CCTC NUR 220 UNIT 2 AND 3 (TEST 2) SOLVED CORRECTLY TO SCORE A+
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Course
CCTC NUR 220
Institution
CCTC NUR 220
CCTC NUR 220 UNIT 2 AND 3 (TEST 2) SOLVED CORRECTLY TO SCORE A+
Cervical Dilatation-
widening of the cervical os and canal from less than 1 cm to 10 cm allowing birth of baby
Cervical Effacement-
the taking up of the internal os and the cervical canal into the uterine side walls - 0% - 100%
...
CCTC NUR 220 UNIT 2 AND 3 (TEST 2) SOLVED
CORRECTLY TO SCORE A+
Cervical Dilatation-
widening of the cervical os and canal from less than 1 cm to 10 cm allowing birth of
baby
Cervical Effacement-
the taking up of the internal os and the cervical canal into the uterine side walls - 0% -
100%
Contractions-
rhythmic tightening and shortening of the uterine muscles
Duration-
-length of time from the beginning of one contraction to the completion of the same
contraction
-how long that one contraction lasts
Frequency-
time between the beginning of one contraction to the beginning of the next
Intensity-
strength of the uterine contraction during acme (peak)
Accelerations-
periodic increases in the baseline FHR (15 beats lasting for 15 secs)
Deceleration-
decreases in FHR below the baseline
presenting part-
portion of the fetus felt through the cervix on exam
Station-
relationship of the presenting part to an imaginary line drawn between the ischial spines
of the maternal pelvis (narrowest point is 0)
Engagement-
occurs when the largest diameter of the presenting part reaches or passes through the
pelvic inlet. Engagement confirms the adequacy of the pelvic inlet. It does not indicate
whether the midpelvis and outlet are adequate
Fetal lie-
relationship of the long (spinal column) axis of the fetus to the long axis of the mother
Critical Factors that Influence Labor:
1. Passageway (mom's vagina, pelvis)
2. Passenger (Fetus)
3. Presentation (Relationship between passage and fetus)
4. Powers of labor - physiologic forces
5. Psychosocial considerations (what mom and fetus is going through)
Factors in labor: Components to look at with the birth passage:
-Size of maternal pelvis
-Type of maternal pelvis
-Ability of the cervix to dilate and efface
Gynecoid pelvis:
,inlet rounded with all inlet diameters adequate, favorable for vaginal delivery. Most
common, 50%. (best one)
Platypelliod Pelvis:
inlet oval in shape with long transverse diameters, not favorable for birth. Head engages
in transverse position. Delay of progress at outlet of pelvis. 5%
Android Pelvis:
heart-shaped inlet with short posterior sagital diameter, not favorable for delivery. Head
enters pelvis in transverse or posterior position and stops. Same as in males. 20%.
Forceps are usually required with extensive perineal lacerations.
Anthropoid Pelvis:
inlet oval in shape with long anteroposterior diameter, favorable for birth. 25%
Factors in labor: Components to look at with the Passenger:
-Fetal Head (size and presence of molding)
-Fetal Attitude (flexion or extension of the fetal body and extremities)
-Fetal Lie
-Fetal Presentation (part of the fetal body entering the pelvis first in a single- or multiple-
gestation pregnancy)
Three parts of the fetal head:
1. base of the skull, fixed
2. roof- vault of the cranium, overlap under pressure (molding) to allow for birth
3. face- fixed
Sutures of the fetal skull:
membranous spaces between the cranial bones
-Frontal (miotic): becomes the anterior continuation of the sagittal suture
-Sagittal Suture: located b/t the parietal bones; divides the skull into left and right; runs
anteroposteriorly, connecting the two fontanells
-Coronal Sutures: located b/t the frontal and parietal bones; extend transversely left and
right from the anterior fontanelle
-Lambdoidal suture: located b/t the two parietal bones and the occipital bone; extends
transversely left and right from the posterior fontanelle.
fontanelles
intersections of the cranial sutures
Mentum-
fetal chin
Sinciput-
anterior area known as the brow (forehead)
Vertex-
area b/t the anterior and posterior fontanells (top of head)
Occiput-
area of the fetal skull occupied by the occipital bone, beneath the posterior fontanelle
(back of the head)
Bregma
The large diamond shaped anterior fontanelle.
posterior fontanelle-
intersection b/t posterior cranial sutures
fetal attitude
,refers to the relationship of the fetal parts to one another
Normal fetal attitude-
moderate flexion of the head so that chin is on the chest, flexion of the arm onto the
chest, and flexion of the legs at the knee onto the abdomen.
Fetal lie-
refers to the relationship of the cephalocaudal axis (spinal column) of the fetus to the
cephalocaudal axis of the woman
longitudinal fetal lie-
occurs when the cephalocaudal axis of the fetus is parallel to the woman's spine
transverse fetal lie-
occurs when the cephalocaudal axis of the fetus is at a right angle to the woman's spine
Fetal presentation-
Determined by fetal lie and by the body part of the fetus that enters the pelvic passage
first called the presenting part.
Cephalic presentation-
fetal head presents first
breech presentation
when the baby's buttocks and/or feet appear first during birth
Complete breech-
hips and knees flexed; the thighs are on the abdomen, and the calves are on the
posterior aspects of the thighs; the buttocks and feet of the fetus present to the maternal
pelvis.
Frank Breech-
The Fetal hips are flexed, and the knees are extended; the buttocks of the fetus present
to the maternal pelvis.
Footling breech-
The fetal hips and legs are extended, and the feet of the fetus present to the maternal
pelvis
Narrowest diameter of the pelvis the fetus must pass through:
ischial spines
Where is the zero station?
ischial spine
Fetal position-
refers to the relationship of a designated landmark on the presenting fetal part to the
front, back, or sides of the maternal pelvis
three notations used to describes fetal position:
1. right (R) or left (L) side of the maternal pelvis
2. The landmark of the fetal presenting part: Occiput (O), mentum (M), sacrum (S), or
acromion process (A)
3. Anterior (A), posterior (P), or transverse (T), depending on whether the landmark is in
the front, back, or side of the pelvis.
Landmarks for fetal position:
Landmark for vertex is occiput
Landmark for face is mentum
Landmark for breech is sacrum
Landmark for shoulder is acromion process on scapula
, Engagement can be determines by:
vaginal exam
When does engagement occur with primigravidas? and Multiparas?
Primigravidas- approximately 2 weeks before term
Multiparas- may occur several weeks before the onset of labor or during the process of
labor.
Ballotable-
When the presenting part is not engaged it is said to be floating
Primary forces of labor-
uterine muscular contractions, which cause the complete effacement and dilation of the
cervix
Secondary force of labor:
The use of abdominal muscles to push during the second stage of labor
How is intensity of a contraction measured?
by palpating the uterine fundus during a contraction, but it may be measured directly
with an intrauterine catheter. When estimating by palpation the nurse determines
whether it is mild, moderate, or strong by judging the amount of indentability of the
uterine wall during the acme of a contraction. This can be affected by maternal weight,
adipose tissue, and positioning of monitor. When measured with an intrauterine
catheter, the normal resting pressure (b/t contractions) in the uterus averages 10-12,
during acme the intensity ranges from 25-40 in early labor to over 100 when pushing.
When does "bearing down" occur? what happens if the woman bears down too
soon?
bearing down occurs after the cervix is completely dilated. If the cervix is not completely
dilated, however, bearing down can cause cervical edema (which slows down dilation),
possible tearing and bruising of the cervix and maternal exhaustion.
Pathophysiology of labor:
- Progesterone - relaxation of smooth muscle tissue
- Estrogen - stimulation of uterine muscle contractions to soften, stretch, and thin the
cervix.
- Connective tissue loosens and permits softening, thinning, opening of cervix
- Muscles of upper uterine segment shorten and cause cervix to thin and flatten
- Fetal body straightened as uterus elongates with each contraction
Pressure of fetal head causes cervical dilation
- Rectum and vagina are drawn upward and forward with each contraction
Possible causes of labor: Progesterone Withdrawal Hypothesis-
progesterone relaxes smooth muscle by interfering with the conduction of impulses from
one cell to the next preventing coordinated contractions. Progesterone is decreased
later in pregnancy maybe because it is being used for lactogenesis.
Possible causes of labor: Prostaglandin Hypothesis-
We know that prostagladin E can be applied vaginally to start labor and an inhibitor of
prostaglandin synthesis like Indomethacin can be used to stop labor. Once
prostaglandin is produced, the stimuli for it's synthesis may include rising levels of
estrogen, decreased availability for progesterone, and increased levels of oxytocin.
Possible causes of labor: Corticotropin-Releasing Hormone Hypothesis-
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