High Risk Intrapartum

Question 1

3 Dysfunctional powers of labor

Answer 1

Hypertonic, hypotonic, precipitous

Question 2

What can dysfunctional labor be caused by?

Answer 2

powers (uterine contractions), passenger (fetus), passage (pelvis)

Question 3

What can dystocia be caused by?

Answer 3

any of the powers of labor

Question 4

What are the 4 problems with the powers that can occur?

Answer 4

frequency, duration, intensity, resting tone of the uterus

Question 5

When does hypertonic labor typically occur?

Answer 5

latent phase of labor

Question 6

What are the characteristics of hypertonic labor?

Answer 6

resting tone of myometrium increases, contractions are more frequent but intensity decreases, painful but ineffective contractions

Question 7

What may hypertonic labor cause?

Answer 7

maternal exhaustion, fetal intolerance of labor which may lead to fetal hypoxia/asphyxia

Question 8

What are the nursing priorities for a laboring mother experiencing hypertonic labor?

Answer 8

promote sleep/rest, promote relaxation, PO/IV hydration, assess FHR, UCs, and vaginal exam, administer pain meds as ordered

Question 9

When does hypotonic labor typically occur?

Answer 9

active phase of labor

Question 10

What are the characteristics of hypotonic labor?

Answer 10

Less than 2-3 UCs in 10 minutes, insufficient UC pressure, contractions are not strong enough to dilate or efface cervix

Question 11

What are the risks of hypotonic labor?

Answer 11

Maternal exhaustion/infection, fetal intolerance of labor (resulting in asphyxia, decrease in variability, or late decelerations)

Question 12

What are the nursing priorities for a mother who is experiencing hypotonic labor?

Answer 12

administer pitocin, encourage voiding/emptying bladder, prevent/treat dehydration (PO/IV fluids), encourage position changes, evaluate FHR, UCs, limit vaginal exams if ROM, provide emotional support/info, consider a sedative to promote rest and relaxation

Question 13

What do “arrest” disorders occur?

Answer 13

in stage 1 or stage 2 of labor (>6cm dilated, >4 hrs of adequate cxs/6 hours inadequate cxs)

Question 14

What are 2 ways to describe “arrest” disorders?

Answer 14

failure to progress, failure to descend

Question 15

How long does precipitous labor last?

Answer 15

<3 hours

Question 16

What are the characteristics of precipitous labor/birth?

Answer 16

UCs occur more frequently, longer duration, and more intense

Question 17

What are risk factors of precipitous labor?

Answer 17

grand multip, history of precip

Question 18

What is the delivery like for precipitous labor?

Answer 18

Delivery is sudden, unexpected, and often unattended (nurse delivery)

Question 19

What are the risks of precipitous labor?

Answer 19

PPH, lacerations, placental abruption, fetal hypoxia/CNS depression

Question 20

Nursing priorities for precipitous labor

Answer 20

monitor closely, comfort measures, assess FHR, UCs Q15min, monitor cervical change, perform SVE if patient feels urge to push, bear down, prep for delivery

Question 21

Which fetal presentations can cause fetal dystocia?

Answer 21

Persistent occipital posterior, brow, face, breech, shoulder (transverse lie)

Question 22

What are 6 reasons that fetal dystocia may be present?

Answer 22

mal-presentation, excessive size, multiples, fetal anomalies, cephalopelvic disproportion (CPD), failure to descend

Question 23

What is the turtle sign? What is this indicative of?

Answer 23

retraction of the fetal head against the perineum. This indicates shoulder dystocia

Question 24

What gets compressed when there is shoulder dystocia?

Answer 24

neck and cord, which causes respiratory exchange to cease

Question 25

What are some things that should be done when shoulder dystocia is present?

Answer 25

suprapubic pressure, midline episiotomy, McRoberts maneuver, empty bladder, request additional staff, anticipate neonatal resuscitation, explain what is going on to the patient and the family

Question 26

How is the McRoberts maneuver performed?

Answer 26

Legs flexed onto abdomen and apply suprapubic pressure to the fetal anterior shoulder

Question 27

What are neonatal complications that are associated with shoulder dystocia?

Answer 27

brachial plexus injury, broken clavicle, neurological injury, asphyxia, death

Question 28

What happens with pelvic dystocia?

Answer 28

One or more of the three planes of the pelvis (inlet, midpelvis, outlet) narrows

Question 29

What are two reasons that CPD may be present?

Answer 29

Fetus is larger than pelvis diameter, abnormal position/presentation of the fetus

Question 30

What are the nursing priorities for CPD?

Answer 30

position changes, support/encouragement, fetal monitoring, teach and provide comfort measures, prep for a C-section

Question 31

How often should NSTs be performed after 42 weeks gestation?

Answer 31

2-3 times a week

Question 32

When is induction considered for a fetus that is post date?

Answer 32

at 41 weeks or greater

Question 33

What happens during an umbilical cord prolapse?

Answer 33

umbilical cord precedes the presenting part

Question 34

Why is an umbilical cord prolapse a cause for concern for the fetus?

Answer 34

it will compress the cord, decrease fetal blood flow, FHR drops and does not recover

Question 35

What are risk factors for an umbilical cord prolapse?

Answer 35

malpresentation, presenting part not engaged, preterm/small infants, multiple gestation, polyhydramnios

Question 36

What is the nurse's first priority when there is an umbilical cord prolapse?

Answer 36

Relieve pressure on cord ASAP

Question 37

What are the nursing priorities when there is an umbilical cord prolapse?

Answer 37

lift presenting part off cord with gloved hand, call for help--> notify provider, administer oxygen and IV bolus, position changes (knee to chest), DC oxytocin, administer a tocolytic, prep for a vaginal/instrumental delivery, prep for c-section

Question 38

What is another name for amniotic fluid embolism?

Answer 38

anaphylactoid syndrome

Question 39

What happens during an amniotic fluid embolism?

Answer 39

amniotic fluid enters into maternal circulation and a massive immune response to fluid/particulate occurs

Question 40

What are the risk factors for an amniotic fluid embolism?

Answer 40

precipitous delivery, AMA, placenta previa or abruption, preeclampsia, instrumental/c-section delivery, cervical lacerations, grand multips

Question 41

What is anaphylactoid syndrome considered?

Answer 41

an EMERGENCY

Question 42

What are some indications of amniotic fluid embolism?

Answer 42

acute dyspnea, hypoxia, cyanosis, hypotension, cardiac and respiratory arrest, uterine atony, massive hemorrhage, disseminated intravascular coagulation

Question 43

What should be done if an amniotic fluid embolism is suspected?

Answer 43

call code, initiate CPR, notify provider, administer oxygen, ensure IV access, administer RBCs/platelets as ordered, provide emotional support, anticipate transfer to the ICU

Question 44

What are risk factors for disseminated intravascular coagulation?

Answer 44

AFE, placental abruption, preeclampsia, HELLP syndrome, sepsis, PPH