Module 6 Flashcards
What is GBS?
Group Beta Strep
-a common bacterium often carried in the intestines or lower genital tract
-associated with poor pregnancy outcomes
What is the treatment for positive GBS status?
-IV antibiotic prophylaxis offered to all labouring pts who test positive (or if culture is not available) or if risk factors are present
-considered adequately treated if pt is given a loading dose and one dose of antibiotics at least 4 hours before birth
What is the admission data that should be gathered for pts with herpes simplex virus?
-free from prodromal symptoms and active visible lesions when labour begins, vaginal birth is preferred
-if they’re experiencing prodromal symptoms or has visible lesions, c-section within 4 hours after labour begins or membranes rupture is recommended
-acyclovir and valacyclovir may be started at 36 weeks to decrease the risk of an active HSV outbreak at the time of birth and reduce the need for a c-section
-newborns who may have been exposed should be carefully observed and have blood tested for the presence of HSV
-some experts recommend prophylactic treatment of newborns who were exposed to HSV during birth
What is the physical assessment data that should be acquired at admission?
-general systems assessment
-vital signs
-leopold manoeuvers
-assessment of fetal heart rate/pattern and contractions
-baseline vaginal examination
-urine specimen
-blood tests
-rupture of the membranes
What psychosocial factor data should be acquired at admission?
-how does she verbally interact
-what is her body language
-what is her perceptual ability
-how does she describe what she is experiencing
-history of sexual abuse
-prior traumatic labour/birth experience
-past negative experience with HCW
-listen to their narrative of previous hospital experiences
-hypersensitivity
-disproportionate distress
What are the 6 key principles of trauma informed care?
1) safety
2) trustworthiness and transparency
3) peer support
4) collaboration and mutuality
5) empowerment, voice and choice
6) cultural, historical, and gender issues
What cultural/religious considerations should be considered during admission?
-consider cultural and religious values, beliefs, and practices
-nursing interventions should include a mutually acceptable plan of care that fosters a sense of safety and control
-the pt should be encouraged to request caregiving behaviours and practices that are important to them
What assessments should be done in the first stage of labour?
-these will vary based on patient status (phase of labour) and use of medications
Latent phase: vaginal show, FH and uterine activity patterns q30-60 min
Active phase: vaginal show, FH and uterine activity patterns q15-30 min
-temp q2h if membranes are ruptured and q4h if not ruptured
How does the lateral position (side lying) help mom and baby during active labour?
-enhances uteroplacental perfusion and relieves backache
-facilitates internal rotation of fetus in a posterior position
-associated with less frequent but more intense contractions
-created mobility of the sacral bone and a hammock for the fetus, as a guide into the pelvis
Describe the Gate Control Theory
feel-good sensations are registered in the brain sooner than the painful sensations so we want to flood those gates with feel good sensations/other distractions
How can hydrotherapy relax mom during the active phase of labour?
-releases endorphins
-reduces pain and decreases anxiety
-softens perineal tissue
-increases oxytocin levels
-decreases interventions
-if in the tub should be in active labour
-management: monitor woman/FH and water temp q1h
What is a Sterile Water Injection (intradermal water block)?
-used only to treat back pain
-0.05 to 1mL of sterile water injected intradermally in four points on the lower back
-two nurses perform
-no massage or counter pressure after the sterile water is injected
-pain relief 1-2 hours
What can the nurse do or say during the transition phase when the mom says “I can not do this anymore and want to go home”
1) firm touch– shift her focus
2) call her by name– this is a personal action that can bring her back to center
3) maintain eye contact– bring control and focus
4) affirm– she is safe, strong and she is doing this
5) giver her relaxation and rhythm– do some relaxation breathing with her
6) giver her a game plan– giver direction so she doesn’t feel there is no end in site
What are some examples of pharmacologic pain management during labour?
-inhalation anesthesia (nitrous oxide)
-systemic analgesia (morphine, fentanyl)
-regional anesthesia (epidural, spinal, PCEA)
What are the nursing considerations with pharmacological care?
-assess progress of labour (pelvic exam)
-timing
-monitor FHR
-education
-assess bladder/empty
-safety (side rails, call bell)
-remember some meds cross the placenta barrier
