Study Guide Test 3 - Tiff Flashcards
Risks to mom for cesarian birth
Risks for mom:
- infxn
- hemorrhagic conditions (abruptio placentae or placenta previa)
- Urinary tract trauma
- thromboembolism
- paralytic ileus
- atelectasis
- anesthesia complic.
What type of aftercare is provided after an amniotomy?
- FHR is assessed for at least one full minute
- quantity, color and odor of amniotic fluid are charted
- the woman’s temp should be assess at least every 2-4 hours
- provide comfort
Advantages of Nonpharmacologic Pain Management:
- Non systemic
- Doesn’t affect fetus
- Doesn’t affect labor
- Does not slow labor
- No side effects or risk of allergy
- Some pharmacologic methods may not eliminate labor pain.
- May be the only realistic option in advanced, rapid labor
lactogenesis is defined as:
the composition of breast milk that changes in three phases
Indications for episiotomy
- shoulder dystocia
- vacuum or forceps birth
- face presentation, preterm
Contraindications to Version
- ruptured membranes
- nuchal cord (cord around fetal body or neck), -
- uteroplacental insufficiency
- previa
- fetal head engagement
What are causes of overdistention of uterus?
- polyhydramnios
- twins
- grand multiparity
- post mature infants
- LGA +gestational diabetes
When should the hearing test be performed?
within the first month
Contraindications to cesarean
- fetal death
- immature fetus
- maternal coag defect
Common Breastfeeding Concerns: Maternal Concerns
- Breast problems
- Illness in mother
- Medications
- Breast surgery
- Employment
- Milk expression
- Storing milk
- Multiple births
- Weaning
- Home care
During what behavioral state or period of reactivity is it a good time to increase bonding and continue to work on breast feeding?
Quiet Alert State, 1st period of reactivity
Signs of neonatal hypoglycemia (more extensive list)
• Jitteriness, tremors • Poor muscle tone • Diaphoresis (sweating) • Poor suck • Tachypnea • Tachycardia • Dyspnea • Grunting • Cyanosis • Apnea • Low temperature • High-pitched cry • Irritability • Lethargy • Seizures - coma
Factors that increase risk for increased bilirubin?
- Excess production
- Red blood cell life
- Liver immaturity
- Intestinal factors - conjugated bilirubin can’t be reduced to urobilinogen or stercobilin for excretion without the action of the normal flora
- Delayed feeding
- Trauma can result in increased hemolysis of
red blood cells. - Fatty acids are released when brown fat is used
If the infant goes home before voiding, after being circumcised, the mother is instructed to call the physician if the baby does not urinate within __ to __hours.
6 - 8
What are the indications for a cesarean birth?
- dystocia
- cephalopelvic disproportion
- HTN
- maternal diseases
- active genital herpes
- fetal distress
- umbilical cord prolapse
- some previous uterine surgical procedures
- persistent non reassuring FHR pattersn
- prolapsed umbilical cord
- fetal malpresentations
- hemorrhagic conditions
Risks to operative vaginal birth:
- trauma to maternal and fetal tissues
- hematoma of the vagina
- fetus may have bruising, facial nerve injury, clavicular fractures, cephlahematoma
Induction/Augmentation Contraindications
- previa
- prolapse cord
- abnormal fetal presentation
- prior upper uterine surgery
- fetal presenting part above the pelvic inlet
What 6 behavioral states do Newborns progress through
- quiet sleep
- active sleep
- drowsy
- quiet alert
- active alert
- crying.
Fetal Indications of Operative (forceps and vacuum) Vaginal birth
- nonreassuring FHR patterns
- Failure of the fetal presenting part to fully
rotate and descend into pelvis - partial separation of the placenta
- Failure of the fetal presenting part to fully
nursing considerations for a women who is having an external version
- provide information (explains risks, informed consent)
- promote maternal and fetal health (NPO for 4 hours incase of section)
- reduce anxiety
After a circumcision an infant should be observed for at least ___ hrs before being released
2
What changes in blood flow occurs after the umbilical cord is clamped and the newborn takes its first breath?
- increase blood flow to the liver and lungs
- Decrease blood flow through the shunts
Indications for Version
- to change fetal position to cephalic (external)
- to change position of second twin during vag birth (internal).
What does the nurse do during and after an episiotomy?
- promote gradual stretching of perineum during second stage (perineum massage)
- delay pushing until the urge is felt
- push with an open glottis
- observe for hematoma and edema
4 Types of Systemic Drugs
- Parenteral (IV) - demerol (not really used much); stadol and fentanyl (early labor); nalbuphine
- Adjunctive - zofran (nausea), Visteril (anxiety and also to potentiate stadol/fentanyl), Phenergan (anxiety or sleep or extreme early labor where contrax not tolerated)
- Sedatives
- Opioid antagonist - naloxone
Assess for jaundice by ….
- blanching the infant’s skin on the nose or sternum.
- Assessment should be done in natural light
- Assess for jaundice every 8 to 12 hours along with vital signs.
- Determine how far down the body the jaundice extends.
- obtain transcutaneous or serum bilirubin measurements in any jaundiced infant.
What blood tests are done to screen for metabolic, hematologic, or genetic disorders ?
When are the tests performed?
- phenylketonuria
- hypothyroidism
- galactosemia
- hemoglobinopathies
- congenital adrenal hyperplasia
24 to 48hrs
4 Ps
- Power - not strong enough contrax- could be from fatigue, meds, overdistended uterus, hypotonic or hypertonic contrax. Use Freedman curve - tells how quickly labor should progress. If she falls off curve, it’s dystocia
- Passage - shape of pelvis or tissue of repro tract
Cephalopelvic disproportion, overly obese with panus, non-gynecoid pelvis - Passenger - LGA or large head, breech, not fully flexed, fetal anomalies, multifetal
- Psyche- fear and anxiety cause release of catecholamines and ineffective perfusion to fetus. Non relaxed mom inhibits contrax. Bad cycle.
name fetal risk associated with a C-section?
- lung immaturity
- inadvertent preterm birth
- transient tachypnea - caused by delayed absorption of lung fluid
- persistent pulmonary HTN of the newborn
- traumatic injury
What is a major risk for an amniotomy? What are other risks?
MAJOR = prolapsed cord
- Infection
- Abruptio placenta if polyhydramnios present
What do you do for APGAR score of 3 - 6
- Gently stimulate by rubbing infant’s back while administering oxygen.
- Determine whether mother received narcotics, which may have depressed infant’s respirations.
- Have naloxone (Narcan) available for administration.
What are the hazards of cold stress?
- Increased oxygen need
- Decreased surfactant production
- Respiratory distress
- Hypoglycemia
- Metabolic acidosis
- Jaundice