1550: L&D 2.25/ch.14

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1550: L&D 2.25/ch.14
2015-03-31 20:07:03
ch14 EXAM II

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  1. Why are vaginal exams done?
    • dilation
    • % effacement
    • Fetal membrane status
    • Gather info. on presentation, position, station
    • Fetal head flexion, and presence of fetal skull swelling or molding.
  2. How is a vag exam done?

    What you can assess if cervix is open.

    What words can you use to identify membrane status?
    • Gloves
    • Use index & middle finger into vag 
    • Palpate cervix to assess dilation, eff, & position.

    If cervix is open to any degree: the presenting fetal part, position, station, & presence of molding can be assessed. 

    Membranes can be evaluated & described as intact, bulging, or ruptured.
  3. What is the priority when assessing membrane rupture?

    Assessing FHR first to identify deceleration.

    • Deceleration may indicate:
    • Cord compression secondary to cord prolapse.
  4. What is cord prolapse?
    The umbilical cord descending into the birth canal before the baby during labor
  5. What can prolonged ruptured membranes cause?

    How is it tested?
    Infection due to ascending vaginal organisms.

    Swab the vagina to determine pH.
  6. What is umbilical compression?
    The vein on the cord becomes compressed leading to CO2 to accumulate in your baby’s blood, which produces respiratory acidosis.
  7. What therapy is performed if the umbilical cord is compressed?

    minor vs severe
    minor: mother gets O2

    severe: pressure is relieved by introducing a saline solution to prevent cord compression.
  8. When is the best time to listen for the FHR and why?
    At the end of a contraction so that late decelerations could be detected.
  9. What does the Baseline FHR refer to?
    The average FHR during a 10 minute segment w/ no rate changes, contractions, and the fetus is not experiencing episodic FHR changes.
  10. What is Baseline variability?
    irregular fluctuations  measured as bpm.
  11. What are the four categories for Baseline Variability and what do they measure?
    • Absent: fluctuation undetectable.
    • Minimal: fluctuation observed <5 bpm.
    • Moderate (normal) fluctuation 6-25 bpm.
    • Marked: fluctuation range >25 bmp.
  12. Protocol for initial maternal assessment intrapartum.

    Define "lightening" as it refers to signs of labor.

    What is referred to as "nesting"?
    When the presenting part of the fetus descends into the maternal pelvis (baby's dropping)

    Nesting: increased energy level.
  13. Protocol for initial maternal assessment intrapartum.

    What is "bloody show"
    Blood mixed w/ mucus resulting in a pink-tinged secretion.
  14. Protocol for initial maternal assessment intrapartum.

    Where are true labor contractions normally felt?

    What do contractions help with?
    In the lower back. 

    Contractions help with the movement of cervix from posterior to anterior position.
  15. Protocol for initial maternal assessment intrapartum.

    How can irregular contractions be decreased (i.e., how can you help the mother decrease irregular contractions)?
    Have mother walk, void, eat, drink fluids, change position.

    Walk around for an  hour or two, if no change, go home.
  16. Protocol for initial maternal assessment intrapartum.

    What are some things to consider regarding the mother?
    • GTPAL
    • Estimated Date of Delivery (EDD)
    • Estimated Gestational Age
    • Pregnancy risk factors
    • Meds: OTC & Herbal
    • Allergies
    • Nutritional status
  17. Protocol for initial maternal assessment intrapartum.

    What are the expected VS and pain level during intrapartum?
    • HR: increase to 10-20 bpm
    • BP up to 35 mmHg 
    • RR: increases
    • T: increased a little b/c of dehydration & muscle activity
  18. True versus False labor.

    What is the difference between true and false labor?
    True: contractions occurring at regular times with increased frequency, duration, and intensity.

    False: contractions are irregular and felt but does not affect the cervix.
  19. Explain the differences between True and False labor according to CONTRACTION:

    Activity (position change effect?)
    Stay or go?
    • Time:
    • T: Regular, becoming closer together, usually 4–6 min apart, lasting 30–60 sec
    • F: irregular, not occurring close together.

    • Strength:
    • T: Become stronger with time, vaginal pressure is usually felt
    • F: Frequently weak, not getting stronger with time or alternating (a strong one followed by weaker ones)

    • Discomfort:
    • T: back to front of abdomen.
    • F: front of abdomen.

    • Activity:
    • T: Contractions continue no matter what positional change is made
    • F: Contractions may stop or slow down with walking or making a position change

    • Stay or go?
    • T: If contractions 5 min apart, last 45–60 sec, and strong enough so that a conversation is not possible—go to hospital.
    • F: Drink fluids and walk-if any change in the intensity of the contractions; if the contractions diminish in intensity after either or both—stay home.
  20. What may fetal hypoxia result in?
    Metabollic acidosis.
  21. What is the purpose of Leopold's maneuver's and when is it performed?
    It is performed when the Pt is admitted. The nurse performs them to determine where the best place is to do an ultrasound to get the FHR.

    *Usually located over the shoulder or back of the fetus.

    Also determines presentation, position, and lie of the fetus.
  22. Explain Leopold's maneuvers (4 maneuvers) and what each maneuver determines.

    Maneuver 1
    What should you feel for and what do they mean?
    For presentation: face women's head, place both hands on abdomen to determine fetal position in the uterine fundus.

    Feel for the butt, soft & irregular indicating VERTEX presentation; feel for head, hard, smooth, round, indicating a BREECH presentation.
  23. Explain Leopold's maneuvers (4 maneuvers) and what each maneuver determines.

    Maneuver 2
    What should you feel for?
    For position: Move hands down lateral sides of abdomen to palpate on which side the back is located.

    Continue to determine on which side the limbs are located.
  24. Explain Leopold's maneuvers (4 maneuvers) and what each maneuver determines.

    Maneuver 3
    What are you confirming? What are you feeling for?
    To confirm presentation: grasp the lower uterine segment and palpate above symphysis pubis.

    Feel for presenting part; if firm, then it is the HEAD; if it is soft, it is the butt.
  25. Explain Leopold's maneuvers (4 maneuvers) and what each maneuver determines.

    Maneuver 4
    flexion or extension?

    How do you know if the head is engaged in the women's pelvic inlet?
    Determines attitude: face Pt's feet, palpate abdomen.

    Move fingers toward each other while applying downward pressure in direction of symph pubis. 

    • Palpate hard area and if: 
    • Flexion: side opposite the fetal back.

    Extension: If hard area same side as back. 

    Engaged: if your fingers meet resistance.
  26. Regarding Leopold's maneuvers, what questions should you ask yourself prior to performing them?
    What fetal part (head or butt) is located in the fundus (top of the uterus)?

    On which maternal side is the fetal back located? (FHR auscultation is on back)

    What is the presenting part?

    Is the fetal head flexed and engaged in the pelvis?
  27. How do position changes effect changes in comfort?
    Promotes fetal rotation by aligning the "presenting part" with the pelvis.
  28. Vag/Cerv examination.

    What is the purpose of this exam?

    Dilation (opening/width; external os)
    Effacement (thinning/length; canal)
    Station: fetal descent & presenting part: how is -/+ number denoted?
    Identifies stage of labor and prognosis for ongoing care.

    • Dilation:
    • 0 cm: external os closed
    • 5 cm: external os halfway dilated
    • 10 cm: external os is fully dilated and ready for birth passage.

    • Effacement:
    • 0%: cervical canal is 2 cm long
    • 50%: cervical canal is 1 cm long
    • 100%: cervical canal is obliterated

    • Station:
    • If presenting is palpated HIGHER than the maternal ischial spines: (-) #
    • If presenting is felt BELOW the maternal ischial spines: (+) #, denoting how many centimeters below zero station
  29. What is the expected progression of "stations" during delivery?
    Negative stations to zero station to the positive stations in a timely manner (-5 --> +5)
  30. Maternal Physiological Responses to labor.

    What Increases, what decreases?

    What are some symptoms she may experience?
    • Increases:
    • T
    • BMR
    • WBCs

    • Decreases:
    • BG
    • Gastric motility & food absorption

    • SX:
    • muscle aches/cramps
  31. Maternal Physiological Responses to labor.

    Anxiety and Relaxation in labor: How do anxiety & relaxation effect labor?
    • Anxiety:
    • May decrease ability to cope w/ pain.
    • Catecholamine's can inhibit uterine and placental perfusion.

    • Relaxation:
    • May increase the natural process of labor.
  32. Amniotic fluid.

    What does foul smelling or cloudy a. fluid indicate (after rupture)?

    What does green fluid indicate?
    Foul/cloudy: infection.

    Greeness: baby has passed meconium, secondary to transient hypoxia, prolonged preg, cord compression, maternal HTN, diabetes, or chorioamnionitis.