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OB/GYN > Ch 32 Labor and Birth Complications > Flashcards

Ch 32 Labor and Birth Complications Flashcards

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1
Q

When does PROM occur?

A

Before 37 weeks gestation

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2
Q

What does PROM care focus on?

A

Prevention of infection

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3
Q

How do nurses prevent infection in patients with PROM?

A

Limit vaginal exams
Change bed pads frequently
Monitor fetus

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4
Q

What are 4 PROM complications?

A

Infection
Abruption
Retained placenta
maternal sepsis and death

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5
Q

What types on infection are mothers with PROM at risk for?

A

Chorioamnionitis

Endometritis

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6
Q

What are the fetal risks of PROM? (10)

A 
Respiratory distress syndrome (RDS)
Intraventricular Hemorrhage (IVH)
Necrotizing enterocolitis (NEC)
Fetal sepsis
Malpresentation
Cord prolapse
Non-reassuring FHT 
Umbilical cord compression related to oligohydramnios
Premature birth
morbidity and mortality
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7
Q

What are the fetal risks of PROM in babies that are 36 or less weeks?

A

Respiratory distress syndrome (RDS)
Intraventricular Hemorrhage (IVH)
Necrotizing enterocolitis (NEC)
Fetal sepsis

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8
Q

Why does PROM cause fetal sepsis in babies less than 36 weeks?

A

Ascending pathogens

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9
Q

concerning PROM, the earlier the gestational age…

A

the more complications

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10
Q

What labs would you draw on a patient with PROM?

A

CBC
CRP
UA
GBS

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11
Q

A patient with PROM will be hospitalized on __ __

A

bed rest

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12
Q

What tools will be used to assess the baby in a mother with PROM?

A

Ultrasound

NST

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13
Q

What should the nurse monitor in PROM concerning infection?

A

Fluid changes…

  • amount
  • color
  • odor
  • consistency
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14
Q

In a patient with PROM, what should stop?

A

Vaginal exams unless indicated (usually done by HCP)

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15
Q

What weeks is magnesium sulfate given?

A

23 6/7 - 31 6/7

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16
Q

Why is magnesium sulfate given to a mother who has PROM?

A

For neural protection, to decrease cerebral palsy

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17
Q

What steroid might be given to a mother who has PROM?

A

Maternal corticosteroid administration for fetal lung maturation

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18
Q

If a patient has PROM, what should the nurse do for her?

A

Answer questions and anticipate birth

Provide psychological support for patient and family

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19
Q

How common is multiple gestation?

A

33.4 per 1000 births

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20
Q

What race has the highest incidence of multiple gestations?

A

African Americans

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21
Q

What are risk factors for multiple gestation?

A

Increased age
Higher parity
Family history of fraternal twins
Women who are tall and overweight

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22
Q

What are fraternal twins called?

A

Dizygotic

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23
Q

Dizygotic twins have…

A

two eggs and two sperm

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24
Q

What are identical twins called?

A

Monozygotic

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25
Monozygotic twins have...
one egg and one sperm
26
How common are identical twins?
4 in every 1000 births
27
What are maternal complications of having multiple gestation?
``` UTI Threatened AB Anemia Gestational hypertension Preeclampsia/Eclampsia PROM Thromboembolism Placenta previa Placental abruption Placental disorders PTL and PTB ```
28
What are fetal/neonatal complications of multiple gestation?
``` Higher mortality rate IUGR Higher incidence of fetal anomalies Prematurity Abnormal presentations Cord accidents Cerebral palsy ```
29
What should the nurse do for a patient hospitalized with multiple gestation?
``` Monitor for complications FHR monitoring Prepare for birth, possible c section Advise neonatal staff Get additional staff Baby A, Baby B, Baby C ```
30
How many calories a day should a mother with multiple gestation consume?
3500 a day
31
How much should the mother consume concerning prenatal vitamins?
PNV daily | Additional 1-4mg folic acid daily
32
What should the nurse teach a mother who is having multiple gestation?
Frequent rest periods Side-lying resting position Body mechanics while lifting Comfort measures: comfort rocking, good posture, pregnancy belt
33
How much amniotic fluid is considered normal?
500 mL
34
What are symptoms of polyhydramnios?
Shortness of breath | Edema in the legs
35
What are complications mothers are at risk for with polyhydramnios?
C section Uterine dysfunction Placental abruption Postpartum hemorrhage
36
What are fetal complications for a mother with polyhydramnios?
``` Malformations Preterm birth Increased mortality rate Prolapsed cord Malpresentation ```
37
What is polyhydramnios?
Too much amniotic fluid around the baby
38
What is oligohydramnios?
Too little amniotic fluid around the baby
39
What are maternal complications with oligohydramnios?
Dysfunction labor with slow progress | Hypertensive disorders
40
What are fetal deformation defects with oligohydramnios?
``` Ahesions Skin and skeletal Pulmonary hypoplasia Umbilical cord compression Head compression ```
41
What conditions can cause polyhydramnios?
Diabetes Rh sensitization Malformations of fetal swallowing
42
What are the major malformations of oligohydramnios?
Renal agenesis Dysplastic kidneys Lower urinary tract obstructive lesions
43
What is a major malformation of polyhydramnios?
Malformation of fetal swallowing
44
If a mother has polyhydramnios and a fetal defect has been identified, what should the nurse do?
Consult with social services
45
What is the nursing care for a mother with polyhydramnios?
Provide information and extra support Maintain sterility during amniocentesis Monitor FHR during procedure
46
What reading on the monitor should the nurse notify the HCP if the mother. has oligohydramnios?
Variable decelerations (cord compression)
47
What should the nurse be looking for on the monitor for a patient who has oligohydramnios?
Variable decelerations | Non-reassuring fetal status
48
What are nursing care of patients with oligohydramnios?
Provide information and encourage questions Evaluate FHR monitor Reposition mother to relieve cord compression
49
What should the nurse assess on a baby whose mother had oligohydramnios?
Anomalies Pulmonary hypoplasia Post-maturity
50
What are the types of dysfunctional labor?
Prolonged labor Tachysystolic labor Hypotonic labor
51
What is tachysystolic labor?
Uterine contractions greater than 6 in 10 mins, lasting longer than 2 mins, OR resting tone increases
52
What are the maternal risks for tachysystolic labor?
``` Uterine muscle cell anoxia Fatigue Stress and poor coping Dehydration Infection Prolonged labor ```
53
What are the fetal/neonatal risks of tachysystolic labor?
non-reassuring fetal status | Prolonged pressure on the fetal head
54
What can prolonged pressure on the fetal head (due to tachysystolic labor) cause?
Cephalohematoma Caput succedaneum Excessive molding
55
What causes the non-reassuring fetal status during tachysystolic labor?
increased uterine tone interferes with uteroplacental exchange
56
What is the major cause of tachysystolic labor?
Pitocin administration (induction/augmentation)
57
What is the first thing the nurse should do if a patient has tachysystolic labor?
Stop Pitocin if infusing
58
What drug will the nurse administer to a patient who is tachysystolic labor?
terbutaline sulfate
59
What does terbutaline sulfate do?
Relaxes uterine smooth muscle
60
What is the MOA of terbutaline sulfate?
Selective B2 agonist
61
What are the nursing implications of a patient in tachysystolic labor?
``` Stop Pitocin Rest Terbutaline sulfate monitor fatiuge Monitor FHR and contractions Provide information and support ```
62
What type of questions might a patient with tachysystolic labor have?
Cause Implications Treatment
63
What are institute supportive measures for tachysystolic labor?
``` Position changes with pillow Quiet soothing environment Touch/massage ygeine Hydrotherapy Sedation Relaxation Visualization Music ```
64
What are risks for hypotonic labor?
``` Maternal exhaustion Stress and poor coping Prolonged labor postpartum hemorrhage from insufficient uterine contractions following birth Intrauterine infection ```
65
What are potential complications for the fetus during hypotonic labor?
Non-reassuring fetal status due to prolonged labor | Fetal sepsis
66
Why can prolonged labor cause fetal sepsis?
Pathogens ascending
67
What should the nurse be monitoring in a patient with hypotonic labor?
Vital signs FHR Contractions I&Os
68
What should the nurse be assessing in a patient with hypotonic contractions?
Amniotic fluid for meconium Bladder for distention Signs of infection
69
What is nursing care for a patient with hypotonic contractions?
``` Encourage voiding every 2 hrs Catheterize as needed with regional block decrease vaginal exams (infection) Start Pitocin per HCP Emotional support Supportive measures ```
70
What is a regional block?
Also called nerve block, consists of infiltrating a peripheral nerve and blocking transmission
71
What are supportive measures for a patient with hypotonic labor?
``` Ambulation Position changes Quiet, soothing environment Touch/massage Personal Hygiene ```
72
What is precipitous labor?
Labor lasting less than 3 hrs resulting in rapid birth
73
What are contributing factors to precipitous labor?
``` Multiparty Large pelvis Previous precipitous labor Small fetus Recent cocaine use ```
74
What are maternal implications of precipitous labor?
Loss of coping Lacerations due to rapid decent Postpartum hemorrhage
75
Why does precipitous labor cause postpartum hemorrhage?
Undetected lacerations | Uterine atony
76
What are the fetal implications of precipitous labor?
Non-reassuring fetal status or hypoxia Cerebral trauma from rapid decent Pneumothorax Branchial plexus injuries
77
Why can precipitous labor cause fetal hypoxia?
Decreased uteroplacental circulation due to intense uterine contractions
78
Who is at risk for precipitous labor?
Accelerated cervix dilation | Intense uterine contractions with little relaxation in between
79
What should a nurse do for a patient with/at risk for precipitous labor?
``` Monitor closely if previous history Have precipitous pack available/prepare Stay in the patients room Supportive, quiet environment Monitor Pitocin ```
80
What should the nurse do if a patient with precipitous labor become tachysystolic?
``` discontinue Pitocin give terbutaline Turn to left side Administer O2 Watch FHR for abnormal ```
81
What is a prolonged pregnancy?
294 days or 42 weeks past the first day of LMP
82
Extremely preterm baby:
at or before 25 weeks
83
Very preterm baby:
at less than 32 weeks
84
Moderatley preterm baby:
between 32 and 34 weeks
85
Late preterm baby:
34-36 6/7 weeks
86
Full term baby:
39-40 6/7 weeks
87
Post-term baby:
Beyond 42 weeks
88
What are risks for the mother of a post-term pregnancy?
``` Probable labor induction Large for gestational age infant Forceps/vacuum assisted birth or c section Psychologic stress Infection ```
89
What are the risk factors for post-term pregnancy?
Primigravidas History of prolonged pregnancy Fetal anencephaly or placental sulfatase deficiency
90
What is primigravida?
A woman who is pregnant for the first time
91
What is anencephaly?
A baby born without parts of the brain or skull
92
What is placental sulfatase insufficiency?
genetic disorder of metabolism
93
What are the risks for the infant with post-term pregnancy?
``` Decreased placental perfusion Oligohydramnios Meconium aspiration Low 5 min APGAR Dysmaturity syndrome or LGA ```
94
What does oligohydramnios cause a baby that is post-term pregnancy?
At risk for cord compression and possible meconium aspiration
95
What will a baby born post-term look like?
``` Dry peeling skin Little old men look minimal lanugo or vernix Deep creases on feet Prominent nipple and breast tissue ```
96
What is lanugo?
Fine soft hair that covers the baby's body
97
What is vernix?
White, waxy substance found coating the skin of the newborn
98
What is community care of the patient that is post-term pregnancy?
Education | Fetal kick counts
99
When a post-term pregnant patient comes into the hospital, when should they deliver?
induce at 41 weeks or continue with expectant management (NST or Biophysical profile)
100
What should the nurse do for the patient who is post-term pregnant in the hospital?
``` FHR monitoring Leopold maneuver Assess labor progression Coping strategies Comfort measures ```
101
What is the nurse looking for on the FHR monitor with a patient who is post-term pregnant?
Variable decelerations
102
Why would the nurse do the Leopold's maneuver for a post-term pregnant patient?
Estimate fetal size
103
What is the nurse monitoring for when assessing labor progression in a patient who is post-term pregnant?
Failure to descend (large gestational age)
104
What is the most common malposition?
Occiput posterior position
105
Why does malposition occur?
Occurs due to fetus not rotating
106
Malposition is most common in an __ pelvis
android
107
What are the s/s of malposition?
``` Intense back pain Dysfunctional labor Hypotonic labor Arrest of dilation Arrest of fetal descent FHR head far laterally on abdomen Wide, diamond-shape fontanelle in anterior portion of pelvis ```
108
What could cause a patient to need a c section due to malposition?
Cephalopelvic disproportion (CPD)
109
What is cephalopelvis disproportion?
Large baby or in difficult position, or too small for mother's pelvis to pass
110
What complications may arise from a forceps or vacuum assisted birth?
Lacerations | Episiotomy
111
What is an episiotomy?
A surgical cute made at the opening of the vagina during childbirth to aid in delivery and preventer rupture of tissues
112
What is molding?
In a head first delivery, the pressure of the vagina may distort the shape of the baby's head
113
What are complications of malposition?
``` Prolonged labor C section Lacerations/episiotomy Cephalohematoma Modling Edema and bruising of the face ```
114
What are maternal position changes that can be used in malposition?
Knee to chest Side to side Pelvic rocking Support and coping mechanisms
115
Describe a breech frank presentation
Flexion at top of thighs, knees extended Feet up by head Buttocks present
116
Describe a breech complete presentation
Thighs AND knees flexed Feet and buttocks present Sort of looks like criss cross apple sauce
117
Describe footling breech presentation
Thighs and knees both extended Foot or both feet present Baby more straight
118
Describe kneeling breech presentation
Thighs extended, knees flexed | Knees present
119
What is an external cephalic version?
procedure to try to move your baby if they are in a breech position to the head-down position.
120
What are contraindications to external cephalic version?
``` Preeclampsia, 3rd trimester bleeding Rupture of membranes Oligohydramnios Previous uterine surgery Multiple gestation Non-reassuring NST IUGR Nuchal cord ```
121
Can a preeclamptic patient have an external cephalic version?
no
122
What is the criteria a patient must meet to have an external cephalic version?
36 weeks or greater Reactive NST Breech is not engaged
123
What maternal conditions are associated with breech presentation?
``` Preterm birth Placenta previa Hydramnios Multiple gestation Uterine anomalies (bicoruate uterus)= ```
124
What fetal conditions are associated with breech presentation?
Anenchaly | Hydrocephaly
125
What is the main risk of breech presentation?
Increased risk of prolapsed cord
126
What are the additional risks of breech presentation?
``` Increased perinatal morbidity and mortality Cervical spinal cord injuries Birth trauma (especially head) Asphyxia Non-reassuring fetal status ```
127
Why does a breech position cause an increased risk of cervical spinal cord injuries?
Hyperextension of fetal head during vaginal birth
128
What should a nurse assess on the fetal monitor during an umbilical cord prolapse?
Non-reassuring fetal status | Decelerations (variables)
129
How long should a nurse assess the fetal monitor during an umbilical cord prolapse?
At least a full minute after rupture of membranes for several contractions
130
What happens if a loop of cord is discovered?
Examiner's gloved fingers must remain in vagina to provide firm pressure on fetal head until birth
131
When a patient has a prolapsed umbilical cord, what are the indicated nursing care?
``` Oxygen via face mask 10l/min Monitor FHR Knee to chest position trendelenburg Transport to delivery or OR room in trendelenburg ```
132
When is an external cephalic version performed?
36-38 weeks
133
What happens if the external cephalic version is unsuccessful?
C section
134
The potential for prolapsed cord is associated with which type of breech?
Footling because increased space
135
If multiple gestation and breech, labor may be
double step up
136
What is fetal macrosomia?
Newborn weighing more than 4500 g
137
How is fetal macrosomia identified?
Palpation of fetus in utero (Leopold's maneuver) Ultrasound of fetus X-ray pelvimetry
138
Fetal macrosomia is associated with what conditions?
``` Obesity DM Prior history of macrosomia Male fetus Grand multiparous Prolonged gestation Hispanic background ```
139
What are maternal risks for macrosomia?
Cephalopelvic disproportion (CPD) Prolonged labor Lacerations Postpartum hemorrhage
140
What type of lacerations is macrosomia associated with?
Third and fourth degree lacerations or extension of episiotomies
141
What are the additional fetal risks of macrosomia?
``` Meconium aspiration Asphyxia Hypoglycemia Polycythemia Hyperbilirubinemaia ```
142
What are the three main fetal risks of macrosomia?
Shoulder dystocia Upper brachial plexus injury Fractured clavicle
143
What are the concerns with fetal macrosomnia?
Early decelerations Lack of fetal decent Labor dysfunction Non-reassuring fetal status
144
What is a possible fetal complication of macrosomnia?
Shoulder dystocia
145
What is the nursing care for fetal macrosomnia?
Fundal massage after birth to prevent hemorrhage from over-distended uterus Close monitoring of vital signs IV Pitocin
146
What is anaphylactoid syndrome of pregnancy?
Small tear in the amnion or chorion high in the uterus, small amount of amniotic fluid gets in there and enters the maternal system as an amniotic fluid embolism
147
What are the signs/symptoms to look out for, for anaphylactoid syndrome of pregnancy?
``` Dyspnea Cyanosis Frothy Sputum Chest pain Tachycardia Hypotension Mental confusion Massive hemorrhage ```
148
What are complications of anaphylactoid syndrome of pregnancy?
``` Sudden onset respiratory distress Acute hemorrhage Circulatory collapse Cor pulmonale Hemorrhagic shock Coma/death Fetal death if birth not immediate ```
149
What is the nursing care for a patient with anaphylactoid syndrome of pregnancy?
``` Get emergency response team Positive pressure O2 Large bore IV CPR if needed Prepare for c section Prep for CVP line insertion Administer blood Family support ```
150
What is cephalopelvic disproportion?
CPD - occurs when fetus is larger than pelvic diameter.
151
What is used to determine CPD?
Clinical and x ray pelvimetry used to determine smallest diameter through which fetal head must pass
152
CPD: What is the shortest AP diameter?
<10cm
153
CPD diagonal conjugate
<11.5 cm
154
CPD greatest transverse diameter
<12 cm
155
CPD: what determines that the pelvis is contracted?
Shortest AP diameter: <10cm Diagonal conjugate: <11.5 cm Greatest transverse diameter: <12 cm
156
Labor is usually __ in the presence of CPD
prolonged
157
Is vaginal birth possible foe CPD?
Yes, depends on type of CPD
158
What should the nurse suspect for a patient with CPD?
Cervical dilation and effacement slow Delayed engagement, lack of descent Head is not well applied to cervix Labor prolonged
159
What should the nurse assess for a patient with CPD?
Adequacy of pelvis | FHR monitor
160
What should a nurse do for patient with CPD?
Frequent position changes - sitting, squatting, rolling from side to side, knee to chest ``` Frequent vaginal exams Keep partner informed Explain procedures Support measures Prepare c section ```
161
What is retained placenta?
Retention of placenta beyond 30 minutes after birth
162
How frequent is retained placenta?
1-2% of vaginal births
163
If the uterus does not expel, what should happen?
Manual removal from uterus
164
What happens if the provider is unable to remove the placenta manually?
Curettage
165
What happens if curettage is not successful in removing the placenta from the uterus?
Hysterectomy
166
What is the nursing care during a hysterectomy?
Prep for surgery Monitor blood loss Monitor vital signs Emotional support
167
When is an amniotomy used?
Induce or augment labor Apply fetal or contraction monitors Assess color and composition of amniotic fluid
168
What is the nursing care during an amniotomy?
``` Pad bed Assess fetal presentation, position, and station Position patient FHR monitor Note color, amount, odor, any blood or meconium Cleanse and dry perineal area Decrease # cervical exams Reassure patient ```
169
When is a ROM performed?
Only when the head is at zero station
170
What is an amnioinfusion?
Instilling saline into the amniotic cavity using an intrauterine catheter
171
What type of fluid is used during an amnioinfusion?
Warmed normal saline or lactated ringers
172
How is the fluid during an amnioinfusion instilled?
Through pump or intrauterine pressure catheter (IUPC)
173
What should the nurse monitor for during an amnioinfusion?
Meconium that will be thin and clear | Variable decelerations - the amnio should cushion the cord
174
What are three methods of induction?
Stripping of the membranes Cervical ripening Pitocin induction
175
What are complementary methods of induction?
Sex Nipple/breast stimulation Herbal use Mechanical dilation of cervix with balloon catheters
176
How does intercourse stimulation induction?
Prostaglandin in semen, female orgasm stimulates uterine contractions
177
How does breast/nipple stimulation cause induction?
Endogenous oxytocin release
178
Which complementary method should the nurse not participate in?
Intercourse and nipple/breast stimulation
179
Which complementary method is not supported by research?
Herbal use
180
What is the mechanical method of stripping of membranes?
Gloved finger inserted into internal os and rotated 360 degrees twice: separating amniotic membranes lying against lower uterine segment
181
Where is stripping of membranes done?
Typically as outpatient service and does not require fetal monitoring
182
What are some disadvantages of stripping of membranes?
May not induce labor | May cause bleeding and cramping
183
What are indications for induction of labor?
``` DM Non-reassuring antepartum testing Preeclampsia or eclampsia PROM Chorioamnionitis Post-term (especially with oligohydramnios) IUFD IUGR Alloimmunization ```
184
What is IUFD?
Intrauterine fetal demise
185
What is alloimmunization?
Induction of immunity in response to foreign antigens encountered through exposure to cells or tissues from a genetically different member of the same species
186
What can cause alloimmunization?
Blood transfusions
187
What are contraindications to induction?
``` Client refusal Placenta previa Floating fetal presenting part Prior uterine incision that could preclude a TOL (trial of labor) Active genital herpes Prolapsed umbilical cord Acute, severe non-reassuring fetal status Absolute CPD ```
188
What is the ACOG recommendation for inductions?
Inductions prior to 39 weeks should be avoided whenever possible due to fetal maturity issues
189
What score on the bishop chart is favorable to induction?
8 or greater
190
Should a patient with a known sensitivity have cervical ripening?
No
191
Should a patient with a non-reassuring FHT have cervical ripening?
No
192
Should a patient with unexplained bleeding during pregnancy have cervical ripening?
No
193
Should a patient with a suspected CPD have cervical ripening?
No
194
Should a patient with current Pitocin running have cervical ripening?
No
195
Should a patient with a suspicion that they shouldn't have a vaginal birth have cervical ripening?
No
196
Should a patient with a history of c section have cervical ripening?
No
197
Should a patient with uterine scarring have cervical ripening?
No
198
Should a patient with a history of uterine rupture have cervical ripening?
No
199
What three conditions should be a caution for cervical ripening?
History of asthma or glaucoma Rupture of membranes Breech presentation
200
What medication is given to induce cervical ripening?
Cervidil
201
What is the generic name of cervidil?
dinoprostone
202
When should cervidil be given?
When induction is indicated but not emergent
203
Where is cervidil given?
Its administered inpatient
204
What should the nurse do when giving cervidil?
Monitor FHR for at least 2 hours after giving
205
What should the nurse do if hyperstimulation or non-reassuring FHT occur after giving cervidil?
Remove insert and give terbutaline for hyperstimulation
206
What is the generic name of cytotec?
Misoprostol
207
What is the brand name of misoprostol?
Cytotec
208
Should a patient with indicated induction receive cytotec in the 2nd trimester?
No
209
Should a patient with indicated induction receive cytotec in the 3rd trimester?
Yes
210
What is the initial dose of cytotec?
25 mcg, which is 1/4 of a tablet
211
How frequent should the nurse give cytotec?
No more than every 3-6 hrs
212
When can Pitocin be administered after cytotec?
4 hours from last dose of cytotec
213
What are nursing care for patients who received cytotec inpatient?
Continuous FHR monitoring | Have terbutaline available
214
A patient is having contractions 3 in every 10 mins, can she have cytotec?
NO
215
What is a major absolute contraindication of cytotec?
Significant maternal history of asthma
216
What readings on the FHT would contraindicate cytotec?
fetal tachycardia
217
If a woman has bleeding during pregnancy, can cytotec be used?
NO
218
What obstetrical history would contraindicate the use of cytotec?
Placenta previa Prior c section Uterine scar
219
What vaginal assessment finding by the nurse would contraindicated cytotec?
Meconium passage
220
What happens if the mother becomes hyper sensitized to Pitocin?
Decreased placental perfusion and non-reassuring fetal status
221
What should a nurse consider when titrating Pitocin?
Facility protocol Clinician order Individual situation Maternal-fetal response
222
When Pitocin is infusion, the nurse should palpate the uterus except when...
IUPC is in place
223
What should be noted about Pitocin and blood pressure?
It may initially DECREASE blood pressure
224
Pitocin is still given after birth to...
decrease bleeding
225
A patient with preeclampsia needs to progress in labor, can the nurse give her pitocin?
NO
226
A patient that needs to progress in labor has a predisposition to uterine rupture, can she have Pitocin?
NO
227
A patient that needs to progress in labor has CPD, can she have Pitocin?
NO
228
A patient that needs to progress in labor has malpresentation or malposition of the fetus, can Pitocin be administered?
NO
229
A patient that needs to progress in labor shows a cord prolapse, can she have Pitocin?
NO
230
A patient that needs to progress in labor has a history of multiple cesarean sections, can Pitocin be administered?
NO
231
A patient that needs to progress in labor is preterm, can Pitocin be used?
NO
232
A patient that needs to progress in labor has a rigid, not ripe cervix. Can Pitocin be used?
NO
233
A patient that needs to progress in labor has a total placental previa. Can Pitocin be used?
NO
234
A patient that needs to progress in labor shows non-reassuring status on the FHR monitor. Can the nurse administer Pitocin?
NO
235
What are the four things the nurse should ASSESS for after administering Pitocin for induction/augmentation?
Continiour FHR monitoring I&Os Vital signs and pain level Cervical exams
236
How often should the nurse assess vital signs and pain when administering Pitocin?
With every increase of Pitocin
237
What is the nurse watching for when assessing the FHR monitor after administering Pitocin for induction?
Baseline, variability, periodic changes (accelereations/delecelerations) Uterine contractions frequency, duration, and strength
238
If after administering Pitocin for induction, the patient begins to have abnormal FHR monitor readings, what should the nurse do next?
Discontinue the Pitocin
239
What should the nurse teach the patient when administering pitocin for induction of labor?
Purpose of procedure Procedure details Breathing and relaxation techniques Comfort measures
240
What factors can predispose women to an episiotomy?
Lithotomy and other recumbent positions Sustained breath holding during second stage of labor Arbitarty time limit place by physical during second stage of labor Macrosomic fetus, OP position, shoulder dystocia, forces/vacuum assisted birth
241
How does sustained breath holding during the second stage of labor predispose the patient to episiotomies?
Causes excessive and rapid perineal stretching
242
How can a side-lying position prevent the need for an episiotomy?
Slows bath, diminishes tears
243
Why should there be gradual expulsion on infant be used?
To prevent need for episiotomy
244
What are 4 tips during labor that can be used to prevent the need for an episiotomy?
Perineal massage during pregnancy for nullips Natural positioning during labor Warm compresses on perineal and firm counter pressure Avoidance of immediate pushing after epidural placement
245
What position should be avoiding to prevent the need for an episiotomy?
Lithotomy or pulling back on legs
246
What is another name for a forceps-assisted birth?
Instrument or operative vaginal birth
247
What are the 3 types of forceps-assisted birth?
Outlet Low midforceps
248
When is an outlet forceps-assisted birth used?
Applied when fetal skull has reached perineum, fetal scalp is visible, and sagittal suture is not more than 45 degrees from midline
249
When is a low forceps assisted birth used?
Applied when leading edge (presenting part) of fetal skull is at station of 2+ of more
250
When is a mid forceps assisted birth used?
Applied when fetal head is engaged
251
When is the fetus considered to be engaged?
at zero station
252
A patient is struggling with birth, she also has heart disease, can she have a forceps assisted birth?
YES
253
A patient is struggling with birth, she also has pulmonary edema, can she have a forceps assisted birth?
YES
254
A patient who has in infection is struggling with birth, can she have a forceps assisted birth?
YES
255
A patient suffering from maternal exhaustion is struggling with birth. Can she have a forceps assisted birth?
YES
256
A patient on the FHR monitor is showing non-reassuring fetal status. Can she have a forceps assisted birth?
YES
257
A patient with premature placental separation is struggling with birth. Can she have a forceps assisted birth?
YES
258
A patient is having a prolonged second stage of labor. Can she have a forceps assisted birth?
YES
259
A patient received a heavy regional block and is having ineffective pushing. Can she have a forceps assisted birth?
YES
260
What are the maternal risks associated with forcep assisted deliveries?
``` Laceration of birth canal Extension of midline episiotomy into anus Increased bleeding Brusing Infection PP hemorrhage Perineal edema Anal incontinence ```
261
What are the FETAL risks associated with forceps assisted deliveries?
``` Bruising and edema Facial lacerations Brachial plexus Caput succedaneium Cephalohematomas Transient facial paralysis Cerebral hemorrhage Fractures Brain damage Fetal death ```
262
What can a cephalohematoma cause in a newborn?
Subsequent hyperbilirubinema
263
What is the nursing care for a forceps delivered birth?
``` Explain procedure Assure adequate anesthesia in place Breathing techniques during application of forceps Continuous FHR monitoring Instruct patient to push with UC Assessment of mom and baby after birth ```
264
What does a forceps assisted birth look like?
Rn instructs patient to push with uterine contractions, physician applies downward, outward for on forceps
265
How does a vacuum extraction birth work?
Assists birth by applying suction to fetal head
266
What is the maximum amount of time that a vacuum assisted birth should be used?
8-10 minutes
267
How is the vacuum assisted birth used?
Progressive decent with first 2 pulls
268
Why is the vacuum assisted birth limited?
To prevent cephalohematomas and jaundice
269
Why does a vacuum assisted birth carry the risk of cephalohematomas and jaundice?
Because of the reabsorption of bruising at cup attachment site
270
What type of birth would a patient with a complete previa need?
C section
271
What type of birth would a patient with CPD need?
c section
272
What type of birth would a patient with a placental abruption need?
c section
273
What type of birth would a patient with active genital herpes need?
c section
274
What type of birth would a patient with an umbilical cord prolapse need?
c section
275
What type of birth would a patient with FTP need?
c section
276
What does FTP mean?
Failure to progress
277
A patient has non-reassuring fetal status, what type of birth do they need?
c section
278
A patient with a previous classical c section will need...
c section from there on
279
If a patient has an obstruction of the birth canal they will need...
a c section
280
What maternal medication conditions will a c section most likely be needed?
``` Cardiac disorders Severe respiratory disease CNS disorders (increased ICP) HIV infection Mental disorders Altered state of consciousness ```
281
What are three types of c section incisions?
Low transverse incision Classical incision Low vertical incision
282
What is the nursing prep for a c section?
``` Explain procedure Establish IV lines FHR monitoring Administer meds Place indwelling catheter Perform abdominal prep and scrub May or may not obtain consent ```
283
What should the nurse assess after a c section?
``` Bowel sounds Heart and respiratory system Homan's sign (unless contraindicated) Pain level Bladder Lochia Fundus Vital signs ```
284
How often after a c section should the nurse assess pain level?
Hourly and with pain medication administration
285
How long is a foley in place for after a c section?
At least 24 hrs
286
How should the fundus feel after a c section?
Firm
287
How long is a pressure dressing on the c section site after surgery?
for 24 hrs
288
What does TOLAC stand for?
trial of labor after c section
289
Who is able to have a TOLAC?
A patient with 1-2 previous c sections and a low transverse incision ONLY
290
These women have higher neonatal death rates and lower success rates of TOLAC
Obese and morbidly obese women
291
What must a woman's uterus look like for a TOLAC?
Absence of other uterine scars or history of uterine rupture
292
What is contraindicated during a TOLAC?
Prostaglandin agents
293
Why can women on prostaglandin agents NOT have a TOLAC?
Increased risk of uterine rupture
294
What is the nursing care during a TOLAC?
``` IV Immediate access to OR Continous FHR monitoring NPO or clear liquid diet Support for couples Follow protocol ```
295
If a patient is high risk and doing a TOLAC, what may be required?
Internal fetal monitoring
296
What is the McRobert's maneuver step 1?
Legs flexed onto abdomen causes rotation of pelvis, alignment of sacrum, and opening of birth canal
297
What is McRobert's maneuver part 2?
Suprapubic pressure applied to fetal anterior shoulder
298
When is the McRobert's maneuver applied?
In case of shoulder dystocia during childbirth

OB/GYN (11 decks)

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