Power Flashcards
1
Q
What are the common causes of dysfunctional labor?
A
- CPD
- Uterine atony or overdistention of the uterus
- Primigravida
- Posterior position or extension of the fetal head
- Full rectum or full bladder
- Inappropriate use of analgesia (excessive/too early)
- Nonripe cervix
- Exhaustion
2
Q
Time-honored term to denote sluggishness of contractions of the force of labor is LESS THAN USUAL.
A
Inertia OR DYSFUNCTIONAL LABOR
3
Q
appears to result from several factors - such as macrosomia or if the contraction is hypotonic, hypertonic, or uncoordinated.
A
PROLONGED LABOR
4
Q
When a pregnant woman has less strength than usual or contraction is rapid but ineffective, ________________________ occurs
A
Dysfunctional Labor
5
Q
Contraction occur because of:
A
- The interplay of the contractile enzyme adenosine triphosphate
- The influence of major electrolytes such as Ca, Na, K
- Specific contractile proteins (actin/myosin)
- Posterior pituitary hormone (epinephrine, norepinephrine, oxytocin)
- Estrogen
- Progesterone
- Prostaglandin
6
Q
Hypotonic Contractions
Contractions:
A
low, infrequent (not more than 2 or 3 in a 10 minute period)
7
Q
Hypotonic Contractions
Frequency:
A
2-3 contractions per 10 minutes (should be at least 3)
8
Q
Hypotonic Contractions
Resting Tone:
A
<10 mmHg (normal is 15 mmHg)
9
Q
Hypotonic Contractions
Strength:
A
Does not exceed 25 mmHg
10
Q
Hypotonic Contractions
Occurs During:
A
- Active labor/phase
- after administration of analgesia especially if the cervix is not dilated to 3-4 cm
11
Q
Risk Factors for Hypotonic Contractions
A
- If the bowel or bladder distention prevents descent or firm engagement
- Uterus is overstretched by multiple gestation
- Larger than usual fetus
- Hydramnios
- Lax uterus from grand multiparity
12
Q
Cause of Hypotonic Contractions
A
- Early administration of analgesia
- Bowel or bladder distention
- Overstretched uterus due to multiple gestation
- Larger than usual fetus
- Hydramnios
- Lax uterus from grand multiparity
13
Q
if the uterus becomes exhausted does not contract, it can lead to?
A
bleeding
14
Q
Nursing Management for Hypotonic Contractions
A
- 1st hour after birth - palpate the uterus, check bp and lochia
- assess lochia every 15 minutes
- oxytocin
15
Q
what may occur from high doses of oxytocin?
A
- Uterine hypertonicity
- spasm
- rupture of the uterus
- tetanic contractions
16
Q
Resting Tone of Hypertonic Contractions
A
more than 15 mmHg
17
Q
Hypertonic Contractions occurs during
A
Latent phase of labor
18
Q
Myometrium keeps on contracting
A
Uncoordinated contractions
19
Q
Uterine contraction appear closely together that they do not allow good cotyledon (blood exchange)
A
Uncoordinated contractions
20
Q
Management of Uncoordinated Contractions
A
- Apply external monitor (tocodynamometer) to assess pattern, resting tone, and fetal response for 15 minutes.
- Administer oxytocin to regulate and strengthen contractions.
21
Q
DYSFUNCTION AT FIRST STAGE OF LABOR
A
- Prolonged latent phase
- Protracted active phase
- Prolonged deceleration phase
- Secondary arrest dilatation
22
Q
Latent phase that is longer than 20 hours in a nullipara and 14 hours in a multipara.
A
Prolonged latent phase
23
Q
It occurs if the cervix is not ripe at the beginning of labor
A
Prolonged latent phase
24
Q
May occur if there is excessive use of an analgesic early in labor
A
Prolonged latent phase
25
in prolonged latent phase, the uterus tends to be _____________________
hypertonic state
26
1. Prolonged latent phase
Nursing MANAGEMENT
- Involves the uterus to rest
- Providing adequate fluid for hydration
- Pain relief with a drug such as morphine sulfate
- Changing the linen and the woman's gown
- Darkening room lights
- Deacreasing noise and stimulation
27
Prolonged latent phase
Collaborative MANAGEMENT
- CS
- Amniotomy
- Oxytocin infusion
28
Latent Phase
Nullipara: Average: _________, Upper limit: _______
8.6 hrs; 20 hrs
29
Latent Phase
Multipara: Average: _______, Upper limit: ______
5.3 hrs; 14 hrs
30
Active Phase
Nullipara: Average: __________, Upper limit: ________
Dilation rate: _________
4.9 hrs; 12 hrs; 1.2 cm/h
31
Active Phase
Multipara: Average: ________, Upper limit: _________
Dilation rate: ___________
2.5 hrs; 6 hrs; 1.5 cm/hr
32
Second Stage
Nullipara: Average: _________, Upper limit: _________
1 hr; 3 hrs
33
Second Stage
Multipara: Average: ________, Upper limit: ___________
0.5 hr; under 1 hr
34
Protracted active phase is associated with
CPD or fetal malpresentation
35
Cervical dilatation does not occur at a rate of at least 1.2 cm/hr in a nullipara or 1.5 cm/hr in a multipara
Protracted active phase
36
Active phase lasts longer than 12 hrs in a primigravida, 6 hrs in a multigravida
Protracted active phase
37
Descent beyond 3 hours for nullipara and 1 hour for multipara
Prolonged deceleration phase
38
Occurred if there is NO progress in cervical dilatation for longer than 2 hours
Secondary arrest dilatation
39
mode of delivery for prolonged deceleration phase
CS
40
mode of delivery for secondary arrest dilatation
CS
41
DYSFUNCTION AT THE SECOND STAGE OF LABOR
1. Prolonged Descent
2. Arrest of Descent
42
Protracted active phase
MANAGEMENT
- CS- if due to CPD that causes delay of dilatation
- Oxytocin is given if CPD is not present
43
Can be suspected if the second stage lasts over 3 hours in a multipara
Prolonged descent
44
Nulli- less than 1 cm/hour, multi-less than 2 cm/hour
Prolonged descent
45
Multi-normal is 2.5 hours but in prolonged descent it's 3 hours
Prolonged descent
46
MANAGEMENT of Prolonged Descent
- rest and fluid intake
- amniotomy
- oxytocin/IV
- Semi-fowler's position, squatting, kneeling
47
Results when NO DESCENT has occurred for 1 hour in a multipara or 2 hours in a nullipara
Arrest of Descent
48
Engagement or movement beyond 0 station has not occured __________ = most likely cause for arrest of descent
CPD
49
Nursing Diagnosis (Dysnfuctional Labor)
RISK FOR FLUID DEFICIT RELATED TO LENGTH AND
WORK OF LABOR
50
Nursing Interventions (Dysfunctional Labor)
1. CHECK URINE: ketones, proteins, glucose, and specific gravity
2. Administration of IVF as ordered.
51
A hard band that forms across the uterus at the junction of the upper and lower uterine segments and interferes with fetal descent.
Contraction Ring
52
common type of contraction ring
Pathologic retraction ring/Bandl’s ring
53
Contraction ring appears at what stage of labor
2nd stage of labor
54
Formed by excessive retraction of the upper uterine segment, the uterine myometrium is much thicker above than below the ring
Contraction Ring
55
Management of Contraction Ring
Manual removal of placenta under general anesthesia
56
Complications of Contraction Ring
- Uterine Rupture
- Neurologic damage to the fetus
- Massive hemorrhage
57
Occurs when auterus undergoes more strain than it is capable of sustaining.
Uterine rupture
58
Occur most commonly when a vertical scar from a previous CS or hysterectomy repair tears.
Uterine rupture
59
Types of Uterine Rupture
Complete Rupture
Incomplete Rupture
60
layers affected in complete uterine rupture
Endometrium, myometrium and peritoneum layers
61
Signs of shock
rapid weak pulse, falling BP, cold clammy skin, dilatation of the nostrils, FHR fades and then are absent.
62
what layer is intact in incomplete uterine rupture
peritoneum layer
63
Management of Uterine Rupture
- administer emergency fluid therapy
- oxytocin
- laparotomy
- Advise not to conceive again
- hysterectomy
- cesarian hysterectomy
- assess the contour
64
UTERINE RUPTURE
PREDISPOSING FACTORS
Prolonged labor
Abnormal presentation
Multiple gestation
Unwise use of oxytocin
Obstructed labor
Traumatic maneuvers of forceps or tractions
65
UTERINE RUPTURE
ASSESSMENT
- Sudden, severe pain during a strong labor contraction
- Tearing sensation
66
Occur when uterine contractions are so strong that a woman gives birth with only a few rapidly occurring contractions.
Precipitate labor
67
Labor that is completed in fewer than 3 hours
Precipitate labor
68
cervical dilatation that occurs at a rate of 5 cm or more /hr in a primipara or 10 cm or more /hr in a multipara
Precipitate dilatation
69
Precipitate Labor occur with
- grand multiparity
- after induction of labor by oxytocin or amniotomy
70
Rapid labor also posses a risk to the fetus resulting to:
subdural hemorrhage
71
PREDISPOSING FACTOR of Precipitate Labor
- Multiparity
- Large babies
- Poor flexion
- Large Pelvis
- Lax unresisting maternal tissue
- Small baby in good position
- Induction of labor amniotomy and oxytocin administration
- Absence of painful sensation and thus lack of awareness of vigorous
72
PRECIRITATE LABOR
ASSESSMENT
- Similar to woman with normal labor pattern but they appear suddenly without warning.
- Patient complains of a sudden, intense urge to push
- Sudden increase in bloody show
- Sudden bulging of the perineum
- Sudden crowning of the presenting part
73
PRECIPITATE LABOR COMPLICATIONS
Maternal
- Laceration of birth canal and uterine rupture
- Postpartum hemorrhage
- Amniotic fluid embolism
74
PRECIPITATE LABOR COMPLICATIONS
Fetus
- Subdural hematoma
- Fetal hypoxia
75
Inverted fundus up to cervix
1st degree
76
Body of uterus protrudes through cervix into vagina
2nd degree
77
Prolapse of inverted uterus outside vulva
3rd degree
78
Prolapse of inverted uterus and vagina
4th degree
79
Refers to the uterus turning inside out with either birth of the fetus or delivery of the placenta
Inversion of the Uterus
80
Inversion of the Uterus occurs at what stage of labor
3rd stage
81
ccur if traction is applied to the umbilical cord to remove the placenta
Inversion of the Uterus
82
Occur if pressre is applied to the uterine fundus when the uterus is not contracted.
Inversion of the Uterus
83
Occur if the placenta is attached at the fundus and during birth the fetus pulls the fundus down
Inversion of the Uterus
84
ASSESSMENT of Inversion of the Uterus
Large amount of blood
Blood loss, dizziness, paleness and diaphoresis
Fundus is not palpable
Uterus is not contracting
Bleeding continuous
85
CAUSE of Inversion of the Uterus
- Pulling placenta when not ready to deliver or when not detached
- Pulling placenta when uterus is not contracting or no strong uterine contraction
86
Uterine Relaxants (Tocolytics)
Indomethacin
Nifedipine
Magnesium Sulfate
Terbutaline
87
are drugs designed to inhibit contractions of myometrial smooth muscle cells
Tocolytic agents
88
Tocolytics should be used with ________________ to prevent respiratory complications in the premature newborn.
corticosteroids
89
are synthetic forms of the endogenous posterior pituitary hormone oxytocin.
Oxytocic drugs
90
They produce uterine contractions and milk ejection for breast-feeding.
Oxytocic drugs
91
Cervical change or effacement and uterine contractions occurring after 20 weeks gestation and prior to 37 weeks of gestation
Preterm Labor
92
Preterm Labor causes
PROM
Hydramnios
Placenta previa
Preeclampsia
Multiple gestation
Abruption placenta
Incompetent cervix
Fetal death
Trauma
Intrauterine infection
Maternal factors: stress, Urinary Tract Infection, Dehydration
93
Preterm Labor Assessment
Suprapubic pressure
Vaginal pressure
Low back pain
Regular uterine contractions
Cervical dilatation and effacement
Bloody show
Rupture of membranes
94
Pregnancy which extends beyond 42 weeks AOG
Prolonged Labor
95
CAUSES of Prolonged Labor
Large fetus
Hypotonic
Hypertonic
Uncoordinated contractions
96
Those who have it (prolonged labor) are at risk of:
Postpartal infection
Hemorrhage
Infant mortality
97
Prolonged labor Assessment
Weight loss and decreased uterine size
Excessively large fetus
Meconium-stained amniotic fluid
Abnormal FHT pattern
98
Prolonged Labor Management
Evaluate fetus-remove MECONIUM stain to prevent DOB
Prevent birth complications
Give emotional and physical support
Educate the patient and her family
