Exam 1 : lecture 1 Flashcards
complications of pregnancy GBS cord prolapse fetal monitoring maternity nursing Pain management during labor Cervical Ripening Agents Augmentation/Induction of labor Glossary of terms
Leopold’s maneuver
-checking felt position by external palpation
Vertex
baby’s head is down
Breech
baby’s buttocks or feet are presenting first
Gravida
how many times pregnant
Para
how many times delivered after 20 weeks
PROM
premature rupture of membranes
PPROM
-preterm premature rupture of membranes (amniotic fluid)
SROM
spontaneous rupture of membranes (on its own)
AROM
artificial rupture of membranes (use of amniotic hook by HCP)
Meconium
baby’s first BM
Amninoinfusion
normal saline infused into uterus while in labor
Amniocentesis
withdrawing amnio fluid through the mother’s abdomen
Cervical Ripening Agents
- Prostaglandin E1, (PGE1): Misoprostol (Cytotec)
- Prostaglandin E2 (PGE2): Dinoprostone (Cervidil Insert; Prepidil Gel)
Augmentation/Induction of labor
Oxytocin / Pitocin
Two most reported medical risk factors w/pregnancies
-hypertension
-diabetes
What does GTPAL stand for?
G = gravidity: # of pregnancies
T = term births: 37weeks to 42 weeks gestation
P = preterm births: 20 to 37 weeks gestation
A = abortions: pregnancy that ends prior to 20 weeks
L = living children
what is GBS?
Group B streptococcus (GBS) is a
naturally occurring bacterium found in
approximately 50% of healthy adults.
- Women who test positive in pregnancy
are considered carriers.
GROUP B STREP INFECTIONS
IN NEWBORNS
- Early onset disease- occurs the first week
of life - Early onset causes sepsis, pneumonia, and
meningitis of newborns - Approximately one out of every 100-200
newborns born to mothers who are GBS
positive develop signs and symptoms of
disease.
Assessments- complications of pregnancy: risk factors
- Prematurity
- Prolonged ROM of >18 hours
- Maternal fever during labor
- Previous infant with GBS
infection - GBS during pregnancy
GBS screenings done when and how
- Screen women at 35-37 weeks with vaginal
and rectal culture - If no culture treat if: < 37 weeks, prolonged
ROM>18 hours, maternal temperature of
100.4 or greater
prevention of transferring GBS (positive mom) to baby
- Can be prevented by giving pregnant women
antibiotics (ABXs) IV during labor usually penicillin - ABs can only be taken during labor, not before,
because bacteria grows quickly
what is cord prolapse?
emergency
-when the umbilical cord comes out before the baby
How does cord prolapse happen?
when the mother’s water breaks BEFORE the baby has moved into the birth canal
cord prolapse causes what?
cord is at high risk for cord compression, blocking oxygen, and blood flow to the baby = fetal distress
emergency C/S
Risks for cord prolapse
-SGA = Small baby (for gestation age)
- unengaged fetal part (head isnt well applied against the cervix)
-AROM
-Polyhydramnios (too much amniotic fluid)
Multiple gestation (if have twins or triplets)
cord prolapse medical management
Pt’s BOW breaks
1st: Look @ FHR, water, if cord is there
If cord prolapse has occurred
1st: call for help
2nd: w/sterile glove, elevate the presentation part off the cord
3rd: reposition (knee chest or trendelenburg) to relieve pressure
4th: educate/emotioinal support while staying calm
5th: call physican
6th: Prepare for c/s delivery - call for charge nurse, OR, NICU
What does CORD stand for in a cord prolapse situation?
For cord prolapse situation
C: call for help
O: organzine delivery
R: receive pressure on the cord
D: deliver
meds to use if cord prolapse were to happen
Tocolytic agents (terbutaline)
- to stop contractions
-route:SQ
-assess HR and lungs (bc this med increases HR)
Cord prolapse delivery
-in most cases emergency c/s
-if birth is imminent (baby right there) deliver vaginally immediately
Types of fetal monitoring
Electronic fetal monitoring
-hospital setting
Intermittent Auscultation
-Dr. office, or at homes/birthing settings
Intermittent monitoring
low risk
-hand held dropper
-fetoscope
-intermittent auscultation (not continuous)
Electronic fetal monitoring -types
- external monitoring
- internal monitoring
External monitoring- placed where + indications
less invasive
external ultrasound (US) transducer
- for FRH
- placed in lower quadrants of mom; below umbilicus
- only this (round) US gets US jelly
external TOCOtransducer
- for uterine contractions
- placed above umbilicus
Internal monitoring- placed where + indications
most invasive+ more accurate than external monitoring
internal fetal scalp electrode (FSE)
- measures the FHR
intrauterine catheter
(IUPC)
-measures strength of uterine contractions internally
What must be done PRIOR to do internal monitoring
Membranes must be ruptured + cervix dilated at least to 2cm
Guidelines for assessing FHR
-Initial 10–20-minute continuous FHR assessment
-Intermittent auscultation every 30 minutes during labor for low risk and every 15 minutes for high-risk woman.
-During second stage, every 15 minutes for
low risk and every 5 minutes for the high risk during pushing
how to count contractions
Duration: beginning to end of one contraction (how long they are lasting)
Frequency: beginning of one contraction to the beginning of the next one (how far apart they are)
Normal: baseline FHR
110-160 for 10 mins
Abnormal: baseline Tachycardia FRH
FHR>160 for >10 mins
Abnormal: baseline Bradycardia FRH
FRH<110 for >10 mins
Normal Variability
Moderate variability
FHR goes up and down
Abnormal Variability
Minimal to absent variability
Tachycardia FHR-usually a sign of..
*early sign of fetal hypoxemia (baby not getting enough oxygen)
-is mom dehydrated?
- is mom any BP meds?
- does mom have a fever?
- infx?
abnormal and provider should be contacted
3 key aspects to determine if FHR is normal + good
Rate
variability
any periodic change
Nursing interventions if FHR is tachycardia
-take mom’s temp, any elevation? (report everything to dr)
-is she @ risk for infx / PROM ?
-dehydrated/ SOB? (PRN orders for a IV bolus)
- usage of drugs or drug abuse?
FHR-Bradycardia: causes
-Maternal supine position (laying on back)
- Hypoxia
- Medications
- Maternal hypotension
- Cord prolapse ( cord compression )
- Rapid fetal descent (mom delivers v fast _ in response the baby’s FHR will fall)
FHR-Bradycardia: nursing interventions
-Maternal supine position: change position/to side
-Maternal hypotension: Prior to epidural 1 L bolus LR given via IV
Baseline Variability significance
Most important characteristic bc it is the paramount indicator of a well oxygenated fetus
What is absent variability
ABNORMAL!!!!
0 BPM + is a straight line
needs immediate attention
what is minimal variability
ABNORMAL!!!!
5 or less BPM
*can result from fetal hypoxemia
what is moderate variability
NORMAL!!WANT!!
6-25 BMP
What makes up periodic changes?
-accelerations (visually abrupt increase but are cherry on top; normal)
-decelerations (normal; early) (abnormal;variable, late, prolonged)
periodic changes: accelerations
-fetal movement
-contractions
-accelerations are positive
periodic changes: what makes an accelerations
Transient increases above the FHR baseline
an acceleration last >15-20secs bpm before going back to baseline
Periodic changes: types of decelerations
-early (normal + could be an expected finding)
-late (abnormal)
-variable (abnormal)
-prolonged (abnormal)
Periodic changes: when do early decelerations occur?
when fetal head is compressed; usually around 8 cm dilated
-called transition period; when pt is almost ready to start pushing
-occurs ONLY at the same time as contractions on strip
Periodic changes: early decelerations - how do they look on the monitor
-early decelerations mirror contractions
Periodic changes: early decelerations- nursing interventions
cervical exam to check for size of dilation
Periodic changes: Variable deceleration- what is caused by?
caused by cord compression
ABNORMAL
Periodic changes: Variable deceleration- what do they look like on the strip
can occur w or w/out contractions
-are very abrupt and look like Vs + Ws
-crowed + not spread out on the strip
Periodic changes: Variable deceleration- Nursing interventions
change position (to side)
Periodic changes: Late deceleration- what is it?
ABNORMAL
-due to uteroplacental insufficiency = baby not getting enough oxygen
Periodic changes:Late deceleration- what does this indicate?
indicates presence of fetal hypoxemia stemming from insufficient placental perfusion during contractions
Periodic changes:Late deceleration- what does it look like?
the deceleration in the heart rate comes AFTER the contraction
-Late onset + HR doesn’t go back to normal baseline UNTIL contraction is OVER/HAS PAST
Periodic changes: nursing interventions on all ABNORMAL FRH/variability/periodic changes on strips
intrauterine Resuscitation shorter than POISON but same interventions
1. change maternal position (on side)
2. increase IV rate (250-500 ml bolus bolus of LR solution)
3. O2 8-10 L/min via mask
4. notify provider
5. start planning delivery
Periodic changes: Prolonged decelerations- what is it?
ABNORMAL
-decrease in FHR of at least 15 bpm BELOW the baseline + lasting MORE than 2 mins BUT LESS THAN 10 mins (if >10mins = bradycardia)
Periodic changes: Prolonged decelerations- what does it indicate ?
indicates there is a disruption in fetal oxygen supply
what does POISON stand for + used for?
for decelerations
P: position change
O: oxytocin/Pitocin off
I: IV (increase fluids)
S: sterile vaginal exam
O: oxygen 8-10 L/min via mask
N: notify provider
FHR patterns: normal and abnormal categories
normal = category 1
abnormal = category 3
FHR patterns: category 1- what is it?
NORMAL
-baseline rate 110-160 bpm
-moderate variability
-early decelerations either present OR absent
-accelerations either present OR absent
-late or variable decelerations ARE ABSENT
category 2 FHR patterns??
FHR patterns: category 3 - what is it?
ABNORMAL
Absent baseline variability with
-recurrent late decelerations
-recurrent variable decelerations
-bradicardia
-sinusoidal pattern (severe fetal anemia)
ALL indicate hypoxemia
What is VEAL CHOP
Place here
Nursing interventions for treatment of non-reassuring FHR patterns (aka fetal distress) in addition to POISON
-Amnioinfusion (through internal monitoring; indicated for cord compression)
-Stimulation; scalp or fetal acoustic stimulation (Buz abdomen or touch baby’s head for cervical exam to see for any activity; indicated to look for accelerations)
