week 5 Flashcards
a nurse is caring for a client who is in labor and is experiencing incomplete uterine relaxation between hypertonic contractions. the nurse should identify that this contraction pattern increases the risk for which of the following complications?
1. prolonged labor
2. reduced fetal oxygen supply
3. delayed cervical dilation
4. increased maternal stress
- reduced fetal oxygen supply
what position helps the fetus rotate
hands and knees
preterm labor is defined as
uterine contractions & cervical change that occur between 20 to 36 weeks and 6 days
very preterm labor occurs
before 32 weeks
fetal fibronectin testing (FFP)
testing of a protein that indicates inflammation
interventions for preterm labor
LEFT side
no sex
fetal tachycardia
modified bed rest w bathroom privileges
Nifedipine
CCB that suppresses contractions by inhibiting calcium from entering smooth muscles
cannot be taken w magnesium sulfate
adv effect is orthostatic hypotension
Magnesium sulfate
suppresses contractions by relaxing smooth muscles
*monitor for MG toxicity = deep tendon reflexes
antidote = calcium gluconate
nifedipine can not be administered with
magnesium sulfate
antidote for magnesium sulfate
calcium gluconate
terbutaline
inhibits uterine activity & relaxes smooth muscle
0.25mg SC Q4hrs for 24 hours
indomethacin
NSAID that suppresses contractions by blocking prostaglandins
*increased risk of closing ductus arteriosus
** admin less than 32 weeks only
indomethacin for labor can only be used in patients
less than 32 weeks gestation
nifedipine, magnesium sulfate, terbutaline, and indomethacin can not be administered in
patients with active bleeding
Betamethasone
enhances fetal lung maturity & surfactant position
24 hours to be effective
2 x IM’s 24 hours a part
@ least 24 hrs before delivery
interventions following rupture of membrane
assess for prolapse umbilical cord
- abrupt variable decels
- prolonged decels
obtain cultures for strep, chlamydia, & gonorrhea
lab tests for rupture of membranes
+ nitrazine paper - BLUE - 6.5 to 7.5
+ ferning test
anaphylactoid syndrome of pregnancy and s/s
emergency - embolism/ infiltration of amniotic fluid into maternal circulation
s/s = dic, resp. distress, sob, chest pain
risk factors for a prolapsed umbilical cord
rupture of membrane
abnormal fetal presentation
transverse lie
small for gestational age
hydroamino
multifetal pregnancy
s/s of prolapse umbilical cord
*VARIABLE DECELS
reports feeling it
excess activity to sudden stop
visible @ introitus
interventions for prolapsed umbilical cord
- call help & stay w patient
- STERILE GLOVE W FINGER APPLYING PRESSURE ON EITHER SIDE OF CORD
- reposition - knee to chest, trendelenberg, & side-lying w towel under hip
- apply warm sterile saline towel to visible cord
s/s of meconium stained amniotic fluid
GREEN thick/thin fluid
variable / late decels
risk for meconium stained amniotic fluid
more than 38 weeks gest age
breech presentation
umbilical cord compression
hypoxia
fetal distress
FHR < 110 or >160
decreased or no variability
interventions for fetal distress
LEFT side
STOP OXYTOCIN
admin O2 & IV fluids
Mc Robert’s maneuver
legs pushed up knee to chest during labor
dystocia
dysfunctional labor related to the 5 P’s
s/s of dystocia
hypotonic uterus
hypertonic uterus (tachysystole) = >5 UC in 10 min
occiput posterior position
oxytocin
used to augment labor & strengthen contractions
NOT USED FOR HYPERTONIC CONTRACTIONS
precipitous labor
labor lasting less than 3 hours from onset of contractions to time of delivery
risk factors for precipitous labor
hypertonic uterine dysfunction
oxytocin stimulation
multiparous client
interventions for precipitous labor
apply light pressure to perineal area and fetal head pressing upward toward vagina – eases expulsion
uterine rupture
rupture of uterine wall, peritoneal cavity, and or broad ligament = internal bleeding
s/s of uterine rupture
sharp pain
feels “ripping” or “tearing”
tenderness
hypovolemic shock
