Maternal Ch 8 & 9

The nurse is assisting in preparing to care for a client undergoing an induction of labor with an infusion of oxytocin. The nurse would include which in the plan of care?

Maintain continuous electronic fetal monitoring

What is the most common method of labor induction?

Oxytocin if women have a favorable or "ripe" cervix

What could a mother on day 12 post pregnancy having dark red blood indicate?

Patients should never progress backwards with lochia, if they do this could be a sign of hemorrhaging. (Pulse would be high, BP low..) check hemoglobin and hematocrit labs

Labor is NOT induced in these conditions:

Placenta prévia Umbilical cord prolapse Active herpes Previous vertical c-section incision Abnormal fetal presentation Station degree of baby

What complications would be present to be induced before 39 weeks?

Placental insufficiency Gestational hypertension Infection in the uterus Worsening of a chronic disease such as diabetes, kidney disease or pulmonary disease.. Ruptured membranes Fetal problems such as incompatibility with fetal and maternal blood type Fetal death

REEDA assessment

Redness (pain, may be an infection) Edema (mild edema is common but severe edema interferes with healing of perineum) Ecchymosis (brushing-superficial bruises are normal) Discharge (no discharge from sutures should be present) Approximation (suture line should be intact with no separation)

A client who is primagravida is receiving magnesium sulfate for gestational hypertension. The nurse is asked to monitor the client every 30 minutes. Which information would be of concern to the nurse?

Respirations of 10 breaths per minute

Mechanical method of inducing labor

"Stripping the amniotic membranes" Involves the separation of the amniotic membranes from the wall of the lower uterine segment and cervix

Between __ and __ weeks is considered pre-term

20 and 37

Labor is induced if:

Continuing the pregnancy is hazardous for the woman or the fetus.

late term pregnancy

41 weeks to 41 weeks and 6 days

post term pregnancy

42 weeks larger baby, weighing more than 10 lbs difficulty delivery mecomium aspiration, infection Placenta ages and becomes less efficient

A primagravida's membranes rupture spontaneously. Which action would the nurse take first?

Determine the fetal heart rate.

A client is scheduled to have an elective cesarean delivery. How would the nurse allay the clients feelings of anxiety?

Encourage the client to discuss her concerns and desires regarding anesthesia options

Complications of oxytocin

Fetal compromise (blood flow to the placenta is reduced because of contractions being too frequent or intense) baby may have late d-cells demonstrating lack of blood to the placenta Uterine rupture (testing tone of the uterus is higher when oxytocin is used) Tachysystole (too frequent/intense contractions)

The nurse is monitoring a client who is receiving oxytocin to augment labor. The nurse determines that the dosage would be decreased and notifies the RN if which is noted?

Fetal tachycardia

The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse would monitor for which adverse effects of this medication?

Flushing Depressed respirations Extreme muscle weakness Hyperactive deep tendon reflexes

High station of the fetus can suggest:

Head is not engaged- which can suggest a preterm fetus or a small maternal pelvis

How to help a mother after perineum tear

Ice for the first 12-24 hours, Heat after for the help of blood flow

The nurse palpates the anterior fontanel of a newborn and notes that it feels soft. What does this datum indicate to the nurse?

A normal finding- the baby has fontanels that can overlap to help with the birthing process

The nurse is monitoring a client in the active stage of labor. The nurse notes a late deceleration on the fetal monitor. Based on this observation, how would the nurse respond?

Administer oxygen via face mask to the mother

What does the nurse do when there are complications with oxytocin administration?

Immediately STOP oxytocin and STOP contractions with tocolytic meds (magnesium sulfate)

A client arrives at the birthing center in active labor. Her membranes are still intact and the nurse-midwife performs an amniotomy. The nurse explains to the client that this procedure will most likely have which effect?

Increased efficiency of contractions

What complications should be observed for after an amniotomy?

Infection Prolapse of umbilical cord Placenta abruption

Precipitous labor

Labor that lasts 3 hours or less from onset of contractions to time of delivery (Taxi birth)

What is vaginal bleeding after pregnancy called?

Lochia

Prior to attempting a Version the baby is assessed for

Non-stress test There must be an adequate amount of amniotic fluid and the woman receives tocolytic to relax the uterus Rhogam will be administered if the mom is Rh-

- Stages of Lochia

Rubra (dark red blood, 1st 3 days after birth) Serosa (pinkish blood from day 3 to 10) Alba (clear colorless or white day 10-21)

The nurse caring for a client who is receiving oxytocin for the induction of labor notes a non reassuring fetal heart rate pattern on the fetal monitor. On the basis of this finding, which is the nurses priority action?

Stop the oxytocin infusion

induction of labor

The intentional initiation of labor BEFORE it begins naturally

2. ) Leopold's maneuvers will be performed on a pregnant client. The client ask the nurse about the procedure. Which information would the nurse provide to the client about Leopolds maneuvers?

The maneuvers are a systematic method for palpating the fetus through the maternal abdominal wall.

An elective cesarean delivery is being planned for a pregnant client. The nurse is reviewing the plans for the surgery with the client. A low transverse uterine incision will be used. The client asks the nurse to explain why this approach is being used. The nurse's response is based on which premise?

This incision allows a vaginal birth after cesarean (VBAC) to be possible in a subsequent pregnancy.

True or False: It is normal that the breast are "lumpy and firm" day 3 after giving birth as milk production starts.

True

Method of changing fetal presentation

Version Done after 37 weeks but BEFORE the onset of labor

Natural methods of inducing labor

Walking- stimulates contractions Nipples stimulation- causes the woman's posterior pituitary gland to secrete oxytocin

Diagnosis of preterm labor is based on

cervical effacement and dilation of more than 2 cm

The nurse is caring for a client scheduled for a cesarean delivery. The nurse reviews the clients health record, knowing that which finding needs to be further investigated before delivery

White blood cell count of 35,000 mm3

amniotomy (artificial rupture of membranes)

incision into the amnion (rupture of the fetal membrane to induce labor; a special hook is generally used to make the incision) May also be used to permit internal fetal monitoring

Augumentation of labor

stimulation of contractions after they have begun naturally

Indomethacin

used as a tocolytic drug, it may cause a vasoconstriction of the fetal ductus arteriosus

The nurse is assigned to care for a client who is in early labor. When collecting data from the client, which would the nurse check first?

Baseline fetal heart rate

Dystocia

difficult labor

How do you strip the amniotic membranes?

Insertion of the examiners gloved finger through the cervix and beyond the internal cervical and rotating the finger along the lower uterine segment

The nurse is assigned to assist with caring for a client who has been admitted to the labor unit. The client is 9cm dilated is experiencing precipitous labor. Which is the priority nursing action?

Keep the client in a side-lying position (fetal heart rate could drop)

Terbutaline

Beta adrenergic agonist Stops contractions within minutes but has cardiac effects (increased HR and BP)

How will the nurse promote comfort after an amniotomy?

Change wet under pads and lines after the membranes rupture