • sepsis
    • Cephlahematoma - breaking down the blood
    • hypoglycemia
  89. Onset for physiologic jaundice
    2-3 days of life
  90. Causes for physiologic jaundice
    • more frequent breakdown of rbc
    • they need to poop to get rid of the conjugated
    • immature liver- lower uptake
    • lock of intestinal bacteria
    • poorly hydrated from inital breastfeeding
  91. incidence of physilogic jaundice
    50% of term and 80% of preterm
  92. Breastfeeding jaundice onset
    2-3 days
  93. prevention of breastfeeding jaundice
    key is to feed the baby! encourage frequent (q2-3 hours) avoid supplementation and accessing materal lactation consultant
  94. Breast milk jaundice onset
    week after delivery
  95. Breast milk jaundice cause
    • extra fatty acids from mom
    • takes more spots in albumin that were meant for bilirubin
  96. Pathologic jaundice onset
    @birth- 24 hours
  97. Pathologic jaundice cause
    blood incompatability, rh factor, ABO factor
  98. Treatment for pathologic jaundice
    phototherapy, exchanged transfusions
  99. Babies at high risk for for jaundice
    rh- moms, o moms, cephlahemmatoma, hypothermia, polycytothemia, 50% term babies
  100. Nuring interventions for jaundice
    • maintain temp
    • monitor number of stools, enourage feeding
    • keep well hydrated
    • educate and support parents
    • maintain phototherapy as ordered
  101. what neurological assessments for babies with hyperbilirubienmia
    hypotonia, diminished reflexes, lethargy or seizure
  102. Capacity of the stomach
    50-60ml
  103. Bowel sounds of new born
    present within the first 30-60 min
  104. meconium  time
  105. 8-24 hours,
  106. transitional poop
    thin green and yellow next day or two
  107. bladder volume
    6-44 ml
  108. Cephelhematoma
    • unilateral or bilateral
    • does NOT cross suture lines
    • onset and resolve
    • associated with physiologic jaundice
    • doesnt come and leave at the same time
  109. Caput succedaneum
    • serious fluid
    • long and diffiult labor
    • nautarl vs vacum extraction
    • CROSSES SUTURE LINES
    • present at birth
    • goes away by discharge
  110. average weightloss for babies
    5-7% in the first 3-4 days
  111. >10% body weight lost in newborns may indicate what?
    inadequate fluid/caloric consumtion and mandates evaluation
  112. would should expect to regain the weight to newborn weight
    10-14 days after birth
  113. Enfamil, Similac, Carnation good start
    cows milk
  114. prosobee, isomil
    soy protein base
  115. Nutramigen, pregestamil, alimenum
    hypoallergenic
  116. neocate, elecare
    elemental amino acid
  117. Medications that contradict breastfeeding
    parlodel, chemotherapy drugs, ergotamine, lithum, methotrexate
  118. how often is breast fed babies fed
    • q1.5-3 hours
    • 6-8 times in 24hrs
  119. how often is formula babies fed
    • q3-4 hrs
    • 6-8 times in 24hrs
  120. breast milk how long air? refridge? freeze
    5hours, 5days, 5months
  121. gaining goal for breastfed babies
    4-8oz each week after the 1st week
  122. how much bm and voids for adequate breastfed babies
    at least 4 BM and >6 voids per day by day 5
  123. cervidil post administration
    remain in recumbant for 2 hours
  124. Cardiovascular effects of pitocin
    • bp initially decreases and then increase by 30%
    • increase of cardiac output and stroke volume
  125. expect pitocin to be decreased when
    once cervical dialation reaches 6cm
  126. max rate for pitocin
    40milliunits/min
  127. Assessment of woman undergoing inductionof labor
    • fetal maturity
    • cervial readiness- anterior, 50% effaced, soft, dialted greater than or equal 2cm.   -1 - 1
    • indicated to induce
    • mom is more that 39 weeks
  128. risk factor for episotomy
    • macrosomia (9000g)
    • vacuum
    • forceps
    • op position
  129. indications for c- section
    • breech
    • transverse lie
    • previous c/s
    • placenta previa
    • failure to decend
    • emergency
    • eclampsia
    • cat 3 efm
    • mi
    • active herpes

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