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ABSN > OB exam 2 - Artificial Mgt of Labor > Flashcards

OB exam 2 - Artificial Mgt of Labor Flashcards

1
Q

advantages to labor induction

A

labor usually occurs in 24-48 hours

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2
Q

disadvantages to labor induction

A

-contractions may be less gradual
-dysfunctional uterine contractions
-increased bloody discharge

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3
Q

what needs to be down before induction of labor

A

-review pt, VS & obtain consent
-obtain reactive NST
-vaginal exam
-bishop score (the higher the score, the higher chance of a regular vaginal delivery)

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4
Q

amniotomy (AROM) nursing interventions

A

-check fetal HR
-note date & time
-note fluid (COAT)
check temp every 2 hours

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5
Q

what is a mechanically induction

A

cervical ripening
uses a foley bulb which puts pressure on the cervix just like the fetal head would causing prostaglandins to be released to soften the cervix

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6
Q

advantages of cervical ripening

A

-cervical effacement
-shorter labor
-lower requirements for oxytocin
-vaginal birth is achieved within 24 hrs for most women
-incidence of C section birth is reduced

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7
Q

risks of cervical ripening

A

-uterine hyperstimulation (for than 5 contractions in 10 mins)
-non reassuring fetal status
-higher incidence of PP hemorrhage
-uterine rupture

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8
Q

what meds can be given to induce labor

A

misoprostol & dineprostone (prostaglandins)
given vaginally to stimulate contractions to thin cervix & oxytocin

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9
Q

Cytotec

A

-dose is 25 mcg every 6 hours
-do not start pitocin induction within 4 hrs of last dose

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10
Q

cervidil

A

-dose 10mg vaginal insert over 12 hours
-bedrest 2 hours after dose then may be up to bathroom (pat dry after voiding)
-to remove, pull string

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11
Q

stripping of the membranes

A

-non pharm possible induction of labor
-separates the amniotic membranes from the lower uterine segment (can be uncomfortable & my see vaginal bleeding after)
-releases prostaglandins that stimulate contractions
only preformed by OB, nurse midwife or NP

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12
Q

what are the uses of Pitocin (Oxytocin)

A

induction or augmentation (help labor along)

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13
Q

risks of pitocin

A

-tachysystole contractions
-uterine rupture
-water intoxication (anti diuretic effect -> confusion, lethargic, vomiting and/or seizure)
-non reassuring fetal heart rate patterns

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14
Q

what do you do if pt experiences water intoxication from pitocin induction

A

stop pitocin -> give 9% normal saline & give furosemide

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15
Q

what needs to be done before administering pitocin

A

-need reactive NST
-vaginal score w/ bishop score
-check for foley bulb (can still use if in place)
-continuous fetal monitoring

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16
Q

how is pitocin titrated

A

increase 1-2 mu/min every 30 mins

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17
Q

what is a major risk if on pitocin for over 7 hours

A

post partum hemorrhage

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18
Q

what happens if you give pitocin as a bolus

A

will cause continuous hard contractions and baby will not get perfused well or good oxygen caused a prolonged decel

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19
Q

when does labor augmentation usually occur

A

during naturally occurring labors w/ hypotonic contractions

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20
Q

what are the main ways of performing labor augmentation

A

-pitocin
-AROM

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21
Q

amnioinfusion

A

warmed sterile NS or LR is placed into the uterus via IUPC

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22
Q

reasons for an amnioinfusion

A

-replacement of lost or absent amniotic fluid
-repetitive variable decelerations w/ increasing intensity
-meconium dilution

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23
Q

what should be occurring when an amnioinfusion is happening

A

water should be leaking back out
if no fluid noted and you have increased uterine resting tone, stop transfusion immediately

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24
Q

what intervention is done to encourage water to come out after amnioinfusion is turned off because of no fluid return

A

try to move baby’s head bc it could be acting as a stopper or change maternal position

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25
Q

factors for use of forceps assisted birth

A

-heart disease
-acute pulmonary edema or pulmonary compromise
-intrapartum infection
-prolonged second stage
-exhaustion
-non reassuring fetal strip

26
Q

episiotomy

A

surgical incision of the perineum to enlarge the vaginal outlet -> two types are midline or mediolateral and can be classified from 1st degree to 4th degree

27
Q

mid forceps

A

fetal head engaged @ 0 station
used rarely bc higher reach

28
Q

low forceps

A

fetal head +2 station

29
Q

outlet forceps

A

fetal head at perineum

30
Q

maternal risks to forceps use

A

-vaginal and cervical lacerations
-periurethral lacerations
-extension of a median episiotomy into the anus
-anal sphincter injury
-perineal edeam

31
Q

neonatal risks of forceps use

A

-ecchymosis, edema, along the sides of face
-caput succedaneum or cephalhematoma
-transient facial paralysis, brachial plexus
-cerebral hemorrhage
-fractures (clavicle)
-elevated neonatal bilirubin levels

32
Q

nursing mgt for forceps assisted births

A

-explain procedure to women
-monitor contractions
-inform physician/CNM of contraction
-encourage women to push during contraction
-reassurance
-document length of the forceps used (when applied & removed)

33
Q

Vacuum Extraction

A

-suction cup placed on fetal occiput
-pump is used to create suction
-traction is applied
-fetal head should descend w/ each contraction
-document length of time vacuum is used (put on, when pressure was applied, when pressure was turned off and when the vacuum was off)

34
Q

Cesarean Birth Indications

A

-complete placenta previa
-CPD
-Placental abruption
-active genital herpes
-umbilical cord prolapse
-failure to progress in labor
-tumors that obstruct the birth canal
-breech presentation
-previous C section
-major congenital anomalies
-non reassuring fetal status

35
Q

what is the usual uterine incision

A

low transverse

36
Q

what does a classical uterine incision or low vertical incision put mother at high risk for

A

a uterine rupture if vaginal delivery to tried
best practice is to have another c sections future children & placenta previa bc placenta will want to attached to scarring

37
Q

nursing mgt before C section

A

-assist w/ epidural or spinal
-unscheduled sections will get get pepcid & reglan to neutralize stomach acid as well as bicitra 30 mins before
- monitor maternal VS
-obtain fetal HR
-insert foley
-prepare abdomen and perineum
-make sure all necessary personnel and equipment are present

38
Q

nursing mgt during C section

A

-position the women on the operating table (wedge for left tilt prior to delivery)
-support the couple
-instrument count (before, during, after)
-time out (final checks for consent & safety)
-document

39
Q

what do you document during a C section

A

incision, delivery of infant, APGARS, AROM if done, placenta extracted, EBL, & meds received

40
Q

nursing mgt after c section

A

-normal newborn post delivery care
-monitor VS every 15 mins
-check the surgical dressing
-palpate the fundus and checking lochia
-monitor intake & output
-administrate IV Oxytocin

41
Q

visceral pain

A

slow deep pain that is dull or aching
very common in first stage of labor

42
Q

somatic pain

A

sharp and localized and is like a burning or tearing feeling
common during the transition or pushing phase of labor

43
Q

do pain meds cross through the placenta during labor

A

yes

44
Q

when are you going to give systemic analgesia

A

since fetal liver and kidney excretion is inadequate for metabolizing med you will do it when women is uncomfortable, in a well established labor pattern, contractions are occurring regularly, there is a significant during of contractions and contractions are moderate to strong in intensity

45
Q

contraindications for systemic analgesia

A

allergies
hypotension
non reassuring fetal strip
don’t give systemic right before delivery bc could affect respiratory off baby

46
Q

what medication can you not give to mothers with substance abuse issues

A

nalbuphine hydrochloride -> can initiate w/draw & cause neonatal abstinence syndrome

47
Q

major consideration for meperidine

A

naloxone (Narcan) does not reserve affects on the infant

48
Q

regional anestesia

A

temporary and reversible loss of sensation & prevents initiation and transmission of nerve impulse for pain control

49
Q

epidural disadvantages

A

-maternal hypotension (give LR bolus)
-post delivery back pain
-meningitis
-cardio respiratory arrest
-vertigo
-onset of analgesia may not occur for up to 30 mins

50
Q

advantages to a spinal

A

-immediate onset of anesthesia
-relative ease of administration
-smaller drug volume

51
Q

disadvantages of a spinal

A

-high incidence of hypotension
-greater potential for fetal hypoxia
-short acting

52
Q

advantages to a combined spinal epidural

A

-spinal has a faster onset
-meds can be added
-low doses

53
Q

disadvantages to a combined spinal epidural

A

-higher incidence of nausea
-pruritus

54
Q

nursing mgt prior to epidural/spinal placement

A

-assess maternal & fetal status
-assess labor progress
-start an IV and administer preload (warmed LR bolus)
-help women into position

55
Q

nursing mgt for after an epidural/spinal

A

-monitor maternal & fetal VS
-assess for hypotension & correct if needed
-administer antiemetics as needed
-monitor respiratory rate
-assess bladder and catheterize if unable to void

56
Q

corrective measures for hypotension

A

-additional fluid bolus
-meds: ephedrine IVP
-oxygen if needed

57
Q

pudendal block (perineal anesthesia)

A

second stage of labor and episiotomy repair

58
Q

pudendal block advantages

A

-ease of administration
-absence of maternal hypotension

59
Q

pudendal block disadvantages

A

urge to bear down may be decreased

60
Q

general anesthesia

A

-emergent delivers
-low platelet count requiring C section
-scheduled C sections and unable place spinal

61
Q

cricoid pressure (for general anesthesia)

A

diminish the chance of aspiration during placement of endotracheal tube

62
Q

general anesthesia problems

A

-fetal respiratory depression (=lower apgar score)
-maternal intubation
-higher risk of aspiration
-higher risk for PP hemorrhage
-less feeling of control
-support person may not present
-maternal amnesia

ABSN (90 decks)

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