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4500 Gender & reproductive health > class 6 labour and birth part 2 > Flashcards

class 6 labour and birth part 2 Flashcards

1
Q

When are we concerned about pain?

A

When there is pain between contractions

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2
Q

What are we concerned about with pain between contractions?

A

placental abruption
uterine rupture

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3
Q

What are the 12 non-pharmacological interventions in the first stage of labour?

A

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

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4
Q

How often should the nurse assess the effectiveness of each position?

A

q 20-30 min

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5
Q

What 3 things do nurses assess when assessing position changes?

A
  1. comfort and anxiety level of birther
  2. progress in labour
  3. fetal heart rate & pattern
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6
Q

When someone is given meds in the first stage what are we always concerned about?

A

1.how is this medication affecting baby?
2. how is this medication affecting birther?

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7
Q

When giving morphine and fentanyl, do we use IA or EFM?

A

IA is fine unless otherwise indicated to use EFM

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8
Q

If someone has epidural, how often do we check with EFM?

A

1 hour and then back to IA if all is good

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9
Q

If the epidural is not working what do we do?

A

there’s something wrong with it - call the specialist to fix it - it’s not normal

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10
Q

What are the 3 pharmacological interventions for pain during the first stage?

A
  1. nitrous oxide/laughing gas
  2. opioids (morphine & fentanyl)
  3. Epidural
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11
Q

What is the MOA of nitrous oxide?

A

CNS depressant - alters pain stimuli - decreased perception of pain

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12
Q

What are the side effects of nitrous oxide?

A

N&V
dizziness

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13
Q

What must ALWAYS be on with nitrous oxide?

A

the suction!

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14
Q

What are 3 important things to remember when pt administers nitrous oxide?

A

deep breaths (during contraction)
tight seal
self-administer only (prevent OD)

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15
Q

Which opioid can you not give IM, morphine or fentanyl?

A

Fentanyl
IV
PCA

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16
Q

How long does morphine last?

A

4-5 hours

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17
Q

how long does fentanyl last?

A

30-60 min

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18
Q

In active labour which opioid do we prefer to give and why?

A

fentanyl
shorter duration so the bab doesn’t come out high

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19
Q

Do we give naloxone to every baby if birther had opoids?

A

no
only if opioid-induced respiratory depression is suspected

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20
Q

What is the med given via epidural ANESTHESIA?

A

Bupivicaine

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21
Q

What is the med given via epidural ANALGESIA?

A

Opioid ( fentanyl)

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22
Q

What’s the most important thing to check before epidural?

A

Platelets

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23
Q

What vital signs are we checking with epidural?

A

BP b/c it vasodilates
temp- because it can mess with the body’s thermostat

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24
Q

what’s a bad risk with epidural?

A

postdural puncture headache/spinal headache

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25
Q

what gauge needle do we insert for IV with epidural and why?

A

18g - hypotension risk

26
Q

how often do we monitor BP after epidural?

A

q2 min x 10 min & FHR
q 30 min

27
Q

What do we ask the patient to do BEFORE epidural insertion?

A

PEE!

28
Q

When is the epidural removed?

A

4th stage- recovery

29
Q

What dermatone level is epidural usually sufficient?

A

T10-T5- vaginal birth
T12-T10 for labour pain

30
Q

If someone’s motor function is 0, what does this mean?

A

no block - or patient has full flexion of foot and knee - can move

31
Q

When can we give fentanyl and not give in stage 2?

A

can- passive phase
can’t- active phase - baby wil be high

32
Q

what does Pudendal block do?

A

pain relief in perineum

33
Q

What are the general signs of complication in labour with contractions?

A

contractions >90 seconds
contractions >5 in 10 min

Relaxation between contractions <30 seconds

34
Q

What are the general signs of complications in labour with FHR?

A

fetal bradycardia/tachy
variability- absent or minimal (not sleep/not opioid related)

Decels - late variable, prolonged decel

irregular FHR/dysrhythmias

35
Q

What are the general signs of complications in labour with Birther ?

A

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

36
Q

How many weeks is a pre-term baby?

A

20-37 weeks

36
Q

what is acrocyanosis?

A

hands and feet are blue- normal finding

36
Q

how many weeks is a late preterm baby?

A

36 weeks

37
Q

what are 4 causes of spontaneous preterm birth?

A
  1. preterm labour
  2. preterm premature rupture of membranes
  3. cervical insufficiency- not closed or too short
  4. amniotitis - infection = inflam. response
38
Q

how many hours apart do we give betamethasone?

A

24 hours apart

39
Q

what helps reduce contractions ?

A

tocolytics

40
Q

what are the early signs of preterm labour?

A

uterine activity
discomfort
vaginal discharge:bleeding, amniotic fluid

41
Q

what should someone do if they are having early labour?

A

pee
*hydrate
lay on side 30min-1 hr
palpate for contractions - hard abdomen
let doc know or go to triage

42
Q

what are the 3 ways we know someone is in preterm labour?

A
  1. <37 weeks gestational age
  2. cervical change d/t contractions
  3. progressive cervical change (+ effacement )
    80% effaced, >2m dilated, regular contractions)
43
Q

what is a Ballard score?

A

a physical examination that estimates a newborn’s gestational age by assessing their physical and neuromuscular maturity

44
Q

what 2meds do we give birthers in preterm labour and why?

A

mag sulphate - neuroprotection + increases blood flow to baby

betamethazone- lung development steroid

45
Q

how long do we give mag sulphate in preterm labour?

A

max 24 hours
or D/C if delivery is not imminent anymore

46
Q

what dilation of the cervix is likely to lead to preterm birth?

A

> 4 cm dilation

47
Q

what is a Bishop score?

A

a calculation that predicts how close a pregnant person is to labor and whether an induced labor will lead to a successful vaginal birth

48
Q

what is one of the leading causes of neonatal mortality?

A

preterm labour and birth

49
Q

who is a high priority for induction?

A

-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

50
Q

what is Cervidil used for?

A

cervical ripining

51
Q

what are 2 mechanical and physical methods of cervical ripening?

A

balloon catheter
membrane sweep

52
Q

what is Amniotomy?

A

artificial rupture of membranes

53
Q

how many contractions is tachysystole?

A

6 or more contractions

54
Q

what are the 6 things we do in an oxytocin emergency?

A
  1. turn off oxytocin
  2. lateral position
  3. IV bolus
  4. 8-10 L o2 - non-rebreather mask
  5. nitroglycerin to decrease uterine activity
  6. notify OB throughout
55
Q

what are the 2 interventions for shoulder dystocia?

A
  1. legs way up towards head to rotate pelvis
  2. pressure on the suprapubic region
56
Q

What are the 4 Obstetrical emergencies ?

A
  1. shoulder dystocia
  2. Prolapsed Umbilical Cord
  3. Uterine Rupture
  4. Amniotic Fluid Embolism
57
Q

What is a prolapsed umbilical cord emergency?

A

cord lies below the presenting part of the fetus
- could get squished in delivery leaving fetus without O2

58
Q

What is Uterine Rupture emergency?

A

When the uterine layers or previous scar dehisces

59
Q

What are the S/S of Uterine rupture?

A
    • Severe pain
  2. *bleeding
  3. contractions cease
  4. change in uterine shape
  5. signs of hemorrhagic shock
  6. *FHR changes - disappears
  7. Palpable fetal parts
60
Q

What is Amniotic Fluid Embolism?

A

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

4500 Gender & reproductive health (11 decks)

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