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Mgmt Test 3 - OB > High Risk L&D > Flashcards

High Risk L&D Flashcards

1
Q

the majority of preterm deaths occurs in babies less than

A

32 weeks gestation

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2
Q

prevention of preterm labor

A

lifestyle changes
progesterone
prenatal care

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3
Q

only effective medication thought to prevent PTL

A

progesterone

given to women who have hx of PTL/short cervix

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4
Q

how does progesterone work

A

anti-inflammatory

supplements low progesterone

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5
Q

determining a short cervix

A

vaginal ultrasound - measures how many cm

vaginal exam

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6
Q

real dx of labor

A

dilation of the cervix

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7
Q

fetal fibronectin test

A

protein substance found between the maternal and fetal membranes (amniotic chorion)
vaginal swab test - must be done prior to vaginal exam to prevent false positive

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8
Q

should we treat a mom in preterm labor w/group b strep

A

yes- treat as if she does

norm test for group b strep 37-38 weeks

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9
Q

treatment for group b strep - preterm

A

ampicillin or penicillin

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10
Q

infections/fxrs contributing to preterm labor

A 
stds
chorio - infected membranes
dental problems
bladder/kidney infection - always do urinalysis
cbc - wbc count
pneumonia (systemic infections)
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11
Q

best treatment if mom is in preterm labor

A

betamethazone (injectable steroid) 12mg IM x2
stimulates baby lungs to produce surfactant
begins to work 24hrs after started - try to hold labor off

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12
Q

another benefit of betamethazone

A

decreases inner-ventricular hemorrhage

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13
Q

another drug routinely given in preterm labor

A

mag sulfate - loading dose
uterus cant contract (relax smooth muscle of the uterus) blocks calcium of the neuromuscular junction (wont allow acytlcholine to make jump between neuro and muscles)

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14
Q

while on mag sulfate check pt for

A

urine output
reflexes
watch fetus for depression (decreased variability/resp. depression)

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15
Q

if mag sulfate doesn’t work to stop preterm labor, what other meds can we try

A

All are off label medications
terbutaline
nifedipine
indomethicin

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16
Q

terbutaline s/e for mom

A 
tremors
tachy
arythmias
chest pain - may need ekg
pulmonary edema esp. w/steroid use
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17
Q

nifedipine - action

A

anti-hypertensive

calcium channel blocker - like mag sulfate

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18
Q

indomethicin - action

A

anti prostoglandin

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19
Q

how is terbutaline given

A

injection - turn off mag sulfate

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20
Q

max amt of time terbutaline, nifedipine, indomethicin is given/used for

A

48-72 hours; they are too strong; too many adverse affects

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21
Q

gold standard med for preterm labor

A

mag sulfate

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22
Q

nifedipine s/e

A

BP - easy Hypertension

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23
Q

indomethicin s/e for fetus

A

can constrict the ductus arteriosis - they need that open while a fetus
cannot be given after 32 weeks - early preterm labor

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24
Q

what happens physiologically if you are on bed-rest

A

muscle atrophy

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25
risk fxr for preterm labor
age stressful job poor nutrition reduce/stop smoking
26
why would we want to induce labor
``` pre-eclampsia diabetes infection (chorionamnioitis) post term preg PROM (after 24 hours infection can start) fetal death ```
27
classification of post term pregnancy
42 weeks
28
who shouldn't be induced
placenta previa transverse lie cord prolapse herpes infection
29
a lot of times inductions lead to what
c-sections - as many as 2/3 of patients
30
determining readiness for induction
bishop score based on 13
31
what does the bishop score look at (5 things)
``` dilation effacement station cervical consistency cervical position ```
32
a bishop score of 8 or more
most likely succeed w/induction w/vaginal delivery
33
a bishop score of 6 or less
cervical ripening required prior to starting pitocin
34
which medication is used for induction
pitocin
35
what is cervical ripening
softening/thinning of cervix
36
medications used for cervical ripening
cytotec - prostoglanding agent (off label (gastric ulcers)) | prepodil
37
mechanical means for cervical ripening
mechanical dilators Cooks catheter w/balloon - irritates cervix to produce own prostoglandin & ripen cervix for dilation can take pt to 5cm
38
why is cervical ripening done
low bishop score | firm, uneffaced, undialated cervix
39
how is cytotec given
a 100mg tablet broken into 4 pcs(25mg each) put into vagina next to cervix causes cramping/contractions may put pt into labor very strong
40
how is prepodil given
gel inserted w/syringe(tube) onto cervix | works in the same way as cytotec, not as strong
41
mechanical means for inducing labor
Sweeping membranes - separates sac from wall of cervix - releases prostoglandins Amniotomy - ruptured membranes - always check fetal hearts
42
if pressure on the cord what will we see on fetal monitoring
bradychardia | variables
43
what is labor augmentation
stimulation of labor after it begins, due to slowing/stopping
44
methods to initiate labor augmentations
amniotomy - rupture membranes nipple stimulation - every 2-3 min oxytocin
45
nurs considerations for induction/augmentation
uterine tachysystole - contractions more than 5-10 min; contracting every 1-2 minutes lasting a min
46
nurs mgmt for uterine tachysystole
``` reduce/discontinue pitocin (esp non-reassuring FHR) iv fluid bolus turn mom on left side 8-10 L of oxygen terbutaline (given for preterm labor) ```
47
dysfunctional labors are
long, difficult, abnormal labor
48
dysfunctional labor classifications
powers - dysfunctional labor pattern (contractions not strong/long enough) passage - small pelvic diameters, full bladder (baby can't come down) passenger - unusually lg baby (maternal diabetes), Mal-presentation, multi-fetal (twins, multiples)
49
dysfunctional labor patterns
hypo-tonic (subnormal frequency) hypo-tonic (subnormal intensity) hypertonic tachysystole
50
norm contraction pattern classification
contractions 2-3 min lasting 60 sec. | pressure 75mmHg
51
hypo-tonic (subnormal intensity) classification | hypo-tonic (subnormal frequency) classification
contractions not measuring much
52
hyptertonic classification
Latent phase uncoordinated contractions give morphine-give her rest-wake up in nice labor pattern
53
tachysystole classification
contractions too close together uterus is over stimulated stop pitocin in extreme cases will give terbutaline
54
never give morphine in active labor t or f
true
55
operative delivery consists of
Forceps Vacuum extraction - can damage blood vessels in babies head; can get a hemorrhage shortens 2nd stage can be used w/moms who have cardiac problems can cause trauma after delivery
56
operative delivery methods nurs mgmt
membranes must be ruptured prior to implementing | ***MUST HAVE EMPTY BLADDER***
57
protocol for vacuum extraction
do not allow more than 3 pop offs
58
c-section (operative delivery) indications
non-reassuring strip (baby looking acidotic) CPD - cephalo pelvic disproportion active herpes infection
59
type of c-section incisions
classical - vertical incision (skin/uterus) pfannestial (bikini) horizontal incision (skin) w/low vertical uterine incision pfannestial (bikini) horizontal incision (skin) w/low transverse (horizontal) uterine incision
60
majority of c-sections today
pfannestial with horizontal through the uterus
61
which incisions are likely to open up if a women goes into labor after a c-section
vertical uterine incisions
62
important nursing consideration post c-section
parent/baby bonding
63
VBAC candidacy
2 or less previous low transverse c-sections w/no other uterine scars
64
risk of VBAC
uterine rupture
65
what happens in uterine rupture
fetus comes out of uterus and goes into abdomen placenta detaches mom hemorrhages
66
what is shoulder dystocia
shoulder gets stuck behind moms pubic bone
67
shoulder dystocia risk to fetus
asphyxia - emergency injured/broken clavicle palsy (may never fully heal)
68
shoulder dystocia risk to mom
increased vaginal bleeding
69
2 signs of shoulder dystocia
double chin - sucked back in | turtle sign - head coming in/out
70
nursing interventions for shoulder dystocia
push moms feet as far back as possible to open outlet | place fist above pubic bone, push down to "unlock" shoulder
71
what is a prolapsed cord
cord slips through presenting part and the cervix babies head comes down and blocks it sometimes it hidden; sometimes its evident
72
treatment priority for prolapsed cord
position change (all fours) relieve pressure on the cord manually hold head off cord stat c-section
73
what is uterine inversion
the uterus turns inside out
74
risk of uterine inversion
maternal hemorrhage - must give a lot of blood products
75
trt for uterine inversion
manually replace the inverted uterus
76
what is anaphylactoid syndrome of pregnancy
amniotic fluid gets into maternal blood stream
77
anaphylactoid syndrome of pregnancy can cause
severe respiratory distress pulmonary collapse rt/lt sided HF clotting/hemorrhage

Mgmt Test 3 - OB (7 decks)

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