Flashcards in Chapter 27: Intrapartum Complications Deck (27):
Intense back pain associated with fetal occiput posterior position
Identifying presence of fetal erythrocytes in the maternal circulation.
Premature rupture of the membranes (PROM)
Rupture of the membranes before the onset of labor
Preterm premature rupture of the membranes (PPROM)
Rupture of the membranes before the end of week 37
Delayed or difficult birth of the shoulders after the head has emerged
Medication to stop preterm or hypertonic uterine contractions
Retraction of fetal head against the mother's perineum after in emerges
What are three characteristics of effective uterine activity?
Uterine contractions must be:
b. Strong enough, and
c. Numerous enough to propel the fetus through the woman's pelvis
Why are nursing measures to manage stress and anxiety important when caring for women with hypotonic or hypertonic labor dysfunction?
Hypotonic dysfunction mau cause anxiety because the woman expects to be progressing faster; hypertonic dysfunction is stressful because of the near-contstant discomfort without significant progress. The stress response, associated with anxiety and fear, causes the secretion of catecholamines and consumption of glucose, which interfere with normal uterine contraction Nursing measure include therapeutic communication, pain relief, promotion of relaxation and rest, and positioning.
What is the central principle of nursing actions when dysfunctional labor is a result of ineffective maternal pushing?
All nursing actions center on helping the woman make each push most effective. Examples include laboring down or delayed using, pushing with every other contraction, use of upright positions to push, explaining the expected sensations, coacher her if she cannot feel the urge to push, and reassuring her that there is not an absolute deadline for delivery.
Why are upright positions good for women who have ineffective second-stage pushing?
Upright positions add the force of gravity to maternal pushes.
List nursing measures to promote normal labor when maternal pushing is ineffective for each reason listed.
a. Fear of injury:
b. Epidural block analgesia:
a. Fear of injury: Help the woman understand that her tissues can distend to accommodate the fetus; apply warm compresses to the perineum.
b. Epidural block analgesia: Coach her about when to push and stop pushing if she cannot feel contractions well. Help her understand that effective pain management by any method, including non-pharmacologic measures, promotes the progress of labor.
c. Exhaustion: Teach the woman to push only when she feels the urge or with every other contraction; administer fluids as ordered; offer reassurance.
Why are upright maternal positions best to relieve persistent occiput posterior positions?
Upright positions favor fetal descent (gravity) and, wiht that descent, fetal head rotation. Effective positions for pushing may include squatting, semisitting, side-lying, pushing on the toilet, and/or lunging.
What are some intrapartum problems that are more likely if a woman has a multifetal pregnancy?
a. uterine overdistention with hypotonic dysfunction
b. abnormal fetal presentations
c. fetal hypoxia
d. postpartum hemorrhage caused by uterine overdistention
What are expected average rates for dilation and fetal descent for the following women after the active phase of labor has been reached?
b. Parous women:
a. Nulliparas: Dilation at least 1.2 cm/hr, descent at least 1.0 cm/hr
b. Parous women: Dilation at least 1.5 cm/hr, descent at least 2.0 cm/hr
What are nursing measures for a woman having prolonged labor and for her fetus?
a. Maternal: Promotion of comfort, conservation of energy, emotional support position changes that favor normal progress, and assessments for infection
b. Fetal: Observation for signs of intrauterine infection and for compromised fetal oxygenation
What are nursing measures that can be used when a woman has precipitate labor?
a. Promoting fetal oxygenation:
b. Promoting maternal comfort:
a. Promoting fetal oxygenation: Place her in side-lying position, administer oxygen, maintain blood volume with nonoxytocin IV fluids, stop oxytocin if in use, administer terbutaline or other tocolytic drug that may be ordered.
b. Promoting maternal comfort: Help the woman focus on nonpharmacologic pain control methods if analgesia is not possible or has not yet taken effect; remain with the woman.
What factors might make a woman think that her membranes have ruptured when they have not?
Urinary incontinence, increased vaginal discharge, loss of mucous plug
What side effects may occur with beta-adrenergic drugs, such as terbutaline?
Maternal and fetal tachycardia, decreased blood pressure, wide pulse pressure, dysrhythmias, myocardial ischemia, chest pain, pulmonary edema, hyperglycemia and hypokalemia, headache, tremors, and restlessness.
How do the following drugs stop preterm labor?
a. Prostaglandin synthesis inhibitors:
b. Calcium channel blockers:
a. Prostaglandin synthesis inhibitors: Block the action of prostaglandins, which stimulate uterine contractions; an example is indomethacin
b. Calcium channel blockers: Block the action of calcium, which is necessary form muscle contraction; an example is nifedipine.
What are the primary nursing assessments related to each of these drugs used in teh treatment of preterm labor?
b. Magnesium sulfate:
a. Terbutaline: Observe maternal BP, pulse, and respirations and fetal heart rate to identify tachycardia or hypotension; assess lung sounds; assess for the presence of dyspnea or chest pain to identify pulmonary edema or myocardial ischemia; obtain ordered glucose and potassium levels.
b. Magnesium sulfate: Observe for urine output of at least 30mL/hr, presence of deep tendon reflexes, and respirations of at least 12 breaths/min; assess heart and lung sounds; observe bowel sounds and assess for constipation; have calcium gluconate available.
c. Indomethacin: Observe for nausea, vomiting, heartburn skin rash, and prolonged bleeding; observe for signs of infection other than fever; check fundal height; have woman do kick counts to identify fetal movements.
d. Nifedipine: Teach about flushing of the skin and headache; observe maternal pulse rate, fetal heart rate, and maternal blood pressure; warn of postural hypotension, and teach woman to assume a sitting or standing position slowly after lying down.
e. Corticosteroids: Assess lung sounds; teach woman to report chest pain or heaviness or any difficulty in breathing.
What are three variations of prolapsed cord?
a. Occult prolapsed cord cannot be seen or felt on vaginal examination but is suspected based on fetal hear rate.
b. The cord may slip into the vagina, where it can be felt as a pulsating mass during vaginal examination.
c. Complete prolapsed cord slips outside the vagina, where it is visible.
What are the two objectives if umbilical cord prolapse occurs or is suspected? Why should the nurse avoid handling the prolapsed cord?
Relieve pressure on the cord by any of several measures, including positioning the woman so that her hops are higher than her head and pushing the fetal presenting part upward; increase oxygen delivery to the placenta. Handling the cord may induce arterial spasm in the cord vessels.
What are 3 variations of uterine rupture?
a. Complete rupture: direct communication between the uterine and peritoneal cavities.
b. Incomplete rupture: rupture into the peritoneum or broad ligament but not into the peritoneal cavity.
c. Dehiscence: partial separation of a previous uterine scar.
Why is it important that the nurse not push on the uncontracted uterine fundus after birth? What is the correct procedure?
Pushing on an uncontracted uterus to expel clots after birth may result in uterine inversion. Massage the uterus until it is firm before expelling clots with fundal pressure. Support the lower uterus with one hand just above the symphysis.
Why can anaphylactoid syndrome result in disseminated intravascular coagulation?
Amniotic fluid is rich in thromboplastin, initiating uncontrolled clotting that consumes normal clotting factors.