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
Contraindications of Operative Vaginal Birth (forceps and vacuum)
severe fetal compromise, high fetal station, cephalopelvic disproportion
because the major adverse effect of prostaglandins is ____________, the drug is administered in a setting in which fetal monitoring and emergency care, including section, are immediately available.
hyper stimulation of uterine contractions
Risks to baby for Cesarean birth
Risks to baby:
- lung immaturity
- inadvertent preterm birth
- transient tachypnea
- persistent pulmonary HTN
- traumatic injury.
At birth the stomach holds __ml/kg
6ml/kg
What are Common Breastfeeding Concerns: Infant Problems
- Sleepy
- Nipple confusion
- Suckling problems
- Infant complications
- Jaundice
- Prematurity
- Illness and congenital defects
Contraindications for giving systemic pain meds during labor
- If patient taking certain herbals
- Allergies
- No Stadol given with opioids!
- Can’t give if the baby is having decreased accels or decreased variability
Induction/Augmentation Indications
- hostile intrauterine environment
- SROM
- post term
- chorioamnionitis - intrauterine infection
- HTN
- abruption
- worsening mom medical condition
- fetal death.
What is done in preparation for a c-section?
- anesthesia
- medication
- lab studies
- prophylactic antibiotics
- skin prep
- foley catheter
- IV insertion
- trim pubic hair
Nurses Role in C-section
- Prep mom: IV, NPO, scrubbed and shaved; consents signed; aware of risks
- Do post-op vitals
- Do bleeding and pain mgmt assessments
____ is a calcium channel blocker that is usually give for problems such as hypertension.
nifedipine
Important newborn meds
- Vitamin K
- Erythromycin - eyes
- Hep B vaccine
How often do you monitor vital signs after an epidural is placed?
Every 3 Min
When is the best time to give systemic pain meds for labor?
AFTER labor pattern well established to avoid slowing down labor
name maternal risks associated with a C-section?
- infection
- hemorrhage
- urinary tract infection or trauma
- thrombophlebits
- paralytic ileus
- atelectasis
- anesthesia complications
Details about vitamin K for newborn
- Jumpstarts clotting case and prevents hemorrhagic disease
- Given IM vastus lateralis within an hour of birth (oral ok but not as effective)
Observing for signs of hypoglycemia is necessary throughout routine assessment and care. Early signs include
- jitteriness and other central nervous system signs
- signs of respiratory difficulty
- decrease in temperature
- poor feeding
What to do if cord prolapse
- Call for help
- Hold baby up off the cord all the way to OR
- Mom in knees to chest position once the baby is up off the cord
this type of reactivity begins at birth and lasts for 30 mins. their temp decreases, and respirations may be as high as 80.
first period of reactivity
How can the nurse help the mother who is breastfeeding and has engorged breasts?
Instruct and assist the mother to massage her breasts
- Massage of the breasts causes release of oxytocin and increases the speed of milk release
What are contraindications to a C-section?
- fetal death
- immature fetus
- maternal coagulation defects
Nursing interventions for an infant with excessive bleeding post circumcision? And what would she anticipate the physician to do?
- Apply pressure
- NOTIFY PHYSICIAN
- Physician would then likely Apply Gelfoam, epinephrine or may suture the small blood vessel
Thermoneutral zone in healthy, unclothed, full-term newborns, an environmental temperature of ______________ provides a thermoneutral zone. When the infant is dressed, the thermoneutral range is ___________
- 6° to 92.3°F
75. 2° to 80.6°F
Name the type of incisions used for a c-section?
- low transverse (can have VBAC)
- low vertical
- classical (not likely to have VBAC)
Clamping of the umbilical cord closes which shunt?
- Ductus Venosus
Causes of cord prolapse
PROM, polyhydramnios, LGA baby not well engaged when membranes rupture, ruptured membranes, shoulder or foot presentations
Induction and Augmentation of Labor: Risks
- Hypertonic uterine activity
- Uterine rupture
- Maternal water intoxication
- Greater risk for chorioamnionitis
- Greater risk for cesarean birth
Details about erythromycin for newborn
- Prophylactic ophthalmic ointment given to prevent ophthalmia neonatorum (not really for gonorrhea like people think)
What is local anesthesia used for ?
- Anesthetizes the lower vagina and part of the perineum
- Provides anesthesia for an episiotomy and vaginal birth
- Mother feels pressure.
Lactogenesis ___ begins 2 to 3 days after birth when transitional milk appears.
lactogenesis II
How to care for a circumcision?
- Observe the circumcision site at each diaper change, and check the amount of bleeding. Call the physician if more than a few drops of blood are present with diaper changes on the first day or any bleeding thereafter.
- Continue to apply petroleum jelly to the penis with each diaper change for the first 4 to 7 days or as directed by your pediatrician.
- If a PlastiBell ring was used, do not use petroleum jelly because it might make the ring fall off too soon.
- Keeping the circumcision site clean is important for healing. Squeeze warm water from a clean washcloth over the penis to wash it. Pat gently to dry the area.
- Fasten the diaper loosely to prevent rubbing or pressure on the incision site.
- Expect a yellow crust or scab to form over the circumcision site. This is a normal part of healing and should not be removed.
- The scab will fall off within 7 to 10 days. If a PlastiBell ring was used, the plastic rim will fall off in 10 to 14 days (AAP, 2011). If it does not fall off by that time or falls off sooner, notify your physician.
- Watch for signs of infection such as fever or drainage that smells bad or has pus in it. Call your physician if you suspect any abnormalities. The circumcision site should be fully healed in approximately 10 days.
Manifestations of hyperthermia?
- metabolic rate rises, causing an increased need for oxygen and glucose and possible metabolic acidosis.
- peripheral vasodilation leads to increased insensible fluid losses.
- Tachypnea
Disdvantages of pharmacological Interventions
- Side affects - itching, vomiting, pruritus, drowsiness, and neonatal depression
- Pain is not eliminated completely
- The fetus can be effected by medications
Risks with a Version
There are only a few.
- cord entanglement
- abruption
- mixing of maternal and fetal blood
What are the 3 shunts in the fetal cardiovascular system and what do they do?
- Ductus Venosus- Directs blood away from liver to inferior vena cava
- Foramen Ovale - a flap valve in the septum between the right and left atria of the fetal heart. As blood flows into the right atrium, 50% to 60% crosses the foramen ovale to the left atrium
- Ductus Arteriosus - Connects the pulmonary artery and the descending aorta
Physiologic effects of excessive pain?
- Fear & anxiety
- Increased maternal metabolic and respiratory rate
Pudendal Anesthesia
Provides pain relief for episiotomy and delivery
Heat is produced in newborns by increased activity, flexion, and metabolism, vasoconstriction, and nonshivering thermogenesis. These factors increase _______ and ________ consumption and may cause respiratory distress, hypoglycemia, acidosis, and jaundice.
- Oxygen
- Glucose
__________ is the transfer of heat to cooler objects that are not in direct contact with the infant.
Radiation
Induction/Augmentation Risks
- hypertonic uterine activity
- rupture
- maternal water intox
- risk for c-section
- risk for chorioamnionitis.
Types of cord prolapse
- Complete - cord thru vagina and out vag canal
- Occult - can’t be felt with vag exam. Decels and decreased variability are signs
- Forelying - can’t see but can feel. FHR decel, no variability
What are the 5 areas of assessed during an APGAR SCORE?
- Heart Rate
- Respiratory effort
- Muscle tone
- Reflex response
- Color
Adverse effects of Epidural block
- Maternal hypotension
- Bladder distention
- Catheter migration
- Cesarean Birth
Oxytocin Administration:
- dilute in isotonic solution
- secondary (piggyback) infusion
- insert oxytocin into the primary IV line
- start slowly, increase gradually
- monitor uterine activity, FHR, and fetal heart patterns frequently
Induction and Augmentation of labor contraindications
- Placenta previa
- Vasa previa
- Umbilical cord prolapse
- Abnormal fetal presentation
- Fetal presenting part above the pelvic inlet
- Previous surgery in the upper uterus
Signs of cord prolapse
- Sustained bradycardia even with position changes
- decreased variability;
- decreased FHR
APGAR scores from ___ to ___ don’t require any interventions
7 - 10
Details about Hep B for newborns
- Optional unless mom has Hep B, then we definitely give!
- If mom has Hep B, we give the vaccine plus Hep B immune globulin within 12 hrs of birth
What are techniques to induction and augmentation of labor?
- cervical ripening
- oxytocin administration
- serial induction of labor
Maternal Indications for Operative Vaginal Birth (forceps and vacuum)
- Performed to shorten second stage of labor for the well-being of the woman or fetus (or both)
- maternal indications (exhaustion, inability to push effectively, and cardiac and pulmonary disease)
- fetal indications (nonreassuring FHR)
RISK FACTORS FOR NEONATAL HYPOGLYCEMIA
- Prematurity
- Postmaturity
- Late preterm infant
- Intrauterine growth restriction
- Large or small for gestational age
- Asphyxia
- Problems at birth
- Cold stress
- Maternal diabetes
- Maternal intake of terbutaline
