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NUR 318 > module 5 > Flashcards

module 5 Flashcards

1
Q

what are the four factors for adequate oxygenation of the fetus?

A

normal maternal blood flow and volume to the placenta
normal oxygen saturation in maternal blood
adequate exchange of oxygen and carbon dioxide
open circulatory path between the placenta and the fetus through vessels in the umbilical cord

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2
Q

continuous fetal monitoring

A

there is a machine that does this. it produces a graphic record of the FHR pattern.
the objective is to give information about fetal oxygenation and prevent fetal injury from hypoxia. helps detect FHR changes early before they are prolonged and profound

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3
Q

fetal response to labor

A

labor is a period of physiologic stress
frequent monitoring of fetal status is part of nursing care during labor
fetal oxygen supply mist be maintained during labor to prevent compromise

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4
Q

what can cause the fetal oxygen supply to decrease

A
  • reduction of blood flow through maternal vessels as a result of hypertension and hypotension
  • reduction of oxygen content in maternal blood as a result of hemorrhage or severe anemia
  • alterations in fetal circulation with compression of the umbilical cord
  • reduction in blood flow to intervillous space in the placcenta
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5
Q

low risk maternal fetal assessment

A

first stage of labor: every 30 mins

second stage every 15 mins

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6
Q

high risk maternal fetal assessmetn

A

first stage: every 15 mins

second stage: every 5 mins

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7
Q

external monitoring

A

FHR: ultrasound transducer
UC: tocotrandsucer

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8
Q

internal fetal monitoring

A

for high-risk pregnancies only
it is invasive and uses a spiral electrode. it measures frequency, duration, and intensity. measured in Montevideo units.

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9
Q

wireless electronic fetal monitoring

A

tend to pick up more artifact than other monitoring. makes it look like there is increased variability.

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10
Q

what is monitored when it comes to fetal heart rate

A

rate
regularity
absence of decrease from baseline
baseline is noted on admission and used as a gauge for FHR during second stage of labor

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11
Q

FHR variability

A

expect to see these fluctuations with fetal sleep and activity. there are classifications of variability and factors that decrease it

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12
Q

baseline fetal heart rate

A

the average during a 10-minute segment excluding periodic or episodic changes, periods of marked variability, segments of the baseline that differ by more than 25 bpm

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13
Q

variability types

A

absent or minimal: abnormal or indeterminate. could mean fetal hypoxemia or metabolic acidemia
moderate: normal. predicts normal fetal acid-base balance
Marked: unclear significance, sinusoidal pattern

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14
Q

normal FHR

A

110-160 bpm

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15
Q

variability

A

irregular waves/ fluctuations in baseline FHR for 2-minute cycle

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16
Q

fetal bradycardia and maternal/ fetal causes

A
  • a FHR < 110 for > 10 mins
  • maternal causes: supine hypotension, hypoglycemia, hypothermia, medications ex: opioids
  • fetal implications: structural defects: cardiac, AV dissociation (heart block), heart failure
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17
Q

clinical significant of bradycardia

A

not only related to decreased oxygen but it depends on the underlying cause and accompanying FHR patterns, including variability, acceleration, or decelerations

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18
Q

FHR acceleration

A

a normal pattern signifies fetal well-being. caused by:
-spontaneous fetal movement, vaginal exam, electrode application, scalp stimulation, breech presentation, occiput posterior presentation, fundal pressure, abdominal palpation

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19
Q

VEAL CHOP

A

variable decelerations: cord compression
early decelerations: head compression
accelerations: okay
late decelerations: placental insufficiency

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20
Q

early decelerations

A

cause: fetal head compression
clinical significance: normal pattern; not associated with fetal hypoxemia or low APGAR scores.
Interventions: none except oversee, document, and prepare for delivery.

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21
Q

variable decelerations

A

umbilical cord compression

-umbilical cord compression occurs in 50% of labors and is usually correctable

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22
Q

FHR category 1

A 
baseline 110-160
moderate variability
late or variable decels absent
early decals and acels may be present or absent
this is the normal finding
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23
Q

category II FHR

A

include ALL FHR tracings not categorized as I or III
bradycardia/ tachycardia
minimal or marked variability
indeterminate: require evaluation and continued surrvailence and reevaluation

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24
Q

category III

A

absent variability and any of the following:
recurrent late decels, recurrent variables, bradycardia, sinusoidal pattern.
ABNORMAL: require prompt evaluation

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25
Q

prolonged decelerations

A

interruption to fetal oxygen supply

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26
Q

care management

A
  • EFM pattern recognition and interpretation: categorize FHR tracings and manage abnormal patterns
  • assessment techniques
  • patient and family teaching
  • documentation
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27
Q

as the nurse dealing with a complication

A
  • must know the normal birthing process
  • prevent and detect deviations from normal
  • when complications arise the risk of morbidity and mortality increases
  • sometimes complications are expected especially with high risk pregnancies
28
Q

indications of preterm birth

A
  • gestational diabetes
  • chronic hypertension and preeclampsia
  • obstetrical disorders
  • insufficient uterine size
  • fetal disorders on the NST and BPP
29
Q

how to identify those at risk for preterm labor and birth

A

risk factors
fetal fibronectin: positive result indicates the amniotic sac is not sticking to the uterine wall
cervical length: soft, dilated, anterior are concerning
-symptoms of PTL

30
Q

prevention of a preterm birth

A

assessment of risks along with history and physical

interventions: prevention and early recognition and diagnosis with the FFN
- lifestyle modifications: activity restriction, especially sexual, home care, transfer hospital, prophylaxis against GBS, antenatal glucocorticoids, and mag sulfate

31
Q

signs and symptoms of preterm birth

A 
change in type of vaginal dishcharge
pelvic or lower abdominal pressure
constant low and dull backache
mild abdominal cramps with wor without diarrhea
regular Braxton hicks
ROM
32
Q

promotion of fetal lung development

A

antenatal glucocorticoids stimulate fetal lung maturation by promoting the release of enzymes that include the production and release of lung surfactant. takes 48 hours for the optimal benefits

33
Q

mag sulfate

A

CNS depressant that relaxes the smooth muscle inhibiting uterine activity

34
Q

BEta adrenergic agonist

A

terbutaline: relaxes smooth muscle inhibiting utering acticity

35
Q

prostaglandin synthetase inhibitors (NSAIDS)

A

inhibits prostaglandins and inhibits uterine activity. encourages lung development

36
Q

calcium channel blickers

A

nifedipine blocks calcium entry into smooth muscles thus inhibiting uterine activity

37
Q

premature rupture of membranes

A

PROM. rupture of the amniotic sac and leakage of amniotic fluid benign at least 1 hour before the onset of labor at any gestational age above 37 wks

38
Q

preterm premature rupture of membranes

A

membrane rupture before 37 0/7 weeks of gestation
infection is a major risk factor: responsible for one-third of all preterm births
there is pathologic weakening of the amniotic membranes: inflammation, stress from uterine contractions, and other factors

39
Q

treatment of ROM

A

-no unsterile digital cervical exams until a woman is in active labor,,. expect to manage underdeveloped fetal lungs

40
Q

nursing assessment for ROM

A

risk factors, signs and symptoms of labor, FHR monitoring, COAT, nitrazine testing, fern testing

41
Q

chorioamnionitis

A

bacterial infection of the amniotic cavity.
clinical findings: maternal fever, fetal tachy, uterine tenderness, foul odor of the amniotic fluid
care: delivery ASAP, may give antenatal glucocorticoid and broad spectrum antibiotics for 7 days

42
Q

posterm pregnancy, labor, birth

A

maternal risks: C-section, dystocia, birth trauma, hemorrhage, and infection
fetal risks: macrosomia, shoulder dystocia, brachial plexus injury, low APGAR score, postmaturity syndrome
fetal kick counts for eval of well being

43
Q

dysfunctional labor

A

dystocia
long, difficult, and abnormal labor
ineffective uterine contractions(power), alterations and pelvic structure (passage), fetal causes (passenger), maternal position, and psychologic response

44
Q

risk factors of dystocia

A 
epidural
multiple gestations
maternal exhaustion
abnormal fetal position
fetal macrosomia
overweight and obese
45
Q

breech presentation nursing assessments

A 
FHR
bradycardia
variable decels
comfort
vital signs
46
Q

induction

A

stimulating contractions vis medial or surgical means`

47
Q

augmentation

A

enhancing ineffective contractions after labor has begun

48
Q

indications of induction or aumentation

A

prolonged gestation, prolonged premature rupture of membranes, gestational hypertension, cardia disease, renal disease chorioamnionitis, dystocia, intrauterine fetal demise, diabetes

49
Q

the bishop score

A

the rating system used to determine the level of cervical inducibility
assesses cervical dilation, effacement, consistency, position, and fetal station
labor induction is most likely to be successful with a higher score of 9+ for nulliparous or 5+ for multiparous

50
Q

induction: cervical ripening

A

chemical agents: prostaglandin gel
mechanical agents: balloon dilators or amniotic stripping
oxytocin

51
Q

what does oxytocin do ?

A

normally produced by the posterior pituitary and stimulates uterine contractions and aids in milk let down
Pitocin is synthetic oxytocin and it is used for induction or augmentation.
watch out for contractions that are too strong or last longer than 60 seconds and more frequent than 3 minutes

52
Q

amniotomy

A

amnihook: nonpharmacological intervention to augment and induce labor or facilitate placement if intrauterine monitors
there is a risk of infection or fetal injury
monitor vs, FHR, dilation, effacement, contractions

53
Q

stripping membranes

A

provider sweeps a gloved finger over the membrane that connects the amniotic sac to the wall of your uterus
may cause relate in prostaglandins and start contractions
there is discomfort and risk of infection and accidental ROM

54
Q

elective induction of labor

A

labor is initiated without a medical indication
many are for the convenience of the woman or her primary health care provider
risks are increased c-section, morbidity and cost

55
Q

why is oxytocin high alter

A

it can cause placental abruption, uterine rupture, unnecessary c-section, hemorrhage, infection, fetal hypoxemia or acidemia

56
Q

indications for forceps or vacuum

A

prolonged second stage of labor, non reassuring FHR pattern, failure of presenting part to fully rotate and descend, limited sensation or inability to push effectively, presumed fetal jeopardy or fetal distress. r
there is a risk of tissue trauma to mother and newborm

57
Q

pre requisites for vacuum or forcepts

A 
fully dilated cervix
ROM
engaged head
vertex position
no evidence of CPD
58
Q

TOL/ VBAC

A

trial of labor observation of a woman and her fetus for a specified length of time to assess the safety of vaginal birth
VBAC: vaginal birth after cesarean birth: indications for primary c section such as should dystocia, breech, or fetal distress are often non recurring, may be a candidate to attempt vaginal birth

59
Q

shoulder dystocia

A

the head is born, but the anterior shoulder cannot pass under the pubic arch. newborn is likely to experience birth injuries such as asphyxia, brachial plexus damage, and fracture
-mothers’ primary risk stems from excessive blood loss from uterin atony or rupture, laceration, an extension of episiotomy or endometritis

60
Q

nursing actions shoulder dystocia

A

stay calm and call for help
empty bladder
pull legs back towards chest (McRobert’s maneuver) or have them go on hands and knees
stand on a stool and give suprapubic pressure prn
no fundal pressure

61
Q

meconium stained amnitotic fluid

A

indicate that the fetus has passed the first stool before birth, this puts the infant at risk for meconium aspiration syndrome and requires the team skilled in neonatal resuscitation

62
Q

prolapse umbilical cord

A 
partial or total oclusion of cord with rapid fetal deterioration
contributions:
-long cord
-malpresentation
-transverse lie
-unengaged presenting part
-multiple gestations
63
Q

nursing actions for a prolapsed cord

A

call for assistance, glove hand and push up on presenting part to relieve pressure, knee to chest positon, or rolled towel under hips, do not attempt to replace cord into vagina or cervix, if it is protruding place under the warm saline towel. admin oxygen and start IV, monitor FHR and prepare for delivery

64
Q

rupture of uterus

A

cause: scared uterus as a result of previous c section
s/s: abnormal FHR tracing with sudden brady, low of fetal station, abdominal pain, shock
assessment: risk factors and onset of fetal distress
management prepare for a c section, and continue to monitor FHR and maternal HR

65
Q

amniotic fluid embolism

A

amniotic fluid contains particles of debris, acute onset of hypotension, hypoxia, cv collapsed and coagulopathy, maternal mortality is high and neonate outcome is poor
assessment: difficulty breathing, hypotension, cyanosis, seizure, tachy, coagulation failure, pulmonary edema, uterine atony and hemorrhage, cardiac arrest
management support measures to maintain oxygenation and hemodynamic function and to correct coagulopathy; crucial care monitoring.

NUR 318 (10 decks)

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