OB exam 2 - Intrapartum 2 Flashcards
what can a birth plan include
-environment
-pain mgt
-in case of emergency
-newborn care
where does the toco go
fundus of the uterus
where should ultrasound be put
in the area where the fetal shoulders are bc it will be the loudest area to hear the heart beat
fetal scalp electrode
-placed on a firm part of the baby’s head (avoid sutures & fontanels)
-gives a continuous trace of HR even if mom is moving
-gives better information about variability
-nurse can place
-requires rupture of membranes & dilation so increase risk for infection & injury
Intrauterine pressure catheter
used if the toco is not providing good readings but is invasive so only use when necessary
they tell intensity which a toco is unable to do
montevideo units (MVUs)
measures the intensity of contractions & helps dx if you have adequate labor
subtract the baseline of uterine pressure from peak of each contraction in a 10 minute time period then add all answers together -> greater than 200 indicates adequate labor & you do not want it to exceed 300
what should resting tone be
less than 25
what is the longest a contraction should last & max frequency
120 seconds & do not want more than 5 contractions in 10 minutes
what do you want to note of ROM
-spontaneous or artificial
-time, color of fluid, amount & odor (coat)
what does nitrazine tape test for
to see if someone’s water is broken
negative = yellow
positive = blue
noninvasive
ferning test
provider takes a sample of vaginal discharge and looks at it under a scope -> if crystallized “ferning” structure appears then it is positive and pt’s water is broken
amnisure test
swabs vaginal discharge -> puts into solvent for 1 min -> insert test strip & two lines equals positive test and pt water is broken
leopold’s maneuver
nurse manually tries to determine fetal positioning and presentation
1st: try to determine between butt (soft) and head (hard) @ fundus
2nd: feel for arms & legs (bumpy) or back (smooth)
3rd: feel for presenting part by palpating the synthesis pubis for head (hard) or butt (soft)
4th: feel outline of fetus w/ palms, higher head = feel more
episodic means
not associated with a contraction
periodic means
associated with a contraction
to determine fetal baseline, how long does FHR need to be monitored
10 minutes (normal is 110-160 bpm)
veal chop
variable = cord compression
early = head compression
acceleration = oxygenation / okay!
late = placenta insufficiency
how long will an early & late decel be
greater than 30 seconds to nadir
in a late decel, what will cause decrease blood flow to placenta
-if pt has high or low BP
-if pt is bleeding bc it creates a volume problem
how long is a variable decel
less than 30 seconds to nadir but can last up to 2 minutes
uncoil (for decels)
UNdo what is occurring
Change position
Oxygen on or Oxytocin off
Ivf bolus
Lower head of the bed
timing of prolonged deceleration
> / 2min but <10 minutes
if >10 than that is considered a baseline change
what is a main reason for a prolonged decel / bradycarida
umbilical cord prolapse (a compressed cord stays compressed)
sinusodial pattern
a perfect small wave pattern that would have an exact baseline -> means that baby could be acidodic and it is extremely important to deliver the baby
1st action is call provider
what is the best indicator of fetal oxygenation
FHR variability
FHR variability
absent: amp range is undetectable (acidotic, distress)
min: <5 bpm (sleep cycle, meds, mag sulf)
mod: 6-25 bpm (goal)
marked: >25 bpm
tachy and brady time
below or above normal range for 10 minutes
main causes of brady
prolapsed cord or maternal bleeding
if your pt is tachy, what do you do first
check temp
non reassuring fetal heart rate patterns
-decels persistent & severe
-late decels of any magnitude
-prolonged decels
-absence of variability
-sinusoidal pattern
-severe (marked) brady or prolonged tachy
category 1 - normal
-normal FHR
-moderate variability
-no variable or late decels (early are ok)
category 2 - intermediate
-minimal or marked variability
-no accels
-prolonged decels
-recurrent variable or late decels
category 3 - abnormal
-sinusoidal pattern
-absent variability
-recurrent late or brady
needs to be delivered asap
if you have late decels w/ oxytocin running, what is your first nursing action
turn off the oxytocin
if contractions are lasting too long or happening too often, what can be done
administer a tocolytic
if monitoring has non reassuring patterns and interventions are not working, what is the next step
prepare for immediate delivery
if vaginal delivery is near then can use forceps or vacuum to progress the birth & get the baby out quickly but if not then C section
latent stage nursing interventions
-education & support
-encourage ambulation
-offer ice chips
-VS every hour
-temp every 4 hours every 2 if ROM
-intermittent FHR every 30-60 min (based on risk status and findings)
active phase nursing interventions
-palpate contractions every 15-30 min or continuous monitoring
-vaginal exams
-encourage voiding every 1-2 hrs
-start IV fluids
-auscultate FHR every 15-30 mins
-assess VS every 15-30 mins
-assess amniotic fluids & FHR when ruptured
-change positions & pads
transition phase nursing interventions
-palpate contractions every 15 mins or continuous monitoring
-sterile vaginal exams
-assess FHR every 15-30mins
-assist w/ breathing
-keep women from pushing until fully dilated
who is the peanut ball good for and why
pt with an epidural bc it helps them open up their pelvis to promote fetal optimal rotation & it is really good if baby is in the OP position to hopefully get the baby to move to the OA position
second stage nursing interventions
-sterile vaginal exams to assess fetal descent
-assess FHR every 5-15mins
-assess maternal VS every 30 min
-provide support and information about labor
-assist w/ pushing
-assist the physician w/ birth
indications of imminent birth
-bulging of the perineum
-uncontrollable urge to bear down
-increased bloody show
third stage nursing interventions
newborn care
-provide simulation & maintain warmth
-VS
-APGAR
- ID
-assessment
-give to mom & skin to skin
maternal care
-monitor for delivery of placenta
fourth stage nursing interventions
-VS every 15 mins for the first hour
-assess temp hourly
-IV fluids w/ pitocin 20 U
-palpate fundus every 15 min for 1 hr
-assess vaginal bleeding & perineum
-encourage bonding
-assist w/ feeding
-count instruments & sponge used in delivery
boggy fundus indicates what
increased bleeding
palpation of fundus
put a hand to support the lower base of the uterus around the symphysis pubis & the other hand cuffs and feels the fundus of the uterus
should feel firm @ midline, if to side then possible full bladder that needs to be emptied
what to note during a vaginal exam
-cervix: posterior, mid position, anterior
-cervical dilation
-cervical effacement
-fetal presentation
-station
