Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NURB 3230 > mgmt of L&D risks > Flashcards

mgmt of L&D risks Flashcards

(75 cards)

Start Studying
1
Q

maternal risk factors for dystocia

A

-short stature
-overweight
-CPD
-pelvic obstructions/contracture
-40yo or greater
-uterine abnormalities
-fatigue, fear, dehydration
-hyper/hypotonic uterus
-inappropriate timing of analgesics/anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

fetal risk factors for dystocia

A

-macrosomia
-malpresentation/malposition
->1 fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

power problems

A

-protracted disorders
-arrest disorder
-precipitate labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

protracted disorders

A

-longer active phase dilation
-delayed fetal descent/failure to descend
-interventions: c-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

arrest disorder

A

-complete cessation of progress
-dilation stops
-interventions: c-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

precipitate labor

A

birth 3 hours or less from the start of ctx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

risks to infant and mother during precipitate labor

A

infant
-head trauma
-nerve damage
-hypoxia
-intracranial hemorrhage

mother
-lacerations
-tissue trauma
-uterine rupture
-postpartum hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

interventions for precipitate labor

A

-don’t leave the client, call for help
-assist to lateral position, apply O2
-continuous monitoring, pain mgmt, provide reassurance
-dont attempt to stop delivery
-apply light pressure to perineum/fetal
-support the infant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

shoulder dystocia

A

-fetal shoulder is stuck after the head is delivered
-call for help immediately
-place mother in McRobert’s position
-C/S if no success with position changes
-document total time from head to body delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

risks for fetus and mother when removing baby with shoulder dystocia

A

fetus: hypoxia, clavicular fracture, brachial-plexus injury
mother: hemorrhage, uterine rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

risks for baby with shoulder dystocia

A

-LGA
-maternal previous soldier dystocia
-post date babies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

passenger/positon problems

A

-multiple gestation
-macrosomia
-malpresentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

multiple gestation

A

-infertility treatments: IVF, ovarian stimulating drugs
-risk for: PPH d/t uterine atony

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

macrosomia

A

-fetal weight >4000 g (8lb 13oz)
-risk for: PPH, shoulder dystocia, soft tissue lacerations, fetal injuries
-may require an elective c/s delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

malpresentation

A

-OP, longer labor/pushing phase
-face/brow, may require c-section
-breech, c/s delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

passageway problems

A

-pelvic shape: favorable?
-CPD: cephalopelvic disproportion
-maternal swelling: soft tissues, cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

psyche problems

A

-dystocia caused by hormones released d/t anxiety
-increased fear, tension, pain… decreases contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

external version

A

attempt to turn a malpositioned fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

external version contraindications

A

-uterine anomalies
-previous c/s
-cpd
-placenta previa
-oligohydramnios
-multifetal gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

external version risks

A

-prolapsed cord
-compression
-placental abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

mgmt of external version

A

-assess fetal status prior and after procedures
-vitals, watch for hypotension
-assess for ROM, bleeding fetal mvmt
-IVF and tocolytics, if ordered
-rhogam if RH-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

preterm labor (PTL)

A

early onset labor (20-37 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

PTL risk factors

A

-anything that can cause harm to fetus
-risky behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

PTL assessment findings

A

-persistent low backache
-UTI
-vaginal bleedings
-ctx
-ROM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
testing for PTL
-cervical length measurement -BPP -NST -early ID is key!!!!!!!!
26
PTL tx
-mg sulfate, stops hemorrhage and contractions -monitor for pulmonary edema and toxicity
27
PTL mgmt
-continuous monitoring, initiate seizure precautions -documentation q hr -VS, I&O, FHM, DTRs, total IVF, neuro checks -toxicity: stop infusion, stat lab, call dr., calcium gluconate
28
s/s of toxicity
-loss of DTR -urine output <30mLs/hr -resp. rate <12/min -blurred vision -chest pain -lethargy -slurred speech -h/a -n/v -difficulty breathing
29
drugs used for PTL tx
-nifedipine (Procardia): inhibits calcium from smooth cells, monitor bp & hr, maternal tachycardia -indomethacin (Indocin): NSAID blocks prostaglandin production, monitor for pulmonary edema & GI stress -betamethasone (Celestone): promotes fetal lung development, 24-34 weeks, IMx2 24 hrs apart, monitor for pulmonary edema, hypoglycemia, and infection
30
intrauterine fetal demise (IUFD) assessment
-US, confirms absences of fetal movement and cardiac activity -hx of decreased fetal movement -requires induction of labor
31
IUFD mgmt
-provide support -assist with grieving -CLS -prepare parents for appearance -allow unlimited time with stillborn -refer to support groups -therapeutic communication
32
post-term pregnancy
-pregnancy longer than 42 weeks -placenta ages and decreases perfusion -oligohydramnios, increases risk for cord compression, fetal hypoxia -high risk for fetal distress!!!!!!!
33
risks for post term pregnancy
-macrosomia, shoulder dystocia, CPD -meconium aspiration-> fetal distress -PPH d/t uterine atony
34
mgmt of post term pregnancy
-fetal monitoring -update nursery staff, prep for resuscitation -support anxiety
35
labor induction
medically initiation of labor
36
labor augmentation
mother's labor has stalled or needs to be sped up via oxytocin or AROM methods
37
labor induction & augmentation contraindications
-placenta previa -transverse fetal lie -umbilical cord prolapse -previous classical C/S incision -active HSV -previous myomectomy -poor bishop score
38
bishop score
-used to determine maternal readiness for labor at 39 weeks or greater -evaluates through scoring: dilation, effacement, station, cervical consistency, position of the cervix
39
cervical ripening
-increases cervical readiness for labor -softens, effaces, and dilates the cervix -performed in conjunction to labor induction or can be performed alone -mechanical and chemical ripening
40
mechanical ripening
-balloon dilation -membrane stripping -amniotomy -hygroscopic dilators (seaweed)
41
chemical ripening
-misoprostol (Cytotec) -dinoprostone (Cervidil) -oxytocin (Pitocin) -can cause hyperstimulation which can lead to fetal distress
42
oxytocin (pitocin)
-used for induction and augmentation of labor, stimulates ctx -iv titration -hospital policy and MD order
43
mgmt of oxytocin (pitocin)
-obtain NST and SVE prior to starting infusion -continuous FHM, VS q 15min -document -call MD for any fetal distress, d/c if fetal distress occurs or uterine hyperstimulation (<2min apart), and tetanic ctx (<90 seconds) -educate on s/s to report
44
amniotomy
-AROM -deliberate puncture of the amniotic sac to release fluid -MD only
45
risks of amniotomy
-umbilical cord prolapse -infection (maternal or fetal) -fetal distress
46
mgmt of amniotomy
-perform SVE prior, if ballotable can have cord relapse -continuous FHM -assess amniotic fluid, ongoing until delivery -obtain temp q 2hr, risk of infection
47
meconium staining
-amniotic fluid is black, brown, green, or yellow, can be thick or thin -loss of sphincter control d//t umbilical cord compression, fetal hypoxia, or fetal distress
48
meconium staining mgmt
-document findings -notify: MD, RT, neonatal team -suction mouth/nose when head is delivered -assess RR, HR, tone
49
fetal distress
-FHR <110 or >160 -decreased or absent variability -recurrent decelerations -fetal activity: hyperactive or inactive
50
fetal distress interventions
-continuous monitoring, notify MD, call for help -maternal position change, left or side lying -IVF bolus LR -d/c oxytocin -O2 via facemask at 10L/min -give terbutaline if ordered (hold if maternal hr >120, or for bleeding) -prepare for c/s
51
operative delivery
-assisted delivery of fetus head -vacuum assisted -ineffective pushing, fetal distress
52
mgmt of operative delivery
-lithotomy position -empty bladder -FHM -document pop offs, release of vacuum extraction
53
infant monitoring with operative delivery
-lacerations -cephalohematoma -caput -bruising -facial nerve palsy -subdural hematomas
54
maternal monitoring with operative delivery
-vag/cervical lacerations -hematoma -urinary retention -hemorrhage
55
cesarean delivery risks
-infection -hemorrhage -UTI -DVT -paralytic ileus -atelectasis
56
indications of c/s
-high risk pregnancy -malpresentation -abnormalities (maternal or fetal) -multiple gestation -previous c/s -OB emergencies
57
preop care for c/s
-ensure consent -document time of decision by provider if not planned -IVF bolus to prevent hypotension -IV abx if non emergent -foley, scd, shave, baseline labs
58
TOLAC
-trial of labor after cesarean -attempt to deliver or be induced
59
VBAC
-vaginal birth after cesarean
60
ACOG guidelines for TOLAC and VBAC
-adequate pelvis -1 previous c/s delivery with low transverse incision -no other uterine scars or previous uterine rupture -OBGYN and anesthesia must be immediately available through active labor
61
contraindications to TOLAC/VBAC
-cervical ripening agents -previous classical incision, myomectomy -obesity, 40yo or greater, inadequate pelvis, inadequate staff/facility
62
mgmt of TOLAC & VBAC
-consent -educate on risks and benefits -document all interventions -continuous monitoring -ensure anesthesia, neonatal, and medical staff are aware of current status and prepared for emergency c/s if needed -advocate for pt
63
uterine rupture
-uterus tears at previous scar into the abdominal cavity, obstetrical emergency
64
uterine rupture risk factors
-uterine scars -prior molar pregnancy -placenta accreta/increta -cocaine/crack use -excessive uterine stimulation
65
uterine rupture s/s
-abrupt fetal distress or complete loss of FHTs -acute/continuous abdominal pain -vaginal bleeding, hematuria -irregular abdominal wall contour -loss of station/presenting part!!! -hypovolemic shock
66
umbilical cord prolapse
-umbilical cord protrudes through the cervix before presenting part -cord compression, compromised fetus
67
umbilical cord prolapse risk factors
-ballotable fetus during ROM -polyhydramnios -fetal malpresentation -prematurity
68
mgmt of umbilical cord prolapse
-immediately relive pressure off the cord- SVE, maternal position -call for help -prep for immediate c/s delivery
69
placental abruption
premature separation of the placenta, emergency
70
placental abruption risk factors
-pre-eclampsia -HTN -AMA -uterine rupture -trauma -smoking/drug use -external cephalic version
71
placental abruption assessment findings
-sudden vaginal bleeding (sometimes none) -rigid abdomen on palpation, extremely painful!!! -fetal distress -no relaxation between ctxs!!!!!
72
mgmt of placental abruption
-fetal monitoring -maintain iv access, IVF bolus -monitor maternal CV status, bleeding, pain, FHT -immediate c/s delivery
73
amniotic fluid embolism
-amniotic fluid particles of debris enters maternal circulation, obstructing pulmonary vessels -causes rapids resp. distress and cardiovascular collapse -obstetric emergency, rare but often fatal for mother and fetus
74
amniotic fluid embolism s/s
sudden hypotension, hypoxia, dyspnea, restlessness, cyanosis, pulmonary edema, tachycardia, DIC bleeding, petechiae/ecchymosis, uterine atony, sense of impending doom
75
mgmt of amniotic fluid embolism
-O2, IVF bolus LR -Immediate C/S delivery! -Maternal position change – side tilt -Continuous monitoring of CV status (VS) -CPR -Mainly supportive to maintain resp/cardio function -**Immediate recognition is key!

NURB 3230 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions