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NUR 220 > High Risk Intrapartum > Flashcards

High Risk Intrapartum Flashcards

1
Q

hypotonic contractions

A

Contractions are not
strong enough during
active labor to cause
cervical change

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2
Q

risk factors for hypotonic contractions

A

Epidural before active labor begins
* Overuse of Oxytocin
* Over-distended uterus
* Macrosomia
* malpresentation
* Multiples
* Polyhydramnios
* Abnormal Shaped Uterus
* Multiparity

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3
Q

assessment findings hypotonic contractions

A

Decreased strength and frequency
of contractions
* Little to no cervical change
* Uterus is indented at peak of
contraction
* Patient is fatigued

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4
Q

medical management for hypotonic contractions

A

Evaluate labor progress
and strength of
contractions with IUPC
* Consider an IUPC
* Consider amniotomy
* Consider use of
Oxytocin
* Cesarean if measures
fail

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5
Q

nsg interventions forhypotonic contractions

A

Assess FHR
* Assess uterine activity
* Assess Maternal status
* Attempt to stimulate

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6
Q

hypertonic contractions

A

Uterus never fully
relaxes between
contractions during
latent phase of labor.

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7
Q

risk factors hypertonic contractions

A

Nulliparous
* Occiput
Posterior
presentation

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8
Q

assessment findings hypertoni contractionbs

A

Painful frequent
uterine
contractions
* Little cervical
change

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9
Q

medical management hypertonic contractions

A

Assess progress
* Hydrate
* Pain management
* Consider amniotomy
* Cesarean if
measures fail

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10
Q

nsg interventions hypertonic contractions

A

Promote rest
* Prevent exhaustion
* Maternal position
changes

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11
Q

maternal pushing risk factors

A

Pushing before ready
* Prolonged second stage

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12
Q

medical management maternal pushing

A

Augment with oxytocin
* Decrease epidural

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13
Q

assessment findings maternal pushings

A

Exhausted mother
* Poor pushing efforts

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14
Q

nsg interventions maternal pushing

A

Breathing patterns
* Change position

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15
Q

precipitous labor

A

labor which lasts fewer than 3 hrs

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16
Q

risk factors precipitous birth

A

Multiparous
* Strong uterine contractions
* History of precipitous labor

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17
Q

assessment findings precipitous brith

A

rapid cervical dilation

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18
Q

medical management precipitous birth

A

Consider tocolytics to slow labor
* Monitor for postpartum
hemorrhage
* Prepare for fetal resuscitation
* Support perineum
* Assess for nuchal cord

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19
Q

nsg interventions precipitous brith

A

Provide maternal support
* Place mom in left lateral position
* Assess vital signs and bleeding
* Assess for fetal resuscitation

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20
Q

labor distocia passeneger

A

head too large

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21
Q

risk factors labor dystocia passeneger

A

Regional anesthesia
* Abnormal fetal
presentation
* Fetal anomalies
* Multiples
* Macrosomia (LGA)

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22
Q

assessment findings labor dystocia passeneger

A

FHR location may be
heard above the
umbilicus
* Presenting part is not
engaged

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23
Q

medical management labor dystocia passeneger

A

External Cephalic Version
* Confirmation via ultrasound

24
Q

nsg interventions labor dystocia passeneger

A

Leopolds maneuver to
determine PP
* Location of FHR
* Notify provider due to
lack of descent

25
labor dysotcia pssageway risk factors
Small pelvis * Abnormal pelvic shape
26
assessment findings labor dystocia passageway
Swelling of the cervix * Delayed fetal descent * Fetal scalp swelling
27
medical management labor dystocia passageway
Cesarean for cephalopelvic disproportion (CPD)
28
nsg intervention labor dystocia passageway
Assess labor progress * Assess fetal station * Alert for uterine rupture
29
indications for operative vaginal birth
Fetal distress * Prolonged second stage * Maternal exhaustion and ineffective pushing efforts * Must be vertex and absence of CPD
30
maternal risks operative vaginal birth
Lacerations of cervix, vagina or perineum * Hematoma * Extension of episiotomy * Hemorrhage * Infection
31
newborn risks operative vaginal birth
Distress after birth * Ecchymosis * Facial and scalp lacerations * Facial nerve injury * Cephalohematoma * Caput * Subarachnoid hemorrhage
32
labor induction indications
post-dates Chorioamnionitis Demise PROM Diabetes IUGR Pre-eclampsia/eclampsia
33
contraindications labor inductions
Placenta Previa Cord prolapse Transverse fetal lie Active herpes lesion Previous classical uterine scar
34
caput
crosses both sides fluid
35
cephalohematoma
bloody doesnt cross suture line
36
score of what is not ready for oxytocin
<4
37
cervical ripening cervidil
Releases dinoprostone at a controlled rate * Inserted next to the cervix * Tail makes for easy removal. * Oxytocin can be administered 30-60 mins after removal Supine with tilt for 2 hours
38
cervical ripening dinoprostone gel
Inserted vaginally next to the cervix * Difficult to remove if tachysystole occurs * Oxytocin may be given 6-12 hours after last instillation of medication * Supine with tilt for 30-60 minutes
39
misoprostol
25 mcg administered vaginally q4 hours * Softens the cervix * Must wait 4 hours after last dose before starting oxytocin * Risk: Tachysystole * Contraindicated: presence of uterine scar * Requires continuous fetal monitoring * Supine with lateral tilt 30-40 mins after inserted
40
action for pitocin
Stimulates uterine contractions * Uterine response is typically 2 -5 minutes * ½ life = 10-12 minutes * Increases should occur no sooner than 30 minutes * Do not exceed 20 milliunits per minute without provider order
41
risks with pitocin
Tachysystole * FHR decelerations * Fetal hypoxia * Increased risk C/S * Increased risk PPH
42
risk factors for should dystocia
Gestational diabetes (macrosomia) * Obesity * Postdates * Pelvic anatomy * History of shoulder dystocia * Discrepancy between size of parents * Precipitous 2nd stage
43
complications shoulder dystocia
Postpartum hemorrhage * Cervical/Vaginal lacerations * Bladder injury * Perineal damage * Uterine rupture
44
helperr
call for help... stop pushing episiotomy considered elevate legs provide suprapubic pressure place hand directly above pubic bone enter maneuvers remove posterior arm roll woman on all 4's
45
umbilical cord prolapse risk factors
Multiparity * ROM * Malpresentation * IUGR/SGA * Fetal anomalies * Polyhydramnios * Multiples * Amnioinfusion * Cervical ripening balloon * External cephalic version
46
assessment findings umbilical cord prolapse
Cord falls below the presenting part of the fetus and protrudes into the vagina or even past the labia. * Sudden fetal bradycardia
47
nsg interventions umbilical cord prolapse
Elevate the presenting part * Call for help * Prepare for delivery * If mother needs transported or cesarean is delayed, place in knee chest position OR Trendelenburg’s * Do not replace cord into uterus * Monitor FHR, oxygen if ordered * Provide emotional support
48
uterine rupture risk factors
Previous uterine surgery * High doses of oxytocin * Prostaglandin preparations * Tachysystole * Multiparity * Abdominal trauma * Forceps * Cephalic External Version * Abnormal Fetal Lie
49
assessment findings uterine rupture
Vomiting * Syncope * Vaginal bleeding * Pallor * Shock * Pain, ripping sensation * Palpate fetus in abdomen * Sudden fetal bradycardia
50
medical management uterine rupture
Emergency cesarean * Hysterectomy * Control bleeding * Transfuse blood products
51
nsg interventions uterine rupture
Call for help * Monitor VS * Provide O2 * IV fluids * Blood products * Provide support
52
indications for c seciton
Labor dystocia (CPD, FTP) *Placental problems (previa or abruption) *Maternal HTN *Active genital herpes lesions *HIV + with high viral load *Diabetes
53
fetal indications c section
Consistent abnormal FHR tracing (fetal distress) *Malpresentation (breech or shoulder presentation) *Cord prolapse *Multiple Gestations *CPD *Placental abnormalities *Dysfunctional labor *Multiples
54
intraoperative period anesthesia
Spinal or epidural anesthesia preferred * Patient remains awake * Support person allowed in room General Anesthesia * In emergent situations * Failed epidural or spinal * No support person in the room * 8 minutes until anesthetic reaches fetus
55

NUR 220 (6 decks)

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