Maternity week 4-2 Flashcards
should dilate
1 cm an hour, or at least be progressing.
latent - how many cm? (latent is zero)
0-5 cm
active - how many cm?
6-10 cm
Induction of nulliparous patients who were induced after 37 weeks for nonmedical purposes,
doubled their chances of having a cesarean birth.
Hypertonic Uterus - what phase is prolonged? (are you hyper, or latent?)
- uterus never fully relaxes
- contractions ineffective
3. prolonged latent phase (2-3cm)
4. reduced placental profusion
Hypertonic Uterus - nursing management (not much but fluids)
Bedrest
Monitor fetal wellbeing
Assess for maternal infection
Promote adequate hydration
Pain management
Educate
Hypotonic uterus - at risk for what?
Hypotonic uterine dysfunction
1. poor quality and intensity
2. arrest of dilation & effacement
3. see this more in the active face of 1st stage (5-6cm)
4. at risk for PP hemorrhage***
hypotonic uterus - nursing management
Administer oxytocin
Assist with amniotomy
Continuous EFM
Assess for maternal/fetal infection
Educate
problems of power - Precipitate labor
Precipitate labor
1. birth <problems of power 3 hours from start of contractions
2. maternal injury
3. fetal traumatic & asphyxia insults
problems of power - Nursing Management
Closely monitor contractions & FHR
May administer tocolytics
Stay with patient
Inform Health Care Provider
Anticipate RN delivery
problems w/ passenger/position - Occiput Posterior Position (takes longer from the back)
Occiput posterior – face up
1. Labor usually longer
2. Maternal exhaustion
3. Extensive caput (fluid bulge on head)
problems w/ passenger/position - nursing management
Pain management
Intense back labor 1st stage
Encourage/Assist patient for position changes
Anticipate operative vaginal delivery (this is forceps or vacuum)
Educate
problems w/ passenger/position - Breech Presentation (frank is extended)
Breech – fetal buttocks, foot, or shoulder as presentation
1. Frank breech – buttocks present with legs fully extended
2. Complete breech – buttocks present with fetus in full flexion
3. Footling/incomplete breech – 1or 2 feet presenting with hips fully extended
problems w/ passenger/position - Breech Presentation - nursing management
Arrange ultrasound to confirm position
Assist with external cephalic version
Trial labor 4-6 hours for progress with unsuccessful version
Prepare for cesarean
Check with provider for Rhogam administration
Educate
Problems with PASSENGER/POSITION - Shoulder Dystocia
Shoulder dystocia – axis of shoulders prevent fetal descent after delivery of the fetal head.
1. fetal injury
2. maternal injury
3. risk for PP hemorrhage
Problems with PASSENGER/POSITION - Shoulder Dystocia - nursing management
Recognize and intervene immediately
McRobert maneuver along with suprapubic pressure (legs behind ears)
Call for help, OR notified
Patient position changes
Educate
Problems with PASSENGER/POSITION - face or brow
Face/Brow present at cervix
1. Poor force against cervix
2. Very rare
3.Associated with fetal anomalies (anencephaly - no brain)
Problems with PASSENGER/POSITION - face or brow - nursing management - prepare for what?
Brow presentation prepare for cesarean birth
EFM for fetal wellbeing
Emotional help patient fetal demise
Educate
breech risk factor - major
cord prolapse
consequences of breech
5,000 new cases of permanent “brachial plexus palsy” a year.
Problems with PASSENGER - Multiple Gestation
More than one fetus
1. higher perinatal mortality rate
2. uterine overdistention
3. Fetal hypoxia
4. Presenting fetus must be in vertex position
Problems with PASSENGER - Multiple Gestation - Nursing Management
EFM for contraction pattern, assess for hypotonia
Confirm gestational age
Notify OR of possible cesarean
Notify NICU of multiple gestation birth (esp if baby is less than 37 weeks)
Educate
percentage of twins
4%