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NURS 320 - Final > Intrapartum > Flashcards

Intrapartum Flashcards

(78 cards)

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1
Q

What are the possible routes of systemic analgesia? (2)

A
  • IV
  • IM
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2
Q

What types of opioids are used for labor analgesia? (5)

A
  • demerol
  • morphine
  • fentanyl
  • stadol
  • nubain
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3
Q

When must opioids be given for labor analgesia?

A

Before 3 cm

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4
Q

It is important to hold ______ in fetal distress situations

A

Systemic analgesia

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5
Q

What is the most frequently used narcotic for labor pain due to its high potency and safety for the fetus?

A

butorphanol (Stadol)

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6
Q

What is the primary side effect of nalbuphine (Nubain)?

A

Dizziness / drowsiness

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7
Q

Describe the primary nursing intervention associated with nalbuphine (Nubain)

A

Provide bedpan - patient should NOT get out of bed

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8
Q

What is the primary benefit of meperidine (Demerol)?

A

Crosses placenta within 90 seconds (rapid pain relief)

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9
Q

When should systemic analgesia be given for primigravida?

A

After start of active labor (> 4 cm) - will slow down labor if given too early

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10
Q

A ______ is the next choice if an epidural block cannot be used

A

Paracervical block

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11
Q

When is a paracervical block used?

A

First stage of labor

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12
Q

What type of pain is relieved by a paracervical block?

A

Cervical dilation pain

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13
Q

When is a pudenal block used?

A

Second stage of labor

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14
Q

What type of pain is relieved by a pudenal block?

A

Vagina / perineum pain from pushing - does NOT block contraction pain

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15
Q

When can an epidural block be given?

A

After start of active labor (> 4 cm)

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16
Q

Where is placement for an epidural block?

A

L3 - L4

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17
Q

What is the most common local epidural agent?

A

Bupivicaine

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18
Q

What are the contraindications of an epidural block? (2)

A
  • Thrombocytopenia
  • Uncorrected hypovolemia
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19
Q

Where is an epidural block injected in relation to the spinal cord?

A

OUTSIDE of the dura - should NOT see CSF fluid during injection

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20
Q

What are the adverse effects of an epidural block? (4)

A
  • Inadvertent spinal
  • Bladder distention
  • Prolonged second stage
  • Maternal hypotension
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21
Q

What is an inadvertent spinal?

A

Accidental injection of anesthetic into dura mater - causes leakage of CSF

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22
Q

What is the primary sign of an inadvertent spinal?

A

Headache

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23
Q

How is a headache prevented after an inadvertent spinal?

A

Lay flat for several hours (not fully supine)

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24
Q

Why can bladder distention occur due to an epidural block?

A

Patient is unable to sense full bladder - void Q 2 hours using catheter

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25
Why can the second stage of labor become prolonged due to an epidural block?
Patient is unable to sense need to push - discontinue epidural
26
What is the primary nursing intervention used to prevent maternal hypotension during labor?
IV fluid pre-load (500 - 1000 cc bolus BEFORE epidural)
27
What is the most common drug used to prevent maternal hypotension during labor?
ephedrine
28
Describe the function of ephedrine
Vasoconstriction (except uterine arteries)
29
What is the most important vital sign to monitor after administration of an epidural block?
BP - monitor for maternal hypotension
30
Which type of anesthesia is most common for c-section delivery?
Spinal anesthesia
31
Where is placement for spinal anesthesia?
L3 - L4
32
Where is spinal anesthesia injected in relation to the spinal cord?
INTO the dura - SHOULD see CSF fluid during injection
33
Which type of anesthesia is used for an emergency c-section / fetal distress?
General anesthesia
34
What is the external cephalic version?
External manipulation of the fundus to rotate the fetus in breech / transverse presentation
35
When can the external cephalic version be done?
> 37 weeks (risk of triggering labor)
36
______ is needed for external cephalic version
Adequate amniotic fluid volume
37
What is the primary nursing intervention prior to the external cephalic version?
Terbutaline SQ injection
38
A Bishop Score (measure of cervical readiness) of ______ is considered favorable for successful induction
≥ 9
39
What is the purpose of stripping the membranes?
Separates amniotic membranes from uterus to release prostaglandins
40
Describe cervical ripening for induction of labor
cervidil is placed into the vagina to soften / efface the cervix
41
What color should cervidil be when removed?
Brown
42
What are the advantages of cervical ripening? (3)
- Easily removed - Decreased need for oxytocin - Shorter labor - birth within 24 hours
43
What are the complications associated with cervical ripening? (2)
- Uterine hyperstimulation - Hemorrhage
44
How is pitocin mixed with IV solution?
10 units of pitocin + 1000 cc of LR
45
In what cases should pitocin be discontinued? (2)
- Fetal distress - Uterine hyperstimulation
46
Describe uterine hyperstimulation
> 5 contractions in 10 min with no uterine relaxation between contractions
47
What is an amniotomy?
Artificial rupture of membranes (AROM) to accelerate the first stage of labor
48
The patient should be at least ______ cm dilated for an amniotomy
2
49
What some possible reasons for conducting an amniotomy? (3)
- Placement of EFM scalp electrode - Fetal scalp blood sampling - Amniotic fluid sampling
50
What is the primary advantage of an amniotomy?
Causes contractions without risk of uterine hypertstimulation
51
What is the primary concern associated with an amniotomy?
Infection - birth must occur within 24 hours
52
What 3 fetal assessments MUST be made prior to an amniotomty?
- Fetal presentation - Fetal position - Fetal station
53
What is an amnioinfusion?
Infusion of warm NSS / LR into uterus via catheter to increase fluid
54
What are the advantages of an amnioinfusion? (2)
- Prevents variable decelerations - Dilutes thick meconium (prevents meconium aspiration)
55
Describe the education associated with vacuum extraction
Head trauma will resolve within 48 - 72 hours
56
What is caput succedaneum?
Clear fluid accumulation around the fetal skull
57
What is cephalohematoma?
Blood accumulation around the fetal skull
58
When can an epiostomy be performed?
Just before birth - typically during crowning
59
What are the advantages of a midline epiostomy? (3)
- Decreased blood loss - Decreased scarring - Decreased postpartum pain
60
What are the advantages of a mediolateral epiostomy? (2)
- Creates larger vaginal opening - Decreased risk of laceration extending into anal sphincter
61
Why might an epiostomy be used for cardiac / pre-eclamptic patients?
To prevent HTN from bearing down
62
What are the indications of a cesarean delivery? (5)
- CPD - Cord prolapse - Genital herpes - Breech / transverse lie - Placenta previa / abruptio placenta
63
Describe the 3 types of c-section incisions
- Low transverse / "bikini" - preferred, future vaginal delivery possible - Vertical - future vaginal delivery unlikely - Classical - future vaginal delivery impossible
64
Describe the consideration regarding fetal lungs in a cesarean delivery compared to a vaginal delivery
Since the fetal chest is not squeezed, lungs may be fluid filled / require suctioning - can cause transient tachypnea of the newborn (TTN)
65
______ refers to the placenta deeply embedded into the uterine wall - becomes retained during labor and causes serve hemorrhage
Placenta accreta
66
______ refers to the umbilical cord implanted at placental margin rather than center of the placenta
Battledore placenta
67
______ refers to the amnion and chorion folded back over the edge of the placenta
Circumvallate placenta
68
______ refers to the placenta containing extra accessory lobes - harmless
Succenturiate placenta
69
What is cord prolapse?
Umbilical cord descends below the fetus after ROM
70
What is the most common cause of cord prolapse?
Breech position
71
Cord prolapse causes ...
Bradycardia due to cord compression
72
Describe the treatment of cord prolapse (2)
- Leave hand in vagina to prevent compression - Emergency c-section
73
Describe McRoberts maneuver
Thighs flexed up to abdomen to increase angle of pelvic outlet
74
What is shoulder dystocia?
Fetal shoulder gets stuck behind symphysis pubis
75
______ is a network of nerves that run from the spine through the shoulder and to the tips of the fingers
The brachial plexus
76
What brachial plexus injury can result from shoulder dystocia?
Erb's palsy
77
What is Erb's palsy?
Arm paralysis due to injury of cranial nerves 5 and 6
78
If the fetal head is unengaged early in labor in primigravida, what condition should the nurse suspect?
Cephalopelvic disproportion (CPD)

NURS 320 - Final (19 decks)

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