Toni - Week 6 - Exam 4 Flashcards
what is the definition of preterm labor?
contractions/cervical change 20 - 37 weeks (36 6/7 week)
what are the risk factors for preterm labor?
short cervix, overstretched uterus (multigravida, twins, large baby), or infection (chorioamnionitis, UTI, STI)
what are the s/sx of preterm labor?
UCs, pelvic pressure, backache.
What can pregnant women do at home to determine if they are having PTL?
- Empty bladder, PO fluids, side-lying
- If UCs >/= 6 UCs/hr, call MD/CNM
In the hospital, what are interventions that we can do for a woman in PTL?
- vaginal exam
- bedrest
- hydration PO
- external fetal monitor
- rule out contraindication to continuing pregnancy ( evidence of chorioamonitis)
PTL Management: what two characteristics predict that delivery is unlikely within the next 2 weeks?
- negative fetal fibronectin test ( protein found in mother’s mucous, made by infant; doesn’t show up until two weeks before birth)
- cervical length > 3 cm (via transvaginal ultrasound)
PTL management: what can delay delivery???
tocolytics - relax smooth muscle
PTL management: what are 3 different types of tocolytics?
- IV magnesium sulfate
- SubQ terbutaline (airway med; ability to quiet contractions right away) - SHORT TERM
- PO nifedipine (Ca2+ channel blocker)
PTL management: how can we accelerate fetal lung maturity?
with betamethasone (corticosteroid)
PTL management: when is betamethadone indicated?
Indicated for PTL between 24 - 34 weeks
PTL management: what is the betamethadone dose and how long is the effect?
2 doses IM 24hrs apart
- ideally give 2nd dose 24hr before delivery
- **effect on fetal lungs lasts for 7 days `
what is dystocia?
abnormal labor
what are the different types of dystocia?
- precipitate (rapid) labor
- FTP: failure to progress - despite everything
- CPD: cephalopelvic disproportion - too big to fit through pelvic
- Macrosomic fetus too large to pass through pelvis
- Malpresentations
What are 2 charcteristics of FTP?
- cervix fails to dilate
- fetus fails to descend (needs to get passed 0 station)
what are the 3 malpresentations?
breech, face/brow, occiput posterior
what are 5 non-medication ways to induce labor?
- nipple stimulation
- castor oil
- soap suds enema
- stripping of membranes (MD)
- amniotomy (AROM) - crochet hook
what is proper nipple stimulation?
one breast at a time; one nipple for 5 minutes, wait 15 minutes → cease if UC
what is the stripping of the membranes?
a vigorous vaginal exam; irritate attachment of cervix
what are the 2 different pharmaceutical inducement methods?
- prostaglandin inserted close to cervix to soften + efface
- oxytocin (pictocin) IV
what are the names of the 2 different prostaglandin drugs used to induce labor?
dinoprostone insert (cervidil) misoprostol tablet (cytotec)
how is oxytocin IV administered and why?
solution is administered with a second pump with primary tubing that is piggy backed into the most proximal port of primary tubing infusing her primary IV - small amount of med is in tubing if have to stop med quickly.
what is the usual order as far as titrating oxytocin IV?
Titrated until UC q 2 - 3 min and 60 - 90 sec
when should the oxytocin infusion be decreased? D/C?
- Decrease infusion if
- UCs become closer than q 2 min
- UC duration > 90 sec
- **D/C infusion if fetal distress
T/F oxytocin IV crosses the placental barrier?
FALSE; it doesn’t cross
T/F we can not administer oxytocin to preeclampic patients
FALSE; we CAN admin to preeclampic patients; can be given at the same time as Mag Sulfate
what are the adverse effects of oxytocin IV”?
uterine hypertonicity (tetanic contraction) water intoxication (lower blood concentration; nausea, muscle cramp, confusion, hyponatremia)
what is shoulder dystocia?
Shoulders stuck above symphysis
what is a sign of shoulder dystocia?
Turtle sign: head appears to retract after emerging
what are three common ways that shoulder dystocia is managed?
–Flex mom’s thighs on abdomen
–Suprapubic pressure to dislodge anterior shoulder
–Mom on all fours to deliver posterior shoulder first
what are 2 rare maneuvers to treat shoulder dystocia?
- Deliberate clavicle fracture
* Push head back into birth canal; then C/S
what is the definition of assisted delivery?
Device used to shorten 2nd stage
what are the indications for assisted delivery?
maternal exhaustion, fetal distress, tight fit
what 2 tools are used in assisted delivery?
Vacuum extractor
Forceps
How is the vacuum extractor used?
- Vacuum cup applied to head with negative pressure
* Gentle traction applied with UC (3 pop-offs allowed
how are the forceps used?
- Curved blades grasp fetal head
* Traction applied during contractions
what is the definition of cesarean section?
delivery via abdominal incision
what is the preferred incision for C/S?
Low transverse incision preferred
what are the indications for C/S?
macrosomia/CPD, fetal distress, breech, previous C/S, FTP
T/F elective C/S is now an option for primipara
TRUE
what are maternal risks for C/S?
Maternal risks include hemorrhage,infection, DVT, organ damage
what are fetal risks for C/S?
Fetal risks include prematurity, birth injury, moist lungs
what occurs during C/S preop prep?
shave, oral antacid, Foley,draw “clot to hold” - Type and cross if needed
what is a spinal block for C/Section?
Anesthetic injected into intrathecal space
• Intrathecal narcotics may also be added *
what are the advantages of a C/S spinal block?
excellent pain
relief & awake for birth
what are the disadvantages of a C/S spinal block?
– Risk of hypotension, urinary retention, spinal HA
– * Narcotic may cause maternal respiratory depression & pruritus
what are the nursing responsibilities for C/S spinal block?
- Give large IV preload
- Intrathecal narcotics - special considerations
- Request blood patch if spinal headache occurs
what are the special nursing responsibilities for intrathecal narcotics (C/S)??
– Monitor respiratory rate q hour x 18 hrs
– Treat pruritis: • IV Benadryl • Narcan (0.4 mg/liter)
in primary IV
what is a vaginal delivery after cesarean? (VBAC) when is this recommended?
• Trial of labor initiated for woman with previous C/S
• Recommended only in hospitals with 24 hr in-house
anesthesia
what is the success rate of VBAC?
80%
when is VBAC contraindicated?
if > 2 previous C/S or vertical uterine
incision; and malpresentation, contracted pelvis, or
macrosomia
what are the risks of VBAC?
possible uterine rupture (< 1% low transverse)
what are the advantages of VBAC?
experience labor & delivery, less costly, less
complications, & faster recovery
when can an umbilical cord prolapse occur?
Can occur when membranes rupture in presence of: high station, breech, transverse lie, small fetus, polyhydramnios
the compressed cord may be ___, ____, or ______
seen, felt, suspected
what are the nursing interventions to correct prolapsed cord?
- Restore fetal O2/blood flow
* Emergency requiring stat C/S
what are ways to restore fetal O2 and blood flow when a cord is prolapsed?
– Pushing presenting part off cord
Place mom in Trendelenberg or knee-chest
– If cord prolapsed through vagina, keep moist
what is the definition of postpartum hemorrhage?
Excessive blood loss first 24 hours:
– > 500 ml after vaginal
– > 1000 after C/S
what are the causes of postpartum hemorrhage?
- Hypotonic uterus r/t: • Over-distention, multiparity, prolonged labor, drugs (mag sulfate, oxytocin), full bladder
– Retained placental fragments
– Laceration of genital tract: continuous bleeding with firm fundus
– Vulvar hematoma: blood loss can be severe: may not see blood → “sitting on egg”
what are 6 nursing interventions for postpartum hemorrhage?
- Catheterize if unable to void
- Assess fundus; massage if boggy
- Weigh pads & chux (1 ml = 1 gm)
- Elevate legs; replace fluids
- Give uterotonic meds
- Balloon tamponade: inflated in uterus to control bleeding
what are the uterotonic medication?
– Oxytocin IV/IM
– Methergine IM/PO -contraindicated if hypertensive
– Prostaglandins
• Misoprostol (Cytotec) rectally (SE: shivering, fever)
• Carboprost (Hemabate) IM (SE: severe cramping,
diarrhea, nausea , vomiting, chills, fever)
what is Deep Vein Thrombosis (DVT)
obstructing clot in deep veins of leg
what are the s/sx of DVT?
pain, unilateral swelling, erythema, heat, edema
positive Homan’s sign may be present
How can DVT be diagnosed?
- doppler ultrasound
- D-dimer blood test (small protein present in blood after clot deteriorated by natural clot buster
what are 8 ways to manage DVT?
• Anticoagulant therapy (heparin → warfarin)
• Bedrest/elevation of leg
• Analgesia
• Measure leg circumference (q shift/q4hr)
• Analgesia
• Monitor for s/sx of PE (SOB, tachypnea, cough, CP)
• Antiembolic stockings only after s/sx decreased
- Not in acute phase
***don’t massage or walk → could dislodge it
what is endometritis? (metritis)
infection of uterine lining
when does endometritis occur?
may occur secondary to C/S, vaginal delivery, SAB, or TAB
what are s/sx of endometritis?
– Temp > 100.4º (38º), tachycardia & chills
– Abnormal amount & odor of lochia (should have fleshy smell)
– Pelvic or abdominal pain
– Malaise, nausea, fatigue
– Labs: ↑ WBC & erythrocyte sed rate, positive blood cultures
what is treatment for endometritis?
– Culture & sensitivity; IV antibiotics
– Analgesics, antipyretics, hydration, rest
where are wound infections possible?
C/S incision (most common), also episiotomy/laceration
what are the s/sx of wound infection?
– T > 100.4, tachycardia & chills
– Malaise, nausea, fatigue
– Pain at incision
– REEDA
what is the treatment for an infected wound?
– Culture wound drainage (sometimes RN/MD) – Antibiotics – Analgesics, antipyretics – Wound care (wet to dry) – Sitz baths if perineal infection
what is mastitis?
Inflammation of breast connective tissue - “cold in the breast”
what are the risk factors for mastitis?
milk stasis, bacteria promotion, nipple trauma,
blocked ducts, fatigue, stress,
what are the s/sx of mastitis?
– Usually involves 1 breast
– Warm, reddened, swollen, painful
– Chills, fever
– May have enlarged, tender axillary lymph nodes
what are 6 ways to PREVENT mastitis?
• Wash hands before feed • Frequent breastfeeding (empty breast) • Avoid pressure on breast • Correct positioning/latch • Maintain nipple integrity • Ensure emptying – Change nursing positions – Gentle massage – Moist heat to breasts
how can you treat mastitis? (2ways)
- Prevent further milk stasis
* Treat infection
mastitis: how can we prevent milk stasis?
– Offer affected breast first
– Breastfeed frequently
– Heat to affected area
mastitis: how can we treat the infection?
– Rest
– Acetaminophen
– Antibiotics if not improved
in 24 hours
what is postpartum blues?
Transient depression occurring after birth - occurs to 80% of women - can last 1 - 10 days
what are the s/sx of postpartum blues?
mood swings, anger, tearfulness, & insomnia
what is the suspected cause of PP blues?
Cause unknown; r/t changes in hormone levels, fatigue, stress
how long does it take to resolve PP blues?
- 1 - 2 weeks
what is good to educate about PP blues?
Teach if symptoms severe or persist, seek evaluation for
postpartum depression
what is the definition of PP depression?
S/sx more intense & persist beyond 2 weeks postpartum
what are the s/sx of PP depression?
– Decreased interest in surroundings, loss of emotional
responses
– Feels guilty, unworthy, inept
– Fatigue, difficulty concentrating, weight changes, sleep
disturbances, panic attacks, suicidal thoughts, obsessive
thoughts
what are the possible causes of PP depression?
hormones, fatigue, marital issues, financial worries
what is the treatment for PP depression?
counseling & drug
define PP psychosis
• May present 3 weeks after birth as bipolar illness, schizophrenia, depression
what are s/sx of PP psychosis?
-- Irritability, hyperactivity, euphoria, little need for sleep, poor judgment & confusion – Tearful, guilt, sleep/appetite disturbances – Hallucinations/delusions, risk suicide infanticide
what are two things important for treatment?
- Need immediate medical attention
* Antipsychotics & hospitalization likely
