[Exam 2] Chapter 21 - Nursing Management of Labor and Birth at Risk Flashcards
(188 cards)
1
Q
Dystocia: What is this?
A
Defined as abnormal or difficult labor, and can be influenced by a vast number of maternal and fetal factors. Said to exist when progress of labor deviates from normal and is a slow/abnormal progression of labor
2
Q
Dystocia: What problems may this include during active labor?
A
Lack of progressive cervical dilation, lack of descent of the fetal head, or both
3
Q
Dystocia: What factors are associated with increased risk for dystocia?
A
Epidural analgeisa, excessive analgesia, multiple pregnancy, hydramniois, maternal exhaustion, ineffective maternal pushing technique
4
Q
Dystocia: Most common indications for primary cesarean births include what?
A
Labor dystocia, abnormal FHR tracing, fetal malpresentation, multiple gestation, and suspected macrosomia
5
Q
Dystocia and Problems with Powers: What happens when the expulsive forces of the uterus become dysfunctional?
A
Uterus may either never fully relax (hypertonic contractions), placing fetus in jeopardy, or relax too much (hypotonic contractions) causing ineffective contractions
6
Q
Dystocia and Problems with Powers: What can occur when uterus contracts so frequently?
A
Rapid birth will take place (precipitate labor)
7
Q
Dystocia and Problems with Powers: When does hypertonic uterine dysfunction occur?
A
When the uterus never fully relaxes between contractions. Contractions are then ineffectual, erratic and poorly coordinated and involve only one portion of uterus.
8
Q
Dystocia and Problems with Powers: What do women with a hypertonic uterine dysfunction experience?
A
A prolonged latent phase, stay at 2-3 cm, and do not dilate as they should . Placental perfusion becomes compromised, thereby reducing oxygen to fetus
9
Q
Dystocia and Problems with Powers - Hypotonic Uterine Dysfunction: When does this occur?
A
During active labor (dilation more than 5-6 cm) when contractions become poor in quality and lack sufficient intensity to dilate and efface the cervix
10
Q
Dystocia and Problems with Powers - Hypotonic Uterine Dysfunction: Factors that cause this include what?
A
Overstrethcing of the uterus, large fetus, multiple fetuses, hydramnios, and bowel/bladder distention prevent descent
11
Q
Dystocia and Problems with Powers - Hypotonic Uterine Dysfunction: What signs may this show up as?
A
Weak contractions that become milder, uterine fundus thats easily distended with fingertip pressure, and contractiosn that become more infrequent and briefer.
12
Q
Dystocia and Problems with Powers - Hypotonic Uterine Dysfunction: Major complication with this?
A
Hemorrhage after giving birth because uterus cannot contract effectively to compress blood vessels
13
Q
Dystocia and Problems with Powers - Protracted Disorders: What is this?
A
Refers to series of events including protracted active phase of dilation (slower than normal rate of cervical dilation) and protracted descent (delayed descent of the fetal head in active phase)
14
Q
Dystocia and Problems with Powers - Protracted Disorders: When will a woman be identified as having this?
A
A laboring woman with a slower than normal rate of cervical dilation
15
Q
Dystocia and Problems with Powers - Protracted Disorders: What treatment would cause women to benefit?
A
Benefit from adequate hydration and some nutrition, emotional reassurance, and position changes
16
Q
Dystocia and Problems with Powers - Precipitate Labor: What is this?
A
Labor that is completed in less than 3 hours from the start of contractions to birth.
17
Q
Dystocia and Problems with Powers - Precipitate Labor: Problem with too fast of a labor?
A
Can result in maternal injury, and place the fetus at risk for traumatic or asphyxia insults.
18
Q
Dystocia and Problems with Powers - Precipitate Labor: What would cause a woman to have this?
A
Those with soft perineal tissues that stretch readily, permitting the fetus to pass through pelvis quickcly, or abnormally strong uterine contractions
19
Q
Dystocia and Problems with Powers - Precipitate Labor: Potential fetal complications of this?
A
Head trauma, such as intracranial hemorrhage or nerve damage, and hypoxia
20
Q
Dystocia and Problems with Passenger: What head presentation from fetus increases probability of dystocia?
A
Any presentation other than occiput anterior (head down and anterior facing)
21
Q
Dystocia and Problems with Passenger: Common problems involve the fetus include what?
A
occiput posterior position, breech presentation, multifetal pregnancy, excessive size (macrosomia)
22
Q
Dystocia and Problems with Passenger - Persistent Occiput Posterior: What is this?
A
Most common malposition. Presents slightly larger diameters to maternal pelvis, slowing fetal descent. Poor uterine contractions may not push the fetal head down into pelvic floor
23
Q
Dystocia and Problems with Passenger: Face and brow presentations are rare and associated with what?
A
Fetal abnormalities, pelvic contractures, high parity, placental previa, hydramnios, and low birht weight
24
Q
Dystocia and Problems with Passenger: By weeks 35-36, fetuses will spontaneously settle into what presentation?
A
Vertix (head down, toward the birth canal)
25
Dystocia and Problems with Passenger: What may occur in a persistent breech presentation?
Increased frequency of prolapsed cord, placenta previa , low birth weight, fatal or uterine abnormalies, and perinatalmorbidity
26
Dystocia and Problems with Passenger - External Cephalic Version: What is this?
A procedure in which fetus is rotated from the breech to the cephalic presentation by manipulation through the mothers abdominal wall at or near term
27
Dystocia and Problems with Passenger - External Cephalic Version: How is this performed?
Only in hospital setting under direct ultrasound guidance and continuous fetral monitoring.
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Dystocia and Problems with Passenger - Shoulder Dystocia: What is this?
Obstruction of fetal descent and birth by the axis of the fetal shoulders after the fetal head has been delivered.
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Dystocia and Problems with Passenger - Shoulder Dystocia: What complications may occur in mother?
Postpartum hemorrhage, vaginal lacerations, anal tears, and uterine rupture.
30
Dystocia and Problems with Passenger - Shoulder Dystocia: Dystocia and Problems with Passenger - Shoulder Dystocia: What complications may occur with child?
Transient Erb or Duchenne brachial plexus and clavical/humeral fractures.
31
Dystocia and Problems with Passenger - Multiple or Multifetal Gestation: Most common complications of this?
Postpatrum hemorhage resulting from uterine atony.
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Dystocia and Problems with Passenger - Excessive Fetal Size and Abnormalities: What is Macrosomia?
Newborn weights 4000-4500 g (8.81 lb to 9.92 lb)
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Dystocia and Problems with Passenger - Excessive Fetal Size and Abnormalities: Macrosomia associcated with what problems later in life?
Obesity, diabetes, and cardiovascular disease.
34
Dystocia and Problems with Passenger - Excessive Fetal Size and Abnormalities: Complications associated with macrosomia?
increased RF postpartum hemorrhage, low Apgar scores, dysfunctional labor, and soft tissue laceration
35
Dystocia and Problems with Passageway: Problems here associated with what?
Contraction of one or more of the three planes of the maternal pelvis: inlet, midpelvis, and outlet.
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Dystocia and Problems with Passageway: What is contraction of the midpelvis associated with?
Causes an arrest of fetal descent.
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Dystocia and Nursing Assessment: Risk factors here may include what?
Maternal short stature, obesity, hydramnios, uterine abnormalities, fetal malpresentation, or overstimulation of oxytocin.
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Dystocia and Nursing Assessment: What will happen to contractions if dysfunctional labor occurs?
They will fail or slow to advance in frequency, duration, or intensity. Cervix will fail to respond to uterine contractions by dilating and effacing
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Dystocia and Nursing Assessment: What can be ordered to treat hypotonic labor contractions?
Oxytocin (Pitocin)
40
Preterm Labor: What is this?
Defined as occurrence of regular uterine contractions accompanied by cervical effacement and dilation before the end of 38th week of gestation.
41
Preterm Labor: Infants born prematurity are at risk for serious injuries such as
respiratory distress syndrome, infections, congenital heart defects, thermoregulation problems, and jaundice.
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Preterm Labor: What can be given prenatally to improve the neonates neurodevelopmental outcome if given before 34 weeks?
Corticosteroids
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Preterm Labor and Therapeutic Management: What are tocolytic drugs?
Drugs that promote uterine relaxation by interfering with uterine contractions. May prolong pregnancy for 2-7 days.
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Preterm Labor and Therapeutic Management: Whaat should antibiotics be reserved for?
group B streptococcal prophylaxis in women wom birth is imminent
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Preterm Labor and Therapeutic Management: What can be given along with tocolytic drugs?
Steroids can be given to improve fetal lung maturity
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Preterm Labor and Therapeutic Management: Why do corticosteroids help?
Significantly reduce the incidence and severity of neonatal respiratory distress syndrome.
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Preterm Labor and Therapeutic Management - Tocolytic Therapy: When is this most likely ordered?
If preterm labor occurs before 34 weeks in an attempt to delay birth adn thereby reduce risk of respiratory distress syndrome.
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Preterm Labor and Therapeutic Management - Tocolytic Therapy: When should someone not take this?
Abruptio Placentae, acute fetal distress or death, eclampsia, or severe preeclampsia and active vaginal bleeding
49
Preterm Labor and Therapeutic Management - Tocolytic Therapy: Why is magnesium sulfate used?
it reduces the muscles ability to contract
50
Preterm Labor and Therapeutic Management - Tocolytic Therapy: What other tocolytics can be used?
Indomethacin (Indocin, prostaglandin synthetase inhibitor)
Atosiban (Tractocile, Antocin, oxytocin receptor antagonist)
Nifedipine (Procardia, calcium channel blocker)
51
Preterm Labor and Therapeutic Management - Corticosteroids: How can these help if giving for mother in preterm labor?
Prevent and reduce the frequency and severity of respiratory distress syndrome in premature infants delievered between 24-34 weeks. Help with fetal lung maturation.
52
Preterm Labor and Health Hx and Physical Exam: What are some subtle symptoms of preterm labor?
Change or increase in vaginal discahrge
Pelvic pressure
Menstrual-like cramps
UTI Symptoms
Feelings of pelvic pressure of fullness
Uterine contractions with/without pain
53
Preterm Labor and Health Hx and Physical Exam: Assess contractions. They must be consistent how?
Four contractions every 20 minutes or eight contractions in 1 hour.
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Preterm Labor and Health Hx and Physical Exam: How is cervical effacement or cervical dilation here?
80% or greater
Dilation is greater than 1 cm
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Preterm Labor and Lab/Diagnostic Testing: What diagnostic tests may be used?
CBC for infection.
Urinalysis to detect bacteria and nitrites (UTI)
Amniotic fluid analysis to determine fetal lung maturity
56
Preterm Labor and Lab/Diagnostic Testing - Fetal Fibronectin: What is this?
Produced by chorion, found at junction of the chorion and decidua. Attaches fetal sac to the uterine lining.
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Preterm Labor and Lab/Diagnostic Testing - Fetal Fibronectin: When is this present?
In cervicovaginal secretions up to 22 weeks of pregnancy and again at end of last trimester. Usually cannot be detected between weeks 24-34.
58
Preterm Labor and Lab/Diagnostic Testing - Fetal Fibronectin: Test is a useful marker for what?
Impending membrane rupture within 7-14 days if the level increases to greater than 0.05 mcg/mL.
59
Preterm Labor and Lab/Diagnostic Testing - Fetal Fibronectin: Negative fetal fibronectin test is a strong predictor of what
that preterm labor in the next 2 weeks is unlikely
60
Preterm Labor and Lab/Diagnostic Testing - Fetal Fibronectin: How is this collected?
Sterile applicator is used to collect the cervicovaginal sample by using speculum
61
Preterm Labor and Lab/Diagnostic Testing - Cervical Length Measurement: Three parameters evaluated during transvaginal ultrasound, which are
Cervical length and width
Funnel width and length
Percentrage of funneling
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Preterm Labor and Lab/Diagnostic Testing - Cervical Length Measurement: Cervical length of 3 cm indicaes what?
Delievery within 14 days unlikely
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Preterm Labor and Lab/Diagnostic Testing - Cervical Length Measurement: Women with cervical length of 2.5 cm during the mid trimester have a greater risk for
preterm birth prior to 35 weeks gestation n
64
Preterm Labor and Administering Tocolytic Therapy: Diagnosis for preterm labor requires what?
Cervical exam of more than 2cm and/or more than 80% effacement in a nulliparous
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Preterm Labor and Administering Tocolytic Therapy: Contraindications for administering this is what?
Intrauerine infection, active hemorrhage, fetal distress, fetus before viability, and fetal abnormality incompatible with life
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Preterm Labor and Administering Tocolytic Therapy: Women at risk for preterm labor are offered what at start of second trimester?
Progesterone therapy
67
Preterm Labor and Administering Tocolytic Therapy: What to know for Magnesium Sulfate?
Is a physiologic calcium antagonist. Given IV. Monitor women for N/V, headache, weakness, hypotension.
68
Labor and Administering Tocolytic Therapy: What should you assess the fetus for with magnesium sulfate?
Decreased FHR variability, drowsiness, and hypotonia.
69
Preterm Labor and Administering Tocolytic Therapy: CCB promote what?
Uterine relaxation by decreasing the influx of calcium ions into myometrium cells to inhibit contractions
70
Preterm Labor and Administering Tocolytic Therapy: CCB How often do you administer these drugs and what to watch mor?
Orally/sublingually every 4-8 hours . Monitor for hypotension, reflex tachycardia, headache, nausea, and facial flushing
71
Preterm Labor and Administering Tocolytic Therapy: Prostaglandin Synthetase Inhibitor does what?
Reduces prostaglandin synthesis from decidual macrophases. REadily crosses placenta and can cause ologohydramnios.
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Preterm Labor and Administering Tocolytic Therapy: Dose/How often is prostaglandin Synthetase Inhibitor given?
50-100 mg orally or per rectum followed bby 25-50 mg every 6 hours for 8 doses
73
Postterm Pregnancy: Pregnancy usually lasts how long?
38-42 weeks
74
Postterm Pregnancy: This is defined as long?
Pregnancy that extends to 42 weeks and beyond.
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Postterm Pregnancy: Theory for why this ay happen?
May be a deficiency of estrogen and continued secretion of progesterone that prohibits the uterus fron contracting
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Postterm Pregnancy: Maternal risks for this?
RElated to large size, which increases C-SEction risk. Dystocia, birth trauma, and postpartum hemorrhage may occur
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Postterm Pregnancy: What mechanical or artifical interventions may be necessary?
Forceps or vacuum-assisted birth and labor induction with oxytocin
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Postterm Pregnancy: Fetal risks associated with this include
Macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores and postmaturity syndrome
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Postterm Pregnancy: What happens as placenta ages?
Perfusion decreases and it becomes less efficient at delievering oxygen and nutrients to fetus. Amniotic fluid volume also declines.
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Postterm Pregnancy: When expectant management is chosen, the nurse should anticipate that assessments for this will include
daily fetal movement counts done by woman, nonstress tests with amniotic fluid assessments as part of biophysical profile done twice weekly.
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Postterm Pregnancy - Providing Care During the Intrapartum Period: What should you assess here?
Continuously assess and monitor FHR to identify potential fetal distress.
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Postterm Pregnancy - Providing Care During the Intrapartum Period: Why should amniotic fluid characteristics be monitored when membranes rupture?
To identify previous fetal hypoxia and prepare for prevention of meconium aspiration.
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Postterm Pregnancy - Providing Care During the Intrapartum Period: Amniofusion may be needed to minimize risk of what?
Meconium aspiration by diluting the meconium in the amniotic fluid expelled by the hypoxic fetus.
84
Women Requiring Labor Induction and Augmentation: What is Labor Induction?
Involves stimulation of uterine contractions by medical or surgical means before the onset of spontaneous labor
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Women Requiring Labor Induction and Augmentation: What else does labor induction also involve?
IV therapy, bed rest, continuous electronic fetal monitoring, and significant discomfort from stimulating uterine contractions
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Women Requiring Labor Induction and Augmentation: Why may a woman induce labor?
PROM, Gestational Hypertension, Cardaic Disease, REnal Disease, Dystotcia, and Intrauterine FEtal Demise.
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Women Requiring Labor Induction and Augmentation: Contraindications for this?
Complete placenta previa, abruptio placentae, transverse lie, prolapsed umbilical cord.
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Women Requiring Labor Induction and Augmentation - Therapeutic Mx: The decision to induce labor is usuallybased on what?
Ultrasound to evaluate fetal size, position, and gestational age.
Engaged Presenting Fetal PArt
Nonstress test to evaluate fetal well-being.
89
Women Requiring Labor Induction and Augmentation - Therapeutic Mx and Cervical Ripening: What is htis?
Process by which the cervix softens via the breakdwon of colalgen fibrils. This is so cervix ix 50% effaced and 2cm dilated at onset of labor.
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Women Requiring Labor Induction and Augmentation - Therapeutic Mx and Cervical Ripening: Difference between a ripe and unripe cervix?
Ripe: Shortened, centered, softened, and partially dilated
Unripe: Long, closed, posterior, and firm
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Women Requiring Labor Induction and Augmentation - Therapeutic Mx and Cervical Ripening: What does a score over 8 indicate for Bishop score?
Successful vaginal birth
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Women Requiring Labor Induction and Augmentation - Therapeutic Mx and Cervical Ripening: Bishop scores less than 6 usually indicate what?
That cervical ripening method should beused prior to induction.
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Women Requiring Labor Induction and Augmentation - Therapeutic Mx and Cervical Ripening: Medical induction of labor has what two components?
Cervical ripening and induction of contractions.
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Women Requiring Labor Induction and Augmentation - Cervical Ripening and Complementary/Alt Medicine Method: What other methods can be used here?
Herbal agents such as evening primose oil, black haw, black and blue cohosh, and red rasberry leaves
Castor oil and hot baths can be used as well
95
Women Requiring Labor Induction and Augmentation - Cervical Ripening and Complementary/Alt Medicine Method: Why can sex be beneficial?
Promotes release of oxytocin which stimulates uterine contractions. Human semen also stimulates prostaglandins
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Women Requiring Labor Induction and Augmentation - Cervical Ripening and Mechanical Methods: How does this work?
Application of local pressure stimulates the release of prostaglandins to ripen the cervix.
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Women Requiring Labor Induction and Augmentation - Cervical Ripening and Mechanical Methods: Risks associated with these?
Infection, bleeding, membrane rupture, and placental disruption.
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Women Requiring Labor Induction and Augmentation - Cervical Ripening and Mechanical Methods: How is an indwelling (Foley) catheter used?
Inserted into endocervical cancel to ripen/dilate cervix. Placed in uterus and balloon is filled. Direct pressure than applied to lower segment. Causes stress in lower uterine segmenet and production of prostaglandins
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Women Requiring Labor Induction and Augmentation - Cervical Ripening and Mechanical Methods: What do Hygroscopic dilators do?
Absorb endocervical and local tissue fluids. As they enlarge, they expand endocervix and provide controlled mechanical pressure.
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Women Requiring Labor Induction and Augmentation - Cervical Ripening and Mechanical Methods:What kind of Hygroscopic dilators are there?
Laminaria (type of dried seaweed), and synthetic dilators coontaining magnesium sulfate.
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Women Requiring Labor Induction and Augmentation - Cervical Ripening and Surgical Methods: What methods can be done?
Stripping of the membranes and performing an amniotomy
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Women Requiring Labor Induction and Augmentation - Cervical Ripening and Surgical Methods:How is stripping of membranes accomplished?
By inserting a finger through the internal cervical os and moving it in a circular direction. Causes membranes to detach.
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Women Requiring Labor Induction and Augmentation - Cervical Ripening and Surgical Methods:What does an amniotomy involve?
Inserting a cervical hook through the cervical os to deliberately rupture the membranes.
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Women Requiring Labor Induction and Augmentation - Cervical Ripening and Pharmacologic Methods: Why are prostaglandins used?
To attain cervical ripening and is highly effective.
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Women Requiring Labor Induction and Augmentation - Cervical Ripening and Pharmacologic Methods: What prostaglandin analogs have been used?
Dinoprostone Gel (Prepidil
Dinoprostone Inserts (Cervidil)
Misoprostol (Cyotex)
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Women Requiring Labor Induction and Augmentation - Cervical Ripening and Pharmacologic Methods: What to know about Misoprostol?
Administered intravaginally. Doses of 25-50 mcg.
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Women Requiring Labor Induction and Augmentation - Cervical Ripening and Pharmacologic Methods: Major adverse effect of Misoprostol?
hyperstimulation of the uterus, which may progress to uterine tetany with makred impairment of uteroplacental blood flow, uterine rupture
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Women Requiring Labor Induction and Augmentation - Oxytocin: What is this used for?
Artificial inducion and augmentation of labor
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Women Requiring Labor Induction and Augmentation - Oxytocin: How is this administered?
Via an IV infusion pump piggybacked into main IV line. 10 units added to 1L.
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Women Requiring Labor Induction and Augmentation - Oxytocin: Advantages of this?
Potent, easy to titrate, and short-life (1-5 mins) and well tolerated.
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Women Requiring Labor Induction and Augmentation - Administering Oxytocin: What should you monitor in the mother after giving this?
Monitor maternal and fetal status. Apply external electronic fetal monitor and obtain mothers VS every 15 minutes during first stage.
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Women Requiring Labor Induction and Augmentation - Administering Oxytocin: Cervical dilates how much if successful
1 cm/ hour
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Vaginal Birth After Cesarean: What does this describe?
A women who gives birth vaginally after having at least one previous cesarean birth.
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Vaginal Birth After Cesarean: Contraindications for this include what?
Prior classic uterine incision, prior transfundal uterine surgery, uterine scar, and contracted pelvis
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Vaginal Birth After Cesarean: What special areas must be focus on here?
Consent
Documentation
Surveillance
Readiness for Emergency
116
Vaginal Birth After Cesarean: What to know about consent?
Essential. Must be advised about risks as well as benefits. Must understand ramifications of uterine rupture
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Vaginal Birth After Cesarean: What to know about documentation
Essential. If emergency occurs, take care of client but also keep track of plan of care, interventions, and their timing.
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Vaginal Birth After Cesarean: What to know about surveillance?
Distressed fetal monitor tracing should alert nurse of uterine rupture. Terminal bradycardia must be considered an emergency siutaiton
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Vaginal Birth After Cesarean: What to know for Readiness for Emergency?
For those who have previous C-Section, physician or nurse practitioner, anesthesia provider, and operating room team must be available
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Intrauterine Fetal Demise: What is the timeline for this?
After 20 weeks gestation but before birth
121
Intrauterine Fetal Demise: What may cause this?
Postterm pregnancy, substance abuse, hypertension, Rh Disease, and Uterine Rupture.
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Intrauterine Fetal Demise: Potential complications include what?
Maternal injury or death, shock, internal hemorrhage, IUFD, abruptio placentae, and uterine rupture.
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Intrauterine Fetal Demise: Early pregnancy loss may be through what?
Spontaneous abortion (miscarriage), induced abortion (therapeutic abortion) or a ruptured ectopic pregnancy
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Intrauterine Fetal Demise: Process of grief occurs how?
Accepting reality of loss
Getting over suffering from loss
Adapting to new enviroment
Getting on with life
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Umbilical Cord Prolapse: What is this?
Protrusion of the umbilical cord alongside (occult) or ahead of the presenting part of the fetus
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Umbilical Cord Prolapse Patho: What does this lead to?
Total or partial occlusion of the cord. Since this is fetus's only lifeline, fetal perfusion deteriorates rapidly and may die.
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Umbilical Cord Prolapse Nursing Assessment: Be aware that cord prolapse is more common with who?
Im prengnancies involving malpresentation, growth restriction, prematurity, rupture membranes
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Umbilical Cord Prolapse Nursing Management: First sign of this?
Fetal bradycardia or recurrent variable decelerations that become progressively more severe.
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Umbilical Cord Prolapse Nursing Management: How can pressure be relieved if membranes are ruptured?
Examiner places sterile glove into the vagina and holds the presenting part of the umbilical cord until delivery
130
Placenta Previa: What is this?
Placental implantation in the lower uterine segment over or near the internal os of the cervix. Results in spontaneous palcental separation and hemorrhage
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Placenta Previa: Who should this be suspected in?
Any woman beyond 24 weeks gestation presenting with vaginal bleeding. Diagnose with ultrasonography
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Placenta Previa: This has a direct relationship with what?
With the number of previous cesarean births due to uterine scarring
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Placenta Previa: Common morbidities include?
Septicemia, renal failure, hemorrhage, and hypovolemic shock.
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Placenta Previa: Risk factors for getting this?
Previous C-Section, > 34, Multiple Gestation, Prior Placenta Previa, and Cigarette smoking
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Placenta Previa: Common neonatal morbidies include what?
Stillbirth, prematurity, malpresentation, fetal growth restriction, and fetal anemia
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Placenta Previa: Maternal signs of having this include what?
Sudden, painless bleeding (heavy), anemia, pallor, hypoxia, low blood pressure, and soft and nontender uterus.
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Placenta Previa: Prompt treatment includes what?
Bed rest, close monitoring, and control/replacement of blood loss.
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Placenta Previa: What may be necessary in order to control severe bleeding?
Pregnancy termination, early birth by cesaran section, or a hysterectomy.
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Placenta Previa: Nursing management for someone with this?
Monitor maternal VS, I/O, Vaginal Bleeding, and Physiologic status of hemorrhage, shock, or infection
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Placenta Previa: What Meds/Fluids would be ordered?
IV Fluids, Packed RBC Platelets, Frozen Plasma, RHoGam if RH negaive, and IV-Augmented Oxytocin to induce labor if needed.
141
Placental Abruption: What is this?
Premature separation of normally implanted placenta from the maternal myometrium.
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Placental Abruption: RF's for this?
Preeclampsia, gestational hypertension, seizure activity, > 34, uterine rupture, smoking, and coagulation defects.
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Placental Abruption: Management depends on what?
gestational age, extent of hemorrhage, and maternal-fetral oxygenation perfusion
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Placental Abruption: What is the focus for treatment normally?
Maintaining the cardiovascular status of the m other and developing a plan to deliver the fetus quickly.
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Uterine Rupture: What is this?
Catastrophic tearing of the uterus at teh site of previous scar into the abdominal cavity
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Uterine Rupture: Onset marked by what?
Sudden fetal bradycardia and tx requires rapid surgery for good outcomes.
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Uterine Rupture: How much time do you have from the rupture until fetal morbidity occurs?
Only 10-30 minutes.
148
Uterine Rupture and Nursing Assessment: Reviews mothers history for risk conditions that include
uterine scars, prior cesarean births, prior rupture, trauma, and labor induction with excesive uterine stimulation.
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Uterine Rupture and Nursing Assessment: Most reliable sign that this has occured?
sudden fetal distress.
Others may include acute/continuous abdominal pain, vaginal bleeding, hematuria, irregular abdomal wall, and loss of station inf etral part
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Uterine Rupture and Nursing Management: What must usually be done ebcause of this?
Urgent delivery by C-Section.
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Uterine Rupture and Nursing Management: What must you do as a nurse?
Monitor mom VS
Contact team
Insert indwellingn urianry catheter.
152
Amniotic Fluid Embolism: What is this characterized by?
Sudden onset of hypotension, hypoxia, and coagulopathy
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Amniotic Fluid Embolism: What happens as amniotic fluid contraining particles of debris (hair, skin) enters maternal circulation?
Obstructs the pulmonary vessels causing respiratory distress and circulatory collapse.
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Amniotic Fluid Embolism Nursing Assessment: Predisposing Factors associated with this include?
Placentral abruption, uterine over distention, fetal demise, uterine trauma, oxytocin-stimualted labor, amnioinfusion, and ruptured membranes
155
Amniotic Fluid Embolism Nursing Assessment: What do most people report with this?
difficulty breathing
Hypotension, cyanosis, hypoxemi, uterine atony, seizures, tachycardia, pulmonary edema, and seizures affect this
156
Amniotic Fluid Embolism Nursing Assessment: this should be suspected in any pregnant women with the acute onset of what?
Dyspnea, hypotension, and DIC
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Amniotic Fluid Embolism Nursing Management: What support measures are traken?
Oxygenation
Circulation
Control of HEmorrhage and Coagulopathy
Seizure Precautions
Administration of Steroids to control the inflammatory response
158
Amniotic Fluid Embolism Nursing Management: What should you monitor?
VS, Pulse Ox, Skin Color, and Temperature and observe for signs of coaglopathy
159
Amniofusion: What is this?
Technique in which a volume of warmed, sterile, normal saline or Ringer lactate solution is introduced into the uterus transvervically through an intrauterine pressure catheter to increase the volume of fluid when oligohydramnios is present . Used during labor
160
Amniofusion: Why is this done?
To change the relationship of the tuerus, placenta, cord, and fetus to improve placental and fetal oxygenation
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Amniofusion: What does an isotonic glucose-free solution do?
Help to cushion the umbilical cord to prevent compression or dilute thick meconium
162
Amniofusion: What is this indicated for?
Variable decelerations due to cord compression, oligohydramnios due to placental insufficiency, postmaturity or rupture of membranes, preerm labor and thick meconium fluid.
163
Amniofusion: When would this not be indicated?
Vaginal bleeding of unknown origin, umbilical cord prolapse, amnionitis, uterine hypertonicity
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Amniofusion: What happens after consent obtained?
Vaginal exam is performed to evaluate for cord prolapse, establush dilation, and confirm presentation
165
Amniofusion: What fluid is infused?
250-500 mL of warmed normal saline or lactated ringer solution over 20-30 mins.
166
Amniofusion: What should you tell woman who is receiving an amnioinfusion?
Explain need for procedure
Inform that mother will remain in bed rest
Assess mothers VS
Maintain I/O
Assess duration/intensity uterine contractions
167
Forceps or Vacuum-Assisted Birth: When are outlet forceps used?
When the fetal head is crowning
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Forceps or Vacuum-Assisted Birth: When are low forceps used?
When fetal head is at +2 station or lower but not yet crowning
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Forceps or Vacuum-Assisted Birth: What is a vacuum extractor?
Cup-shaped instrument attached to a suction pump used for extraction of the fetal head. Placed against occiput of fetal head. Pump create neegative traction and uses until fetal head emerges
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Forceps or Vacuum-Assisted Birth: Why would these be used?
Because of prolonged 2nd stage of labor, distressed FHR pattern, failure to rotat, and descent in the pelvis.
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Forceps or Vacuum-Assisted Birth: What trauma may be caused to mother?
Laceration of the cervix, vagina or perineum, hematoma, extension of episiotomy incision into the anus, hemorrhage, and infecion
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Forceps or Vacuum-Assisted Birth: Potential newborn trauma?
Ecchymoses, facial/scalp laceration, facial nerve injury, cephalhematoma, and caput succedaneum
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Forceps or Vacuum-Assisted Birth: Criteria for this to e applied?
Membranes ruptured, cervix completely dilated, fetus vertex and engaged.
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Forceps or Vacuum-Assisted Birth: How to prevent using these techniques?
Frequently change client position, encourage ambulation, remind to empty bladder, and provide adequate hydration
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Cesarean Birth: What two incisions may be used?
Classic (vertical) or low transverse (horizontal) (most common today)
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Cesarean Birth: What increased risks may the client have because of this?
Infection, hemorrhage, aspiration, pulmonary embolism, UTI, thrombophlebitis, and paralytic ileus
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Cesarean Birth: What may cause a woman to want this?
Active genital herpes, fetal macrosomia, fetopelvis disproportion, prolapsed umbilicl cord, and previous classic uterine incision or sccar
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Cesarean Birth: What preoperative procedures may be done for this?
Prepare the surgical site
Start IV infusion for fluid replacement
Insert an indwelling foley catheter
ADminister any preop medsd
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Cesarean Birth: How often will VS be assessed?
Every 15 mins for first hour
30 mins for next hour
Then every 4 hours if stable.
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Cesarean Birth: Wy would you provide early ambulation?
To prevent respiratory and cardiovascular problems and to promote peristalsis
181
When reviewing the medical record of a client, the nurse notes that the woman has a condition in which the fetus cannot physically pass through the maternal pelvis. The nurse interprets this as:
Cervical insufficiency
Contracted pelvis
Maternal disproportion
Fetopelvic disproportion
Fetopelvic Disproportion
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The nurse would anticipate a cesarean birth for a client who has which active infection present at the onset of labor?
Hepatitis
Herpes simplex virus
Toxoplasmosis
Human papillomavirus
Herpes
183
After a vaginal examination, the nurse determines that the client’s fetus is in an occiput posterior position. The nurse would anticipate that the client will have:
Intense back pain
Frequent leg cramps
Nausea and vomiting
A precipitous birth
Intense back pain
184
When assessing the following women, which would the nurse identify as being at the greatest risk for preterm labor?
Woman who had twins in a previous pregnancy
Client living in a large city close to the subway
Woman working full time as a computer programmer
Client with a history of a previous preterm birth
Client with history of previous preterm birth
185
The rationale for using a prostaglandin gel for a client prior to the induction of labor is to:
Stimulate uterine contractions
Numb cervical pain receptors
Prevent cervical lacerations
Soften and efface the cervix
Soften and efface the cervix
186
A client who was in active labor and whose cervix had dilated to 4 cm experiences a weakening in the intensity and frequency of her contractions and exhibits no further progress in labor. The nurse interprets this as a sign of:
Hypertonic labor
Precipitate labor
Hypotonic labor
Dysfunctional labor
Hypotonic Labor
187
The nurse is developing a plan of care for a woman experiencing dystocia. Which of the following nursing interventions would be the nurse’s high priority?
Changing the woman’s position frequently
Providing comfort measures to the woman
Monitoring the fetal heart rate patterns
Keeping the couple informed of the labor progress
Monitoring the fetal heart rate patterns
188
The nurse is caring for a woman experiencing hypertonic uterine dystocia. The woman’s contractions are erratic in their frequency, duration, and of high intensity. The priority nursing intervention would be to:
Encourage ambulation every 30 minutes
Provide pain relief measures
Monitor the Pitocin infusion rate closely
Prepare the woman for an amniotomy
Provide pain relief measures
