N3262 FINAL (POSTMIDTERM CONTENT)
EXAM STUDY GUIDE
fetal fibronectin - ANSWER fetal cells that circulate before 20 weeks (positive
swab)
- after 20 weeks will not have these cells in vagina
- see this again in 2 weeks of birth (mucous plug out and fetal cells in uterus and
amniotic sac enter vagina)
what is the only way you test for fetal fibronectin - ANSWER sterile vagina
speculum
**** preterm labor = we do not touch, do sterile swab then assess cervix (risk
artificially introduce FF = false positive)
10 units of ___________ are given in ALL 2nd stage deliveries - ANSWER oxytocin
- after birth of anterior shoulder (so baby doesnt get stuck)
nonanalgesia interventions in birth - ANSWER positions like standing squatting,
all 4s
pelvic rocking
birthing ball, rope, stool
massage - sacral pressure
hydrotherapy
entonox/ nitronox - ANSWER 50/50 02 and nitrous
- for term and preterm, good during fast labor, transitioning
- noncumulative effects, moderate analgesia
- inhale as soon as contraction starts and stop when contraction ends
-N/V, dizzy
benzodiazepines like diazepam, lorazepam ativan are used to enhance pain
relief when given with an ________ - ANSWER opioid
- to reduce nausea and vomiting
systemic analgesia is concerning because - ANSWER it crosses BBB
- fetal resp depression, decreased alertness
opioid agonist examples - ANSWER fentanyl, morphine, sufenatil
- slow newborn RR, impair breastfeeding
t or f opioids delay gastric emptying and increase gastric acid secretion -
ANSWER true
- increases risk for aspiration
,opioids should be used cautiously in __________ - ANSWER premature labor
- respiratory depression
nerve block analgesia (local) - ANSWER temporary interruption in nerve
conductors
- lidocaine, bupivicane, tetracaine
spinal block - ANSWER anaesthetic with or without opioid injected through 3,4,
or 5 lumbar subarachnoid space
epidural - ANSWER anaesthetic injected in 4 or 5 lumbar epidural space
position for spinal block for lower segment c section insertion - ANSWER left
lateral
why does hypotension occur in a spinal or epidural - ANSWER sympathetic block
= give large bolus
- we are worried about placental perfusion
- drop no more than 20% of mom baseline
CSF leak headache - ANSWER puncture wound causes CSF leak into wound
- caffeine reduce headache, sit upright intensifies headache
- watch for numbness and tingling, no straining
contraindications of epidural - ANSWER antepartum hemorrhage/ hypovolemia
anticoag therapy or bleeding disorder
allergies
cardiac conditions
3 medications received in potential preterm labor - ANSWER broad spectrum
antibiotics
magnesium sulfate
corticosteroids
assessment for potential preterm labor - ANSWER S&S
Fetal Heart Rate: 110-160
Fluid from vagina? Blood? Amniotic Fluid?/COAT?
pre-activities?
NO VE until after speculum!!!
VS-Description of contractions-timing? Frequency?
tocolytic - ANSWER agent that stops or delays premature labor and contractions
- magnesium sulfate
- nifepidine
- terbutaline
, induction - ANSWER induce labor
bishop score - ANSWER Score for induction of labor/ cervix favorability
- soft or hard - firmness? can dilate?
- effacement - thin or thick?
-Score of >8 = can do induction of labor
if bishop score is lower and cervix is hard, what should you need to give -
ANSWER prostaglandins
- ejaculate
- cervadil (tampon with prostaglandin)
- gel (not recommended, burns)
uterotonics - ANSWER increase tone and contractions of uterus
- oxytocin
side effects of uterotonics - ANSWER uterine rupture - too many artificial
contractions
placental deatachement/ fetal demise
increase c/s rates
starting dose of oxytocin - ANSWER 1mL/hr
- strong drug, attach at port closest to patient in case need to stop
why are we worried about giving morphine during birth - ANSWER resp
depression
- worried for baby once expelled and takes first both
t or f entonox can only be used by patient, nurse cant hold it for them - ANSWER
true
- works instantly, self limiting
fentanyl IV how long last - ANSWER 30 minutes- 1 hr
- worried about resp depression
why would you not give morphine to a mother in transition phase of labour -
ANSWER because it lasts 4-5 hours, they are going to be iminant to give birth so
it wouldnt make sense
- if woman comes in ask if they are multip (faster in labor)
when is it ok to give fentanyl based on stages of labor - ANSWER latent/ active
- not great in transition
if a mother is a multip they will be _______ in labor - ANSWER faster
EXAM STUDY GUIDE
fetal fibronectin - ANSWER fetal cells that circulate before 20 weeks (positive
swab)
- after 20 weeks will not have these cells in vagina
- see this again in 2 weeks of birth (mucous plug out and fetal cells in uterus and
amniotic sac enter vagina)
what is the only way you test for fetal fibronectin - ANSWER sterile vagina
speculum
**** preterm labor = we do not touch, do sterile swab then assess cervix (risk
artificially introduce FF = false positive)
10 units of ___________ are given in ALL 2nd stage deliveries - ANSWER oxytocin
- after birth of anterior shoulder (so baby doesnt get stuck)
nonanalgesia interventions in birth - ANSWER positions like standing squatting,
all 4s
pelvic rocking
birthing ball, rope, stool
massage - sacral pressure
hydrotherapy
entonox/ nitronox - ANSWER 50/50 02 and nitrous
- for term and preterm, good during fast labor, transitioning
- noncumulative effects, moderate analgesia
- inhale as soon as contraction starts and stop when contraction ends
-N/V, dizzy
benzodiazepines like diazepam, lorazepam ativan are used to enhance pain
relief when given with an ________ - ANSWER opioid
- to reduce nausea and vomiting
systemic analgesia is concerning because - ANSWER it crosses BBB
- fetal resp depression, decreased alertness
opioid agonist examples - ANSWER fentanyl, morphine, sufenatil
- slow newborn RR, impair breastfeeding
t or f opioids delay gastric emptying and increase gastric acid secretion -
ANSWER true
- increases risk for aspiration
,opioids should be used cautiously in __________ - ANSWER premature labor
- respiratory depression
nerve block analgesia (local) - ANSWER temporary interruption in nerve
conductors
- lidocaine, bupivicane, tetracaine
spinal block - ANSWER anaesthetic with or without opioid injected through 3,4,
or 5 lumbar subarachnoid space
epidural - ANSWER anaesthetic injected in 4 or 5 lumbar epidural space
position for spinal block for lower segment c section insertion - ANSWER left
lateral
why does hypotension occur in a spinal or epidural - ANSWER sympathetic block
= give large bolus
- we are worried about placental perfusion
- drop no more than 20% of mom baseline
CSF leak headache - ANSWER puncture wound causes CSF leak into wound
- caffeine reduce headache, sit upright intensifies headache
- watch for numbness and tingling, no straining
contraindications of epidural - ANSWER antepartum hemorrhage/ hypovolemia
anticoag therapy or bleeding disorder
allergies
cardiac conditions
3 medications received in potential preterm labor - ANSWER broad spectrum
antibiotics
magnesium sulfate
corticosteroids
assessment for potential preterm labor - ANSWER S&S
Fetal Heart Rate: 110-160
Fluid from vagina? Blood? Amniotic Fluid?/COAT?
pre-activities?
NO VE until after speculum!!!
VS-Description of contractions-timing? Frequency?
tocolytic - ANSWER agent that stops or delays premature labor and contractions
- magnesium sulfate
- nifepidine
- terbutaline
, induction - ANSWER induce labor
bishop score - ANSWER Score for induction of labor/ cervix favorability
- soft or hard - firmness? can dilate?
- effacement - thin or thick?
-Score of >8 = can do induction of labor
if bishop score is lower and cervix is hard, what should you need to give -
ANSWER prostaglandins
- ejaculate
- cervadil (tampon with prostaglandin)
- gel (not recommended, burns)
uterotonics - ANSWER increase tone and contractions of uterus
- oxytocin
side effects of uterotonics - ANSWER uterine rupture - too many artificial
contractions
placental deatachement/ fetal demise
increase c/s rates
starting dose of oxytocin - ANSWER 1mL/hr
- strong drug, attach at port closest to patient in case need to stop
why are we worried about giving morphine during birth - ANSWER resp
depression
- worried for baby once expelled and takes first both
t or f entonox can only be used by patient, nurse cant hold it for them - ANSWER
true
- works instantly, self limiting
fentanyl IV how long last - ANSWER 30 minutes- 1 hr
- worried about resp depression
why would you not give morphine to a mother in transition phase of labour -
ANSWER because it lasts 4-5 hours, they are going to be iminant to give birth so
it wouldnt make sense
- if woman comes in ask if they are multip (faster in labor)
when is it ok to give fentanyl based on stages of labor - ANSWER latent/ active
- not great in transition
if a mother is a multip they will be _______ in labor - ANSWER faster
