Part V Flashcards
(24 cards)
What are Key things to know about Oxytocin (Pitocin)? What is the goal with this?
OXYTOCIN (PITOCIN)
- Used IV piggyback to augment or induce labor
- GOALS: contractions will be a frequency of 2-3 minutes and a duration of 40-60 seconds; adequate labor pattern w/o tachysystole (more than 5 contractions in 10 minutes is too many!!)
- Dose is gradually increased by policy, based on fetal/uterine response
- Augmentation indicated if fewer than three contractions in 10 minutes averaged over 30 minutes
- Bolus also given following delivery to encourage uterine involution and reduced PP bleeding
What is is Tachysytole?
more than 5 contractions in 10 minutes is too many
What are some risks associated with Oxytocin (Pitocin)?
RISKS: Abruption, uterine rupture, rapid labor & birth (maternal and fetal trauma), fetal hypoxia, NB hyperbilirubinemia
What would motivate a nurse to stop Oxytocin (Pitocin)?
- hypertone
- Tachysistolic labor
- Persistent Late Decels (at least 50% of time)
What is an amniotomy (AROM)?
AMNIOTOMY (AROM)- Artificial Rupture of Membranes
Criteria:
* 3 cm or more dilatation
* Engaged fetal head at -2 station or lower & Reassuring FHT pattern
* Contraindications: opposite the criteria
RISKS: Abruption, infection, amniotic fluid embolus (d/t rapid uterine decompression with small amts. of fluid entering the vascular system under the placental edge), fetal injury, variable deceleration risks, & bleeding
What is the nursing care associated with an Amniotomy?
Nursing Care:
* Must have 30 minutes or more reassuring FHT before
* Priority! Monitor FHT 1 minute continuously after!!!* Compare the FHT before and after for irregularities
* Strict sterile technique and limited vaginal exams after
* Frequent peri-care after to reduce infection and increase comfort
What are the goals/benefits of an Amniotomy?
Goals/Benefits:
* More natural labor intervention and less expensive than synthetic prostaglandins
* Amniotic fluid can be evaluated for color and composition (should not be too red or full of baby poop)
* Progression of labor with less monitoring and risks than oxytocin IV
* Encourages release natural prostaglandins to produce labor
* To allow placement of fetal scalp electrode and IUPC
What is an Episiotomy?
EPISIOTOMY-Surgical incision in the perineal body
Indications:
* Added room for forceps or vacuum
* Shoulder dystocia
* OP position
* Large fetus
* Maternal exhaustion
Details:
* EBP advises against routine episiotomies
* Completed just prior to birth
* Can be midline or mediolateral
* M/L (mediolateral) can help prevent 3rd or 4th degree laceration
* Repaired following delivery of placenta
* Ice packs immediately following repair!
What is an amnioinfusion? Name goals, contraindications, and risks
AMNIOINFUSION -Warmed, sterile, normal saline orLR introduced into the uterus through the IUPC
Goals:
- Relieve cord pressure
- Reduce fetal nonperiodic or variable heart decelerations
- Improve outcomes, reduce cesarean risk
- Reduce meconium
Contraindications:
- All contraindications to vaginal delivery
- Uterine hypertonus (contractions with extremely high acme),hydramnios (too much fluid)
- Fetal or uterine anomaly
- NRFHT (non-reassuring fetal heart tones)
RISKS: Cord prolapse, amniotic fluid embolism, uterine rupture
Describe Forceps and Vaccum Extraction.
FORCEPS & VACUUM EXTRACTION
* Instruments to assist with birth to shorten 2nd labor stage
* Used when a condition exists that threatens life to mother/baby
* Membranes must be ruptured and cervix completely dilated
* No more than 3 “pop offs” with vacuum
* Discontinued immediately if descent does not occu
What are some Baby and Mom risks with Forceps and Vaccum Extraction?
BABY RISKS:
* Head trauma-Caput, cephalohematoma, ecchymosis, fractures, forcep marks, edema, eye injuries
* Hyperbilirubinemia
* Facial paralysis
MOM RISKS:
* 3rd or 4th degree lacerations
* Bleeding, bruising, pain, pelvic floor injuries, postpartum infections, sexual dysfunction, incontinence
What are some indications for Cesarean Section?
Indications for surgery:
- Cord prolapse
- Previous classical incision
- Placenta previa or abruption
- Failure to progress
- NRFHT
- Active genital Herpes
- Malpresentation
What is the preparation for a Cesarean Section?
Preparation:
- NPO after midnight,
- IV, FHT monitoring, labs,
- abdominal prep,
- anesthesia, Foley, IV antibiotics preoperatively,
- wedge under right hip to displace uterus, antacids prior to surgery
What are some C-section mom and baby risks?
Mother
* HEMORRHAGE
* Infection
* Urinary tract trauma-Foley helps keep bladder empty to protect it during surgery
* Paralytic ileus
* Anesthesia complications
* Thrombophlebitis and embolism (DVT & PE)
Baby
* Inadvertent preterm birth
* Transient tachypnea (d/t delayed absorption of lung fluid)
* Injury during surgery (Fractures, lacerations, bruising)
What is the major C-section risk to watch for during recovery?
Hemorrhage is a HUGE risk!
What does C-section recovery look like?
Cesarean Section Recovery:
* Hemorrhage is a HUGE risk!
- Assess dressing/incision, vitals every 5 minutes until stable-then every 15 mins for an hour-then per policy (typically every 30 min until she moves to postpartum unit), vaginal bleeding, pain, sensation/distal circulation, LOC, fundus, urinary output, IV status, help establish/support breastfeeding when stable.
- Assess bowel sounds
- Turn, cough, deep breathe every 2 hours while awake
- Teach, comfort, promote skin-to-skin and BF when indicated
- Typically in bed 6-12 hours following
- Diet usually graduates from ice chips to solid food depending on tolerance
What is Trial of Labor after Cesarean (TOLAC) or VBAC?
TRIAL OF LABOR AFTER CESAREAN (TOLAC)
- Also called a Vaginal Birth After Cesarean (VBAC)
- Close monitoring required!!!
Indications/Guidelines:
* One previous low transverse cesarean-no other uterine scars
* Adequate pelvis
* In-house physician and anesthesia ready for cesarean if needed
What are some benefits if Cesarean can be avoided?
Benefits if Cesarean can be Avoided:
- Less blood loss
- Less surgery/PP risks & easier recovery
- Decreased hospital stay & cost
- Less adhesions & less future risk of abnormal placental placement
What are some risks associated with Vaginal Birth After Cesarean?
RISKS:
- Slightly increased risk of uterine rupture due to scar
- Risk of emergency cesarean
Always put a pregnant women on their _______ side if you want to increase oxygen to the baby.
left
What is beat-to-beat variability?
Heart rate in the baby that indicates the ANS system is adapting to environment stimulation.
*This has nothing to do with contractions
*If Nalbuphine (pain med) has been given recently or baby is sleeping, there will be less beat-to-beat variability.
What is a drug used to stop preterm labor?
Magnesium (controls BP and labor)
What could indicate magnesium toxicity? What is the antidote?
Mag Toxicity - low RR, low BP, hard to wake them up, etc.
*Antidote: Calcium Gluconate
What is Labor Dystocia? What is this related to?
LABOR DYSTOCIA (difficulty; abnormal labor)
Can be related to….
o Contraction patterns (the Power)
o Fetal position/size/presentation (the Passenger)
o Maternal soft tissue/pelvis (the Passageway)
