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OB/GYN > Ch 32 Labor and Birth Complications > Flashcards

Ch 32 Labor and Birth Complications Flashcards

1
Q

When does PROM occur?

A

Before 37 weeks gestation

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2
Q

What does PROM care focus on?

A

Prevention of infection

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3
Q

How do nurses prevent infection in patients with PROM?

A

Limit vaginal exams
Change bed pads frequently
Monitor fetus

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4
Q

What are 4 PROM complications?

A

Infection
Abruption
Retained placenta
maternal sepsis and death

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5
Q

What types on infection are mothers with PROM at risk for?

A

Chorioamnionitis

Endometritis

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6
Q

What are the fetal risks of PROM? (10)

A 
Respiratory distress syndrome (RDS)
Intraventricular Hemorrhage (IVH)
Necrotizing enterocolitis (NEC)
Fetal sepsis
Malpresentation
Cord prolapse
Non-reassuring FHT 
Umbilical cord compression related to oligohydramnios
Premature birth
morbidity and mortality
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7
Q

What are the fetal risks of PROM in babies that are 36 or less weeks?

A

Respiratory distress syndrome (RDS)
Intraventricular Hemorrhage (IVH)
Necrotizing enterocolitis (NEC)
Fetal sepsis

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8
Q

Why does PROM cause fetal sepsis in babies less than 36 weeks?

A

Ascending pathogens

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9
Q

concerning PROM, the earlier the gestational age…

A

the more complications

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10
Q

What labs would you draw on a patient with PROM?

A

CBC
CRP
UA
GBS

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11
Q

A patient with PROM will be hospitalized on __ __

A

bed rest

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12
Q

What tools will be used to assess the baby in a mother with PROM?

A

Ultrasound

NST

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13
Q

What should the nurse monitor in PROM concerning infection?

A

Fluid changes…

  • amount
  • color
  • odor
  • consistency
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14
Q

In a patient with PROM, what should stop?

A

Vaginal exams unless indicated (usually done by HCP)

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15
Q

What weeks is magnesium sulfate given?

A

23 6/7 - 31 6/7

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16
Q

Why is magnesium sulfate given to a mother who has PROM?

A

For neural protection, to decrease cerebral palsy

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17
Q

What steroid might be given to a mother who has PROM?

A

Maternal corticosteroid administration for fetal lung maturation

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18
Q

If a patient has PROM, what should the nurse do for her?

A

Answer questions and anticipate birth

Provide psychological support for patient and family

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19
Q

How common is multiple gestation?

A

33.4 per 1000 births

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20
Q

What race has the highest incidence of multiple gestations?

A

African Americans

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21
Q

What are risk factors for multiple gestation?

A

Increased age
Higher parity
Family history of fraternal twins
Women who are tall and overweight

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22
Q

What are fraternal twins called?

A

Dizygotic

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23
Q

Dizygotic twins have…

A

two eggs and two sperm

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24
Q

What are identical twins called?

A

Monozygotic

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25
Q

Monozygotic twins have…

A

one egg and one sperm

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26
Q

How common are identical twins?

A

4 in every 1000 births

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27
Q

What are maternal complications of having multiple gestation?

A 
UTI
Threatened AB
Anemia
Gestational hypertension
Preeclampsia/Eclampsia
PROM
Thromboembolism
Placenta previa
Placental abruption
Placental disorders
PTL and PTB
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28
Q

What are fetal/neonatal complications of multiple gestation?

A 
Higher mortality rate
IUGR
Higher incidence of fetal anomalies
Prematurity 
Abnormal presentations
Cord accidents
Cerebral palsy
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29
Q

What should the nurse do for a patient hospitalized with multiple gestation?

A 
Monitor for complications
FHR monitoring
Prepare for birth, possible c section
Advise neonatal staff
Get additional staff
Baby A, Baby B, Baby C
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30
Q

How many calories a day should a mother with multiple gestation consume?

A

3500 a day

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31
Q

How much should the mother consume concerning prenatal vitamins?

A

PNV daily

Additional 1-4mg folic acid daily

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32
Q

What should the nurse teach a mother who is having multiple gestation?

A

Frequent rest periods
Side-lying resting position
Body mechanics while lifting
Comfort measures: comfort rocking, good posture, pregnancy belt

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33
Q

How much amniotic fluid is considered normal?

A

500 mL

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34
Q

What are symptoms of polyhydramnios?

A

Shortness of breath

Edema in the legs

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35
Q

What are complications mothers are at risk for with polyhydramnios?

A

C section
Uterine dysfunction
Placental abruption
Postpartum hemorrhage

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36
Q

What are fetal complications for a mother with polyhydramnios?

A 
Malformations
Preterm birth
Increased mortality rate
Prolapsed cord
Malpresentation
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37
Q

What is polyhydramnios?

A

Too much amniotic fluid around the baby

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38
Q

What is oligohydramnios?

A

Too little amniotic fluid around the baby

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39
Q

What are maternal complications with oligohydramnios?

A

Dysfunction labor with slow progress

Hypertensive disorders

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40
Q

What are fetal deformation defects with oligohydramnios?

A 
Ahesions
Skin and skeletal
Pulmonary hypoplasia
Umbilical cord compression
Head compression
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41
Q

What conditions can cause polyhydramnios?

A

Diabetes
Rh sensitization
Malformations of fetal swallowing

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42
Q

What are the major malformations of oligohydramnios?

A

Renal agenesis
Dysplastic kidneys
Lower urinary tract obstructive lesions

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43
Q

What is a major malformation of polyhydramnios?

A

Malformation of fetal swallowing

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44
Q

If a mother has polyhydramnios and a fetal defect has been identified, what should the nurse do?

A

Consult with social services

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45
Q

What is the nursing care for a mother with polyhydramnios?

A

Provide information and extra support
Maintain sterility during amniocentesis
Monitor FHR during procedure

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46
Q

What reading on the monitor should the nurse notify the HCP if the mother. has oligohydramnios?

A

Variable decelerations (cord compression)

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47
Q

What should the nurse be looking for on the monitor for a patient who has oligohydramnios?

A

Variable decelerations

Non-reassuring fetal status

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48
Q

What are nursing care of patients with oligohydramnios?

A

Provide information and encourage questions
Evaluate FHR monitor
Reposition mother to relieve cord compression

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49
Q

What should the nurse assess on a baby whose mother had oligohydramnios?

A

Anomalies
Pulmonary hypoplasia
Post-maturity

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50
Q

What are the types of dysfunctional labor?

A

Prolonged labor
Tachysystolic labor
Hypotonic labor

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51
Q

What is tachysystolic labor?

A

Uterine contractions greater than 6 in 10 mins, lasting longer than 2 mins, OR resting tone increases

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52
Q

What are the maternal risks for tachysystolic labor?

A 
Uterine muscle cell anoxia
Fatigue
Stress and poor coping
Dehydration 
Infection
Prolonged labor
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53
Q

What are the fetal/neonatal risks of tachysystolic labor?

A

non-reassuring fetal status

Prolonged pressure on the fetal head

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54
Q

What can prolonged pressure on the fetal head (due to tachysystolic labor) cause?

A

Cephalohematoma
Caput succedaneum
Excessive molding

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55
Q

What causes the non-reassuring fetal status during tachysystolic labor?

A

increased uterine tone interferes with uteroplacental exchange

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56
Q

What is the major cause of tachysystolic labor?

A

Pitocin administration (induction/augmentation)

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57
Q

What is the first thing the nurse should do if a patient has tachysystolic labor?

A

Stop Pitocin if infusing

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58
Q

What drug will the nurse administer to a patient who is tachysystolic labor?

A

terbutaline sulfate

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59
Q

What does terbutaline sulfate do?

A

Relaxes uterine smooth muscle

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60
Q

What is the MOA of terbutaline sulfate?

A

Selective B2 agonist

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61
Q

What are the nursing implications of a patient in tachysystolic labor?

A 
Stop Pitocin
Rest
Terbutaline sulfate
monitor fatiuge
Monitor FHR and contractions
Provide information and support
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62
Q

What type of questions might a patient with tachysystolic labor have?

A

Cause
Implications
Treatment

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63
Q

What are institute supportive measures for tachysystolic labor?

A 
Position changes with pillow
Quiet soothing environment 
Touch/massage
ygeine 
Hydrotherapy
Sedation
Relaxation
Visualization
Music
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64
Q

What are risks for hypotonic labor?

A 
Maternal exhaustion 
Stress and poor coping
Prolonged labor
postpartum hemorrhage from insufficient uterine contractions following birth
Intrauterine infection
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65
Q

What are potential complications for the fetus during hypotonic labor?

A

Non-reassuring fetal status due to prolonged labor

Fetal sepsis

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66
Q

Why can prolonged labor cause fetal sepsis?

A

Pathogens ascending

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67
Q

What should the nurse be monitoring in a patient with hypotonic labor?

A

Vital signs
FHR
Contractions
I&Os

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68
Q

What should the nurse be assessing in a patient with hypotonic contractions?

A

Amniotic fluid for meconium
Bladder for distention
Signs of infection

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69
Q

What is nursing care for a patient with hypotonic contractions?

A 
Encourage voiding every 2 hrs
Catheterize as needed with regional block
decrease vaginal exams (infection)
Start Pitocin per HCP
Emotional support
Supportive measures
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70
Q

What is a regional block?

A

Also called nerve block, consists of infiltrating a peripheral nerve and blocking transmission

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71
Q

What are supportive measures for a patient with hypotonic labor?

A 
Ambulation
Position changes
Quiet, soothing environment
Touch/massage
Personal Hygiene
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72
Q

What is precipitous labor?

A

Labor lasting less than 3 hrs resulting in rapid birth

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73
Q

What are contributing factors to precipitous labor?

A 
Multiparty 
Large pelvis
Previous precipitous labor
Small fetus
Recent cocaine use
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74
Q

What are maternal implications of precipitous labor?

A

Loss of coping
Lacerations due to rapid decent
Postpartum hemorrhage

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75
Q

Why does precipitous labor cause postpartum hemorrhage?

A

Undetected lacerations

Uterine atony

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76
Q

What are the fetal implications of precipitous labor?

A

Non-reassuring fetal status or hypoxia
Cerebral trauma from rapid decent
Pneumothorax
Branchial plexus injuries

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77
Q

Why can precipitous labor cause fetal hypoxia?

A

Decreased uteroplacental circulation due to intense uterine contractions

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78
Q

Who is at risk for precipitous labor?

A

Accelerated cervix dilation

Intense uterine contractions with little relaxation in between

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79
Q

What should a nurse do for a patient with/at risk for precipitous labor?

A 
Monitor closely if previous history
Have precipitous pack available/prepare
Stay in the patients room
Supportive, quiet environment
Monitor Pitocin
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80
Q

What should the nurse do if a patient with precipitous labor become tachysystolic?

A 
discontinue Pitocin
give terbutaline 
Turn to left side
Administer O2
Watch FHR for abnormal
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81
Q

What is a prolonged pregnancy?

A

294 days or 42 weeks past the first day of LMP

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82
Q

Extremely preterm baby:

A

at or before 25 weeks

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83
Q

Very preterm baby:

A

at less than 32 weeks

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84
Q

Moderatley preterm baby:

A

between 32 and 34 weeks

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85
Q

Late preterm baby:

A

34-36 6/7 weeks

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86
Q

Full term baby:

A

39-40 6/7 weeks

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87
Q

Post-term baby:

A

Beyond 42 weeks

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88
Q

What are risks for the mother of a post-term pregnancy?

A 
Probable labor induction
Large for gestational age infant
Forceps/vacuum assisted birth or c section
Psychologic stress 
Infection
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89
Q

What are the risk factors for post-term pregnancy?

A

Primigravidas
History of prolonged pregnancy
Fetal anencephaly or placental sulfatase deficiency

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90
Q

What is primigravida?

A

A woman who is pregnant for the first time

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91
Q

What is anencephaly?

A

A baby born without parts of the brain or skull

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92
Q

What is placental sulfatase insufficiency?

A

genetic disorder of metabolism

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93
Q

What are the risks for the infant with post-term pregnancy?

A 
Decreased placental perfusion
Oligohydramnios
Meconium aspiration
Low 5 min APGAR
Dysmaturity syndrome or LGA
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94
Q

What does oligohydramnios cause a baby that is post-term pregnancy?

A

At risk for cord compression and possible meconium aspiration

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95
Q

What will a baby born post-term look like?

A 
Dry peeling skin
Little old men look
minimal lanugo or vernix
Deep creases on feet
Prominent nipple and breast tissue
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96
Q

What is lanugo?

A

Fine soft hair that covers the baby’s body

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97
Q

What is vernix?

A

White, waxy substance found coating the skin of the newborn

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98
Q

What is community care of the patient that is post-term pregnancy?

A

Education

Fetal kick counts

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99
Q

When a post-term pregnant patient comes into the hospital, when should they deliver?

A

induce at 41 weeks or continue with expectant management (NST or Biophysical profile)

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100
Q

What should the nurse do for the patient who is post-term pregnant in the hospital?

A 
FHR monitoring
Leopold maneuver 
Assess labor progression
Coping strategies 
Comfort measures
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101
Q

What is the nurse looking for on the FHR monitor with a patient who is post-term pregnant?

A

Variable decelerations

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102
Q

Why would the nurse do the Leopold’s maneuver for a post-term pregnant patient?

A

Estimate fetal size

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103
Q

What is the nurse monitoring for when assessing labor progression in a patient who is post-term pregnant?

A

Failure to descend (large gestational age)

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104
Q

What is the most common malposition?

A

Occiput posterior position

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105
Q

Why does malposition occur?

A

Occurs due to fetus not rotating

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106
Q

Malposition is most common in an __ pelvis

A

android

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107
Q

What are the s/s of malposition?

A 
Intense back pain
Dysfunctional labor
Hypotonic labor 
Arrest of dilation
Arrest of fetal descent 
FHR head far laterally on abdomen
Wide, diamond-shape fontanelle in anterior portion of pelvis
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108
Q

What could cause a patient to need a c section due to malposition?

A

Cephalopelvic disproportion (CPD)

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109
Q

What is cephalopelvis disproportion?

A

Large baby or in difficult position, or too small for mother’s pelvis to pass

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110
Q

What complications may arise from a forceps or vacuum assisted birth?

A

Lacerations

Episiotomy

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111
Q

What is an episiotomy?

A

A surgical cute made at the opening of the vagina during childbirth to aid in delivery and preventer rupture of tissues

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112
Q

What is molding?

A

In a head first delivery, the pressure of the vagina may distort the shape of the baby’s head

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113
Q

What are complications of malposition?

A 
Prolonged labor
C section
Lacerations/episiotomy
Cephalohematoma
Modling
Edema and bruising of the face
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114
Q

What are maternal position changes that can be used in malposition?

A

Knee to chest
Side to side
Pelvic rocking
Support and coping mechanisms

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115
Q

Describe a breech frank presentation

A

Flexion at top of thighs, knees extended
Feet up by head
Buttocks present

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116
Q

Describe a breech complete presentation

A

Thighs AND knees flexed
Feet and buttocks present
Sort of looks like criss cross apple sauce

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117
Q

Describe footling breech presentation

A

Thighs and knees both extended
Foot or both feet present
Baby more straight

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118
Q

Describe kneeling breech presentation

A

Thighs extended, knees flexed

Knees present

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119
Q

What is an external cephalic version?

A

procedure to try to move your baby if they are in a breech position to the head-down position.

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120
Q

What are contraindications to external cephalic version?

A 
Preeclampsia,
3rd trimester bleeding
Rupture of membranes
Oligohydramnios
Previous uterine surgery
Multiple gestation
Non-reassuring NST
IUGR
Nuchal cord
121
Q

Can a preeclamptic patient have an external cephalic version?

A

no

122
Q

What is the criteria a patient must meet to have an external cephalic version?

A

36 weeks or greater
Reactive NST
Breech is not engaged

123
Q

What maternal conditions are associated with breech presentation?

A 
Preterm birth
Placenta previa
Hydramnios 
Multiple gestation 
Uterine anomalies (bicoruate uterus)=
124
Q

What fetal conditions are associated with breech presentation?

A

Anenchaly

Hydrocephaly

125
Q

What is the main risk of breech presentation?

A

Increased risk of prolapsed cord

126
Q

What are the additional risks of breech presentation?

A 
Increased perinatal morbidity and mortality
Cervical spinal cord injuries
Birth trauma (especially head)
Asphyxia
Non-reassuring fetal status
127
Q

Why does a breech position cause an increased risk of cervical spinal cord injuries?

A

Hyperextension of fetal head during vaginal birth

128
Q

What should a nurse assess on the fetal monitor during an umbilical cord prolapse?

A

Non-reassuring fetal status

Decelerations (variables)

129
Q

How long should a nurse assess the fetal monitor during an umbilical cord prolapse?

A

At least a full minute after rupture of membranes for several contractions

130
Q

What happens if a loop of cord is discovered?

A

Examiner’s gloved fingers must remain in vagina to provide firm pressure on fetal head until birth

131
Q

When a patient has a prolapsed umbilical cord, what are the indicated nursing care?

A 
Oxygen via face mask 10l/min
Monitor FHR
Knee to chest position 
trendelenburg 
Transport to delivery or OR room in trendelenburg
132
Q

When is an external cephalic version performed?

A

36-38 weeks

133
Q

What happens if the external cephalic version is unsuccessful?

A

C section

134
Q

The potential for prolapsed cord is associated with which type of breech?

A

Footling because increased space

135
Q

If multiple gestation and breech, labor may be

A

double step up

136
Q

What is fetal macrosomia?

A

Newborn weighing more than 4500 g

137
Q

How is fetal macrosomia identified?

A

Palpation of fetus in utero (Leopold’s maneuver)
Ultrasound of fetus
X-ray pelvimetry

138
Q

Fetal macrosomia is associated with what conditions?

A 
Obesity
DM
Prior history of macrosomia
Male fetus
Grand multiparous
Prolonged gestation
Hispanic background
139
Q

What are maternal risks for macrosomia?

A

Cephalopelvic disproportion (CPD)
Prolonged labor
Lacerations
Postpartum hemorrhage

140
Q

What type of lacerations is macrosomia associated with?

A

Third and fourth degree lacerations or extension of episiotomies

141
Q

What are the additional fetal risks of macrosomia?

A 
Meconium aspiration
Asphyxia
Hypoglycemia
Polycythemia
Hyperbilirubinemaia
142
Q

What are the three main fetal risks of macrosomia?

A

Shoulder dystocia
Upper brachial plexus injury
Fractured clavicle

143
Q

What are the concerns with fetal macrosomnia?

A

Early decelerations
Lack of fetal decent
Labor dysfunction
Non-reassuring fetal status

144
Q

What is a possible fetal complication of macrosomnia?

A

Shoulder dystocia

145
Q

What is the nursing care for fetal macrosomnia?

A

Fundal massage after birth to prevent hemorrhage from over-distended uterus
Close monitoring of vital signs
IV Pitocin

146
Q

What is anaphylactoid syndrome of pregnancy?

A

Small tear in the amnion or chorion high in the uterus, small amount of amniotic fluid gets in there and enters the maternal system as an amniotic fluid embolism

147
Q

What are the signs/symptoms to look out for, for anaphylactoid syndrome of pregnancy?

A 
Dyspnea
Cyanosis 
Frothy Sputum
Chest pain
Tachycardia
Hypotension
Mental confusion
Massive hemorrhage
148
Q

What are complications of anaphylactoid syndrome of pregnancy?

A 
Sudden onset respiratory distress 
Acute hemorrhage
Circulatory collapse
Cor pulmonale 
Hemorrhagic shock
Coma/death
Fetal death if birth not immediate
149
Q

What is the nursing care for a patient with anaphylactoid syndrome of pregnancy?

A 
Get emergency response team
Positive pressure O2
Large bore IV
CPR if needed
Prepare for c section
Prep for CVP line insertion
Administer blood
Family support
150
Q

What is cephalopelvic disproportion?

A

CPD - occurs when fetus is larger than pelvic diameter.

151
Q

What is used to determine CPD?

A

Clinical and x ray pelvimetry used to determine smallest diameter through which fetal head must pass

152
Q

CPD: What is the shortest AP diameter?

A

<10cm

153
Q

CPD diagonal conjugate

A

<11.5 cm

154
Q

CPD greatest transverse diameter

A

<12 cm

155
Q

CPD: what determines that the pelvis is contracted?

A

Shortest AP diameter: <10cm
Diagonal conjugate: <11.5 cm
Greatest transverse diameter: <12 cm

156
Q

Labor is usually __ in the presence of CPD

A

prolonged

157
Q

Is vaginal birth possible foe CPD?

A

Yes, depends on type of CPD

158
Q

What should the nurse suspect for a patient with CPD?

A

Cervical dilation and effacement slow
Delayed engagement, lack of descent
Head is not well applied to cervix
Labor prolonged

159
Q

What should the nurse assess for a patient with CPD?

A

Adequacy of pelvis

FHR monitor

160
Q

What should a nurse do for patient with CPD?

A

Frequent position changes - sitting, squatting, rolling from side to side, knee to chest

Frequent vaginal exams
Keep partner informed
Explain procedures
Support measures
Prepare c section
161
Q

What is retained placenta?

A

Retention of placenta beyond 30 minutes after birth

162
Q

How frequent is retained placenta?

A

1-2% of vaginal births

163
Q

If the uterus does not expel, what should happen?

A

Manual removal from uterus

164
Q

What happens if the provider is unable to remove the placenta manually?

A

Curettage

165
Q

What happens if curettage is not successful in removing the placenta from the uterus?

A

Hysterectomy

166
Q

What is the nursing care during a hysterectomy?

A

Prep for surgery
Monitor blood loss
Monitor vital signs
Emotional support

167
Q

When is an amniotomy used?

A

Induce or augment labor
Apply fetal or contraction monitors
Assess color and composition of amniotic fluid

168
Q

What is the nursing care during an amniotomy?

A 
Pad bed
Assess fetal presentation, position, and station
Position patient 
FHR monitor
Note color, amount, odor, any blood or meconium 
Cleanse and dry perineal area
Decrease # cervical exams
Reassure patient
169
Q

When is a ROM performed?

A

Only when the head is at zero station

170
Q

What is an amnioinfusion?

A

Instilling saline into the amniotic cavity using an intrauterine catheter

171
Q

What type of fluid is used during an amnioinfusion?

A

Warmed normal saline or lactated ringers

172
Q

How is the fluid during an amnioinfusion instilled?

A

Through pump or intrauterine pressure catheter (IUPC)

173
Q

What should the nurse monitor for during an amnioinfusion?

A

Meconium that will be thin and clear

Variable decelerations - the amnio should cushion the cord

174
Q

What are three methods of induction?

A

Stripping of the membranes
Cervical ripening
Pitocin induction

175
Q

What are complementary methods of induction?

A

Sex
Nipple/breast stimulation
Herbal use
Mechanical dilation of cervix with balloon catheters

176
Q

How does intercourse stimulation induction?

A

Prostaglandin in semen, female orgasm stimulates uterine contractions

177
Q

How does breast/nipple stimulation cause induction?

A

Endogenous oxytocin release

178
Q

Which complementary method should the nurse not participate in?

A

Intercourse and nipple/breast stimulation

179
Q

Which complementary method is not supported by research?

A

Herbal use

180
Q

What is the mechanical method of stripping of membranes?

A

Gloved finger inserted into internal os and rotated 360 degrees twice: separating amniotic membranes lying against lower uterine segment

181
Q

Where is stripping of membranes done?

A

Typically as outpatient service and does not require fetal monitoring

182
Q

What are some disadvantages of stripping of membranes?

A

May not induce labor

May cause bleeding and cramping

183
Q

What are indications for induction of labor?

A 
DM
Non-reassuring antepartum testing
Preeclampsia or eclampsia 
PROM
Chorioamnionitis 
Post-term (especially with oligohydramnios)
IUFD
IUGR
Alloimmunization
184
Q

What is IUFD?

A

Intrauterine fetal demise

185
Q

What is alloimmunization?

A

Induction of immunity in response to foreign antigens encountered through exposure to cells or tissues from a genetically different member of the same species

186
Q

What can cause alloimmunization?

A

Blood transfusions

187
Q

What are contraindications to induction?

A 
Client refusal
Placenta previa
Floating fetal presenting part
Prior uterine incision that could preclude a TOL (trial of labor)
Active genital herpes
Prolapsed umbilical cord
Acute, severe non-reassuring fetal status
Absolute CPD
188
Q

What is the ACOG recommendation for inductions?

A

Inductions prior to 39 weeks should be avoided whenever possible due to fetal maturity issues

189
Q

What score on the bishop chart is favorable to induction?

A

8 or greater

190
Q

Should a patient with a known sensitivity have cervical ripening?

A

No

191
Q

Should a patient with a non-reassuring FHT have cervical ripening?

A

No

192
Q

Should a patient with unexplained bleeding during pregnancy have cervical ripening?

A

No

193
Q

Should a patient with a suspected CPD have cervical ripening?

A

No

194
Q

Should a patient with current Pitocin running have cervical ripening?

A

No

195
Q

Should a patient with a suspicion that they shouldn’t have a vaginal birth have cervical ripening?

A

No

196
Q

Should a patient with a history of c section have cervical ripening?

A

No

197
Q

Should a patient with uterine scarring have cervical ripening?

A

No

198
Q

Should a patient with a history of uterine rupture have cervical ripening?

A

No

199
Q

What three conditions should be a caution for cervical ripening?

A

History of asthma or glaucoma
Rupture of membranes
Breech presentation

200
Q

What medication is given to induce cervical ripening?

A

Cervidil

201
Q

What is the generic name of cervidil?

A

dinoprostone

202
Q

When should cervidil be given?

A

When induction is indicated but not emergent

203
Q

Where is cervidil given?

A

Its administered inpatient

204
Q

What should the nurse do when giving cervidil?

A

Monitor FHR for at least 2 hours after giving

205
Q

What should the nurse do if hyperstimulation or non-reassuring FHT occur after giving cervidil?

A

Remove insert and give terbutaline for hyperstimulation

206
Q

What is the generic name of cytotec?

A

Misoprostol

207
Q

What is the brand name of misoprostol?

A

Cytotec

208
Q

Should a patient with indicated induction receive cytotec in the 2nd trimester?

A

No

209
Q

Should a patient with indicated induction receive cytotec in the 3rd trimester?

A

Yes

210
Q

What is the initial dose of cytotec?

A

25 mcg, which is 1/4 of a tablet

211
Q

How frequent should the nurse give cytotec?

A

No more than every 3-6 hrs

212
Q

When can Pitocin be administered after cytotec?

A

4 hours from last dose of cytotec

213
Q

What are nursing care for patients who received cytotec inpatient?

A

Continuous FHR monitoring

Have terbutaline available

214
Q

A patient is having contractions 3 in every 10 mins, can she have cytotec?

A

NO

215
Q

What is a major absolute contraindication of cytotec?

A

Significant maternal history of asthma

216
Q

What readings on the FHT would contraindicate cytotec?

A

fetal tachycardia

217
Q

If a woman has bleeding during pregnancy, can cytotec be used?

A

NO

218
Q

What obstetrical history would contraindicate the use of cytotec?

A

Placenta previa
Prior c section
Uterine scar

219
Q

What vaginal assessment finding by the nurse would contraindicated cytotec?

A

Meconium passage

220
Q

What happens if the mother becomes hyper sensitized to Pitocin?

A

Decreased placental perfusion and non-reassuring fetal status

221
Q

What should a nurse consider when titrating Pitocin?

A

Facility protocol
Clinician order
Individual situation
Maternal-fetal response

222
Q

When Pitocin is infusion, the nurse should palpate the uterus except when…

A

IUPC is in place

223
Q

What should be noted about Pitocin and blood pressure?

A

It may initially DECREASE blood pressure

224
Q

Pitocin is still given after birth to…

A

decrease bleeding

225
Q

A patient with preeclampsia needs to progress in labor, can the nurse give her pitocin?

A

NO

226
Q

A patient that needs to progress in labor has a predisposition to uterine rupture, can she have Pitocin?

A

NO

227
Q

A patient that needs to progress in labor has CPD, can she have Pitocin?

A

NO

228
Q

A patient that needs to progress in labor has malpresentation or malposition of the fetus, can Pitocin be administered?

A

NO

229
Q

A patient that needs to progress in labor shows a cord prolapse, can she have Pitocin?

A

NO

230
Q

A patient that needs to progress in labor has a history of multiple cesarean sections, can Pitocin be administered?

A

NO

231
Q

A patient that needs to progress in labor is preterm, can Pitocin be used?

A

NO

232
Q

A patient that needs to progress in labor has a rigid, not ripe cervix. Can Pitocin be used?

A

NO

233
Q

A patient that needs to progress in labor has a total placental previa. Can Pitocin be used?

A

NO

234
Q

A patient that needs to progress in labor shows non-reassuring status on the FHR monitor. Can the nurse administer Pitocin?

A

NO

235
Q

What are the four things the nurse should ASSESS for after administering Pitocin for induction/augmentation?

A

Continiour FHR monitoring
I&Os
Vital signs and pain level
Cervical exams

236
Q

How often should the nurse assess vital signs and pain when administering Pitocin?

A

With every increase of Pitocin

237
Q

What is the nurse watching for when assessing the FHR monitor after administering Pitocin for induction?

A

Baseline, variability, periodic changes (accelereations/delecelerations)

Uterine contractions frequency, duration, and strength

238
Q

If after administering Pitocin for induction, the patient begins to have abnormal FHR monitor readings, what should the nurse do next?

A

Discontinue the Pitocin

239
Q

What should the nurse teach the patient when administering pitocin for induction of labor?

A

Purpose of procedure
Procedure details
Breathing and relaxation techniques
Comfort measures

240
Q

What factors can predispose women to an episiotomy?

A

Lithotomy and other recumbent positions
Sustained breath holding during second stage of labor
Arbitarty time limit place by physical during second stage of labor
Macrosomic fetus, OP position, shoulder dystocia, forces/vacuum assisted birth

241
Q

How does sustained breath holding during the second stage of labor predispose the patient to episiotomies?

A

Causes excessive and rapid perineal stretching

242
Q

How can a side-lying position prevent the need for an episiotomy?

A

Slows bath, diminishes tears

243
Q

Why should there be gradual expulsion on infant be used?

A

To prevent need for episiotomy

244
Q

What are 4 tips during labor that can be used to prevent the need for an episiotomy?

A

Perineal massage during pregnancy for nullips
Natural positioning during labor
Warm compresses on perineal and firm counter pressure
Avoidance of immediate pushing after epidural placement

245
Q

What position should be avoiding to prevent the need for an episiotomy?

A

Lithotomy or pulling back on legs

246
Q

What is another name for a forceps-assisted birth?

A

Instrument or operative vaginal birth

247
Q

What are the 3 types of forceps-assisted birth?

A

Outlet
Low
midforceps

248
Q

When is an outlet forceps-assisted birth used?

A

Applied when fetal skull has reached perineum, fetal scalp is visible, and sagittal suture is not more than 45 degrees from midline

249
Q

When is a low forceps assisted birth used?

A

Applied when leading edge (presenting part) of fetal skull is at station of 2+ of more

250
Q

When is a mid forceps assisted birth used?

A

Applied when fetal head is engaged

251
Q

When is the fetus considered to be engaged?

A

at zero station

252
Q

A patient is struggling with birth, she also has heart disease, can she have a forceps assisted birth?

A

YES

253
Q

A patient is struggling with birth, she also has pulmonary edema, can she have a forceps assisted birth?

A

YES

254
Q

A patient who has in infection is struggling with birth, can she have a forceps assisted birth?

A

YES

255
Q

A patient suffering from maternal exhaustion is struggling with birth. Can she have a forceps assisted birth?

A

YES

256
Q

A patient on the FHR monitor is showing non-reassuring fetal status. Can she have a forceps assisted birth?

A

YES

257
Q

A patient with premature placental separation is struggling with birth. Can she have a forceps assisted birth?

A

YES

258
Q

A patient is having a prolonged second stage of labor. Can she have a forceps assisted birth?

A

YES

259
Q

A patient received a heavy regional block and is having ineffective pushing. Can she have a forceps assisted birth?

A

YES

260
Q

What are the maternal risks associated with forcep assisted deliveries?

A 
Laceration of birth canal
Extension of midline episiotomy into anus
Increased bleeding
Brusing 
Infection
PP hemorrhage
Perineal edema
Anal incontinence
261
Q

What are the FETAL risks associated with forceps assisted deliveries?

A 
Bruising and edema
Facial lacerations
Brachial plexus
Caput succedaneium
Cephalohematomas 
Transient facial paralysis 
Cerebral hemorrhage
Fractures
Brain damage
Fetal death
262
Q

What can a cephalohematoma cause in a newborn?

A

Subsequent hyperbilirubinema

263
Q

What is the nursing care for a forceps delivered birth?

A 
Explain procedure 
Assure adequate anesthesia in place
Breathing techniques during application of forceps
Continuous FHR monitoring
Instruct patient to push with UC
Assessment of mom and baby after birth
264
Q

What does a forceps assisted birth look like?

A

Rn instructs patient to push with uterine contractions, physician applies downward, outward for on forceps

265
Q

How does a vacuum extraction birth work?

A

Assists birth by applying suction to fetal head

266
Q

What is the maximum amount of time that a vacuum assisted birth should be used?

A

8-10 minutes

267
Q

How is the vacuum assisted birth used?

A

Progressive decent with first 2 pulls

268
Q

Why is the vacuum assisted birth limited?

A

To prevent cephalohematomas and jaundice

269
Q

Why does a vacuum assisted birth carry the risk of cephalohematomas and jaundice?

A

Because of the reabsorption of bruising at cup attachment site

270
Q

What type of birth would a patient with a complete previa need?

A

C section

271
Q

What type of birth would a patient with CPD need?

A

c section

272
Q

What type of birth would a patient with a placental abruption need?

A

c section

273
Q

What type of birth would a patient with active genital herpes need?

A

c section

274
Q

What type of birth would a patient with an umbilical cord prolapse need?

A

c section

275
Q

What type of birth would a patient with FTP need?

A

c section

276
Q

What does FTP mean?

A

Failure to progress

277
Q

A patient has non-reassuring fetal status, what type of birth do they need?

A

c section

278
Q

A patient with a previous classical c section will need…

A

c section from there on

279
Q

If a patient has an obstruction of the birth canal they will need…

A

a c section

280
Q

What maternal medication conditions will a c section most likely be needed?

A 
Cardiac disorders
Severe respiratory disease
CNS disorders (increased ICP)
HIV infection
Mental disorders 
Altered state of consciousness
281
Q

What are three types of c section incisions?

A

Low transverse incision
Classical incision
Low vertical incision

282
Q

What is the nursing prep for a c section?

A 
Explain procedure 
Establish IV lines
FHR monitoring 
Administer meds
Place indwelling catheter
Perform abdominal prep and scrub
May or may not obtain consent
283
Q

What should the nurse assess after a c section?

A 
Bowel sounds
Heart and respiratory system
Homan's sign (unless contraindicated)
Pain level
Bladder
Lochia
Fundus
Vital signs
284
Q

How often after a c section should the nurse assess pain level?

A

Hourly and with pain medication administration

285
Q

How long is a foley in place for after a c section?

A

At least 24 hrs

286
Q

How should the fundus feel after a c section?

A

Firm

287
Q

How long is a pressure dressing on the c section site after surgery?

A

for 24 hrs

288
Q

What does TOLAC stand for?

A

trial of labor after c section

289
Q

Who is able to have a TOLAC?

A

A patient with 1-2 previous c sections and a low transverse incision ONLY

290
Q

These women have higher neonatal death rates and lower success rates of TOLAC

A

Obese and morbidly obese women

291
Q

What must a woman’s uterus look like for a TOLAC?

A

Absence of other uterine scars or history of uterine rupture

292
Q

What is contraindicated during a TOLAC?

A

Prostaglandin agents

293
Q

Why can women on prostaglandin agents NOT have a TOLAC?

A

Increased risk of uterine rupture

294
Q

What is the nursing care during a TOLAC?

A 
IV
Immediate access to OR
Continous FHR monitoring
NPO or clear liquid diet
Support for couples
Follow protocol
295
Q

If a patient is high risk and doing a TOLAC, what may be required?

A

Internal fetal monitoring

296
Q

What is the McRobert’s maneuver step 1?

A

Legs flexed onto abdomen causes rotation of pelvis, alignment of sacrum, and opening of birth canal

297
Q

What is McRobert’s maneuver part 2?

A

Suprapubic pressure applied to fetal anterior shoulder

298
Q

When is the McRobert’s maneuver applied?

A

In case of shoulder dystocia during childbirth

OB/GYN (11 decks)

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