NUR 306 - Exam 2 Flashcards
true labor
CERVICAL CHANGE
regular, frequent contractions
bloody show
fetus descends into true pelvis
false labor
NO CERVICAL CHANGE
painless, irregular contractions
NO bloody show
where are fetal heart sounds heard in cephalic position?
lower abdomen
where are fetal heart sounds heard in breech postition?
above umbilicus
pitocin action
stim uterine contractions for inductions and given postpartum to prevent/treat hemorrhage
pitocin considerations
continuous fetal monitoring
- tachy, uterine rupture, abruptio placenta
chronic hypertension
HTN before pregnancy for before 20 weeks
reading of 140/90 twice 4 hours apart and not stablizing
preeclampsia
HTN with proteinuria or signs of organ damage (severe features) after 20 wks
eclampsia
preeclampsia with seizures
HELLP syndrome
Hemolysis, Elevated Liver enzymes, Low Platelet count; a severe form of preeclampsia
management of Chronic Hypertension, Preeclampsia, Eclampsia, HELLP
Mag Sulfate, antihypertensives, early delivery
risk of multiple gestation
preterm labor, C/S, HTN disorders, placenta previa, PP hemorrhage
dystocia
difficult labor due to contractions, dilation, descent, and pelvic shape
pelvic dystocia
abnormal shape of pelvis
soft tissue dystocia
placenta previa, benign fibroid tumor, distended bladder
hypotonic labor dystocia
inefficient contractions - Pit or artificial ROM
hypertonic labor dystocia
delivering too fast - uterine rupture, laceration of birth canal, fetal distress - call MD
contraindictions for pitocin
too many contractions, fetal distress
pitocin complications and actions
hyperstimulation, HTN, N/V, arrythmias, fluid volume issues
preterm labor risk factors
metabolic diseases, infection, increased maternal age, smoking/drugs, violence, low maternal weight prepregnancy, previous PTL, uterine issues, recurrent cervical dilation, placental issues, multiple gestation, PROM
signs of onset preterm labor
contractions, “period-like” cramps, low back pain, discharge w foul odor, urinary freq.
interventions for preterm labor
terbutaline, tocolytics, corticosteroids for baby, bed rest, hydration
gate control theory + example
new pain distracts from exisiting pain ex. injecting saline to distract from labor pains
endogenous biochemical theory + example
once pain gets to a ceratin level brain releases morphine-like chemical that reduces pain ex. oxytocin in brain decreases labor stress
fear/tension theory
pain will increase with fear and tension - nurses have the biggest impact on this theory
cognitive control theory
dissociation- focus on something nonpainful
interference- focus on something not related at all
when to reassess pain
1 hour after PO med
20 min after IV med
systemic meds
opioids, analgensic potentiators, antiemetics
side effects of systemic meds
- resp. depression
- slow labor
- sedation
- cross the placenta
contraindictions for systemic meds
- allergies
- resp. issues
- myasthenia gravis
- addiction
opioids analgesics
stadol, nubain, demerol, fentanyl
analgesic potentiators
phenergan and vistaril
action of analgesic potentiators
antiemetics, relaxation, increase effectiveness of analgesics
opioids antagonist
narcan
when to give systemic meds
early in labor to avoid fetal resp depression
anesthesia
block sensation
analgesia
decrease pain