Artificial management of labor

Question 1

Labor induction

Answer 1

Promotes labor in a non-laboring patient

Obtain vital signs, consent, reactive NST, SVE, Bishop score

Question 2

Bishop score

Answer 2

Cervical dilation
Cervical effacement
Cervical station
Cervical consistency
Fetal position

Normal equals greater than or equal to eight

Likelihood to go into labor and vaginal delivery

Question 3

Amniotomy

Answer 3

AROM, augment
Small tear by Amnio hook in amniotic membrane which allows fluid to escape

Only OB or midwife can do this

Question 4

nursing care for amniotomy

Answer 4

Check FHR
Document date, time, fluid appearance, amount, odor

q2hr temperature

Question 5

Cervical ripening

Answer 5

foley bulb – mechanical ROM
releases prostaglandins to soften cervix and lessen cramps

Question 6

Misoprostol

Answer 6

Prostaglandin given vaginally to stimulate contractions to thin cervix

Dissolving pill, no removing

Don’t start Pitocin within four hours of last dose

Question 7

Dinoprostone

Answer 7

Prostaglandin giving vaginally to simulate contractions, and then cervix

Pat dry after voiding, remove by pulling string
Bedrest two hours after

Question 8

Stripping membranes

Answer 8

Nonpharmacologic
Separates amniotic membrane from lower uterine segment
Very uncomfortable
Releases prostaglandins to stimulate contractions

Question 9

oxytocin

Answer 9

Can be used to induce or augment labor

Risks - tachysystole, rupture, water intoxication

Question 10

What should be done if water intoxication occurs?

Answer 10

stop oxytocin
Give 0.9% NS
Furosemide

Question 11

how to titrate oxytocin

Answer 11

D5LR, NS, LR
increased by 1–2 MU/minutes every 30 minutes
Check blood pressure before titrating up

Question 12

Amnioinfusion

Answer 12

Warm sterile, LR/NS placed in uterus via IUPC

used for repetitive variable decels, lost amniotic fluid

Question 13

should the fluid leak out or remain inside the mom of an amnioinfusion?

Answer 13

Leak back out

Question 14

forceps assisted birth

Answer 14

Mid – fetal head engaged
Low- 2+ station
Outlet - perineum, crowning

Question 15

does the mom still push with forceps assisted?

Answer 15

Yes, forceps use extra grip

Question 16

Nursing care for forceps assisted

Answer 16

explain procedure
Monitor contractions
Document length of time being used

Question 17

vacuum extraction

Answer 17

Suction cup placed on fetal occiput

Question 18

nursing care for vacuum extraction

Answer 18

Document length of time, time, put on, pressure on/off

Question 19

skin incisions for a C-section

Answer 19

Transverse, bikini cut
Vertical

Question 20

uterine incisions

Answer 20

Low transverse
Classical
low vertical

Question 21

which uterine incisions will require a repeat C-section after

Answer 21

classical
Lo vertical

Question 22

nursing, Care before C-section

Answer 22

Assist with epidural/spinal
IV. Bolus, LR 1500 ML.
Pepcid or Reglan
BiCitra
Monitor, vital signs, FHR
Insert a catheter

Question 23

nursing Care during C-section

Answer 23

Position wedge under right hip
Support couplet
Instrument count
Time out
Document incision, delivery, Apgar, ROM, placenta passage

Question 24

nursing Care after C-section

Answer 24

Monitor vital signs Q 15
Check surgical dressing
Palpate fundus and check lochia
monitor I/O
Administer IV oxytocin

Question 25

What constitutes a good candidate for vaginal delivery after previous C-section?

Answer 25

lo transverse incision
Adequate pelvis
No uterine scars or previous rupture

Question 26

does systemic analgesia cross the placenta barrier

Answer 26

Yes

Question 27

what are contraindications to systemic analgesia

Answer 27

Allergies
Hypotension
Non-reassuring strip
Immediate delivery

Question 28

will naloxone reverse effects of meperidine

Answer 28

No

Question 29

should substance users use nalbuphine for analgesia

Answer 29

No, can cause withdrawal syndrome in fetus

Question 30

does butorphanol have a rapid or slow onset

Answer 30

Rapid less than two minutes

Question 31

What is a short acting opioid that can be used as an epidural

Answer 31

fentanyl

IV has immediate onset
Shorter half life

Question 32

naloxone functions

Answer 32

Opiate antagonist
Reverse is mild respiratory depression
Can relieve extreme itching

Question 33

advantages of an epidural

Answer 33

Fully awake during labor and birth
Continuous blocking for each stage
dose can be adjusted

Question 34

Disadvantages of an epidural

Answer 34

hypotension
Meningitis
Vertigo
Back pain
Urinary retention
Itching

Question 35

spinal epidural

Answer 35

Immediate onset
CSF returns from needle

Question 36

What should be done prior to a spinal epidural

Answer 36

IV. Fluid bolus before.

Question 37

nursing, Care before placement

Answer 37

Assess mom and fetus, labor progress
Start IV preload – warmed LR
Help to position, rounded back

Question 38

nursing Care after placement

Answer 38

Assess for hypotension
Administer anti-emetics
Monitor respiratory rate
Assess bladder function

Question 39

how to correct hypotension after placement

Answer 39

IV. Bolus
Ephedrine
Oxygen

Question 40

pudenual block

Answer 40

Perineal anesthesia
Can be used during episiotomy repair
Decreases urge to bear down

Question 41

local analgesic

Answer 41

1% lidocaine injected into perineum
Repair of episiotomy or laceration

Question 42

what kind of anesthesia is used for emergent deliveries?

Answer 42

General anesthesia
Usually avoid it if possible

Question 43

Cricoid pressure

Answer 43

for general anesthesia
helps prevent aspiration while pressure applied during ET tube insertion