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Exam 1 : lecture 1 Flashcards

complications of pregnancy GBS cord prolapse fetal monitoring maternity nursing Pain management during labor Cervical Ripening Agents Augmentation/Induction of labor Glossary of terms

1
Q

Leopold’s maneuver

A

-checking felt position by external palpation

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2
Q

Vertex

A

baby’s head is down

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3
Q

Breech

A

baby’s buttocks or feet are presenting first

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4
Q

Gravida

A

how many times pregnant

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5
Q

Para

A

how many times delivered after 20 weeks

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6
Q

PROM

A

premature rupture of membranes

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7
Q

PPROM

A

-preterm premature rupture of membranes (amniotic fluid)

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8
Q

SROM

A

spontaneous rupture of membranes (on its own)

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9
Q

AROM

A

artificial rupture of membranes (use of amniotic hook by HCP)

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10
Q

Meconium

A

baby’s first BM

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11
Q

Amninoinfusion

A

normal saline infused into uterus while in labor

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12
Q

Amniocentesis

A

withdrawing amnio fluid through the mother’s abdomen

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13
Q

Cervical Ripening Agents

A
  • Prostaglandin E1, (PGE1): Misoprostol (Cytotec)
  • Prostaglandin E2 (PGE2): Dinoprostone (Cervidil Insert; Prepidil Gel)
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14
Q

Augmentation/Induction of labor

A

Oxytocin / Pitocin

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15
Q

Two most reported medical risk factors w/pregnancies

A

-hypertension
-diabetes

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16
Q

What does GTPAL stand for?

A

G = gravidity: # of pregnancies
T = term births: 37weeks to 42 weeks gestation
P = preterm births: 20 to 37 weeks gestation
A = abortions: pregnancy that ends prior to 20 weeks
L = living children

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17
Q

what is GBS?

A

Group B streptococcus (GBS) is a
naturally occurring bacterium found in
approximately 50% of healthy adults.
- Women who test positive in pregnancy
are considered carriers.

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18
Q

GROUP B STREP INFECTIONS
IN NEWBORNS

A
  • Early onset disease- occurs the first week
    of life
  • Early onset causes sepsis, pneumonia, and
    meningitis of newborns
  • Approximately one out of every 100-200
    newborns born to mothers who are GBS
    positive develop signs and symptoms of
    disease.
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19
Q

Assessments- complications of pregnancy: risk factors

A
  • Prematurity
  • Prolonged ROM of >18 hours
  • Maternal fever during labor
  • Previous infant with GBS
    infection
  • GBS during pregnancy
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20
Q

GBS screenings done when and how

A
  • Screen women at 35-37 weeks with vaginal
    and rectal culture
  • If no culture treat if: < 37 weeks, prolonged
    ROM>18 hours, maternal temperature of
    100.4 or greater
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21
Q

prevention of transferring GBS (positive mom) to baby

A
  • Can be prevented by giving pregnant women
    antibiotics (ABXs) IV during labor usually penicillin
  • ABs can only be taken during labor, not before,
    because bacteria grows quickly
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22
Q

what is cord prolapse?

A

emergency
-when the umbilical cord comes out before the baby

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23
Q

How does cord prolapse happen?

A

when the mother’s water breaks BEFORE the baby has moved into the birth canal

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24
Q

cord prolapse causes what?

A

cord is at high risk for cord compression, blocking oxygen, and blood flow to the baby = fetal distress
emergency C/S

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25
Risks for cord prolapse
-SGA = Small baby (for gestation age) - unengaged fetal part (head isnt well applied against the cervix) -AROM -Polyhydramnios (too much amniotic fluid) Multiple gestation (if have twins or triplets)
26
cord prolapse medical management
Pt's BOW breaks 1st: Look @ FHR, water, if cord is there If cord prolapse has occurred 1st: call for help 2nd: w/sterile glove, elevate the presentation part off the cord 3rd: reposition (knee chest or trendelenburg) to relieve pressure 4th: educate/emotioinal support while staying calm 5th: call physican 6th: Prepare for c/s delivery - call for charge nurse, OR, NICU
27
What does CORD stand for in a cord prolapse situation?
For cord prolapse situation C: call for help O: organzine delivery R: receive pressure on the cord D: deliver
28
meds to use if cord prolapse were to happen
Tocolytic agents (terbutaline) - to stop contractions -route:SQ -assess HR and lungs (bc this med increases HR)
29
Cord prolapse delivery
-in most cases emergency c/s -if birth is imminent (baby right there) deliver vaginally immediately
30
Types of fetal monitoring
Electronic fetal monitoring -hospital setting Intermittent Auscultation -Dr. office, or at homes/birthing settings
31
Intermittent monitoring
*low risk* -hand held dropper -fetoscope -intermittent auscultation (not continuous)
32
Electronic fetal monitoring -types
- external monitoring - internal monitoring
33
External monitoring- placed where + indications
*less invasive* external ultrasound (US) transducer - for FRH - placed in lower quadrants of mom; below umbilicus - only this (round) US gets US jelly external TOCOtransducer - for uterine contractions - placed above umbilicus
34
Internal monitoring- placed where + indications
*most invasive+ more accurate than external monitoring* internal fetal scalp electrode (FSE) - measures the FHR intrauterine catheter (IUPC) -measures strength of uterine contractions internally
35
What must be done PRIOR to do internal monitoring
Membranes must be ruptured + cervix dilated at least to 2cm
36
Guidelines for assessing FHR
-Initial 10–20-minute continuous FHR assessment -Intermittent auscultation every 30 minutes during labor for low risk and every 15 minutes for high-risk woman. -During second stage, every 15 minutes for low risk and every 5 minutes for the high risk during pushing
37
how to count contractions
Duration: beginning to end of one contraction (how long they are lasting) Frequency: beginning of one contraction to the beginning of the next one (how far apart they are)
38
Normal: baseline FHR
110-160 for 10 mins
39
Abnormal: baseline Tachycardia FRH
FHR>160 for >10 mins
40
Abnormal: baseline Bradycardia FRH
FRH<110 for >10 mins
41
Normal Variability
**Moderate variability** FHR goes up and down
42
Abnormal Variability
Minimal to absent variability
43
Tachycardia FHR-usually a sign of..
*early sign of fetal hypoxemia (baby not getting enough oxygen) -is mom dehydrated? - is mom any BP meds? - does mom have a fever? - infx? *abnormal and provider should be contacted*
44
3 key aspects to determine if FHR is normal + good
Rate *variability* any periodic change
45
Nursing interventions if FHR is tachycardia
-take mom's temp, any elevation? (report everything to dr) -is she @ risk for infx / PROM ? -dehydrated/ SOB? (PRN orders for a IV bolus) - usage of drugs or drug abuse?
46
FHR-Bradycardia: causes
-Maternal supine position (laying on back) - Hypoxia - Medications - Maternal hypotension - Cord prolapse ( cord compression ) - Rapid fetal descent (mom delivers v fast _ in response the baby's FHR will fall)
47
FHR-Bradycardia: nursing interventions
-Maternal supine position: change position/to side -Maternal hypotension: Prior to epidural 1 L bolus LR given via IV
48
Baseline Variability significance
*Most important characteristic bc it is the paramount indicator of a well oxygenated fetus*
49
What is absent variability
ABNORMAL!!!! 0 BPM + is a straight line *needs immediate attention*
50
what is minimal variability
ABNORMAL!!!! 5 or less BPM *can result from fetal hypoxemia
51
what is moderate variability
NORMAL!!WANT!! 6-25 BMP
52
What makes up periodic changes?
-accelerations (visually abrupt increase but are cherry on top; normal) -decelerations (normal; early) (abnormal;variable, late, prolonged)
53
periodic changes: accelerations
-fetal movement -contractions -accelerations are positive
54
periodic changes: what makes an accelerations
Transient increases above the FHR baseline *an acceleration last >15-20secs bpm before going back to baseline*
55
Periodic changes: types of decelerations
-early (normal + could be an expected finding) -late (abnormal) -variable (abnormal) -prolonged (abnormal)
56
Periodic changes: when do early decelerations occur?
*when fetal head is compressed; usually around 8 cm dilated* -called transition period; when pt is almost ready to start pushing -occurs ONLY at the same time as contractions on strip
56
Periodic changes: early decelerations - how do they look on the monitor
-early decelerations mirror contractions
57
Periodic changes: early decelerations- nursing interventions
cervical exam to check for size of dilation
58
Periodic changes: Variable deceleration- what is caused by?
caused by cord compression *ABNORMAL*
59
Periodic changes: Variable deceleration- what do they look like on the strip
*can occur w or w/out contractions* -are very abrupt and look like Vs + Ws -crowed + not spread out on the strip
60
Periodic changes: Variable deceleration- Nursing interventions
change position (to side)
61
Periodic changes: Late deceleration- what is it?
*ABNORMAL* -due to uteroplacental insufficiency = baby not getting enough oxygen
62
Periodic changes:Late deceleration- what does this indicate?
indicates presence of fetal hypoxemia stemming from insufficient placental perfusion during contractions
63
Periodic changes:Late deceleration- what does it look like?
the deceleration in the heart rate comes AFTER the contraction -Late onset + HR doesn't go back to normal baseline UNTIL contraction is OVER/HAS PAST
64
Periodic changes: nursing interventions on all ABNORMAL FRH/variability/periodic changes on strips
*intrauterine Resuscitation shorter than POISON but same interventions* 1. change maternal position (on side) 2. increase IV rate (250-500 ml bolus bolus of LR solution) 3. O2 8-10 L/min via mask 4. notify provider 5. start planning delivery
65
Periodic changes: Prolonged decelerations- what is it?
*ABNORMAL* -decrease in FHR of at least 15 bpm BELOW the baseline + lasting MORE than 2 mins BUT LESS THAN 10 mins (if >10mins = bradycardia)
66
Periodic changes: Prolonged decelerations- what does it indicate ?
indicates there is a disruption in fetal oxygen supply
67
what does POISON stand for + used for?
*for decelerations* P: position change O: oxytocin/Pitocin off I: IV (increase fluids) S: sterile vaginal exam O: oxygen 8-10 L/min via mask N: notify provider
68
FHR patterns: normal and abnormal categories
normal = category 1 abnormal = category 3
69
FHR patterns: category 1- what is it?
*NORMAL* -baseline rate 110-160 bpm -moderate variability -early decelerations either present OR absent -accelerations either present OR absent -late or variable decelerations ARE ABSENT
70
category 2 FHR patterns??
71
FHR patterns: category 3 - what is it?
*ABNORMAL* Absent baseline variability with -recurrent late decelerations -recurrent variable decelerations -bradicardia -sinusoidal pattern (severe fetal anemia) *ALL indicate hypoxemia*
72
What is VEAL CHOP
Place here
73
Nursing interventions for treatment of non-reassuring FHR patterns (aka fetal distress) in addition to POISON
-Amnioinfusion (through internal monitoring; indicated for cord compression) -Stimulation; scalp or fetal acoustic stimulation (Buz abdomen or touch baby's head for cervical exam to see for any activity; indicated to look for accelerations)

OB (8 decks)

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