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labor and comp > labor and complications > Flashcards

labor and complications Flashcards

1
Q

True labor (3)

A
  • UC: regular, stronger, longer, closer, more intense if walking, more moaning, may not be able to breathe or talk
  • cervix: effaces, dilates, anterior position
  • fetus becomes engaged (in the pelvic inlet)
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2
Q

False labor (3)

A
  • UC: irregular or regular temporarily, may stop with position change
  • cervix: no change in effacement or dilation
  • fetus: not usually engaged
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3
Q

Premonitory signs of labor (6)

A
  • cervical changes (cervical softening, possible cervical dilation)
  • lightening: settled into pelvis, dropped down
  • increased energy level (nesting)
  • bloody show: bloody discharge, not bleeding just mixed with mucus
  • braxton hicks
  • srom
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4
Q

Critical factors affecting labor and birth, 5 P’s (5)

A
  • passageway (birth canal shape-pelvis and soft tissues)
  • passenger (fetus and placenta)
  • powers (contractions)
  • position (maternal)
  • psychological response (emotionally prepared, lamaze classes, interior factors that can predict good labor outcome or not)
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5
Q

Passenger (7)

A
  • fetal skull: info about the baby based on which part can be felt
  • fetal attitude: in the pelvis
  • fetal lie: direction of baby in the pelvis
  • fetal presentation: what presenting part is nearest the internal cervical os
  • fetal position: three letter abbreviation for id using presentation and lie
  • fetal station: where baby is located to zero station in between the pelvic inlets of mom
  • fetal engagement
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6
Q

Passenger: fetal skull (4)

A
  • largest and least compressible structure
  • sutures: allow for overlapping and changes in shape (molding), help identify position of fetal head
  • fontanels: intersections of sutures, help in identifying position of fetal head and in molding
  • diameters: occipitofrontal, occipitomental, suboccipitobregmatic, and biparietal
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7
Q

Dimensions of the skull (4)

A
  • occiput: back
  • sinciput: front
  • vetex: middle
  • biparietal: sides
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8
Q

Fetal lie (2)

A
  • longitudinal lie (up and down)

- transverse lie (side to side), can’t deliver vag

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9
Q

Fetal presentation: Cephalic/vertex (4)

A

-Cephalic (vertex): baby head down in the pelvis, arms over chest, knees flexed,
:military: same as general flexion but back is straight
:brow: the brow is presenting first
:face: the face is presenting first

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10
Q

Fetal Presentation: Breech (4)

A

-Breech: high-risk preg
:frank arms crossed, head down, legs straight up
:full or complete: general flexion but upside down, legs crossed
:footling or incomplete: general flexion with one foot sticking out straight

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11
Q

Fetal Position (5)

A

Landmarks:
: occipital bone (o): vertex presentation
: chin (mentum (m)): face presentation
: buttocks (sacrum (s)): breech presentation
: scapula/shoulder (acromion process (a)): shoulder presentation
-three-letter abbreviation for identification: ROP, LOT, LMA, RST, etc

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12
Q

Fetal Station (4)

A
  • assessed through sterile vagina exam and use 3 number abbrev for dilation, effacement of cervix (% how thin), fetal station of passenger ex: 5/80/-1
  • how far the baby is in the pelvis nearing the 0 station
  • above zero is negative 1-4
  • below zero is positive 1-4
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13
Q

Fetal engagement (2)

A
  • presenting part reaching 0 station

- floating: no engagement, presenting part freely movable about pelvic inlet

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14
Q

Cardinal movements

A

-normal birth movements

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15
Q

Powers (5)

A

-Uterine contractions (primary power)
-intra-abdominal pressure (from mother pushing and bearing down)
-contractions: involuntary–> thin and dilate cervix
-three parameters: frequency, duration, intensity
:intensity-uterus feels like
: mild: tip of nose
: moderate: tip of chin
: severe: tip of forehead

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16
Q

Position (5)

A

-nonmoving, back-lying positions during labor are usually not healthy
-maternal position can influence pelvis size and contours:
: changing position, walking–> facilitate fetal descent and rotation
: squatting, inc pelvic outlet by 25%
: kneeling (hands and knees), –> removes pressure on maternal vena cava, helps fetal rotation (posterior to anterior)

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17
Q

Benefits of maternal positions (9)

A
  • dec length of first stage labor
  • dec duration of second stage labor
  • dec number of assisted deliveries (vacuum and forceps)
  • dec episiotomies and perineal tears
  • contribute to fewer abnormal fhr patterns
  • inc comfort dec requests for pain med
  • enhance a sense of control by mom
  • alter the shape and size of pelvis, assisting in descent
  • assist gravity to move the fetus downward
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18
Q

Psychological response (7)

A

factors influencing a positive birth experience

  • clear info on procedures
  • support, not being alone
  • sense of mastery, self-confidence
  • trust in staff caring for her
  • positive reaction to pregnancy
  • personal control over breathing
  • preparation for childbirth experience
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19
Q

Physiologic responses to labor (9)

A
  • inc heart rate, cardiac output, blood pressure (during contractions)
  • inc white blood cell count
  • inc respiratory rate and 02 consumption
  • dec gastric motility and food absorption
  • dec gastric emptying and gastric ph
  • slight temp elevation
  • muscle aches/cramps
  • inc BMR
  • dec blood glucose levels
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20
Q

Fetal physio responses to labor (5)

A
  • periodic FHR accelerations and slight decelerations
  • dec in circulation and perfusion
  • inc in arterial CO2 pressure
  • dec in fetal breathing movements
  • dec in fetal oxygen pressure, dec in partial pressure of oxygen
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21
Q

Stages of Labor: 1 and 2 (6)

A

-First stage: true labor to complete cervical dilation (10 cm)
: Longest of all stages
: three phases
1) latent phase: 0-3 cm
2) active phase: 4-7 cm
3) transition phase: 8-10 cm
-Second stage: cervix dilated 10 cm to birth of baby

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22
Q

Stages of labor: 3 and 4 (4)

A
  • Third stage: birth of infant to placental separation
  • placental separation
  • placental expulsion
  • Fourth stage: 1-4 hours following delivery
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23
Q

Nursing care management of labor (6)

A

-General measures
: obtain admission hx
: check results of routine lab tests and any special tests
: ask about childbirth plan
: complete a physical assessment
-initial contact either by phone or in person

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24
Q

Admission assessment (8)

A

-maternal health history
-physical assessment (body systems, vital signs, heart and lung sounds, ht and wt)
: fundal ht measurement
: uterine activity, including contraction freq, duration, and intensity
: status of membranes (intact or ruptured)
: cervical dilation and degree of effacement
: fetal heart rate, position, station
: pain level

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25
Q

Continuing assessment (8)

A
  • woman’s knowledge, experience, and expectations
  • vital signs
  • vaginal examinations
  • uterine contractions
  • pain level
  • coping ability
  • FHR
  • amniotic fluid: color (clear), odor, consistency
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26
Q

Nursing interventions during labor (5)

A
  • supporting woman and partner in active decision making
  • supporting involuntary bearing down efforts, encouraging no pushing until strong desired or until descent and rotation of fetal head well advanced
  • providing instructions, assistance, pain relief
  • using maternal positions to enhance descent and reduce pain
  • preparing for assisting with delivery
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27
Q

Nursing care during labor and delivery (9)

A

1) Assessment
- placental separation
- placenta and fetal membranes examination
- perineal trauma: episiotomy, lacerations
2) Interventions
- instructing to push when separation is apparent
- giving oxytocin if ordered
- assisting woman to comfy position, providing warmth, applying ice to perineum if episiotomy
- explaining assessments to come
- monitoring mom’s physical status
- recording birth statistics, documenting birth in birth book

28
Q

Interventions with birth (6)

A

-cleansing of perineal area and vulva
-assisting with birth, suctioning of newborn (amnio fluid), and umbilical cord clamping
-providing immediate care of newborn
: drying
: apgar score: color, resp, crying, muscle tone, reflex
: identification

29
Q

Nursing care after delivery (12)

A

1) Assessment
- vital signs
- fundus
- perineal area
- comfort level
- lochia
- bladder status
2) Interventions
- support and info
- fundal check; perineal care and hygiene
- bladder status and voiding
- comfort measures
- parent-newborn attachment
- teaching

30
Q

Placenta Previa (10)

A 
-complete, partial, or marginal from implantation in lower uterus causing placenta to grow in front of uterus
Sx: 
-painless bleeding
-uterus is soft, non-tender
Care:
-stabilize mother and fetus
-VS,IV,CBC
-monitor FHR
-no vag exams
-ultrasound
-bedrest
-unstable-> deliver infant
31
Q

Abruptio Placenta (15)

A

-can be partial or complete, concealed or apparent hemorrhage
-placenta is pulling away from uterus, only 10% are viable
Sx:
-bleeding
-tenderness to pain
-backache
-abdominal firmness, rigidity, “boardlike abdomen”
-uterine hypertonicity: strong, long duration, frequent
-contractions
-shock
Care:
-stabilize mother and fetus
-VS, IV, CBC
-no vag exams
-monitor FHR, UC, observe
-unstable—> deliver c/s
-labs: prothrombin time (PI), activated partial thromboplastin (aPTT)

32
Q

DIC: disseminating intravascular coagulation (4)

A
  • precipitating events
  • thromboplastin release
  • fibrin clot formation
  • fibrinogen and platelet depletion
33
Q

DIC sx, lab, care (10)

A 
-secondary to something else that caused it
SX
-bleeding gums, nosebleed, petechiae, bruising with injections and venipuncture
-tachycardia
-diaphoresis
LAB
-low platelets
-low fibrinogen
-prolonged PT, PTT
Care
-correct underlying problem (need to deliver)
-volume/blood/blood product replacement
-oxygen
34
Q

Hypertension Classifications (7)

A
  • Pregnancy induced HTN (PIH): onset after 20 weeks, no proteinuria
  • Transient htn: isolated episode
  • preeclampsia
  • ecclampsia
  • chronic htn: had htn before pregnancy
  • chronic htn with superimposed preeclampsia
  • chronic htn/ecclampsia
35
Q

Pre-eclamspia (5)

A
  • htn: 140/90 or increase 30/15
  • proteinuria: 350 mg or more in 24 hours, +1 or higher on dipstick
  • edema
  • sx: blurry vision, starry eyes, dizziness, HA, epigastric pain
  • labs: elevated LFT, AST, ALT
36
Q

Pre-eclampsia etiology (3)

A
  • unknown
  • risk
  • young, primigravida, over 35, grand multigravida, multiple pregnancy, diabetes, severe obesity
37
Q

Patholophysiology of pre-eclampsia (3)

A
  • change endothelial cells
  • vasospasm of arteries
  • dec blood flow to organs
38
Q

HELLP SYndrome (6)

A 
H: hemolysis
EL: elevated liver enzymes
LP: low platelets
-can be caused by pre-eclampsia
-hepatic disfunction
-thrombocytopenia
39
Q

Management of PIH (2)

A

-assessment: early dx
-observation for edema
1+= 2mm 2+=4mm 3+=6mm 4+=8mm, pitting or dependent

40
Q

Evaluation CNS-DTR and Clonus (3)

A
  • check for deep tendon reflexes and clonus
  • brisk response isn’t good as sign of CNS stimulation when can mean impending seizure
  • clonus: foot relaxed and dorsiflex and release, should go back to place in a smooth manner, if stoccato count the beats/jerks
41
Q

Ecclampisa 3)

A
  • stop infusion of plasma and pitocin if seizing
  • stop meds, and use seizure precautions (pad bed rails, report, monitor, side laying position)
  • after use 02 via face mask
42
Q

Care of PIH (4)

A
  • bedrest, dec activity, dec CO
  • frequent prenatal visits and fetal assessments
  • self-care
  • diet
43
Q

Care for severe preeclampisa/eclampsia HELLP syndrome (6)

A
  • dx
  • hospital
  • bestrest/stabilization/delivery
  • seizure precautions
  • anticonvulsants
  • fetal monitoring/assessment
44
Q

Anti-convulsant: Magnesium Sulfate (8)

A
  • Pharmacology: blocks neuromuscular transmission and decreasing the amount of acetylcholine liberated at the end-plate by the motor nerve impulse
  • depressant effect on the central nervous system, but it does not adversely affect the woman
  • bp: 160/110
  • lower bp, stops/depresses uterine contractions
  • antidote is calcium gluconate
  • loading dose 4g, maintenance rate 2g/hr
  • relaxes muscle, bladder, uterine muscle (can increase bleeding so pitocin is also given)
  • dec LOC
45
Q

Monitor for MgSO4 toxicity (5)

A
  • bp
  • urine output
  • loc
  • dec reflexes
  • respiratory depression
46
Q

Postpartum preeclampisa (5)

A
  • continue MgSO4 for 24 hrs
  • sx dec rapidly
  • diuresis
  • risk of hemorrhage
  • continue seizure precautions
47
Q

Hemorrhagic complications/spontaneous abortion (7)

A
  • threatened: slight bleeding, not aborted, cervix closed
  • inevitable: going to happen, cervix open, lots of bleeding
  • incomplete: placenta, fetal tissue, still there, cervix still open
  • complete: fetal tissue expelled, common before 12 weeks, cervix closed
  • missed: baby died but not expelled–> TAB cervix opened here
  • recurrent: 3 or more abortions, often related to genetic disorders
  • septic: mom is infected and has abortion
48
Q

Management of hemorrhage (5)

A
  • threatened: bedrest
  • inevitable, incomplete: D&C
  • missed: if no SAB, then D&C
  • second trimester abortion: D&E
  • septic abortion: D&C, antibiotics
49
Q

D&C

D&E

A

D&C: dilation, currettage: dilate cervix with med, surgical instrument to scrape uterus contents
D&E: dilation, evacuation with vacuum, because the fetus is too big

50
Q

Cervical insufficiency (7)

A

: premature dilation

  • cerclage: sew cervix closed, 12-13 wk
  • monitor UC, FHR
  • observe for R/M
  • bedrest, activity restrictions
  • tocolytics: anti-contraction meds
  • education re: labor
51
Q

Tocolytic: terbutaline (9)

A

-B2 adrenergic receptor agonist
-side effects:
: uterine relaxation, bronchodilation, vasodilation, muscle glycogenesis
: CNS: dizzy, drowsy, HA, restlessness
: BP: widening pulse pressure
: HR: palpitations, tachycardia, chest pain
: GI: N/V
: Resp: SOB, cough, PEdema
: Metabolic: maternal hyperglycemia
: Fetal: tachycardia, hypoglycemia

52
Q

Postpartum hemorrhage (4)

A
  • definition: loss of blood following a delivery resulting in hypovolemia or otherwise causing the pt to become symptomatic
  • ebl or qbl
  • vaginal delivery: 500 ml
  • c/s: 1000 ml
53
Q

Oxytocin (pitocin) (5)

A
  • IV, IM
  • hormone normally stimulate labor, post pit
  • used for PPH
  • bolus or maintenance rate
  • side effects: not common, anaphylactic reaction, pelvic hematoma, cardiac arrhythmia, subarachnoid hemorrhage, hypertensive episodes, nausea, rupture of the uterus, vomiting
54
Q

Misoprostol (cytotec) (4)

A
  • misoprostol to soften their cervix or induce contractions to begin labor
  • cause mild contractions
  • misoprostol is sometimes used to decrease blood loss after delivery of a baby
  • these uses are not approved by the FDA
55
Q

Methergine (3)

A
  • smooth muscle constrictor, acts mostly on uterus
  • commonly used to prevent or control excessive bleeding
  • contraindication: pt with htn
  • postpartum only for pph
56
Q

Cesarian birth (3)

A
  • vertical no longer done here
  • horizontal is the most common form, low transverse
  • less risk of bleeding, infection, uterine antony
57
Q

C/S pre-op care (5)

A
  • include support person
  • anesthesia visit, informed consent
  • foley, abdominal prep
  • antacid is standing order, sodium citrate
  • discuss post-op care
58
Q

C/S post-op care (4)

A
  • treat her like a mother who has given birth
  • major surgery: IV, foley, incision
  • complications: atelectasis/pneumonia, urinary retention/infection, wound infection, GI complications, hemorrhage
  • postpartum care-continue
59
Q

Fetal assessment via electronic fetal monitoring (2)

A
  • non-stress test-NST, 20 mins

- contraction stress test: given pitocin to see if baby can tolerate it

60
Q

Non-stress test (2)

A
  • evaluate fhr during movement on monitor
  • reactive= normal= acceleration of fhr equal to or greater than 15 bpm over baseline and lasting 15 sec and 2 or more accelerations with movement in 20 mins
61
Q

Contraction stress test (3)

A
  • evaluate fhr with uterine contractions
  • negative=normal=no decelerations of fhr with 3 uc’s (lasting 40-60 sec) in 10 mins
  • positive=abnormal=decels with 50% or more of uc’s
62
Q

Absent variability

A
  • flatline, ominous sign
63
Q

Minimal fluctuation

A

<6 bpm

64
Q

Moderate fluctuation

A

<6-25 bpm

-ideal

65
Q

Marked variability

A

> 25 bpm

66
Q

Veal Chop

A

v: variable decel
e: early decel
a: acceleration
l: late decel
c: cord compression
h: head compression
o: ok
p: placental insufficiency

67
Q

Early decel
Late decel
Variable decel

A

Early: mirror image of contractions and decel
Late: repetitively after contraction
Var: abrupt decel with contraction

labor and comp (1 decks)

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