Chapter 16: Nursing Care During Obstetric Procedures Flashcards
Augmentation
Stimulation to improve effectiveness of spontaneous labor contractions.
Chignon
Newborn scalp edema caused by a vacuum extractor
Dystocia
Difficult or prolonged labor
Iatrogenic
Adverse condition resulting from treatment
Montevideo unit
Method to calculate the intensity of uterine contractions over 10 minutes
Nuchal cord
Cord around the fetal neck
Pfannenstiel
“Bikini” skin incision
Piper
Forceps used to assist vaginal breech birth
What are potential complications of amniotomy?
Prolapse of the umbilical cord, infection, and placental abruption.
What are 3 nursing measures after the use of prostaglandin E2 to ripen the cervix and give the rationale for each.
a. have the woman lie flat for 15 to 20 minutes to reduce leakage.
b. observe the fetal heart rate for changes that may occur with uterine contractions.
c. assess for excessive contractions that can reduce fetal oxygen supply
Describe fetal and maternal nursing assessments associated with oxytocin infusion. What are signs of problems?
a. Fetal assessments:
b. Maternal assessments:
a. Fetal assessments: Assess FHR every 15 minutes during first-stage labor and every 5 minutes during second-stage labor. Problems may be indicated by tachycardia (>160 bpm), bradycardia (<110 bpm), late decelerations, and reduced FHR variability.
b. Maternal assessments: Assess uterine activity for contractions that are too frequent or too long or a uterus that does not relax for at least 30-60 seconds between contractions. Blood pressure and pulse identify changes from the baseline; temperature assessment identifies infection that may occur with ruptured membranes. Intake and output, assessment for headache, blurred vision, behavioral changes, increased blood pressure and respirations, decreased pulse, rales, wheezing, and coughing identify possible water intoxication. Postpartum hemorrhage may occur if an overstimulated uterus cannot contract effectively after birth.
List nursing interventions if fetal or maternal assessments are not reassuring when oxytocin induction or augmentation of labor is being performed.
In addition to identifying the true cause of the nonreassuring assessments, interventions may include stopping the oxytocin infusion, increasing the rate of the nonadditive infusion, positioning to avoid aortocaval compression, and giving oxygen by face mask. Internal monitoring may be initiated if not already in place. The physician may also order a tocolytic drug if uterine hyperactivity is the problem.
Explain the purpose of each aspect of care for the woman having external version.
a. Nonstress test or biophysical profile:
b. Epidural block or sedative:
c. Ultrasound:
d. Tocolytic drug:
e. Rh immune globulin:
f. Fetal heart rate monitoring:
g. Uterine activity monitoring:
a. Nonstress test or biophysical profile: Evaluates placental function and apparent fetal health to avoid stressing a fetus that may already be compromised.
b. Epidural block or sedative: Provides pain relief for this uncomfortable procedure, although maternal discomfort would also provide a sign of problems that may indicate that the version procedure should be stopped.
c. Ultrasound: Guides the version and helps monitor the FHR.
d. Tocolytic drug: Relaxes the uterus to make the version easier to perform.
e. Rh immune globulin: Destroys fetal Rh-positive RBCs that might stimulate anti-Rh antibodies in the Rh-negative woman, These may enter the mother’s bloodstream because of tiny placental disruptions during the version.
f. Fetal heart rate monitoring: Evaluates how the fetus is tolerating the version and when the fetal condition returns to baseline afterward.
g. Uterine activity monitoring:Identifies persistent contractions that may herald the onset of labor following the version.
Describe nursing care associated with a forceps- or vacuum extractor-assisted birth. What is the rationale for each? Are there counter indications for either methods?
a. Maternal:
b. Fetal-neonatal:
c. Contraindications:
a. Maternal: Add a catheter to the delivery table to empty the mother’s bladder (if she is not already catheterized), making more room for the instrument-assisted birth. In the postpartum period, observe for trauma, usually lacerations (bright red bleeding with a firm fundus) or hematoma (excessive pain, edema, discoloration). Cold packs to the perineal area limit bruising and edema.
b. Fetal-neonatal: Observe for reddening, mild bruising, or small lacerations where forceps were applied. A chignon is typical if a vacuum extractor is used. Explain that these minor problems usually resolve quickly. Facial asymmetry, usually seen when the infant is crying, suggests nerve damage that resolves more slowly.
c. Contraindications: Conditions that may make a cesarean birth preferable to speed delivery or reduce trauma, such as severe fetal compromise, acute maternal conditions, high fetal station, and conflict between fetal and pelvic sizes.
Explain why cesarean birth is not always easy for the newborn.
The infant may be born preterm if a cesarean birth is scheduled. Transient tachypnea may occur, caused by delayed absorption of lung fluid or persistent pulmonary hypertension. Injury can occur, such as laceration or bruising.
