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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
Q

Uterine activity UA assessment

Duration

A

45-90 seconds

26
Q

Uterine activity UA assessment

Intensity

A

Palpate: mild/moderate/strong

IUPC:
Good: 50-80mmhg
Resting tone: 10-20 mmhg

Relaxation time: time between contractions

27
Q

FHR with electronic fetal monitoring

Evaluated over how long
Excludes what
Normal range

A

10mins

Excluding:
Accels, decels, periods of marked variability

Normal range: 110-160 bpm

28
Q

Tachycardia

Cause

A

160 bpm + for 10 +mins

Cause:
Maternal fever, infection, chorioamnionitis
Fetal infection/anemia
Maternal use of cocaine/methamphetamines

29
Q

Bradycardia

Causes

A

110 bpm or less for 10mins

Causes:
Placental insufficiency
Cord prolapse
Prolonged cord compression
Mother in supine position/HOTN
Hypoxia

30
Q

FHR variability

Flucuations in bpm over how long

Indicates well what

A

10 minutes

Indicates well:
-oxygenation
-neurological system

(We want variability)

31
Q

Which variability is what we want

A

Moderate

32
Q

VEAL CHOP

A

V: variabile decels = C: cord compression

E: early decels = H: head compression

A: accels = O: oxygenation/OK

L: Late decels = P: placental insufficiency

33
Q

Early decels

Causes
What we see

A

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
Q

GOOD to be what
BAD to be what

A

GOOD to be EARLY
BAD to be LATE

35
Q

Late decels
Cause
What we see

A

Decreased placental blood flow:
-Uterine tachysystole
-maternal HOTN/HTN
-epi/spinal anesthesia
-postmaturity
-IUGR

gradual decrease of FHR after contraction starts

non-reassuring

36
Q

Late decels interventions

A

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
Q

Variable decels
Causes
What we see

A

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
Q

Variable decels
Frequently below what
Shape

A

Below 100 bpm
U,V,W
No relation to contraction

39
Q

Variable decels
Interventions

A

Position
Vag exam (find prolapse)
O2 @ 10L
D/C oxytocin

Notify MD
Tocolysis (stop contractions)
Amnioinfusion (route: thru IUPC)

40
Q

Prolonged decels
What it looks like

A

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
Q

Prolonged decels
Causes

A

Prolapse of cord

Maternal HOTN (epi/spinal)

Tachysystole

Seizures

42
Q

Prolonged decels
Interventions

A

Position
Vag ecam to r/o prolapse
O2 @ 10L
Correct maternal HOTN (LR)

D/C oxytocin
Notify MD
Plan for expediated delivery

43
Q

Complications of labor
(Contraction)

A

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
Q

Complications of labor
(Others)

A

Absent variability
Fetal tachy/bradycardia
Late and variable decels

Meconium-stained fluid

Foul smelling discharge/fever (infection)

Persistent bleeding

45
Q

Nonpharmacologic treatment

A

Relaxtion:
-music, meditation, aromatherapy

Paced breathing

Cutaneous stimulation:
-thermal(hot pad), accupressure/sacral pressure

Hydrotherapy

46
Q

Analgesics in labor
Opioid analgesics

A

Primary action in CNS

Given IV during early part of active labor (4-7cm)

Fetal and maternal resp depression(EXAM)

Opiate antagonist (Narcan)

47
Q

Barbituates/benzos

A

Traquilizing an sedative effects

Promote relaxation but dont take away pain

Used during early/ latent phase

48
Q

Antiemetics

A

Potentiate effects of opioids (makes it work better)

Decreases nausea and vomiting
Increase sedation

metoclopramide, promethazine

49
Q

Nitrous oxide inhalation

A

Reduces anxiety, mild analgesia

Mother control the administration

Minimal/no effect on fetus

50
Q

Pudendal nerve block

A

Transvaginal

Relief in lower vagina, vulva, perineum, and rectum

Second(pushing)/third(placenta removal or repair) stages of labor

51
Q

Epidural block

Does what
Blocks what
During what phase
Makes what difficult

A

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
Q

Epidural block contraindications

A

maternal HOTN

Coagulation disorders

Local infection

Drug allergies

Uncorrected loss of blood

Mom refuses

53
Q

Epidural nursing care
Give what
Get what
IV if
Monitor what

A

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
Q

Epidural Adverse effects

A

Mom HOTN
Fetal bradycardia
Prolonged second stage of labor (difficult to push)
Bladder distantion (catheter placed)

55
Q

Mom HOTN tx

A

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
Q

Spinal block

A

Done quickly for c-section

Local anesthetic injected into subarachnoid space into CSF

57
Q

Spinal block
AE
High incidences of what
Monitor for what (TX) only relief with what

A

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
Q

General anesthesia
Emergency what
Concerns

A

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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