class 6 labour and birth part 2 Flashcards
When are we concerned about pain?
When there is pain between contractions
What are we concerned about with pain between contractions?
placental abruption
uterine rupture
What are the 12 non-pharmacological interventions in the first stage of labour?
1.Therapeutic touch: massage, counter pressure, double hip squeeze
2. Position changes: walking, rocking, birth balls, etc.
3. Application of heat/cold
4. Hydrotherapy: showers, bath, birth tub
5. Intradermal sterile water injections
6. TENS
7. Acupressure/acupuncture
8. Breathing techniques/relaxation
9. Music
10. Imagery & visualization focal points
11. Aromatherapy
How often should the nurse assess the effectiveness of each position?
q 20-30 min
What 3 things do nurses assess when assessing position changes?
- comfort and anxiety level of birther
- progress in labour
- fetal heart rate & pattern
When someone is given meds in the first stage what are we always concerned about?
1.how is this medication affecting baby?
2. how is this medication affecting birther?
When giving morphine and fentanyl, do we use IA or EFM?
IA is fine unless otherwise indicated to use EFM
If someone has epidural, how often do we check with EFM?
1 hour and then back to IA if all is good
If the epidural is not working what do we do?
there’s something wrong with it - call the specialist to fix it - it’s not normal
What are the 3 pharmacological interventions for pain during the first stage?
- nitrous oxide/laughing gas
- opioids (morphine & fentanyl)
- Epidural
What is the MOA of nitrous oxide?
CNS depressant - alters pain stimuli - decreased perception of pain
What are the side effects of nitrous oxide?
N&V
dizziness
What must ALWAYS be on with nitrous oxide?
the suction!
What are 3 important things to remember when pt administers nitrous oxide?
deep breaths (during contraction)
tight seal
self-administer only (prevent OD)
Which opioid can you not give IM, morphine or fentanyl?
Fentanyl
IV
PCA
How long does morphine last?
4-5 hours
how long does fentanyl last?
30-60 min
In active labour which opioid do we prefer to give and why?
fentanyl
shorter duration so the bab doesn’t come out high
Do we give naloxone to every baby if birther had opoids?
no
only if opioid-induced respiratory depression is suspected
What is the med given via epidural ANESTHESIA?
Bupivicaine
What is the med given via epidural ANALGESIA?
Opioid ( fentanyl)
What’s the most important thing to check before epidural?
Platelets
What vital signs are we checking with epidural?
BP b/c it vasodilates
temp- because it can mess with the body’s thermostat
what’s a bad risk with epidural?
postdural puncture headache/spinal headache
what gauge needle do we insert for IV with epidural and why?
18g - hypotension risk
how often do we monitor BP after epidural?
q2 min x 10 min & FHR
q 30 min
What do we ask the patient to do BEFORE epidural insertion?
PEE!
When is the epidural removed?
4th stage- recovery
What dermatone level is epidural usually sufficient?
T10-T5- vaginal birth
T12-T10 for labour pain
If someone’s motor function is 0, what does this mean?
no block - or patient has full flexion of foot and knee - can move
When can we give fentanyl and not give in stage 2?
can- passive phase
can’t- active phase - baby wil be high
what does Pudendal block do?
pain relief in perineum
What are the general signs of complication in labour with contractions?
contractions >90 seconds
contractions >5 in 10 min
Relaxation between contractions <30 seconds
What are the general signs of complications in labour with FHR?
fetal bradycardia/tachy
variability- absent or minimal (not sleep/not opioid related)
Decels - late variable, prolonged decel
irregular FHR/dysrhythmias
What are the general signs of complications in labour with Birther ?
meconium-stained amniotic fluid
blood from vagina
bright red or dark-red
foul smell vaginal discharge
Temp >38 when labouring
issues with dilation, effacement, descent
How many weeks is a pre-term baby?
20-37 weeks
what is acrocyanosis?
hands and feet are blue- normal finding
how many weeks is a late preterm baby?
36 weeks
what are 4 causes of spontaneous preterm birth?
- preterm labour
- preterm premature rupture of membranes
- cervical insufficiency- not closed or too short
- amniotitis - infection = inflam. response
how many hours apart do we give betamethasone?
24 hours apart
what helps reduce contractions ?
tocolytics
what are the early signs of preterm labour?
uterine activity
discomfort
vaginal discharge:bleeding, amniotic fluid
what should someone do if they are having early labour?
pee
*hydrate
lay on side 30min-1 hr
palpate for contractions - hard abdomen
let doc know or go to triage
what are the 3 ways we know someone is in preterm labour?
- <37 weeks gestational age
- cervical change d/t contractions
- progressive cervical change (+ effacement )
80% effaced, >2m dilated, regular contractions)
what is a Ballard score?
a physical examination that estimates a newborn’s gestational age by assessing their physical and neuromuscular maturity
what 2meds do we give birthers in preterm labour and why?
mag sulphate - neuroprotection + increases blood flow to baby
betamethazone- lung development steroid
how long do we give mag sulphate in preterm labour?
max 24 hours
or D/C if delivery is not imminent anymore
what dilation of the cervix is likely to lead to preterm birth?
> 4 cm dilation
what is a Bishop score?
a calculation that predicts how close a pregnant person is to labor and whether an induced labor will lead to a successful vaginal birth
what is one of the leading causes of neonatal mortality?
preterm labour and birth
who is a high priority for induction?
-Pre-eclampsia >37 weeks
-Significant birther disease
-Significant but stable antepartum hemorrhage
-Chorioamnionitis
-Suspected fetal compromise
-Term prelabour rupture of membranes (PROM) with GBS colonization
what is Cervidil used for?
cervical ripining
what are 2 mechanical and physical methods of cervical ripening?
balloon catheter
membrane sweep
what is Amniotomy?
artificial rupture of membranes
how many contractions is tachysystole?
6 or more contractions
what are the 6 things we do in an oxytocin emergency?
- turn off oxytocin
- lateral position
- IV bolus
- 8-10 L o2 - non-rebreather mask
- nitroglycerin to decrease uterine activity
- notify OB throughout
what are the 2 interventions for shoulder dystocia?
- legs way up towards head to rotate pelvis
- pressure on the suprapubic region
What are the 4 Obstetrical emergencies ?
- shoulder dystocia
- Prolapsed Umbilical Cord
- Uterine Rupture
- Amniotic Fluid Embolism
What is a prolapsed umbilical cord emergency?
cord lies below the presenting part of the fetus
- could get squished in delivery leaving fetus without O2
What is Uterine Rupture emergency?
When the uterine layers or previous scar dehisces
What are the S/S of Uterine rupture?
- Severe pain
- *bleeding
- contractions cease
- change in uterine shape
- signs of hemorrhagic shock
- *FHR changes - disappears
- Palpable fetal parts
What is Amniotic Fluid Embolism?
Amniotic fluid gets into mom’s system
system gets confused so it just collapses
-very sudden acute S/S- very bad outcomes
- hypoxia
- hypotension
- cardiovascular collapse
- clotting
