Chapter 14: Caring for the Woman Experiencing Complications During Labor and Birth Flashcards

Question

Nursing Considerations for a Amnioinfusion

Answer 1

- careful monitoring of the infusion, the intensity and frequency of uterine contractions, and the maternal vital signs - some may sign an informed consent before intervention - educate the woman and her support person regarding the infusion ad its purpose - document amount of solution infused and presence of any vaginal discharge

Answer 2

- assess the patient's response to the fluid infusion - continually monitor the frequency and intensity of uterine contractions - stop the infusion if the following signs and symptoms are noted: maternal shortness of breath, an overdistended uterus, hypotension, or tachycardia

Answer 3

artificial rupture of membranes (AROM), is a nonpharmacological intervention that may be done to augment or induce labor or to facilitate the placement of internal monitors during labor

Answer 4

insertion of an Amnihook or other sharp instrument into the lower segment of the fetal membrane; following rupture, the fluid is allowed to drain slowly >the rupture of the membranes causes a release of arachidonic acid, which converts to prostaglandins, known inducers of labor through the stimulation of oxytocin in the uterus >labor usually happens within 12 hours after artificial rupture -if not, there's an increased risk of infection; or fetal injury and umbilical cord prolapse >because of risk for infection; amniotomy is used with oxytocin induction to facilitate delivery

Answer 5

-vital signs, cervical effacement and dilation, station of the presenting part, FHR, and contractions are documented -the presenting part must be engaged and well applied to the cervix to prevent umbilical cord prolapse (protrusion of the umbilical cord in advance of the presenting part) >there should be no evidence of active infection of the genital tract (e.g. herpes) or HIV infection

Answer 6

-provides information, assesses woman's understanding of the procedure, and assures it will be painless to her and her fetus although she may experience discomfort when the instrument is inserted through the vagina and cervix -necessary equipment assembled: sterile gloves, lubricant, and the Amnihook or Allis clamp -place hip pads under buttocks to absorb fluid -positions woman on a padded bedpan or with rolled up linens to elevate hips >unwrap and pass equipment

Answer 7

after the rupture, the nurse notes and record FHR and pattern -color, odor, consistency, and clarity (and amount, if unusual) of the amniotic fluid are documented -document time of rupture and the indication for the amniotomy -patient may request analgesia or epidural anesthesia before the procedure >if not requested medications, nurse assists with relaxation and breathing techniques during the contractions following the amniotomy because they are likely to be stronger -perform a vaginal exam to palpate for umbilical cord, and determine fetal station and presentation -maternal temperature assessed frequently (q 2 hours) to rule out infection (tempt > 100.4, chills, uterine tenderness on palpation, foul smelling vaginal discharge, and fetal tachycardia)

Answer 8

the use of chemical or mechanical modalities to initiate uterine contractions (before their spontaneous onset) to bring about childbirth

Answer 9

considered when either a maternal or fetal condition exists that dictates the need for medical intervention in the labor process - post term pregnancy - maternal medical conditions (e.g. diabetes mellitus, renal disease, chronic pulmonary disease, chronic hypertension, or antiphospholipid syndrome) - gestational hypertension - fetal demise - chorioamnionitis - premature rupture of membranes - fetal compromise (e.g. severe fetal growth restriction, isoimmunization, or oligohydramnios) - preeclampsia, eclampsia

Answer 10

rating system that may be used to determine the level of cervical inducibility - series of points is awarded to cervical dilation, effacement, station, consistency, and position - labor induction more successful with a higher score (9 or more for nulliparous, and % or more for multiparous)

Answer 11

if the cervix is not favorable for oxytocin induction, a chemical cervical ripening agent may be prescribed >prostaglandin E1 (PGE1) (Misoprostol) >prostaglandin E2 (PGE2) (Dinoprostone)

Answer 12

ripens the cervix (causes softening and initiates dilation and effacement); stimulates uterine contractions -used for both cervical ripening and induction of labor -Adverse effects: diarrhea, nausea and vomiting, headaches, fever, tachysystole (> 5 uterine contractions in 10 minutes over a 30 minute window without alteration of FHR or pattern), uterine hyperstimulation (tachysystole with non-reassuring FHR or patterns), fetal passage of meconium -intravaginally, orally, or sublingually >at least 4 hours after last dose, oxytocin may be given for the induction of labor if cervical ripening has occurred and labor has not begun

Answer 13

ripens the cervix (causes softening and initiates dilation and effacement); stimulates uterine contractions -Adverse Effects: diarrhea, nausea and vomiting, headache, back pain, fever, hypotension, tachysystole (> 5 uterine contractions in 10 minutes averaged over a 30 minute window without alteration in FHR or pattern), uterine hyperstimulation (tachysystole with non-reassuring fetal heart rate or patterns), fetal passage of meconium >Dinoprostone vaginal gel (Prepidil and Prostin E2) or Dinoprostone vaginal insert (Cervidil); vaginal insert releases prostaglandins at a slower rate than the gel >used when bishop score is 4 or less >uterine contractions begin 5 to 7 hours after administration >induction with oxytocin can be initiated 30 to 60 minutes after removal of vaginal insert >when using gel, oxytocin must be delayed until 6 to 12 hours after last instillation of medication >Cervidil advantage; can be removed if uterine tachysystole occurs

Answer 14

-prior to administration, explains the procedure, ensures informed consent has been obtained, and asks patient to void -maternal vital signs and FHR and pattern are assessed before each medication administration and periodically throughout according to protocol -after placement of medication, nurse assists woman to maintain a supine position with lateral tilt or a side lying position (30 to 40 minutes after misoprostol; 30 to 60 minutes after Dinoprostone gel; 2 hours after placement of Dinoprostone insert) >in the advent of adverse effects, nurse uses saline-soaked gauze wrapped around the fingers to swab the vagina (or grasps pull string attached to insert) to remove remaining medication and prepares to administer terbutaline subQ or intravenously

Answer 15

hormone produced by the pituitary gland , stimulates uterine contractions -used to induce labor or augment a labor that is progressing slowly because of ineffective uterine contractions

Answer 16

- explanation and assessment of patients level of understanding - position woman to a side-lying or upright position - assessment of patient and fetus is conducted and documented - solution is prepared and administered via pump delivery system; the piggyback solution is flagged with a medication label and connected to the intravenous infusion at the port nearest the point of venous insertion - medication administered as ordered; ongoing assessments according to protocol - documents the medication (kind, amount, time of beginning of infusion, increasing the dose, maintaining the dose, and discontinuing the infusion) - documents maternal-fetal reactions (FHR and pattern, maternal vital signs, pattern and progress of labor, nursing interventions, and maternal response) and when notification of primary health-care provider takes place

Answer 17

-uterine contractions that last greater than 90 seconds and occur more frequently than every 2 minutes -uterine resting tone greater than 20 to 25 mm Hg with a peak pressure greater than 80 mm Hg -non-reassuring FHR and pattern (baseline less than 100 or greater than 160 bpm; absent variability; repeated late decelerations or prolonged decelerations (with more frequent contractions there is less relaxation time for the fetus to get oxygen)

Answer 18

reduced blood flow through the placenta and results in FHR decelerations, fetal asphyxia, and neonatal hypoxia

Answer 19

- vasa previa or complete placenta previa - transverse fetal lie - umbilical cord prolapse - previous classical cesarean delivery - active genital herpes infection - previous myomectomy (surgical excision of a fibroid) entering the endometrial cavity

Answer 20

- breech presentation - multifetal pregnancy - presenting part above the pelvic inlet - severe hypertension - maternal heart disease - polyhydramnios - one or more previous low transverse cesarean deliveries - abnormal FHR patterns not necessitating emergent delivery

Answer 21

used to stimulate uterine contractions after labor has begun spontaneously but is not progressing satisfactorily >management of hypotonic uterine dysfunction >accomplished with amniotomy, oxytocin infusion, and nipple stimulation >noninvasive approaches include: ambulation, hydration, relaxation, and hydrotherapy (attempt this before invasive measures)

Answer 22

-obtaining informed consent for the procedure after physician explanation -monitoring of the labor >following should be placed on a flowsheet: -vital signs (BP, pulse, and respirations q 30 to 60 minutes and with every increment in medication dose) -FHR (electronic monitoring) -frequency, duration, and strength of contractions (note contraction pattern and uterine resting tone q 15 minutes and with very increment in medication dose during first stage; then monitor q 5 minutes during second stage) -cervical effacement and dilation -fetal station and lie -rate of oxytocin infusion -intake and urine output (limit IV intake to 1000 mL/8 hr.; output should be 120 mL or more every 4 hours) -any untoward effect of the medication administration (nausea, vomiting, headache, or hypotension) -psychological response to the patient

Answer 23

-1:1 nurse-to-patient ratio -nurse remains alert to signs indicative of complications; uterine tachysystole, especially coupled with non-reassuring FHR pattern, and suspected uterine rupture >management of tachysystole: efforts to reduce uterine activity to minimize the risk of evolving fetal hypoxemia or acidemia >immediate emergency measures: discontinuing oxytocin per protocol, positioning patient on her side, IV fluid bolus and/or increasing the primary IV rate up to 200 ml/hr. (unless evidence of water intoxication--in this situation, the rate is decreased to one that keeps the veins open), administering oxygen by face mask at 8 to 10 L/min per order or protocol, and preparing to administer tocolytic medications (e.g. terbutaline) per order or protocol

Answer 24

instrument consisting of cephalic-curved blades similar to the shape of a fetal head -the two blades slide together at the shaft to form a handle -the first blade is inserted into the maternal vagina next to the fetal head; the second blade is then inserted and applied to the opposite side of the fetal head; the shafts of the forceps are brought together in the midline and secure to form a handle -forceps prevent pressure from being exerted on the fetal head and facilitate birth >some form of anesthesia is administered before forceps application to achieve pelvic relaxation and decrease pain; episiotomy is performed to prevent perineal tearing

Answer 25

-a need to shorten the second stage of labor for: dystocia, an inability to push with contractions (e.g. because of exhaustion, spinal or epidural anesthesia, or spinal cord injury), and to prevent worsening of serious medical complications such as cardiac compensation >fetal indications: abnormal presentation, arrest of rotation, immaturity, and distress from complications such as a prolapsed cord

Answer 26

- the cervix must be fully dilated; bladder empty; presenting part engaged - membranes must be ruptured - cephalopelvic disproportion (CPD) not present - informed consent

Answer 27

-FHR and pattern is assessed and recorded before forceps application >when the forceps are applied, there is a danger of compression of the cord between the fetal head and the forceps blade; causes a decrease in FHR >assess and record the FHR and pattern again immediately after the forceps application

Answer 28

-fetal morbidity in direct response to occipital trauma -superficial scalp and facial markings; trauma marks gradually disappear -(rarely occur): facial nerve injury, cephalhematoma (or cephalohematoma), retinal hemorrhage, and ocular trauma >neonatal intracranial bleeding is a concern but it can be from forceps or related to the difficult birth

Answer 29

method used in an assisted vaginal delivery -vacuum extractor consists of a soft plastic cup that is attached to the fetal head over the posterior fontanelle and a suction apparatus that uses negative pressure to facilitate the birth of the head >used for patient who is unable to voluntarily push (because of exhaustion or pharmacological agents), fetal distress, or failure to progress -advantages over forceps: little anesthesia required (fetus is less depressed at birth), associated with fewer lacerations of the maternal birth canal >should not be used following fetal scalp sampling; the suction pressure can cause excessive bleeding at the sampling site -not recommended for preterm fetuses whose skulls are extremely soft

Answer 30

-nurse provides education and support and encourages the woman's continued participation by pushing during contractions -FHR and pattern are assessed before and throughout procedure -assists woman to lithotomy position (in which the patient is on their back with the hips and knees flexed and the thighs apart) >primary care provider applies the cup to the fetal head, and a caput (swelling of the soft tissue) develops inside the cup as pressure is initiated; gentle traction is applied to facilitate descent of the fetal head; an episiotomy may be performed as the head crowns; the caput begins to disappear in several hours but may persist up to 7 days; caput swelling is not harmful to the infant and markings will decrease rapidly

Answer 31

- patient education and support - perinatal team must communicate frequently during the procedure as they each assess progress or lack of progress - following protocols, can advocate for a cesarean birth if maternal exhaustion and/or failure of descent indicates that the vacuum assistance is not effective

Answer 32

-cephalohematoma, subgaleal hematoma, subdural hematoma, intracranial hemorrhage, scalp lacerations, and retinal hemorrhage

Answer 33

if the nurse fails to communicate concerns and there is an untoward event, the nurse can be held liable -liability also incurred if the nurse fails to document a detailed sequence of events (e.g. number of applications, number of pulls, occurrence of pop-offs, and maximum amount of suction applied) during the vacuum assistance along with the maternal-fetal response >after an assisted birth, the nurse who assesses the neonate is also liable with regard to the documentation of vital signs and the neonatal assessment

Answer 34

-women who have been diagnosed with severe preeclampsia or HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets) may be placed in an obstetric critical care unit or a medical intensive care unit for hemodynamic monitoring, maternal vital signs, fetal heart rate (FHR), urine output, deep tendon reflexes, level of edema, and mental orientation and neurological status are assessed

Answer 35

- uncontrolled severe hypertension - eclampsia - persistent oliguria (greater than 500 mL/24 hr. - abruptio placentae - platelet count less than 100,000 mm3 - elevated liver enzyme levels with epigastric pain or right upper quadrant tenderness - pulmonary edema - persistent severe headache or visual changes - spontaneous labor - fetal death - rupture of the membranes - gestational age less than 34 weeks - evidence of fetal compromise

Answer 36

-assessments are critical -plans and evaluates all interventions on a continuous basis -because any change in condition may require an emergency intervention, nurse must be prepared to provide care immediately >continuous monitoring of these key essential components: blood pressure, medication administration, renal balance, neurological status, pulmonary status, psychological status, advancing symptoms, seizures, and fetal status >laboratory tests: CBC with platelets, coagulation profile to assess for disseminated intravascular coagulation (DIC), metabolic studies for determination of liver enzymes (aspartate aminotransferase (AST)), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) and electrolyte studies for renal functioning

Answer 37

- taken q 4 hours or more frequently according to orders or protocol - taken in the same arm at each assessment - assume a side-lying position to enhance uterine perfusion (left side) - record the data; notify physician of an increase in BP

Answer 38

- administer as ordered and evaluate its effect - hospital protocol for magnesium sulfate infusion - monitor maternal vital signs, FHR and pattern, urine output, deep tendon reflexes (DTRs), IV flow rate, and serum magnesium sulfate levels to assess for toxicity (e.g. depressed respirations, hyporeflexia, sudden onset of hypotension, oliguria, and indicators of fetal compromise) - administer calcium gluconate (antidote for magnesium sulfate toxicity) for respirations below 12 breaths/min and discontinue magnesium sulfate infusion

Answer 39

edema is rated on a scale of 1 to 4; 4 is generalized massive edema that includes the face, abdomen, and sacrum -assess and record urinary output; an indwelling catheter may be inserted to more accurately measure urinary output >urine output of less than 30 mL/hr. is indicative of oliguria and should be reported -a dipstick measurement is performed q 4 hours or more frequently to assess urinary protein on a scale of 1 to 4; reading over 2 + is indicative of worsening conditon

Answer 40

deep tendon reflexes (DTR's) assessed q 4 hr. (or more) and rated on a scale 1 to 4 - reflexes greater than 2+ = worsening status - if dorsiflexion of foot produces clonus (convulsive spasm) = deteriorating maternal condition

Answer 41

-auscultation of lungs q 4 hr. or more to assess for dyspnea, crackles, and diminished breath sounds; indicative of pulmonary edema -respiratory rate assessed q 4 hr. or more >patients receiving magnesium sulfate require more frequent respiratory assessments because a rate below 12 breaths/min = toxicity -hemoglobin oxygen saturation assessed with pulse oximeter

Answer 42

- assess for indicators of anxiety and fear - educate about treatment protocols and status of maternal condition - assess level of understanding - provide updates when indicated

Answer 43

headaches, blurred vision, severe right upper quadrant epigastric pain, and restlessness = indicators of impending eclampsia -prepare for immediate delivery

Answer 44

- protect patient - keep airway patent: turn head to one side and place a pillow or folded linen under one shoulder or back - call for assistance - ensure side rails raised - observe and document all seizure activity - notify physician and prepare for delivery - administer oxygen

Answer 45

- monitor FHR and pattern q 4 hr. or more frequently as indicated - assess fetal movements - notify physician if indicators of fetal compromise are noted

Answer 46

- monitor lab values - follow plan of care for patient with severe preeclampsia - responsible for administering 5 to 10 units of platelets on the physicians order before birth to prevent thrombocytopenia (low number of platelets in the blood) - provide ongoing information to decrease anxiety and fear

Answer 47

because of the risk of vena cava compression and decreased venous return from the weight of the gravid uterus

Answer 48

-close surveillance of maternal hydration and blood glucose levels to prevent complications associated with dehydration, hyperglycemia, and hypoglycemia -IV infusion of a maintenance fluid such as Lactated ringer's solution or 5% dextrose in lactated Ringer's solution may be ordered -insulin administered by continuous infusion; only regular insulin be administered intravenously -patients who use continuous subcutaneous insulin infusion (infusion pump) are closely monitored -blood glucose levels assessed every hour and fluid/insulin adjustments are made as needed to maintain maternal blood glucose levels between 80 and 120 mg/dL >maternal hyperglycemia during intrapartal period be avoided to prevent neonatal metabolic problems such as hypoglycemia

Answer 49

- causes: premature rupture of membranes combined with cervical insufficiency - patients experience "silent" asymptomatic contractions throughout pregnancy that contribute to progressive cervical effacement and dilation

Answer 50

- bedrest, hydration, and tocolytic therapy (for up to 48 hours to allow for administration of antenatal steroids) used to inhibit contractions - if the woman's membranes have ruptured or if the cervix is greater than 50% effaced and 3 to 4 cm dilated, it is unlikely that the labor can be stopped; if the fetus is very immature and birth is deemed inevitable, a cesarean birth may be planned to reduce pressure on the fetal head and decrease the possibility or a subdural or intraventricular hemorrhage

Answer 51

- careful maternal monitoring - FHR monitoring (most important) - identify and report signs of hypoxia - assess psychological status of patient and support person

Answer 52

malpresentations are all presentations of the fetus other than vertex -face -brow -shoulder -compound -breech >these can place the woman at risk for complications during labor and birth >diagnosed by abdominal palpation (i.e. Leopold maneuvers) and vaginal examination and confirmed by ultrasonography

Answer 53

- when in breech presentation, presence of meconium in the amniotic fluid may not be indicative of fetal distress - pressure exerted on the fetal abdomen during the birth process may cause the passage of meconium - important to assess FHR and pattern to ensure there are changes indicative of fetal hypoxia - when in breech position, FHR best auscultated at or above the maternal umbilicus

Answer 54

the fetal head is presenting at a different angle than expected -ex: face and brow >these hyperextend the neck and increase the overall circumference of the presenting part -uncommon and associated with fetal anomalies (e.g. anencephaly), macrosomia, cephalopelvic disproportion (CPD), and contractures of the maternal pelvis

Answer 55

turning of a fetus from one presentation to another -may be done externally or internally by physician -ultrasound guidance is used as the physician slowly applies gentle, steady pressure over the fetal head and buttocks to rotate the position >complications: umbilical cord compression, placental abruption, maternal hemorrhage, and fetal bradycardia >procedure requires uterine relaxation; Tocolytic agents such as magnesium sulfate or terbutaline

Answer 56

an attempt to turn the fetus from a breech presentation to a vertex presentation to allow a vaginal birth - offer an alternative to surgery - attempted after 37 weeks gestation - contraindications: previous cesarean births, uterine anomalies, CPD, placenta previa, multifetal gestation, and oligohydramnios

Answer 57

- ultrasonography is obtained to confirm fetal position; locate umbilical cord; rule out placenta previa, and assess maternal pelvic dimensions and the amniotic fluid volume, fetal size and gestational age, and presence of anomalies - a non-stress test (NST) is performed to confirm fetal well-being or the FHR and pattern may be electronically monitored for a brief period (10 to 20 min)

Answer 58

- obtaining written consent from the patient after physician explanation, providing teaching regarding the procedure, administering medications as ordered, and conducting constant surveillance of the maternal-infant dyad - patient must be aware of attempt might not be successful and that rupture of membranes, fetal bradycardia, and discomfort can occur - during version, if any indications of compromise, the nurse prepares woman for C-section - woman who are Rh(-) are given RhoGAM because the manipulation may cause feto-maternal bleeding

Answer 59

physician rotates the fetus by inserting a hand into the uterus and changes the fetal presentation to cephalic (head) or podalic (foot) - used with multifetal gestations to deliver the second fetus - C-section usually performed; C-section usually performed in multiple gestations

Answer 60

anterior shoulder cannot pass under the maternal pubic arch - not identified until head is born - risk factors: maternal pelvic abnormalities, hx of shoulder dystocia, obesity, diabetes, short stature, prolonged labor, postdate pregnancy and fetal macrosomia - no methods to predict or prevent shoulder dystocia - fetal/neonatal injuries r/t birth asphyxia, damage to the brachial plexus and fractures of humerus or clavicle - maternal injury associated with blood loss that results from uterine atony or rupture; lacerations, extension of the episiotomy, rectovaginal fistula, symphyseal separation, and postpartum endometritis

Answer 61

-alert to indicators: slowed labor progression and formation of a caput succedaneum that increases in size >when fetal head emerges on the perineum (crowning) it retracts instead of protruding with subsequent contractions ("turtle sign") and external rotation does not occur

Answer 62

-McRoberts maneuver: placed in a dorsal lithotomy position, thighs are sharply flexed on her abdomen -hands-and-knees position -squatting -lateral recumbent position >do not use fundal pressure

Answer 63

describes unsuccessful attempts at vaginal birth - when present, the fetus cannot fit through the maternal pelvis to allow a vaginal birth - r/t excessive fetal size (macrosomia) - indicators: slow progression of effacement and dilation, lack of fetal descent, and excessive pain

Answer 64

- nursing assessment: review of present and past pregnancies; hx of CPD are at increased risk - interventions: maternal position changes; upright position (e.g. sitting or squatting) to widen pelvic girdle, relaxation, and water therapy to facilitate labor progression - analgesics to alleviate pain

Answer 65

- associated with more complications - because of multiple fetuses, abnormal fetal presentation may occur - fetal/newborn complications r/t problems associated with low birth-weight infants because of preterm birth and intrauterine growth restrictions - want to have neonatal intensive care units available - if triplets or more = mostly likely a C-section

Answer 66

-risk indicator for cesarean birth

Answer 67

- "we are concerned about your baby's heart rate pattern" - "I am going to change your position to your side to increase oxygen flow to your baby" - "I am also going to place this oxygen mask on your face to increase the oxygen flow to you and your baby, and increase your IV rate" - "do you have any questions?" - "I am here to help in any way, and I will stay here with you. Please let me know what concerns you have"

Answer 68

a cord that is wrapped around the infants neck >loosened and carefully slipped over baby's head >if too tight, cord i clamped twice, cut between the clamps, and unwound around the neck before the shoulders are delivered >the cord could tear and interfere with fetal oxygen supply

Answer 69

less than 300 mL of amniotic fluid -result from fetal renal abnormalities, poor placental perfusion, or premature rupture of membranes -absence of amniotic fluid may lead to cord compression during contractions and decreased blood flow as e/b variable heart rate decelerations >careful nursing and medical surveillance; Amnioinfusion may be needed

Answer 70

(polyhydramnios) greater than 2 L of amniotic fluid -occurs in multiple gestations, fetal anomalies, and as a complication of maternal disease such as diabetes -can cause fetal malpresentation because of the extra uterine space that it provides for the fetus to turn -at risk for umbilical cord prolapse -at risk for preterm rupture of membranes

Answer 71

during intrapartal period is an indication for fetal surveillance by electronic fetal monitoring and possibly fetal blood scalp sampling >reasons for passage of meconium: -hypoxia-related peristalsis and sphincter relaxation -breech presentation or normal physiological function that occurs with fetal maturity -following umbilical cord compression-induced vagal stimulation in the mature fetus

Answer 72

- placenta previa | - placental abruption

Answer 73

acquired disorder of blood clotting -can experience widespread internal and external bleeding and clotting -symptoms: easy bruising, appearance of multiple petechiae, and bleeding from intravenous sites -often triggered by release of large amounts of tissue thromboplastin, which occurs in abrupto placentae and in retained dead fetus and amniotic fluid syndromes >the anticoagulation and procoagulation factors are activated simultaneously; thromboplastin (clotting factor) is released into circulation as a result of placental bleeding and the consequent clot formation; circulating levels of thromboplastin activate widespread clotting throughout the microcirculation; this consumes or uses-up other clotting factors such as fibrinogen and platelets -lab results reveal low hemoglobin, hematocrit, platelets, and fibrinogen and elevated fibrin split/ degradation products

Answer 74

correct underlying condition -replace fluids and essential clotting factors >when premature placental separation has triggered the coagulopathy, delivery of the fetus and placenta must be accomplished so that the production of thromboplastin, which is the driving process, is halted; accomplished by administration of Heparin to stop clotting cascade >administration of blood and platelets usually delayed after completion of heparin so that the newly infused blood factors are not consumed by the widespread coagulation process

Answer 75

- continuous maternal-fetal assessment - administering prescribed fluids, blood, and blood products - assessing for signs of complications of the replacement products - positioned in a side-lying position to maximize placental perfusion - oxygen may be administered via rebreathing mask at 8 to 10 L/min or protocol - urinary output monitored; renal failure may result from DIC

Answer 76

occurs when the fetal vessels separate at the distal end of the cord and insert into the placenta at a distance away from the margin -vessels are not protected by Wharton's jelly and are subject to compression, rupture, and thrombosis, major complications that may lead to severe fetal distress and death -occurs with placenta previa and multiple pregnancies -rupture of the membranes or traction on the umbilical cord may tear the fetal vessels; produces rapid, fatal, fetal hemorrhage >detectable by ultrasound -nurse may note a drop in FHR during vaginal exam; a ready FHR return to the baseline after the exam may be indicative >ruled out via careful vaginal exam with cervical palpation for detection of exposed vessels

Answer 77

occurs when the unprotected fetal vessels cover the cervical os and precede the fetus -usually seen with Velamentous insertion of the umbilical cord -because the vessels are not covered with Wharton's jelly, the examiner may be able to feel pulsations of the umbilical cord -lacerations of the vessels cause sudden fetal blood loss; onset of sudden, painless bleeding at the beginning of cervical dilation or during rupture of membranes may signal presence of vasa previa >diagnosis confirmed by sonogram

Answer 78

death of a fetus or infant from the time of conception through the end of the newborn period 28 days after birth

Answer 79

- its gods will - you can always have another - there was a problem with this baby - there's always next time

Answer 80

be available for the mother - "what are you most worried or fearful about?" - how supportive is the baby's father and your family or friends? - what coping techniques have been helpful for you in the past?

Answer 81

- give parents idea of their infant's appearance - photography; can be stored in medical record and given upon request - encouraged to hold, touch, and hold deceased - provide privacy; indicator outside the room that indicates a loss (single red rose, "remembrance card" - acknowledge it not avoid it - resource guide - support group

Answer 82

birth of the fetus through an abdominal incision into the uterus; performed to preserve the life of the mother and fetus

Answer 83

when the health of the mother or her fetus is jeopardized - hypertensive disorders, active genital herpes, positive HIV status, and diabetes - cephalopelvic disproportion, malpresentations (i.e. breech or shoulder), placental abnormalities (abruptio previa), dysfunctional labor patterns, fetal distress, multiple gestation, and umbilical cord prolapse

Answer 84

-Classic (vertical) incision -Lower-segment transverse (LST) >decision based on patients condition and fetal status

Answer 85

this type of incision is associated with complications such as blood loss, infection, and uterine rupture with subsequent pregnancies

Answer 86

less blood loss, fewer post-op infections, and a decreased likelihood of uterine rupture during subsequent pregnancies

Answer 87

- blood work, type and cross match and a CBC obtained before admission - orients patient to unit, reviews prenatal hx, responds to questions or concerns - informed consent is signed - fetal monitor placed on abdomen for 20-30 minute baseline assessment - vital signs taken and charted - in preparation, abdomen cleaned and shaved - IV line is placed - indwelling urinary catheter is inserted to keep the bladder empty during the operation - medications administered per order - if an epidural is to be used, nurse properly positions the patient and supports her during administration - if general anesthetic is to be used, an antacid may be prescribed to neutralize gastric secretions in the event of aspiration

Answer 88

- nurses role varies; one assists physician, other circulates - team consisting of neonatal nurse and a neonatologist or nurse skilled in neonatal resuscitation is in attendance - patient is placed on the surgical table with a hip wedge to slightly elevate hips - FHR is continuously monitored until patients abdomen is ready for surgical preparation - if the woman remains awake, nurses provide information about the events taking place and sensations the woman is experiencing - Pattern of events: delivery of the head, nose and mouth are suctioned, delivery of the shoulders, delivery of the body, newborn presented to parents

Answer 89

- transferred to recovery room or labor room - assess recovery process: effects from anesthesia, status of postoperative/post-birth uterus, and the degree of pain - if general anesthesia was used, special attention of patent airway - positioned to prevent aspiration - vital signs assessed q 15 minutes for the first 2 hours or until stable - inspects incisional dressing and assesses the fundus, the amount of lochia, the intravenous infusion, and the urinary output - assisted to turn, cough, and deep breathe, and perform leg exercises - pain medications PRN - facilitate family bonding; breastfeed

Answer 90

- one previous low-transverse cesarean birth (if two prior cesarean births, only those who have also had a vaginal birth as well should be considered candidates for a spontaneous labor) - clinically adequate pelvis in relation to fetal size - no other uterine scars, anomalies, or previous rupture - physician immediately available throughout active labor capable of monitoring labor and performing an emergency cesarean birth - availability of anesthesia and personnel for emergency C-section

Answer 91

one that extends beyond 294 days or 42 weeks past the first day of the last normal menstrual period -"postdate", pregnancy that has gone past the estimated date of birth >may experience fatigue, and psychological responses such as depression, frustration, loss of control, and feelings of inadequacy as the pregnancy extends beyond estimated date of birth

Answer 92

- fetal macrosomia associated with shoulder dystocia and fetal injury, oligohydramnios, meconium aspiration, intrapartum fetal distress, and stillbirth - neonatal problems: asphyxia, meconium aspiration syndrome, hypoglycemia, polycythemia, respiratory distress, and dysmaturity syndrome - maternal risks: trauma, hemorrhage, infection, or labor abnormalities - because the placenta ages rapidly past the 40th week of gestation, it becomes inefficient and cannot adequately support the fetus

Answer 93

-induction with prostaglandins or oxytocin, forceps or vacuum assisted birth, and cesarean birth

Answer 94

dystocia--a long difficult or abnormal labor-- may arise from any of the three major components of the labor process: the powers, passenger, or passageway - during a trial of labor, nursing responsibilities center on assessment of maternal vital signs and FHR and pattern - oxytocin used during labor induction and augmentation should always be administered as a piggyback solution, and a uterine and FHR monitor should be used continuously during the infusion - forceps and vacuum extraction are methods to assist birth; the mother and infant require special observation during and after these procedures - management of hypertensive disorders during intrapartum is focused on preventing further deterioration of affected organs and fostering a positive maternal-fetal outcome - cesarean birth, which may be scheduled or emergency, is associated with increased risk for the mother and her infant and should be undertaken only when medially necessary - perinatal loss necessitates a collaborative response from all professionals involved in the care of the patient