OB exam 2 - Artificial Mgt of Labor

Question 1

advantages to labor induction

Answer 1

labor usually occurs in 24-48 hours

Question 2

disadvantages to labor induction

Answer 2

-contractions may be less gradual
-dysfunctional uterine contractions
-increased bloody discharge

Question 3

what needs to be down before induction of labor

Answer 3

-review pt, VS & obtain consent
-obtain reactive NST
-vaginal exam
-bishop score (the higher the score, the higher chance of a regular vaginal delivery)

Question 4

amniotomy (AROM) nursing interventions

Answer 4

-check fetal HR
-note date & time
-note fluid (COAT)
check temp every 2 hours

Question 5

what is a mechanically induction

Answer 5

cervical ripening
uses a foley bulb which puts pressure on the cervix just like the fetal head would causing prostaglandins to be released to soften the cervix

Question 6

advantages of cervical ripening

Answer 6

-cervical effacement
-shorter labor
-lower requirements for oxytocin
-vaginal birth is achieved within 24 hrs for most women
-incidence of C section birth is reduced

Question 7

risks of cervical ripening

Answer 7

-uterine hyperstimulation (for than 5 contractions in 10 mins)
-non reassuring fetal status
-higher incidence of PP hemorrhage
-uterine rupture

Question 8

what meds can be given to induce labor

Answer 8

misoprostol & dineprostone (prostaglandins)
given vaginally to stimulate contractions to thin cervix & oxytocin

Question 9

Cytotec

Answer 9

-dose is 25 mcg every 6 hours
-do not start pitocin induction within 4 hrs of last dose

Question 10

cervidil

Answer 10

-dose 10mg vaginal insert over 12 hours
-bedrest 2 hours after dose then may be up to bathroom (pat dry after voiding)
-to remove, pull string

Question 11

stripping of the membranes

Answer 11

-non pharm possible induction of labor
-separates the amniotic membranes from the lower uterine segment (can be uncomfortable & my see vaginal bleeding after)
-releases prostaglandins that stimulate contractions
only preformed by OB, nurse midwife or NP

Question 12

what are the uses of Pitocin (Oxytocin)

Answer 12

induction or augmentation (help labor along)

Question 13

risks of pitocin

Answer 13

-tachysystole contractions
-uterine rupture
-water intoxication (anti diuretic effect -> confusion, lethargic, vomiting and/or seizure)
-non reassuring fetal heart rate patterns

Question 14

what do you do if pt experiences water intoxication from pitocin induction

Answer 14

stop pitocin -> give 9% normal saline & give furosemide

Question 15

what needs to be done before administering pitocin

Answer 15

-need reactive NST
-vaginal score w/ bishop score
-check for foley bulb (can still use if in place)
-continuous fetal monitoring

Question 16

how is pitocin titrated

Answer 16

increase 1-2 mu/min every 30 mins

Question 17

what is a major risk if on pitocin for over 7 hours

Answer 17

post partum hemorrhage

Question 18

what happens if you give pitocin as a bolus

Answer 18

will cause continuous hard contractions and baby will not get perfused well or good oxygen caused a prolonged decel

Question 19

when does labor augmentation usually occur

Answer 19

during naturally occurring labors w/ hypotonic contractions

Question 20

what are the main ways of performing labor augmentation

Answer 20

-pitocin
-AROM

Question 21

amnioinfusion

Answer 21

warmed sterile NS or LR is placed into the uterus via IUPC

Question 22

reasons for an amnioinfusion

Answer 22

-replacement of lost or absent amniotic fluid
-repetitive variable decelerations w/ increasing intensity
-meconium dilution

Question 23

what should be occurring when an amnioinfusion is happening

Answer 23

water should be leaking back out
if no fluid noted and you have increased uterine resting tone, stop transfusion immediately

Question 24

what intervention is done to encourage water to come out after amnioinfusion is turned off because of no fluid return

Answer 24

try to move baby’s head bc it could be acting as a stopper or change maternal position

Question 25

factors for use of forceps assisted birth

Answer 25

-heart disease -acute pulmonary edema or pulmonary compromise -intrapartum infection -prolonged second stage -exhaustion -non reassuring fetal strip

Question 26

episiotomy

Answer 26

surgical incision of the perineum to enlarge the vaginal outlet -> two types are midline or mediolateral and can be classified from 1st degree to 4th degree

Question 27

mid forceps

Answer 27

fetal head engaged @ 0 station **used rarely bc higher reach**

Question 28

low forceps

Answer 28

fetal head +2 station

Question 29

outlet forceps

Answer 29

fetal head at perineum

Question 30

maternal risks to forceps use

Answer 30

-vaginal and cervical lacerations -periurethral lacerations -extension of a median episiotomy into the anus -anal sphincter injury -perineal edeam

Question 31

neonatal risks of forceps use

Answer 31

-ecchymosis, edema, along the sides of face -caput succedaneum or cephalhematoma -transient facial paralysis, brachial plexus -cerebral hemorrhage -fractures (clavicle) -elevated neonatal bilirubin levels

Question 32

nursing mgt for forceps assisted births

Answer 32

-explain procedure to women -monitor contractions -inform physician/CNM of contraction -encourage women to push during contraction -reassurance -document length of the forceps used (when applied & removed)

Question 33

Vacuum Extraction

Answer 33

-suction cup placed on fetal occiput -pump is used to create suction -traction is applied -fetal head should descend w/ each contraction -document length of time vacuum is used (put on, when pressure was applied, when pressure was turned off and when the vacuum was off)

Question 34

Cesarean Birth Indications

Answer 34

-complete placenta previa -CPD -Placental abruption -active genital herpes -umbilical cord prolapse -failure to progress in labor -tumors that obstruct the birth canal -breech presentation -previous C section -major congenital anomalies -non reassuring fetal status

Question 35

what is the usual uterine incision

Answer 35

low transverse

Question 36

what does a classical uterine incision or low vertical incision put mother at high risk for

Answer 36

a uterine rupture if vaginal delivery to tried **best practice is to have another c sections future children** & placenta previa bc placenta will want to attached to scarring

Question 37

nursing mgt before C section

Answer 37

-assist w/ epidural or spinal -unscheduled sections will get get pepcid & reglan to neutralize stomach acid as well as bicitra 30 mins before - monitor maternal VS -obtain fetal HR -insert foley -prepare abdomen and perineum -make sure all necessary personnel and equipment are present

Question 38

nursing mgt during C section

Answer 38

-position the women on the operating table (wedge for left tilt prior to delivery) -support the couple -instrument count (**before, during, after**) -time out (final checks for consent & safety) -document

Question 39

what do you document during a C section

Answer 39

incision, delivery of infant, APGARS, AROM if done, placenta extracted, EBL, & meds received

Question 40

nursing mgt after c section

Answer 40

-normal newborn post delivery care -monitor VS every 15 mins -check the surgical dressing -palpate the fundus and checking lochia -monitor intake & output -administrate IV Oxytocin

Question 41

visceral pain

Answer 41

slow deep pain that is dull or aching **very common in first stage of labor**

Question 42

somatic pain

Answer 42

sharp and localized and is like a burning or tearing feeling **common during the transition or pushing phase of labor**

Question 43

do pain meds cross through the placenta during labor

Answer 43

yes

Question 44

when are you going to give systemic analgesia

Answer 44

since fetal liver and kidney excretion is inadequate for metabolizing med you will do it when women is uncomfortable, in a well established labor pattern, contractions are occurring regularly, there is a significant during of contractions and contractions are moderate to strong in intensity

Question 45

contraindications for systemic analgesia

Answer 45

allergies hypotension non reassuring fetal strip **don't give systemic right before delivery bc could affect respiratory off baby**

Question 46

what medication can you not give to mothers with substance abuse issues

Answer 46

nalbuphine hydrochloride -> can initiate w/draw & cause neonatal abstinence syndrome

Question 47

major consideration for meperidine

Answer 47

naloxone (Narcan) does not reserve affects on the infant

Question 48

regional anestesia

Answer 48

temporary and reversible loss of sensation & prevents initiation and transmission of nerve impulse for pain control

Question 49

epidural disadvantages

Answer 49

-maternal hypotension (give LR bolus) -post delivery back pain -meningitis -cardio respiratory arrest -vertigo -onset of analgesia may not occur for up to 30 mins

Question 50

advantages to a spinal

Answer 50

-immediate onset of anesthesia -relative ease of administration -smaller drug volume

Question 51

disadvantages of a spinal

Answer 51

-high incidence of hypotension -greater potential for fetal hypoxia -short acting

Question 52

advantages to a combined spinal epidural

Answer 52

-spinal has a faster onset -meds can be added -low doses

Question 53

disadvantages to a combined spinal epidural

Answer 53

-higher incidence of nausea -pruritus

Question 54

nursing mgt prior to epidural/spinal placement

Answer 54

-assess maternal & fetal status -assess labor progress -start an IV and administer preload (warmed LR bolus) -help women into position

Question 55

nursing mgt for after an epidural/spinal

Answer 55

-monitor maternal & fetal VS -assess for hypotension & correct if needed -administer antiemetics as needed -monitor respiratory rate -assess bladder and catheterize if unable to void

Question 56

corrective measures for hypotension

Answer 56

-additional fluid bolus -meds: ephedrine IVP -oxygen if needed

Question 57

pudendal block (perineal anesthesia)

Answer 57

second stage of labor and episiotomy repair

Question 58

pudendal block advantages

Answer 58

-ease of administration -absence of maternal hypotension

Question 59

pudendal block disadvantages

Answer 59

urge to bear down may be decreased

Question 60

general anesthesia

Answer 60

-emergent delivers -low platelet count requiring C section -scheduled C sections and unable place spinal

Question 61

cricoid pressure (for general anesthesia)

Answer 61

diminish the chance of aspiration during placement of endotracheal tube

Question 62

general anesthesia problems

Answer 62

-fetal respiratory depression (=lower apgar score) -maternal intubation -higher risk of aspiration -higher risk for PP hemorrhage -less feeling of control -support person may not present -maternal amnesia