L&D III Flashcards
what is the nursing responsibility during a version?
get NST and BPP to determine if baby is doing well and can tolerate procedure
What station does the baby need to be at to use the vacuum ?
zero station
What are we doing with a category three baby?
were going to go ahead and do a c section
what are you going to do if the mom is a repeat c section?
NST and BPP
when are prophylactic antibiotics given before surgery?
right before
when is classic c section indicated?
low lying placenta or placenta previa. possibly shoulder dystocia.
what are the criteria for trial of labor after cesarean vaginally
two or less low transverse
dysfunctional labor is a failure of ______________
tachystystole: turn off ______, (possibly give ______ if baby is really struggeling)
____ –hands in knees –standing up slightly.
one of the four Ps, Pitocin, tocolytic, OP
_______________ - occurs within 3 hrs of onset
_________________ – no provider present
Precipitatous labor, Precipatous birth
postdates is usually from moms who do not have _____________
prenatal care.
intrapartum emergencies:
Mortality can be ________: bc we can lose mom and baby
“200%”
What is placenta accreta, increta, percreta?
accreta -implanted into uterine wall
increta-myometrium
percreta -through uterus into other organs such as the bladder
these are all where the placenta implants too deep
______ is the least worst
_________ is middle worst
_________ is the worst
_____________________ are our biggest concerna
not uncommon for mom to loose _____ of blood with _____
THIS IS A MAJOR BLEEDING RISK
need to get a _________________________
accreta, increta, percreta, hemmorhage and infection, 3-5 L, percreta, blood transfusion consent
what can happen if you pull too hard on the umbilical cord while trying to get placenta out?
uterine inversion
what are s/s of unterine inversion?
absent or depressed fundal area
uterus poking through cervis into vagina
massive hemorrhage, shock, severe pain
what are risks with uterine ivnersion?
bleeding, infection, possible hysterectomy
what are nursing considerations for uterine inversion?
Maintain blood volume
Frequent fundal assessments
Observe vital signs and oxygen saturation
Monitor for shock/cardiac dysrhythmias
Foley catheter, intake and output
NPO until stable
when can uterine rupture occur? when does it happen most of the time?
pre, intra or postpartum. intrapartum
what are s/s of uterine rupture?
chest/shoulder pain, abd pain and tenderness
absent FHR
cessation of contractions
palpation of fetus outside uterus
hypovolemic shock
nursing considerations for uterine rupture
stabilize for c section
possible hysterectomy
blood and blood products
what do you do for prolapsed umbilical cord?
knee chest, trendelenburg, hips elevated with side lying, keep head off cord, prep for c section
what are diagnostic criteria for amniotic fluid embolus or anaphylactoid sydrome of pregnancy?
sudden onset of cardipulmonaryarrest or hypothension and respiratory compromise
DIC
during labor or within 30 min of placental delivery
afebrile during labor
what do patients report right before going into AFE?
doom feeling
what do late, variable, or prolonged decels indicate?
cord prolapse, cord compression, uteroplacental insufficiency
What is a sign of shoulder dystocia? what inteventions are indicated?
turtle sign,
for interventions -wait until physician tells you to
McRoberts (take moms leg and move knees back as far as we can to open area), suprapubic pressure, supine position, count time
what can turtle sign cause?
fetal hypoxia —cerebral paulsey
what is contraindicated with shoulder dystocia?
DO NOT push harder
what is the difference between PROM and PROM?
PROM -rupture of amniotic sac before true labor
PPROM -rupture of amnitoic sac before true labor and less than 37 weeks
What are special considerations with PROM?
no SVE and nothing to stimulate contractions, no breast stimulation
what is the biggest concern with PROM and PPROM? what are s/s
infection -yellow foul smelling fluid and fever
what is considered term labor and what is considered pre term labor? what is nonviable?
20-37 weeks is preterm
37-41 is considered term
less than 24 is nonviable
what can cause perterm labor?
infection, GDM, smoking, drug abuse, no preatal care, history of PTL, IVF
what is present when labor is about to occur and will tell you if mom is going to go into labor in the next two weeks?
fetal fibronectin swab
will fetabl fibronectin swab tell you she isnt going to go into labor?
DO NOT DO ___BEFORE DOING A FETAL FIBRONECTIN VAGINAL SWAB
no, SVE
What do oxytocic drugs do? what do you need to monitor for ?
stimulate contractions and prevent hemorrhage.
monitor tachysystole and also continuous FHR monitoring
what are the mostcommon oxytocic drugs used to prevent hemorrhage? what is it contraindicated with?
methergine (IM), contraindicated with HTN
hemabate (IM, IU) -asthma
what is oxytocin primarily used for?
induction of labor
what is cytotec ?
oxytocic given PO or IU
*Tocolytics are most likely to be used if ____ weeks… most effective if ____
MOST OF THESE ARE SHORT TERM: GET __________ ON BOARD AND SLOW LABOR PROGRESSION
<34, <3cm, CORTICOSTEROIDS
Tell me about terbutaline?
no long term use
given SQ
tocolytic
Tell me about magnesium sulfate?
tocolytic
no long term use
calcium gluconate is antidote
tell me about nifedipine
tocolytic, can be used long term
moms can take on their own
what is indomethacin ?
tocolytic
what do corticosteroids do and when are they indicated?
accelerate fetal lung maturity
indicated a birth at 24 to 34 weeks -two administrations
34-37 -single course
how much time is ideal for corticosteroids? how are they given?
24 hours. IM
