Artificial management of labor Flashcards
Labor induction
Promotes labor in a non-laboring patient
Obtain vital signs, consent, reactive NST, SVE, Bishop score
Bishop score
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
Amniotomy
AROM, augment
Small tear by Amnio hook in amniotic membrane which allows fluid to escape
Only OB or midwife can do this
nursing care for amniotomy
Check FHR
Document date, time, fluid appearance, amount, odor
q2hr temperature
Cervical ripening
foley bulb – mechanical ROM
releases prostaglandins to soften cervix and lessen cramps
Misoprostol
Prostaglandin given vaginally to stimulate contractions to thin cervix
Dissolving pill, no removing
Don’t start Pitocin within four hours of last dose
Dinoprostone
Prostaglandin giving vaginally to simulate contractions, and then cervix
Pat dry after voiding, remove by pulling string
Bedrest two hours after
Stripping membranes
Nonpharmacologic
Separates amniotic membrane from lower uterine segment
Very uncomfortable
Releases prostaglandins to stimulate contractions
oxytocin
Can be used to induce or augment labor
Risks - tachysystole, rupture, water intoxication
What should be done if water intoxication occurs?
stop oxytocin
Give 0.9% NS
Furosemide
how to titrate oxytocin
D5LR, NS, LR
increased by 1–2 MU/minutes every 30 minutes
Check blood pressure before titrating up
Amnioinfusion
Warm sterile, LR/NS placed in uterus via IUPC
used for repetitive variable decels, lost amniotic fluid
should the fluid leak out or remain inside the mom of an amnioinfusion?
Leak back out
forceps assisted birth
Mid – fetal head engaged
Low- 2+ station
Outlet - perineum, crowning
does the mom still push with forceps assisted?
Yes, forceps use extra grip
Nursing care for forceps assisted
explain procedure
Monitor contractions
Document length of time being used
vacuum extraction
Suction cup placed on fetal occiput
nursing care for vacuum extraction
Document length of time, time, put on, pressure on/off
skin incisions for a C-section
Transverse, bikini cut
Vertical
uterine incisions
Low transverse
Classical
low vertical
which uterine incisions will require a repeat C-section after
classical
Lo vertical
nursing, Care before C-section
Assist with epidural/spinal
IV. Bolus, LR 1500 ML.
Pepcid or Reglan
BiCitra
Monitor, vital signs, FHR
Insert a catheter
nursing Care during C-section
Position wedge under right hip
Support couplet
Instrument count
Time out
Document incision, delivery, Apgar, ROM, placenta passage
nursing Care after C-section
Monitor vital signs Q 15
Check surgical dressing
Palpate fundus and check lochia
monitor I/O
Administer IV oxytocin
What constitutes a good candidate for vaginal delivery after previous C-section?
lo transverse incision
Adequate pelvis
No uterine scars or previous rupture
does systemic analgesia cross the placenta barrier
Yes
what are contraindications to systemic analgesia
Allergies
Hypotension
Non-reassuring strip
Immediate delivery
will naloxone reverse effects of meperidine
No
should substance users use nalbuphine for analgesia
No, can cause withdrawal syndrome in fetus
does butorphanol have a rapid or slow onset
Rapid less than two minutes
What is a short acting opioid that can be used as an epidural
fentanyl
IV has immediate onset
Shorter half life
naloxone functions
Opiate antagonist
Reverse is mild respiratory depression
Can relieve extreme itching
advantages of an epidural
Fully awake during labor and birth
Continuous blocking for each stage
dose can be adjusted
Disadvantages of an epidural
hypotension
Meningitis
Vertigo
Back pain
Urinary retention
Itching
spinal epidural
Immediate onset
CSF returns from needle
What should be done prior to a spinal epidural
IV. Fluid bolus before.
nursing, Care before placement
Assess mom and fetus, labor progress
Start IV preload – warmed LR
Help to position, rounded back
nursing Care after placement
Assess for hypotension
Administer anti-emetics
Monitor respiratory rate
Assess bladder function
how to correct hypotension after placement
IV. Bolus
Ephedrine
Oxygen
pudenual block
Perineal anesthesia
Can be used during episiotomy repair
Decreases urge to bear down
local analgesic
1% lidocaine injected into perineum
Repair of episiotomy or laceration
what kind of anesthesia is used for emergent deliveries?
General anesthesia
Usually avoid it if possible
Cricoid pressure
for general anesthesia
helps prevent aspiration while pressure applied during ET tube insertion
