Exam 2 Summary Set Flashcards
at what stage of labor are epidurals and opioids no longer safe?
stage 2
____ is the only stage where sedatives are appropriate for pain management.
stage 1 - early labor
____ does not stay in the system after inhalation
nitrous oxide
what are sedatives used for in labor?
relaxation and possibly sleep
____ is the sedative used in labor
vistaril
what is the dose for vistaril?
25-100 mg
what are the two opioids used in labor?
morphine, fentanyl
____ (opioid) is most commonly used in early labor
morphine
which opioid is more rapid-acting?
fentanyl
what happens if we give opioids too late into labor?
no relief and can lead to neonatal respiratory depression
what pain management method is used during a c-section?
spinal anesthesia
____ block is used during vaginal birth
epidural
____ is typically reserved for emergency situations, such as STAT c/s
general anesthesia
what are the most common postpartum pain management options for NSVB?
analgesics (acetaminophen) and NSAIDs PO
what is the pain management regimen for c-section postpartum?
(1) opioid analgesic PCA x24 hr, then ->
(2) opioid analgesic PO
(3) NSAID IV x24 hour, then ->
(4) NSAID PO
IV and PO ____ canNOT be used at the same time!
NSAIDs
risk factors for labor dystocia / dysfunction
(1) nullip
(2) obesity
(3) AMA
(4) short stature
(5) Induction of labor
(6) complications during pregnancy
what is the nursing priority for hypertonic labor dysfunction?
maternal therapeutic rest and support for coping
what are the nursing priorities for hypotonic labor dysfunction?
augmentation and position changes
what are the nursing priorities for ineffective pushing dysfunction?
(1) position changes
(2) call to change epidural infusion rate
(3) assisted delivery
(4) prep for c/s
what are the risk associated with prolonged labor? (4)
(1) infection
(2) maternal exhaustion
(3) higher levels of fear/anxiety
(4) maternal hemorrhage
the biggest complication of precipitate labor is ___
tears / lacerations
safe, high-quality care that recognizes and adapts to physical and psychosocial needs of the family
family-centered care
basic principles of family-centered care
(1) childbirth is a normal, healthy event
(2) childbirth affects the entire family
(3) families can make decisions about their care if given adequate info
settings for childbirth are
(1) hospital
(2) free-standing birth centers
(3) home births
US birth rate is ___
declining
____ are more likely to delivery low-birth weight or preterm infants, compared to older women
teenagers
The death of a woman while pregnant or within 42 days of termination of pregnancy
maternal death
______ population has 3x higher maternal mortality rates, compared to non-Hispanic white population
non-Hispanic Black
infant mortality rate is highest for which ethnic population?
Non-Hispanic Black
An approach that recognizes the impact of trauma on individuals and creates a safe, supportive environment for healing
trauma-informed care
two things that can happen prior to the onset of birth are
lightening and engagement
widest part of the baby’s head passes through the pelvic inlet and into the pelvis
engagement
subjective feeling of the baby settling into the lower uterine segment
lightening
T/F you can be in active labor and not have rupture of membranes occur yet
T
name the general stages of labor
stage 1 - cervical dilation
stage 2 - pushing
stage 3 - delivery of placenta
stage 4 - maternal stabilization
what are the 3 sub-stages of stage 1 of labor?
(1) latent
(2) active
(3) transition
during the latent stage, the cervix dilates ____
0 to ~3-5 cm
steady contractions that are very spaced out can be seen in __ stage
latent stage 1
in active stage 1, the _____ is complete
effacement
during the active stage 1, the cervix dilates ____
from 5 to 8 cm
at which stage does the fetal head engage?
active stage 1
when does coping during labor really initiate? (can have N/V, shaking, etc.)
active stage 1
in transition stage 1, the cervix dilates ____
from 8 to 10 cm
____ is common during the transition stage 1
emesis
contraction intensity is ____ during the transition stage 1
strong!
what is cervical effacement?
going from long and thick cervix (0%) to paper thin (100%)
the vagina will ___ to allow for distention during labor
stretch
when the cervix is 10 cm dilated, it is as big as a
grapefruit
how do we assess cervical effacement and dilation?
vaginal exam
during stage ____, mother will have the spontaneous urge to push
2
swelling that appears as a cone-shaped head
caput
baby’s head should ideally have ____ to be the smallest diameter during birth
the chin tucked
labor is longer for ___ than ___
nullips; multips
when should you take vitals during labor and why?
resting phase / between contractions b/c BP will increase during contractions
CO, HR, BP, and RR will __ during labor
increase
WBC count will ___ during labor
increase
it is normal for ____ to be slightly elevated during labor
temperature
what two physiological changes reflect a decrease during labor/
(1) gastric motility
(2) blood glucose
name the 5 Ps of labor
(1) passenger (fetus and placenta)
(2) passageway (pelvis)
(3) position (mom and fetus)
(4) power (contractions)
(5) psyche
part of the fetus that is entering into the pelvic inlet first
presentation
when the shoulder or scapula enters first, this is ____ presentation
transverse
when the fetus is head-down, this is ___ presentation
cephalic
when the fetus is sideways, this is ___ presentation
transverse lie
relationship of the maternal spine to the fetal spine is called ___
lie
the two types of lie are ____
longitudinal; transverse
relationship of the fetal body parts to one another
attitude
the two types of attitude are ____
flexion and extension
the ideal birthing position for the fetus is
left occiput anterior (LOA)
the 2nd best birthing position is
right occiput anterior (ROA)
the most optimal pelvic shape for delivery is ____
gynecoid
____ pelvic shape is not conducive for vaginal birth
platypelloid
the ___ pelvic shape can have birth occur but it may not progress
android
which pelvic shape often results in occiput posterior (OP) birth?
anthropoid
the 3 parts of the fetal are ____
face, base of the skull, and vault of the cranium
the _____ of the fetal head is not well-fused and meant to shift and mold
vault of the cranium
the relationship of the presenting part to an imaginary line b/w the ischial spines of the maternal pelvis is the ___
fetal station
when the fetus is at station 0, this means
the fetal head is engaged
what does +3 / +4 fetal station mean?
the fetus is close to crowning
we don’t recommend pushing until the fetal head is at station ____
0 or lower
the beginning to the completion of one contraction is the
duration
the time between the beginning of one contraction and the beginning of another is
frequency
palpating a mild intensity contraction will feel like
tip of the nose
palpating a moderate-intensity contraction will feel like
the chin
palpating a strong-intensity contraction will feel like
a forehead
feelings of helplessness or loss of control may indicate ___
suffering
name at least 3 comfort measures for physical pain
(1) create a relaxing atmosphere
(2) give partner suggestions
(3) provide pressure / massage
(4) encouraging words of praise
(5) calming music
what is the main nursing priority in the 3rd stage of labor?
inspect the placenta when it is delivered to make sure it is intact
if the placenta is not delivered within 30 minutes, it is a ____
retained placenta
name at least 3 physical assessments that nurses perform during labor
(1) vital signs
(2) Leopold’s maneuvers
(3) heart
(4) lung
(5) cervical dilation and effacement
(6) membranes status (ROM?)
(7) pain
(8) contractions
the 3 components of labor status are ___
contractions, cervix, and membranes
the amniotic fluid / membrane should be ___ in color
clear
during stage 1 of labor, what are the nursing assessments that must be completed?
(1) prenatal Hx and labs
(2) culture, language, religion
(3) labor status
(4) fetal status
(5) maternal status
during ___ stage, you should:
-help with position changes
-have delivery meds ready
-continue monitoring labor/parent/fetus
second (pushing)
during stage 3, _____ continue to deliver the placenta
uterine contractions
weighing pads for bleeding assessment, frequent fundal checks, and setup for laceration repair occurs in which stage of labor?
stage 3
helping parent bond with baby is important in which stage(s) of labor?
stage 3 and 4
the two major things we monitor for the fetus are ___
FHR and contractions / uterine activity
the external methods of FHR monitoring are ___
(1) intermittent auscultation
(2) continuous with transducer
the internal method of FHR monitoring is ____
internal fetal scalp electrode
the external method to measure uterine activity is
toco / transducer
the internal method to measure uterine activity is
intrauterine pressure catheter (IUPC)
the toco should be at the ____ location
top of the fundus
the transducer should be at the ____ location for best reading
fetal back
what are 3 reasons we would use an internal fetal scalp electrode?
(1) patient is moving
(2) patient’s body type
(3) fetal position
a flexible thin tube that sits alongside the baby describes the ___
intrauterine pressure catheter
which device can measure the strength of a contraction?
intrauterine pressure catheter
the top of a FHR tracing shows the ___
FHR
the bottom section of a FHR tracing shows the ____
contractions
baseline normal FHR should be
110-160 bpm
<110 bpm is
bradycardia
fetal bradycardia could be due to ____
fetal hypoxia
maternal fever or fetal distress can cause
tachycardia
minimal variability is ____ change in amplitude
0-5 bpm
moderate variability is ____ change in amplitude
6-25 bpm
marked variability is ____ change in amplitude
> 25 bpm
moderate variability indicates what?
reassuring sign of a well-oxygenated fetus with functioning autonomic nervous system
minimal or absent variability can suggest
hypoxia or acidemia
marked variability may suggest
acute hypoxia or cord compression
which type of variability is often seen during stage 2 of labor?
marked
temporary increases in the FHR from baseline of at least 15 bpm for at least 15 seconds
accelerations
___ are generally a reassuring sign of a well-oxygenated fetus responding to stimulus
accelerations
a gradual decrease and return to baseline where the nadir of decel and peak of contraction happen at the same time
early deceleration
VEAL CHOP stands for…
V - variable decels
E - early decel
A - acceleration
L - late decel
C - cord compression
H - head compression
O - Ok
P - placental insufficiency
onset to nadir is ____ seconds for an early and late decel
> 30
gradual decrease and return to baseline where the nadir occurs after the peak of contraction
late deceleration
____ may indicate placental insufficiency
late deceleration
an abrupt decrease that is >= 15 bpm and lasts less than 2 min from onset
variable decel
variable decels are due to ____
umbilical cord compression
a decrease in FHR that is 15 bpm or more and lasts 2 to 10 minutes
prolonged decel
name 4 causes of a prolonged decel
(1) labor progressing quickly
(2) patient getting an epidural
(3) sudden position changes
(4) baby sudden position change
a ____ decel can lead to an emergency c-section
prolonged
tachysystole is defined as
> 5 contractions in 10 minutes over a 30-minute window
name the 3 nursing interventions for tachysystole
(1) IV fluid bolus
(2) maternal repositioning
(3) stop pitocin and other meds that stimulate contractions
category I FHR patterns
(1) normal baseline
(2) moderate variability
(3) no late or variable decels
(4) early decels - present or absent OK
category III FHR patterns
absent variability AND
(1) recurrent late decels
(2) recurrent variable decels
(3) bradycardia
(4) sinusoidal pattern
the primary source of pain in stage 1 of labor is ____
dilation of the cervix
hypoxia of the uterine muscles causes pain in which stages of labor?
stage 1 and 2
pressure on lower back, buttocks, and thighs causes pain in which stages of labor?
stage 1 and 2
pain in stage 3 is caused by…
(1) cervical dilation as placenta is expelled
(2) uterine contractions
(3) perineal pain
what are the main sources of pain in stage 4 of labor?
(1) uterine contractions
(2) after pains
(3) perineal pain
(4) incisional pain
when asking about labor, what nurse should say:
“how are you coping with your labor?”
name the pain management options from least to most invasive
(1) nothing
(2) non-pharm methods
(3) NO
(4) sedatives
(5) opioids
(6) pudendal nerve block
(7) epidural analgesia
(8) spinal anesthesia
name at least 4 non-pharmacological methods for pain management
(1) heat / cold
(2) massage
(3) hydrotherapy
(4) breathing techniques
(5) counterpressure
(6) birth ball
(7) movement
____ can induce sleep at higher doses
vistaril
why do we give fentanyl more frequently?
It is not as long-lasting
why is narcan contraindicated in mother / fetus with maternal narcotic drug use or methadone treatment?
it can precipitate drug withdrawal
_____ provides some pain relief and motor block
regional analgesia
____ provides complete pain relief and motor block
regional anesthesia
primary use of local perineal infiltration anesthesia is ____
repair of perineal lacerations
pudendal nerve block is appropriate during which stages of labor?
stages 2 and 3
the two advantages of spinal anesthesia during c/s are
(1) pt stays awake and can participate in birth
(2) pt retains airway reflex
name at least 3 limitations to spinal anesthesia
(1) maternal hypotension
(2) FHR changes
(3) delayed respiratory depression
(4) N/V
(5) pruritus
(6) spinal headache
(7) urinary retention
____ leads to reduced motor function from xiphoid process down to toes
spinal block
pts can typically have movement in their legs but can’t walk with ____
epidural
____ is given continuous infusion via catheter of anesthetic and opiate
epidural
the most important thing to monitor during an epidural is ___
maternal hypotension
what should be given to offset maternal hypotension with an epidural?
IV fluid bolus
what two things should be available when someone gets an epidural?
O2 and suction
name 3 health consequences of preterm birth
(1) developmental delays
(2) chronic respiratory issues
(3) vision and hearing impairment
name at least 3 risk factors for preterm labor
(1) low pre-pregnancy weight
(2) smoking
(3) substance use
(4) history of preterm labor
(5) cervical length issues
(6) infection
(7) short interval b/w pregnancies
s/s of preterm labor include (name at least 4)
(1) cramping
(2) palpable contractions
(3) vaginal bleeding or spotting
(4) sense of “feeling badly”
(5) ROM
(6) pelvic / vaginal pressure
4 contractions in 20 minutes or 8 contractions in 60 minutes + cervical changes indicates ____
labor / preterm labor
labor before 37 weeks gestation is considered
preterm
___ and ___ are inefficient in preventing preterm birth
bedrest and hydration
the 4 meds for management of preterm labor are
(1) betamethasone
(2) terbutaline
(3) nifedipine
(4) Mg sulfate
the purpose of betamethasone/corticosteroids in preterm labor is ___
to enhance fetal lung maturity
betamethasone is given ___ route
IM
betamethasone 12mg dose is given ___ times
2
terbutaline route
subQ
side effects of terbutaline are
tachycardia (both mom and fetus) and palpitations
which medications are tocolytics for preterm labor?
terbutaline and nifedipine
what is the purpose of tocolytics in preterm labor?
reduce uterine contractions and slow down labor
Nifedipine route
PO
side effects of Nifedipine
hypotension, headache, dizziness, flushing, nausea
Mg sulfate is used in preterm labor for ____ at <32w GA
fetal neuroprotection
____ is key in preventing preterm birth
prenatal care
artificial rupture of membranes is
rupture by a clinician
when someone’s water breaks, we call this
spontaneous rupture of membranes
when ROM occurs, nurses should assess:
when, amount, color, and odor
when ROM occurs, patients should be instructed to ____
come to the clinic or hospital for evaluation
most term PROM cases lead to labor within ___
24 hours
PPROM increases the risk of…
neonatal and maternal complication
when ROM occurs but there is no labor yet
PROM
when prelabor ROM occurs before term
PPROM
the most significant consequence of PROM is ___
intrauterine infection
PPROM can lead to ____
premature birth
PROM and PPROM can put newborns at risk for ____& ____
sepsis and respiratory distress
name at least 3 risk factors for PROM and PPROM
(1) amniotic infection
(2) h/o PROM or PPROM
(3) low BMI
(4) smoking
(5) illicit drug use
(6) T2/T3 bleeding
(7) short cervical length
(8) low SES
___ is a social factor and risk for preterm labor
race
management of PROM includes 3 main things:
(1) weigh risk vs. benefits of induction
(2) assess GBS status
(3) monitor for infection and fetus status
if fetus is <34 weeks gestation with PPROM, you need to ___
weigh risk vs. benefit of premature induction vs. infection
if fetus is >34 weeks gestation with PPROM, typically they will __
have induction of labor
bacterial infection of the amniotic cavity is ___
chorioamnionitis
what is the triple I of chorioamnionitis?
(1) intrauterine inflammation
(2) infection
(3) both
name at least 3 risk factors for chorioamnionitis
(1) prolonged ROM
(2) multiple vaginal exams
(3) prolonged labor
(4) low SES
(5) young age
(6) nullip
diagnosis of chorioamnionitis
maternal temp > 38 C / 100 F +
-WBC >15,000
-maternal HR > 100
-FHR > 160
-tender uterus
-foul smell amniotic fluid
pneumonia, bacteremia, meningitis, and RDS are all neonatal results of
chorioamnionitis
chorioamnionitis is treated with ____
antibiotics (ampicillin/gentamicin, penicillin)
postpartum with chorioamnionitis, monitor for ___, ___, and ___
endometritis, UTI, sepsis
when it prolapses out of the uterus in front of the presenting fetus after ROM
cord prolapse
why is cord prolapse a medical emergency?
interrupts blood flow and O2 -> potentially fatal to fetus
name at least 3 risk factors for cord prolapse
(1) PROM
(2) polyhydramnios
(3) long umbilical cord
(4) fetal malpresentation
(5) multip
(6) growth restricted fetus
what is the main nursing role during cord prolapse?
support the fetal head until delivery by emergency c-section
why do you support the fetal head during cord prolapse?
to relieve cord compression and avoid cutting off blood / O2 supply
descent of anterior shoulder obstructed by symphysis pubis
shoulder dystocia
the head going in and out from the vaginal canal is called
turtle sign
turtle sign is an indicator of
shoulder dystocia
name two obstetric emergencies
cord prolapse and shoulder dystocia
maternal complications r/t shoulder dystocia are
(1) PPH
(2) perineal lacerations
(3) maneuvers of fetal manipulation & anal sphincter injuries
neonatal complications r/t shoulder dystocia are
(1) encephalopathy
(2) brachial plexus injuries
(3) clavicle and humerus fractures
(4) death
name at least 3 risk factors for shoulder dystocia
(1) LGA
(2) maternal diabetes
(3) prolonged labor
(4) excessive weight gain during pregnancy
(5) h/o shoulder dystocia
what should you NEVER do during shoulder dystocia?
give fundal pressure
explain 3 things you SHOULD do during shoulder dystocia
(1) document time of head delivery, time of diagnosis, and maneuvers used
(2) request assistance from NICU, providers, etc.
(3) assist with maneuvers
(4) ask pregnant person NOT to push
which maneuver is when the knees are tucked up to help with shoulder dystocia?
McRoberts Maneuver
process that prepares the cervix for labor induction
cervical ripening
procedures that stimulate contractions of labor
inudction
stimulation of uterine contractions after labor has already started
augmentation
name at least 3 maternal indications for induction of labor (IOL)
(1) PROM
(2) HTN disorders
(3) maternal diabetes
(4) post-term pregnancy
(5) elective
name at least 3 fetal indications for induction of labor (IOL)
(1) fetal growth restriction
(2) oligohydramnios
(3) chorioamnionitis
(4) non-reassuring tracings
complete placenta previa, non-cephalic presentation, and active genital herpes are all _____
contraindications for IOL
if we can’t IOL, we do ___
c-section
we do a ____ to start an induction
vaginal exam
the vaginal exam is used to get a ___ score
Bishop
a Bishop score of ____ indicates need for cervical ripening
6 or less
the two types of cervical ripening are ___ and ___
mechanical, pharmacologic
___ is the mechanical method of cervical ripening
intracervical balloon
the main benefit of the intracervical balloon is ___
it is safe for those with previous c-section
the cons of intracervical balloon are ____
(1) can cause SROM upon insertion
(2) displacement of the fetal head
____ are the pharmacologic method for cervical ripening
prostaglandins
the two types of prostaglandins used for cervical ripening are ___ and ___
misoprostol; dinoprostone
____ is contraindicated for prostaglandin cervical ripening
previous c-section or uterine surgery
the main risk of use of prostaglandins for cervical ripening is ___
tachysystole
____ is the brand name for vaginal insert of a prostaglandin
Cervadil
misoprostol route for cervical ripening
PO, vaginal
the most common form of induction method is
IV Pitocin
what are the potential dangers of pitocin? (3)
(1) tachysystole
(2) uterine rupture
(3) uterine atony and PPH
why do you hang the IV pitocin as close to the venipuncture site as possible?
it limits the amount of drug that is infused after stopping it
describe the administration of pitocin for induction of labor
start at a low dose and increase every 20-30 minutes until regular uterine contractions occur
___ is a high-risk med and requires two nurses to check
pitocin
monitor patient’s BP and HR at what interval when on pitocin?
q30 minutes
what can be administered if pitocin use leads to fetal non-reassuring patterns?
terbutaline
AROM can be used for ____
labor induction and augmentation
the two risks of AROM are
(1) cord prolapse
(2) chorioamnionitis
amnihook is used to perforate the amniotic sac in ___
amniotomy
the nursing priorities for an amniotomy are _____ (4)
(1) monitor FHR baseline and during procedure
(2) provide supplies
(3) chart color, quantity, and odor of fluid
(4) assess for infection
the two types of operative vaginal delivery are
(1) vacuum
(2) forceps
the main indication for operative vaginal delivery is to ___
shorten stage 2 of labor for any reason
the major risks of operative vaginal delivery for mom are ___, ___, and ___
lacerations, hematoma, episiotomy
ecchymoses, facial and scalp lacerations, facial nerve injury, cephalohematoma, and intracranial hemorrhage are risks of what?
operative vaginal delivery for fetus
what are the main nursing priorities prior and after operative vaginal delivery?
(1) ensure pt’s bladder is empty
(2) assess FHR
(3) observe for trauma to pt or baby
(4) check fundus for firmness
(5) reduce pain with cold pack
when assessing the newborn after an operative vaginal delivery, look for…
(1) skin breaks
(2) facial asymmetry
(3) neurologic abnormalities
(4) scalp edema
TOLAC
trial of labor after cesarean
VBAC
vaginal birth after cesarean
unsuccessful TOLAC ending in cesarean has _____, compared to elective repeat or VBAC
more complications
3 benefits of TOLAC include
(1) avoid surgery
(2) lower rates of hemorrhage, infection, TE
(3) shorter recovery
(4) decrease risks associated with multiple cesarean
___ and ___ account for ~50% of all C-sections
labor dystocia; abnormal FHR tracings
name at least 3 indications for C-section
(1) suspected macrosomia
(2) multiple gestation
(3) cord prolapse
(4) previous / elected
(5) placental abnormalities
name at least 3 risks of C-section
(1) hemorrhage
(2) infection
(3) cardiac arrest
(4) anesthetic complications
(5) injury to newborn
(6) uterine rupture
(7) shock
pt needs to be NPO for ____ prior to c-section
8 hrs
what lab work should be obtained before c/s?
(1) CBC
(2) blood type and screening
what two medications will be given prior to c/s?
(1) Antibiotic - Ancef IV push
(2) Bicitra/pepcid for gastric secretions
T/F - insert a catheter before c/s?
True
the three main buckets of perinatal mental health are
(1) baby blues
(2) postpartum major mood disorders
(3) postpartum pyschosis
transient period of “depression” that subsides in 10-12 days is
baby blues
major or minor episodes that occur during or in the first 12 months after birth is
perinatal depression
what is the biggest risk factor for postpartum depression?
depression during pregnancy
most common medication to treat postpartum depression is ___
sertraline / Zoloft
___ is a psychiatric emergency
postpartum psychosis
bipolar disorder and family h/o psychotic illness are risk factors for
postpartum psychosis
perinatal anxiety disorders can be…
GAD, OCD, PTSD
the 5 stages of grief are
(1) shock / denial
(2) anger / guilt
(3) bargaining
(4) depression / disorientation
(5) acceptance / resolution
____ may receive less support during perinatal loss than their partner
the birthing person’s partner (AKA the other parent)
never say ____ to a grieving parent
“god’s will”
“it was for the best”
the main nursing role during perinatal loss is ___
facilitate bonding and create an environment to initiate the grieving process
1st degree laceration
skin only
2nd degree laceration
tears of the perineal muscle and fascia
3rd degree laceration
anal sphincter is torn
4th degree laceration
rectal tears
which drugs are safe during TOLAC, and which are contraindicated?
Safe - Pitocin
Contraindicated - Prostaglandins
The two main indications for cesarean birth are
labor dystocia and abnormal / indeterminate FHR tracing
patient must be NPO ____ hrs before c-section
8
what medications are administered prior to C-section?
(1) antibiotic - Ancef IV Push
(2) Bicitra / Pepcid for gastric secretions
every day, the uterus will be about ____ lower
1 fingerbreadth lower
If blood collects and forms clots within uterus, what happens to the fundus?
it rises and becomes boggy
it’s normal to not have first spontaneous BM for ____ after birth
2-3 days
normal elimination pattern will return by ____
8-14 days
Breastfeeding people may get their period as early as ____ or as late as _____
8 weeks; 18 months
what are signs of a distended bladder? (4)
(1) fundus is displaced from midline
(2) excessive lochia
(3) bladder discomfort
(4) bulge of bladder above symphysis
name the 10 physical assessments to do during labor
(1) VS
(2) Leopold’s
(3) headache/dizziness/vision changes
(4) contractions
(5) cervical dilation and effacement
(6) membranes status
(7) heart
(8) lungs
(9) pain
(10) pulses
nursing interventions for epidural
(1) IV fluid bolus
(2) monitor maternal and fetal VS
(3) side-lying position
(4) coach pushing
(5) O2 and suction available
(6) SCD for prophylaxis
(7) insert catheter
(8) monitor for return of sensation and standing for first time
REEDA is an acronym that describes lacerations. What does it stand for?
R = redness
E = edema
E = ecchymoses
D = discharge
A = approximation
Methergine is contraindicated in ____
hypertension and cardiac disease
Methergine MOA is to ____
contract smooth muscle
Hemabate is contraindicated in ____
asthma; renal, cardio, and liver disease
you can use ____ instead of methergine if patient has HTN or cardiac disease
hemabate
____ is a side effect of hemabate
diarrhea
Tranexamic Acid (TXA) is given to ___
aid in clotting
Which patient is at greatest risk for an early PPH?
a. 41 weeks being induced with Pitocin
b. pt who is receiving Mg sulfate, severe preeclampsia, and urgent c/s
c. spontaneous labor at full term
B
the single biggest cause of postpartum hemorrhage is
uterine atony
the #1 thing to do during PPH is
massage the fundus
the 5 drug options during PPH are
(1) Pitocin
(2) Methergine
(3) Cytotec
(4) Hemabate
(5) TXA
risk factors that put someone at low risk for PPH are (4)
(1) singleton
(2) <4 previous deliveries
(3) no uterine scarring
(4) no past h/o PPH
name 3 risk factors that put someone at moderate risk for postpartum hemorrhage
(1) previous c/s or uterine surgery
(2) chorioamnionitis
(3) use of Mg sulfate
(4) prolonged use of oxytocin
name 3 risk factors that put someone at high risk for postpartum hemorrhage
(1) placental abnormalities
(2) bleeding admission
(3) h/o postpartum hemorrhage
(4) known coagulation defect
the main causes of hematomas are ___ and ___
lacerations, blood vessel injury
what are 3 risk factors for hematomas?
(1) nullips
(2) babies > 4000 g
(3) prolonged 2nd stage
(4) preeclampsia
(5) multifetal pregnancy
(6) vulvar variscosities
deep, severe unilateral pain and hypovolemia are s/s of ____
hematoma
the three treatment options for hematoma are ___, ___, and ___
conservative management, surgery, and arterial embolization
risk factors for retained placenta are G and 5Ps - what are they?
Grand multip
Prematurity
Previous c/s
Placenta previa
Placental manipulation in 3rd stage
Prolonged 3rd stage
how can you remove a retained placenta?
(1) manual removal
(2) dilation and curettage
the 4 most common postpartum infections are
endometritis, UTI, mastitis, and wound infection
fever, chills, tender uterus, and foul-smelling lochia may describe
endometritis
endometritis is treated with
IV antibiotics
2 common causes of UTI are
urinary stasis, catheterization
CVA tenderness, flank pain, and nausea and vomiting may indicate
pyelonephritis
which infection should get a UA/UC?
UTI
the main complication r/t mastitis is ___
an abscess
___ and ___ can lead to mastitis
milk stasis; breast engorgement
name 3 s/s of mastitis
fever, pain, redness, localized lump
3 things someone with mastitis should do to treat it are
(1) PO antibiotics
(2) ice packs / heat pads
(3) keep breastfeeding on affected side
management of wound infection can include:
(1) come into doctor’s office
(2) drain wound
(3) culture exudate
(4) analgesics
(5) warm compresses and sitz baths
SSRIs may cause ___ in the newborn
RDS (respiratory distress syndrome)
cultural and/or public display of one’s grief
mourning
the three types of thromboembolism that are common in postpartum are
(1) superficial venous thrombophlebitis
(2) DVT
(3) PE
hardened vein over the thrombosis and calf tenderness are s/s of
DVT
management of DVT includes
(1) elevate limb above the heart
(2) frequent position changes
(3) warm, moist compresses
(4) DO NOT Massage
(5) NSAIDs for pain
(6) anticoagulant (warfarin, heparin)
(7) measure calf size regularly
name s/s of PE
dyspnea
chest pain
tachycardia
tachypnea
hemoptysis
decreased O2
management of PE includes
(1) call for help
(2) VS, esp. RR and breath sounds
(3) raise HOB
(4) narcotic analgesics (morphine)
(5) O2 at 8-20 LPM face mask
(6) ensure IV access
involution / after pains can be most acute for…
multips; overdistention of uterus; breastfeeding
if the fundus is above the _____ in postpartum, this can be a cue that the bladder is full
belly button
on days 4-10 PP, lochia is
serosa - pink or brown
on days 11-14, lochia is
alba - yellow, cream, or white
on days 1-3, lochia is
rubra - dark red
at birth, lochia is
bright red
we expect ____ of blood loss before we become concerned
~500 mL
during labor, CO will ____ and will return to pre-labor values within ____
increase; 1 hour
Cardiac output will return to pre-pregnancy levels by
6-12 weeks
how does plasma volume return to normal pre-pregnancy levels?
diuresis and diaphoresis
WBC will return to normal levels within ___
6 days
coagulation risk is increased for _____ weeks postpartum
4-6
first spontaneous bowel movement may not be for ____ after birth
2-3 days
normal bowel pattern returns ____ days after birth
8-14
flatulence is common postpartum, especially for ___
c-section patients
if fundus is higher than expected on palpation and is not midline, we would suspect
bladder distention
diastasis recti usually resolves within
6 weeks
spinal headaches are usually relieved by which position?
supine
the first few menstrual cycles for lactating and non-lactating patients are often
anovulatory
immediate postpartum weight loss is ____ lbs d/t fetus, fluids, and blood
10-12 lbs
an additional 9 lbs is lost in the first 2 weeks d/t
fluid loss
adipose tissue gained during pregnancy can take how long to lose?
6-12 months
postpartum assessment schedul
q15 minutes for 1 hour
q30 minutes for 1 hour
q1h for 2 hours
q4h for 24 hours (c/s)
q8h for 24 hours (NSVD and c/s after 24 hours)
the 7Bs + E are
Brain
Breast
Belly
Bladder
Bowel
Bottom
Blood
Extremities
Brain assessment is looking at ___ status
emotional
when assessing Breast, a “lump” may indicate
various lobes beginning to produce milk
the two main things to assess for Belly are
incision and uterus
if the uterus is soft and “boggy” we ___
perform a fundal massage
we want to monitor ____ in Bladder assessment
(1) first 2-3 voids
(2) signs of distended bladder
typically 300-400 mL void indicates ___
bladder has been emptied
name 3 things we can do to care for Bottom during postpartum?
change pads, ice for comfort, topical agents
we want to assess the ___, ___, and ___ in postpartum blood
amount, type, odor
constipation in postpartum may cause
hemorrhoids
DTR should be ____ or ___ in postpartum
1+ or 2+
in Extremities assessment, we are looking for
(1) varicosities
(2) s/s of thrombophlebitis
(3) edema
(4) DTR
first 12 hours, sitz bath should have ___ water
cool
stitches will __ in the perineum
dissolve
the 6 warning signs to call a provider in postpartum are:
(1) severe mood changes
(2) concerns for infection
(3) heavy bleeding
(4) high blood pressure
(5) increase in swelling (edema)
(6) shortness of breath
nothing is recommended in the vagina for ___ following birth
6 weeks
which type of birth control are NOT recommended in postpartum?
CHCs
Which treatment for postpartum hemorrhage has the slowest onset of action?
a. methergine
b. oxytocin
c. cytotec
d. hemabate
C
primary concerns with uterine tachysystole
decreased fetal oxygenation, maternal exhaustion, uterine rupture
Trendelenburg position is associated with what condition?
cord prolapse
which maternal condition is most commonly associated with polyhydramnios?
a. gestational HTN
b. gestational diabetes
c. preeclampsia
d. fetal growth restriction
B
What is the typical timeline for the uterus to return to its pre-pregnancy size?
6 weeks
a patient experiencing hypotonic labor would have ____ type of contractions
frequent but weak
prolonged labor, precipitous labor, and fetal macrosomia are all risk factors for ____
postpartum hemorrhage
Which intervention is most effective in promoting fetal rotation from occiput posterior to occiput anterior?
hands-and-knees position
Which of the following interventions may help correct fetal malposition (e.g., occiput posterior)? (Select all that apply.)
a. hands-and-knees position
b. peanut ball between legs
c. encourage side-lying position
d. continuous supine position
A, B, C
