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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
Q

labor dysotcia pssageway risk factors

A

Small pelvis
* Abnormal pelvic shape

26
Q

assessment findings labor dystocia passageway

A

Swelling of the cervix
* Delayed fetal descent
* Fetal scalp swelling

27
Q

medical management labor dystocia passageway

A

Cesarean for
cephalopelvic
disproportion (CPD)

28
Q

nsg intervention labor dystocia passageway

A

Assess labor progress
* Assess fetal station
* Alert for uterine rupture

29
Q

indications for operative vaginal birth

A

Fetal distress
* Prolonged second
stage
* Maternal exhaustion
and ineffective
pushing efforts
* Must be vertex
and absence of CPD

30
Q

maternal risks operative vaginal birth

A

Lacerations of cervix, vagina or
perineum
* Hematoma
* Extension of episiotomy
* Hemorrhage
* Infection

31
Q

newborn risks operative vaginal birth

A

Distress after birth
* Ecchymosis
* Facial and scalp lacerations
* Facial nerve injury
* Cephalohematoma
* Caput
* Subarachnoid hemorrhage

32
Q

labor induction indications

A

post-dates
Chorioamnionitis
Demise
PROM
Diabetes
IUGR
Pre-eclampsia/eclampsia

33
Q

contraindications labor inductions

A

Placenta Previa
Cord prolapse
Transverse fetal lie
Active herpes lesion
Previous classical uterine scar

34
Q

caput

A

crosses both sides
fluid

35
Q

cephalohematoma

A

bloody
doesnt cross suture line

36
Q

score of what is not ready for oxytocin

A

<4

37
Q

cervical ripening cervidil

A

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
Q

cervical ripening dinoprostone gel

A

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
Q

misoprostol

A

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
Q

action for pitocin

A

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
Q

risks with pitocin

A

Tachysystole
* FHR decelerations
* Fetal hypoxia
* Increased risk C/S
* Increased risk PPH

42
Q

risk factors for should dystocia

A

Gestational diabetes
(macrosomia)
* Obesity
* Postdates
* Pelvic anatomy
* History of shoulder dystocia
* Discrepancy between size of
parents
* Precipitous 2nd stage

43
Q

complications shoulder dystocia

A

Postpartum hemorrhage
* Cervical/Vaginal lacerations
* Bladder injury
* Perineal damage
* Uterine rupture

44
Q

helperr

A

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
Q

umbilical cord prolapse risk factors

A

Multiparity
* ROM
* Malpresentation
* IUGR/SGA
* Fetal anomalies
* Polyhydramnios
* Multiples
* Amnioinfusion
* Cervical ripening balloon
* External cephalic version

46
Q

assessment findings umbilical cord prolapse

A

Cord falls below the presenting
part of the fetus and protrudes into
the vagina or even past the labia.
* Sudden fetal bradycardia

47
Q

nsg interventions umbilical cord prolapse

A

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
Q

uterine rupture risk factors

A

Previous uterine surgery
* High doses of oxytocin
* Prostaglandin preparations
* Tachysystole
* Multiparity
* Abdominal trauma
* Forceps
* Cephalic External Version
* Abnormal Fetal Lie

49
Q

assessment findings uterine rupture

A

Vomiting
* Syncope
* Vaginal bleeding
* Pallor
* Shock
* Pain, ripping sensation
* Palpate fetus in abdomen
* Sudden fetal bradycardia

50
Q

medical management uterine rupture

A

Emergency cesarean
* Hysterectomy
* Control bleeding
* Transfuse blood
products

51
Q

nsg interventions uterine rupture

A

Call for help
* Monitor VS
* Provide O2
* IV fluids
* Blood products
* Provide support

52
Q

indications for c seciton

A

Labor dystocia (CPD, FTP)
*Placental problems (previa or
abruption)
*Maternal HTN
*Active genital herpes lesions
*HIV + with high viral load
*Diabetes

53
Q

fetal indications c section

A

Consistent abnormal FHR tracing
(fetal distress)
*Malpresentation (breech or
shoulder presentation)
*Cord prolapse
*Multiple Gestations
*CPD
*Placental abnormalities
*Dysfunctional labor
*Multiples

54
Q

intraoperative period anesthesia

A

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
Q
A

NUR 220 (6 decks)

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