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Women's Health Test I > Chapter 16: Obstetric Procedures > Flashcards

Chapter 16: Obstetric Procedures Flashcards

1
Q

explain an amniotomy

what are the indications?

A
  • it is an artificial rupture of membranes w/ amnihook (disposable plastic membrane perforator)
  • indications:
    • induce labor
    • augment labor
    • allow internal monitoring
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2
Q

risks of an amniotomy

A
  • umbilical cord prolapse
    • defer rupture if presenting part is high OR if presentation is not cephalic
  • infection
  • placental abruption
    • can occur w/ polyhydramnios
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3
Q

amniotomy: nursing care before

A
  • obtaining baseline information: FHR for 20-30 min prior to procedure
  • assisting w/ amniotomy:
    • place absorbent pads under mother
    • gater equipment
    • no more painful than a vaginal exam
    • make sure to wear goggle–universal precautions
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4
Q

amniotomy: nursing care after

A
  • PRIORITY: monitor FHR immediately after AROM
  • assess amniotic fluid
  • assess maternal V/S
    • assess temp Q4h before ROM, then assess Q2h after AROM, but if mom spikes a fever, assess Q1h
  • promote comfort
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5
Q

what are possible observations to make with amniotic fluid?

A
  • what to assess:
    • T: time
    • A: amount
    • C: color (clear, bloody, yellow, green)
    • O: odor
  • problem observations:
    • polyhydramnios: more than 2000 mL
    • oligohydramnios: less than 500 mL
    • large amount of vernix (preterm)
    • greenish (meconium b/c post term or placental insufficiency)
    • odor (chorioamniotis)
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6
Q

why does oligohydramnios occur?

A
  • maternal HTN
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7
Q

what is the difference b/w induction and augmentation?

A
  • induction: artificial initiation of labor
  • augmentation: artificial stimulation of ineffective uterine contractions
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8
Q

what are the 2 chemical methods used for cervical ripening?

A
  • Dinoprostone (Cervidil)–Prostaglandin E2
  • Misoprostol (Cytotec)–Prostaglandin E1
    • used for cervical ripening and induction
    • inserted into the posterior vaginal fornix (25 mcg)
    • not given to woman who had previous C/S
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9
Q

what are possible ADRs when trying to induce/augment labor?

A
  • uterine hyperstimulation
  • uterine rupture
  • maternal water intoxication
    • watch for: HA and vomiting
  • neonatal jaundice
  • inc risk of chorioamnionitis and C/S
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10
Q

what are medical indications for induction?

A
  • hostile intrauterine environment
  • premature ROM (PROM)–mom has ruptured, but no contractions, so have to give oxytocin
  • chorioamnionitis
  • HTN–main reason for induction
  • placental abruption
  • maternal medical conditions: (G)DM, lupus
  • fetal death
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11
Q

what are other possible reasons that a mom may choose to induce labor?

A
  • hx of rapid labors
  • living a long way from hospital
  • maternity leave
  • change in insurance
  • fetal anomaly
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12
Q

what is the Bishop Score?

A
  • used to determine successful induction
  • ACOG: vaginal delivery more likely if higher than 8 out of 12
    • nullipara most successful when 7 or more
    • multipara most successful when 5 or more
  • looks at position of cervix, consistency of cervix, effacement, dilation, baby’s station
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13
Q

what are the mechanical methods used for cervical ripening?

A
  • used infrequently
  • moisture attracting inserts are placed in the cervical canal–absorb H2O and swell
    • Dilapan: synthetic material
    • Lamicel: sponge with MgSO4
    • Laminaria: dried seawee
  • foley bulb
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14
Q

Oxytocin Administration for Induction

A
  • dilute oxytocin in isotonic fluid
  • secondary infusion via PUMP
  • insert oxytocin line close to venipuncture site
  • assess uterine activity, FHR, maternal BP and HR
  • start slow and inc infusion rate gradually
    • nurse decides when to start, change, and stop oxytocin by hospital protocol and Dr.’s orders
    • inc by 1-2 milliunits/min
  • monitor uterine activity and FHR frequently
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15
Q

what is important to recognize during induction or augmentation?

A
  • tachysystole/hypertonus
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16
Q

how to recognize tachysystole (hypertonus)?

A
  • duration longer than 90-120 sec
  • frequency <2 min
  • relaxation <30 sec
  • resting tone >20 mmHg
  • peak pressure >90 mmHg
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17
Q

what are nursing actions to do for tachysystole?

A
  • reduce or stop Pitocin & increase primary fluids
  • non-supine, lateral position
  • O2 by face mask at 8-10 L/min
  • notify doctor
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18
Q

what to observe for with induction/augmentation of labor?

A
  • assess blood pressure and pulse frequently
  • record I&O
  • observe for signs of water intoxication
  • pain management
  • assess for uterine atony in postpartum period
  • assess for jaundice in newborn
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19
Q

risks of induction and augmentation

A
  • uterine hyperstimulation
  • uterine rupture
  • maternal water intoxication
  • greater risk of chorioamnionitis and C/S
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20
Q

what are S/S of maternal water intoxication?

A
  • HA
  • blurred vision
  • behavior change
  • inc BP and RR
21
Q

indications for version

A
  • external version: change fetal position to cephalic position to inc chance of vaginal birth
    • attempted after 37 weeks
  • internal version: vaginal birth of twins
22
Q

nursing considerations and promoting fetal and maternal health with an external version

A
  • provide information and reduce anxiety
  • assess NST or BPP for fetal well being
  • assess maternal V/S
  • monitor FHR for baseline and reassuring pattern
  • IV line
    • administer tocolytic: terbutaline 0.25 mg subQ (may inc HR)
  • observe for complications:
    • nonreassuring FHR
    • persistent pain: suggests placental abruption
    • regular contractions
23
Q

Nursing Care after an External Version

A
  • monitor for 1 hour
  • perform NST
  • monitor for U/Cs, bleeding, ROM, decreased fetal movement
  • if Rh negative, check Kleinhauer Betke test
    • checks for presence of fetal blood in maternal circulation
  • V/S: pulse should NOT be greater than 120
24
Q

amnioinfusion

A
  • a volume of LR or sterile NS is introduced into the uterus through an IUPC
25
Q

amnioinfusion: indications

A
  • cord compression is suspected (d/t variable decels)
  • meconium stained fluid (usually medium or heavy amounts)
  • preterm labor with PROM
26
Q

amnioinfusion: nursing considerations

A
  • monitor maternal V/S
  • monitor FHR
  • keep mom and partner informed
  • comfort measures: ie. dry pads
  • positioning
  • return of fluid
27
Q

what is used during assisted or operative vaginal births?

A
  • forceps (occasionally used)
  • vacuum extractor:
    • if 2nd stage needs to be shortened
    • maternal exhaustion/inability to push
    • cardiac & pulmonary dz
28
Q

forceps: technique

A
  • With correct placement of the blades, the handles lock easily.
    • During uterine contractions traction is applied to the forceps in a downward and outward direction to follow the birth canal combined with maternal pushing efforts.
29
Q

vacuum extractor: technique

A
  • The cup is placed on the fetal occiput and suction is created.
    • Traction is applied in a downward and outward direction with maternal pushing efforts.
30
Q

risks for mom with a operative vaginal birth

A
  • lacerations and hematomas of the vagina
31
Q

risks for fetus with an operative vaginal birth

A
  • ecchymosis
  • facial/scalp lacerations and abrasions
  • cephalohematomas: collection of blood; does NOT cross suture lines
  • intracranial or subgaleal bleeds
32
Q

what is an episiotomy? what are the types?

A
  • surgical incision of the perineum
  • types:
    • ML: midline
    • RML or LML: right or left medial lateral
33
Q

advantages of an episiotomy

A
  • allows more room
  • dec pressure on the head
34
Q

disadvantages of an episiotomy

A
  • inc postpartum pain
  • more scarring
  • prolonged dysparunia
  • inc risk of infection
  • may extend to rectum
35
Q

episiotomy: indications

A
  • to prevent pressure on fetal head
  • control direction of vagina opening
  • clean incision simpler to repair than a laceration
36
Q

How to Prevent an Episiotomy

A
  • upright position for pushing
  • open glottis pushing
  • no arbitrary length of time for 2nd stage
  • daily perineal massage and stretching after 36 weeks
37
Q

types of lacerations

A
  • 1st degree: skin and mucosa
  • 2nd degree: muscle
  • 3rd degree: involves the anal sphincter, anterior wall of rectum
  • 4th degree: through the rectal mucosa to the lumen of the rectum
38
Q

how to provide pain relief for lacerations or episiotomy

A
  • ice pack first 24 hours
  • analgesic spray or ointment as prescribed
  • sitz baths after 24 hours (not regularly used)
39
Q

how to prevent infection with lacerations and episiotomies

A
  • perineal care with each void
  • dry perineal area from front to back
  • blot rather than wipe
  • shower rather than tub bath
  • apply peri pad front to back
  • don’t touch inside of pad
  • report any bleeding or discharge to physician
40
Q

what are the fetal risks of cesarean birth?

A
  • inadvertent premature birth
  • transient tachypnea
  • persistent pulmonary HTN of the newborn
  • traumatic injury
41
Q

C/S pre-op nursing responsibilities

A
  • informed consent
  • patient education and family support
  • additional interventions:
    • clip hair
    • insert bladder catheter
    • T&C
    • grounding pad
    • instrument & sponge counts
  • pre-op meds: anti-emetics, antibiotics
42
Q

vertical skin incision with C/S

A
  • advantages:
    • quicker
    • better visualization
    • can extend upward
    • better for obese women
  • disadvantages:
    • visible when healed
    • greater chance of dehiscence and hernia
    • w/ classic: inc risk of uterine rupture in subsequent pregnancies/labor
43
Q

Pfannenstiel skin incision with C/S

A
  • preferred
  • advantages:
    • less visible
    • less dehiscence and hernia risk
  • disadvantages:
    • less visualization of uterus
    • takes more time and can’t be easily extended
    • subsequent births take more time
44
Q

low transverse uterine incision w/ C/S

A
  • advantages:
    • unlikely to rupture in subsequent births
    • makes VBAC possible w/ next birth
    • less blood loss
    • easier repair
    • less adhesion formation
  • disadvantage:
    • limited ability to extend
45
Q

low vertical uterine incision w/ C/S

A
  • advantage:
    • can be extended upward
  • disadvantage:
    • slightly more likely to rupture in subsequent births
    • tear may extend incision down to cervix
46
Q

classic uterine incision w/ C/S

A
  • advantage:
    • may be the only choice if:
      • implantation of placenta previa on lower anterior uterine wall
      • presence of dense adhesions
      • transverse lie of large fetus
  • disadvantage:
    • most likely to rupture in subsequent births
    • eliminates VBAC as an option
47
Q

C/S intra-op nursing responsibilities

A
  • circulator
  • maintaining counts at cavity closures
  • extra supplies
  • recording data
  • observing sterile field
48
Q

recovery room care after C/S

A
  • postpartum assessment:
    • fundus, lochia, dressing, V/S
    • urine output
  • pain: assess need for analgesia
  • assess for return of sensation
    • turn frequently prior to its return
  • SCD
  • promote bonding w/ infant
  • airway protection if general anesthesia
49
Q

VBAC

A
  • vaginal birth after C/S
  • physician’s responsibility to discuss during prenatal care
  • reinforce explanations:
    • advantages of a vaginal birth
    • present in a positive way
    • acknowledge that a cesarean delivery may be needed

Women's Health Test I (8 decks)

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