Repro 2, part 1 Flashcards by Jenise Hughes

Hot or cold packs to suppress breast milk production?

Cold compresses to suppress; cold cabbage leaves too

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Name 3 interventions that you can encourage a formula feeding mother to do in order to suppress lactation:

wear a 24 hour support bra
apply cabbage leaves to the breast tissue
avoid all nipple stim for 7-10 days

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What comfort measures can you encourage a breastfeeding mother to use?

warm compresses, making sure to fully drain a breast of milk, lanolin on dry/cracked nipples, ensure a proper latch is occurring

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What is preterm labor?

labor between 20-36 completed weeks gestation

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What is a lab test that can confirm preterm labor?

fFN (22-34 weeks) Fetal fibronectin leaks into the vagina and a + test result means that a mother will go into preterm labor, although it may not be for weeks

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What other s/s must be present in addition to fFN to confirm that the mother is currently in preterm labor (PTL)?

A +fFN and cervical change (length and funneling)

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Name some of the most common risks for PTL:

preg. with multiples, polyhydramnios, fetal anomaly, trauma, smoking, HTN, obesity, substance abuse, Hx of PTL, uterine anomaly, febrile illness

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Risks to moms in PTL?

medication side effects (pulmonary edema)
chorio amnionitis-if causes is PPROM
thromboembolism if on bedrest
financial loss
child care issues

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Define PPROM

Preterm Premature rupture of membranes

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What are the risks to the baby of a mom in PTL?

increased morbidity and mortality rate
respiratory distress and lung immaturity
intraventricular hemorrhage
necrotizing enterocolitis (NE)

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What is the goal of medical intervention in PTL?

To slow/cease the process of labor and prolong the length of fetal gestation

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In which cases would you not want to prolong the length of gestation for a mom in PTL?

in cases of fetal demise, fetal anomaly, severe preeclampsia/eclampsia, hemorrhage, severe IUGR, olighydramnios, reversed Doppler flow

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Do you treat a mom in PTL with antibiotic prophylaxis?

It’s a debated point and is provider-dependent

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What is the med to have on hand when using Magnesium sulfate?

Calcium Gluconate

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What are some nursing priorities for a mom in PTL?

monitor mom and baby's vitals
administer meds/antibiotics/fluids as prescribed
encourage rest and hydration
Treat any underlying infection
Prepare parents for a preterm infant

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What talking points should be discussed with a mom in PTL when delivery is probable?

educate parents on the process-transport if necessary, NICU stay for baby, introduce social work and maternal and fetal medicine provider, offer support

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What is the cervical stitch called?

A cerclage

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when would magnesium sulfate be an appropriate med to administer to a gravid mom?

When mom has severe preeclampsia and/or when mom is in PTL WITH cervical change.

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What is the rate you give calcium gluconate via IV should you need to reverse the effects of Mag Sulf.?

1g via IV over 3 minutes

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What is the therapeutic level of Mag Sulf?

4-8mg/dL

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What are some nursing assessments performed on a mom on Mag Sulf?

BP (make sure pt is no longer hypertensive, but monitor how well pt responds to catch any s/s of hypotension)
reflexes-test ankle in dorsiflexion (turn Mag down if reflexes severely diminished)
respirations
Urine output should be less than 30 cc/hour

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What is polyhydramnios?

Excessive amniotic fluid

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what is olighydramnios?

deficient amniotic fluid

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What can increase the risk of oligohydramnios?

diabetes
HTN/preeclampsia=IUGR of placental insufficiency 
substance abuse
maternal dehydration
fetal birth defect
postmaturity
leaking amniotic fluid

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What would you suspect if fundal height is less than expected?

oligohydramnios

What is a major concern of a mother delivering with known oligohydramnios?

cord compression

What is a red flag in monitoring a baby with suspecting oligohydramnios?

a nonreassuring FHR

What are 2 common birth defects associated with polyhydramnios?

hydrocephalus and anencephaly

What increases the risk of polyhydramnios?

diabetes=macrosomnia fetal anomaly fetal anemia past Hx of polyhydramnios

common complications of polyhydramnios:

``` cord prolapse**** inadequate labor malpresentations postpartum hemorrhage PTL maternal discomfort ```

What's the normal FHR?

110-160bpm

What could early decelerations indicate?

usually head compression

What would late decelerations indicate?

usually a placental issue

What would variable decelerations indicate?

usually a cord issue

Is variability in FHR a good or bad sign?

Good-moderate variability w/o decels | BAD-Marked variability or variability with decels

What are some interventions for a worrisome FHR?

lay mom on left side or reposition apply O2 manage pain/anxiety w/ meds or distraction assess for bleeding monitor contractions-uterus could be hyperstimulated which may not give baby enough time to recover between contractions

Accelerations of the FHR: good or bad?

Good

What would absent variability indicate in a FHR?

no neuro involvement

How often do you assess FHR in the latent stage of labor?

Q30mins

How often do you assess the FHR in the active stage of labor?

Q30mins

How often do you assess the FHR in the transitional stage of labor?

Q15-30 mins

When would you notify a provider of the need for intervention based on FHR readings?

``` Late decels prolonged decels that do not return to baseline variable decels (may need to relace amniotic fluid with amnioinfusion ```

What is a diagnosis that accompanies severe pre eclampsia?

HELLP syndrome: Hemolysis Elevated Liver enzymes and Low Platelets

What is the cure of pre-eclampsia?

birth (but continure to monitor for 48 hours as seizures may still occur)

What is the classification of pre-eclampsia and severe pre-eclampsia?

pre-eclampsia= BP 140/90 with proteinuria of 300mg/24 hours | severe pre-eclampsia=BP 160/110 with proteinuria of 500mg/24hours and nausea, hyperreflexia and epigastric pain

What is eclampsia?

BP of at least 140/90 with proteinuria and the presences of SEIZURES

what's the difference between preeclampsia and gestational HTN?

Preeclampsia involves the presence of proteinuria

What is the most common medical complication of pregnancy?

hypertensive disorders of pregnancy

pre-eclampsia can lead to what risk factors?

thrombocytopenia, fetal growth restriction, pulmonary edema, elevated liver enzymes, seizures and coma

What are some rick factors to developing pre-eclampsia?

``` Hx of pregnancies w/ preeclampsia multiple gestation poor nutrition age= VERY YOUNG OR OVER40 obesity chronic kidney disease preexisting hypertension pregnancy after donor insemination ```

What is the treatment for mild preeclampsia?

``` rest in left lateral position frequent prenatal visits fetal surveillance maternal lab work: CBC, liver enzymes, clotting studies 24 hour urine screen for protein ```

What is the treatment for severe preeclampsia?

``` hospitalization lab work fetal surveillance vigilant reflex assessments seizure prevention Mag Sulfate betamethasone, IM for fetal lung maturity if pre-term quiet environment Vitals ```

What are the meds used to treat preeclampsia?

labetalol and mag sulfate

What are s/s that require immediate attention as a result of a preeclampsia diagnosis?

facial edema and clonus

S/S of preeclampsia?

``` elevated BP at least 140/90 edema epitaxis headaches dizziness proteinuria ```

What med can you administer for a rapid contraction pattern?

Terbutaline

What causes pain in labor?

cervical dilation effacement pressure of the descending fetus anxiety

What are some non-pharmacological labor pain management interventions?

breathing, visualization, massage, music, movement, tub

Common side effect of Nubain?

sedation, sweating, N/V

What's the dosage of Nubain?

10-20mg Q3-6 hours via IV/SC/IM

Nursing considerations upon administering Nubain?

Nubain is for moderate to severe pain and analgesic effect is equal to morphine; alert provider if RR is <12, assist patient with ambulation after administering

What is the dosage for Stadol?

IM: 1-4mg Q3-4h IV: .5-2mg Q6-8h

What is the common side effect of Stadol?

sedation; life threatening respiratory depression

What are contraindications for using Stadol for labor pain?

narcotic dependency, breastfeeding

Dosage for Demerol for labor pain relief?

50-100mg IM or SC Q3-4h; | 23-50mg IV Q3-4 hours

What are some contraindications for using Demerol for labor pain relief?

narcotic dependency, epilepsy, hypersensitivity to the drug

What is the dosage for Morphine for labor pain relief?

IV: 2.5-15mg Q4h | IM/SC: 5-20mgQ4h

What are common side effects of Morphine?

itching, nausea, constipation

What are contraindications for using morphine?

hypersensitivity to opiates, acute asthma, chronic pulmonary diseases, pulmonary edema, decreased respirations, Addison disease, hypothyroidism

Name 2 antiemetics used for labor and delivery:

ondansetron and phenergan

What are some pharmacologic interventions to assist with labor anxieties?

Vistaril, Benadryl, Nitrous, valium

What meds are used in epidural pain relief?

Fentanyl and/or local anesthetic

What's the dosage for a bolus of Mag Sulfate?

4-6g IV in 100 ML of fluids of 20 mins

What is nifedipine?

a calcium channel blocker used to stop PTL by reducing contractile activity.

Who is contraindicated from receiving Nifedipine?

women with heart disease, cardiovascular compromise, multiple gestation, maternal HTN, and intrauterine infection

What is the dosing of Nifedipine?

20mg orally stat followed by 20mg orally Q 30 mins in contractions persisit followed by 20mg Q3-8 hours for the next 48-72 if contractions persist. MAX des 160 mg per day

What prostaglandin is usually effective in stopping PTL?

Indomethacin (but no longer widely used d/t being associated with necrotizing colitis. Not used past 34 weeks gestation)

What does terbutaline do?

relax the uterus

What is the dosage of terbutaline?

.25mg IM, a second does of .25mg IM in 15-30 mins if uterus has not relaxed

What is a tocolytic?

A medication used in an attempt to stop labor

What are some of the side effects of tocolytics?

hypotension, cardiac arrhythmias, tachycardia, palpitations, myocardial ischemia, pulmonary edema, and maternal hyperglycemia

What are contraindications for using tocolytics?

It's case dependent upon maternal presentation: health history and risk factors

What is recommended to be administered to a woman at risk of PTL?

A cortico steroid (either betamethasone or dexamethasone) for fetal lung maturity.