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Intrapartum 2 Flashcards

1
Q

Maternal Assessment during Labor and Birth:

a vaginal examination or ultrasound assessment is performed to assess cervical dilation ONLY IF

A
  • If there is no vaginal bleeding upon admission.
  • After which it is monitored periodically as necessary to identify progress.
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2
Q

WHAT IS ASSESSED DURING labor/birth

A
  • Woman-centered care
  • Upon Admission
  • Vital Signs: Temp, BP, HR, RR
  • Pain & Response to interventions
  • Vaginal Exam- Only if NO vaginal bleeding
  • Assess cervical
    -Dilation
    -Effacement
    -Position
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3
Q

Vaginal Assessment IS DONE every

A

4 hrs

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4
Q

Vaginal assessment includes:

A
  • cervix: dialation 0-10cm
  • effacement 0%, 50%, or 100%
  • Fetal: position, station, skull
  • Rupture of membranes- PRIORITY CHECK
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5
Q

UNRUPTURE of membranes will feel like

A

soft bulge

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6
Q

Why is Rupture of membranes important to check ?

A
  • identify FHR deceleration indicating cord compression secondary to cord prolapse.
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7
Q

To confirm Rupture of membranes what test is done?

A
  • Nitrazine yellow dye swab is used on sample of fluid from vagina.
  • POS rupture = swab turns blue-green with PH 6.5 - 7.5 (amniotic fluid is more ALKALINE)
  • NEG rupture = swab remains yellot to olive green with ph 5-6.
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8
Q

AFTER rupture of membranes, signs of intrauterine infection sinclude

A
  • maternal fever
  • fetal and maternal tachycardia
  • foul odor of vaginal discharge
  • increase in white blood cell count
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9
Q

Assessing Uterine contractions:
When PALPATIONIng uterine describe how it feels.

A

Place pads of your fingers on fundus & describe how it feels:
* Tip of nose (mild)
* Chin (moderate)
* **Forehead (strong) **

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10
Q

What intensity (in mm/Hg) is needed for cervical dialation to start

A
  • 30 mm Hg or greater are needed for cervical dilation
  • during labor: intensity reaches @ 50 to 80 mm Hg.
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11
Q

Maneuver 1:
soft and irregular feel on fundus is

A

the buttocks

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12
Q

Maneuver 2:
hard and smooth and round feel on fundus is

A

the head

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13
Q

Maneuver 2:
finding fetal back should feel

A

hard and smooth

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14
Q

Maneuver 3:
If presenting part in symphysis pubis is ROUND, FIRM, AND ballattable

A

the head

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15
Q

Maneuver 3:
If presenting part in symphysis pubis is soft and irregular

A

the buttocks.

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16
Q

Manuever 4:

(turn facing moms feet for this step only)
if palpate a hard area on OPPOSITE SIDE Of fetal back fetus is in

A

flexion - this is what we want.

hard area on opposite side of fetal back that means you have touched its chin

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17
Q

Manuever 4:

(turn facing moms feet for this step only)
if palpate a hard area on SAME SIDE of fetal back then fetus is in

A

Extension - area palpated is the occiput (back of head)

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18
Q

cultural considerations with pain:

  • Placing a hatchet or knife under the bed – cuts pain
A

APPALACHIAN culture

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19
Q

cultural considerations with pain:
* Moms at birth

A

Asian, Latina, Orthodox Jew

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20
Q

cultural considerations with pain:
* remain quiet

A

Cherokee, Hmong, Japanese

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21
Q

MOM non-coping signs

A
  • crying/fear
  • no focus or concentrated
  • panicked during contractions
  • jitteriness
  • clawing/biting
  • tense
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22
Q

Coping with labor:

Nurse should observe for

A
  • cues for 15-30 mins and throughout labor
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23
Q

Nonpharmacologic measures include

A
  • Continuous Labor Support - Assisting
  • hydrotherapy- tub
  • ambulation and position change (q30 mins)
  • acupuncture and acupressure
  • patterned-paced breathing (pursed lips)
  • Attentionc focus/imagery
  • massage/effleurage (stroking of abdomen)
  • heat or cold applications
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24
Q

Hydrotherpy only to be used when pt is

A

in active labor >6 cm dialated

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25
Pharmacologic Measures for pain relief during labor includes
* Systemic, Regional, or Local Anesthesia * Neuraxial Analgesia/Anesthesia - Epidural Or Intrathecal
26
System Analgesia
* adminsitered via: PO, IM, IV * Most important complication respiratory depression
27
Systemic Analgesia: opioids given CLOSE TO TIME OF BIRTH can cause
CNS depression in newborn
28
Reversal drug of Opioids
naloxone (narcan)
29
categories of drugs used in SYSTEMIC ANALGESIA
1. **Opioids**: butorphanol, nalbuphine, meperidine, morphine, fentanyl 2. **Ataractics**: hydroxyzine, promethazine, prochlorperazine 3. **Benzodiazepines**: diazepam, midazolam
30
INHALED ANALGESIC
* Nitrous oxide “Laughing Gas” * 50% nitrous oxide gas * 50% oxygen * using a mask or mouthpiece * **Maternal control-self administered**
31
NITROUS OXIDE SIDE EFFECTS
* N/V, dizziness, dysphoria * **NO fetal abnormalities** to its use
32
**Regional Anesthesia** is the LOSS OF PAIN SENSATIoN below
**T8 - T10** * Without loss of consciousness * With or without added opioids
33
DIFFERENT TYPES OF **REGIONAL ANESTHESIA**
* Epidural Block * Combo – Spinal/Epidural * Local Infiltration (ONLY on site) * Pudendal block (in perineum) * Intrathecal (spinal) Anesthesia/Analgesia
34
Type of anesthesia: INJECTIONof a local anesthetic agent and an opioid analgesic agent INTO THE LUMBAR EPIDURAL SPACE
EPIDURAL ANALGESIA
35
CONTRAINDICATIONS for Epidural analgesia
* H/O spinal surgery or abnormalities * Coagulation defects * **Cardiac disease** * **Obesity** * Infections * **Hypovolemia** * On anticoagulation
36
type of anesthesia: * Combines a spine and epidural anesthesia * one needle in epidural space and other in subarachnoid space * Opioid WITHOUT anesthesia
Combo spinal and epidural analgesia
37
Advantages of COMBO
* Works faster (3 to 5 mins) * Allows ambulation **“walking epidural”** * Lower incidence of urinary retention
38
TYPE OF ANESTHESIA: * Local anesthetic in perineal area before an episiotomy * Doesn’t alter pain of contractions * Doesn’t cause side effects
Local infiltration (numbs immediate area)
39
type of anesthesia: * Local anesthetic in pudendal nerve * Pain relief - lower vagina, vulva, & perineum
Pudendal Nerve Block
40
local infiltration and Pudendal nerve block INDICATIONS
* **2nd stage of labor** * **Episiotomies** (cut (incision) made in the tissue between the vaginal opening and the anus during childbirth. This area is called the perineum) * **Birth with forceps or vacuum extraction** * Takes 15 mins to work * **NO common maternal or fetal complications**
41
TYPE OF ANESTHESIA: * Anesthetic agent with or without opioids * INTO Subarachnoid space * INTRATHECAL- into cerebral spinal fluid * For emergent or elective C/S
SPINAL (INTRATHECAL) ANESTHESIA
42
Compared to epidurals, SPINALs are
* Easy to administer * Need smaller med. Vol. * Rapid onset pain relief * Less - Newborn Respiratory Depression * NO motor blockade
43
ADVERSE REACTIONS TO SPINAL ANALGESIA
* HYPOTENSION * SPINAL HEADACHE
44
TYpe of anesthesia: * reserved for ER cesarian births- no time for spinal/epidurals * OR if woman contraindicates for regional anesthesia * RAPID loss of consciousness
GENERAL ANESTHESIA
45
How is GENERAL ANESTHESIA administered
* IV or inhalation * **UNCONSCIOUS followed by MUSCLE RELAXANT & INTUBATION**
46
Complications with General anesthesia
* fetal depression * maternal comiting & aspiration
47
Nursing considerations: Antacids to administer during General anesthesia to REDUCE GASTRIC ACIDITY
* **Nonparticulate (clear) ORAL antacid:** Bicitra or sodium citrate OR * **Proton pump inhibitor:** protonix as ordered
48
Do ALL anesthetic agents cross placental barrier and affect fetus?
YES
49
ADmission history: **MAIN things** that nurses can do during admission assessment for pregnant women.
* EDD, VS, GTPAL * perform leopold's * perform vaginal exam * assess & interpret FHR to contractions * Fundal height measurement
50
Labs needed include
* UA * Blood Type & RH * Syphilis * Hep B * HIV * Drug Screening * Group B Strep
51
RX GIVEN AT ONSET OF LABOR OR ROM (rupture of membrances)
PCN (penicillin)
52
What is an episiotomy
a cut (incision) through the area between your vaginal opening and your anus to provide MOER SPACE to the presenting fetus heaad.
53
Nursing interventions: During 1st stage of labor
* Provide clear fluids * Maintain parenteral fluids * Keep perineal area clean and dry * Check on bladder status q 2 hr. & encourage voiding * Encourage maternal movement
54
Nursing interventions: During 2nd stage of labor
IF no complication= nurses dont control this stage rather empower mom * direct mom towards effective pushing positions * perineal lacerations occur- extent of lacerations is defined by its **DEPTH**.
55
PERINEAL lacerations: 1st degree
laceration extends through the skin
56
Perineal lacerations: 2nd degree
laceration extends through the muscles of the perineal body (muscles)
57
Perineal lacerations: 3rd degree
Through anal sphincter muscle
58
Perineal lacerations: 4th degree
involves anterior rectal wall
59
**SIGNS** of 2nd stage of Labor
* incr of bloody show * rectal or perineal pressure * crowning ( see babys head)
60
2nd stage of labor begins and ends when
* Begins with cervical completion * Ends with birth of the infant
61
Once fetal head emerges: Birth attendant explores fetal neck for nuchal cord if YES
cord is slipped OVER HEAD
62
AFTER HEAD DELIVERY
* Birth attendant suctions mouth FIRST & nose SECOND * umbilical cord is double clamped & cut
63
WHEN does 3rd stage of labor occur
delivery of baby to delivery of placenta
64
3 IMPORTANT HORMONES PLAY A PART IN 3RD STAGE OF LABOR
Oxytocin endorphins (cause analgesic effect) adrenaline
65
The hormone oxytocin causes
* uterine contractions * helps the woman enact instinctive mothering behaviors such as holding the newborn close to her body and cuddling the baby.
66
CONTINUATION of regular contractions does what
* Leads to decrease in uterine size * Helps with placental separation
67
Nurses during 3rd stage of labor need to observe s/s of placental separation which include
* Firmly contracting uterus * Change in uterine shape from discoid to globular ovoid * Sudden gush of dark blood from vaginal opening * Lengthening of umbilical cord protruding from vagina
68
NURSES CRUCIAL ROLE IN 3RD STAGE OF LABOR
* To protect natural hormonal process by * Ensuring unhurried & uninterrupted contact between mom & baby after birth * Providing warmed blankets to prevent shivering * Allowing skin-to-skin contact with initial breastfeeding.
69
SOFT AND WEAK UTERUS AFTER delivery most common cause of Post-partum hemorrhage
uterine atony (uterine tone)
70
Nurses during 4th stage of labor should check V/S in the **1st hour of birth every**
q 15 min then q 30 min * BP should remain stable * Close obsevation for hemorrhage
71
Baby head-to-toe VS are done every
15 mins until stable
72
4th stage of labor: Assess
* perineal and vaginal area * lochia amount: blood loss after birth * Bladder- if full, displaces fundus to the right of midline.
73
4th stage of labor: assessing fundus
* needs to remain firm= prevent excessive postpartum bleeding * feels/size/consistency of a GRAPEFRUIT * located in midline and below umbilicus * if boggy- massage it until it is firm!!!!!

TEST 2 (6 decks)

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