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TEST 2 > Intrapartum 2 > Flashcards

Intrapartum 2 Flashcards

1
Q

Maternal Assessment during Labor and Birth:

a vaginal examination or ultrasound assessment is performed to assess cervical dilation ONLY IF

A
  • If there is no vaginal bleeding upon admission.
  • After which it is monitored periodically as necessary to identify progress.
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2
Q

WHAT IS ASSESSED DURING labor/birth

A
  • Woman-centered care
  • Upon Admission
  • Vital Signs: Temp, BP, HR, RR
  • Pain & Response to interventions
  • Vaginal Exam- Only if NO vaginal bleeding
  • Assess cervical
    -Dilation
    -Effacement
    -Position
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3
Q

Vaginal Assessment IS DONE every

A

4 hrs

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4
Q

Vaginal assessment includes:

A
  • cervix: dialation 0-10cm
  • effacement 0%, 50%, or 100%
  • Fetal: position, station, skull
  • Rupture of membranes- PRIORITY CHECK
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5
Q

UNRUPTURE of membranes will feel like

A

soft bulge

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6
Q

Why is Rupture of membranes important to check ?

A
  • identify FHR deceleration indicating cord compression secondary to cord prolapse.
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7
Q

To confirm Rupture of membranes what test is done?

A
  • Nitrazine yellow dye swab is used on sample of fluid from vagina.
  • POS rupture = swab turns blue-green with PH 6.5 - 7.5 (amniotic fluid is more ALKALINE)
  • NEG rupture = swab remains yellot to olive green with ph 5-6.
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8
Q

AFTER rupture of membranes, signs of intrauterine infection sinclude

A
  • maternal fever
  • fetal and maternal tachycardia
  • foul odor of vaginal discharge
  • increase in white blood cell count
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9
Q

Assessing Uterine contractions:
When PALPATIONIng uterine describe how it feels.

A

Place pads of your fingers on fundus & describe how it feels:
* Tip of nose (mild)
* Chin (moderate)
* **Forehead (strong) **

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10
Q

What intensity (in mm/Hg) is needed for cervical dialation to start

A
  • 30 mm Hg or greater are needed for cervical dilation
  • during labor: intensity reaches @ 50 to 80 mm Hg.
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11
Q

Maneuver 1:
soft and irregular feel on fundus is

A

the buttocks

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12
Q

Maneuver 2:
hard and smooth and round feel on fundus is

A

the head

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13
Q

Maneuver 2:
finding fetal back should feel

A

hard and smooth

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14
Q

Maneuver 3:
If presenting part in symphysis pubis is ROUND, FIRM, AND ballattable

A

the head

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15
Q

Maneuver 3:
If presenting part in symphysis pubis is soft and irregular

A

the buttocks.

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16
Q

Manuever 4:

(turn facing moms feet for this step only)
if palpate a hard area on OPPOSITE SIDE Of fetal back fetus is in

A

flexion - this is what we want.

hard area on opposite side of fetal back that means you have touched its chin

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17
Q

Manuever 4:

(turn facing moms feet for this step only)
if palpate a hard area on SAME SIDE of fetal back then fetus is in

A

Extension - area palpated is the occiput (back of head)

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18
Q

cultural considerations with pain:

  • Placing a hatchet or knife under the bed – cuts pain
A

APPALACHIAN culture

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19
Q

cultural considerations with pain:
* Moms at birth

A

Asian, Latina, Orthodox Jew

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20
Q

cultural considerations with pain:
* remain quiet

A

Cherokee, Hmong, Japanese

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21
Q

MOM non-coping signs

A
  • crying/fear
  • no focus or concentrated
  • panicked during contractions
  • jitteriness
  • clawing/biting
  • tense
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22
Q

Coping with labor:

Nurse should observe for

A
  • cues for 15-30 mins and throughout labor
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23
Q

Nonpharmacologic measures include

A
  • Continuous Labor Support - Assisting
  • hydrotherapy- tub
  • ambulation and position change (q30 mins)
  • acupuncture and acupressure
  • patterned-paced breathing (pursed lips)
  • Attentionc focus/imagery
  • massage/effleurage (stroking of abdomen)
  • heat or cold applications
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24
Q

Hydrotherpy only to be used when pt is

A

in active labor >6 cm dialated

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25
Q

Pharmacologic Measures for pain relief during labor includes

A
  • Systemic, Regional, or Local Anesthesia
  • Neuraxial Analgesia/Anesthesia - Epidural Or Intrathecal
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26
Q

System Analgesia

A
  • adminsitered via: PO, IM, IV
  • Most important complication respiratory depression
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27
Q

Systemic Analgesia:

opioids given CLOSE TO TIME OF BIRTH can cause

A

CNS depression in newborn

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28
Q

Reversal drug of Opioids

A

naloxone (narcan)

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29
Q

categories of drugs used in SYSTEMIC ANALGESIA

A
  1. Opioids: butorphanol, nalbuphine, meperidine, morphine, fentanyl
  2. Ataractics: hydroxyzine, promethazine, prochlorperazine
  3. Benzodiazepines: diazepam, midazolam
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30
Q

INHALED ANALGESIC

A
  • Nitrous oxide “Laughing Gas”
  • 50% nitrous oxide gas
  • 50% oxygen
  • using a mask or mouthpiece
  • Maternal control-self administered
31
Q

NITROUS OXIDE SIDE EFFECTS

A
  • N/V, dizziness, dysphoria
  • NO fetal abnormalities to its use
32
Q

Regional Anesthesia is the LOSS OF PAIN SENSATIoN below

A

T8 - T10

  • Without loss of consciousness
  • With or without added opioids
33
Q

DIFFERENT TYPES OF REGIONAL ANESTHESIA

A
  • Epidural Block
  • Combo – Spinal/Epidural
  • Local Infiltration (ONLY on site)
  • Pudendal block (in perineum)
  • Intrathecal (spinal) Anesthesia/Analgesia
34
Q

Type of anesthesia:

INJECTIONof a local anesthetic agent and an opioid analgesic agent INTO THE LUMBAR EPIDURAL SPACE

A

EPIDURAL ANALGESIA

35
Q

CONTRAINDICATIONS for Epidural analgesia

A
  • H/O spinal surgery or abnormalities
  • Coagulation defects
  • Cardiac disease
  • Obesity
  • Infections
  • Hypovolemia
  • On anticoagulation
36
Q

type of anesthesia:

  • Combines a spine and epidural anesthesia
  • one needle in epidural space and other in subarachnoid space
  • Opioid WITHOUT anesthesia
A

Combo spinal and epidural analgesia

37
Q

Advantages of COMBO

A
  • Works faster (3 to 5 mins)
  • Allows ambulation “walking epidural”
  • Lower incidence of urinary retention
38
Q

TYPE OF ANESTHESIA:

  • Local anesthetic in perineal area before an episiotomy
  • Doesn’t alter pain of contractions
  • Doesn’t cause side effects
A

Local infiltration
(numbs immediate area)

39
Q

type of anesthesia:

  • Local anesthetic in pudendal nerve
  • Pain relief - lower vagina, vulva, & perineum
A

Pudendal Nerve Block

40
Q

local infiltration and Pudendal nerve block INDICATIONS

A
  • 2nd stage of labor
  • Episiotomies (cut (incision) made in the tissue between the vaginal opening and the anus during childbirth. This area is called the perineum)
  • Birth with forceps or vacuum extraction
  • Takes 15 mins to work
  • NO common maternal or fetal complications
41
Q

TYPE OF ANESTHESIA:

  • Anesthetic agent with or without opioids
  • INTO Subarachnoid space
  • INTRATHECAL- into cerebral spinal fluid
  • For emergent or elective C/S
A

SPINAL (INTRATHECAL) ANESTHESIA

42
Q

Compared to epidurals, SPINALs are

A
  • Easy to administer
  • Need smaller med. Vol.
  • Rapid onset pain relief
  • Less - Newborn Respiratory Depression
  • NO motor blockade
43
Q

ADVERSE REACTIONS TO SPINAL ANALGESIA

A
  • HYPOTENSION
  • SPINAL HEADACHE
44
Q

TYpe of anesthesia:

  • reserved for ER cesarian births- no time for spinal/epidurals
  • OR if woman contraindicates for regional anesthesia
  • RAPID loss of consciousness
A

GENERAL ANESTHESIA

45
Q

How is GENERAL ANESTHESIA administered

A
  • IV or inhalation
  • UNCONSCIOUS followed by MUSCLE RELAXANT & INTUBATION
46
Q

Complications with General anesthesia

A
  • fetal depression
  • maternal comiting & aspiration
47
Q

Nursing considerations:

Antacids to administer during General anesthesia to REDUCE GASTRIC ACIDITY

A
  • Nonparticulate (clear) ORAL antacid: Bicitra or sodium citrate
    OR
  • Proton pump inhibitor: protonix as ordered
48
Q

Do ALL anesthetic agents cross placental barrier and affect fetus?

A

YES

49
Q

ADmission history:

MAIN things that nurses can do during admission assessment for pregnant women.

A
  • EDD, VS, GTPAL
  • perform leopold’s
  • perform vaginal exam
  • assess & interpret FHR to contractions
  • Fundal height measurement
50
Q

Labs needed include

A
  • UA
  • Blood Type & RH
  • Syphilis
  • Hep B
  • HIV
  • Drug Screening
  • Group B Strep
51
Q

RX GIVEN AT ONSET OF LABOR OR ROM (rupture of membrances)

A

PCN (penicillin)

52
Q

What is an episiotomy

A

a cut (incision) through the area between your vaginal opening and your anus to provide MOER SPACE to the presenting fetus heaad.

53
Q

Nursing interventions:
During 1st stage of labor

A
  • Provide clear fluids
  • Maintain parenteral fluids
  • Keep perineal area clean and dry
  • Check on bladder status q 2 hr. & encourage voiding
  • Encourage maternal movement
54
Q

Nursing interventions:
During 2nd stage of labor

A

IF no complication= nurses dont control this stage rather empower mom
* direct mom towards effective pushing positions
* perineal lacerations occur- extent of lacerations is defined by its DEPTH.

55
Q

PERINEAL lacerations: 1st degree

A

laceration extends through the skin

56
Q

Perineal lacerations: 2nd degree

A

laceration extends through the muscles of the perineal body (muscles)

57
Q

Perineal lacerations: 3rd degree

A

Through anal sphincter
muscle

58
Q

Perineal lacerations: 4th degree

A

involves anterior rectal wall

59
Q

SIGNS of 2nd stage of Labor

A
  • incr of bloody show
  • rectal or perineal pressure
  • crowning ( see babys head)
60
Q

2nd stage of labor begins and ends when

A
  • Begins with cervical completion
  • Ends with birth of the infant
61
Q

Once fetal head emerges:

Birth attendant explores fetal neck for nuchal cord if YES

A

cord is slipped OVER HEAD

62
Q

AFTER HEAD DELIVERY

A
  • Birth attendant suctions mouth FIRST & nose SECOND
  • umbilical cord is double clamped & cut
63
Q

WHEN does 3rd stage of labor occur

A

delivery of baby to delivery of placenta

64
Q

3 IMPORTANT HORMONES PLAY A PART IN 3RD STAGE OF LABOR

A

Oxytocin
endorphins (cause analgesic effect)
adrenaline

65
Q

The hormone oxytocin causes

A
  • uterine contractions
  • helps the woman enact instinctive mothering behaviors such as holding the newborn close to her body and cuddling the baby.
66
Q

CONTINUATION of regular contractions does what

A
  • Leads to decrease in uterine size
  • Helps with placental separation
67
Q

Nurses during 3rd stage of labor need to observe s/s of placental separation which include

A
  • Firmly contracting uterus
  • Change in uterine shape from discoid to globular ovoid
  • Sudden gush of dark blood from vaginal opening
  • Lengthening of umbilical cord protruding from vagina
68
Q

NURSES CRUCIAL ROLE IN 3RD STAGE OF LABOR

A
  • To protect natural hormonal process by
  • Ensuring unhurried & uninterrupted contact between mom & baby after birth
  • Providing warmed blankets to prevent shivering
  • Allowing skin-to-skin contact with initial breastfeeding.
69
Q

SOFT AND WEAK UTERUS AFTER delivery
most common cause of Post-partum hemorrhage

A

uterine atony
(uterine tone)

70
Q

Nurses during 4th stage of labor should check V/S in the 1st hour of birth every

A

q 15 min then
q 30 min
* BP should remain stable
* Close obsevation for hemorrhage

71
Q

Baby head-to-toe VS are done every

A

15 mins until stable

72
Q

4th stage of labor:
Assess

A
  • perineal and vaginal area
  • lochia amount: blood loss after birth
  • Bladder- if full, displaces fundus to the right of midline.
73
Q

4th stage of labor:

assessing fundus

A
  • needs to remain firm= prevent excessive postpartum bleeding
  • feels/size/consistency of a GRAPEFRUIT
  • located in midline and below umbilicus
  • if boggy- massage it until it is firm!!!!!

TEST 2 (6 decks)

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