Brainscape's Knowledge GenomeTM

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


See full index

NURS3112 > M7.2: Epidurals, induction, delivery, lacerations > Flashcards

M7.2: Epidurals, induction, delivery, lacerations Flashcards

1
Q

What is an epidural?

A

epidural block involves injection of a local anesthetic agent into the epidural space, which is accessed through the lumbar area

provides analgesia and anesthesia from active labor through the birth and episiotomy repair

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

What are the risks of epidurals?

A
  • Urinary catheterization
  • Pitocin augmentation of labor
  • Intrauterine pressure catheter use
  • Fetal malpresentation associated with decreased maternal movement during labor
  • Increased rates of assisted vaginal deliveries (forceps or vacuum assistance)
  • Spinal headaches
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are disadvantages to epidurals?

A
  • maternal hypotension
  • onset of analgesia may not occur for up to 30 minutes.
  • Some women with epidurals may have decreased sensation and movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how often should you monitor mother after epidural?

A

every 5 mins for first 15 mins and then every 15 mins until block wears off

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

How can you prevent hypotension?

A

preloading with a rapid infusion of IV fluids, then providing IV fluids continuously until birth

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

What is the risk with hypotension on the fetus?

A

Variability of the FHR may decrease, and late decelerations can occur if maternal hypotension develops

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

What are the interventions if hypotension occurs?

A
  • reposition woman on her side
  • increase fluids
  • administer O2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define: softening and effacing the cervix

A

cervical ripening

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

What are the pharmacologic methods for cervical ripening?

A
  • Misoprostol (cytotec): synthetic PGE analog, Tablet that can be inserted into vagina or taken orally/sublingually

Prostaglandin agents (cervidil, prepidil)
- Prepidil gel: placed intracervically
- Cervidil: intravaginal insert placed in posterior vagina

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

What is the mechanical method to cervical ripening?

A

Balloon catheters have been used for cervical ripening for many years to promote mechanical dilatation. A Foley catheter with a 30-mL to 50-mL balloon is passed through the undilated cervix and then inflated. The weighted balloon applies pressure on the internal os of the cervix and acts to ripen the cervix

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

What are the risks with using balloon catheters for ripening?

A
  • Uterine hyperstimulation
  • Increased incidence of PPH and uterine rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are forms of uterine overactivity?

A

hyperstimulation, tachysystole, hypertonus

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

Define: persistent pattern of five or more contractions in 10 minutes

A

tachysystole

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

Define: tachysystole or hypertonus associated with abnormalities in FHR

A

hyperstimulation

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

Define: a single contraction lasting longer than 2 minutes

A

hypertonus

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

What is labour induction?

A

stimulation of uterine contractions before the spontaneous onset of labour, with or without ruptured fetal membranes

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

What is labour augmentation?

A

artificial stimulation of uterine contractions when spontaneous contractions have failed to result in progressive cervical dilation or descent of fetus

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

Difference between labour induction and augmentation

A

Labor induction is the process of starting labor before it begins on its own. Augmentation of labor is when labor is already in progress, but needs a little help to move along

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

How do prostaglandins induce or augment labour?

A

Prostaglandins (Cervidil, Prepidil) are used to induce labour b/c they inhibit the release of progesterone while increasing oxytocin concentrations

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

What are contraindications of induction or augmentation

A
  • Vasa previa or complete placenta previa
  • Transverse fetal lie
  • Umbilical cord prolapse
  • Previous classical cesarean delivery
  • Active genital herpes infection
  • Previous myomectomy entering the endometrial cavity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does stripping the membranes work to induce or augment labour?

A
  • physician/CNM inserts a gloved finger as far as possible into the internal cervical os and rotates the finger 360 degrees, twice.
  • motion separates the amniotic membranes that are lying against the lower uterine segment and internal os from the distal part of the lower uterine segment
  • stripping or sweeping is thought to release prostaglandin from the amniotic membranes or prostaglandin from the cervix
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

why would you do stripping of membranes to augment labour?

A

stripping of the membranes can be performed in the birthing room in an attempt to strengthen contractions without the need for oxytocin administration

stripping or sweeping is thought to release prostaglandin from the amniotic membranes or prostaglandin from the cervix

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

What are the side effects of stripping the membranes?

A
  • Discomfort
  • Uterine contractions
  • Cramping
  • Bloody discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does oxytocin do to induce/augment labour?

A

Oxytocin affects the myometrial cells of the uterus by increasing the excitability of the muscle cell, increasing the strength of the muscle contraction, and supporting propagation of the contraction (movement of the contraction from one myometrial cell to the next)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why is oxytocin given to augment labour?

A
  • oxytocin is given intravenously to achieve a desirable labor pattern with strong contractions that will result in cervical dilatation and fetal descent.
  • indicated if fewer than 3 contractions in a 10-minute period or if the intensity is less than 25 mmHg as indicated by an internal uterine pressure catheter during the active phase of labor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the maternal side affects of oxytocin

A
  • hyperstimulation of the uterus resulting in hypercontractility which could lead to abruption placenta
  • rapid labour and birth (lacerations, uterine atony)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the fetal side effects of oxytocin

A
  • hypercontractility of the uterus leading to fetal hypoxia (seen in FHR - decreases)
  • Other: hyperbilirubinemia (for augmentation), trauma from rapid birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is an amniotomy (AROM)?

A
  • Aka Artificial Rupture of the Amniotic Membranes or AROM
  • an Amni-hook™, is inserted through the cervix to puncture the amniotic sac
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How dilated do you have to be to perform a AROM?

A

at least 2 cm

30
Q

T or F: engagement must occur before AROM

A

true

31
Q

Why should engagement occur before doing AROM?

A

decrease the risk of a prolapsed cord when the fluid is expelled

32
Q

Why should you monitor temperature every 2 hours after AROM?

A

risk of infection

33
Q

What are risk factors for forceps or vacuum?

A
  • Nulliparity
  • Maternal age (35 and over)
  • Maternal height of less than 150 cm (4 ft 11 in.)
  • Pregnancy weight gain of more than 15 kg (33 lb)
  • Postdate gestation (41 weeks or more)
  • Epidural anesthesia
  • Fetal presentation other than occipitoanterior
  • Presence of dystocia
  • Presence of a midline episiotomy
  • Abnormal FHR tracing.
34
Q

What is the purpose for forceps?

A
  • Provide traction
  • Used to rotate the head to an occiput-anterior position
  • All forceps are used for baby in cephalic position
    EXCEPT for PIPER forceps (used for breech)
35
Q

What are indications for forceps?

A
  • Presence of any condition that threatens mother or fetus and that can be relieved by birth
  • Woman: heart disease, acute pulmonary edema or pulmonary compromise, certain neurologic conditions, intrapartum infection, prolonged second stage, or exhaustion
  • Fetus: premature placental separation, prolapsed umbilical cord, and nonreassuring fetal status
36
Q

What are the prerequisites for forceps?

A
  • Cervix must be completely dilated
  • Fetal head must be engaged, in vertex or face presentation with chin anterior
  • Rupture of amniotic membranes
  • Bladder empty
37
Q

What are the forcep complications for newborn?

A
  • Edema
  • Forceps marks,
  • Caput
  • Cephalhematoma
  • Fractured clavicle
  • Transient facial paralysis
  • Retinal hemmorhage
38
Q

What are forcep complications for mother?

A
  • 3rd or 4th degree lacerations of birth canal urethra, or cervix,
  • Hematoma
  • Infection
  • Urinary and rectal incontinence
39
Q

Can the woman push during forcep application?

A

No

40
Q

When is the traction applied?

A

only with contraction

After forceps in place: With contraction, physician provides traction on forceps as woman pushes

41
Q

T or F: bradycardia (slow HR) may occur due to head compression during forcep use

A

T

42
Q

What is the newborn assessed for after birth using forceps?

A

facial edema, bruising, caput succedaneum, cephalohematoma, corneal abrasion, and any sign of cerebral edema

43
Q

What is the mother assessed for after birth using forceps?

A

perineal swelling, bruising, hematoma, excessive bleeding, and hemorrhage.

  • important to assess for signs of infection if lacerations occurred
44
Q

What is a vacuum extraction?

A

obstetric procedure used by physicians/CNMs to assist the birth of a fetus by applying suction to the fetal head

45
Q

What are contraindications for vacuum extraction?

A
  • True cephalopelvic disproportion (CPD) is an absolute contraindication to vacuum extraction.

Other contraindications include nonvertex presentations, maternal or suspected fetal coagulation defects, known or suspected hydrocephalus, and fetal scalp trauma

46
Q

How long should you apply the negative suction of vacuum?

A
  • indicates negative suction applied for more than 10 mins = greater incidence of scalp injury
  • Longer duration = more risk of scalp injury
  • ACOG advises 30 minute time limit
47
Q

How many pop-off until discontinuation of vacuum?

A

3

48
Q

Vacuum: Presenting part must be ____ and must be at ___ station or below

A

vertex, 0

49
Q

What are newborn complications of vacuum?

A

**cephalohematomas, shoulder dystocia

scalp lacerations, bruising, subgaleal hematomas, intracranial hemorrhages, subconjunctival hemorrhages, neonatal jaundice, fractured clavicle, Erb palsy, damage to the sixth and seventh cranial nerves, ocular injuries, retinal hemorrhage, and fetal death

50
Q

What are maternal complications of vacuum?

A
  • Postpartum hemorrhage**
  • perineal trauma, edema, third- and fourth-degree lacerations, postpartum pain, and infection
51
Q

What are indications for C/S?

A
  • Cord prolapse
  • Placenta previa
  • CPD
  • Placental abruption
  • Active genital herpes
  • Failure to progress in labour
  • Nonreassuring fetal status
  • Benign and malignant tumours that obstruct birth canal
52
Q

Define which uterine incision for C/S: lower uterine segment

A

transverse

53
Q

Define which uterine incision for C/S: classic vertical

A

upper uterine segment

54
Q

What is the risk with classic vertical incision?

A
  • More blood loss and more difficult to repair
  • Carries increased risk of uterine rupture with next pregnancy, labour, and birth because upper segment is most contractile part of uterus
55
Q

What are some nursing actions to prepare for C/S?

A
  • Practice turning, coughing, and deep breathing
  • Sign informed consent form
  • Give nothing by mouth
  • Indwelling catheter inserting to prevent bladder distention
  • Start IV line with needle to permit blood administration and order preoperative medication
  • Adjust operating table
  • last-minute check is done to ensure that the fetal scalp electrode has been removed if the fetus was internally monitored
56
Q

What is TOLAC and VBAC?

A
  • Trial of labour after caesarean (TOLAC): planned attempt to labour by woman who had previous C/S and wants vaginal delivery
  • Vaginal birth after caesarean (VBAC)
57
Q

What are the guidelines for TOLAC/VBAC?

A
  • One previous caesarean birth and a low transverse uterine incision
  • An adequate pelvis
  • No other uterine scars or previous uterine rupture
58
Q

Risks with repeat C/S

A
  • Blood loss
  • Abnormal placentation: placenta previa, placenta accreta, and placenta abruption
  • Surgical injury to bowel or bladder
  • Adhesions
  • Postsurgical complications
  • Longer hospitalization
  • Increased cost
  • Hysterectomy
59
Q

Type of laceration: Limited to the fourchette, perineal skin, and vaginal mucous membrane

A

First-degree

60
Q

Type of laceration: Involves the perineal skin, vaginal mucous membrane, underlying fascia, and muscles of the perineal body; it may extend upward on one or both sides of the vagina

A

Second-degree

61
Q

type of laceration: Extends through the perineal skin, vaginal mucous membranes, and perineal body and involves the anal sphincter

A

Third degree

62
Q

type of laceration: Similar to the third degree but extends through the rectal mucosa to the lumen of the rectum

A

Fourth degree

63
Q

What is an episiotomy?

A
  • surgical incision of the perineal body
  • performed with a sharp scissors that has rounded points, just before birth, when approximately 3 to 4 cm of the fetal head is visible during a contraction
64
Q

Risk factors for episiotomy

A
  • Primigravid status
  • Large or macrosomic fetus
  • Occiput-posterior position
  • Use of forceps or vacuum extractor
  • Shoulder dystocia
  • White race
  • Physician provider
  • Private practice physician
  • Nocturnal birth times
65
Q

Complications to episiotomy

A
  • blood loss
  • infection
  • pain
  • perineal discomfort that may continue for days or weeks past birth
  • dyspareunia (painful intercourse)
  • Flatal incontinence (uncontrollable passage of gas)
66
Q

What is benefit of ice pack to perineum?

A
  • ice causes vasoconstriction
67
Q

How long should you keep icepack on for?

A

ice pack is left more than 30 minutes, vasodilation and subsequent edema may occur

68
Q

how often should you inspect the episiotomy site?

A

every 15 minutes during the first hour after the birth

69
Q

What is benefit of sitz bath?

A

provides comfort, decreases pain, and increases circulation to the tissues, which promotes healing and reduces the incidence of infection

70
Q

Inventions for episiotomy care

A
  • ice pack
  • sitz bath
  • use of peribottle after voiding or defecation
  • change pad after each elimination and at reg intervals
71
Q

what are signs of infection

A

redness, edema, drainage, incomplete approximation of the edges

NURS3112 (10 decks)

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