Routine Prenatal Care and Infections: Labor and Delivery Flashcards
(117 cards)
1
Q
EDC
A
Estimated Date of Confinement
2
Q
EDD
A
Estimated Date of Delivery
3
Q
Prenatal hx inclueds
A
*Obstetric hx
*Due date for this preg
*Month/week/prenatal visits
*Lab values
*Maternal medical hx
*Ultrasound results
4
Q
TPAL
A
Term births
Preterm Births
Abortions (spontaneous and therapeutic)
Living Child
5
Q
Gravida (G)
A
of pregnancies
6
Q
Para (P)
A
of gestationally viable births
7
Q
Cues for high risk pregnancy
A
*High BP
*Hx of previous postpartum hemorrhage
*Hx of previous shoulder dystocia
*Rh negative
*Gestational diabetes
*More than 5 previous births
8
Q
Which of the following clients is at highest risk for developing a hypertensive
illness of pregnancy?
1. G1 P0000, age 41 with history of diabetes mellitus.
2. G2 P0101, age 34 with history of rheumatic fever.
3. G3 P1102, age 27 with history of scoliosis.
4. G3 P1011, age 20 with history of celiac disease.
A
- G1 P0000, age 41 with history of diabetes mellitus.
9
Q
A 15-year-old client is being seen for her first prenatal visit. Because of
this client’s special nutritional needs, the nurse evaluates the client’s
intake of:
1. Protein and magnesium.
2. Calcium and iron.
3. Carbohydrates and zinc.
4. Pyroxidine and thiamine.
A
- Calcium and iron.
10
Q
Risk factors w/ STDs
A
*Increased risk of preterm labor and preterm birth
*Premature rupture of membranes w/ risk of infection
11
Q
Risk factors for group B strep
A
*<37 wks gestation
*Ruptured membrane >/= 18 hrs
*Maternal temp >/+ 100.4 F
*GBS bacteriuria this preg
*Hx of infant w/ GBS disease1
12
Q
Increased risk for Diabetic Mothers
A
*Pyelonphritis
*Ketoacidosis
*Preeclampsia
13
Q
Increased risks for infants of diabetic moms
A
*Macrosomia
*Birth trama
*Congenital anomalies
*Resp distress syndrome
*Hypoglycemia
*Hyperbilirubinemia
*Fetal Malformations
*Fetal demise
14
Q
- Before actively trying to become pregnant, the client is strongly encouraged to
stabilize her blood glucose to reduce the possibility of her baby developing which
of the following?
A. Port wine stain.
B. Cardiac defect.
C. Hip dysplasia.
D. Intussusception.
A
B. Cardiac defect.
15
Q
Which of the following assessments can the nurse anticipate that the
provider will monitor to reduce the risk of the identified. Select 2 answers
complication? Select two.
A. Glycosylated hemoglobin (HgbA1c) level.
B. Blood pressures.
C. Weight.
D. Preprandial blood sugar assessments.
A
A. Glycosylated hemoglobin (HgbA1c) level.
D. Preprandial blood sugar assessments.
16
Q
- Specify two interventions the nurse should recommend to the client
as a way to reduce the risks of the identified complication. Select two.
A. Regular blood pressure monitoring.
B. Carbohydrate counting.
C. Regular exercise.
D. Support stockings.
A
B. Carbohydrate counting.
C. Regular exercise.
17
Q
Cues for maternal substance abuse: Medical Hx
A
◼ Cellulitis
◼ Hepatitis/Cirrhosis
◼ Depression/Suicide attempt
◼ STDs/HIV/AIDS
18
Q
Cues for maternal substance abuse:
A
◼ Placental abruption
◼ Unexplained fetal death
◼ Spontaneous abortions
◼ Preterm labor/birth
◼ Low birth weight
19
Q
Cues for intimate partner violence (IPV)
A
◼ Unplanned pregnancy
◼ Delayed or no prenatal care
◼ STD’s
◼ Bleeding, miscarriage
◼ Fetal injury, fetal demise
◼ PTL (Pre term labor), low birth weight
◼ Depression, substance use
20
Q
Teratogens
A
Substances that cause congenital disorders in developing embryo or fetus
21
Q
Examples of teratogens
A
*Smoking
*Alcohol
*Drugs
*Occupational hazards
*Viruses
*Nutritional deficiencies
22
Q
Smoking can cause…
A
cleft lip/palate or both
23
Q
Alcohol can cause…
A
*Fetal alcohol syndrome
*Mental disabilities
*Dysmorphic facial features
24
Q
When do teratogens affect fetus
A
*about 10-14 days after conception
*Neural tubes close at 3-5 wks, during this time teratogens can cause neural tube defects (spina bifida)
25
Which organs are sensitive to teratogens during the whole pregnancies
Brain and spinal cord
26
TORCH Neonatal Viral infections
Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes
Syphilis
27
What might a neonate present with is positive for a viral infection
◼ Fever
◼ Sepsis
◼ Disseminated Intravascular Coagulation (DIC)
◼ Respiratory Distress Syndrome (RDS)
28
Toxoplasmosis
infection with a parasite
29
Mode of transmission of toxoplasmosis
*transplacental
*eating or handling raw meat
*exposure to infected cat feces
30
Prevention of toxoplasmosis
Cook meat thoroughly, wash hands and food prep surfaces carefully, avoid scooping cat litters
31
Hep B: mode of transmission
Direct contact w/ infected blood/body fluids
32
Hep B: practices
Infants Hep B positive moms are given HBIG (immune globulin) and hep B vaccines w/i 12 hrs of birth. 2 more doses w/i 1st yr
33
Hep B: Maternal effects
*No specific tx
*Breastfeeding is not contraindicated unless nipples are cracked and bleeding
34
Rubella antibody
Rubella antibody titer of 1:8-1:10 or more indicates immune status -- reassuring
35
Most common cause of congenital deafness
Rubella
36
If woman is not immune to rubella
should be immunized before becoming pregnant or prior to hospital discharge postpartum
37
HSV: when acquired for neonates
during delivery or by ascending infection
38
HSV: Maternal effects
◼ Painful cervical, vaginal or genital lesions
◼ Virus sheds until lesions are completely healed
39
HSV: tx
oral antiviral therapy
*C-section if active genital lesions when presenting in labor
40
Most common cause of neonatal infectious morbidity & mortality in the U.S.
Group B strep
41
GBS: Prevention approach and screening
◼ Urine culture at prenatal visit
◼ Vaginal/anal culture at 35 weeks
◼ If positive, treatment with Penicillin starts when in labor
◼ At least 2 doses before the birth can be protective for baby
42
Four full-term babies were admitted to the neonatal nursery. The mothers of each of the babies had labors of 4 hours or less. The nursery nurse should carefully monitor which of the babies for tachypnea?
1. The baby whose mother cultured positive for group B streptococci during her third trimester.
2. The baby whose mother has cerebral palsy.
3. The baby whose mother was hospitalized for 3 months with complete placenta previa.
4. The baby whose mother previously had a stillbirth.
1. The baby whose mother cultured positive for group B streptococci during her third trimester.
➢ Because her labor was so fast, it’s not likely she received a dose of PCN in time to protect the fetus, who may show symptoms of GBS infection after the delivery
43
Who is the most common demographic for gonorrhea
Teenage pregnancies
44
Gonorrhea: fetal and neonate effects
*Premature rupture of membranes
*PTD
*Chorioamnionitis
*Neonatal sepsis
45
Syphilis: transmission
Infection can be transmitted to the fetus at any stage of the disease
46
Syphilis: pregnancy results
◼ Miscarriage
◼ Fetal death
◼ Newborn death
47
HIV/AIDS: transmission
transplacental, intrapartum, or from breastmilk
48
Initial eval in labor
◼ Presenting complaint
◼ EDD/EDC
◼ Pregnancy history (Gravida, para, TPAL, complications)
◼ Frequency, duration & intensity of contractions
◼ Membrane status
◼ Presence/absence of bleeding
◼ Cervical status
◼ Thoroughly review prenatal record –blood type, platelets, etc
◼ Any complications of pregnancy
49
Cues that warrant closer focus
◼ Bleeding
◼ History of genital herpes and current sx
◼ Ruptured membranes (GBS)
◼ Advanced cervical dilation
◼ FHR minimal variability or decelerations
◼ Large or small for gestational age
◼ Previous Complications i.e. postpartum
hemorrhage, shoulder dystocia, etc.
50
Performing Leopold's maneuvers
*Determine fetal line: Up and down, or across (transverse line)
*Presentation: head/buttocks, shoulder, face, brow coming first
*Position: Engaged in the pelvis or not
*Assists in determining best site for FHR auscultation
51
Performing a vaginal exam with sterile gloves,
assess cervix for:
◼ Dilation—how open is the cervix?
◼ Effacement—how thin is the cervix?
◼ Station—how low is the presenting part?
52
Effacement
The gradual thinning, shortening, and drawing up of the cervix measured in percentage from 1-100%
53
Dilation
The gradual opening of the cervix measured in cm from 0-10 cm
54
Fetal Station
Relationship of presenting part to the ischial spines. "Will the baby fit through the pelvis?"
55
“Minus 1” or “Minus 2, 3, 4, 5” means:
Presenting part is above zero station and
higher than the ischial spines.
56
* “Plus 1” or “Plus 2, 3, 4, 5” means:
Presenting part has descended lower than
the ischial spines.
*Positive (+) 4 is at the outlet.
57
Stages and Phases of labor
◼ 1st Stage
* Pre-Labor
* Phase 1 – Latent Labor
* Phase 2 - Active Labor
* Phase 3 – Transition
◼ 2nd Stage- Pushing
◼ 3rd Stage- Birth
58
Hormonal theories of labor: Progesterone
◼ Progesterone inhibits uterine contraction
◼ Labor begins when progesterone’s inhibition is overcome by an increase in the levels of estrogen
59
False labor
produces pain at irregular intervals (Braxton Hicks contractions) but there is no cervical dilation
60
True labor
begins when contractions occur at regular intervals and there is cervical change
61
Pain of true labor
◼ Tight metal belt from back around to below uterus
◼ Heat and tightness with each contraction
◼ Back pain increases with walking
62
5 P's that influence labor process
*power
*passenger
*passageway
*positions
*psychology
63
Bedside nurse's job during labor
◼ Support maternal and family birth plan,
◼ Monitor, assess, intervene, educate
◼ Provide safe environment
64
Nursing assessment during labor includes
◼ Duration
◼ Frequency
◼ Intensity -- palpation
◼ Resting tone
65
Intensity contraction palpations
Mild = nose
Moderate = chin
Strong = forehead
66
Timing of contractions
From the beginning of one to the beginning to another
67
Tachysystole
Danger: Too many contractions
*More than 5 contractions in 10 min (Closer than 2 min apart) for 30 min
68
Fetal descent through the birth canal is determined by:
◼ Size of fetal head
◼ Fetal lie
◼ Fetal presentation
◼ Fetal attitude
◼ Fetal position
69
What assessment monitors fetal descent
Leopold's
70
Fetal lie
Relationship of long axis (spine) of the fetus to long axis of mom
71
2 primary lies
Longitudinal
Transverse or oblique
72
Attitude of lie
Flexion of the head toward the chest
73
Fetal presentations
*Cephalic: Head first
*Breach: feet first
*Shoulder
*Compound: hand by head
74
Average first labor is
15 hrs from 4 cm dilation
75
Active phase labor
*At least 4 cm dilated
*Regular, frequent, usually painful contractions
*Dilate at least 1.2-1.5 cm/hr
*Are not comfortable w/ talking/laugh during their contractions
76
1st stage of labor nursing care
*When in bed, side-lying or semi-fowler's position
*Contractions monitored
*Fetal heart tones: variable, baseline rate, decelerations/accelerations
* Maternal Vital Signs
* Fetal heart rate
* Subsequent Vaginal Examinations
77
SROM
Spontaneous rupture of membranes
78
AROM
Artificial rupture of membranes
79
SROMs occur when?
at the height of the contraction with gush of fluid out of vagina
80
How long to monitor AROMs
30 min afterwards to confirm no prolapse
81
Cardinal movements of labor
*engagement
*descent
*flexion
*internal rotation
*extension
*external rotation
*expulsion
82
Flexion
Fetal head against the chest
83
Internal rrotation
fetal head rotates from transverse to anterior
84
Extension
Head extends with crowning
85
External rotation (restitution)
Head returns to its transverse orientation
86
Expulsion
shoulders and torso of the baby are delivered
87
Engagement
*Largest diameter of presenting part reaches or passes through the pelvic inlet
*In most instances, the occiput is at the level of the ischial spines at 0 station
88
Posterior presentation
Back of the bb's head is towards the bed (sunny side up)
89
Cue of posterior presentation
Severe back pain, slow progress of labor
90
When does mom need help: Early labor
◼ Tensing at peak of contraction
◼ Ragged or strained breathing
◼ Expression of dread for contractions
91
When does mom need help: Active labor
◼ Activity unfocused, random, lacking rhythm
◼ Writhing, wincing, crying out,
◼ Panic
92
labor pain relief
◼ Warm tub
◼ Nitrous oxide
◼ IV medication
◼ Local anesthetic block
◼ Epidural
93
Counterstimulation during labor
◼ Counter pressure
◼ Hydrotherapy
◼ Hot or cold packs
94
Nitrous oxide: how, what
*How:
◼ Inhaled anesthetic and analgesic gas
◼ Self-administered via a facemask or
mouthpiece
*What:
◼ Increases release of endorphin, dopamine,
and other natural pain relievers in the brain,
◼ Reduces anxiety
95
Fentanyl dose
50-100 mcg/q2hr prn
*Start w/ lowest does and repeat in 30 min
96
Local anesthetic block
◼ Pudendal, Cervical
97
Regional anesthesia
◼ Epidural on continuous infusion
98
Epidural analgesia
*Analgesia w/ some motor blockade
*Reduces maternal serum catecholamin concentrations, which in turn improves uteroplacental perfusion
99
Nursing care after Epidural
◼ Position patient in semi reclining position with lateral tilt
◼ Frequent vital signs initially (20 min) then hourly
◼ Treat hypotensive episodes
◼ Bladder assessment
100
SE of epidural
◼ Hypotension
◼ Itching – Naloxone (Narcan)
◼ Nausea and vomiting
◼ Urinary retention
◼ Shivering
◼ Impaired motor ability
101
Contraindications of epidural
◼ Maternal refusal
◼ Local or systemic infection
◼ Coagulation disorders
◼ Low platelet counts : Less than 100,000
◼ Hypovolemia
◼ Allergy to specific agents
◼ Suspicion of neurological disease
102
2nd stage of labor: Nursing care cues
◼ FHR variables
◼ Increase in vaginal show
◼ Suprapubic pain if epidural present
◼ Grunting if no epidural
◼ “I’m going to poop!”
103
2nd stage of labor: Nursing care actions
◼ SVE to confirm 10 cm and station
◼ Notify Provider
◼ Set up warmer and turn on!: 8 cm for multip, 10 cm for primip
◼ Delivery table in room
◼ Coach pushing
◼ Document time head is delivered
◼ Document time body is delivered
104
After labor: nursing care
◼ After the birth, Mother & Baby skin-to-skin
◼ Hat, warm blankets
◼ Assign Apgar scores
◼ Some providers ask for Pitocin IM after head delivered to prevent PPH
◼ Prepare pitocin bag to run after placenta delivered at rate ordered. DO NOT HANG UNTIL AFTER THE BIRTH
105
Nursing care: placenta delivery s/s
◼ Patient uncomfortable – crampy
◼ Gush of blood
◼ Umbilical cord protrudes further
106
Nursing care: placenta delivery psych changes
◼ Women may feel relief
◼ Usually focused on infant
107
“Assisted Delivery”
“Instrumented Delivery”
“Operative Delivery”
◼ Vacuum Extractor
◼ Forceps
108
Recovery time
in 1st hr of life, bb can crawl and self-attach to breast
109
Prolapsed cord
* Umbilical cord slips out through the vagina before the baby when the bag of waters (BOW) breaks and head is not engaged
* Potentially fatal complication
110
Risk factors of prolapsed cord
➢ Multiples (twins or triplets)
➢ Preterm labor
➢ Low birth-weight baby
➢ Breech presentation
➢ Transverse lie (across the uterus from left-to-right instead
of up and down)
➢ Ruptured membranes with unengaged fetal head
111
What if the baby is stuck? (Shoulder dystocia)
*Lower mom's head
*McRobert's maneuver: Have stool at bedside
112
Common reasons for c/s
◼ Multiples
◼ Breech presentation
◼ Previous uterine surgery (not c/s)
◼ Vertical uterine incision with prior c/s
◼ Placenta previa
◼ Placental abruption
◼ No progress with pushing after several hours
◼ Fetal intolerance of labor
113
TOLAC
Trial of Labor after c-section
114
VBAC
Vaginal birth after c-section
115
Vertical incision
cannot have TOLAC after due to risk of rupture
116
Horizontal incision
TOLC and VBAC are possible
117
C/S recovery
*2 hrs
*mom may breastfeed
*fundal checks just as for vaginal births
*may have less lochia initially due to uterus being wiped during surgery
