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SEM 1 > W5: Labor At Risk > Flashcards

W5: Labor At Risk Flashcards

1
Q

Caring for high risk clients requires:

A

understanding the normal birth process
prevent & detect deviations
implement nursing measures when complications arise

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2
Q

Preterm Labor

A

cervical changes + contractions
20-37w

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3
Q

Preterm birth

A

any birth occuring before 37w

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4
Q

Preterm Causes

A

infections
vaginal bleeding
hormone changes
stretching of uterus

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5
Q

S/S of Preterm Labor

A

UTERINE ACTIVITY:
uterine contractions more frequenct than q10m, for 1+hrs,

DISCOMFORT:
lower abd pain (~gas pain), diarrhea, dull back pain, cramps, suprapubic pressure, pain, heaviness

VAGINAL D/C:
change in character + amt, colour, odour

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6
Q

Preterm Labor Diagnositc criteria

A

20-37
regular uterine activity + cervical changes
regular contractions + 2cm+ dilation

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7
Q

NC: preterm labor

A

address risk factors (stress, nutrtion, diet)
administer prophylactic progesterone to decrease rate

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8
Q

Interdisciplinary care

A

tooclytics- suppression of uterine activity
bethamethasone- fetal lung maturity, surfactant
magnesium sulphate to prevent/reduce newborn neurological morbidity [inevitable birth]

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9
Q

Patient Teachinf Preterm Labor

A

stop what you’re doing
empty bladder
2-3 glasses of water/juice
lie down on the side for 1hr

symptoms continue: doctor
go away:
- resume light activity
- not what you were doing before

Immediate hospital:
- leakage of amniotic fluid
-vaginal bleeding
- uterine contractions q10mins for 1hr

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10
Q

PROM

A

rupture of amniotic sac and leakage of fluid before onset of labor

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11
Q

pPROM

A

rupture of membranes before 37w

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12
Q

Interdisciplinary Care: PROM

A

term pregnancy: induction of labor
34-36 weeks: mgt if low risk of infection
<32weeks: expectant mgt for fetal lunf maturity

betamethasone: 24-34w:
magnesium sulphate: <34w

  • NST, BPP
  • antibiotics (7days)
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13
Q

Nursing Care: PROM

A

teach fetal movement counting
keep vagina clear, and don’t introduce anything new
Signs of infection: foul d/c, tachy (m/f)

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13
Q

Maternal Complications: PROM

A

placental abruption
retained placenta –> hem. –> sepsis –> death
chorioamnionitis:

d/t :
pronlonged rupture
vaginale xaminations
internal monitors
young maternal age
low SES
nulliparity
pre-existing infections

mgt: broadspectrum antibiotics

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13
Q

Fetal Complications: PROM

A

intrauterine infection
cord prolapse, umbilical cord compression (assoc w/ oligohydramnios)

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14
Q

Post-term Pregnancy

A

beyond 42 weeks

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15
Q

Risk factors: Post-Term

A

hx of post-term
male fetus
obesity
genetic disposition

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16
Q

Maternal Risk: Post-term

A

labor dystocia
perineal injuries
chorioamnionitis
endomyometritis
PPH
c-section
anxeity

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17
Q

Fetal Risk: Post-term

A

macrosomia/SGA
birth trauma
asphyxia
oligohydramnios (cord compression, abnormal FHR)
aging placenta (still birth)
meconium stained fluid, meconium aspiration
low apgar scores
convulsions in newborn

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18
Q

NC: Post-term

A

41w: FMC, NST, AFV, BPP, CST

42+6w= birth recommended

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19
Q

Patient teaching: post-term

A

daily fetal movement counts
assess for signs of labor

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20
Q

Dystocia

A

slow progress of labor
4+ hrs w/ less than 0.5cm dilation
1+hr hour of pushing w/ no descent

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21
Q

Causes of Dystocia (5 P’s)

A

power: ineffectice contractions, pushing
passageway: structure, abnormalities
passenger: presentation, multiple babies, size
position: of pt
psychological: prep, hx

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22
Q

Interventions for Dystocia

A

external cephalic versin
cervical ripening
induction/augmentation of labor
operatice procedures (forcepts, vaccum)
c-section

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23
Complications of Labor Dystocia
fetal distres risk of infection PPH uterine rupture trauma uterine/organ prolapse obsetrical fistula (vesico-vaginal, rectovaginal), incontinence sacroiliac joint dislocation
24
Management of Cord Prolapse
goal- relieving pressure on cord knee-chest position manual decompression (hcp elevates head) trendelenburg position tocolytics - less pressure, better perfusion cord: kept warm & moist [prevent vasospasm] fetal monitoring c-section: minimal dilation, fetal compromise risk
25
Recognizing Cord Prolapse
sudden gush of fluid followed by feeling of vaginal pressure/fullness seek immediate care assume knee-chest positon
26
Shoulder dystocia
head born but shoulder can't pass d/t: fetopelvic disproportion (>4000g) - macrosomia pelvic abnormalities prolonged 2nd stage of labor hx of shoulder dystocia
27
Shoulder Dystocia
Interventions: McRobert's maneuver (legs to chest) suprapubic rpessure over anterior shoulder gaskin maneuver (hands & knees)
28
Shoulder Dystocia: complications
brachial plexus fracture of humerus/clavicle asphyxia
29
Amniotic Fluid Embolism (AFE)
introduction of amniotic fluid into circulation ot pt during birth or after birth
30
Effects of AFE
respiratory distress: restlessness dyspnea cyanosis pulmonary edema respiratory arrest circulatory collapse: hypotension tachycardia shock cardic arrest hemorrhage: coagulation faliure uterine atony
31
Interventions of AFE
oxygenate: administer 10L/min tilt pt 30 degrees to the side cardiac ouput position on side IV fluids blood catheter (measure output) correct coagulation faliure
32
induction of labour
chemical or mechnicals intiation of uterine contractions for birth
33
high priority indications of induction
pre-eclampsia >37w maternal dx not responding to tx antepartum hemorrhage chorioamninitis suspected fetal compromise PROM + group b streptococcus
34
Contraindications of induction
suspected fetal macrosomia absence of fetal or maternal indication convinience
35
Cervical ripening Agents Induction
ripens cervix, making it softer, dilation, contraction. prostaglandins E2 cervidil insert prepidil gel
36
NC: Cervical Ripening Agents
bring prepidil to room temp before administration (no hot water/microwave) keep cervidil frozen until before insertion, warm pt void before insertion pt maintain supine position w/ later tilt for 30 mins (gel), 2 hrs (insert) pt to ambulate pull string to remove insert if AE occur - delay oxytocin for induction by 6hrs after last gel OR 30-60mins since removal of insert
37
Mechanical Induction
balloon catheters, release prostaglandins, ripen cervix
38
Balloon Catheters
inflated above os w/ 30-50ml results in pressure = prostaglandins balloon will fall out when 3cm dilation OR removed after 24 hrs
39
Balloon Catheters Contraindications
low-lying placenta antepartum hemorrhage rupture of membranes evidence of lower genital tract infection
40
Hydrascopic Dialators
substance absorbs fluid from tissue and enlarges laminaria tent (seaweed) lamicel synthetic dialators w/ mag sulp
41
Mechanical & Physical Methods of Induction
sexual intercourse (prostaglandins in semin, contractions w/ orgasm) nipple stimulation (oxytocin released) ambulation/walking (gravity applies pressure on cervix = oxytocin)
42
Alternative Induction: Amniotomy
aritificial rupture of membranes labor begins within 12 hrs combined w/ oxytocin
43
Amniotomy Indications
presenting part of fetus is engaged & well applied to cervix no active infections of genital tract HIV status is negative, viral load is low
44
Alternative Induction methods
amniotomy blue cohosh + castor oil (labor stimulation) black cohosh + evening primrose (ripen cervix)
45
Compolications of Amniotomy
chorioamnionitis d/t prolonged rupture w/o labor variable FHR decelerations d/t cord compression d/t cord prolapse OR dec AFV
46
Oxytocin
stimulates uterine contractions induction/augmentation of labor given via IV
47
Oxytocin Contraindications
abnormal FHR cephalopelvic disproportion prolapsed cord transverse lie plaventa rpevia hx of uterine surgery herpes cancer of cervix uterine rupture
48
Complications of Oxytocin
uterine tachysystole (~FHR changes) abnormal FHR suspected uterine rupture inadequate uterine response
49
NC: Oxytocin
monitor fetal status: q15m w/ every dose change - 1st stage q5m w/ active pushing - 2nd stage monitor contraction pattern & uterine tone q15m w/ every dose change - 1st stage q5m - 2nd stage BP, pulse , RR : q30-60m w/ every dose change assess I/O - iV intake 1000ml only / 8hrs - output 120+ml / 4hr
50
NC: AE Oxytocin
discontinue oxytocin turn pt to later side give IV bolus if pt is hypovolemic/hypotensive oxygen (8-10L/m)- w/ hypoxia/hypovolemia NO to decrease uterine activity
51
Augmentation of Labor
stimulation of uterine contractions after labor has started spontaneously but progress is unsatisfactory hypotonic uterine dysfunction Common methods: oxytocin infusion amniotomy non-invasiveness methods: empty bladder, ambulation, position changes, relaxation, nourishment, hydration, hydrotherapy
52
External Cephalic Version (ECV)
manual turning of fetus from breech to transverse to vertex
53
ECV Contraindications
multiple fetuses non-assuring fetal status placenta previa placenta abruption
54
ECV Required Assessment
determine fetal position locate umbilical cord rule out placenta previa detect multiple gestation, oligohydramnios, or fetal abnormalities measure fetal dimension
55
Indications: Forceps-Assisted Birth
m: prolonged 2nd stage for maternal reasons f: abnormal FHR, abnormal presenstation, arrest of rotation, delivery of head in breech
56
Consideratins: Forceps-Asissted Birth
memrane ruptured assess pelvic-head ratio dully dilated cervix w/ engaged head empty bladder
57
Nursing Care: Forceps- Assisted Birth
bleedinf urinary retention f: abrasions, brusiing facial palsy d/t pressure on facial nerve subdural hematoma
58
Vacuum Assissted Birth
attachment of vacuum cup to fetal head using negative pressure to assist birh of head
59
vacuum assisted birth: fetal risks
cephalohematoma scalp lacerations subdural hematoma
60
scheduled c-section
labor and vaginal birth are contraindicated
61
unplanned c-section
changes in labouring pt & family's expecatations
62
forced c-section
to protect well being of pt and babty
63
Maternal Indicatins of C-section
cardiac dx respiraotry dx intracranial pressure mechanical obstruction hx of c-sections elective c-section
64
fetal indications of c-section
abnormal FHR malpresentation mama herpes, hiv congenital abnormalies
65
maternal-fetal indications for c-section
dysfunctional labor (diproportion head) placenta abruption placenta previa
66
Contraindications of TOLAC
classical uterine incision inverted T or low uterine incision uterine rupture uterine surgery pt requests c-section inability to preform c-section if necessary

SEM 1 (11 decks)

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