Exam 2 Flashcards

Question

Baseline fetal heart rate:

Answer 1

baseline rate is average during 10-20 min excluding: acceleration, deceleration, periods of marked variability, normal range at term 110-160 beat/min average heart rate of the fetus Normal 110-160 bpm

Answer 2

FHR variability is described as fluncuations in the FHR baseline that are irregular in frequency & amplitude Expected variability is moderate Tachycardia: baseline more than 160 beat/min for 10 minute or longer Bradycardia: baseline less than 110 beats/min for duration of 10 minutes or longer Absent: non-reassuring Minimal: deteactable but less than 5/min Moderate: 6-25 minute Marked: more than 25 minute

Answer 3

temporary increases in the fetal heart rate of atleast 15 beat/min above the baseline: lasting 15 seconds shows fetal well-being and are often associated with fetal movement

Answer 4

Deceleration: temporary decrease in FHR Early: response to fetal head compression: happening with contraction: mirror contraction pattern Late: uteroplacental insuffiency/ fetal distress: DO NOT WANT THIS: after peak of contraction Variable: umbilical cord compression: abrupt decrease in FHR that can occur anytime: short duration

Answer 5

Causes: inadequate fetal oxygenation maternal hypotension, placenta previa, abruptio, uterine hyperstimulatin with pitocin preeclampsia post term pregnancy Diabetes Intervention: Place client on left side IV, increase fluid discontinue pitocin elevate legs notify provider prepare of assisted vag del or c/s

Answer 6

useful tool for visualizing fetal heart rate (FHR) patterns on monitor screen or printed tracing External: > FHR: ultrasound transducer >UCs: tocotransducer Internal: (invasive) - fetal spiral/scalp electrode IUPC (intrauterine pressure cath)

Answer 7

consistent changes in the fetal heart rate pattern that are associated with contraction include accelerations and deceleration that correlate with uterine activity

Answer 8

General measures: Obtain admission history Check results of routine lab test and any special test Ask about childbirth plan Complete a physical assessment Initial contact either by phone or person

Answer 9

Uses a machine to produce a continuous tracing of the FHR Produce a graphic record of the FHR pattern Primary objective: >To provide information about fetal oxygenation and prevent fetal injury from impaired oxygenation > To detect fetal heart rate changes early before they are prolonged and profound Criteria: Ruptured membranes Cervical dilation of at least 2 cm Present fetal part low enough to allow placement of the scalp electrodes Skilled practitioner available to insert spiral electrode

Answer 10

Route: typically, administered parenterally through existing IV line Drugs: >Opioids (butorphanol, nalbuphine, meperidine, fentanyl) >Ataractics (hydroxyzine, promethazine) >Benzodiazepines (diazepam, midazolam)

Answer 11

Epidural block: continous infusion or intermittent injection usually started when dilated more than 5 cm Combined spinal-epidural block (“walking epidural”) Patient controlled epidural Local infiltration (usually for episiotomy or laceration repair) Pundenal block (usually for 2nd stage, episiotomy, or operative vaginal birth) Intrathecal (spinal) analgesia/anesthesia (during labor and cesarean birth)

Answer 12

Emergency cesarean birth or women with contraindication to use of reginal anesthesia IV injection, inhalation, or both Commonly, first thiopental IV to produce unconsciousness Next, muscle relaxant Then intubation, followed by administration of nitrous oxide and oxygen; volatile halogenated agent also possible to produce amnesia

Answer 13

The pressure of the uterine contraction is insufficent (less than 25 mm Hg) to promote cervical dilation and effacement Risk factors: multiples, in active phase, fear Assessment finding: decrease in frequency, strength, duration of the Uterine contraction, no cervical change, fear/anxiety Management: evaluate labor progress, determine cause, pitocin, amniotomy, possible c-section Causes: exhaustion, full bladder, uterine overdistention

Answer 14

defined as uncoordinated uterine activity: contractions are excessively frequent, or intense in contraction that lead to inadequate relaxation of the uterus between contraction Risk: nulliparous women Assessment finding: painful, frequent, ineffective Management: evaluation, hydrate, pain management, lateral position, O2 by facemask as needed Nursing: promote relaxation ,treat pain, hydrate

Answer 15

downward traction may be applies to fetal head with suprapubic pressure extended midline episiotomy McRoberts Maneuver, wood corkscrew manuever deliver posterior shoulder by sweeping post, arm across fetal chest followed by delivery of arm most resolved by manuevers Zancanelli manuever: cephalic replacement into the pelvis and then c/s

Answer 16

refers to the difficulty encountered during delivery of the shoulders after the birth of the head Risk factors: fetal macrosomia, maternal diabetes, hx of shoulder dystocia, prolonged second stage, exessive weight gain associated risk: fetal injury/death, brachial plexus injury, fractured clavicle, maternal complication: laceration, infection, hemorrhage Assessment finding: delay in delivery of shoulder, retraction of the head against maternal perineum after delivery of head "turtle sign" MEDICAL EMERGENCY

Answer 17

MEDICAL EMERGENCY the cord lies below the presenting part of the fetus Risk factor: Malpresentation (breech) unengaged presenting part, polyhydramniosis, small/preterm fetus, multiple gestation, high parity Assessment: sudden fetal bradycardia, prolapsed cord on the vaginal exam, protruding from the vagina Medical Management: STAT C/S Nursing action: Lift presenting part off the cord with vaginal exam, knee chest position or Trandeleburg to relieve pressure on an occluded cord

Answer 18

obsteteric emergency: onset marked by sudden fetal bradycardia, PAIN Nursing assessment: onset of sudden fetal distress, irregular abdominal wall contour, hypotension, tachycardia, pallor, fetal presenting part in pelvis, loss of station > severe tearing, burning, stabbing pain, vaginal bleeding Management: urgent C/S, continous maternal and fetal monitor, control bleeding, hysterectomy Risk: previous c/section, VBAC, previous uterine surgery, tachysystole

Answer 19

EMERGENCY sudden onset of hypotension, hypoxia, coagulopathy, due to breakage in barrier between maternal circulation and amniotic fluid Nursing assessment: difficulty breathing, hypotension, cyanosis, seizures, tachycardia, coagulation failure, DIC, pulmonary edema, uterine atony with subsequent hemorrhage, ARDS, cardiac arrest Management: supportive measures to maintain oxygenation and hemodynamic function and to correct coagulopathy; critical care monitoring

Answer 20

Induction: stimulating contraction via medical or surgical means Augmentation: enhancing ineffective contractions after labor has begun Indications: prolonged gestation, prolonged premature rupture of the membranes, gestational hypertension, cardiac disease, renal disease, chorioamnionitis, dystocia, intrauterine fetal demise, isoimmunization, and diabetes Assesment: Relative indications; gestational age determination Fetal status; maternal status; Bishop’s score Management: Explanations (Patient teaching) Oxytocin administration Pain relief and support

Answer 21

Regular uterine contractions with cervical effacement and dilation between 20 and 37 weeks’ gestation One of most common obstetric complications Therapeutic Management: Risk prediction Tocolytic drugs: there are no clear first-line drugs to manage preterm labor; may prolong pregnancy for 2 to 7 days while steroids can be given for fetal lung maturity Antibiotic prophylaxis for women with group B streptococcus Nursing assessment: Risk factors Subtle signs Contraction pattern (4 contractions every 20 minutes or 8 contractions in 1 hour) Laboratory and diagnostic testing: CBC, urinalysis, amniotic fluid analysis, fetal fibronectin, cervical length via transvaginal ultrasound, salivary estriol, home uterine activity monitoring Expected finding: uterine contraction, pressure in pelvis, GI cramping/diarrhea, urinary freq, vaginal discharge

Answer 22

Nifedipine: Ca channel blocker Monitor for headache, flushing, dizziness & nausea Magnesium Sulfate: >Tocolytic, relaxes smooth muscle of uterus, suppresses contractions >Instruct client to notify RN of distress (blurred vision, headache, nausea, vomiting, difficulty breathing) >Monitor for s/s of Mag. Tox. (loss of DTRs, urinary output < 30 cc/hr, respiratory depression, pulmonary edema, chest pain) >Administer Calcium Gluconate as an antidote as needed Indomethacin: >NSAID that suppresses PTL by blocking the production of prostiglandins (this suppresses contractions) >Rx for no more than 48 hours, only with gestational age <32 weeks, monitor for PPH r/t reduced platelet aggregation Betamethasone: >Glucocorticoid, IM x 2, q 24 hrs, to enhance fetal lung maturity & surfactant production, 24-34 wks gest. > Monitor for fetal & neonatal: pulmonary edema (chest pain, SOB, crackles), hyperglycemia, heart rate changes Psychological support is essential

Answer 23

Vacuum- assisted delivery/ Forceps > application of traction to fetal head Indications: Prolonged second stage of labor, nonreassuring FHR pattern, failure of presenting part to fully rotate and descend, limited sensation or inability to push effectively, presumed fetal jeopardy or fetal distress, maternal heart disease, acute pulmonary edema, intrapartum infection, maternal fatigue, infection Risk of tissue trauma to mother and newborn > caput common with vacuum assist, facial abraision common with forceps prevetion is key

Answer 24

The cesarean section rate in the United States remains 32% Complications of cesarean delivery for mothers include bowel and bladder injury during surgery, hemorrhage, amniotic fluid embolism, and infection. A major neonatal complication is respiratory distress Indications for cesarean delivery include: Failure to progress No reassuring fetal heart rate Fetal malpresentation Umbilical cord prolapses Fetal macrosomia Unplanned cesarean delivery may cause women a sense of frustration, disappointment, even failure Types of uterine incisions include classical (vertical), low vertical, or low transverse it is the safest to attempt a vaginal delivery after cesarean if a low transverse incision was used