OB Exam 2

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jwhughes
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309040
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OB Exam 2
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2015-10-05 16:22:26
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OB
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Exam 2
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  1. What is relation of the other fetal body parts to one another (position the fetus assumes as it conforms to the shape of the uterine cavity)
    Fetal attitude
  2. What is normal general flexion
    • head flexed
    • chin on chest
    • arms crossed over chest
    • legs flexed at knees
  3. What fetal lie is ideal?
    Longitudinal (fetal spine parallel to mom)
  4. What is the relationship of the fetal long axis (head to tail or cephalocaudal) to the mothers spine (longitudinal ideal)
    Fetal lie
  5. What is it called when the fetal spine is at a right angle to the mother's spine
    transverse lie
  6. How should a baby be delivered that is in transverse lie
    c section (NO VAGINAL)
  7. What determines the presentation of the baby
    fetal lie
  8. What presentation is most common and most desired
    vertex (head completely flexed on chest, smallest diameter of head presented to pelvis)
  9. What presentation is most commonly felt?
    cephalic
  10. What is named according to the presenting part at the cervix and leads thru the birth canal during labor?
    Presentation
  11. What breech presentation has hips and legs extended, feet present, can be single or double?
    Footling
  12. When do you feel the presentation
    during exam of the cervix
  13. Name 3 abnormal cephalic fetal lies
    • Brow
    • Face
    • Shoulder
  14. What type of fetal lie is when the head is partly extended, largest AP diameter if presented to the pelvis
    Brow cephalic fetal lie
  15. What type of cephalic lie occurs when the head is hyperextended
    Face
  16. What presentation occurs when the presenting part is lower extremity/extremities or buttocks
    Breech
  17. How is the Breech position classified
    According to the position of the hips and knees
  18. Breech position in which the knees and hips are both flexed and the feet present to the pelvis
    complete
  19. Breech position in which hips are flexed, knees are extended with feet in front of face, and butt is present
    frank
  20. What occurs when the largest part of the presenting part reaches or passes thru pelvic inlet
    engagement
  21. When is the baby said to be engaged
    when the head is flexed and the AP diameter is the largest part of the skull
  22. When does engagement occur in primips?
    2 weeks
  23. What is the baby said to be if it is not engaged
    floating or ballotable
  24. Acronym for fetal stations with corresponding score
    • F: -3 (floating high)
    • I: -2 (In the right direction)
    • S: -1 (Settling in)
    • H: 0 (Halfway there)
    • I: +1 (Inching out)
    • N: +2 (nearly there)
    • G: +3 (Get the crown)
  25. What is the relationship of presenting part to the imaginary line between the ischial spines of the maternal pelvis
    Station
  26. What marks the narrowest diameter through which the fetus must pass
    station
  27. At what station is delivery imminent
    +3
  28. When would the landmark be a zero station
    • If higher than spines number assigned is negative (-5 at inlet)
    • If lower than the spines, number assigned is positive (+4 at outlet)
  29. What is the relationship between the presenting part to sides of maternal pelvis
    Fetal position (right or left)
  30. Is the baby is posteriorly positioned, what may occur
    • back labor (more pressure on sacral nerves)
    • May feel need to push earlier
    • 2nd stage may be prolonged
  31. What are the 4 landmarks with the occiput (fetal position)
    • Left anterior
    • Right anterior
    • Left posterior
    • Right posterior
  32. Notations when describing position of baby
    • Right or left
    • Presenting part
    • Anterior, Posterior, or transverse
  33. Name 4 presenting parts of baby during positioning
    • Occipital (O)
    • Mentum (M)
    • Sacrum (S)
    • Scapula (Sc)
  34. What are the two most common positions of baby in notation
    • ROA (Right, occipital, anterior)
    • LOA (Left, occipital, anterior)
  35. Name 4 possible causes of labor
    • progesterone withdrawal
    • oxytocin
    • prostaglandins
    • Corticotropin releasing hormone (CHG)
  36. What do u tell mom to do if suspected ROM
    go to hospital, doctor
  37. What is a medical emergency risk that occurs when there is a rupture of membranes without engagement
    cord prolapse
  38. When does labor usually begin following bloody show
    12-24 hrs
  39. What is it called when softening and effacement cause the mucus plug to become expelled
    bloody show (small blood and the plug exposed)
  40. What 5 things can lightening cause
    • leg cramps/pain
    • increased pelvic pressure
    • Increased venous stasis (LE edema)
    • Increased urinary frequency
    • Increased vaginal secretions
  41. What occurs when fetus begins to settle into the pelvis (engagement). Uterine moves downward and fundus no longer presses on the diaphragm
    Lightening
  42. What facilitates engagement
    round ligament pulls the fundus forward, aligning the fetus within the bony pelvis
  43. When does effacement usually occur in primips
    precedes dilation
  44. What is the taking up and drawing up of the cervical os and cervical canal into the uterine walls (cervix changes from long, thick structure to a tissue paper thin)
    effacement
  45. Name primary forces of labor
    • uterine contractions
    • complete effacement and dilation of cervix
  46. Name secondary forces of labor
    abd muscles push baby out
  47. What is important to allow mom to do between contraction and why
    rest to allow uterine muscles to relax to restore placental circulation to fetus
  48. 3 phases of contraction
    • Phase 1: building up (increment: longest phase)
    • Phase 2: acme (peak)
    • Phase 3: decrement (letting up)
  49. What can measure intensity of contractions best?
    Intrauterine catheter
  50. What can occur if a woman bears down and the cervix is not completely dilated
    cervical edema which retards dilation, possible tearing, and bruising of cervix
  51. What happens to uterus during labor??
    It divides into 2 sections: upper and lower
  52. What portion of placenta is contractile segment and becomes progressively thicker as labor advances
    Upper portion
  53. What portion of placenta includes the lower uterine segment and cervix is passive, as labor continues, it expands and thins
    lower portion
  54. What is the time between the beginning of one contraction and the beginning of the next
    frequency
  55. What is measured from the beginning of the contraction to the completion
    duration
  56. What is the strength of the contraction
    intensity
  57. What is normal resting tone intensity of contractions
    10-12 mm
  58. What is the peak intensity of contractions
    • 25-40 (early)
    • 50-70 (late)
  59. What is the intensity of contraction during transition
    80-100 mm
  60. What is the intensity of contraction during pushing
    >100 mm
  61. What are the 3 phases during first stage of labor
    • Latent
    • Active
    • Transition
  62. How long does epidural increase first stage of labor by
    1 hr
  63. Name signs of early labor
    • Lightening
    • Braxton hicks
    • Cervical ripening
    • Bloody show
    • ROM
    • sudden burst of energy
    • weight loss, increased back ache
    • n/v/d, indigestion
  64. What is the first stage of labor also known as
    latent
  65. How long is the latent phase of labor usually
    • 5-7 hours (6.8 primis)
    • 5.3 (multips)
  66. What is the cervix dilated to for first stage of labor
    0-3 cm
  67. How often are the contractions during the first stage of labor
    3-30 min
  68. What is the duration of contractions during the first stage of labor
    20-40 seconds
  69. What is the intensity of contractions during first stage of labor
    mild-moderate
  70. What emotional state is the mother in during the first stage of labor
    • Happy, excited about upcoming delivery
    • divert self with activities
    • pelvic rocking for backache
    • abd breathing for contraction pain
  71. What is the cervix dilated to during active labor
    4-7 cm
  72. How long does active phase of labor usually last
    2-5 hours
  73. What is frequency of contractions during active labor
    q 2-5 min
  74. What is the duration of the contractions during active labor
    40-60 seconds
  75. What is the intensity of contractions during active phase of labor
    moderate to strong
  76. How is the woman reacting to active phase of labor
    • Increased anxiety
    • Fears of coping with pain
    • Need companion
    • Tries a comfortable position
    • Uses focal point
    • Back rub for pain
    • may ask for meds/epidural
  77. How long does the transition phase last during first stage of labor
    3.5 hours
  78. How much is cervix dilated during active labor
    8-10 cm
  79. How frequent are the contractions? Duration? Intensity?
    • 1.5-3 min
    • 60-90 sec
    • Strong
  80. How is the woman reacting to active phase of labor
    • Uncontrollable urge to bear down
    • Significant anxiety, restless, tired
    • Difficulty coping with contractions
    • Irritable, withdraws
    • Yelling
    • Foul language
    • shallow chest breathing
  81. What stage of labor consists of complete dilation to birth
    2nd stage
  82. When is the 2nd stage usually completed
    within 2 hours after cervix is completely dilated
  83. How frequent are contractions during 2nd stage of labor? duration? Intensity?
    • q 1.5-2 min
    • 60-90 sec
    • Strong
  84. How is the mom reacting to 2nd stage of labor
    • desire to have bowel movement
    • need reassurance
    • Explosive grunt with exhalation
    • Complete exhaustion
    • Bend in C shape and take deep breath, bend knee and push while exhaling, blow out to control delivery
  85. What cardinal movement occur when the head enters the inlet in the occiput transverse or oblique position because the pelvic inlet is widest from side to side. The saggital suture is an equal distance from the sym pubis and sacral promontory
    descent
  86. What cardinal movement includes: Head descends and meets resistance from the soft tissues of the pelvis, the muscles of the pelvic floor and cervix. As a result, the chin flexes downward onto the chest
    flexion
  87. What cardinal movement includes: head must rotate to fit the diameter of pelvic cavity which is widest at the AP diameter. As the occiput of the head meets resistance, it rotates from left to right and the sagittal suture aligns in the AP pelvic diameter
    Internal rotation
  88. What cardinal movement includes: Resistance of pelvic floor and the opening of the vulva assist with the extension of the fetal head as it passes under the sym pubis. With this position change, the occiput, brow and face emerge
    Extension
  89. What cardinal movement includes: Shoulders enter the pelvis obliquely and remain so when the head rotates to the AP diameter through internal rotation. B/C of this the neck becomes twisted. Once the head emerges and is free of pelvis resistance, the neck untwists, turning the head to one side (restitution) and aligns with the position of the back in the birth canal.
    Restitution
  90. What cardinal movement includes: as shoulder rotate to the AP position in the pelvis, the head is turned farther to one side
    external rotation
  91. What cardinal movement includes: after external rotation, the anterior shoulder meets the undersurface of the sym pubis and slips under it. As lateral flexion of the shoulder and head occurs, the anterior shoulder is born before the posterior shoulder. The body quickly follows.
    Expulsion
  92. What 4 forces cause descent
    • pressures of AF
    • Direct pressure of fundus on breech
    • Contraction of abdominal muscles
    • Extension/straightening of fetal body
  93. Name 7 cardinal movements (mechanisms of labor)
    • Descent
    • Flexion
    • Internal rotation
    • Extension
    • Restitution
    • External rotation
    • Expulsion
  94. What stage of labor includes birth to placental expulsion
    third stage
  95. What occurs during the third stage of labor
    • placental separation
    • membranes separate
    • placental delivery
  96. What is it called if the placenta separates from the inside to the outer margins expelling with the fetal side presenting
    Schultze mechanism
  97. What is it called if the placenta separates from the outer margins inward and it rolls up and presents sideways with the maternal surface delivering first
    Duncan mechanism
  98. What causes placental separation
    decrease in surface area
  99. What happens if it more than 30 minutes have lapsed during placental delivery
    The placenta is "retained"
  100. What stage of labor includes 1-4 hours after birth
    4th stage
  101. What hemodynamic changes occur during the fourth stage of labor
    • Blood loss (redistributed into venous beds)
    • Moderate drop in BP
    • Moderate tachycardia
  102. How much blood is lost by the 4th stage of labor
    250-500 mLs
  103. What occurs with the uterus, fundus, and cervix during 4th stage of labor
    • Uterus: contracted and midline
    • Fundus: halfway between umbilicus and sym pubis and contracted
    • Cervix: widely spread and thick
  104. What are symptoms of mom during 4th stage of labor
    • n/v
    • thirst/hungry
    • shaking/chills
    • Bladder hypotonic (urinary retention)
  105. 5 factors that affect process of labor
    • Passenger (baby)
    • Passage (birth canal)
    • Power (contractions, hydrostatic pressure, pushing)
    • Positioning (upright verse lying down)
    • Psychological state of mom
  106. Describe the pathway of birth canal
    True pelvis>Cervix>vagina>pelvic floor
  107. What pelvic shape is the most common and most suited to vaginal delivery
    Gynecoid
  108. What pelvic shape is most common in men
    Android
  109. What pelvic shape is when the inlet is oval shaped
    Anthropoid
  110. What type of pelvic shape results in slow descent, maked fetal head engage in transverse/occipital position; frequently causes extreme molding, arrest of labor, need for forces, perineal lacerations, and sometimes a c-section
    Android
  111. What does the inlet look like for an android pelvis
    heart shaped
  112. What does the inlet look like for gynecoid pelvis
    rounded and wider than deep front to back
  113. What does the anterior fontanel look like? posterior?
    AF: 2-3 cm (diamond shaped-junction of sagittal, coronal, and frontal sutures)

    PF: 1-2 cm (triangle shaped area between occipital and parietal bone
  114. When are copies of prenatal records sent for intrapartum assessment
    36 weeks
  115. What minimal assessment do you do during imminent delivery
    • VS
    • Labor status (contractions, dilation, effacement, station, membrane status)
    • Fetal status (presentation/position, FHT, movement)
    • Labs
  116. When does hearing begin and become fully developed in utero
    23-24 weeks, 28 weeks
  117. How long is sleep cycle in utero
    40 min
  118. What is a disadvantage of external monitoring of contraction using a tocodynamometer
    DOES NOT MEASURE INTENSITY
  119. What does internal pressure catheter measure (IUPC)
    • pressure in uterus
    • resting tone between contractions
    • intensity
  120. What is a disadvantage of IUPC
    • membranes have to be ruptured
    • Invasive
    • doctor puts in not nurse
  121. What is normal FHT
    110-160
  122. What do u have to look at together when monitoring contractions
    FHT in relation to contraction
  123. Are acels good or bad
    EXCELLENT
  124. What is considered fetal bradycardia
    <110 for 10 min
  125. What should be done if a nurse detects a wandering baseline on the FHT monitor
    IMMINENT DELIVERY
  126. What is baseline fluctuations of two cycles per minute or greater in the FHR and classified by the visually quantified amplitude of peak-to-trough in beats per minute
    variability
  127. Name 4 classifications of variability
    • Absent (not detectable)
    • Minimal (<5)
    • Moderate (6-25)
    • Marked (>25)
  128. What variability to we want for FHR
    moderate
  129. What is an acceleration
    abrupt increase in baseline (fetal movement/simulation)
  130. What is the lowest point on the FHR monitor
    NADIR
  131. What does an early deceleration look like
    mirrors contraction pattern
  132. Nursing actions for late decelerations (top 3 to do right away)
    • Turn mom side to side
    • oxygen to mom
    • stop oxytocin
  133. What deceleration has NADIR after the peak of the contraction
    LATE
  134. What causes late decelerations
    placental insufficiency
  135. What causes early decelerations
    head compression
  136. What causes variable decels
    compression of cord
  137. Acronym for evaluating fetal heart tone changes
    • V: variables C:cord compression
    • E: earlies    H: head compression
    • A: accels     O: okay
    • L: late         P: placental insufficiency
  138. When would u send sample of cord blood analysis to be tested
    if apgar score is < 7 at 5 min
  139. What does the cord blood analysis determine in relation to fetal academia
    if it was from cord compression or placental insufficiency
  140. How can you gurantee you are getting arterial sample from cord blood
    puncture two vessels
  141. When should the mom go to doctor/hospital
    • ROM
    • Decreased fetal movement
    • Regular, frequent contractions (q 5 min primip)
    • Any vaginal bleeding
  142. When do Hispanic women go to hospital
    late in labor
  143. If upon inspecting the cord, only 1 artery is noticed what should the nurse suspect
    GU abnormalities
  144. What 5 things does Apgar assess
    • HR
    • RR
    • Muscle tone
    • Reflex irritability
    • Skin color
  145. What score is desirable for Apgar? moderately depressed? Severely depressed?
    • 7-10
    • 4-6
    • 0-3
  146. What is the most important part of the Apgar score
    HR
  147. What does the Apgar NOT do
    guide resuscitation
  148. If 5 min Apgar <5, what should the nurse do?
    continue Apgar scoring q 5 min until above 5
  149. What is code pink
    child abduction in hospital
  150. Acronym that describes what to do in case of a code pink
    • STORK:
    • Search/Secure scene
    • Telephone 111/give info
    • Obtain info/protect crime scene
    • Report/reassign mom/family to different room
    • Keep all staff and visitors on unit till police arrives
  151. What does ballooning of uterus indicate
    relaxation and bleeding
  152. What are signs of placental separation
    • Uterus rises up while placenta settles down
    • Umbilical cord lengthens
    • Sudden trickle/spurt of blood
    • Uterus changes from discoid
  153. 5 dangers to report in the 4th stage
    • Tachycardia
    • Hypotension
    • Uterine atony
    • Excessive bleeding
    • Fever <100
  154. What is the main side effect of epidural, how is it prevented
    hypotension, fluid bolus administered
  155. How is hypotension TREATED following an epidural
    turn mom on left side, increase IVF, give ephedrine and oxygen if indicated
  156. What causes hypotension following an epidural
    Anesthesia: lowers peripheral resistance, decreases venous return to heart which decreases cardiac output
  157. When is spinal block indicated
    C-section
  158. When is Pudendal block indicated
    2nd stage of labor, birth, EPISIOTOMY
  159. When is general anesthesia used
    ONLY FOR EMERGENCY C-section
  160. What criteria is required for mom to get pharmacological pain relief
    • Mother wants it, stable VS
    • FHR: 120-160
    • NST reactive
    • Variability present
    • No late decels/meconium stains
    • Labor contraction established
    • Cervix dilated to 4 cm gravid 1, 3 cm gravida 2
    • Presenting part engaged
    • Progressive descent of presenting part
  161. Why is oral pain meds not used
    too slow onset and decreases GI blood flow
  162. When phase of labor is morphine not used and why
    active, too long lasting, causes CNS depression and depressed respirations
  163. What 4 things does Anesthesia include
    • Analgesia
    • Amnesia
    • Relaxation
    • Reflex activity
  164. What is birth between 37-38 weeks
    Early-term
  165. What is birth between 38-39 weeks
    full-term
  166. What is birth between 39-40 6/7 weeks
    Late-term
  167. What is birth after 42 weeks
    Post-term
  168. What is considered low birth weight infant?
    <2500 g
  169. What is labor that occurs between 20-37 weeks
    Preterm labor (PTL)
  170. What is the number 1 cause of infant mortality and neuro disabilities in the US
    preterm birth
  171. Is pre-term birth increasing or decreasing
    decreasing
  172. What race is 2x more likely to have preterm or low birth weight
    African American
  173. What is the most common lower GU infection in women of childbearing age
    Bacterial Vaginosis (BV)
  174. What is the criteria for pre-term labor (1 of the following)
    • Contractions q 5 min
    • 8 contractions in 60 min
    • Documented cervical change or cervical effacement of 80%
    • Cervical dilation >1cm
  175. What are signs of preterm labor
    • pain
    • cramps
    • vag bleeding
    • bloody show
    • pelvic pressure
    • diarrhea
  176. When is progesterone indicated
    Prevention or recurrent preterm delivery d/t SROM or SPTL
  177. What should a woman receive if she is a candidate for tocolytics and why
    betamethasone or dexamethasone to enhance fetal lung maturity
  178. What serious side effect can occur with Beta-mimetics (terbutaline, ritodrine)
    pulmonary edema
  179. What are nursing interventions r/t PTL
    • Teach signs/sx of preterm labor and when to call doctor
    • Teach woman to palpate for contractions twice a day while lying on her side
  180. What do you teach the woman who experiences sx of PTL with activity
    • Empty bladder
    • lie on side
    • drink 3-4 cups of fluid
    • soak in a warm bath w/ uterus submerged
    • Rest for 30 min after sx subside
    • Call if sx persist
  181. What is rupture of BOW after 37 weeks but before onset of labor (if labor hasn't occurred within 12 hours)
    PROM
  182. What test is used to detect PROM and what does it measure
    Nitrazine test, amniotic fluid in vaginal secretions (pH)
  183. What are the interventions for PROM for discharge
    • Bedrest except bathroom
    • Monitor temp 4x/day
    • Fetal movement record
    • Labs 2x/week
  184. what might be seen for cervical insufficiency
    funneling
  185. What is hydraminos
    >2000 mL of AF
  186. What is the dangers of hydraminos with ROM
    prolapsed cord
  187. What med may be given for hydraminos
    indomethacin
  188. What is oligohydraminos
    <500 mL
  189. What life-threatening condition can result from oligohydraminos (in baby)
    pulmonary hypoplasia
  190. 2 meds for cervix ripening
    • misoprostol
    • prostaglandin
  191. When should oxytocin be given in relation to misoprostol
    give oxytocin 4 hours after
  192. What is abnormal labor patterns due to problems associated with the power, passenger, or passage
    Dystocia
  193. Most common cause of mother experiencing dystocia
    uncoordinated, ineffective uterine contraction
  194. What is ineffective uterine contractions of poor quality in the latent phase of labor
    tachysystolic labor patterns
  195. What to do if tachysystole occurs
    lay mom on left side, give oxygen
  196. What do you tell mom to do after mechanical cervical ripening
    stay recumbent with wedge under right hip
  197. Nursing interventions for amniotomy
    • mom is semi-reclining
    • underpads to absorb fluid
    • Inspect AF for blood/meconium
    • Frequent peri-care
    • Sterile vag exams
    • Check temp q 2 hr
    • Bedrest till presenting part engaged
    • dry birth
  198. When should oxytocin be discontinued
    • FHT unreassuring
    • Contractions > q 2 min
    • Duration >60 sec
    • Insufficient relaxation of uterus between contractions
  199. What does the cervix have to be for amniotomy
    2 cm at least
  200. What is the biggest risk of vaginal birth for Macrosomia
    shoulder dystocia
  201. What to do if prolapsed cord is detected
    • Med emergency
    • Use fingers to push up on presenting part
    • Place woman in knee chest position
    • oxygen
  202. What is the leading cause of maternal death
    amniotic fluid embolism
  203. What is usually the first sign of uterine rupture
    Nonreassuring FHT followed by bradycardia

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