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cnur 303 maternal services > FHS, Labor Support, Induction > Flashcards

FHS, Labor Support, Induction Flashcards

1
Q

What is Frequency?

A

How often contractions occur?
Normal: <= 5 contractions in 10 mins, and averaged over a 30 minute period
Tachysystole: [More] lack of uterine rest

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2
Q

What is Duration?

A

How long the contractions are
Normal: <90seconds
Tachysysole: [Longer] baby not oxygenated

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3
Q

What is Strength?

A

How strong the contractions are
Weak, Moderate, Strong

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4
Q

What is Resting tone?

A

Uterine Relaxation
Re-oxygenation for Fetus
Normal: >= 30 seconds

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5
Q

What is Tachysystole?
- Frequency, Duration, Resting Tone

A

Frequency: >5 in 10 mins
Duration: >90seconds
Resting Tone: <30 seconds

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6
Q

Benefits and Limitation EFM
- External, Internal

A

External:
- benefits: Less invasive
- limitations: with positioning, not assessing radial pulse

Internal:
- benefits: extremely accurate, can move around
- limitations: invasive, dilated, and ROM

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7
Q

[EFM] Acceleration?

A

Abrupt increase in FHR (Onset to peak <30 secs)
[Baseline] >= 15 bpm x >= 15 seconds
Increase strength of cardiac contractions
Can be reaction to stimuli
Is OK

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8
Q

[EFM] Early Deceleration?

A

Gradual (>= 30 s from baseline to nadir)
Mirror image of contraction
Fetal Head compression
Is Normal (consider clinical picture)

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9
Q

[EFM] Late Deceleration?

A

Gradual (>=30s from baseline to nadir)
Nadir at the end of contraction
Decreased Uteroplacental Blood flow & hypoxia
Can be associated with hypotension
Placenta getting old

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10
Q

[EFM] Variable Deceleration?

A

Abrupt (< 30s from baseline to nadir)[
[Baseline] 15bpm x >= 15s
Similar to Acceleration but flipped, U shaped
Altered umbilical blood flow/Cord compression
Left Lateral, reposition

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11
Q

[EFM] Variability?

A

Fluctuation in baseline
Indicates mature CNS, oxygenated brainstem, and intact medulla

Absent: no range
Minimal: <=5 bpm
Moderate: 6-25 bpm
Marked: >25bpm

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12
Q

What is a Non Stress Test?

A

Looking at Fetal Wellbeing
20 min strip
Need 2 accelerations in 20 minutes
If not, reposition, or give some sugar

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13
Q

What are the goals for Intrauterine Resuscitation?

A

Improve uterine blood flow

Improve Umbilical Circulation

Improve maternal oxygenation

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14
Q

What are the actions in Intrauterine Resuscitation?

A
  • Confirm FHR and MHR
  • Position Change (left, right, then all 4s)
  • Remove/Stop IOL
  • Modify or pause pushing
  • Maternal hydration
  • Vaginal Exam
  • Tocolysis
  • Supportive Care
  • Oxygen by mask
  • Communicate/Document
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15
Q

What are the reasons to induce?

A
  • Post Dates (41^3+)
  • PROM
  • Maternal Morbidity
  • Fetal distress/IUFD
  • Fetal Size
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16
Q

What are the reasons NOT to induce?

A
  • No consent
  • Not safe for delivery
  • Complications: SD, CPD, malposition
  • Placenta Previa
  • STI
  • Vertical Uterus Scar
17
Q

What are the risk to inductions?

A
  • Failure
  • Fetal distress
  • C/s
18
Q

What is mechanical induction?

A
  • At home methods (seduction. nipple stimulation)
  • Stripping membrane
  • AROM
  • Cervical Ripening Balloon (falls out = 100% effaced)
19
Q

What are the benefits to Cervidil?

A
  • Slow Release
  • Simple admin
  • Easy to remove (Fetal distress, hyper stimulation)
  • Easy monitoring
  • Hospital pass
  • Helps to ripen cervix
  • Up to 3 cervidil (up to 3 days)
20
Q

What is Oxytocin Induction?
- Pathos

A

Pathos:
- Similar to ADH
- Released from the pituitary gland
- Promotes smooth muscle contractions of myometrial cells of the uterus and myoepithelial cells of the breasts
- Uterine response to oxytocin dependent on estrogen

21
Q

What are the nursing consideration for Oxytocin Induction?

A
  • May skip early labor phase
  • Role: NST, admin/titration, education, monitoring (mat q30mins BP contractions, FHR q15mins with continuous EFM)
  • Increase risk for PPH d/t uterine fatigue
  • Continue in PP period
  • Monitor for s/s of PPH (change in v/s, bleeding, fundus)
  • Must obtain order to go over 20mu/min
22
Q

What is Oxygen Titration?

A

Start at 1mu/min and increase by 2 mu/min q30mins
Augmentation
TOLAC/VBAC
CST
8-12mu/min is usual
Ideally 5 contractions/10 mins

23
Q

What is the Nursing Role in Labor Support?

A
  • Safe environment
  • Communication
  • Empowerment
  • Promote maternal coping
  • Support mom&family
  • Educate
  • Reassure
  • Cultural Consideration
24
Q

What are the benefits of Labor Support?

A
  • Likely to have SVD
  • Shorter labors
  • Less likely to: Report neg feelings, use intrapartum analgesia, require OVD, have baby with low APGAR
25
Q

What are some non-pharmacological labor support methods?

A
  • Breathing
  • Massage Technique
  • Hydrotherapy
  • Hot vs Cold
  • Walking/moving
  • Imagery/visual/meditation
  • Birthing ball
26
Q

What are the advantage and disadvantage for using Nitrous Oxide?

A

Inhaled/Self-Admin
CNS Depressant
Advantage:
- Rapid effect,
- no effect on uterine activity,
- decrease effect on neonate

Disadvantage:
- Increase use = decrease effectiveness

27
Q

Morphine?
- Onset, duration, side effects?
- When is it most suitable?

A

Onset: 15 mins
Duration: 7 hours
Side Effects: N&V
Neonatal Consideration

Suitable for: Early Phase
b/c cross placenta barrier, so not too close to delivery

28
Q

Fentanyl?
- Onset, Duration, Side Effects?
- When is it most suitable?

A

Onset: 3-5 mins
Duration: <60 minutes
Side Effects: dizzy, loopy, tired
Neonatal Consideration

Suitable for: Later 1st Stage
b/c safer than morphine, baby will recover faster

29
Q

What is Lidocaine used for?

A

Local Anestheisia

  • Episiotomy
  • Perineum Repair
  • Pudendal Block: end of labor, no effect on fetus
30
Q

What are advantage and disadvantage of using Epidural?

A

Advantage:
- Safe for mom&baby
- Minimal side effects
- Effective
- Mobility

Disadvantage:
- hypotension = decreased fetal HR
- Wet tap (spinal headache)
- bladder dysfunction
- mobility/pushing
- Pruritus
- Failure
- Neurological Complications

31
Q

What are the nursing roles when administrating Epidural

A
  • Positioning for precedure
  • Support patient
  • Assist Anesthetist
  • Manage any hemodynamic concerns
  • Post Epidural Monitoring (v/s, FHR, dermatomes)
32
Q

What is Spinal Anesthesia?

A

Local Anesthesia into spinal canal
Commonly in c/s
Very quick onset and last up to 4 hours

33
Q

What is General Anesthesia?
- And Nursing Role

A
  • In emergency
  • Intubation may be difficult
  • Risk of Aspiration
  • Increase Pain po-op
  • Consider PCA

Nursing Role:
- Managing post op pain control
- Consider PCA
- Advocate for pain needs
- Educate patient and family

cnur 303 maternal services (9 decks)

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