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XIO > Maternity week 4-1 > Flashcards

Maternity week 4-1 Flashcards

1
Q

Initial Assessment of Patient

A

Admit patient to triage
POC (point of care - bedside): Urine dip
Initiate fetal monitoring
Obtain VS
Characteristics of Labor (contractions? bleeding? leaking fluid? is your baby moving?)
Assess for VB
Assess FM: Subjective
Check for Ruptured Membranes/Dilation
Prenatal Record
Physical Exam: Including high risk s/sx
Report to provider

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2
Q

Admit or Send Home

A

Is pt in active labor?
ROM? GBS status?
Coping well?
Labor Hx?
High risk dx?
Fetal concerns?
Earlier admission= intervention
Delayed admission= Less labor augmentation, c/s, antibiotics and internal monitors.

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3
Q

Diagnosing Rupture of Membranes

A

PROM - premature rupture of membrane

PPROM - premature or prelabor before 37 weeks

SROM - spontaneous

AROM - artificial

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4
Q

latenent - how many cm? (latent at zero)

A

0-5 cm

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5
Q

dilation

A
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6
Q

10 cm is

A

complete

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7
Q

normal cervix is how long?

A

3 cm long

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8
Q

station is measured in

A

cm. minus stations are above.

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9
Q

Diagnosing Rupture of Membranes

A

Nitrazine + Pooling + Fern (pattern on strip test) Test - this means their water broke.
Speculum exam
Cervical fluid collected and viewed under microscope
Pooling:
Ferning: Crystallization of
proteins + salt

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10
Q

Nitrazine Testing for ROM - what pH is not ruptured? (don’t rupture before age 6.5)

A

ACIDIC: NOT RUPTURED Yellow = pH 5.0
Olive-yellow =pH5.5
Olive-green =pH 6.0
ALKALINE = MEMBRANES RUPTURED
Blue-green = pH 6.5

this is rupture:
ALKALINE = MEMBRANES RUPTURED 7.1 - 7.3 or 7.5
Blue-gray = pH7.0
Deep blue = pH 7.5

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11
Q

Assessment of
Vaginal bleeding - what amount is normal?

A

Bloody show
Scant bleeding normal after SVE
Report any VB to MD/CNM
Closely monitor mod to heavy bleeding (pad counts/weights)
Sources of abnormal bleeding:
Placentia previa
Placental abruption

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12
Q

Assessment of uterine activity

A

Subjective assessment: questions? how often? how long? pain? (pain in lower back sign of preg)
Objective assessment
Palpation: “nose, chin, forehead”: mild, mod, strong
Observation
Tocometer
IUPC

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13
Q

SVE - sterile vaginal exam - do what first?

A

spectacle exam to get specimen before you insert something w/ bacteria

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14
Q

Signs of Possible
Intrapartum Complications - contractions and pressure - the numbers?

A

Increased IUP (intra uterine pressure?)
Contractions lasting > 90
Tachysystole: More than 5 UCs/10 min averaged over 30 min

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15
Q

Common intrapartum
NURSING interventions

A

Assessments/Monitoring
Fluid intake: oral/IV
Bladder/bowel evacuations
Pain management
Ambulation & Position changes
Nutritional needs
Emotional Support
Integrating care team (includes other providers, family/friend support, doulas etc.)

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16
Q

Components of Nursing care: stage 1

A

Review: What comprises the first stage of labor?
Monitoring the labor pt: VS, screenings, assessments
Fetal assessment
Pain management/Labor support
Communication with team
Consider Maslow’s Hierarchy

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17
Q

Nursing care in the first stage of labor:
Pain management

A

Part of a normal process: nothing bad is happening

Intensity increases as labor progresses

Occurs in a predictable pattern with regular respite (in a normal labor)

Ends with the birth of the baby

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18
Q

Sources of Pain: Stage 1 (stretch on stage 1)

A

Uterine Anoxia

Stretching of the cervix

Stretching of the uterine ligaments

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19
Q

when does baby get oxygen during labor?***

A

in between contractions

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20
Q

Sources of Pain: Stage 2 (vaginas and pressure on stage 2)

A

Distention of the vagina and perineum
Pressure of the baby on tissue and organs (bladder, rectum, etc)

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21
Q

Sources of Pain: Stage 3 (the cramps on stage 3)

A

Uterine Cramping

Lacerations

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22
Q

Factors that Influence Pain

A

Fear and Anxiety
Fatigue
Individual pain tolerance
Support
Cultural expression of pain
Psychosocial factors
Preparation
Previous experience (self and others)
Information/Lack of
Length of labor

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23
Q

Signs the patient is coping well may include: (with pain) (rocking w/ pain is good)

A

States they are coping well
Rhythmic activity during UCs, such as rocking, swaying
Focused inward
Rhythmic breathing
Able to relax between UC
Vocalization, such as moaning, chanting, counting

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24
Q

not coping with pain - signs

A

States she is NOT coping
Crying, tearfulness, tremulous voice
Inability to focus or concentrate
Panicked activity during contractions
Jitteriness, thrashing in bed
Tense, sweaty

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25
Q

Options for managing intrapartum pain

A

Non-pharmacologic

Pharmacologic

Center patient in decision-making process around interventions for pain.
movements.

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26
Q

Non-Pharmacological Management Cont’d

A

Hydrotherapy

Aromatherapy

Guided relaxation/breathing

Massage/Effleurage

Position Changes/Ambulation
Sacral Pressure (Counter Pressure)
Hip Squeeze

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27
Q

Doulas

A

Professional, trained birth attendant
Patients half as likely to have complications
Reduced rates of intervention
Greater client satisfaction with birth
Outcomes linked to emotional, physical support, and information given.

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28
Q

types of agents

A

Systemic Analgesics

Inhaled Analgesics

Local Anesthesia

Regional Analgesia/Anesthesia

General Anesthesia

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29
Q

check slide

A

49

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30
Q

Opioids: - Morphine

A

Morphine:
Early labor
Therapeutic effect: 4-6 hours
12-15 mg IM w/ Hydroxizine

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31
Q

Fentanyl

A

Active labor and/or severe pain
50-100mcg IVP
Therapeutic effect: 30-60 min

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32
Q

Hydroxyzine (hydro w/ morphine)

A

Hydroxyzine:
50-100mg IM
IM w/ Morphine
Potentiates opioid, antihistamine/antiemetic
Promethezine: antiemetic/antihistamine w/ opioid

33
Q

Pharmacological Management
Nursing Care : considerations

A

Assess labor progress
Assess pain and coping
Assess patient’s labor goals and expected outcomes
Assess FHR
Parenteral Route
Efficacy
Document
Narcan (naloxone)

34
Q

Precautions with N20 (what about the fetus?)

A

Current vitamin B12 deficiency
Abnormal FHR tracing
Hemodynamic instability and/or impaired oxygenation
Observe for respiratory depression
Covid +/other respiratory illness

35
Q

Contraindications to N20

A

Acute drug or alcohol intoxication or impaired consciousness
Inability to hold face mask
Some medical conditions, such as pneumothorax or increased intracranial pressure

36
Q

EPIDURAL - how quickly does it work? (lepi takes a loooong time)

A

20-30 min

37
Q

SPINAL ANESTHESIA (don’t use when?)

A

Imminent vaginal delivery or C/S, not suitable for labor
Risk of spinal (post-dural) H/A
Risk for  BP
Rapid onset: full effect=5-10 min

38
Q

COMBINED SPINAL-EPIDURAL (CSE)

A

Spinal/Epidural administered during same procedure

Provides rapid/continuous anesthesia/analgesia

Labor or C/S

39
Q

DISADVANTAGES OF EPIDURAL ANESTHESIA (think decreased breathing and baby)

A

 BP: may affect placental perfusion
Urinary retention
Limited mobility
May  2nd stage
 risk of low forceps or vacuum assisted

40
Q

Contraindications 
to
regional anesthesia (clot in one spot)

A

Clotting disorders including thrombocytopenia
Medication allergy
Anatomical problems: scoliosis, spinal fusion/anomalies
Unable to place

41
Q

pre-EPIDURAL PLACEMENT - nursing care (think of fluids)

A

Educate patient

Confirm consents completed

Pre-hydrate: IV bolus/prevent hypotension

Obtain medication/equipment

Position patient/place BP cuff/pulsox

Time out

Continue labor support/maintain fetal monitoring

42
Q

NURSING CARE: 
 EPIDURAL PLACEMENT

A

Safety
Independent double checks
Pharmacy prepared meds
Clearly label solutions and lines
Patient Monitoring
Documentation

43
Q

time out (3 things - think of the OR)

A

Verify:
Correct pt
Correct procedure
Correct site

44
Q

NURSING CARE: 
POST EPIDURAL PLACEMENT (change positioning?)

A

Assess VS
Monitor FHR/UCs
Assess pain level
Place foley catheter
Order clear diet
Change patient position q 30-60 min: lateral or tilt

45
Q

General Anesthesia - when to use

A

Administered by Anesthesiologist (MD) or CRNA
Not for labor: C/S only!
Not routine: emergency, failed regional anesthesia, contraindication to regional anesthesia
Combination of agents may include: Fentanyl, versed, propofol, ketamine etc.
Pt recovered in PACU

46
Q

Labor
Stages 2-4

A

2nd stage: 10 cm dilation-delivery, “pushing”

3rd stage: Delivery of placenta

4th stage: After delivery of placenta until up to 4 hours after (“recovery”)

47
Q

2nd Stage:
Nursing assessments - how often to assess vital signs and contractions?

A

VS: “per protocol”, per Ricci: q-5-15
FHR: q5-15 dependent on risk level
UCs: document q5-15
Coping/pain
Fetal descent

48
Q

2nd Stage:
Nursing interventions

A

Prepare room for delivery
Communicate with providers PRN (OB, NICU etc.)
Support patient with every pushing effort
Continue comfort measures
D/C Foley
Ensure adequate hydration
Respond to abnormal assessment findings
Assist w/ delivery

49
Q

3rd stage
assessments - think what happens in the 3rd stage

A

VS: q 15
Apgars: 1 min, 5 min
Observe for placental separation
Assess fundus/lochia following delivery of placenta

50
Q

bonding

A

it’s just the parent.

51
Q

look at slide

A

85

52
Q

3rd stage:
nursing interventions

A

Respond to abnormal assessment findings
Administer uterotonics PRN/as ordered
Active management of the 3rd stage
Assist with BRF & Monitor NB
Post: assist w/ repair, pain meds, ice to perineum PRN

53
Q

4th stage: nursing assessment (after birth, what drops?)

A

Fundal check/lochia assessment:
Q 15 x 4
Q 30 x 2
Vitals/Pain assessment
NB admission exam

54
Q

4th stage:
nursing interventions

A

Pain interventions prn
Hydrate/provide nutrition
Facilitate voiding ASAP
Promote rest
Assist w/ first amb/assess for readiness to amb post-anesthesia
Education

55
Q

4th stage:
nursing interventions
Newborn (NB)

A

Assist w/ NB feeding
Administer NB meds
Infant security
Education

56
Q

Nursing Diagnoses:
Stages 2-4

A

Risk for injury to patient and fetus/NB
Knowledge deficit
Pain
Ineffective coping
Anxiety
Risk for infection
Risk for fluid volume deficit/excessive blood loss

57
Q

Fetal assessment

A

Subjective: pt report, “kick counts’
Objective:
Continuous fetal monitoring
EFM
FSE
Intermittent auscultation

58
Q

Assessment frequency

A

Stage 1
Low risk: early labor Q 1 hour, active labor Q30 min
High risk: early labor Q 30 min, active labor Q15 min
Stage 2
Low risk: Q 15 min
High risk: Q 5 min

59
Q

Intermittent auscultation

A

Low risk patients
Assess maternal pulse
Associated with lower rate of c/s/unnecessary intervention
Equal perinatal outcomes in low risk pt
Auscultate 3-5 min through UC, one min after
Assessment frequency=cont. monitoring

60
Q

Fetal Monitor Tracing Interpretation

A

NICHD: Standardized terminology
Visual interpretation
Identify FHR baseline
Identify variability
Identify accels/decels
Determine UC pattern
Intervene PRN

61
Q

Variability

A

Variability:
Irregular fluctuations in baseline FHR
Sympathetic/Parasympathetic interplay
Normal variability=CNS WNL & absence of acidemia (CO2 buildup)
Absent: undetectable
Minimal: < 5 bpm
Moderate: 6-25 bpm
Marked: >25 bpm

62
Q

Accelerations

A

Abrupt inc: 15 x 15 at 32 weeks or >
< 32 weeks: 10 x 10 ok
> 10 min= new baseline

63
Q

Early decelerations - how long is onset to nadar? (30 is early)

A

Associated w/ Ucs
Gradual dec in baseline, mirrors UC
Onset to nadir > 30 sec

64
Q

Variable decelerations (V is for variable) and what causes it?

A

Abrupt drop from baseline, < 30 sec onset to nadir
May occur w/out UC
“V” shaped
At least 15 x 15.
cause is cord compression.

65
Q

Late decelerations (onset to nadar time - it’s 30 again) and what causes it?

A

Associated w/ Ucs
Gradual dec in baseline, nadir after UC peak
Onset to nadir > 30 sec
Return to baseline after UC. cause - placential insufficiency

66
Q

Early decel

A

Early decel: head compression/vagus nerve stimulation

67
Q

Late decel

A

Late decel: uteroplacental insufficiency, interruption in “oxygen pathway”

68
Q

Accel - is normal or abnormal?

A

Accel: acid/base status wnl

69
Q

Variable decel - causes (C causes V)

A

Variable decel: cord compression

70
Q

FHR categories - what number is good and bad? (backwards for you)

A

1 is good, 3 is bad.

71
Q

FHR - CAT III (the 3 are late, variable, brady and sinus)

A

CAT III, Includes at least one of the following:
Absent variability with recurrent late decels
Absent variability with recurrent variable decels
Absent variability with bradycardia
Sinusoidal Pattern

72
Q

FHR - cat. 1 (1 cat does not decelerate)

A

CAT I:
FHR wnl, Accels may or may not be present
Decels are absent
Predictive of normal acid/base balance

73
Q

FHR - cat 2 (2 cats just don’t fit)

A

CAT II:
Tracings that don’t fit in CAT I or III
Not predictive of normal acid/base balance
Indeterminate significance; cont to monitor

74
Q

contractions - Tachysystole (you already know this)

A

Tachysystole: > 5 UCs/10 min averaged over 30 min

75
Q

Nursing interventions for abnormal FHR - what drug?

A

Intrauterine resuscitation
Change pt position
IV fluid bolus: PL/LR
Treat hypotension
Turn of pitocin
O2 not evidenced based (listed as intervention in Ricci, 5th ed.)
Tocolytic administration:
Terbutaline: 0.25 mg SC: tachycardia, half-life=3 hours, smooth muscle relaxant
Rapid delivery PRN

76
Q

Terbutaline effects - what is normal?

A

can cause fetal tachycardia, but it is transient. this is NORMAL.

77
Q

intrapartum complications - Cat tracings

A

Abnormal fetal heart tracing: Cat II or III
Amniotic fluid: Meconium-stained, Cloudy, Foul-smelling
Labor dystocia (Failure to progress/FTP)

78
Q

intrapartum complications - temperature - what is an abnormal temp in the mother?

A

Maternal Temp > 38
Foul smelling discharge,
Continuous bright red bleeding

XIO (372 decks)

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