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XIO > Maternity week 4-2 > Flashcards

Maternity week 4-2 Flashcards

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1
Q

should dilate

A

1 cm an hour, or at least be progressing.

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2
Q

latent - how many cm? (latent is zero)

A

0-5 cm

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3
Q

active - how many cm?

A

6-10 cm

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4
Q

Induction of nulliparous patients who were induced after 37 weeks for nonmedical purposes,

A

doubled their chances of having a cesarean birth.

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5
Q

Hypertonic Uterus - what phase is prolonged? (are you hyper, or latent?)

A
  1. uterus never fully relaxes
  2. contractions ineffective
    3. prolonged latent phase (2-3cm)
    4. reduced placental profusion
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6
Q

Hypertonic Uterus - nursing management (not much but fluids)

A

Bedrest
Monitor fetal wellbeing
Assess for maternal infection
Promote adequate hydration
Pain management
Educate

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7
Q

Hypotonic uterus - at risk for what?

A

Hypotonic uterine dysfunction
1. poor quality and intensity
2. arrest of dilation & effacement
3. see this more in the active face of 1st stage (5-6cm)
4. at risk for PP hemorrhage***

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8
Q

hypotonic uterus - nursing management

A

Administer oxytocin
Assist with amniotomy
Continuous EFM
Assess for maternal/fetal infection
Educate

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9
Q

problems of power - Precipitate labor

A

Precipitate labor
1. birth <problems of power 3 hours from start of contractions
2. maternal injury
3. fetal traumatic & asphyxia insults

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10
Q

problems of power - Nursing Management

A

Closely monitor contractions & FHR
May administer tocolytics
Stay with patient
Inform Health Care Provider
Anticipate RN delivery

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11
Q

problems w/ passenger/position - Occiput Posterior Position (takes longer from the back)

A

Occiput posterior – face up
1. Labor usually longer
2. Maternal exhaustion
3. Extensive caput (fluid bulge on head)

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12
Q

problems w/ passenger/position - nursing management

A

Pain management
Intense back labor 1st stage
Encourage/Assist patient for position changes
Anticipate operative vaginal delivery (this is forceps or vacuum)
Educate

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13
Q

problems w/ passenger/position - Breech Presentation (frank is extended)

A

Breech – fetal buttocks, foot, or shoulder as presentation
1. Frank breech – buttocks present with legs fully extended
2. Complete breech – buttocks present with fetus in full flexion
3. Footling/incomplete breech – 1or 2 feet presenting with hips fully extended

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14
Q

problems w/ passenger/position - Breech Presentation - nursing management

A

Arrange ultrasound to confirm position
Assist with external cephalic version
Trial labor 4-6 hours for progress with unsuccessful version
Prepare for cesarean
Check with provider for Rhogam administration
Educate

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15
Q

Problems with PASSENGER/POSITION - Shoulder Dystocia

A

Shoulder dystocia – axis of shoulders prevent fetal descent after delivery of the fetal head.
1. fetal injury
2. maternal injury
3. risk for PP hemorrhage

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16
Q

Problems with PASSENGER/POSITION - Shoulder Dystocia - nursing management

A

Recognize and intervene immediately
McRobert maneuver along with suprapubic pressure (legs behind ears)
Call for help, OR notified
Patient position changes
Educate

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17
Q

Problems with PASSENGER/POSITION - face or brow

A

Face/Brow present at cervix
1. Poor force against cervix
2. Very rare
3.Associated with fetal anomalies (anencephaly - no brain)

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18
Q

Problems with PASSENGER/POSITION - face or brow - nursing management - prepare for what?

A

Brow presentation prepare for cesarean birth
EFM for fetal wellbeing
Emotional help patient fetal demise
Educate

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19
Q

breech risk factor - major

A

cord prolapse

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20
Q

consequences of breech

A

5,000 new cases of permanent “brachial plexus palsy” a year.

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21
Q

Problems with PASSENGER - Multiple Gestation

A

More than one fetus
1. higher perinatal mortality rate
2. uterine overdistention
3. Fetal hypoxia
4. Presenting fetus must be in vertex position

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22
Q

Problems with PASSENGER - Multiple Gestation - Nursing Management

A

EFM for contraction pattern, assess for hypotonia
Confirm gestational age
Notify OR of possible cesarean
Notify NICU of multiple gestation birth (esp if baby is less than 37 weeks)
Educate

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23
Q

percentage of twins

A

4%

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24
Q

Problems with PASSENGER - Macrosomia

Study These Flashcards
A

Macrosomia – neonate weight > 4,000 mg
1. fetopelvic disproportion
2, overdistended uterus
3. fetal injury
4. maternal injury
5. maternal fatigue

25
Problems with PASSENGER - Macrosomia - Nursing Management
Fetal wellbeing Pain management Inadequate contraction pattern/strength Anticipate vaginal operative delivery Educate
26
Problems with PASSAGEWAY - Pelvic or Canal Disproportion
Contraction of any 3 of the pelvic planes or swelling of soft tissues or placenta issues. Failure to descend with adequate contractions Obstruction of the birth canal
27
Problems with PASSAGEWAY - Pelvic or Canal Disproportion - Nursing Management
Assess for contraction pattern, cervical dilation Evaluate for bladder distention Evaluate for fecal interference Plan for cesarean birth Educate
28
Problems with PSYCHE - Psyche Dystocia
Sympathetic nervous system releases hormones. 1. catecholamines can create myometrium dysfunction 2. norepinephrine and epinephrine can lead to uncoordinated or increased uterine activity 3. increased fear & tension can reduce pain tolerance
29
Problems with PSYCHE - Psyche Dystocia - Nursing Management
Environment control Encourage partner participation Keep patient informed Encourage relaxation & comfort techniques Educate
30
All patients
Monitor vital signs EFM (external fetal monitoring) (10-15 min an hour to start, then 10-15 every 30 min, then continuous and need to document every 5 min) Assess fluid balance Provide physical & emotional comfort Empower your patient
31
Preterm Labor
Regular contractions causing cervical change at < 37 weeks gestation (and greater than 20 weeks). Sequelae of complications  Lifelong disabilities for many low back ache, discharge. how to tell if it's preterm labor: can do fetalfirbronectin test to check if it's really preterm labor, pH paper, ferning test,
31
preterm labor - Nursing Management
Prediction and prevention Administering Tocolytics – oral or IV Administering Antibiotics for presumed or confirmed infections Corticosteroids Lab work Educate
32
Post-Term Pregnancy - what is the main issue?
Pregnancy lasting > 42 weeks gestation Unknown etiology Incorrect dating Maternal injury- baby can recede also Fetal injury Hypoxia oligohydramnios main issue is placental deficiency***
33
Post-Term Pregnancy - nursing management
EFM Fetal wellbeing BPP Assessing maternal coping Anticipate induction Educate post maturity syndrome - loss of sub q fat and muscle and meconium stain due to prolonged time in utero***
34
Labor Induction (before 37 weeks)
Stimulation of uterine contractions by medical or surgical means before onset of labor. Maternal injury Fetal injury Medical reasons only
35
Labor Induction (before 37 weeks) - Nursing management
U/S fetal/placental positioning Non-stress test (EFM) Lab work Cervical exam (Bishop scoring) Non-pharmacological Cervidil or misoprostol Oxytocin IV Pain management Confirm gestational age Educate Informed consent
36
Oxytocin Administration - does it cross placenta?
Side effects – water intoxication, hypotension, & uterine hypertonicity Short half-life (1-5) minutes, works well for titration Use facility protocol Does not cross the placental barrier. Continuous EFM – document every 15" during active phase and every 5" during 2nd stage Fluid balance assessment
36
VBAC - what is the main concern? (Volcano rupture)
Vaginal birth after cesarean birth Contraindicated if they had a classic incision (up and down-rupture more often) Why did they need a cesarean? Contraindications Uterine rupture***this is the main concern
37
VBAC- Nursing Management
Continuous EFM Pain management Consent form signed Advise OR, Anesthesia of VBAC Educate
38
emergency c-section - how fast?
30 min from call to the cut (this is reportable)
39
Intrauterine Fetal Demise
Fetal death occurring > 20weeks but before birth Maternal injury Shock Induction wanted by most women
40
Intrauterine Fetal Demise - Nursing Management
EFM for contractions only Recovery care Environment Allow grieving Allow unlimited time with stillborn Provide baby mementos Follow facility guidelines Educate – support groups
41
Umbilical Cord Prolapse - when does this occur most often? *
Umbilical cord is either visualized or is palpated with cervical exam. Hypoxia for fetus can lead to asphyxia and death. 50% mortality rate Cesarean birth most commonly occurs when fluid breaks***
42
Umbilical Cord Prolapse - nursing management
Assessing EFM  Keep fingers in between cervix and head Call for help Trendelenburg or hands/knee position Immediate cesarean Educate
43
Placenta Previa
Complete or partial covering of the internal os by the placenta Placental separation with cervical dilation Hemorrhage/hysterectomy Fetal hypoxia and/or death Vaginal bleeding > 24 weeks gestation Vaginal U/S increase the accuracy of diagnosis, all placentas covering part of the cervix are placenta previa, those close to cervix are termed low-lying
44
Placenta Previa - nursing management
Partial – bedrest, EFM Measure blood loss Possible blood transfusion Check for sepsis Plan for cesarean delivery U/S for confirmation Administer Rhogam if indicated Administer steroids if indicated Educate
45
Uterine Rupture - main symptom* (ruptured my shoulder)
Catastrophic tearing of the uterus at a previous scar. Sudden fetal bradycardia Constant abdominal pain, vaginal bleeding, loss of fetal station, maternal hypovolemic shock Fetal morbidity or mortality shoulder pain is one main symptom***
46
Uterine Rupture - nursing management
Assess maternal history EFM Alert OR, anesthesia VBAC is being attempted Immediate cesarean/hysterectomy IV fluids for volume replacement Educate
47
Uterine Inversion
Uterine inversion occurs when the uterine fundus collapses into the endometrial cavity, turning the uterus partially or completely inside out. It is a rare complication of vaginal or cesarean delivery ●1st degree (also called incomplete) – The fundus is within the endometrial cavity ●2nd degree (also called complete) – The fundus protrudes through the cervical os ●3rd degree (also called prolapsed) – The fundus protrudes to or beyond the introitus ●4th degree (also called total) – Both the uterus and vagina are inverted.
48
Uterine Inversion - cont
Discontinue uterotonic drugs  Call for immediate assistance Establish adequate intravenous access and aggressive fluid/blood product resuscitation Do not remove the placenta Immediately attempt to manually replace the inverted uterus Give uterine relaxants (tocolytics) Prepare for surgical repair if the above interventions do not work. Oxygen Blood transfusions
49
Anaphylactoid Syndrome of Pregnancy
Amniotic fluid containing fetal particles enters maternal blood stream blocks pulmonary vessels. a.k.a. "amniotic fluid emboli". Rare and often fatal 1 in 40,000 births with 20% mortality rate (50% in the 1st hour) Fetal & Maternal hypoxic neurologic damage
50
Anaphylactoid Syndrome of Pregnancy - Nursing Management
Recognize symptoms – sudden onset of hypotension, cardiac collapse, and respiratory distress. Resuscitation, 100% oxygen IV fluids to maintain cardiac output/B/P Hemorrhage control Steroids for inflammatory process Seizure precautions Transfer to ICU Educate
51
Forceps
Metal instruments look like large tongs Lock so as not to crush fetal skull Outlet forceps & Low forceps Fetal injury Maternal Injury
52
Forceps - Nursing Management
EFM Mark application time, and amount of time for each pull. (work with contractions). Assess maternal tissues for damage & hemorrhage Assess fetal face and skull for soft tissue damage Educate
53
Vacuum Extractor
Soft cup placed on the occiput with negative pressure Fetal Injury Maternal Injury 2 types
54
Vacuum Extractor - Nursing Management
EFM Mark application time, and amount of time for each pull. (work with contractions). Mark pop-offs Assess for neonate injury Assess for maternal injury Educate
55
Cesarean Birth
Neonate born through an incision of the abdomen and uterine walls. Most common surgery in the U.S. Maternal complications Fetal injury
56
Cesarean Birth - nursing management
Preoperative blood work and education EFM Type & Cross Blood U/S for fetal & placental lie Informed consent Educate partner  Post-operative care – policy protocol Educate

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