Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Peds/OB > Labor & Birth At Risk > Flashcards

Labor & Birth At Risk Flashcards

1
Q

Nurse and obstetric team must use knowledge and skills in a concerted effort to provide care in event of complication
Understand normal birth process
Prevent and detect deviations from normal labor and birth
Implement nursing measures if complications arise
Get report pt and circling all risk factors and wondering how die on us - need be prepared - one can see and one cannot
Good understanding of norm - detect and intervene early to have better outcomes

A

Nursing responsibilities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Preterm labor: cervical changes and uterine contractions occurring between 20 and before end 37 weeks of pregnancy; 20-37 weeks; can stop preterm labor usually
Preterm birth: any birth that occurs before completion of 37 weeks of pregnancy
Spontaneous preterm birth
Indicated preterm birth

A

Preterm labor and birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

An early initiation of the labor process
Comprises 75% of preterm births

A

Spontaneous preterm birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Induced - need baby to come out
C-section
Having absent variability - C-section so not stress baby more so not die
Severe pre-eclampsia - get baby out
A means to resolve maternal or fetal risk

A

Indicated preterm birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Infection
Bleeding at the site of placental attachment
Stress
Decrease in progesterone

A

Causes of preterm birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Number 1 reason
Raging GBS
Gonorrhea
Chlamydia
Bad STI
Bad bacterial vaginosis - irritate cervix and uterus
Bad UTI
Bad pyleonephritis
Ones get septic
COVID

A

Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Placenta previa
Placenta abruption
Anything disrupt placenta cause uterine to contract

A

Bleeding at the site of placental attachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Find husband after commit suicide
No support
No food to eat
Nutrition - lack
Lack resources
MVC - traumatic to abdomen and her - stress and bleeding beside placenta

A

Stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Progesterone - maintains pregnancy - not enough not maintain pregnancy
Hx preterm birth - no cause otherwise - lack progesterone - not monitor progesterone in labor; prophalcatically give progesterone if hx

A

Decrease in progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk factors
Prevention

A

Preterm labor and birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

History of spontaneous preterm birth - can happen again esp if no related cause
African-American race
Genital tract infections
Multifetal gestation - lot babies in uterus
Second trimester bleeding
Low pre-pregnancy weight - underweight BMI

A

Risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Preventive strategies to address risk factors
Health promotion and disease prevention
Preconception counseling
Interventions to prevent spontaneous preterm birth
Sometimes not know why - prepare for it

A

Prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Organization that works with preterm birth: March of Dimes - sponsoring of research into babies - infant mortality better as viability changed

A

Preventive strategies to address risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Education - get via good prenatal care

A

Health promotion and disease prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Esp for chronic disease moms - how care for self and prepare for baby

A

Preconception counseling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Indomethacin, Nifidepine, Magnesium Sulfate (hospital)
Drugs identify for preterm labor - help slow down contractions or stop them

A

Interventions to prevent spontaneous preterm birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Have all symptoms of true labor
Uterine Activity
Discomfort
Vaginal discharge
Symptoms and has cervical change

A

Signs and symptoms of preterm labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

More than 4-6 contractions in an hour or longer
10-15 mins - preterm come in; not full term
Not big contractions where start in back and come to front - dull low back pain but feel like UTI but no burning with UTI - feel like about start period or pelvic pressure - could be UTI
Water broken or change in vaginal discharge
Vaginal infection - treat that
Water broken - prepare for delivery of baby - soon after baby

A

Uterine Activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Dull, intermittent low back pain
Menstrual-like cramps
Pelvic pressure/heaviness

A

Discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Rupture of membranes
Change in discharge

A

Vaginal discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Glucocorticorticoid steroids - help mature fetal lungs - prepare baby to breathe - 24 hrs apart - improve surfactant levels so transition better
Before 32 weeks - give mag sulfate to relax everything
Sometime not stop it - may send to higher level NICU

A

Symptoms and has cervical change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Spontaneous (SROM)
Artificial (AROM)
Can do nitrozine papers - litmus paper - not as applicable as looking underneath stethoscope for crystalized fern - turn bright blue - semen can turn it, amniotic fluid

A

Ruptured membranes in labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

On own

A

Spontaneous (SROM)

24
Q

Provider - Most common done by them
Risk for infection
Placenta behind it
Crochet hook - prick bag and water everywhere

A

Artificial (AROM)

25
Q

After water breaks - assess fetus - draining bath
Polyhydramnios - GI issues - not taking in amniotic fluid
Always assess FHR immediately after membranes rupture
Risk for Prolapsed Cord - med emergency - always assess baby first
Artificially - how baby react to change in environment - assess FHR immediately

A

Ruptured membranes: risks

26
Q

Assess FHR immediately
Note time, amount, color, odor (TACO) - qualify - HCP make determination; amount not big deal; color big deal - clear, odor - bleach - not bad - may be infection brewing in chorion
Increased risk for infection (chorioamnionitis)

A

Ruptured membranes: nursing care

27
Q

Taken last protection for mom and baby - plug and amniotic fluid - direct conduit for infection - hands out as much
Temp qhr - rise in body temp - treat - abx - directly to baby
VS
Palpate uterus for tenderness
FHR pattern
Hygiene - pericare; water broken - keeps coming out - every time contract more fluid out
Odor
Avoid invasive procedures

A

Increased risk for infection (chorioamnionitis)

28
Q

External Cephalic Version
Induction/Augmentation of Labor
Episiotomy
Laceration repair
Operative Deliveries
Cesarean Birth

A

Obstetric procedures

29
Q

Baby that is breach - try get vertex - HCP on top abdomen - move baby externally - not comfy - usually in OR - may do C-section; usually not do when 40 weeks; more likely 37 weeks; risk high; ask for this - high vaginal deliveries - good canditate and everything good - cord out way
Usually to providers - epidural given - send home not give epidural; sometimes works; sometimes not - send home - and do again
Not first time mom - not know pelvis
Environment be just right to do this
Determine fetal position
Locate the umbilical cord
Rule out previa
Evaluate adequacy of pelvis
Assess for anomalies, fluid level, and gestational age

A

External Cephalic Version

30
Q

Oxytocin/Pitocin
Not do elective inductions until 39 weeks
Increase C-section because elective inductions - increase maternal mortality and morbidity
Start labor via
Cervical ripening

A

Induction/Augmentation of Labor

31
Q

Starting oxytocin places woman at high risk - routine often
High risk-drug
Careful monitoring of mom and fetus
contractions harder - higher epidural rate - do more interventions and more assessments - change acuity
Nurse can rupture uterus or kill baby because not put in pump correctly

A

Oxytocin/Pitocin

32
Q

Sex - best way
Breaking water enough
Nipple stimulation - release endogenous oxytocin
Tea
Strip membranes - separate cervix from membrane

A

Start labor via

33
Q

Warm up cervix - when 39-41 weeks
Cervidil
Misoprostol

A

Cervical ripening

34
Q

Risks vs. benefits
Start doing cutting - extend do cutting - leave bottom alone and tends to do better

A

Episiotomy

35
Q

4th degree - worse - down into rectal capsule - retum not sterile; have get revised and surgery over and over; suggest C-section for next delivery - mess with; sex prob; defecating is prob; heal in months
1st and 2nd degree - 6 weeks healing

A

Laceration repair

36
Q

Forcep-Assisted
Vacuum-Assisted
Indications

A

Operative Deliveries

37
Q

Provider skill
Pudenal block
Low or mid (more damage - nerve damage - bell’s palsy)

A

Forcep-Assisted

38
Q

Most often used
Low
More used - soft suction
Mom pushes and they pull
Labia separated and crowning for this

A

Vacuum-Assisted

39
Q

Do because baby low and mom exhausted
Baby has to be crowning and labia separated

A

Maternal - Indications

40
Q

Fetal distress - pushing well and sitting on perineum - helping out - see head - not hunt

A

Fetal - Indications

41
Q

Indications
Scheduled vs. Non-scheduled
Complications and Risks
Anesthesia
Pre-operative care
Post-operative care
Her recovery up to 1 yr; space pregnancies out; skin healed potentially - layers underneath it need to heal
Vaginal delivery - 6 weeks as long as not bad tear - heals perfectly

A

Cesarean Birth

42
Q

Muscle in uterus - cutting with grain - heal better when go horizontal - mimics vaginal birth
Vertical - against grain - not heal as well - preterm birth - preserve head - not squeeze head - only have C-sections - not want to contract - scar tissue not secure because against grain

A

Indications

43
Q

Scheduled - pick date; not stressed; wet lungs for awhile after lungs sometimes
Non-scheduled - labor to C-section; babies do better with this; less amniotic fluid when stressed during labor

A

Scheduled vs. Non-scheduled

44
Q

Hemorrhage
Infection of site - IV and indwelling of catheter
Knicking bladder or bowel - bladder knicks - catheter long time; fascia heals for longer time
Surgery - DVTs, ileus - passing gas - bowels moving

A

Complications and Risks

45
Q

Vaginal no need
C-section do
Potential rxn

A

Anesthesia

46
Q

Drugs
Prophylactic abx - after cord cut - for mom and baby
Settle stomach with medications

A

Pre-operative care

47
Q

L&D - PACU as well; hook up to EKG; take VS; assess site; meet criteria - cont with fourth stage - cont VS and fundal; pressure dressing; assess fundal tone q15 then q30
Indwelling catheter - gets bloodier
Most up walking within 6 hrs - take out catheter - increased risk DVT

A

Post-operative care

48
Q

Meconium-stained amniotic fluid
Shoulder Dystocia
Uterine rupture
Prolapsed umbilical cord
Amniotic fluid embolism (anaphylactoid syndrome of pregnancy)

A

Obstetric emergencies

49
Q

Indicates that the fetus has passed the first stool before birth - sterile - not smell bad; baby is sterile
Concern - not know when happened - can tell how long ago because may stain baby
Issues what stain pharynx - Places infant at risk for meconium aspiration syndrome

A

Meconium-stained amniotic fluid

50
Q

Head is born, but anterior shoulder cannot pass under pubic arch
Broad shoulders get stuck
Anterior shoulders - push out - McRoberts - push to dislodge - hyperflex hips - simulate squat - change diameter so larger
Symphysis pubis breaking apart to help it
Most time break clavicle - sometimes nere damage for awhile
Newborn is more likely to experience birth injuries
Brachial plexus
Maternal complications (hemorrhage, rectal injury, pelvic floor injury - happens) - turtle sign - comes head then head goes back

A

Shoulder Dystocia

51
Q

FHR suddenly drop; late decels
Mom report - excruciating pain; Abdomen rigid; into shock; massive blood loss
Vaginal exam - lots blood - bright red; cervix, level of baby - no baby - tissue and no baby
Often rupture - integrity uterus so thin that ruptures - ruptures that where head goes - baby ends up in abdomen
Often after epidural - feel not right and hurts bad
Hopefully save uterus
Baby out
Abnormal FHR tracing
Loss of fetal station - moves opp direction
Titrating pitocin not right
Non gravida uterus - smaller and thicker - pitocin given after
Gravida - thinner - given during
Abdominal pain
Shock

A

Uterine rupture

52
Q

During cervical exam - feel head and squishy thing that pulsating - not move hand until baby out
Get help in room - get mom on hands and knees; they give O2; they call for people; do not move hand; prep for C-section; position first - 2 nurses help her position - O2 on her
Need presenting part off cord - baby survivng via cord - cannot shove cord
When cord lies below presenting part of fetus
Interventions:

A

Prolapsed umbilical cord

53
Q

DO NOT REMOVE YOUR HAND!
Call for help
100% O2
Prep for Cesarean
Position mother in trendelenberg or knee-chest

A

Interventions: - Prolapsed umbilical cord

54
Q

Most rare comp
Amniotic fluid containing particles of debris
Causes anaphylactic rxn to particle - outcomes are bad
Acute onset of hypotension, hypoxia, cardiovascular collapse, and coagulopathy - DIC
No hives, no itching, no swelling, all sudden BP drops, not breathe
Maternal mortality to 61% or higher - affecting mom
Neonatal outcome is poor - affects baby if mom dies - get baby out quick

A

Amniotic fluid embolism (anaphylactoid syndrome of pregnancy)

55
Q

A G3T0P1A0L1 Caucasian woman is currently pregnant with twins. She is being treated for chlamydia. What are her specific risk factors for preterm birth? Select all that apply
A) Caucasian race
B) Previous preterm delivery
C) Current vaginal infection
D) Multifetal gestation
E) Low socioeconomic status

A

Answer: B,C,D
Hx preterm; 2 babies, treated for vaginal infection
The risk factors - low SES - would be but not specific to her

Peds/OB (68 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions