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Nurs 368 > High Risk Intrapartum > Flashcards

High Risk Intrapartum Flashcards

1
Q

3 Dysfunctional powers of labor

A

Hypertonic, hypotonic, precipitous

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2
Q

What can dysfunctional labor be caused by?

A

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

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3
Q

What can dystocia be caused by?

A

any of the powers of labor

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4
Q

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

A

frequency, duration, intensity, resting tone of the uterus

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5
Q

When does hypertonic labor typically occur?

A

latent phase of labor

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6
Q

What are the characteristics of hypertonic labor?

A

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

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7
Q

What may hypertonic labor cause?

A

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

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8
Q

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

A

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

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9
Q

When does hypotonic labor typically occur?

A

active phase of labor

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10
Q

What are the characteristics of hypotonic labor?

A

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

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11
Q

What are the risks of hypotonic labor?

A

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

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12
Q

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

A

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

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13
Q

What do “arrest” disorders occur?

A

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

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14
Q

What are 2 ways to describe “arrest” disorders?

A

failure to progress, failure to descend

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15
Q

How long does precipitous labor last?

A

<3 hours

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16
Q

What are the characteristics of precipitous labor/birth?

A

UCs occur more frequently, longer duration, and more intense

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17
Q

What are risk factors of precipitous labor?

A

grand multip, history of precip

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18
Q

What is the delivery like for precipitous labor?

A

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

19
Q

What are the risks of precipitous labor?

A

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

20
Q

Nursing priorities for precipitous labor

A

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

21
Q

Which fetal presentations can cause fetal dystocia?

A

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

22
Q

What are 6 reasons that fetal dystocia may be present?

A

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

23
Q

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

A

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

24
Q

What gets compressed when there is shoulder dystocia?

A

neck and cord, which causes respiratory exchange to cease

25
Q

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

A

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

26
Q

How is the McRoberts maneuver performed?

A

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

27
Q

What are neonatal complications that are associated with shoulder dystocia?

A

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

28
Q

What happens with pelvic dystocia?

A

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

29
Q

What are two reasons that CPD may be present?

A

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

30
Q

What are the nursing priorities for CPD?

A

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

31
Q

How often should NSTs be performed after 42 weeks gestation?

A

2-3 times a week

32
Q

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

A

at 41 weeks or greater

33
Q

What happens during an umbilical cord prolapse?

A

umbilical cord precedes the presenting part

34
Q

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

A

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

35
Q

What are risk factors for an umbilical cord prolapse?

A

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

36
Q

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

A

Relieve pressure on cord ASAP

37
Q

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

A

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

38
Q

What is another name for amniotic fluid embolism?

A

anaphylactoid syndrome

39
Q

What happens during an amniotic fluid embolism?

A

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

40
Q

What are the risk factors for an amniotic fluid embolism?

A

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

41
Q

What is anaphylactoid syndrome considered?

A

an EMERGENCY

42
Q

What are some indications of amniotic fluid embolism?

A

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

43
Q

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

A

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

44
Q

What are risk factors for disseminated intravascular coagulation?

A

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

Nurs 368 (20 decks)

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