Test 2 - Book Flashcards
Uterine Rupture variations
complete rupture - incomplete rupture - dehiscence
Uterine Rupture complete rupture
direct communication btwn uterine and peritoneal cavities
Uterine Rupture incomplete rupture
rupture into the peritoneum covering the uterus or into the broad ligament but not into the peritoneal cavity
Uterine Rupture dehiscence
partial separation of an old uterine scar, little to no bleeding, rupture, “window”, may be found by accident by a future abd surgery
Uterine Rupture etiology
rare - commoner in women with previous uterine surgeries (c-s, fibroid removal) (higher in women who had vertical c-s), use of pitocin
Uterine Rupture Manifestations
abd pain even with analgesics - chest pain on inspiration - hypovolemic shock (TC, TP, pallor, cool clammy skin, anxiety, HoT(late sign)) - stop of ctx - palp of fetus outside of uterus - late decels
Uterine rupture Ix
stabilize and perform c-s
Uterine rupture RN considerations
Carefully admin pitocin - be aware of hypertonic ctx (w/ or w/o pitocin)
Cord prolapse what
when the cord slips down after the membrane rupture subjecting it to compression between fetus and pelvis
Cord prolapse etiology
when there is poor fit between the presenting part of the fetus and the pelvis when the membrane ruptures, more likely to occur when: fetus at high station - small fetus - fetus is breech or transverse - hydramnios (large amount of fluid in the amniotic sac)
Cord prolapse SS
can be complete with it visible at the vaginal opening, palpable but inside, or an occult prolapse (can’t be seen or palp but is detectable via FHR changes)
Cord prolapse Ix
Priority is to relieve pressure – 1. position hips higher than head (knee-chest, trendelenburg) – 2. if no change sterile gloved hand into vagina to push fetus back – Avoid/min manual palp or handling of cord (vasospasm/vessel trauma) – US to confirm FHR before c-s – give O2 8-10L or terbutalin, saline towel to prevent cord drying
– woman prognosis good, baby’s depends
Meconium aspiration syndrome
10-15% of births - obstruction, air trapping and chemical pneumonia caused by meconium in lungs
Meconium aspiration pathology
hypoxia causes more peristalsis in SI/LI and anal sphincter relaxation releasing meconium. Causes deep respiratory passage obstruction, atalectasis, asphyxiation
Meconium aspiration SS
respiratory distress present at birth with cyanosis, retractions, nasal flaring, grunting, rales, meconium stains on body, barrel-chest from hyperinflation
–radiography (atelectasis, consolidation, hyperexpansion)
Meconium aspiration Ix
if infant vigorous (good respirations, muscle tone, HR>100) no action is needed; if not endotracheal tube is used to remove meconium
Meconium aspiration RN considerations
notify MD as soon as meconium is seen so that NICU RN and neonatologist are available with O2and suction –attn to thermoregulation and decreased stimulation
Dysfunctional labor - the 4 P et al
Problem with the powers, passenger, passage, psyche, duration
Power - Ineffective contractions
caused by fatigue, analgesia, F/E imbalance, hypotonic/hypertonic dysfunction
Power - Hypotonic dysfunction / secondary arrest
coordinated contractions that are too weak,
Power - hypertonic dysfunction
painful but ineffective, long and nonproductive - high resting tone - seen in abruptio placentae (premature separation of placenta) - dont give O - tocolytic drugs needed (reduce tone)
Power - ineffective maternal pushing
caused by technique, fear of injury, no urge to push, tired, analgesia,
Problem with passenger
macrosomia (>8 lb 13 oz, or 4kg), shoulder dystocia, rotation abnormalities, breach, deflexion abn (face presentation), multips, fetal abn
Passage problems
Pelvis small or shape (good: gynecoid, anthropoid; poor: android, platypellpod), full bladder
Problems with psyche
stress from pain, fear, nonsupport, circumstance causes energy depletion, more pain perception
Abn labor duration
dilation at 1.4cm/hr - caused by infection, tired, anxiety - precipitous birth
PPD SS
- feelings of sadness
- loss of pleasure in usual activities
- anxiety, agitation, irritability
- feelings of guilt
- fatigue, sleep disturbances
- diff concentrating, making decisions
- depression
- suicidal thoughts
PPD when
- 50% starts antepartum
- >2 wks of depressed mood
PPD Dx criteria
> 4 SS
- change in appetite or wt
- decreased energy
- feelings of worthlessness or guilt
- concentration/decision-making impairment
- suicidal
PPD etiology
Hx of mental illness, stress, chronic illness, child’s illness
PPD impact
family avoids mom making things worse, worsens relationship with partner
- mother thinks self as incompetent, fails to meet babies needs
PPD Tx
therapy, Rx, early ID (identifying early subjective signs: apathy, sadness, sleeplessness)
Uterine Atony what
relaxing of uterine muscles allowing rapid bleeding
Uterine atony etiology
uterine distension, macrosomia, hydramnios (too much amniotic fluid), obesity, long or strong labor, assisted delivery
Uterine atony SS
- boggy uterus
- hard to find uterus
- uterus losses tone after massage
- higher than normal uterus
- excessive bright red lochia
- excessive clots
Uterine atony Ix
- admin IV O fast or IM
- massage uterus and express (don’t push on uterus that is not contracted bc could invert and cause massive hemorrhage and rapid shock)
- Foley
- IV LR until >30 ml/hr
PP discharge criteria
- Mom no complications and assessments normal
- labs and injections taken and administered
- mother given all instructions on self-care, deviations from normal and responses for danger signs
- mom given instructions on PP activity restrictions
Puerperal Infection types
could be endometritis, mastitis, endomyomitritis, endoparametritis, Metritis
Puerperal Infection RF
Hx of past infections, c-s, trauma, foley, hemorrhage, poor health
Endometritis bacteria
caused by strep, E coli, K. pneumonia, Proteus, Bacteriods, gardnerella
Endometritis SS
looks sick, fever, chills, malaise, anorexia, abd pain, uterine pain, foul lochia,
Endometritis Ix
IV ATB (cephalosporins, clindamycins, gentamycin, ampicillin) `
Endometritis complications
sterility, sepsis, peritonitis
Endometritis RN considerations
place in fowlers, VS q2hr
pregnancy wastage
can conceive but repeatedly lose pregnancy before it is old enough to survive
factors that impair sperm
hormones, disease, environment, drugs
factors that cause male infertility
abn sperm, erections (ED), ejaculation (retrograde ejaculation - into bladder, hypospadias), seminal fluid
factors that cause female infertility
ovulation disorders, fallopian tube abn, cervical disorders
