intrapartum Flashcards
Advantages on FEM ultrasound
continuous graphic recording
Baseline, variability, changes in FHR
Noninvasive
Doesn’t require ROM
Nurse can place
disadvantages to FEM ultrasound
Susceptible to interference with movement
Weak signal
Tracing may be difficult to interpret
where should the ultrasound be placed to obtain the best reading?
Fetal shoulder area
advantages of FEM with toco monitor
Noninvasive, easy to place
Intermittent use
Permanent continuous recording
Nurse can place and palpate contractions
disadvantages of FEM with toco monitor
Nurse must compare to subjective data
belt may be uncomfortable
Mom may feel limited to move
Doesn’t measure intensity
where should the Toco monitor be placed to get the best reading?
On the fundus
Advantages of internal fetal scalp monitor
Clear tracings
Better information about variability
Nurse can place
Useful for overweight moms, due to increased Adipose tissue
Disadvantages of fetal scalp monitor
infection, injury
Requires ROM, cervical dilation, invasive
Cannot be used in HIV positive moms
advantages of IUPC
Pressure measurements for intensity/resting tone
Accurate timing of contractions
Permanent record of uterine activity
Disadvantages of IUPC
ROM required with adequate dilation
Invasive
Risk for infection, uterine/personal injury
Provider places
ways to test rupture of membranes
Nitrazine paper
Ferning test
Amnisure
early decelerations
Caused by head compression
Mirrors inversely; contraction increases, HR decreases
Last 30 seconds
Occurs at zero station
Late decelerations
due to uteroplacental insufficiency,
Hypo/hypertension, bleeding
Onset at peak of contraction
variable decelerations
Due to cord compression
With or without contractions
Abrupt onset to Nadir
Are intermittent variable decelerations normal?
Yes, physiologic labor response
Nursing interventions for decelerations
change position
Oxygen
Turn oxytocin off
IVF. Bolus.
Lower HOB
prolonged decelerations
Greater than or equal to two minutes for less than 10 minutes
What is considered a baseline change?
Increase or decrease in heart rate for longer than 10 minutes
sinusoidal pattern
Perfect waveform, category three
Indicates acidosis
Notify HCP, need to be delivered
what is the best indication of fetal oxygenation?
Variability
Absent variability
undetectable
In distress
Minimal variability
<5 bpm
Can indicate sleep cycle, pain, medication, relaxation, magnesium sulfate
moderate variability
6–25 bpm
Desired range
Marked variability
> 25 bpm
if the baby is tachycardic what is the next best nursing action?
Check the mothers temperature
reassuring FHR
110–160
Long-term variability
Appropriate accelerations
non-reassuring FHR
Late decelerations
Low variability
Severe Brady/tachycardia
Sinusoidal pattern
Persistent variables
nursing care for non-reassuring patterns
Change positions
Turn off Pitocin
Increase IVF
Lower HOB
Oxygen – 10 L nonrebreather
Notify HCP and document
Tocolytics, if contracting
Delivery preparation
Nursing Care first stage latent
anticipatory guidance
Encourage ambulation
VS Q1 hour
Temp Q4/Q2 ROM
FHR Q 30–60 minutes
nursing Care, first stage active
Palpate contractions Q 15–30 minutes
Vaginal exam
Encourage voiding Q 1–2 hours
IVF
Auscultate, HR 15–30 minutes
VS Q 15–30 minutes
Change positions and pads
nursing Care, first stage transition
Palpate contractions Q 15 minutes
Sterile vaginal exam
FHR 15–30 minutes
assist with breathing
Keep from pushing less than 10 cm
* peanut ball good for epidural
Comfort care first stage
clear fluids, ice chips
Ambulation, Peri care
Position changes
Distraction, circular massage
Firm pressure on back/sacrum
Controlled breathing
Hydrotherapy
Nursing, Care, Second stage
sterile vaginal exam
FHR Q 5– 15 minutes
VS Q 30 minutes
Assist with pushing and birth
Comfort second stage
cool cloth
Rest between contractions
Assist into pushing position
nursing Care third stage
Newborn care
Provide stimulation and maintain warmth
Apgar, newborn ID
Facilitate kangaroo care
Monitor for delivery of placenta
nursing Care fourth stage
VS Q 15 minutes for first hour
IVF. – Pitocin.
Palpate fundus Q 15 minutes for first hour
Assess vaginal bleeding
Assist with feeding methods
Comfort care fourth stage
Heated blanket
Food/fluids, PRN
Ice pack to perineum
Pain, meds, PRN
postpartum danger signs
Hypotension
Tachycardia
Uterine atony
Excessive bleeding
Hematoma
discharge criteria
Stable vital signs, bleeding
Nondistended bladder
Firm fundus
Report return of sensations from anesthesia
