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Women and Families > childbirth at risk > Flashcards

childbirth at risk Flashcards

1
Q

preterm labor

A

20-37 6/7 weeks

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2
Q

predictors of preterm labors

A
  • overdistention: multiple gestation, polyhydraminoas
  • bleeding
  • infection
  • vascular: DM, preeclampsia, substance abuse
  • stress/trauma
  • history of preterm birth
  • cervical insufficiency
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3
Q

signs and symptoms of preterm labor

A
  • uterine contraction every 10 minutes or less, pain in abdomen, pelvis, back
  • mild menstrual like cramps felt low in the abdomen with or without diarrhea
  • pelvic pressure
  • rupture of membranes or vaginal bleeding
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4
Q

preterm labor screening

A
  • fetal fibronectin
  • cervical length
  • bacterial vaginosis
  • UTI
  • bishop score
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5
Q

preterm labor: goals of clinical therapy

A
  • detect uterine contractions
  • maintain good uterine blood flow
  • ensure that fetus is stable
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6
Q

preterm labor: nursing interventions

A
  • lateral positioning: Iv fluids, labs
  • ultrasounds
  • preterm birth prevention programs: HUAM: bedrest, pelvic rest, hydration
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7
Q

preterm labor: clinical theraoy

A

short term therapy
-tocolytic drug therapy
delayed birth and allow course of betamethasone
-mag sulfate protect against CP, nifedipine, indomethacin

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8
Q

betamethasone

What? Risks?

A
  • single course (24-34wk)
  • given if at risk for delivery within 7 days.
  • decreases chances fo neonatal complication
  • risk: maternal hypoglycemia and fetal hypoglycemia and sepsis
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9
Q

maternal risk of preterm labor

A
  • what caused it: hemorrhage, trauma, infection

- treatment: side effects of meds and stress

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10
Q

fetal risk of preterm labor

A
  • correlate to gestational age

- mortality increase and maturational deficiencies

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11
Q

nursing care of PTL

A
  • assess educational needs
  • teach about important of recognizing onset of labor
  • identify risk for PTL
    (primary: universal interventions, secondary: intervention for those at risk, tertiary: intervention for those with disease/PTL)
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12
Q

fetal malpresentation

A

cephalic: sinciput (military), brow, face
- breech
- transverse/shoulder
- compound

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13
Q

nursing and clinical interventions for breech presentation

A
  • external cephalic version
  • planned c/s
  • continuous EFM, assess FHR
  • Ongoing assessment of labor progress
  • emotional support
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14
Q

fetal malposition (OP): fetal and maternal risks

A
  • not much for baby

- maternal: severe back pin

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15
Q

nursing assessment of fetal malpostion

A
  • intesive back pain in first stages of labor
  • dysfunctional labor pattern
  • FHR may be hear laterally on maternal abdomen
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16
Q

fetal malposition close monitoring and birth

A
  • vaginal exam: anterior fontanelle
  • intrapartum u/s, Leopold maneuvers
  • possible vaginal birth, force assisted birth
17
Q

abruption/abruptio placenta

A

premature separation of implanted placenta from the uterine wall

18
Q

risk factors for abruption

A
  • maternal hypertension
  • trauma (IPV)
  • prior abruption
  • advanced maternal age
  • cigarette smoking/ cocaine abuse
19
Q

maternal risk for abruption

A
  • hemorrhage
  • hypovolemic shock
  • possible hysterectomy
20
Q

-fetal risks of abruption

A

complications from preterm labor, anemia, hypoxia

-demise

21
Q

nursing assessment/ intervention of abruption

A
  • immediate priorities are maintain maternal cardiovascular status and developing a delivery plan
  • hypovolemia: blood transfusion, evaluate clotting factors, administer IV fluids
  • delivery plan: c/s is safest, induction of labor may be indicated, if still born: vaginal delivery unless hemorrhaging
22
Q

placenta previa

A

placenta improperly implanted in the lower uterine segment

23
Q

risk facets of placenta previa

A
  • prior previa
  • multiparty
  • increasing age
  • prior c/s or uterine surgery
  • smoking/cocaine abuse
  • previous spontaneous or induced abortion
24
Q

signs and symptoms of placenta previa vs abruptio

A

previa: slow onset, bright red blood, soft and palpable fundus
- abruption: immediate onset, dark blood color, firm and hard fundus

25
Q

nursing interventions for placenta previa

A
  • administer IV fluid, betamethasone
  • emotional status
  • assessment of fetal status: FHR continue
  • monitor blood loss, pain, uterine contractility: no vaginal exams, blood transfusion, VS, complete lab evaluation
26
Q

prolapsed umbilical cord

A
  • umbilical cord precedes fetal presenting part: it get trapped between presenting part and maternal pelvis and presenting part not firmly against cervix
  • higher incidence in malpresentation(breech)
27
Q

maternal and fetal risks of prolapsed cords

A
  • maternal: stress

- fetal: compression of cord:impaired gas exchange, bradycardia, persistent variable desecrations–> late

28
Q

nursing intervention of prolapsed cord

A
  • push presenting part back in

- positioning: hips high

29
Q

indications for C/S

A
  • prolapsed cord
  • cephalopelvic disproportion
  • placental abruption
  • malpresentation
  • non reassuring fetal HR tracing
  • placenta previa
30
Q

maternal risk for C/S

A
  • infection
  • reaction to anesthesia agents
  • blood lots
  • ureteral injury, bladder laceration
  • wound infection
31
Q

preparations for C/s

A
  • possible preferences: choice of anesthetic, present of partner, audio, video, physical contact, or holding newborn while on operating table
  • preop teaching: coughing, deep breathing exercises, splinting, what to expect
32
Q

nursing management before C/S

A
  • assisting with epidural
  • monitor maternal VS and FHR
  • insert urinary catheter
  • preparing abdomen and perineum
  • all necessary personal and equipment present
  • position woman on operating table
  • supporting the couple
  • instrument count
33
Q

nursing management after C/S

A
  • normal newborn post delivery care
  • monitor VS post anesthesia
  • checking the surgical dressing
  • palpating the fundus and checking lochia
  • monitoring intake/output
  • administration of oxytocin and pain management

Women and Families (7 decks)

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