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N330 > 2 Nursing Care During Labor & Birth > Flashcards

2 Nursing Care During Labor & Birth Flashcards

1
Q

When should the pt come to the hospital 4

A

ROM
Contractions 5 min apart, lasting 45-60seconds
Any vaginal bleeding
Any danger signals (⬇️ FM, swelling, s/s preclampsia)

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2
Q

Labor admission assessment
Priority

A

Mother Vs:

BP <140/90
Temp <100.4

Fetal status:

FHR 110-160
Moderate variability

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3
Q

Additional data needed for labor admission
Contractions
Membrane
Pelvic exam
Prenatal hx

A

Contraction: freq, duration, intensity

Status of membranes: time, amount, color, monitor FHR x1 minute post rupture (if ruptured worried about infection)

Pelvic exam: cerical dilation/effacement and station

Prenatal hx: EDD/EDB

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4
Q

Addiritional data needed upon admission
Birthplan
Leopolds maneuver
Collection of what
Types of labs

A

Birthplan

Leopolds maneuver: vertex(cephalic)

Collect urine specimen

Labs:
CBC (h&h, plt, wbcs)
Type and screen
GBS status ( if unknown or + = give PCN)

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5
Q

Leopolds maneuver

A

1: palpate fundus: what part is up there (tells us fetal lie)

2: palpate sides: find fetal back for monitoring

3: find what i presenting in pelvis

4: find if baby is flexed or extended

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6
Q

Membrane status

Ruptured membranes

A

ROM/SROM/ AROM (amniotomy/artificial)
PROM(prelabor ROM)/ PPROM (preterm premture ROM)

Sterile procedure (nitrazine paper(alkaline (blue) or fen test

Presence of fluid in vagina

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7
Q

Membrane status

Assessment

A

FHR tracing (#1 priority with ROM=check on baby)

Fluid color (clear/straw colored, meconium stained)
Odor (odorless)
Time of rupture (important for infection)

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8
Q

1 issue with ruptures

A

Cord compression
Cord prolapse

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9
Q

Vaginal examination

A

Sterile

Hips flexed and abducted

Perform exam between uterine contractions

Assess: cervical dilation/effacement/station/presentation of fetus

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10
Q

What stage and phase does epidurals happen?

A

Stage one
Active phase

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11
Q

Stages of labor 1st stage (latent phase)
(how often, and increase in cm)

Vs
Temp
Contractions

Vag exam

A

BP,P,R q30-60min
Temp q4 unless ROM then q2
Contractions and FHR 30-60min

Vag exxam ass needed:
Progress once at 6cm
Primip: 1cm/hr
Multip: 1.5cm/hr

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12
Q

Stages of labor 1st stage (active phase)

Vs
Temp
Contractions
Meds
Want them to be doing if no epidural
Can intake what
Void how often
Vag exam
Support

A

BP,P,R q30min
Temp q4h unless ROM then q2
Contractions and FHR q15-30
Epidural and analgesics
Ambulation/positioning
Ice chips/clear liquids
Void q2h if no folely catheter (inhibits fetal descent)
Vag exam as needed
Emotional support

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13
Q

First stage of labor transition phase
Nursing measures

A

Lots of encouragement
Dont leave alone
Monitory cervix (may feel like they need to have a bowel)
Assess for urge to push,pressure, perineal, building/crowning

VS: 15-30min
Contractions 10-15min
FHR 15-30min

Preparation for delivery

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14
Q

For the first stage phases we just need to know what about VS and contractions and FHR

A

That the later phases will need to be monitored more frequently

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15
Q

Second stage of labor: pushing

A

Begins with complete cervical dilation and ends with birth of neonate

Ecourage pushing with contractions, wait for urge

Vitals q 15
FHR q5-15
Coaching with pushing/open glottis, discourage holding breath

Position upright/squatting

Perineal cleansing/stretching

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16
Q

Second stage of labor
Lengths

A

Lengths:
Nullipara:
Without epidural: 3hrs
With epidural: 4hrs

Multipara:
Without epidural:2hrs
With epidural:3hrs

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17
Q

Second stage of labor
signs of impending birth

A

Increased bloody show

Burning/stretching/bulging/crowning of perineum

Uncontrollable urge to push

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18
Q

Second stage of labor: birth

Dont do what
Support what
Check for what
Rotate how and what comes out first
How to cut cord

A

Dont leave pt alone
Support head
Check for nuchal cord
External rotation/delivery of anterior should first

Cord is clamped twice and cut between the clamps

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19
Q

Immediate newborn care

(5 things)

Can be delayed after what

A

Mucus removed by bulb syringe

Record time of birth

Inspect cord for 2A and 1V

Apgar scoring at 1min and 5 min includes vitals

Vit k and erythromycin

Measurements can be delayed until after skin to skin/breast feeding if stable

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20
Q

Third stage of labor

What is it
Length
Signs of placental dettachment (3)
Inspect what 2 things
Administer what

A

Start with birth of neonate and ends with delivery of placenta

Approx: 5-15min
VS 15min

Signs of placental detachment:
Lengthening of cord, breif gush of dark blood, fundus firmly contracting

Inspect placenta and perineal (may need repair)

Aminister oxytocin (helps with hemorrhage)

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21
Q

EFM monitoring

Labor does what to fetus (how)
EFM provides what info

A

Labor creates stress to fetus:
Compression of spiral arteries

EFM provides info on:
Fetal oxygenation and contaction patterns

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22
Q

EFM types for FHR and contractions

A

FHR:
External: ultrasound transducer(goes on back)
Internal: fetal scalp electrode (FSE) need ROM

Contractions:
External: Toco transducer (goes on fundus)
Internal: intrauterine pressure catheter (IUPC) tells us intensity and needs ROM

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23
Q

When can internal EFM be placed

Can toco monitor intensity?

A

With ROM

NO, you have to palpate for that

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24
Q

Uterine activity UA assessment

Frequency

A

Number present in a 10min window, but avg over 30 mins

Normal: 5 or fewer contractions in 10min avg over 30mins

Tachysystole: more than 5 contractions in 10min avg over 30mins (uterus not relaxing-at risk of rupture)

25
Uterine activity UA assessment Duration
45-90 seconds
26
Uterine activity UA assessment Intensity
Palpate: mild/moderate/strong IUPC: Good: 50-80mmhg Resting tone: 10-20 mmhg Relaxation time: time between contractions
27
FHR with electronic fetal monitoring Evaluated over how long Excludes what Normal range
10mins Excluding: Accels, decels, periods of marked variability Normal range: 110-160 bpm
28
Tachycardia Cause
160 bpm + for 10 +mins Cause: Maternal fever, infection, chorioamnionitis Fetal infection/anemia Maternal use of cocaine/methamphetamines
29
Bradycardia Causes
110 bpm or less for 10mins Causes: Placental insufficiency Cord prolapse Prolonged cord compression Mother in supine position/HOTN Hypoxia
30
FHR variability Flucuations in bpm over how long Indicates well what
10 minutes Indicates well: -oxygenation -neurological system (We want variability)
31
Which variability is what we want
Moderate
32
VEAL CHOP
V: variabile decels = C: cord compression E: early decels = H: head compression A: accels = O: oxygenation/OK L: Late decels = P: placental insufficiency
33
Early decels Causes What we see
Head compression Gradual decrease of FHR starts with/ contraction and ends with/ contraction Mirror image of UC REASSURING PATTERNS (baby is tolerating contractions) ***Intervention not required***
34
GOOD to be what BAD to be what
GOOD to be EARLY BAD to be LATE
35
Late decels Cause What we see
Decreased placental blood flow: -Uterine tachysystole -maternal HOTN/HTN -epi/spinal anesthesia -postmaturity -IUGR gradual decrease of FHR after contraction starts ***non-reassuring***
36
Late decels interventions
Repositioning Correct maternal HOTN: IV fluids/meds O2 @ 10L non rebreather mask Tocolysis: (stopping contractions) positioning, D/C oxytocin, meds Notify MD Plan for expedited delivery
37
Variable decels Causes What we see
Causes: cord compression -position -nuchal cord -true knot in cord -prolapsed cord Abrupt FHR decrease from onset to nadir <30secs Drop in FHR at least 15 bpm for at least 15 secs Rapid return to baseline `
38
Variable decels Frequently below what Shape
Below 100 bpm U,V,W No relation to contraction
39
Variable decels Interventions
Position Vag exam (find prolapse) O2 @ 10L D/C oxytocin Notify MD Tocolysis (stop contractions) Amnioinfusion (route: thru IUPC)
40
Prolonged decels What it looks like
Depth of 15 bpm lasting >2minutes up to 10 min After 10 min = change in baseline W/without contractions Associated with loss of FHR variablilty
41
Prolonged decels Causes
Prolapse of cord Maternal HOTN (epi/spinal) Tachysystole Seizures
42
Prolonged decels Interventions
Position Vag ecam to r/o prolapse O2 @ 10L Correct maternal HOTN (LR) D/C oxytocin Notify MD Plan for expediated delivery
43
Complications of labor (Contraction)
Intrauterine pressure over 80 Resting tone greater than 20 Contraction duration equal to or greater than 90secs (Want 45-90secs) Contractions more freq than q2minutes
44
Complications of labor (Others)
Absent variability Fetal tachy/bradycardia Late and variable decels Meconium-stained fluid Foul smelling discharge/fever (infection) Persistent bleeding
45
Nonpharmacologic treatment
Relaxtion: -music, meditation, aromatherapy Paced breathing Cutaneous stimulation: -thermal(hot pad), accupressure/sacral pressure Hydrotherapy
46
Analgesics in labor Opioid analgesics
Primary action in CNS Given IV during early part of active labor (4-7cm) Fetal and maternal resp depression(EXAM) Opiate antagonist (Narcan)
47
Barbituates/benzos
Traquilizing an sedative effects Promote relaxation but dont take away pain Used during early/ latent phase
48
Antiemetics
Potentiate effects of opioids (makes it work better) Decreases nausea and vomiting Increase sedation *metoclopramide, promethazine*
49
Nitrous oxide inhalation
Reduces anxiety, mild analgesia Mother control the administration Minimal/no effect on fetus
50
Pudendal nerve block
Transvaginal Relief in lower vagina, vulva, perineum, and rectum Second(pushing)/third(placenta removal or repair) stages of labor
51
Epidural block Does what Blocks what During what phase Makes what difficult
Produces a loss of sensation or with opioid use pain control Entire pelvis by blocking impulses from T12-S5 During active labor (at least 4cm) Make pushing difficult in second stage of labor (prolong)
52
Epidural block contraindications
maternal HOTN Coagulation disorders Local infection Drug allergies Uncorrected loss of blood Mom refuses
53
Epidural nursing care Give what Get what IV if Monitor what
500-1000ml IV fluid bolus recommended to prevent HOTN Consent, positioning, local anesthetic, catheter inserted Intravascular if: numbness in tongue/lips, tinnitus, dizziness Monitor Mom VS(BP) FHR Adverse effects
54
Epidural Adverse effects
Mom HOTN Fetal bradycardia Prolonged second stage of labor (difficult to push) Bladder distantion (catheter placed)
55
Mom HOTN tx
Place mother in left lateral position Bolus/increase rate of IVF per protocol IV Vasopressor(ephedrine) O2 administered via non-rebreather IF SEVERE: mother in trandelenburg position
56
Spinal block
Done quickly for c-section Local anesthetic injected into subarachnoid space into CSF
57
Spinal block AE High incidences of what Monitor for what (TX) only relief with what
AE: similar to epidural (HOTN, fetal bradycardia, prolonged second stage of birth, bladdr distention) Higher incedences of bladder and uterine atony Monitor: for spinal HA (caused by dural puncture) -Epidural blood patch (with moms blood) ***only get relief from lying down***
58
General anesthesia Emergency what Concerns
Emergency c-section (no time for spinal or epi) CONCERNS: All agents cross placental barrier So fetal depression is a concern Concern of maternal aspirations TX: (NPO, famotidine, metoclopramide) Urterine atony, res depression

N330 (17 decks)

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