chapter 10: nursing care of the woman w/ complications Flashcards
preterm labor
- uterine contractions that cause effacement and dilation to cervix ior to 37 weeks
- exact cause unknown
- leading cause of neonatal mortality in US
preterm labor risk factors
- late or no prenatal care
- previous preterm birth
- maternal age
- domestic violence
- placenta abruption
- overdistension of uterus
- incompetent cervix
- cervical inflammation
- maternal inflammation
- TORCH infections
- hormonal changes
- inadequate perfusion
- short cervix
preterm labor interventions
- start w/ verification of gestational age of fetus
- goal is to delay delivery for fetal lungs to mature
- monitor labor contractions
- assess for changes in effacement and dilation of cervix
- confirm presence of fetal fibronectin (fFN): protein that helps amniotic sac adhere to uterine wall, detected BEFORE 22 weeks and AFTER 37 weeks
- detection between 22-37 wks indicates preterm labor
preterm labor medical interventions
- progesterone supplementation
- treatment of infections
- IV hydration
- bedrest
- tocolytic drugs
- corticosteroid therapy
preterm labor nursing care
- assessing pt for signs of infection and rupture of membranes
- assessing cervical effacement and dilation
- assessing fetal heart rate and uterine contractions
- obtaining fluid for fFn testing
- providing oral and/or IV hydration
- administering antibiotics
- administering tocolytics and monitoring effectiveness and side efects
- administering corticosteroids (betamethasone)
patient teaching to prevent preterm labor
- follow activity restrictions
- drink 8 glasses of fluid each day
- eat healthy, balanced diet
follow medication schedule - perform daily kick count - notify if <10 kicks in 2 hours
- notice tightening of uterine muscle using finger on fundus - notify if >5 contractions in 1 hour
- notify provider if membranes rupture, low backache, cramping or pelvic pressure, fever >38 degrees celsius (100.4 F)
premature rupture of membranes (PROM)
- pt is 37 wks or later and membranes rupture before onset of labor
preterm premature rupture of membranes (PPROM)
rupure of membranes prior to 37 weeks gestation
if amniotic membranes rupture, delivery must occur within…
24 hours
> 24hrs increases risk of infection for mom and fetus
- medical interventions: expectant management
chorioamnionitis
infection of amniotic and chorionic membranes
- most serious complication associated w/ PROM
- risk increases after 24 hours post rupture
- clinica signs and symptoms
- medical interventions
- nursing care: pt teaching guidelines: signs of PROm infection
post term pregnancy is pregnancy over…
42 weeks gestation
- placental insuffiiency
- increased risk of being stillborn
- increased mortality
macrosomia
excessive newborn weight
cephalopelvic disproportion
where fetal head is too large for maternal pelvis
shoulder dystocia
fetal shoulders are wedged or stuck in maternal pelvis
polyhydramnios
abnormally high level of fluid
- complications: preterm labor, amniotic fluid embolism, maternal hemorrhage
medical interventions: indomethacin (reduces preterm labor with too much fluid in amniotic sac)
oligohydramnios
abnormally low level of fluid
- complications: preterm labor, fetal distress due to cord compression, amniotic band syndrome, musculoskeletal deformities
dysfunctional labor: passage birth control
- pelvic bones are too narrow to allow passage
- fetus has more tissue to pass through for delivery in obese patient
passenger: the fetus
- size of passenger contributes to dysfunctional labor
dysfunctional labor: powers - labor contractions
- contractions are too mild to produce cervical dilation
- scarring or fibroids disrupt communication between uterine segments, causing uterine muscle to not contract
dysfunctional labor: position - fetal presentation
- posterior, brow, shoulder, or breech cause slower cervical dilation and labor progression
dysfunctional labor: psyche
dysfunctional labor: pain management
- IV medication too early can slow
dysfunctional labor: patience
breech presentation
breech presentation: medical interventions
macrosomia
- birth weight >4000 grams
- monitor FHR for nonreassuring patterns
- preparing woman for cesarean delivery
- providing emotional support, comfort measures, pain control
prolapsed umbilical cord
- obstetrical emergency when cord passes through the cervix at same time as or before presenting part
- compression causes decreased blood flow and oxygen to fetus: severe, sudden FHR decelerations w/ prolonged bradycardia or variable decelerations on monitor
- medical interventions
precipitous labor and birth
- refers to unusually rapid labor of <3 hours and ending w/ rapid spontaneous delivery of infant
nursing care of precipitous labor and birth
- obtaining thorough history
- assessing pt for impending delivery
- remaining calm and notifying HCP
- not leaving pt alone
- obtaining a precipitous delivery pack
- washing hands and applying gloves
- cleansing the perineum
- giving clear directions to the woman and assistants
- checking for amniotic sac
precipitous labor and birth delivery
- support perineum and infant’s head as it emerges
- after head emerges, use bulb syringe to suction mouth and nose
- allow infant to spontaneously complete birth movement
- check for nuchal cord - umbilical cord aroundf etus’s neck
- after delivery, thoroughly suction infant’s MOUTH THEN NOSE
- prevent hypothermia of infant
- determine 1 and 5 minute Apgar scores
- assess placenta for intactness (one side meaty, one side shiny)
- massage the uterus (massage if boggy)
- place the infant to be breastfed (if mom wishes)
- documentation
shoulder dystocia
one or both shoulders wedge in maternal pelvis after the head has been delivered
risk factors of shoulder dystocia
history of shoulder dystocia
fetal macrosomia
diabetes
excessive maternal weight gain
obesity
post term pregnancy
precipitous second stage of labor
prolonged second stage of labor
induction of labor for potential macrosomia
uterine rupture
- nonsurgical opening of uterus
- notify hcp of suspected rupture
- notify anesthesiologist, neonatologist, and NICu of impending birth
- monitor fetal and maternal vital signs
- give mother oxygen by mask or nasal cannula
- prepare pt for cesarean birth
- insert indwelling urinary catheter
- reassure and provide emotional support
- perform blood type and crossmatch
- insert IV line (18g)
uterine inversion
- uterine fundus proapses to or through dilated cervix
- flaccid uterus
- excessive pressure on fundus during delivery of placenta
- placenta accreta
- application of too much traction on umbilical cord in attempt to deliver placenta
retained placent
- entire placenta or fragments of placenta still attached to the uterus
amniotic fluid embolism (AFE)
- disorder progresses in 2 phases:
phase 1: hypoxia
phase 2: massive hemorrhage, uterine atony, and disseminated intravascular coagulation (massive blood loss)
AFE signs and symptoms
- dyspnea
- altered mental status
- severe hypotension
- seizures
- cyanosis
- fetal bradycardia if undelivered
- pulmonary edema
- uterine atony
- severe hemorrhage
- cardiac arrest
atony
not toned uterus
AFE medical interventions
- administer oxygen to keep sat normal
- initiate CPR if pt arrests
- treat hypotension
- arrange cesarean birth if required
- order ABGs, CBC, coagulation tests
- admit pt to ICU
perinatal loss (pregnancy loss)
- ectopic pregnancy
- spontaneous abortion
- late pregnancy loss
- stillbirth
- newborn death up to 28th day of life
- fetal demise: death of a fetus at ANY stage
