instrumental and surgical births

Question 1

indications for instrumental birth

Answer 1

abnormal FHR pattern, prolonged second stage of labour, failure of the presenting part to fully rotate and descend into pelvis, lifted sensation, inability to push due to regional anaesthesia, heart disease, pulmonary edema, client exhaustion, or infection

Question 2

TOL factors

Answer 2

informed consent, documentation, surveillance, readiness for emergency

Question 3

prevention to avoid using these methods

Answer 3

asking client to frequently change positions, ambulation, remind client to urinate (maximum space for uterus/birth), adequate hydration throughout birth

Question 4

what does the nursing care include

Answer 4

vital signs, contraction pattern, fetal stats, clients response to procedure

Question 5

risks for newborn

Answer 5

scalp lacerations and bruising, facial nerve palsy, retinal hemorrhage, hyperbilirubinemia (yellowing of skin), intracranial hemorrhage

Question 6

risks for mother

Answer 6

tearing (vacuum), homorrahe, lacerations (cuts) of the cervix, vagina, or perineum, infection

Question 7

factors for increased number of caesarean births

Answer 7

older childbearing age, increasing obesity, reduced parity, reduced number of forceps assisted births, convince to client and doctor, use of electronic fetal monitoring which identifies complications early on

Question 8

criteria to be met for instrument assisted birth to occur

Answer 8

proper analgesic is applied, vertex presentation, cervix is fully dilated and membranes are ruptured and head is fully engaged, informed consent
adequate backup is there and ready to respond if needed
back up plan
clients bladder is emptied

Question 9

what is a caesarean birth

Answer 9

surgical birth of the fetus through an incision in the abdomen and the uterine wall

Question 10

lochia

Answer 10

discharge after birth: blood, mucus, uterine tissue, heavy at first but will get lighter as it goes away, musty smell

Question 11

risks that occur with c sections for parent

Answer 11

thrombophlebitis, hemorrhage, aspiration, pulmonary embolism, urinary tract trauma, paralytic ileum and atelectasis

Question 12

what anesthesia is used for c sections

Answer 12

spinal, epidural or general
spinal and epidural is most common–>less risk and people are usually awake during the surgery

Question 13

nursing management for c section

Answer 13

diagnostic tests: CBC, ultrasound, urinalysis (checking for infection), blood type and cross-match
center on patient safety and supporting the needs of the family

Question 14

preoperative care

Answer 14

make sure client is informed of the benefits, risks, alternatives and that they consent
allow for discussion of fears and expectations
education
what is the family’s understanding of the procedure?
evaluate diagnostic test results
assess fetal status and client frequently

Question 15

how to reduce risks of postoperative complications

Answer 15

early ambulation
splinting of incision
surgical site care
positioning in bed with newborn
medications and other strategies for pain relief

Question 16

preoperative procedures

Answer 16

prepping the incision site
starting an IV infusion for fluid replacement as ordered
inserting catheter
administering preoperative medications as prescribed
surgical safety checklist

Question 17

postoperative care

Answer 17

assist with perineal care
encourage and assist ambulation
changing position in bed
inspect abdominal dressing and document drainage
assess uterine tone–>fundal firmness
check the IV line–>any redness around the site–>how is the flow rate?
assess for abdominal distension and auscletate bowel sounds

Question 18

how many times checking vital signs and lochia after surgery?

Answer 18

every 15 minutes for the first hour, every 30 minutes in the second hour, and then if stable, every 4 hours

Question 19

postoperative care for general anesthesia

Answer 19

encourage coughing
perform deep breathing exercises
use the incentive spirometer every 2 hours

Question 20

postoperative care for regional anesthesia

Answer 20

monitor for the return of sensation and motor control in the legs

Question 21

LOCs

Answer 21

asses these if sedative drugs were administered

Question 22

client teachings prior to discharge

Answer 22

recognize signs of infection, and postpartum hemorrhage
incision care
pain management strategies
review of prescription

Question 23

amnioinfusion

Answer 23

a volume of warmed, sterile normal saline or Ringer’s lactate solution is introduced into the uterus transcervically through an intrauterine pressure catheter
for olgiohydraminos present during labour

Question 24

what does amnioinfusion do?

Answer 24

changes the relationship of the uterus, placenta, cord and fetus to improve placental and fetal oxygenation
CUSHIONS UMBLICAL CORD TO PREVENT COMPRESSION DUHHH

Question 25

vbac contradictions

Answer 25

prior classic uterine incision
myomectomy (transfundal uterine surgery)
uterine scar other than low-transverse caesarean scar
placenta praevia
placenta malpresentation
uterine rupture
inadequate staff or facility to proved an emergency c-section if needed
client requests c-section, DOES NOT consent to TOL

Question 26

dystocia

Answer 26

slow dilation of cervix or descent of fetus during active labour

Question 27

risks for fetus c section

Answer 27

injury, transient tachypnea (retained fetal lung fluid)