ATI Maternal Newborn Chapter 16 Essay

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What is a prolapsed umbilical cord?
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When the umbilical cord is displaced, preceding the presenting part of the fetus, or protruding through the cervix.
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How does a prolapsed cord affect the fetus?
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Results in cord compression and compromised fetal circulation.
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What are some risk factors for a prolapsed cord?
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1. Rupture of amniotic membranes 2. Abnormal fetal presentation (any presentation other than vertex [occiput presenting]) 3. Transverse lie – Presenting part is not engaged, leaves room for the cord to descend. 4. Small-for-gestational-age fetus 5. Unusually long umbilical cord 6. Multifetal pregnancy 7. Cephalopelvic disproportion – due to unusual space between maternal pelvis and presenting part, leaving room for the cord to descend. 8. Placent previa 9. Intrauterine tumor – prevents engagement of presenting part. 10. Hydramnios
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What subjective data would indicate a prolapsed cord?
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Client reports that she feels something coming through her vagina.
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What objective data would indicate a prolapsed cord?
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•Visualization/palpation of the umbilical cord protruding. •FHR monitoring show variable or prolonged deceleration •Excessive fetal activity followed by cessation of movement; suggestive of severe fetal hypoxia
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What are the priority actions of the nurse if a prolapsed cord is assessed?
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•Call for assistance immediately •Notify the provider •Use sterile-gloved hand, insert two fingers, apply finger pressure on either side of the cord to the fetal presenting part to elevate it off of the cord. •Reposition client: knee-chest, Trendelenburg, or a (either) side-lying position with rolled towel under hip to relieve pressure on the cord. •Apply a warm, sterile, saline-soaked towel to the visible cord to prevent drying and to maintain blood flow. •Provide continuous electronic monitoring of FHR for variable decelerations, which indicate fetal asphyxia and hypoxia. •Administer oxygen at 8-10 L/min via a face mask to improve fetal oxygenation. •Initiate IV access, administer IV fluid bolus. •Prepare for a cesarean birth if other measures fail. •Inform and educate the client and her partner about the interventions.
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Is meconium-stained amniotic fluid associated with unfavorable fetal outcome? How did this happen?
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No. The fetus has had an episode of loss of sphincter control, allowing meconium to pass into amniotic fluid.
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At what point is there an increased incidence for meconium in the amniotic fluid? Why?
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38 weeks. Due to fetal maturity of normal physiological functions.
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What is another cause of meconium-stained amniotic fluid?
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Cord compression > fetal hypoxia > vagal nerve stimulation > induces peristalsis of the fetal GI tract and relaxation of the anal sphincter.
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What color may the amniotic fluid be? Consistency?
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black to greenish, yellow, or brown. Consistency may be thin or heavy.
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What are the criteria for evaluation/assessment of meconium-stained amniotic fluid?
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•Often present in breech presentation, and may not indicate fetal hypoxia. •Present with no changes in FHR •Stained fluid accompanied by variable or late decelerations in FHR (ominous sign)
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What interventions would the nurse implement upon finding meconium-stained amniotic fluid?
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•Document color and consistency •Notify neonatal resuscitation team to be present at birth •Gather equipment needed for neonatal resuscitation
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What respiratory interventions would the nurse implement upon delivering a baby with good respirations, muscle tone, and HR who had meconium-stained amniotic fluid?
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•Follow designated suction protocol -Assess neonate’s respiratory efforts, muscle tone, HR. -Suction mouth and nose using bulb syringe if respiratory efforts strong, muscle tone good, and HR > 100/min.
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What respiratory interventions would the nurse implement upon delivering a baby with poor respirations, muscle tone, and HR who had meconium-stained amniotic fluid?
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•Suction below the vocal cords using an endotracheal tube before spontaneous breaths occur if respirations are depressed, muscle tone decreased, and heart rate < 100/min.
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What are signs of fetal distress?
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•FHR is below 110/min or above 160/min •FHR shows decreased or no variability •There is fetal hyperactivity or no fetal activity.
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What are some risk factors associated with fetal distress?
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•Fetal anomalies •Uterine anomalies •Complications of labor and birth
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What objective assessments are associated with fetal distress?
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•Non-reassuring FHR pattern with decreased or no variability.
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What diagnostic procedures can be used to assess for fetal distress?
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•Monitor uterine contractions •Monitor FHR •Monitor findings of ultrasound and any other prescribed diagnostics.
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If fetal distress is found, what nursing interventions are appropriate?
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•Monitor vital signs and FHR. •Position the client in the left side-lying reclining position with legs elevated. •Administer 8-10 L/min of oxygen via a face mask. •D/C Pitocin if being administered •Increase IV fluid rate and treat hypotension if indicated •Prepare the client for an emergency cesarean birth.
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What is dystocia?
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Dysfunctional labor that is difficult or abnormal.
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What is happening during dystocia?
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•Atypical uterine contraction patterns prevent the normal process of labor and its progression.
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What are the two types of contractions occur during dystocia and how are they defined?
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•Hypotonic: weak, inefficient, or completely absent •Hypertonic: excessively frequent, uncoordinated, and of strong intensity with inadequate uterine relaxation. **All with failure to efface and dilate the cervix.
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What are the risk factors for dystocia?
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•Short stature, overweight status •Age > 40 years •Uterine abnormalities •Pelvic soft tissue obstructions or pelvic contracture •Cephalopelvic disproportion (fetal head larger than maternal pelvis) •Fetal macrosomia (LGA) •Fetal malpresentation, malposition •Multifetal pregnancy •Hypertonic or hypotonic uterus •Maternal fatigue, fear, or dehydration •Inappropriate timing or anesthesia or analgesics
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What object assessments can be made when dystocia is present?
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•Lack of progress in dilation, effacement, or fetal decent during labor. Hypotonic uterus stay soft even at peace contractions. Hypertonic uterus stays hard even between contracts. •Client is ineffective in pushing with no voluntary urge to bear down. Occiput position…prolongs labor…greater back pain reported by client as fetus presses against sacrum.
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What diagnostic procedures are used to determine presence of dystocia?
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•Ultrasound •Amniotomy or stripping of membranes ir not ruptured.
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•What therapeutic procedures are implemented when dystocia is present?
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•Oxytocin infusion •Vacuum-assited birth •Cesarean birth
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What nursing interventions are implemented during dystocia?
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•Assist with application of fetal scalp electrode and/or IUPC. •Assist with amniotomy (article rupture of membranes) •Encourage client to engage in regular voiding to empty bladder •Assist the client into a beneficial position for pushing and coach her about how to bear down with contractions. •Apply counter pressure using fist or heel of hand to sacral area to alleviate discomfort. •Prepare for a possible foreceps-assisted, vacuum-assisted, or cesarean birth.
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If a baby is found to be posterior, what interventions can assist in turning the baby into the anterior position?
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•Encourage position changes to aid in fetal descent or to open up the pelvic outlet. Hands-knees position to help fetus rotate from posterior to anterior position.
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What interventions may be implemented for hypertonic contractions?
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•Maintain hydration •Promote rest and relaxation, comfort measures between contractions. •Place the client in a lateral position, provide oxygen by mouth.
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What medications might be utilized during dystocia?
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•Oxytocin: used to augment labor and strengthen uterine contractions. Not used for hypertonic contractions. •Administer analgesics if prescribed for rest from hypertonic contractions.

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