week 4 content Flashcards
Nursing care: ___________ c/s
- Position woman on table – wedge under right hip to prevent supine hypotension
- Support couple
- Instrument count – before, during, after
- Time out
- Document
- Time of Incision
- Time of Delivery of infant
- APGARS
- AROM
- Time of Placenta extracted
- EBL – estimated blood loss
- Meds received
during
Are these predictors of cervical insufficiency or Pre-Term Labor?
- shortened cervical length – less than 25 mm before term
- history of previous spontaneous abortion without contractions
Cervical insufficiency
Vacuum extraction or forceps?
- Suction cup placed on fetal occiput
- Pump is used to create suction
- Traction is applied
- Fetal head should descend with each contraction
Vacuum extraction
are these risks associated with CPD or macrosomia?
- dysfunctional labor
- uterine rupture
- perineal lacerations
- postpartum hemorrhage
- shoulder dystocia
macrosomia
what is this?
- thin tube with a balloon at the end
- used to induce labor
- inserted through the vagina and cervix into the lower part of the uterus.
- The balloon is then filled with sterile saline solution.
- The inflation of the balloon puts gentle pressure on the cervix, which can help it to soften and begin to open.
foley bulb
are these meds tocolytics or pitocin/oxytocin?
what do they do?
- Procardia (nifedipine)
- Magnesium sulfate
- Terbutaline (brethine)
- Progesterone therapy (Prometrium)
tocolytics
stop contractions
Are these advantages of combined spinal-epidural or spinal (regional anesthesia)?
- Onset – faster than just epidural
- Meds can be added to increase effectiveness
- Most drugs use low dose
combined spinal-epidural
if laboring mom with ROM has a fever, what will the nurse expect the FHR to be tachycardia or bradycardia?
tachycardia
Reassuring or Non-reassuring fetal status:
- Bradycardia
- Tachycardia
- Decreased fetal movement
- Meconium-stained amniotic fluid
- Persistent late decelerations
- accelerations
- Persistent severe variable decelerations
- moderate variability
- baseline between 110-160
N- Bradycardia
N- Tachycardia
N- Decreased fetal movement
N- Meconium-stained amniotic fluid
N- Persistent late decelerations
R- accelerations
N- Persistent severe variable decelerations
R - moderate variability
R - baseline between 110-160
T/F
what risks is the fetus/newborn exposed to when PROM or PPROM occurs?
- Respiratory distress
- Fetal sepsis
- asthma
- Malpresentation
- Prolapse of umbilical cord
- Non-reassuring FHR pattern
- itching
- Compression of the umbilical cord
- Premature birth
- Respiratory distress
- Fetal sepsis
F - asthma is not a risk associated with PROM/PPROM - Malpresentation
- Prolapse of umbilical cord
- Non-reassuring FHR pattern
F - itching is not a risk associated with PROM/PPROM - Compression of the umbilical cord
- Premature birth
which regional anesthesia is this describing - pudendal block or local analgesic?
Advantages
- Easy to admin
- No maternal hypotension risk
Disadvantage
- Urge to bear down may be decreased
pudendal block
If the patient is being induced/augmented with oxytocin and you notice a pattern of tachysystole followed by the onset of late decelerations, which UNCOIL would you implement first?
UNDO cause = you would first turn off the oxytocin because the cause was likely the lack of resting tone between contractions.
If not immediately resolved you would start implementing the other UNCOIL measures.
Painless dilation/thinning of cervix without contractions
Cervical insufficiency
“Incompetent cervix”
what is cricoid pressure is an intervention to prevent ___________ during placement of endotracheal tube, when the patient is under __________ anesthesia.
what is cricoid pressure is an intervention to prevent aspiration during placement of endotracheal tube, when the patient is under general anesthesia.
put the Stages of grief in order:
- depression
- denial
- anger
- acceptance
- bargain
Stages of grief
- denial
- anger
- bargain
- depression
- acceptance
4 types of ______________:
1. Foley bulb
2. Prostaglandin - Cytotec (misoprostol)
3. Prostaglandin - cervidil (dinoprostone)
4. Stripping of membranes
Cervical ripening
Nursing care: ______ c/s (before , during, after)
- Assist with epidural or spinal
- Admin ordered meds to neutralize stomach acid – Pepcid, reglan, bicitra
- Monitor maternal vitals under anesthesia
- Monitor FHR with doppler or internal lead (FSE)
- Insert foley catheter
- Prepare abdomen and perineum – shave
- Make sure all necessary staff and equipment are present
before
match term to definition:
Regional anesthesia, Systemic analgesia, general anesthesia
IV pain med management
Temporary and reversible loss of sensation
puts you in an unconscious state, eliminating awareness of pain and sensation
Systemic analgesia
IV pain med management
Regional anesthesia
Temporary and reversible loss of sensation
general anesthesia
puts you in an unconscious state, eliminating awareness of pain and sensation
what is this? Episiotomy or Amniotomy
OB or nurse mid wife causes AROM by using hook to create a small tear in the amniotic membrane which allows fluid to escape
Amniotomy
foley bulb:
risks
- uterine hypo/hyper stimulation?
- non-reassuring/reassuring fetal status?
- higher/lower rate of postpartum hemorrhage?
- uterine rupture/atony?
risks
- uterine hyperstimulation
- non-reassuring fetal status
- higher rate of postpartum hemorrhage
- uterine rupture
T/F about systemic analgesia admin
- All systemic meds used for pain relief during labor cross the placental barrier
- Fetal liver and kidney excretion is adequate for metabolizing meds
true - All systemic meds used for pain relief during labor cross the placental barrier
False - Fetal liver and kidney excretion is inadequate for metabolizing meds
which ones help speed up labor?
- cerclage
- amniotomy
- foley bulb
- prostaglandins
- tocolytics
- stripping of membranes
- pitocin
- epidural
speed up labor:
- amniotomy
- foley bulb
- prostaglandins
- stripping of membranes
- pitocin
rationale:
- cerclage - sutures on the cervix
- tocolytics - stop contractions
- epidural - for pain, may actually slow labor
Cervical ripening
Performed before/after induction
Cervical ripening
Performed before induction, helps speed it up
nursing care:
Pt c/o sudden onset of large gush of blood and painful abdomen.
FHR is reassuring.
suspect _________?
Next step?
- Suspect abruptio placentae
- Palpate abdomen for firmness
placental abruption or placenta previa
_____________ = placenta detachment
______________ = placenta over cervix
placenta previa = placenta over cervix
placental abruption = placenta detachment
placental abruption or placenta previa?
painful
placental abruption
Nursing care: after epidural or spinal placement
T/F
- Monitor maternal and fetal vitals
- Assess for hypotension and intervene if necessary (UNCOIL)
- Admin antiemetics as ordered
- Monitor RR
- Assess bladder and catheterize if unable to void
- Assess for difficulty breathing, ringing in ears, funny taste in mouth
- lower HOB
T - Monitor maternal and fetal vitals
T - Assess for hypotension and intervene if necessary
T - Admin antiemetics
T - Monitor RR
T - Assess bladder and catheterize if unable to void
T - Assess for difficulty breathing, ringing in ears, funny taste in mouth
F - Keep HOB raised!! – gravity makes anesthesia go to abdomen and back area
VBAC or TOLAC?
considered __________ until successful vaginal birth after c/s
considered ___________ once successful vaginal birth after c/s has been achieved
TOLAC - Pt considered TOLAC (trial of labor after cesarean) until successful
VBAC - Vaginal birth after c/s
T/F - Naloxone (Narcan) reverses mild respiratory depression of opiates/opioids on mom and fetus
T/F - Naloxone (Narcan) can cause withdrawal and Neonatal Abstinence Syndrome (NAS) if mother has Substance Use Disorder (SUD) so it is contraindicated for these patients
True
True
Are these disadvantages of epidural or spinal (regional anesthesia)?
- Maternal hypotension
- Urinary retention
- Itching
- May slow down labor and contractions – can add pit
- Post delivery back pain
- Meningitis
- Cardio respiratory arrest
- Vertigo
- Onset – up to 30 mins
epidural
with a foley bulb - the inflated balloon puts gentle pressure on the cervix, which can help it to ______ and ________
soften and begin to open
Hydramnios/polyhydramnios or Oligohydramnios:
________________
- preterm labor risk
- amniocentesis
__________________
- monitor fetus for risks
- renal and urinary malformations
- fetal skin and skeletal abnormalities
- pulmonary hypoplasia – underdeveloped lungs
- cord compression
Hydramnios/polyhydramnios = 2000 mL+
- preterm labor risk
- may need to removal excess fluid – amniocentesis
Oligohydramnios = less than 500 mL
- monitor fetus for risks
- renal and urinary malformations
- fetal skin and skeletal abnormalities
- pulmonary hypoplasia – underdeveloped lungs
- cord compression
T/F
Possible causes of PROM/PPROM
- UTI
- Previous history of PPROM
- Oligohydramnios
- Multiple pregnancies
T - any infection
T - Previous history of PPROM
F - Hydramnios
T - Multiple pregnancies
are these risks associated with multiple gestation or AMA?
- preterm labor
- uterine dysfunction
- abnormal fetal presentations
- instrumental or c/s birth
- postpartum hemorrhage
- higher mortality rate than for single fetus
- decreased intrauterine growth rate
- increased incidence of fetal anomalies
- increased cord accidents
- increase in Cerebral Palsy
multiple gestation
T/F about systemic analgesia admin
admin when:
- mom is uncomfortable
- there is a well established labor pattern
- contractions are occurring irregularly
- there is a significant duration of contractions
- contractions are mild intensity
Admin systemic analgesia when:
T - when mom is uncomfortable
T - well established labor pattern
F - contractions must be occurring regularly
T - significant duration of contractions
F - contractions must be moderate to strong intensity
what would the nurse suspect with these s/s
- sudden onset
- chest pain
- dyspnea
- cyanosis
- frothy sputum
- tachycardia
- hypotension
- massive hemorrhage
Amniotic fluid embolism
(Anaphylactoid syndrome)
T/F
nursing care: macrosomia
- identify macrosomia before labor begins
- evaluate maternal pelvis
- estimate fetal size by US
- consider c/s
- lack of fetal descent may indicate too large for vaginal birth
- risk for unexpected shoulder dystocia
- nurse may need to get woman into mcroberts maneuver or apply suprapubic pressure to help deliver shoulder dystocia baby
- apply fundal pressure
- identify macrosomia before labor begins
- evaluate maternal pelvis
- estimate fetal size by US
- consider c/s
- lack of fetal descent may indicate too large for vaginal birth
- risk for unexpected shoulder dystocia
- nurse may need to get woman into mcroberts maneuver or apply suprapubic pressure to help deliver shoulder dystocia baby
F - NEVER apply fundal pressure
what is this?
the umbilical cord slips down into the vagina ahead of the baby during labor or delivery, it is compressed against mom’s pelvis and oxygen supply to fetus is cut off
Umbilical cord prolapse
what is the nurse concerned with when giving pt systemic analgesia (opioids and opiates)?
maternal s/e
- Drowsiness?
- Dizzy?
- Fainting?
- anemia?
- Hypotension or hypertension?
- Respiratory depression?
- Constipation or diarrhea?
- fever?
- Itching?
- is a history of substance abuse a concern?
- n/v?
neonatal s/e
- Respiratory depression?
- Neurobehavioral depression?
- Respiratory acidosis?
maternal s/e
- Drowsiness
- Dizzy
- Fainting
- Hypotension
- Respiratory depression
- Constipation
- Itching
- is a history of substance abuse a concern - YES
- n/v
neonatal s/e
- Respiratory depression
- Neurobehavioral depression
- Respiratory acidosis
Fetal risk associated with PTL or post term pregnancy?
- Decreased perfusion
- Oligohydramnios
- Small for gestational age (SGA)
- Macrosomia – big for gestational age
- Increased risk for meconium-stained fluid
- Risk for meconium aspiration syndrome
Post term pregnancy
- Decreased perfusion as placenta gets older
cesarean birth
what are the 2 Skin incisions?
what are the 3 uterine incisions?
transverse, low transverse, classical, low vertical, vertical
Skin incision:
- Transverse incision – horizontal, Pfannenstial “bikini”
- Vertical incision
Uterine incision:
- Low transverse incision – horizontal
- Classical incision – vertical, mid belly
- Low vertical incision – vertical, low belly
amnioinfusion
Purpose:
- Replace _____________
- repetitive __________ decels with increasing intensity
- Meconium _____________
- Replace amniotic fluid
- repetitive variable decels with increasing intensity
- Meconium dilution
which bishop score is best?
2/13
5/13
7/13
10/13
higher score = higher likelihood of vaginal birth
8+/13 is ideal
Forceps assisted birth:
Forceps used to
- guide baby out with push of contractions
or
- pull baby out bc mom’s too exhausted to push
Forceps assisted birth
Forceps used to guide baby out with push of contractions, not pull baby out
which intrapartum complication would we expect to treat with:
- serial cervical US assessments
- bed rest
- progesterone (tocolytic)
- antibiotics
- cerclage
- monitor cervical length
- transvaginal US starting 16-24 weeks gestation
- teach warning signs of impending birth
cervical insufficiency, PPROM/PROM, or PTL?
Cervical insufficiency - Painless dilation/thinning of cervix without contractions
progesterone - Helps sustain pregnancy
Nursing care: Pts BP drops after admin of regional anesthesia (epidural), also some FHR late decelerations are noted
what should the nurse do?
- give oxygen
- reposition
- oxytocin
- ephedrine
- stop IV fluid bolus
- lower HOB
- UNCOIL!!!
- give Oxygen
- Turn/reposition
- stop pitocin/oxytocin
- give Ephedrine – vasoconstrictor
- give IV fluid bolus
- Lower HOB
prostaglandins
cytotec (miso) or cervidil (dino)?
-route – vaginal
-purpose – stimulate contractions to thin cervix
-can remove by pulling string (like tampon)
-bedrest for 2 hours after dose, then pt can be up to bathroom
-pat dry after voiding, don’t wipe to avoid pulling it out of place
cervidil (dino)
2 types of episiotomy incisions
-Midline –
-Mediolateral –
- Midline – straight line down from vagina to anus
- Mediolateral – diagonal incision from vagina out towards leg
T/F
Nursing care: placenta previa
- SVE
- Assess for bleeding – may need transfusion
- Assess mom vitals
- Assess fetal status
- FHR- internal monitor
- External toco for contraction monitoring
- Anticipate unengaged fetal presenting part
- Transverse lie is common
- Get consents for c/s
- Admin tocolytics (magnesium sulfate, Procardia, terbutaline)
F - No SVE!! For confirmed and suspected – even if there is the slightest chance of a previa nothing in the vagina, no exam
- Assess for bleeding – may need transfusion
- Assess mom vitals
- Assess fetal status
F - FHR- external monitor
- External toco for contraction monitoring
- Anticipate unengaged fetal presenting part
- Transverse lie is common
- Get consents for c/s
- Admin tocolytics (magnesium sulfate, Procardia, terbutaline) – meds that stop contractions
placental abruption or placenta previa?
- Placenta is in the right spot, but it is separating/ripping away from uterine wall prematurely
there is less perfusion and oxygen getting to fetus since the placenta is losing connection to uterus - Instead of placenta being at the top of the uterus, it is at the bottom covering the cervix opening
- as the uterus contracts and dilates at the bottom where the cervix is, the placenta is less and less connected to uterine wall
- bright red, painless bleeding occurs
- abruptio placentae
- placenta previa
nursing care: hypertonic/tachysystole contractions or hypotonic contractions?
- assess contractions, vitals, and FHR
- provide comfort and support – back rubs
- change positions
- turn of oxytocin
- tocolytics
- sedation or pain meds
nursing care: hypertonic/tachysystole contractions
- assess contractions, vitals, and FHR
- provide comfort and support – back rubs
- change positions
- turn of oxytocin
- tocolytics – stop contractions
- sedation or pain meds
what is this?
baby’s head is too large or the mother’s pelvis is too small to allow for a vaginal delivery.
Deliver c/s
CPD
Cephalopelvic disproportion
Nursing care: before or after epidural or spinal placement?
- Assess maternal and fetal status
- Assess labor process
- Start IV and admin warmed LR
- Help woman into position for placement
before placement
which 2 regional anesthesia are usually used in 2nd stage of labor or laceration/episiotomy repair?
epidural, spinal, combined epidural-spinal, pudendal block, or local analgesic?
pudendal block
local analgesic
which meds STOP contractions?
pitocin/oxytocin or tocolytics?
tocolytics
which are examples of labor augmentation?
- Pitocin
- amniotomy
- Stripping membranes
- Ambulation
all
The pt is:
8 cm/100%/0
c/o 10/10 pain
begging for IV pain meds/opioids/systemic analgesia
Should the nurse give the ordered dose of IV pain meds/opioids/systemic analgesia - why or why not?
No, do not give IV pain meds/opioids/systemic analgesia if delivery is close bc it causes neonatal respiratory depression and we don’t want the newborns respiratory system to be depressed when born
8 cm/100%/0 = Delivery in immediate future = contraindication
Nursing care for amniotomy
- Check ________ (#1 nursing priority after water breaks)
- C –
- O –
- A –
- T -
- Maternal temp Q ___ hours
- Check FHR (#1 nursing priority after water breaks)
- C – fluid color, clear, bloody, meconium
- O – foul odor or odorless
- A – amount, scant, moderate, copious
- T - Date and time of AROM
- Maternal temp Q2 hours
are these complications associated with general anesthesia or regional anesthesia?
- fetal respiratory depression
- maternal intubation
- aspiration!!
- Higher risk of Postpartum hemorrhage
- Less feeling of control
- Not awake during labor and birth
- Support person may not be present
- Maternal amnesia – doesn’t remember labor and birth
general anesthesia
Premature rupture of membranes (PROM) or Preterm premature rupture of membranes (PPROM) :
- water breaks before the onset of labor (no contractions)
- less than 37 weeks
Preterm premature rupture of membranes (PPROM) :
