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