class 6 labour and birth part 2

Question 1

When are we concerned about pain?

Answer 1

When there is pain between contractions

Question 2

What are we concerned about with pain between contractions?

Answer 2

placental abruption
uterine rupture

Question 3

What are the 12 non-pharmacological interventions in the first stage of labour?

Answer 3

1.Therapeutic touch: massage, counter pressure, double hip squeeze
2. Position changes: walking, rocking, birth balls, etc.
3. Application of heat/cold
4. Hydrotherapy: showers, bath, birth tub
5. Intradermal sterile water injections
6. TENS
7. Acupressure/acupuncture
8. Breathing techniques/relaxation
9. Music
10. Imagery & visualization focal points
11. Aromatherapy

Question 4

How often should the nurse assess the effectiveness of each position?

Answer 4

q 20-30 min

Question 5

What 3 things do nurses assess when assessing position changes?

Answer 5

1. comfort and anxiety level of birther
2. progress in labour
3. fetal heart rate & pattern

Question 6

When someone is given meds in the first stage what are we always concerned about?

Answer 6

1.how is this medication affecting baby?
2. how is this medication affecting birther?

Question 7

When giving morphine and fentanyl, do we use IA or EFM?

Answer 7

IA is fine unless otherwise indicated to use EFM

Question 8

If someone has epidural, how often do we check with EFM?

Answer 8

1 hour and then back to IA if all is good

Question 9

If the epidural is not working what do we do?

Answer 9

there’s something wrong with it - call the specialist to fix it - it’s not normal

Question 10

What are the 3 pharmacological interventions for pain during the first stage?

Answer 10

1. nitrous oxide/laughing gas
2. opioids (morphine & fentanyl)
3. Epidural

Question 11

What is the MOA of nitrous oxide?

Answer 11

CNS depressant - alters pain stimuli - decreased perception of pain

Question 12

What are the side effects of nitrous oxide?

Answer 12

N&V
dizziness

Question 13

What must ALWAYS be on with nitrous oxide?

Answer 13

the suction!

Question 14

What are 3 important things to remember when pt administers nitrous oxide?

Answer 14

deep breaths (during contraction)
tight seal
self-administer only (prevent OD)

Question 15

Which opioid can you not give IM, morphine or fentanyl?

Answer 15

Fentanyl
IV
PCA

Question 16

How long does morphine last?

Answer 16

4-5 hours

Question 17

how long does fentanyl last?

Answer 17

30-60 min

Question 18

In active labour which opioid do we prefer to give and why?

Answer 18

fentanyl
shorter duration so the bab doesn’t come out high

Question 19

Do we give naloxone to every baby if birther had opoids?

Answer 19

no
only if opioid-induced respiratory depression is suspected

Question 20

What is the med given via epidural ANESTHESIA?

Answer 20

Bupivicaine

Question 21

What is the med given via epidural ANALGESIA?

Answer 21

Opioid ( fentanyl)

Question 22

What’s the most important thing to check before epidural?

Answer 22

Platelets

Question 23

What vital signs are we checking with epidural?

Answer 23

BP b/c it vasodilates
temp- because it can mess with the body’s thermostat

Question 24

what’s a bad risk with epidural?

Answer 24

postdural puncture headache/spinal headache

Question 25

what gauge needle do we insert for IV with epidural and why?

Answer 25

18g - hypotension risk

Question 26

how often do we monitor BP after epidural?

Answer 26

q2 min x 10 min & FHR q 30 min

Question 27

What do we ask the patient to do BEFORE epidural insertion?

Answer 27

PEE!

Question 28

When is the epidural removed?

Answer 28

4th stage- recovery

Question 29

What dermatone level is epidural usually sufficient?

Answer 29

T10-T5- vaginal birth T12-T10 for labour pain

Question 30

If someone's motor function is 0, what does this mean?

Answer 30

no block - or patient has full flexion of foot and knee - can move

Question 31

When can we give fentanyl and not give in stage 2?

Answer 31

can- passive phase can't- active phase - baby wil be high

Question 32

what does Pudendal block do?

Answer 32

pain relief in perineum

Question 33

What are the general signs of complication in labour with contractions?

Answer 33

contractions >90 seconds contractions >5 in 10 min Relaxation between contractions <30 seconds

Question 34

What are the general signs of complications in labour with FHR?

Answer 34

fetal bradycardia/tachy variability- absent or minimal (not sleep/not opioid related) Decels - late variable, prolonged decel irregular FHR/dysrhythmias

Question 35

What are the general signs of complications in labour with Birther ?

Answer 35

meconium-stained amniotic fluid blood from vagina bright red or dark-red foul smell vaginal discharge Temp >38 when labouring issues with dilation, effacement, descent

Question 36

How many weeks is a pre-term baby?

Answer 36

20-37 weeks

Question 36

what is acrocyanosis?

Answer 36

hands and feet are blue- normal finding

Question 36

how many weeks is a late preterm baby?

Answer 36

36 weeks

Question 37

what are 4 causes of spontaneous preterm birth?

Answer 37

1. preterm labour 2. preterm premature rupture of membranes 3. cervical insufficiency- not closed or too short 4. amniotitis - infection = inflam. response

Question 38

how many hours apart do we give betamethasone?

Answer 38

24 hours apart

Question 39

what helps reduce contractions ?

Answer 39

tocolytics

Question 40

what are the early signs of preterm labour?

Answer 40

uterine activity discomfort vaginal discharge:bleeding, amniotic fluid

Question 41

what should someone do if they are having early labour?

Answer 41

pee *hydrate lay on side 30min-1 hr palpate for contractions - hard abdomen let doc know or go to triage

Question 42

what are the 3 ways we know someone is in preterm labour?

Answer 42

1. <37 weeks gestational age 2. cervical change d/t contractions 3. progressive cervical change (+ effacement ) 80% effaced, >2m dilated, regular contractions)

Question 43

what is a Ballard score?

Answer 43

a physical examination that estimates a newborn's gestational age by assessing their physical and neuromuscular maturity

Question 44

what 2meds do we give birthers in preterm labour and why?

Answer 44

mag sulphate - neuroprotection + increases blood flow to baby betamethazone- lung development steroid

Question 45

how long do we give mag sulphate in preterm labour?

Answer 45

max 24 hours or D/C if delivery is not imminent anymore

Question 46

what dilation of the cervix is likely to lead to preterm birth?

Answer 46

>4 cm dilation

Question 47

what is a Bishop score?

Answer 47

a calculation that predicts how close a pregnant person is to labor and whether an induced labor will lead to a successful vaginal birth

Question 48

what is one of the leading causes of neonatal mortality?

Answer 48

preterm labour and birth

Question 49

who is a high priority for induction?

Answer 49

-Pre-eclampsia >37 weeks -Significant birther disease -Significant but stable antepartum hemorrhage -Chorioamnionitis -Suspected fetal compromise -Term prelabour rupture of membranes (PROM) with GBS colonization

Question 50

what is Cervidil used for?

Answer 50

cervical ripining

Question 51

what are 2 mechanical and physical methods of cervical ripening?

Answer 51

balloon catheter membrane sweep

Question 52

what is Amniotomy?

Answer 52

artificial rupture of membranes

Question 53

how many contractions is tachysystole?

Answer 53

6 or more contractions

Question 54

what are the 6 things we do in an oxytocin emergency?

Answer 54

1. turn off oxytocin 2. lateral position 3. IV bolus 4. 8-10 L o2 - non-rebreather mask 5. nitroglycerin to decrease uterine activity 6. notify OB throughout

Question 55

what are the 2 interventions for shoulder dystocia?

Answer 55

1. legs way up towards head to rotate pelvis 2. pressure on the suprapubic region

Question 56

What are the 4 Obstetrical emergencies ?

Answer 56

1. shoulder dystocia 2. Prolapsed Umbilical Cord 3. Uterine Rupture 4. Amniotic Fluid Embolism

Question 57

What is a prolapsed umbilical cord emergency?

Answer 57

cord lies below the presenting part of the fetus - could get squished in delivery leaving fetus without O2

Question 58

What is Uterine Rupture emergency?

Answer 58

When the uterine layers or previous scar dehisces

Question 59

What are the S/S of Uterine rupture?

Answer 59

1. * Severe pain 2. *bleeding 3. contractions cease 4. change in uterine shape 5. signs of hemorrhagic shock 6. *FHR changes - disappears 7. Palpable fetal parts

Question 60

What is Amniotic Fluid Embolism?

Answer 60

Amniotic fluid gets into mom's system system gets confused so it just collapses -very sudden acute S/S- very bad outcomes - hypoxia - hypotension - cardiovascular collapse - clotting