Chapter 7 - Obstetrical/Gynecological Flashcards
Vaginal Bleeding - 7010
TREATMENT: (6)
• Place patient in POSITION OF COMFORT
• Airway /breathing management
▪Monitor SpO2
▪ administer 02 via proper adjunct to maintain oxygen saturation of 95% or greater
• Initiate cardiac monitoring
• Apply pads to vaginal area for significant bleeding
• Determine last menstrual period (LMP)
• If pregnant and greater than 26 weeks
▪ Place patient in the RECOVERY POSITION (left side)
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* No - Determine blood glucose level or Assess temperature*
Pre-Eclampsia/Eclampsia - 7020
TREATMENT: (7)
• Airway/breathing management
▪Monitor SpO2
▪ Administer to via proper adjunct to maintain oxygen saturation of 95% or greater
• Determine blood glucose level
• Initiate cardiac monitoring
• Assess temperature
• Place patient on LEFT SIDE if greater than 20 WEEKS pregnant
• PRE-ECLAMPSIA
▪ Physical exam may reveal blood pressure greater than 140/90 mmHg tachycardia, tachypnea, pulmonary edema, confusion and generalized edema
• ECLAMPSIA
▪ Physical exam may reveal seizure and blood pressure greater than 160/110 mmHg
Imminent Delivery - 7030
General Treatment: (9)
• Provide rapid transport
• Airway/breathing management
▪Monitor SpO2
▪ Administer via proper adjunct to maintain oxygen saturation of 95% or greater
• Determine blood glucose levels
• Initiate cardiac monitoring
• Maintain body temperature of neonate Post delivery
• Evaluate infant on delivery - APGAR score
• Placenta must be brought to the hospital for evaluation postpartum
• Assess for postpartum hemorrhage
▪ Gently massage uterus until firm
• For imminent birth or complication, transport to nearest Emergency Room
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* No - Assess temperature *
Imminent Delivery - 7030
Specific Treatment:
Delivery - Without complications (14)
- Apply gentle perineal pressure to allow a slow, controlled delivery of the head
- Observe for meconium staining; suctioning imperative
- As soon as the head is delivered, support with hand and SUCTION the OROPHARYNX FIRST then the nostrils
- Gently guide the head downward to allow delivery of the upper shoulder. Do not pull on the newborn to facilitate delivery
- Once the shoulders are delivered, the newborns trunk and legs will follow rapidly. Be prepared to grasp and support the new born as it emerges.
- Once the newborn is delivered, maintain body position at the same level as the vagina to prevent blood drainage from the umbilical cord
- Wipe any blood or mucus from the newborns nose and mouth with the sterile gauze
- Use a bulb syringe to suction the nose and the nostrils again
- Dry the newborn and wrap and a dry blanket
- Record the time of birth
- apply to clamps (2 to 3 inches apart), 7 to 10 inches from the abdomen of the neonate
- Cut cord between clamps
- Closely monitor the cut umbilical cord for bleeding
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Imminent Delivery - 7030
Specific Treatment:
Delivery - with complications Nuchal Cord (3)
• Feel for the cord around the neck as soon as the head is delivered
• Gently remove the cord from around the neck
• If unable to remove, clamp and cut the cord
▪ Use extreme caution when cutting the cord
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Imminent Delivery - 7030
Specific Treatment:
Delivery - with complications Breech Delivery (2)
• If delivery is not immediate:
▪ Place the mother in the KNEE-CHEST POSITION
• If delivery is immediate:
▪ Allow the buttocks or feet to deliver on their own and support the trunk
▪ Check for the umbilical cord around the neonate’s neck and allow the head to deliver
▪ If the head does not deliver within 3 minute, use a gloved hand to make an airway for the neonate, using the fingers to make airspace
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Imminent Delivery - 7030
Specific Treatment
Limb or Brow Presentation (1)
• Place mother in the KNEE-CHEST POSITION
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Imminent Delivery - 7030
Specific Treatment
Prolapsed Cord (3)
• Assessment should focus on the presence of pulses in the umbilical cord and relief of the pressure obstructing blood flow within the cord
• Place the mother in the KNEE-CHEST position or SUPINE WITH HIPS ELEVATED
• Relieve pressure from the prolapsed cord if no pulses are detected in the cord
▪Use gloved hand to gently but firmly push the neonate’s head back into the vagina; avoid pushing on the fontanels
▪stop pushing upon the return of pulses in the cord
▪ do not push the cord back into the vagina, but keep moist with Normal Saline soakd towels
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Imminent Delivery - 7030
Specific Treatment
Abruptio Placenta or Placenta Previa (1)
• Treat for shock if indicated
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Newborn Stabilization/Resuscitation - 7040
General Treatment/Guidelines: (10)
• If complications present with mother or child, request a second rescue
• During delivery, suction the mouth and the nostrils. Suction should be done after delivery of the head but before delivery of the body
• Thoroughly dry the newborn with towels or blankets. Wrap newborn in a dry blanket
• Administer tactile stimulation, if required, by TAPPING SOLES OF FEET
• Assess and record APGAR at 1 minute and 5 minutes Post delivery
• Position infant in the Supine position with the neck in a neutral position. A 1” blanket roll under the shoulders will help maintain the head position, if aggressive Airway management is needed
• Re-assess newborn every 30 seconds
determine BGL by HEEL STICK
• initiate cardiac monitoring
• Airway/breathing management
▪Assess respiratory rate and effort
• Consider specific treatment situations: (3)
Newborn Stabilization/Resuscitation - 7040
Specific Treatment:
• Cyanosis isolated to the extremities (acrocyanosis): (2)
- Saturation may remain less than normal for up to 10 minutes after birth
- Administer Blow by O2
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Newborn Stabilization/Resuscitation - 7040
Specific Treatment:
• Heart rate less than 100 with labored breathing, apnea, persistent central cyanosis and/or no muscle tone: (2)
- Provide 100% O2 at 40 to 60 breaths/minute via infant BVM
- If symptoms persist, consider intubation of patient
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Newborn Stabilization/Resuscitation - 7040
Specific Treatment:
HR less than 60: (2)
- Administer chest compressions at a rate of 120 per minute
- Provide 100% O2 at 40 to 60 breaths/minute via infant BVM
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