Dressler Module 4 Complications of Labor Flashcards
Prenatal and Antepartum is referring to _____ birth
prior to
Nutritional Status of newborn is greatly affected with ________ patients
overweight
What are some Socio-Demographic factors that may affect birth
Low income No prenatal care Age (Under 16, Over 40) Parity Support System
This fetal status test visualizes fetal & maternal structures
Ultrasound
This fetal status test can be done transvaginally
Ultrasound
This fetal status test is to check for abnormalities usually prior to 20 weeks
Amniocentesis
This test can check for genetic diseases, quadruple screening, and fetal lung maturity
Amniocentesis
This Fetal Status Test can be done externally referred to as Reactive vs Nonreactive
Non-stress test
A maternal HGB test can be used to check for _______ levels and ______ levels
Blood and Oxygen
An indirect coombs test can be used to check for (2)
Rh factor and Billy rubin
The triple screen tests consists of what three levels and when is it usually done
Usually done at 16 weeks
AFP
HCG
Estriol
AFP stands for
Alpha Fetal Protein
HCG stands for
Human Choreographic (too much is a problem)
Elevated estriol could lead to
Down Syndrome
Glucose Screening can be used to check for
diabetic ketoacidosis
Vaginal Culture can be used to check for
localized infection
Newborn Vital sign norms
B/P 60/40
Pulse 110-160
Resp 35-45
Excessive & difficult to alleviate N&V, in young obese non-smoker is called
Hyperemesis Gravidarum
A lot of vomiting during pregnancy is called
Hyperemesis Gravidarum
Signs and Symptoms of Hyperemesis Gravidarum include
Weight loss Dehydration Ketonuria Acetonuria Electrolyte imbalances
What is the main difference between morning sickness and Hyperemesis
Dehydration
PPN stands for
Partial Parenteral Nutrition
TPN stands for
Total Parenteral Nutrition
What are some treatments for hyperemesis
Rest
IV fluids
Antiemetics
Small Meals
Painless, premature dilation of cervix and being at risk for a spontaneous abortion is having an
Incompetent Cervix
The main job of the cervix is
stays closed to help maintain pregnancy
What is a Cervical Cerclage and when is it needed and when is it usually done
When the cervix is dilated more than 3cm, between 14-26 weeks and it is the SUTURING OF THE CERVIX (ARTIFICIAL PLUG TO KEEP CERVIX FROM DILATING
Spontaneous Abortions, Ectopic Pregnancy, Hydatidiform Mole are bleeding disorders during
Early Pregnancy
Placenta Previa and Placenta Abruptio are bleeding disorders during
late pregnancy
A spontaneous abortion is loss of pregnancy before
20 weeks
Abortion is the medical term for
miscarriage
Vaginal bleeding, closed cervix, mild cramps where the fetus is in danger is called a _______ spontaneous abortion
threatened
Cervical dilation, ruptured membranes, vaginal bleeding, not being able to maintain pregnancy are S&S of a _________ spontaneous abortion
inevitable
products of conception expelled, uterine contractions, bleeding are S&S of a ___________ spontaneous abortion
Complete
POC stands for
Products of conception
Profuse bleeding, and retained tissue parts are S&S of _______ spontaneous abortion
Incomplete
Fetus dies but retained, amenorrhea, foul smelling discharge or bleeding (fetus will die in utero, not expelled, becomes necrotic) is an example of a __________ spontaneous abortion
Missed
Infection of uterus, not all tissue is expelled is S&S of ________ spontaneous abortion
Septic
3 or more consecutive losses becomes to get called a ______ spontaneous abortion and the most frustrating thing is that …
Habitual
We don’t really know what’s going on
What is the treatment for spontaneous abortion
IV Oxytocin
Dilation and Curettage
Vacuum evacuation
What is the best treatment for Threatened spontaneous abortion
Bedrest
What does Oxytocin do
causes contractions so we can expel stuff
D+C is when you
scoop everything out after Dilation
Vacuum evacuation is ….
attached to cervix to remove products, LESS INVASIVE THAN D+C
Provide nursing care for Rhogam is RH
Negative
Not occupying uterine cavity, increases with STD’s, Endometriosis is the etiology for
Ectopic Pregnancies
Abdomen Tenderness, Spotting, Bleeding, decreased H&H, Increased WBC, shoulder pain are S&S of
Ectopic Pregnancies
Referred pain is the same is ________ pain
Radiated
Main treatment for Ectopic Pregnancy (3)
Trans vaginal ultrasound
Methotrexate
Salpingectomy
decreasing production of cells, kills of rapidly growing cells, so no rupturing occurs is called
Methotrexate
If rupturing occurs with a Ectopic Pregnancy mom can go into
Shock
Removal of fallopian tubes is called
Salpingectomy
Nursing care of Ectopic pregnancy would include
Pre and post op care Monitor at risk for shock Grief counseling Pregnancy counseling Monitor HCG levels
After an ectopic pregnancy resident should wait at least _____ before next pregnancy
1 year
Abnormal trophoblastic tissue - avascular vesicles. Instead of layers forming, cells keep multiplying. WILL NOT DEVELOP INTO EMBRYO/FETUS is called a
Hydatidiform Mole
Abnormal Uterine growth, PIH, increased HCG levels, excessive N/V, and vaginal bleeding are S&S of
Hydatidiform Mole
Treatment for a Hydatidiform Mole would include (3)
Transvaginal Ultrasound
D&C
Rhogam (If Negative)
Hydatidiform Mole puts mom at high risk for
Chorionic Carcinoma
What is Chorionic Carcinoma
Choriocarcinoma is a quick-growing form of cancer that occurs in a woman’s uterus (womb). The abnormal cells start in the tissue that would normally become the placenta, the organ that develops during pregnancy to feed the fetus. Choriocarcinoma is a type of gestational trophoblastic disease.
Abnormal placement of the placenta, placenta being misplaced in the uterus is called
Placenta Previa
Marginal Placenta Previa means fetus is placed near _____ and there is a ______ chance of c-section
Sidewall
High
Partial Placenta Previa means placenta is located
comes close to cervix
Total placenta previa means
Placenta is completely upside down
With partial placenta previa, or total placenta previa c section is
guaranteed
Placenta Previa can be diagnosed by looking at
a sonogram
Painless bleeding in 3rd trimester could be a sign of
Placenta Previa
The goal for a resident with placenta previa is to get lots of ______ and reach ____ weeks
Bedrest
34
What are some Nursing care tactics with Placenta Previa
Monitor FHR
Assess for hemorrhage
Assess FUNDUS
PIH stands for
Pregnancy induced hypertension
PIH, H/o abruption, smoking, cocaine, PROM are means for diagnosing a
Abruptio Placentae
PROM stands for
Premature rupture of membrane
Painful bleeding, sudden bleeding, severe pain, fetal distress, hard uterus, maternal shock are S&S of
Abruptio Placentae
Best treatment for partial abruption is
Bedrest
When a resident is diagnosed with Abruptio Placentae we have about ______ to take baby out
30-45
Fetus not getting any circulation is called
Fetal distress
In complete abruption mom has a
concealed hemorrhage
With abruptio Placentae mom is at risk for
shock or death, Fetal brain damage, Fetal demise (Death)
Dysfunctional labor can also be called
Dystocia
Friedman curve is used to
graph dilation and descent
With Dystocia mom and fetus has a potential for
Infection
Postpartum hemorrhage
Exhaustion to mother
Dystocia can be related to
Power Contractions
Position or Presentation of fetus
Size of Fetus
Amniotomy is the
breaking of water
IV pitocin is given to
speed up contractions
Hypotonic Contractions are
unprogressive contractions
Treatment for hypotonic contractions are
Amniotomy
IV pitocin
C-section
Hypertonic contractions are
Strong uncoordinated contractions
We can diagnose Hypertonic Contractions during ______ phase
Latent
Hypertonic contractions can be treated with
Sedative or medication to relax uterus
Forceps mean to
Pull baby forward
Abnormal position is treated with
Forceps
Trying to rotate to normal position
Cephalopelvic Disproportion is a term for saying
Head too large or pelvis too small
Possible C-section
Large baby, frequently due to diabetic mother is called
Macrosomia
Linea Terminalis means
100% c-section
Precipitous Labor is labor with _____ usually completed within ___
Strong frequent contractions usually completed within 3 hours
During precipitous labor is more common in ______ and best thing to do is
Multips
DO NOT LEAVE MOTHER ALONE
Accelerates or helps labor after it has started is called
Augmentation
Cervical Gel is also called
Prostaglandins
Dried seaweed is used to ________ and is called ______
pulls fluid out of cervix
Laminaria
Nipple stimulation is increasing
secretion of oxytocin from posterior pituitary
Walking helps
induce labor
Oxytocin does….. and is usually given in
Stimulates uterine contractions
10units/1000cc Ringers
contractions closer than every 2min, longer than 90sec, rest less than 60, possible fetal distress, rupture of uterus are S&S of
Overstimulation of Oxytocin
What are some conditions where we don’t want to induce labor
Placental abnormalities, abnormal presentation, prolapsed cord, obstructed cord, fetal distress, prior C-section with classic or low vertical incision.
Bikini line incision means
less healing time
Sometimes inducing labor can be
dangerous
Artificial rupture of membranes to stimulate or augment labor
Amniotomy
What are some potential complications of an Amniotomy (3)
Umbilical Cord Prolapse
Infection
Abruption
A post term pregnancy is one that lasts longer than
42 weeks
Post term pregnancy etiology examples are
Decrease placental perfusion risk of decrease O2 to the fetus
May pass meconium
Decrease in amniotic fluid
Fetus keeps gaining weight
PIH after 20 weeks, no proteinuria, Hypertension, INCREASE IN 30mm Systolic, INCREASE in 15mm Diastolic are signs of
Toxemia
Treatment for Toxemia includes
low salt diet, rest monitor closely make personal
Contractions causes B/P to go
Sky high
Any hypertension before 20 weeks is called _________ and is not due to ________
Essential hypertension
Pregnancy
If PIH isn’t treated ______ can occur
Pre eclampsia
Hypertension after 20 weeks is called _______ and it can be _______ or _______
20 weeks
Mild or severe
Edema of hands and face, H/A, Blurry vision, and DAMAGE TO EPITHELIUM LINING of blood vessels due to low blood supply are S&S of
Pre eclampsia
Pre Eclampsia can lead to the __________
HELLP Syndrome / Eclampsia
Hemolysis Elevated Liver Enzyme Low Platelets can also be considered the
HELLP Syndrome
Pre eclampsia can lead to damage to the _______ causing a decrease of ______ supply
Placenta
Oxygen
Treatment for Mild Pre Eclampsia includes
Limit activity
Possible CBR (complete bed rest) lying on back or left side
Antihypertensive meds
Treatment for Severe Pre Eclampsia includes
Hospitalization Antihypertensives MagSO4/Calcium Gluconate Lasix Amniocentesis
MagSO4 / Calcium Gluconate helps
decrease smooth muscle action in the myometrium
Once a pre eclamptic mom has had a seizure she is considered
eclamptic
S&S of Preeclampsia w/ a seizure, P/F abruption, Fetal compromise, Fetal death, Maternal Death are etiology examples for
Eclampsia
Seizures, proteinuria, DECREASED URINARY OUTPUT, INCREASED BUN & CREATININE, DECREASED PLATELETS, pulmonary edema, visual problems are S&S or
Eclampsia
Explain how Eclampsia can affect visual senses
pressure on optic nerve can cause eyesight blockage
With an eclamptic mom we might put mom on Dialysis to
Give Kidneys a rest
Treatment for Eclampsia includes
Antihypertensives MagSO4 Calcium Gluconate Lasix Amniocentesis
When U/O is less than 30ml/hour mom is going into
Renal Failure
A sign of loss in deep tendon reflex, (coming from too much MagSO4 is ______ and we should administer ______
Hands turn out
Calcium Gluconate
Nursing care for mom with Pre eclampsia / Eclampsia include
Quiet room Dim lights SIDE LYING POSITION Seizure precautions Padded side rails Keep suction machine at bedside INCREASE PROTEIN
Mom is still at risk _______ after labor for Pre eclamptic Seizure
48 hours
ABO blood incompatibility happens when mom is ____ and Fetus is ____ . This can cause ________ or _______
Mom is O
Fetus is A or B
Jaundice or Hepatosplenomegaly
Rh incompatibility happens when Mom is ____ and Fetus is ____ this can cause ______
Mom is RH-
Fetus is RH+
Leakage of antibodies
Treatment for blood incompatibility includes
Rhogam (immunoglobulin) 72 hours after delivery
In sickle cell moms we might want to administer extra
Oxygen
In mothers with a prolapsed cord what are the priorities
Need to decrease compression
In mothers with prolapsed cord what position should we put them in
Trendelenburg / Side lying
What are some of the things that happen with a Uterine Rupture (3)
Strong contractions with little descent
Fetal distress
Maternal shock
With a Uterine rupture a ______ is most likely to happen
Emergency C-section or a Hysterectomy
What are some nursing implications for a mom with Uterine Inversion
Fundal Massage
Cord pulled
Surgery to revert uterus
Hysterectomy
Define hysterectomy
hysterectomy is an operation to remove a woman’s uterus
What are the signs and symptoms for Uterine Atony
Boggy Fundus
Increase lochia with clots
No muscle tone with possible loss of contractions is called
Uterine Atony
Treatment for a Uterine Atony includes
Fundal massage
Meds to increase contractions
Two main meds that increase contractions are
Oxytocin
Methergine
Possible complications of C-sections (5)
Infection Hemorrhage Paralytic Ileus Thrombophlebitis Dehiscence
What are priorities for mom post op c-section (5)
Empty bladder Monitor VS Monitor incision Asses homans sign Bowel Sounds
Mom may develop _______ post op c-section that are very painful where she would not like to move
Gas pockets
Near incision post op c-section it is important to make sure ….
there isnt any drainage
Locchia should be ….. post op c section
same amount as vaginal delivery
VBAC stands for
Vaginal Birth After C-section
Major complication for Premature Rupture of membranes
Umbilical cord coming out
Premature Rupture of Membranes happens
before 38 weeks
What is Chorioamnionitis and what might it cause
Inflammation of Chorion Amniotic Sac, may cause premature rupture of membranes
What can we use to check pH of Vagina
Nitrazine Paper
Hypertension can
induce labor
Temp of 100.5 or more in pregnant mom may call for
C-section, induced labor
When baby is at risk for being born immaturely we try our best to
get labor to at least 32 weeks, then 34, then 36 hopefully
At 36 weeks baby begins to make its own
Surfactin
Premature labor can be caused by (5)
Young mother under 17 Incompetent cervix Decreased blood supply to uterus Abdominal trauma Polyhydramnios
Tocolytics are given to
Relax uterus and stop contractions
Betamethasone is given to
hasten fetal maturity and increase surfactant production in fetus
Nursing care for Pre term Labor
Give Tocolytics
Give Betamethasone
bed rest
IV hydration
Retinal Atrophy of Prematurity is
eyes, oxygen effects optic nerve
Blood loss greater than 500cc for NSVD or 1000cc for c/sec is defined as
Hemorrhage
Mom is at risk for _______ after labor for Hemorrhage
48 hours
NSVD stands for
Normal Delivery
Treatment for Hemorrhage is
Blood transfusion
Before a blood transfusion we must
stop the bleeding with a vigorous massage
Fluid or fetal cells enters mothers venous system is defined as
Amniotic Fluid Embolism
Massive clotting, then massive fibrinogen breaks down causes bleeding from all orifices is called
DIC - Disseminated Intravascular Coagulation
Possible DIC is
bleeding from IV site
Tears to perineum, cervix or both during delivery is called
Perineal Lacerations
1st and 2nd degree Lacerations are
tear of perineum not extending to rectal sphincter
3rd degree Lacerations are
involves anal sphincter
3rd degree Lacerations are bad because
difficult to repair, can have permanent damage
4th degree lacerations are
lacerations in the recto vaginal wall
Nursing care for lacerations include
Sitz bath
meds
ice pack
ball of blood, accumulation of blood under the skin is defined as
Hematomoa
Nursing care of Hematoma include
Ice pack to area
pain management
1 egg that separates into 2 fetus
Monozygotic
2 sperm fertilize 2 eggs
Dizygotic
Vomiting during pregnancy that results in electrolyte imbalance
Hyperemesis
Premature dilation of cervix early in pregnancy
Incompetent Cervix
Procedure done to keep cervix closed
Cerclage
Loss of pregnancy prior to 20 weeks gestations; Can be threatened; inevitable; incomplete; missed; or septic
Spontaneous Abortion
defines a woman who has had 3 or more consecutive spontaneous abortions
Habitual Spontaneous Abortions
medication given to RH NEGATIVE mothers at 28 weeks of pregnancy and 72 hours after delivery to prevent production of antibodies
Rhogam
pregnancy that takes place outside the uterus (tubal pregnancy
Ectopic pregnancy
failure of embryo to develop after fertilization; abnormality of the trophoblast
Hydatidiform mole
condition in which the placenta is implanted close the the cervical is which impacts delivery, can be marginal, partial, or complete
Placenta Previa
sudden separation of the placenta from the uterine wall characterize by severe abdominal pain and bleeding
Placental abruption
Pregnancy induced Hypertension or toxemia is known as
PIH
PIH with proteinuria
Pre-eclampsia
PIH, with proteinuria and seizures
Eclampsia
medication given IV to prevent seizures of eclampsia
Magnesium sulfate
Antidote for Magnesium Sulfate
Calcium gluconate
Difficult labor is defined as
Dystocia
contractions that are too weak to effectively progress labor
Hypotonic contrations
contractions that are too intense and may put mom and fetus at risk
Hypertonic contractions
baby born bigger than average size is known as
Macrosomia
the repositioning of a breech or transverse fetus
Version
labor that is completed in less than 3 hours
Precipitate labor
an intervention to help labor progress
Augmentation
an intervention to help labor process start
Induction
Drug applied topically to cervix to help increase dilation of cervix
Prostaglandin
product applied to cervix that absorbs fluid and hastens labor process
Laminaria
Pitocin; medication given IV to induce or augment uterine contractions
Oxytocin
artificial rupture of the membranes
Amniotomy
the rupture of the uterus due to abnormal strong and frequent contractions requires surgical repair
Uterine rupture
the descent of the umbilical cord before the fetus causing pressure and impaired circulation
Prolapsed cord
the fundus inverts down into uterus after delivery is called
Uterine inversion
