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A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe:
Bloody show.
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The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be:
Progressive uterine contractions
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What are the 5 factors or "Ps" of labor and birth
- passenger
- passageway
- powers
- position
- physiologic response
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What are membrane filled spaces that are located where the membranous sutures that unite the bones in the fetal skull intersect
fontanels
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what is a slight overlapping of the bones of the fetal skull that occurs duing childbirth; it permits the skull to adapt to the various pelvic diameters
molding
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what is the part of the fetus that enter the pelvic inlet first called
presenting part
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what are the 3 main types of the presenting parts
- cephalic (head first)
- breech (butt first)
- shoulder
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what is the relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother called
lie
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what are the two types of fetal lie
- longitudinal (spines are parallel to each other)
- transverse or oblique (spines are at right angles or diagonal to each other)
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what is the relationship of the fetal body parts to one another called
attitude
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What is the most common type of attitude
flexion
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what is the largest transverse diameter of the fetal skull
biparietal
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what is the smallest anteroposterior diameter of the fetal skull to enter the maternal pelvis when the fetal head is in complete flexion
suboccipitobregmatic
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what is the relationship of the fetal presenting part to the 4 quadrants of the maternal pelvis called
position
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What is the term that indicates that the largest transverse diamter of the presenting part has passed through the maternal pelvic brim or inlet into the true pelvis reaching the level of the ischial spines
engagement
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what is the relationship of the presenting part of the fetus to an imaginary line drawn b/t the maternal ischial spines; this is a measure of the degree of fetal descent through the birth canal
station
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what are the 2 components of the maternal passageway or birth canal
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what is the shortening and thinning of the cervix during the 1st stage of labor and expressed as a %
effacement
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what is the enlargement or widening of the cervical opening and the cervical canal which occurs once labor has begun
dilation
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what is the descent of the fetus's presenting part into the true pelvis approximately 2 weeks before term for the primigravida and after uterine contractions are established and true labor is in progress for the multipara called
lightening
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what are the primary powers of labor called
involuntary uterine contractions (effacement, dilation, ferguson reflex)
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what are the secondary powers of labor called
bearing down (pushing)
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what is the brownish or blood-tinged cervical mucus represnting the passage of the mucous plug as the cervix ripens in prep for labor
Operculum
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what are the 7 cardinal movements of birth
- engagement
- descent
- flexion
- internal rotation
- extension
- external rotation (restitution)
- expulsion
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what is the pushing method during the 2nd stage of labor characterized by a closed glottis w/ prolonged bearing down called
valsalva maneuver
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the first stage of labor is considered to last from the onset of to full
- regular uterine contractions
- dilation and effacement of the cervix
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what are the 4 factors that affect fetal circulation during labor
- position
- BP
- uterine contractions
- umbicial cord blood flow
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what maternal changes would be expected during labor
- slight increase in HR during 1st and 2nd stages
- decrease in gastric motility leading to N/V during the 1st stage of labor
- hypoglycemia
- proteinuria up to 1+
- increased WBCs, temp and respirations
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what are some signs preceding the onset of labor
- urinary frequency
- engery surge
- bloody show
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A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed. The nurse's immediate response would be to:
Help the woman breathe into a paper bag
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what are the lamaze institute's for normal birth 6 care principles from WHO
- labor begins on its own
- freedom of movement throughout labor
- continuous labor support
- no routine interventions (except IV site)
- nonsupine positions for birth
- no separation of mom and babe
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what is included under passenger
- size of fetal head
- fetal presentation
- fetal lie
- fetal attitude
- fetal position
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what does the passageway consist of?
- bony pelvis
- lower uterine segment
- cervix
- pelvic floor muscles
- vagina
- introitus (external opening to the vagina)
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what are the different types of pelvis's
- gynecoid (round shaped, SVD)
- android (heart shaped C/S)
- anthropoid (oval shaped C/S)
- platypelloid (flat shaped (SVD)
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what is included in the soft tissue
- upper and lower uterine segment
- physiologic retraction ring
- cervix, pelvic floor, vagina, introitus
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what are the 3 phases in the first stage of labor
- latent (0-3 cm)
- active (4-7 cm)
- Transition (8-10 cm)
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what are the 3 phases in the second stage of labor
- latent phase (0 to 2+ station)
- descent phase (2+ to 4+ station)
- transitional phase (4+ to birth)
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why do you perform leopold's maneuver's
- to determine # of fetuses
- presenting part
- fetal lie
- fetal attitude
- degree of presenting part's descent into pelvis
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What should the color of the ROM be
pale straw colored with white particles
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how much ROM should there be at term
500-1200 ml
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what is the nitrazine test and how should it be documented
- differentiates amniotic fluid (alkaline) from urine and purulent materal (acidic)
- membranes intact 5-6 (acidic)
- membranes ruptured 6.5-7.5 (alkaline)
- document as positive or negative
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what are signs necessitating immediate interventions during labor
- non-reassuring FHR patterns
- inadequate uterine relaxation
- vaginal bleeding
- infection
- prolapse of the cord
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What are types of episiotomies
- midline (median - most common in US)
- mediolateral (greater blood loss, more difficult to repair)
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what are the types of perineal lacerations
- first degree - laceration extends through skin and structures superficial to muscles
- second degree - laceration extending through muscles of perineal body
- third degree - laceration continues through anal sphincter muscles
- fourth - involves anterior rectal wall
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what is pain that predominates during the 1st stage of labor
visceral pain
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what is pain that results from cervical changes, distention of the lower uterine segment, and uterine ischemia
visceral pain
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what is pain that predominates during the 2nd stage of labor
somatic pain
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what is pain that results from stretching and distention of perineal tissues and the pelivc floor to allow passage of the fetus
somatic pain
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what is paced breathing technique during which a woman breaths at about 6-8 breaths per min
slow-paced breathing
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what is a paced breathing technique during which a woman breathes at about 32-40 breaths per minute
moidified-paced breathing
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what is a paced breathing technique during which a woman breaths about 32-40 breaths per minute interspersed with blowing out of air in a ratio of 3:1 or 4:1
patterned paced breathing
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what is a relaxation technique that can be used for labor that is based on the theory that if a person can recognize physical signals, certain internal physiologic events can be changed
biodfeedback
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what is the abolition of pain perception by interrupting nerve impulses going to the brain. Loss of sensation (partial or complete) and sometimes loss of consciousness occurs
anesthesia
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what is a method used to repair a tear or hole in the dura mater around the spinal cord as a result of spinal anesthesia; the goal is to prevent or treat postdural puncture headaches
autologous epidural blood patch
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single-injection, subarachnoid anesthesia useful for pain control during birth but not for labor; often used for C/S
spinal anesthesia (block)
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systemic analgesic such as nalbuphine and butorphanol that relieves pain w/o causing maternal or neonatal repiratory depression and is less likely to cause N/V
Opioid agonist-antagonist analgesic
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provides rapid perineal anesthesia for performing and repairing an episiotomy or lacerations
local infiltration anesthesia
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medication such as phenothiazines and benzodiazepines that can be used ot relieve anxiety, to induce sleep, augment the effectiveness of analgesics, and to reduce N/V
sedative
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drug that promplty reverses the effects of opioids, including maternal and neonatal CNS depression, especially respiratory depression
opioid antagonist
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use of a med such as an opioid analgesic that is administered IM or IV for pain relief during labor
systemic analgesic
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alleviation of pain sensation or raising of the pain threshold w/o loss of consciousness
analgesia
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relief from pain of uterine contractions and birth by injecting a local anesthetic agent, an opioid, or both into the peridural space
epidural analgesia/anesthesia (block)
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systemic analgesic such as meperidine or fentanyl that relieves pain, creates a feeling of well-being, but can also result in respiratory depression, N/V
opioid agonist analgesic
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