High Risk Intrapartum

Question 1

why are contractions lasting over 90 seconds dangerous?

Answer 1

can cause uterine rupture, fetal anoxia

Question 2

uterine tachysystole

Answer 2

more than 5 contractions in a 10 minute period

Question 3

uterine tachysystole treatment

Answer 3

tocolytics - terbutaline

Question 4

interventions for prolonged latent phase

Answer 4

increase/start pitocin, foley bulb

Question 5

protracted active phase

Answer 5

occurs d/t fetal malposition or CPD, dilation slows

Question 6

most common cause of arrest of descent

Answer 6

CPD, malposition

Question 7

hypotonic contractions

Answer 7

infrequent contractions, 0-3 in 10 min

Question 8

when are hypotonic contractions likely to occur

Answer 8

active phase of labor

Question 9

hypertonic contractions

Answer 9

tachysystole

Question 10

when are hypertonic contractions likely to occur

Answer 10

latent phase of labor

Question 11

risks of hypertonic contractions/tachysystole

Answer 11

fetal anoxia

Question 12

precipitate dilation

Answer 12

5+ cm/hour in nullipara and 10cm/hour in multipara

Question 13

risks of precipitate birth

Answer 13

maternal hemorrhage, tearing, fetal subdural hematoma, fetal RDS

Question 14

medications to encourage effacement

Answer 14

misoprostol, dinoprostone

Question 15

how does the foley bulb work?

Answer 15

oxytocin loop, strengthens contractions to increase dilation

Question 16

oxytocin risks

Answer 16

PPH, tachysystole, hypotension, water toxicity

Question 17

water toxicity s/s

Answer 17

headache, dizziness, n/v, oliguria

Question 18

nursing interventions for prolapsed cord

Answer 18

staff assist, Trendelenburg

Question 19

most common cause of a prolapsed cord

Answer 19

PROM, AROM

Question 20

turtle’s sign

Answer 20

sign of shoulder dystocia, head pokes in & out

Question 21

risk factors for shoulder dystocia

Answer 21

large baby - macrosomia, post term

Question 22

nursing interventions for shoulder dystocia

Answer 22

McRobert’s Maneuver, suprapubic pressure

Question 23

CPD

Answer 23

cephalopelvic disproportion, fetal head is too large to pass

Question 24

CPD treatment

Answer 24

can have a TOL, if adequate progress does not occur then C section

Question 25

external cephalic version

Answer 25

procedure to turn fetus to occipital/cephalic presentation

Question 26

risks of external cephalic version

Answer 26

rupture, cord compression

Question 27

velamentous insertion of the cord

Answer 27

umbilical cord attaches outside of the placenta, vessels are exposed

Question 28

velamentous cord insertion concerns

Answer 28

hemorrhage

Question 29

vasa previa

Answer 29

umbilical cord delivers before the fetus, risk of cord tearing

Question 30

vasa previa concerns

Answer 30

hemorrhage, impaired blood flow to fetus

Question 31

most common uterine rupture cause

Answer 31

previous C sections

Question 32

s/s of uterine rupture

Answer 32

NRFHT, loss of fetal station, abd pain, hypovolemic shock

Question 33

management of uterine rupture

Answer 33

blood, fluids, surgery advise not to conceive again

Question 34

amniotic fluid embolism s/s

Answer 34

hypoxia, hypotension, CV collapse, DIC

Question 35

AFE treatment

Answer 35

fluids, blood, coags, CPR, oxygenate, emergency birth

Question 36

amniotomy risks

Answer 36

prolapsed cord, infection

Question 37

amniotomy nursing interventions

Answer 37

FHR, note fluid color & amount, infection assessment, monitor temp

Question 38

most common C section indications

Answer 38

CPD, active HSV/HIV, classical incision, placenta previa, cord prolapse, macrosomia, NRFHT, fetal malposition, multi gestation

Question 39

most severe risks of C section

Answer 39

hemorrhage, AFE, fetal RDS, fetal asphyxia