Test #3 Flashcards
what is the difference between bonding and attachment?
bonding-parent to baby
attachment-parent to baby AND baby to parent
Bonding is the attraction to the infant from the parent. usually occurs right after birth.
attachment is the development of an affectionate relationship between mother and baby.
what are the phases of maternal adjustment
taking in
taking hold
letting go
what is the taking in phase
the stage immediately after birth. this is a time when the mother is dependent on others.
this is the time when the mother is reliving what she just went through and is exploring her infant.
the mother claims the baby and identifies specific features that tie the infant to her.
she is taking in what has just occurred and taking in her infant and making it a reality
what is the taking hold phase.
- occurs a few days after birth
- the woman shows independence by caring for herself and learning to care for her newborn.
- she may experience mood swings.
what is the letting go phase.
- the woman reestablishes relationships with other people. -she adapts to parenthood.
- focus of this phase is moving forward by assuming the parental role.
- the mother relinquishes the fantasy of the infant and accepts the real one
what is engrossment
the partner is absorbed and preoccupied with the infant.
- visual awareness of the newborn
- tactile awareness
- sees the newborn as perfect
- strong attraction to the newborn
- sees distinct features.
- feels increased self esteem and proudness
what can you do to help the father feel involved
teach the partner what he can do to assist and care for the infant such as feeding, swaddling, changing diapers, the 5 S’s etc.
what are some things you can do to promote adaptation to parenthood
- allow skin to skin immediately after birth-with breastfeeding
- delay any procedures until after 1st hour
- keep the infant in the room with the parents
- provide pain relief for mom
- teach comforting measures for infant
- support the parent and model infant care
what are positive infant behaviors
- alert
- smiles
- strong grass
- sucks well/feeds easily
- enjoys being held
- makes eye to eye contact
- follows parents face
- is consolable when crying
what are positive parental behaviors
- en face
- claims infant as their own
- points out common features
- expresses pride in parent role
- assigns meaning to infants actions
- touches infant
- names infant
what are negative infant behaviors
- poor feeding
- regurgitates often
- fussy/cries
- inconsolable
- stiff when held
what are negative parental behaviors
- expresses disapointment/displeasure in infant
- fails to “explore” infant
- avoids caring for infant
- finds excuses not to hold infant
- assigns negative attributes to infant
what is APGAR
appearance, pulse, grimace, activity, respiration
-it is a way to evaluate a newborns physical condition at 1 minute and at 5 minutes after birth
when would an additional apgar score be done
if the 5 minute score is less than 7
what should a newborns apgar score be
8-10 points
what do low apgar scores indicate
the baby is having a hard time adjusting and needs help adjusting to extrauterine life.
what contributes to an infants first breath
- decreased O2
- increased Co2
- decreased pH
- decreased pulmonary pressure
what is a concern regarding breathing with a infant born via C-section
fluid still in the lungs
- the squeeze on the way out of the birth canal helps get the excess fluid out of the lungs. A c/s baby does not have that therefore they may sound bubbly on lung sounds
- as long as all other areas look good the baby is ok
what do you need to assess regarding respirations with a newborn
- listen to their breathing for sounds like grunting
- check effort of breathing
- look at skin color
- check cap refill
- auscultate lungs anteriorly and axillary
What type of interventions can you implement for an infant who is having difficulty breathing
- reposition to facilitate drainage
- bulb syringe secretions from mouth then nose
- percussion w/ hand or infant O2 mask
what would put the infant at risk for respiratory distress
babys are nose breathers so if they have a blocked nasal passage this puts them at risk for breathing difficulty
if you hear grunting what else should you assess
the effort the baby is using to breathe.
-lift shirt up and look for retractions
how long can babys hands and feet stay a bluish color
it can stay for up to 48 hours.
what is conduction
the transfer of heat from the infant to something else the infant is touching
what could you do to intervene with conduction
- keep the baby under the warmer
- skin to skin with mom
what is convection
the flow of body heat to cooler air
-the heat leaves the baby and goes towards the cool air
what could you do to prevent convection heat loss
warm up the room.
keep baby wrapped
what is radiation heat loss
heat escapes through indirect contact
what could you do to intervene with radiation heat loss
keep baby bassinet away from window
why are babies predisposed to heat loss
- their heads are larger-highly vascular =more heat loss
- thin skin-vessels closer to the surface
- little musculature unable to shiver-causes infant to have a hard time regulating their temp
when will babyies develop the ability to shiver
at about 3 months old
what is brown fat
it is a one time supply of highly vascularized fat that infants are born with
creates the ability for infants to generate heat
what does brown fat need in order to generate heat
O2 and glucose
if a baby is consistently cold what can happen
it can result in hypoxia and hypoglycemia because the body is continuously using up the stores of O2 and glucose to keep the baby warm
when does brown fat form and how long does it last
it forms in the third trimester and lasts from 3-5 weeks after birth
where is brown fat found on an infant
between the scapulae axilla nape of the neck mediastinum areas surrounding the adrenal glands and kidneys
what are interventions the nurse can use to maintain newborn temperature
- wiped down immediately after birth
- skin to skin with mom and cover both with a warm blanket
- promote early breast feeding-provides fuel for thermogenesis
- place baby under warmer
- keep the baby in a flexed position
- delay bath until temp is stable
- apply a hat
- keep baby swaddled
- continue to monitor temp
what is the temp that would require interventions on a newborn
anything less than 97.7 F
or 36.5 C
a cold baby can be a sign of what
sepsis
how long after you intervene with a cold baby should you reassess the temp
15 minutes
what are the transitions to extrauterine life
- 1st period of reactivity
- period of decreased responsiveness
- 2nd period of reactivity
what is the 1st period of reactivity and how long does it last
the baby is awake and alert right after birth.
this is the time you want the baby to be with mom and dad.
promote breast feeding during this time
-can last from 30 minutes -2hours
what is the period of decreased responsiveness and how long will it last
the “baby coma”
it is the time after birth when the baby is in a deep restorative sleep. HR and RR slow
very hard to wake the baby up
-it can last 2-4hours
what is the 2nd period of reactivity and how long does this last
-the baby awakens from the deep sleep and is alert with increased tone
baby is refreshed and restored
may exhibit hunger cues
-lasts from 2-6 hours
what is the moro reflex
the startle reflex
what is abnormal vs normal when assessing a newborn head
- Normal: feeling the anterior and posterior fontanels. they must be flat. seeing the heart beat in the fontanels. overriding sutures
- Abnormal: bulging or sunken in fontanels, separated sutures
what is caput succedaneum
fluid/edema caused from being stuck in the birth canal or being vacuum extracted
feels soft and will cross over the suture line.
this needs to be monitored to ensure the more fluid isn’t collecting
what is cephalohematoma
a blood collection under the pereosteum.
this is caused by pressure,
it does not cross the suture line
why would you be concerned with cephalohematoma
because it can cause excess pressure in the head and because excess bleeding will be associated with excess RBC breakdown which will increase bilirubin levels which can be detrimental to the newborn.
what is expected with a cephalohematoma
it will be present for approx 6-8 weeks.
it will get hard and colorful
what is the average head circumference
32-38 cm
what is a normal complication of birth in the eyes of the newborn
-subconjunctival hemorrhage- caused from the pressure of being expelled out of the uterus
what is abnormal relating to newborn eyes and nose
-any type of discharge.
newborns do not have tears so anything coming out of their eyes is cause for concern
-also any discharge from the nose is concerning as well
what does it mean if the ears are not at eye level
a sign of chromosomal abnormalities.
when should the baby have its first meconium
within 24 hours of birth
what is significant about the newborn GI system
it is sterile. it does not have the normal intestinal bacteria that forms vitamin K
why is regurgitation common in a newborn
because their cardiac sphincter is still immature therefore it allows contents to come back up
what can you do to reduce regurgitation
sit the baby up and burp them so food doesn’t come up with air
how often should the infant be voiding at 1 week of age
6-8 wet diapers/day
what is normal about the infant GU system
- swollen genitalia
- pigmented genitals
- uric acid crystals(which will cause a pinkish color in their diaper
- female psuedomenstration
- undescended testicles
what will help if the baby has uric acid crystals
the intake of fluid.
as the baby takes in more it will help resolve the issue
what is erythema toxicum
aka the “flea bite rash”
rash that looks like flea bites. common occurrence on the face chest and back.
it appears in one spot, goes away and appears in a different spot
what is erythema toxicum caused by
it is thought d/t the babys eosinophils reacting to extrauterine life as the immune system matures.
labs can show an abundance of eosinophils.
what occurs during the newborn orientation behavioral response
the response of newborns to stimuli
it reflects the babys response to auditory and visual stimuli
what is the babys behavioral response in the habituation stage
having the ability to block out external stimuli once accustomed to the activity
baby should be able to get accustomed to the environment and be able to sleep
what are the 5 ways to soothe a baby
swaddle side/stomach lying sounds swing suck
what is the HR, RR and temp of newborns
100-160HR
30-60RR
36.5-37.5(97.7-99.5F) Temp
where do you take a newborns BP
on the rt arm and leg
when is O2 sat monitored and why
it is on the rt arm and leg before discharge to rule out a congenial heart disease
what is the allowable difference of the O2 sat reading
difference of 3% between O2 on arm and leg
if more than that it is cause for concern
what does the o2 have to be above on a newborn
at or above 95% on BOTH extremities (arm and leg)
what is colostrum high in
protein minerals fat soluble vitamines immunoglobulins natural laxative
what does breast milk contain
protein fat carbohydrate water minerals vitamins enzymes
what benefits does breast feeding have for the mother
- decreased risk for cancer (ovary breast and uterine)
- decreased risk of osteoporosis
- decreased risk of CV disease
- decreased risk of DM type2
- decreased risk PPD
- promotes uterine involution
- increases weight loss(burning extra calories)
- facilitates bonding
what benefits does breast feeding have for the baby
- it is easily absorbable
- safe for all babies
- contains immunoglobulins from mom helping build baby immune system
- -decreases illness and allergies
- decreased chance of SIDS
- increases cognitive development
- decreased risk for obesity(decreases occurrence of overfeeding)
what produces milk in the breast
alveoli
what is the latch scoring system
L: latch-if the infant latches on or not
a: audible swallowing
t: type of nipple (inverted, flat, portruding)
c: comfort of nipple (engorged, cracked; filling, redenned; soft non tender)
h: hold (nurse holds infant, minimal assistance, no assistance needed
what is the breast milk supply made vs how much the infant needs per day
at 1-6 months:
breast milk supply is 25-35 oz/day
infants need approx 25-35 oz per day
what is the average breast meal
3-5 oz
what does weight gain look like in a newborn
baby loses 10% of birth weight and but should gain it back by day 10.
baby should gain 1lb in 1 month
by 2nd month-2lbs
3rd month 1 lb
by six months baby should double birth weight and by 1 year baby should triple birth weight
what interventions can be used for flat or inverted nipples
the use of a nipple or breast shield
what could be the cause of sore/redenned nipples
- incorrect latch
- candida
what would cause you to suspect a candida infection
- sore red nipples
- thrush in babys mouth
what can you do to intervene for sore nipples
- correct breast feeding latch/positino
- lanolin cream
- hydrogel pads
what interventions can be used to help a woman with a low milk supply
- feed q2-3 hours
- pump after each feeding
- fenugreek, domperidone
- finish one breast before switching to the other
why is it important to “finish” one breast for breast feeding before switching to the other side
because the hind milk is the richest milk. the fore milk is more water and can cause upset stomach for infant
what are the 3 types of formula
powder
concentrated
ready to eat
what is worrisome about powdered formula and what should you do
powdered formula can contain bacteria that can cause harm to the infant
you want to heat up the formula to at least 70C by boiling it to kill the bacteria
what do you NOT want to do when heating up formula
put it in the microwave because it can create hot spots and burn your infant
how long is unused formula good for
2 hours
how often should a formula fed baby get fed
Q3-4 hours
how often should a bottle fed baby get burped
about every 0.5-1oz
what is REQUIRED when performing a heel stick on a newborn
a heal warmer applied 5 minutes prior to the heel stick
what are complications of a heel stick
scarring
infection
osteomyelitis
what screening tests do we do in SLO county for newborns
PKU Galactosemia congenital hypothyroidism sickle cell disease tay sachs
what is PKU
phenylketonuria-
unable to metabolize amino acid phenylalanine which can cause retardation if not recognized
-controlled by diet
what kind of diet would be indicated for a newborn with PKU
a low protein diet
what is galactosemia
- the inability to metabolize galactose(converts milk sugar to glucose)
- can lead to mental retardation and dehydration and death if untreated
- controlled by diet
what kind of diet would be indicated for galactosemia
a soy milk diet
what is congenital hypothyroidism and what can we do to treat it
deficiency in thyroid hormone
- can cause intellectual disabilities if untreated
- will need thyroid replacement therapy
what is sickle cell anemia and problems associated with it
abnormal shaped RBCs causing inadequate perfusion
- can result in anemia d/t RBCs die more quickly
- form clumps in the vessels
- causes pain, organ damage as well
- no cure but needs hydration, rest, and pain management
what is tay-sacks disease and what can it lead to
abnormal lipid build up in the nervous system(in the synapse in the neurons)
-can cause developmental regression
-leads to microcephaly, seizures, blind, deaf and death by the age of 4
there is no treatment but comforting measures
what newborn prophylactic treatments to we give to the newborn
erythromycin ointment- to prevent newborn eye infections
-Vitamin K - to prevent newborn hemorrhage
what would newborn eye infections be caused by
STIs - gonorrhea & chlamydia,
what is the only vaccine newborns receive
hepatitis B
what is the recommended schedule for hep b vaccination
0, 3 & 6months
what are the benefits of circumcision
decreased risk of UTIs, STIs including HIV, penile cancer
what is to be expected post circumcision
-crusted yellow exudate for 2-3 days
what do you want to monitor for with circumcision
- bleeding or signs of infection
- void within 8 hours of procedure
what intervention can help ease pain during post circumcision
apply neosporin or petroleum jelly to area and diaper.
this will prevent the penis from sticking to the diaper during diaper changes.
what are the two procedures for circumcision
Plastibell- makes a cut in the foreskin and applies plastic device over penis tying it off. leaves a ring on penis that is taken off after 7 days
Gomco clamp-foreskin is clamped for 5 minutes
what is group b strep
an opportunistic pathogen that can colonize the vagina and rectum in some women.
when and how do we screen for group b strep
at 35-37 weeks
via swab/culture of womans rectum and vagina
what do we do if a woman is GBS +
we administer abx during labor
either penicillin G or ampicillin
dose delivered within 4 hours of delivery
what can happen if a newborn contracts GBS
sepsis and meningitis
pneumonia
what is cervical insufficiency
the premature dilation of the cervix WITHOUT contractions
the dilation is usually rapid and relatively PAINLESS with minimal bleeding
what are risk factors for cervical insufficiency
short cervix - < 2.5 cm long
cervical trauma
what are managements of cervical insufficiency
- bedrest
- pelvic rest- no tampons, sex etc
- avoid heavy lifting
- possible tocolysis(meds to decrease/stop contractions)
why would cerclage be done
if the conservative measures were not working
what is cerclage
a have purse-string suture applied around the cervix to reinforce closed cervix.
it is placed around 12-14 weeks
it is removed at term or if pt is contracting
why would you want to remove cerclage sutures if woman is contracting
because if the uterus is contracting it is expanding and relaxing and it can cause the sutures to tear the cervix d/t increased pressure
what is hyperemesis gravidarum associated with
significant dehydration and weight loss
how do you differentiate between morning sickness and hyperemesis
normal morning sickness usually ends at 12 weeks (end of first trimester
hyperemesis gravidarum lasts for the first 20 weeks and is much more severe nausea and vomiting
what are the interventions for hyperemesis gravidarum
- IV fluids and electrolytes, vitamins(HIGHEST PRIORITY)
- antiemetics
- Sea-bands, ginger, herbal tea
- small meals
- if woman still is unable to keep things down, TPN may be necesary
what do you want to monitor when a woman has hyperemesis gravidarum
-hydration status
also you want to monitor the fetal growth to make sure the mother is supplying the fetus with adequate nutrition.
this is done via ultrasound
what are the 3 different locations of placenta previa
- marginal- part of placenta covering cervix
- complete- the whole placenta is over the cervical os
- low lying- the placenta is near the cervical ox
what are the s/s of placenta previa
-PAINLESS bleeding without contractions after 20 wks gestation
what is a problem with the placenta being in the lower uterine segment
the lower uterine segment doesn’t have the right muscles and therefore cannot contract efficiently nor ligate as easily therefore allows the pt to bleed more freely.
what laboratory values do you want to look at for someone with placenta previa
CBC:
Hct and Hgb- will tell us her blood volume
what instructions do you want to give a woman with placenta previa regarding her bowels
do not strain during bowel movements. this can cause increase in bleeding
how do you confirm placenta previa
via ultrasound
what is the management for someone with placenta previa
- insert IV
- EFM- to assess fetus
- bed rest/pelvic rest
- no straining during BM
- NO vaginal exams
- assess blood loss
who is at risk for placenta previa
- hx of c-section(placenta attaches to scar tissue)
- older women
- multi parity
- smoking(smoking causes issues with placenta)
can a woman have vaginal birth if she has placenta previa
only if it is marginal or low lying.
as the uterus contracts, if it pulls the placenta up and out of the way the woman can give birth vaginally
if it is complete then the woman has to have a c/s
what is abruptio placentae
the premature separation of the placenta from the uterus
occurs after 20 weeks
can be a partial or complete separation
can lead to hemorrhage
what are the signs and symptoms of abruptio placenta
- pain
- hard abdomen-caused by blood filling her abd
- vaginal bleeding-dark blood
- uterine irritability
- fetal distress
- late decals (HR drops ater UC has ended)- caused by uteroplacental insufficiency
what are the risk factors for having abruptio placentae
- abdominal trauma
- HTN
- smoking
- cocaine- vasoconstrictor and will effect placental function
- alcohol use
what is the management of abruptio placentae
- ct scan
- bedrest
- EFM
- IV- to reverse hypovolemia
- type and cross- will most likely need blood
- CBC- H&H
what is the mother at risk for with abruptio placentae
depleting her clotting factors
she is bleeding so her body is using those clotting factors up to stop the bleeding therefore she is running low which allows her to bleed more.
what are s/s of preeclampsia
- BP at or greater than 140/90 (on 2 occasions)
- protein in the urine >300mg/L in 24 hr urine
aslo
edema (increased protein in blood), weight gain(from edema), oliguria, increased BUN creatinine (decreased kidney perfusion) HA, tinnitus, visual disturbances, epigastric/ruq pain, hyperreflexia
when does preeclampsia occur
after 20 wks gestation but women have an increased incidence postpartum
who is at risk for preeclampsia
- 1st time mothers
- > 40
- hx of preeclampsia
- obesity
what are the fetal problems that can arise from preeclampsia
-intrauterine growth retardation
-prematurity
-death
(the uterine environment is not adequate to grow a fetus so the fetus needs to come out. but if it occurs too early the fetus may not be viable
what are maternal problems that arise from preeclampsia
- abruption(increased risk for hemorrhage)
- renal failure(decreased renal perfusion)
- liver infarction/rutpure (hepatic malfunction)
- stroke-incracranial bleed (endothelial injury)
- retinal detachment
- pulmonary edema
- cns changes
- death
what is HELLP syndrome
a complication from preeclampsia. more severe than preeclampsia
H-drop in hbg and hct- increase in bilirubin
E- elevated
L- liver enzymes- AST and ALT labs
L-low
P-platelet <100,000- seen on labs and bruising
what complications can arise from HELLP syndrome
- liver rupture
- stroke
- seizure
- renal damage
- diseminated intravascular coagulopathy
what interventions can be implemented to a woman with preeclampsia
- bedrest- laying in lateral position b/c better perfusion to fetus on moms side
- calm environment to decrease BP
- padded side rails- at risk for seizures
- high protein diet- d/t the protien being lost in her urine
- strict I&O- at least 30mLs/hr
- monitor CBC, LFTs, clotting studies, proteinuria
- monitor BP
- assess weight (weight gain caused by edema)
- HA, visual disturbances, epigastric pain
- assess DTRs & clonus
what can we give the patient to help with the effects of preeclampsia
- antihypertensive drugs
- mag sulfate- to reduce risk of seizure
- betamethasone to help fetus develop surfactant
- deliver placenta
what are side effects of mg sulfate
heaviness
feeling flushed
warmth
muscle weakness
what is the therapeutic goal for mg sulfate
4-8mg/dL
how would you assess for mg toxicity
- oliguria
- decreased/absent DTRs
- resp <12
if your pt is suffering from mg toxicity what can you give as the antidote
calcium gluconate
what are the potential risks when administering mg sulfate
increased risk of postpartum hemorrhage d/t the fact that mg sulfate is relaxing the smooth muscle therefore the uterus will not contract as it should- (therefore petocin may be given to help uterus contract)
aslo
fetal CNS depression
why does a pregnant woman become resistant to insulin
because the body is reserving more BG to be supplied to the fetus to support fetal growth
what can result from the resistance to insulin
an increased insulin demand d/t the extra glucose in the blood as well as maternal hyperglycemia if insulin production is inadequate
how long after birth are women with gestational diabetes monitored
up to 6 wks to evaluate for continued glucose intolerance
what assessments will be performed to assess for gestational diabetes
-1 hr glucose tolerance test at 24-48 wks
if >140 they will have a 3 hr get
-A1c test- measures the long term glucose control for the last 120 days
what level of the A1c indicates good glucose control
<7%
how to manage gestational diabetes
- tight blood sugar control- fasting <92mg/dL
- nutrition
- weight(you don’t want her to lose weight but have a healthy weight gain)
- mild exercise
- blood glucose and keytone testing
- admnister meds(insulin or oral)
what should you monitor for with the fetus in a mother who has gestational diabetes
- monitor MSAFP
- monitor fetal kick counts
- NST
- Biophysical profile (done when someone has non reactive stress test)
- ultrasounds
- amniocentesis
why is a gestational diabetic a candidate for induction at 38 weeks
-because morbidity and mortality rates spike at 38 wks and on
what is the main action you would take with someone with ROM
-monitor for infection
fever, WBC
what do you NOT want to do with someone with PROM
a vaginal exam- you would be introducing bacteria into the environment,
UNLESS SHE IS CONTRACTING then it is ok
what happens when PROM occurs
women present with leakage of fluid, vaginal discharge, vaginal bleeding and pelvic pressure
BUT
NO contractions
how is PROM diagnosed
with a sterile speculum exam
what is PAMG
a test where you collect fluid at the bottom of the cervix to test if it is amniotic fluid or watery mucous from mother
what is included in prenatal substance use
alcohol tobacco other drugs non medical use of Rx drugs **all pass readily through the placenta
what is the highest substance use while pregnant in SLO county
- alcohol
second is tobacco
3rd is opiates
what are ways to assess substance use
- self report
- urine toxicology screens (have to have consent)
what should you teach your patient who has substance abuse
- the negative effects on her pregnancy
- the importance of nutrition
- s/s of preterm labor and placental abruption
what constitutes preterm labor
contractions and cervical changes at 20-37 weeks
what illness can cause the uterus to begin contracting
UTIs
need to identify if pt has UTI because once uti has cleared the contractions will stop.
what risk factors would cause pre term labor
short cervix
overstretched uterus
infection(chorioamnionitis, UTI, STI)
If a patient calls from home and thinks she is in pre term labor what should she do
- empty her bladder
- drink fluids
- lay on her side and count the contractions (if more than 6 contractions in an hour she is in labor)
what are the two ways to predict if a woman will be unlikely to give birth in the next 2 weeks
- a negative fetal fibronectin test
- cervical length > or equal to 3cm
what are the tocolytics to delay deliver
IV-magnesium sulfate
subQ-terbutaline
PO-nefedipine
when is betamethazone indicated
for PTL between 24-34 weeks gestation
used for lung maturity acceleration- helps generate surfactant
given 2 doses IM- 2nd dose should be given within 24 hrs of delivery and it has an effect on the fetal lungs for 7 days
what causes failure to progress in labor
- cervix fails to dilate
- fetus fails to descend
what are labor induction methods (not medications)
- nipple stimulation (stimulates oxytocin)
- castor oil (usually used for laxative but when GI is stimulated it can stimulate uterus to contract)
- soap suds enema
- ROM-allows head to sit on cervix and stimulate contractions -needs to be at at least 0 station
what medications can induce labor
-prostaglandin-inserted close to cervix to soften and efface
-cervidil- (insert)
cytotec (tablet)
-oxytocin-(iv)
what can happen in an amniotomy if the fetus is not at at least 0 station
umbilical cord prolapse
what is the protocol for attaching pitocin to an IV
-it needs its own pump and needs to be connected to the most proximal port of primary iv tubing
how fast do you run pitocin
it needs to be slowly titrated up until the contractions are at 2 minutes apart and lsat for 60-90 seconds.
if they become closer or last longer the pitocin needs to be slowed down or d/c’d
what do you need to monitor while running pitocin
-the fetal monitor
you need to assess if the fetus is in distress.
if you see late d cells or variable d cells, bradycardia or absence of variability, you need to turn off the pitocin.
however if they are variable you could communicate with the MD first and let him decide
what are adverse effects of pitocin
tetanic contractions and water intoxication
what are possible ways to help birth a baby with shoulder dystocia
- flex moms thighs on abdomen-allows max opening
- suprapubic pressure-helps the shoulder slip under symphanis pubis and deliver
- mom on all 4s to deliver the posterior shoulder first
rare but happen:
deliberate clavicle fracture
push head back into birth canal and then c/s
what is a concern with pushing the head back into the birth canal when birthing a shoulder dystocia baby
you can cause neck trauma and neurological damage to the fetus d/t the lack of oxygen
what are indications for c-section
- cephaolopelvic disproportion
- dystocia
- fetal distress
- breech
- previous c/s
- failure to progress
what are the maternal risks for c-section
- aspiration
- hemorrhage
- infection
- bowel/bladder injury
- thrombophlebitis
- PE
what are fetal risks for c/s
- premi
- injury at birth
- resp problems
what are nursing interventions prior to c/s
- pre op and post op teaching
- NPO at least 8 hrs prior
- witness consent
- shave prep
- insert catheter in OR or after spinal
- IV fluid bolus
- administer oral antacid to decrease acidity of stomach in case of aspiration
- collect a “clot to hold” blood sample in case a blood transfusion is needed
what type of anesthetic is typically used for c/s
a subarachnoid (spinal) block it contains an opioid (often fentanyl) with a local anesthetic and is injected into the subarachnoid space(below where the spinal cordd ends) lasts about 1-3 hrs
what are the advantages of a spinal block
- pain relief
- contractions aren’t felt
- remains awake during c/s
what can occur as an adverse effect of spinal block
- maternal hypotension
- post-spinal HA
- urinary retention
why would a woman complain of itching after intrathecal narcotics
because it is a side effect
-drs usually order IV push of benadryl or small amount of narcan to relieve the itching
what do you want to monitor post spinal block
respirations
you want to monitor for respiratory depression 12-18 hours post block because pt may have a rebound respiratory depression from opioid
what relieves a spinal HA
injecting 10-15mLs of the womans blood into the epidural space
it there forms a gelatinous seal over the hole in the dura stopping the spinal fluid leakage
aka “blood patch”
what is a VBAC
and what is the criteria that has to be met
vaginal birth after c-section
- only one previous c/s with a lower transverse incision
- fetus is in vertex position
- clinically adequate pelvis
- fetus is not macrosomic
what are the risks associated with VBAC
uterine rupture from prior c/s
in what cases can an umbilical cord prolapse occur
- polyhydramnios
- high station
- breech
- small fetus
- transverse lie
what is the main intervention with umbilical cord prolapse
-restore fetal o2 and blood supply
do this by pushing the presenting part off of the cord via vaginal exam or putting pt in trandelenburg position or knee-chest position
if cord has prolapsed outside the vagina keep the cord moist
this is an emergent situation and emergency c/s is required
what is the main cause of umbilical cord prolapse
ROM-either spontaneous or performed artificially
what will cause you to suspect umbilical cord prolapse
fetal HR changes- bradycardia or variables
cord may be visible or felt upon vaginal exam
when pushing presenting part off of the cord in umbilical cord prolapse what do you need to be cautious of
be careful not to palpate the cord. this cn cause vasospasm worsening the situation
how would you keep a prolapsed umbilical cord moist if it prolapsed out of the vagina
- gently reinsert it into the vagina
- a moist tampon or 4x4 gauze can be inserted gently to hold the cord in place
what is the transmission rate of HIV from a mother to her baby
<7% vaginally
<1% c/s
what is given to the patient during labor and birth to protect the baby from the mothers HIV
AZT- given intravenously
what action can even further reduce the risk of transmission in an HIV positive pt
schedule a c/s at 38 wks gestation
typically this is not recommended for women who have been taking anti-HIV medications
this is an intervention for women who have not received anti-HIV medications during pregnancy or who have a high viral load
what do you want to avoid doing during labor to protect the fetus from contracting HIV from its mother
-avoid doing anything that could break the fetal skin such as amniotomy, fetal scalp electrode, use of forceps or vacuum extractor
