Labor and Birth Management Ch 14 Flashcards
What is the Amnio Hook used for?
A device to artificially rupture membranes and induce labor.
What are the abnormal findings of the amniotic fluid?
Blue, green, black fluid.
Indicates baby passed meconium in the utero - should not happen.
Indications for meconium in the amniotic fluid. (2)
Fetal hypoxia and fetal distress.
Normal duration of uterine contractions.
30-60 seconds.
What is the purpose of Leopold Maneuvers? Describe Maneuver 1, 2, 3, 4.
Method to determine presentation, position, and lie of the fetus.
M1: Where to find the head and buttocks in the fundus.
M2: Identify the fetal back.
M3: Presenting part.
M4: Indicate for engagement in pelvis.
What does the Electronic Fetal Monitor (EFM) assess?
Oxygenation and Heart Beat
How long should be the first FHR assessment upon entry into L&D area?
10-20 minutes.
Describe absent baseline variability?
The baby is dead.
Undetectable fluctuation range.
Minimal Variability
Baby is usually asleep, and/or the mother is on magnesium.
<5pm Fluc.Range
Moderate Variability
Baby is well oxygenated.
FR: 6-25 bpm.
What is the fluctuation range for marked variability?
> 25 bpm
What is umbilical cord analysis?
Samples are drawn from the umbilical cord to analyze acid-base levels of the newborn.
Normal pH: 7.2-7.3
What is fetal scalp stimulation? Outcome? Precaution (Vibroacoustic)? Contraindications (4)?
Evaluates fetal oxygenation and acid/base balance.
The réponse is active when the baby is well oxygenated. Fluctuation and accelerations are present in the EFM.
Precaution: Vibroacoustic stimulation may cause agitation on stomach.
Contraindication: Preterms, IU infection, placenta previa, fever.
List nonpharmacologic measures for pain management (7).
- Continuous labor support
- Hydrotherapy
- Ambulation and position changes
-Accupunture and acupressure
Attention focusing and imagery - Effleurage
- Breathing techniques
What is the epidural block used for during labor?
Provides pain relief from contractions and birth canal distention.
{local anesthetic and opioid into epidural space}
What is the pre-procedure nursing action for epidural block therapy?
Obtain consent from patient and administer bolus of IV fluid (PCA Pump)
Adverse effects of Epidural Block (4)
maternal hypotension
fetal bradycardia (decelerations: d/t bolus, IUR, ephedrine)
inability to sense need to void
loss of bearing down reflex
What is are nursing actions after epidural therapy (6)?
Assess for orthostatic hypotension
Administer IV vasopressor (ephedrine)
Place mother on side
provide oxygen
Assess bladder
Monitor for sensation
How often should the nurse assess BP for hypotension (a.e. of epidural block)?
5-10 minutes
Why should the nurse administer IV bolus (w/ PCA pump) before the epidural block procedure?
Decreased rusk for hypotension.
What is the combines spinal-epidural block analgesia used for?
Used to block pain transmissions with conflicting motor functions.
Where to feel the effects of epidural block?
From the waist down.
Where to feel the effects of spinal block?
Whole body.
“Walking epidural”
Combined Spinal-Epidural Analgesia
How often is the patient controlled epidural analgesia (PCA) bolus administered?
q10 minutes
What is the Patient Controlled Epidural Analgesia (PCA) pump used for?
The PCA allows the patient to control dosage of the infused medication.
When is local infiltration (anesthetic) used during labor (3)?
Before episoitx and suture of lacerations, and precipitous delivery.
What body part does the pudendal nerve block anesthesia affect?
Lower vagina/ perineum
Medications of pudendal nerve block (3)
Ropivacaine and bupivicane
Indications for pudendal nerve block (3)
Stage 2 labor, epiostomy, operative vaginal birth
Can the pudendal nerve block block pain from uterine contractions.
No.
When can pudendal nerve block be administer before performing sutures?
10 minutes prior sutures.
How long is spinal block effective?
1-3 hours
Route of Spinal Block injection
subarachnoid space into spinal fluid
Main indication for spinal block anesthesia (2)
SCHEDULED Cesarean and labor birth
Complication of spinal block (2)
atony : uterus and bladder
h/a d/t CSF leakage at puncture site
maternal hypotension
How to use a blood patch to treat CSF leakage?
Draw blood and inject med into area of leakage to coagulate the bleeding.
What are the three medications used to while the patient is going through labor (vaginally and cesarean)? FDB
Fentanyl, Duramorph, Bupivacaine
What does the epidural block have that the spinal block does not?
Epidural is controlled by the PCA pump.
CONTINUOUS pain medication.
What is the main side effect of using spinal block? Intervention?
Pruritis; give antihistamine
How long should patient be NPO before schedule anesthesia?
patient most be NPO 8 hours before scheduled C-section
Routes of general anesthesia
IV and/or inhalation
Indications for general anesthesia
emergency c-section or the woman cannot use regional anesthesia
First degree Perineal Laceration
laceration that extends through the skin and vaginal mucous membrane
Second degree perineal Laceration
Extends to the fascia and muscle
Third degree perineal laceration
Extends to external anal sphincter
Fourth degree perineal Laceration
Extends completely through the rectal mucosa, disrupting both the internal and external anal sphincters
What are mother with third/fourth degree at risk for? (2)
Hemmorhage and constriction
What laceration finding is reportable to HCP?
Painful BM (from 3&4 degree laceration)
First findings for 4th degree laceration
Location of episiotomy suture lines.
Mediolateral (L or R) and Median (Midline)
Indication for episiotomy (2).
Macrocephaly
Mother cannot push the baby out anymore (LGA)
