UVU nursing 3310 mom/baby test #2-2 – Flashcards
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When to go to birth center or hospital
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-rupture of membranes - uterine contractions 3 min apart for 1 hour - vaginal bleeding greater than a bloody show - decreased getal movement less than 10 movements in 2 hours
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Labor assessment
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- due date - onset of contractions - frequency, duration and intensity or contractions - when the membrane ruptured - dilation and effacement and fetal station
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Maternal assessment
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- history - physical exam - assessment of membranes - vaginal exam - ultra sound for fetal position - vital signs - lab tests
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Fetal assessment
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Lie, position, presentation, station - fetal heart rate 110-160 - EFM
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Contraction assessment
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- palpitation: at the fungus - frequency - intensity - duration - relaxation time.
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Nursing Care of labor
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- respect ion contraction time - promote position change - promote voiding and bladder care - respect pain management
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Pushing
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- stay with patient - open glottis pushing - upright positions
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Most common position
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- lithotomy most common - hands and knees - squatting
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Third stage of labor nursing care
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- watch for signs of the placenta seperation - add pitocin to IV to help epulsion of placenta
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Immediate care of the new born
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- monitor respitory effort - stimulate infant by vigorously drying - maintain temperature - vital signs - APGAR assessment 1-5 minutes A-appearance P- pulse G-grimace A-activity R-respiratory effort - rate each section from 0-2
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Fourth stage of labor nursing care
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- perineal repair, hygine and comforts - evaluate vital signs - ice pack to perineium - medications - food and fluids - voiding
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Gate control theory (Pharm management)
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- activities that tend to close the pain gate Exp: - application of pressure - cutaneous stimulation - the use or heat or cold
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Factors that influence labor discomfort
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- intermittent contraction of the fibers or the cervix - increased uterine stretching - pain during the first stage T10-L1 - pain during the second stage s2-s4
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Goals of Pharm management
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- must relax a woman and relieve her discomfort - have minimal effect on contractions, her pushing effort and fetus - ACOG recommends receiving pain meds when they want it.
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Pharm management in first stage
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- choose the right med to reduce infant sleepiness - premature infants do not detoxify drugs well - given to soon they can slow the progress of labor.
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Narcotic agonists use in labor
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- Demerol/Meperidine no longer used - morphine - fentanyl
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Agonist - antagonist used in labor
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- stadol- -Nubian
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Tranquilizers used in labor
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- phenergan - vistaril
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Regional anesthesia
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- Spinal: used in c-section, use IV fluids to prevent hypotension - Epidural: hydrate to prevent hypotension,
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Obstetric anesthesia
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- General anesthesia: used in emergencies when need rapid effect
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Local anesthesia
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-Local: infiltration of anesthetic - Pudendal block: bilateral infiltration of the prudently plexis - PAracervical block (not uses a more)
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Electronic fetal monitoring contractions
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- palpating ion - external: to dynamometer - Internal: IUPC - tachysystoly
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Assess FHR before:
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1. Initiation r labor enhancing drugs 2. Periods of ambulation 3. Administration of meds 4. Administration analgesics
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Fetal heart rate patterns
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- Baseline: between contractions over a 10 min period, round to the nearest 5 - Tachycardia: FGR baseline > 160 - Bradycaria: FHR baseline<110
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Baseline variability
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- long term variability- fluctuation s of the FHR monitor that occur from 2-6/min
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Reduced variability
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- can lead to medication, infant or mother sleep cycles or infant distress
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-Fetal heart rate accelerations
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- FHR increase by 15 bpm above baseline less than 1o minutes - before 32 weeks increase FHR of bpm for 10 seconds - prolonged: acceleration > 2min <10 min
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FHR decelerations
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- Early: mirror contractions, gradual decrease and return to baseline, check her cervix - Late: gradual slowing of FHR after the peak of contraction with a delayed return to baseline. Associated with uterine hyperactivity and maternal hypotension - Prolonged late decelerations: Last >2 minutes, <10 minutes - Variable decelerations: periodic, unpredictable abrupt slowing of the FHR, from umbilical cord compression.
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Early decelerations
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mirror contractions, gradual decrease and return to baseline, check her cervix
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Late declerations
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gradual slowing of FHR after the peak of contraction with a delayed return to baseline. Associated with uterine hyperactivity and maternal hypotension
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Prolonged late declerations
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Last >2 minutes, <10 minute
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Variable decelerations
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periodic, unpredictable abrupt slowing of the FHR, from umbilical cord compression
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Amniofusion
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Addition of sterile fluid to uterus
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Meconium stained amniotic fluid
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Sign of fetal distress except with breech presentations
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Sinusoidal FHR
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Severely anemic or hypoxia, frequently undulating wave ominous
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Category I, interpretation of FHR
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- normal -baseline 110-160 - moderate variability - late or amiable decelerations absent - early decels absent or present - accels absent or present
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Category II, interpretation of FHR
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- indeterminate - bradycardia with variability - tachycardia, - minimal variability, ---pretty much anything not abnormal or normal
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CAtegry III, interpretation or FHR
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- abnormal - either absent variability with recurrent late or variable decels - bradycardia sinusoidal pattern
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Nursing interventions for FHR monitoring
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- Early: none needed, check her cervix as this may indicate coercive is dilated - late: turn patient to side, O2@ 10L/mask, stop oxytocin, sterile vaginal exam, notify HCP - Variable: reposition patient, SVE for cord prolapse, O2at 10L/mask, notify HCP, Amnioinfusion if severe.
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What do you do when there are concerning FHR
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- you must document intervention and fetal response.
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Special monitoring circumstances
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-preterm fetus - multiple gestation
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Dystocia
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Dysfunctional labor - alteration in cervical dilation and baby decent - risk to mother, exhaustion, infection - risk to fetus, hypoxia, birth trauma - most common reason for primary c/s
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Common cause of dysfunction
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- inappropriate use of analgesics - pelvic bone contraction - for fetal position - uterine abnormalities - uterine distention - not ripe uterus - exhastion
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Hypertonic uterine dysfuntion
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- painful frequent contractions with little rest inbetween Category II or III - treat with fluids, relaxation,
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Hypotonic dysfuntion
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Decrease frequency and intensity of UC - no or title cervical change - monitor mother and baby
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Inadequate expulsion forces
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-maternal exhaustion - epidural anesthesia - coach woman on pushing
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Problems with the passenger
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Fetal abnormalities: - Macrosomia >4000gm (shoulder dystocia ) Fetal malpresentation: - occipital posterior - face, brow, shoulder and breech - c/s
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Problems with the passage
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Cephalopelvic Disproportion- trial of labor
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Nursing care for labor complications
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- physical comfort - assess temp q 1-2 HR - Asses for meconium - at risk for postpartum hemorrage
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Infant assessment
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- palate clavicles for crepitus - assess movements - assess symmetrical movements - assess head for molding - assess for injury from tools
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Precipitous labor
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< 3 hours - coach woman -STAY WITH HER - promote fetal oxygenation with side laying position - assess blue equipment - provide support
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-Precipitous birth
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- STAY WITH THE WOMAN - wash hands - maintain flexion with gentle pressure - after birth wipe of head and use syringe in mouth then nose - head downward to deliver anterior shoulder then upward to deliver posterior shoulder
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Immediate care of newborn
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- drain secretions - wrap and dry - wait to deliver placent till HCP is there - check fo uterine bleeding and firmness
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Maternal obesity
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BMI >30 risks for delivery: - abnormal progress of labor - fetal Macrosomia - shoulder dystocia - high rates of c/s - epidural and spinal anesthesia are hard - higher failure rate for VBAC - increase postpartum complications
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Induction or augmentation of labor
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Indications: - pre existing maternal diseas - 37 weeks without onset of labor - post term pregnancy - suspected fetal jeopardy - fetal death without onset of labor - distance from hospital and prior rapid delivery
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Contraindications of induction
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Maternal: - previous c/s with classical incision - placental anomalies - active herpes - pelvic anomalies - cord prolapse Fetal: - abnormal lie or presentation - fetal distress
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Bishops score
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0-3 1. Dilation 2. Effacement 3. station 4. Cervical consistency 5. Cervix position - score of 5 for multip and 9 for primp
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Cervical ripening
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- mechanical cervical ripening - prostaglandin - cervidil=inserted at night removed in 12 hrs - stripping of membranes
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Oxytocin
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Given piggyback IV - Low dose - gradual increase to 4u/min - regular- start at 1u/min, increase 1-2u/min Q30 min, to 20u/min - high dose - increase by 4 u/min Q30 min to 20 u/min - must monitor continuously
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External cephalic version
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Risks: - uterine rupture - PROM - transient FHR Fetal demise
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Criteria for ECV
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- 37 weeks - unengaged - intact membranes - no signs of fetal distress - maternal abdominal wall is thin enough
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Mangement of shoulder dystocia
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- downward traction of head with super public pressure - extend /Make episiotomy - Paul knees back - sweep posterior arm across shoulder - c/s
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Umbilical cord prolapse
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- obstetric emergency - sever bradycardia do or prolonged variable decels - treat -call for help, patient in knee chest position, lift head off Cord - c/s
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Placenta succenturiata
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One or more lobes are in the membranes a distance away from the main placenta
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Cesarean birth maternal factors
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Maternal factors: - herpies - AIDS or HIV - Cephalic disproportion - disabling conditions, PIH, heart diseas - failed induction - previous c/switch classic incision - elective
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Cesarean birth placental factors
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-Placenta Previa -abrupt ion - umbilical cord prolapse
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Cesarean birth fetal factors
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- fetal distress - extreme prematurity/ low birth wt - transverse or breech position - multiple gestation or conjoined twins
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Effects of surgery on the woman
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- stress response - interference with body defense - interference with circulatory function - interference with organ function - interference with body or self image - longer more painful recovery
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Operative risk to newborn
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- respitory distress
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C/S nursing care
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- prophylactic antibiotics - prep skin - foley cath - baseline vitals
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C/S complications
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- hemorrhage -bladder, ureter and bowl trauma - maternal hypotension - maternal respiratory depression - infections - DVT - paralytic ileus
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VBAC's rates decreased 67%. Indications
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- 1-2 low transverse c/s - adequate pelvis - physican and or team immediately available
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Contraindications of VBACs
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- prior T shaped incision - previous uterine rupture - pelvic anomalies - medical or obstetric complications that would preclude vaginal birth - inability to perform immediate C/S
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Risks of VBACs
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- rupture of membranes - a failed TOLAC is associated with more complications than elective repeat C/S - neonatal morbidity is higher in the setting of TOLAC (trial of labor after C/S)
