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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
Q

risk fxr for preterm labor

A

age
stressful job
poor nutrition
reduce/stop smoking

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26
Q

why would we want to induce labor

A 
pre-eclampsia
diabetes
infection (chorionamnioitis)
post term preg
PROM (after 24 hours infection can start)
fetal death
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27
Q

classification of post term pregnancy

A

42 weeks

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28
Q

who shouldn’t be induced

A

placenta previa
transverse lie
cord prolapse
herpes infection

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29
Q

a lot of times inductions lead to what

A

c-sections - as many as 2/3 of patients

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30
Q

determining readiness for induction

A

bishop score based on 13

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31
Q

what does the bishop score look at (5 things)

A 
dilation
effacement
station
cervical consistency
cervical position
32
Q

a bishop score of 8 or more

A

most likely succeed w/induction w/vaginal delivery

33
Q

a bishop score of 6 or less

A

cervical ripening required prior to starting pitocin

34
Q

which medication is used for induction

A

pitocin

35
Q

what is cervical ripening

A

softening/thinning of cervix

36
Q

medications used for cervical ripening

A

cytotec - prostoglanding agent (off label (gastric ulcers))

prepodil

37
Q

mechanical means for cervical ripening

A

mechanical dilators
Cooks catheter w/balloon - irritates cervix to produce own prostoglandin & ripen cervix for dilation
can take pt to 5cm

38
Q

why is cervical ripening done

A

low bishop score

firm, uneffaced, undialated cervix

39
Q

how is cytotec given

A

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
Q

how is prepodil given

A

gel inserted w/syringe(tube) onto cervix

works in the same way as cytotec, not as strong

41
Q

mechanical means for inducing labor

A

Sweeping membranes - separates sac from wall of cervix - releases prostoglandins
Amniotomy - ruptured membranes - always check fetal hearts

42
Q

if pressure on the cord what will we see on fetal monitoring

A

bradychardia

variables

43
Q

what is labor augmentation

A

stimulation of labor after it begins, due to slowing/stopping

44
Q

methods to initiate labor augmentations

A

amniotomy - rupture membranes
nipple stimulation - every 2-3 min
oxytocin

45
Q

nurs considerations for induction/augmentation

A

uterine tachysystole - contractions more than 5-10 min; contracting every 1-2 minutes lasting a min

46
Q

nurs mgmt for uterine tachysystole

A 
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
Q

dysfunctional labors are

A

long, difficult, abnormal labor

48
Q

dysfunctional labor classifications

A

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
Q

dysfunctional labor patterns

A

hypo-tonic (subnormal frequency)
hypo-tonic (subnormal intensity)
hypertonic
tachysystole

50
Q

norm contraction pattern classification

A

contractions 2-3 min lasting 60 sec.

pressure 75mmHg

51
Q

hypo-tonic (subnormal intensity) classification

hypo-tonic (subnormal frequency) classification

A

contractions not measuring much

52
Q

hyptertonic classification

A

Latent phase
uncoordinated contractions
give morphine-give her rest-wake up in nice labor pattern

53
Q

tachysystole classification

A

contractions too close together
uterus is over stimulated
stop pitocin
in extreme cases will give terbutaline

54
Q

never give morphine in active labor t or f

A

true

55
Q

operative delivery consists of

A

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
Q

operative delivery methods nurs mgmt

A

membranes must be ruptured prior to implementing

MUST HAVE EMPTY BLADDER

57
Q

protocol for vacuum extraction

A

do not allow more than 3 pop offs

58
Q

c-section (operative delivery) indications

A

non-reassuring strip (baby looking acidotic)
CPD - cephalo pelvic disproportion
active herpes infection

59
Q

type of c-section incisions

A

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
Q

majority of c-sections today

A

pfannestial with horizontal through the uterus

61
Q

which incisions are likely to open up if a women goes into labor after a c-section

A

vertical uterine incisions

62
Q

important nursing consideration post c-section

A

parent/baby bonding

63
Q

VBAC candidacy

A

2 or less previous low transverse c-sections w/no other uterine scars

64
Q

risk of VBAC

A

uterine rupture

65
Q

what happens in uterine rupture

A

fetus comes out of uterus and goes into abdomen
placenta detaches
mom hemorrhages

66
Q

what is shoulder dystocia

A

shoulder gets stuck behind moms pubic bone

67
Q

shoulder dystocia risk to fetus

A

asphyxia - emergency
injured/broken clavicle
palsy (may never fully heal)

68
Q

shoulder dystocia risk to mom

A

increased vaginal bleeding

69
Q

2 signs of shoulder dystocia

A

double chin - sucked back in

turtle sign - head coming in/out

70
Q

nursing interventions for shoulder dystocia

A

push moms feet as far back as possible to open outlet

place fist above pubic bone, push down to “unlock” shoulder

71
Q

what is a prolapsed cord

A

cord slips through presenting part and the cervix
babies head comes down and blocks it
sometimes it hidden; sometimes its evident

72
Q

treatment priority for prolapsed cord

A

position change (all fours)
relieve pressure on the cord
manually hold head off cord
stat c-section

73
Q

what is uterine inversion

A

the uterus turns inside out

74
Q

risk of uterine inversion

A

maternal hemorrhage - must give a lot of blood products

75
Q

trt for uterine inversion

A

manually replace the inverted uterus

76
Q

what is anaphylactoid syndrome of pregnancy

A

amniotic fluid gets into maternal blood stream

77
Q

anaphylactoid syndrome of pregnancy can cause

A

severe respiratory distress
pulmonary collapse
rt/lt sided HF
clotting/hemorrhage

Mgmt Test 3 - OB (7 decks)

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