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NUR 332 > Artificial Management of Labor > Flashcards

Artificial Management of Labor Flashcards

1
Q

induction

A

promotion of labor in a non laboring mother
- adv: labor in about 24-48 hrs
- dis: contractions less gradual, dysfunctional uterine contraction, inc blood discharge

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2
Q

what is a bishop score

A

the likelihood that a mom will deliver spontaneously
- the higher the score the better than chances

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3
Q

categories of bishop score

A

dilation
effacement
fetal station
cervical consistency
cervical position

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4
Q

what is an amniotomy

A

artificial rupture of the membrane
- use amnihook
- HCP or midwife

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5
Q

nursing intervention for amniotomy

A
  • FHR
  • date and time
  • clear, bloody, meconium
  • scant, moderate, copious
  • foul odor
  • start checking mom’s temp q 2 hours
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6
Q

types of induction

A

amniotomy
cervical ripening
stripping of membrane
pitocin

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7
Q

what is cervical ripening

A

mechanical induction that uses foley bulb

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8
Q

what is a foley bulb

A

balloon inserted into cervix that applies pressure
- pressure inc release of prostaglandins, which inc contractions and cramping

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9
Q

risks of cervical ripening

A
  • uterine hyperstimulation
  • non reassurring fetal states
  • higher incidence of post partum hemorrhage
  • uterine rupture
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10
Q

prostaglandin medications

A

cytotec
cervidil

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11
Q

cytotec (misoprostol)

A

given vaginally to stimulate contractions and thin cervix
- do start pit until 4 hours after (it will inc contractions)
- cant remove once placed

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12
Q

cervidil (dinoprostone)

A

given vaginally to stimulate contractions and to thin cervix
- bed rest for 2 hours
- pat dry after voiding
- remove by pulling strings

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13
Q

what is stripping of the membranes

A

separation of the amniotic membranes from the lower uterine segment which stimulates release of prostaglandins
- some bleeding
- OB, midwife, NP

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14
Q

administration of pit risks

A
  • uterine tachysystole
  • uterine rupture
  • water intoxication
  • non reassuring FHR
  • post partum hemorrhage
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15
Q

what can water intoxication occur with pit and how do you treat it

A

pit has similar affects to ADH to inc water retention which causes hypoNa
- treat by stopping med, admin NS, and give furosemide

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16
Q

what must be done before starting pit

A
  • reactive NST
  • vaginal exam
  • Bishop score
  • sometimes used with foley bulb so would need to place
  • titrate: inc 1-2 mu/30 mins
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17
Q

why are pit patients at risk for postpartum hemorrhage

A

uterus is overstimulated for so long that it stops reacting to the drug
- as a result the uterus doesnt contract anymore after birth and bleed

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18
Q

what a volutrol

A

allows for 2 hours of medication worth
- prevents bolus (bolus would cause constant contraction that would dec perfusion to the baby)

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19
Q

what is labor augmentation

A

stimulating labor that is naturally occurring
- have hypotonic contractions
- pitocin and AROM

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20
Q

what is an amnioinfusion

A

warmed NS or LR that is placed into uterus via IUPC
- fluid should still be leaking out of mother, if not SVE and lift baby’s head to release

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21
Q

why do you have an amnioinfusion

A
  • replacement of lost or absence amniotic fluid
  • repetitive variable decels with inc intensity (adding fluid prevents cord clamp)
  • meconium dilution
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22
Q

what is an episiotomy

A

surgical incision of the perneum to enlarge the vaginal outlet

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23
Q

types of episiotomy

A

midline: straight down
mediolateral: to side at an angle

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24
Q

what is forceps assisted birth used for

A
  • mother’s with heart disease
  • acute pulm edema or pulm compromise
  • intrapartum infection
  • prolonged second stage
  • exhaustion
  • non reassuring fetal strip
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25
Q

what are the types of forceps

A

mid forceps: fetal head engaged
low forceps: fetal head at 2+
outlet forceps: fetal head at perineum

26
Q

when do you use pull with forceps and vacuum

A

when the mother is contracting and pushing

27
Q

maternal risks when use forceps

A

lacerations
extension of episiotomy
anal sphincter injury
perineal edema

28
Q

neonatal risks when use forceps

A

bruising, edema
caput succedaneum or cephalhematoma
transient facial paralysis
cerebral hemorrhage
fractures
elevated bilirubin levels

29
Q

nursing management for forcep births

A
  • explain procedure
  • monitor contractions
  • push during contractions
  • document length of time forceps used
    *only used when indicated
30
Q

what is vacuum assisted birth

A

suction cup placed on fetal occiput
- pull when mom contracts and pushes
- fetus should descent with each contraction
- document : pressure applied, pressure off, vacuum off (time used)

31
Q

indications for a c/s

A
  • complete placenta previa
  • cephalopelvic disproportion
  • placental abruption
  • active genital herpes
  • cord prolapse
  • failure to progress
  • tumor obstructing birth canal
  • breech presentation
  • previous c/s
  • congenital abnormalities
  • bad fetal status
32
Q

types of c/s incisions

A

skin incision and muscle incisions are different
- skin: transverse (most common) and vertical
- muscle: low transverse, classical, low vertical

33
Q

which is the best c/s incision

A

low transverse
- classical and low vertical inc risk for rupture later

34
Q

nursing care before c/s

A
  • epidural
  • bolus
  • pepcid and reglan and bicitra (neutralizes stomach acid)
  • monitor VS
  • FHR
  • foley
  • prepare abdomen and perineum
  • all ppl and equipment
35
Q

nursing care during c/s

A
  • position: wedge to left tilt prior to delivery
  • instrument count
  • time out
  • document: incision, delivery of infant, APGARS, AROM, placenta extracted, EBL (est. blood loss), meds given
36
Q

what is supine hypotension and how to treat it

A

mom lays on back and baby squished vena cava
- place wedge on R hip to lie on L side

37
Q

nursing care after c/s

A
  • newborn care
  • VS 15 mins
  • surgical dressing
  • palpate fundus
  • check lochia
  • I and Os
  • admin oxy and pain meds
38
Q

what is a vbac

A

vaginal birth after c/s

39
Q

what is a tolac

A

trial of labor after c/s
- classified as this until the mom gives birth

40
Q

vbac qualifications

A
  • low transverse uterine incision
  • adequate pelvis
  • no other uterine scars or rupture
  • HCP and anesthesia
41
Q

referred pain

A

contractions felt else where in the body

42
Q

visceral pain

A

slow, dull, achy pain

43
Q

somatic pain

A

sharp and localized
- burning, tearing pain
- transition or push pain

44
Q

systemic analgesia

A

provides maximum pain relief at minimum risk for the mother or fetus
- all meds cross placental barrier
- fetal liver and kidneys can metabolize meds so only admin when necessary

45
Q

butorphanol tartrate

A

opioid
- onset 30-60
- mom: drowsiness, dizziness, fainting, hypotension
- fetus: resp depression

46
Q

nalbuphine hydrochloride

A

opioid
- onset 15-20mins
- mom: resp depression, drowsiness
- fetus: resp depression
- higher doses don’t indicate inc risk of depression
*dont give to women with substance abuse problems

47
Q

meperidine

A

opioid
- mom: resp depression, constipation, dizziness, itching
- fetus: neurobehavioral depression, resp acidosis
* not reversed by naloxone *

48
Q

fentanyl

A

short acting opiate
- IV immediate response
- IM 5-7 mins
- mom: hypotension, N, V, resp depression
- fetus: some neurobehavioral depression
* short half life and rapidly crosses placenta*

49
Q

naloxone

A

opioid reversal agent
- if mother had substance abuse problems, giving naloxone will inc risk for wdrawal seizures

50
Q

regional anesthesia

A

temporary and reversible loss of sensation
- prevent initiation and transmission of nerve impulses for pain control

51
Q

disadvantages or epidural

A
  • maternal hypotension
  • post delivery back pain
  • meningitis
  • cardiac arrest
  • vertigo
52
Q

difference between epidural and spinal anesthesia

A

epidural is constant medication into epidural space while spinal anesthesia is an injection and no catheter remains

53
Q

nursing management prior to epidural

A
  • maternal and fetal status
  • assess labor process
  • IV with warmed LR
  • get into position
54
Q

what position does a woman need to be in for an epidural

A
  • chin to chest to round out back
  • nurse should put hands on shoulder in support
55
Q

what is the biggest thing you need to assess for after an epidural

A

bp for hypotension

56
Q

how do you correct hypotension post epidural

A
  • fluid bolus
  • ephedrine will inc BP
  • oxygen non rebreather
57
Q

pudendal block

A

perineal anesthesia used during second stage of labor and episiotomy repair

58
Q

advantages of pudendal block

A

ease of administration (to access nerve)
absence of maternal hypotension

59
Q

disadvantage of pudendal block

A

urge to bear down may be decreased
- will need to push longer

60
Q

general anesthesia

A

emergent deliveries
low platelet count
scheduled c/s delivery and unable to place spinal (scoliosis)

61
Q

cricoid pressure

A

diminished chance of aspiration during placement of endotracheal tube for general anesthesia
- press on cartilage to close until anesthesia tells you to lift

62
Q

potential problems with anesthesia

A
  • fetal resp depression
  • sore throat
  • higher risk of aspiration
  • inc risk of postpartum hemorrhage
  • less feeling of control
  • everyone misses birth

NUR 332 (3 decks)

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