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maternal ob > Labor and Birth Management Ch 14 > Flashcards

Labor and Birth Management Ch 14 Flashcards

1
Q

What is the Amnio Hook used for?

A

A device to artificially rupture membranes and induce labor.

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2
Q

What are the abnormal findings of the amniotic fluid?

A

Blue, green, black fluid.

Indicates baby passed meconium in the utero - should not happen.

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3
Q

Indications for meconium in the amniotic fluid. (2)

A

Fetal hypoxia and fetal distress.

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4
Q

Normal duration of uterine contractions.

A

30-60 seconds.

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5
Q

What is the purpose of Leopold Maneuvers? Describe Maneuver 1, 2, 3, 4.

A

Method to determine presentation, position, and lie of the fetus.

M1: Where to find the head and buttocks in the fundus.
M2: Identify the fetal back.
M3: Presenting part.
M4: Indicate for engagement in pelvis.

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6
Q

What does the Electronic Fetal Monitor (EFM) assess?

A

Oxygenation and Heart Beat

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7
Q

How long should be the first FHR assessment upon entry into L&D area?

A

10-20 minutes.

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8
Q

Describe absent baseline variability?

A

The baby is dead.

Undetectable fluctuation range.

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9
Q

Minimal Variability

A

Baby is usually asleep, and/or the mother is on magnesium.

<5pm Fluc.Range

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10
Q

Moderate Variability

A

Baby is well oxygenated.

FR: 6-25 bpm.

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11
Q

What is the fluctuation range for marked variability?

A

> 25 bpm

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12
Q

What is umbilical cord analysis?

A

Samples are drawn from the umbilical cord to analyze acid-base levels of the newborn.

Normal pH: 7.2-7.3

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13
Q

What is fetal scalp stimulation? Outcome? Precaution (Vibroacoustic)? Contraindications (4)?

A

Evaluates fetal oxygenation and acid/base balance.

The réponse is active when the baby is well oxygenated. Fluctuation and accelerations are present in the EFM.

Precaution: Vibroacoustic stimulation may cause agitation on stomach.

Contraindication: Preterms, IU infection, placenta previa, fever.

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14
Q

List nonpharmacologic measures for pain management (7).

A
  • Continuous labor support
  • Hydrotherapy
  • Ambulation and position changes
    -Accupunture and acupressure
    Attention focusing and imagery
  • Effleurage
  • Breathing techniques
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15
Q

What is the epidural block used for during labor?

A

Provides pain relief from contractions and birth canal distention.

{local anesthetic and opioid into epidural space}

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16
Q

What is the pre-procedure nursing action for epidural block therapy?

A

Obtain consent from patient and administer bolus of IV fluid (PCA Pump)

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17
Q

Adverse effects of Epidural Block (4)

A

maternal hypotension

fetal bradycardia (decelerations: d/t bolus, IUR, ephedrine)

inability to sense need to void

loss of bearing down reflex

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18
Q

What is are nursing actions after epidural therapy (6)?

A

Assess for orthostatic hypotension

Administer IV vasopressor (ephedrine)

Place mother on side

provide oxygen

Assess bladder

Monitor for sensation

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19
Q

How often should the nurse assess BP for hypotension (a.e. of epidural block)?

A

5-10 minutes

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20
Q

Why should the nurse administer IV bolus (w/ PCA pump) before the epidural block procedure?

A

Decreased rusk for hypotension.

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21
Q

What is the combines spinal-epidural block analgesia used for?

A

Used to block pain transmissions with conflicting motor functions.

22
Q

Where to feel the effects of epidural block?

A

From the waist down.

23
Q

Where to feel the effects of spinal block?

A

Whole body.

24
Q

“Walking epidural”

A

Combined Spinal-Epidural Analgesia

25
Q

How often is the patient controlled epidural analgesia (PCA) bolus administered?

A

q10 minutes

26
Q

What is the Patient Controlled Epidural Analgesia (PCA) pump used for?

A

The PCA allows the patient to control dosage of the infused medication.

27
Q

When is local infiltration (anesthetic) used during labor (3)?

A

Before episoitx and suture of lacerations, and precipitous delivery.

28
Q

What body part does the pudendal nerve block anesthesia affect?

A

Lower vagina/ perineum

29
Q

Medications of pudendal nerve block (3)

A

Ropivacaine and bupivicane

30
Q

Indications for pudendal nerve block (3)

A

Stage 2 labor, epiostomy, operative vaginal birth

31
Q

Can the pudendal nerve block block pain from uterine contractions.

A

No.

32
Q

When can pudendal nerve block be administer before performing sutures?

A

10 minutes prior sutures.

33
Q

How long is spinal block effective?

A

1-3 hours

34
Q

Route of Spinal Block injection

A

subarachnoid space into spinal fluid

35
Q

Main indication for spinal block anesthesia (2)

A

SCHEDULED Cesarean and labor birth

36
Q

Complication of spinal block (2)

A

atony : uterus and bladder

h/a d/t CSF leakage at puncture site

maternal hypotension

37
Q

How to use a blood patch to treat CSF leakage?

A

Draw blood and inject med into area of leakage to coagulate the bleeding.

38
Q

What are the three medications used to while the patient is going through labor (vaginally and cesarean)? FDB

A

Fentanyl, Duramorph, Bupivacaine

39
Q

What does the epidural block have that the spinal block does not?

A

Epidural is controlled by the PCA pump.

CONTINUOUS pain medication.

40
Q

What is the main side effect of using spinal block? Intervention?

A

Pruritis; give antihistamine

41
Q

How long should patient be NPO before schedule anesthesia?

A

patient most be NPO 8 hours before scheduled C-section

42
Q

Routes of general anesthesia

A

IV and/or inhalation

43
Q

Indications for general anesthesia

A

emergency c-section or the woman cannot use regional anesthesia

44
Q

First degree Perineal Laceration

A

laceration that extends through the skin and vaginal mucous membrane

45
Q

Second degree perineal Laceration

A

Extends to the fascia and muscle

46
Q

Third degree perineal laceration

A

Extends to external anal sphincter

47
Q

Fourth degree perineal Laceration

A

Extends completely through the rectal mucosa, disrupting both the internal and external anal sphincters

48
Q

What are mother with third/fourth degree at risk for? (2)

A

Hemmorhage and constriction

49
Q

What laceration finding is reportable to HCP?

A

Painful BM (from 3&4 degree laceration)

First findings for 4th degree laceration

50
Q

Location of episiotomy suture lines.

A

Mediolateral (L or R) and Median (Midline)

51
Q

Indication for episiotomy (2).

A

Macrocephaly

Mother cannot push the baby out anymore (LGA)

maternal ob (12 decks)

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