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L/d Exam 2 > Week 6 Day 7 > Flashcards

Week 6 Day 7 Flashcards

1
Q

Pharmacological pain management conciderations

A

Any drug taken may affect fetus

Drugs may have effects in pregnancy that they do not have in a nonpregnant person

DRUGS CAN AFFECT THE COURSE AND LENGTH OF LABOR

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2
Q

Local anesthesia

A

Lidocaine (numbing) - given before episiotomy or when repairing a tear(sutures)

NO EFFECT ON THE FETUS

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3
Q

Epidural block

A

Used for both vaginal and c-sections
Injecting local anesthetic into epidural space
Small test does may be given before full dose to ensure placement
Pts sometimes feel contractions and not pain is normal

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4
Q

Wrong placement of epidural

A

Dizziness
Draw back and have blood return
Tongue numb
Only one side of the body numb

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5
Q

Episiotomy

A

Cutting the vaginal opening

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6
Q

Adverse effects of epidural

A 
Maternal low BP
Bladder distention (cannot feel the urge to pee)
Prolonged labor- slows down
Migration of the epidural catheter
Fever
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7
Q

Interventions for epidural block

A

Assisting during insertion (give support and help pt stay in position
Frequent vs
Urinary catheterizations
Help reposition
Make pt aware of contractions( may not feel them) and encourage pushing efforts
Observe for signs associated with catheter migration or adverse effects

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8
Q

Inhalants

A

Nitrous oxides is delivered by face mask in a 50% mixture with oxygen

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9
Q

What cocktail is in an epidural

A 
Bupivacaine
Levobupivacaine
Lidocaine
Combined with 
Morphine or fentanyl
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10
Q

Opioids- pts who dont want and epidural block

A 
Meperidine
Fentanyl
Butorphanol
Nalbuphine
ADMINISTER AT THE START OF A CONTRACTION TO DECREASE THE AMOUNT TRANSFERRED TO THE FETUS
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11
Q

Sedatives- rarely used

A

Barbiturates

Small dose may be given to promote rest in exhausted woman from false labor or a prolonged latent phase

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12
Q

Poor candidates for epidural

A

Woman with scoliosis or spine surgery

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13
Q

General anesthesia used on…

A

C-section pts that cannot get an epidural block

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14
Q

General anesthesia involves

A

LOC
Woman breaths O2 for 3-5 min or 4 deep breaths to increase her oxygen stores for the short period of apnea during anesthesia induction
Position to promote placental blood flow (use wedge to put pt slightly on her right side)
Pt will be intubated and monitored
Meds are administered IV

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15
Q

Causes of ineffective contractions (power)

A 
Fatigue
Maternal inactivity
Fluid and electrolyte imbalance
Low blood glucose
Excessive pain meds
Maternal response to stress or pain
Disproportion between the pelvis and the presenting part
Uterine distention
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16
Q

Hypotonic labor dysfunction

A

Weak contractions
Coordinated
Less frequent and shorter duration
Active phase after 4cm dilated

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17
Q

Management of hypotonic labor dysfunction

A

Amniotomy
Oxytocin administration
C-section might be needed if labor does not progress

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18
Q

Amniotomy

A

Artificially breaking of water

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19
Q

Hypertonic labor dysfunction

A

Contractions uncoordinated, unpredictable
Painful but ineffective
Usually occurs during latent phase
Uterus does not relax between contractions
Decreases fetal O2 supply
Woman has constant cramping pain

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20
Q

Management of hypertonic labor dysfunction

A

Pain management
Amniotomy if it occurs in active phase
Tocolytic drugs

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21
Q

Tocolytic drugs do what

A

Inhibit uterine contractions
Makes contractions weaker
Only used when contractions are strong but not affective

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22
Q

Macrosomia

A 
Big baby
Between 4000-4500g
May cause uterine overdistention- reducing strength of contractions
Usually need an episiotomy
C-section worse case scenerio
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23
Q

Shoulder dystocia

A

Requires immediate intervention b/c umbilical cord and chest is compressed

Unpredictable-can happen at any wt

Shoulders stuck in pubis after head is delivered

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24
Q

Intervention for shoulder dystocia

A

McRoberts maneuver- thighs/knees to belly/chest

Superpubic pressure- pressure like CPR at the pubis

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25
Q

Classic sign for shoulder dystocia

A

Turtle sign- head comes out but comes back in a little

26
Q

Abnormal fetal position

Can cause delay in fetal descent and other mechanisms of labor

A

Occiput posterior or occiput transverse is not preferred

Posterior position usually causes back pain in labor

Most OP position during early labor will rotate spontaneously to occiput anterior position

27
Q

What maternal position changes can help fetus get into OA position

A

Rocking pelvis while on hands and knees

Side-lying (epidural)

Lunges

Squatting

28
Q

When to use vacuum extractor or forceps

A

Baby position in OP position

29
Q

C-section

A

Transverse or breech positions

30
Q

Breech presentation

A

Cervical dilation and effacement are often slower
Head is delivered last causing cord compression
External version attempted to change baby’s presentation w/ manipulation (scheduled before labor occurs not during delivery
C-SECTION MOST COMMON

31
Q

Hypotonic dysfunctions main cause

A

Uterine over distention from multifetal pregnancy

32
Q

Multifetal vaginal delivery FHR

A

Each FHR is monitored separately

After the birth of the first baby, the FHR is still being monitored until its birth

33
Q

Twin c-section birth

A

1st twin- nonvertex position w/ 2nd twin- vertex position

Both twins- non vertex position

34
Q

Twin trail of labor

A

Both twins are in vertex position

1st twin is vertex position, 2nd twin is in nonvertex position

35
Q

Precipitate labor

A

Labor begins then the baby is born within 3hrs.

Pain meds are not usually an option

36
Q

Precipitate birth

A

Birth occurs so quickly the Dr. is NOT PRESENT

Pain meds are usually not an option

37
Q

Never do what during precipitate labor/birth

A

Close mothers legs to the fetal head help back!!! NEVER EVER DO THIS!!!

38
Q

Complications from a precipitate labor/birth

A

Fetal intracranial hemorrhage or nerve damage

Fetus may become hypoxia

39
Q

Premature ROM

A

Rupture of amniotic sac before the onset of true labor

40
Q

Risk factors for premature ROM

A 
Infections
Amniotic sac w/ weak structure
Chorioamnionitis
Previous preterm birth
Fetal abnormalities
Incompetent cervix
Overdistention of the uterus
Recent vaginal intercourse
41
Q

Complications of premature ROM

A

Preterm birth

Maternal and/or fetal infection

42
Q

Therapeutic management of premature ROM

A

Depends on gestation and presence of infection
Determine if true rupture of membrane
Determination of lung maturity may be needed
Labor induction or C-section

43
Q

What to do if premature ROM in preterm and ruled out induction or c-section

A

36 weeks & below
May stay inpatient until birth or receive 48 hrs of antibiotics then continue 5 days oral antibiotics at home
Avoid intercourse, orgasm, or breast stimulation
Check temp at least 4 times a day and report if greater than 100
Activity restriction
Report contractions or vaginal drainage with a foul odor

44
Q

Preterm labor

A

Labor between 20 - 36 weeks gestation

45
Q

Preterm risk factors

A 
Maternal UTI, diabetes, drug use, domestic violence episodes, smoking, obesity
IVF
MULTIFETAL- BIGGEST RISK FACTOR
Preterm ROM
Oligoamnios
Birth defects
Inadequate prenatal care
46
Q

Oligoamnios

A

Low amniotic fluid

47
Q

Chorioamnionitis

A

Bacteria infection inside the amniotic sac

48
Q

Preterm labor S/S

A 
Uterine contractions
Cramps 
Backache
Pelvic pressure
Pain, discomfort, or pressure in the vulva or thighs
Change or increase in vaginal discharge
49
Q

Interventions to delay/stop preterm labor

A

Activity restriction
Prevent dehydration
TOCOLYTIC medication
Corticosteroids

50
Q

Why do they give corticosteroids during preterm labor?

A

If gestation is before 34 weeks is given to the mother to mature fetal lung maturity.

Betamethasone
Dexamethasone
Serfacton

51
Q

Tocolytic medications

A

Inhibit uterine contractions(weakens them)
Magnesium sulfate: can make mom feel sick
Calcium antagonists:Nifedipine, Nicardipine
Prostanglandin synthesis inhibitors: Indomethacin
Beta- adrenergics: TERBUTALINE (usually 1st choice)

52
Q

Prolapsed cord

A

Feel pulse w/cervical exam or you can see the umbilical cord
Cord comes out before the baby
Usually occurs when the fit is poor between the fetal presenting part and the maternal pelvis when ROM occurs

53
Q

Risk factors for prolapsed cord

A 
Fetus that remains at a high station
A very small fetus
BREECH presentation 
Transverse LIE
Hydra NIPS
54
Q

S/S Of a PROLAPSED CORD

A

Umbilical cord presenting before head, visible at vaginal opening
Umbilical palpable
Changes in FHR: bradycardia or variable decelerations

55
Q

Prolapsed cord intervention

A

Move baby’s head not the cord!!!
Position moms hips higher than her head
Give oxygen 8-10 L by face mask
USUALLY HAVE A C-SECTION

56
Q

Uterine rupture

A

Rare-emergency

Tear in the uterine wall

57
Q

Uterine rupture s/s

A 
Labor stops (contractions stop)
Vaginal & internal bleeding
Abdominal pain/tenderness
Chest pain, pain in shoulder area
Hypovolemic shock
Absent fetal heart sound
Changes in FHR
Palpating of the fetus outside the uterus
58
Q

Uterine rupture interventions

A

Stabilize woman and fetus
Perform c-section delivery
Repair uterus or perform hysterectomy
Blood transfusion, if needed

59
Q

Uterine inversion

Very uncommon

A

Uterus completely or partly turns inside out

Placenta still attached to the uterine wall

60
Q

Uterine inversion s/s

A

Uterus doesn’t feel like its in the right place

The interior of the uterus is protruding from the vagina

Massive blood loss, shock, pelvic pain

61
Q

Signs a Dr should watch for before pulling the cord

A
  1. Umbilical cord leugthus
  2. Gush of blood
  3. Uterus feels firm/ globular
  4. Uterus rises to abdominal wall
62
Q

Uterine inversion intervention

A

Dr. Attempts to replace the uterus thru the vagina
Give tocolytic drugs
If that doesn’t work laparotomy w/replacement is performed
Hysterectomy last resort
After uterus is replaced, oxytocin is administered to contract the uterus and control blood loss
Several units of blood are usually needed for transfusion

L/d Exam 2 (2 decks)

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